Patent Publication Number: US-2015088142-A1

Title: Patient specific instrument

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     This application claims priority to and the full benefit of U.S. Provisional Application Ser. No. 61/491,917 filed Jun. 1, 2011, and titled “Patient Specific Instrument,” the entire contents of which are incorporated herein by reference. 
    
    
     RELATED FIELDS 
     Patient specific instruments for use in, for instance, knee arthroplasty procedures such as total or partial knee replacements. 
     BACKGROUND 
     Knee arthritis and trauma in various forms can cause loss of joint cartilage, including for example, osteoarthritis, excessive wear or sudden trauma, rheumatoid arthritis, or infectious arthritis. When joint cartilage is worn away, the bone beneath the cartilage is left exposed, and bone-on-bone contact can be very painful and damaging. Other types of problems can occur when the bone itself becomes diseased. Conventional solutions for these types of joint problems may be total or partial knee replacements. 
     In some knee arthroplasty procedures, for example, in preparing a femur to receive a femoral implant, a series of resections are made to the distal end of the femur. In “distal cut first” techniques, the first cut is a distal planar resection. Conventionally, after the distal resection has been made, a “four-in-one” cutting guide is positioned on the distal end of the femur relative to the planar distal resection. The four-in-one cutting guide typically includes four slots for guiding a cutting instrument to create a series of cuts on the distal femur. In some instances, the four-in-one cutting guide is placed on the distal femoral resection, making posterior bone cuts to the medial and lateral condyles, making posterior chamfer bone cuts to the medial and lateral condyles, making an anterior bone cut to the distal femur, and making an anterior chamfer bone cut. 
     It is important that the four-in-one cutting guide be positioned correctly on the distal end of the femur with respect to the distal cut since the position and orientation of the four-in-one guide (and the cuts made using it) will control the position and orientation of the femoral implant in at least some degrees of freedom. In some instances, properly positioning and orienting these resections to achieve optimal positions and orientations for the femoral implant can be difficult and time consuming. For example, some traditional four-in-one cutting guides have a planar surface that mates directly against the distal femur cut, and thus, in at least some instances, constitutes a planar joint that can be translated in at least two degrees of freedom and rotated in at least one degree of freedom (e.g., translated in medial/lateral and anterior/posterior directions and rotated in internal/external manners). The rotational and translational alignment of the guide may be set by drilling two pin holes into the distal femur. The four-in-one guide has two integrated pins that are then positioned inside the two drilled holes and the guide is then impacted against the distal cut. As force is applied to the center of the four-in-one cutting guide to secure the guide to the bone, a moment can be created that rotates the four-in-one cutting guide so that the position of the guide when it is secured to the bone is different from the intended position of the guide. Other factors can also cause improper position and/or orientation of the cutting guide on the distal cut. If the cutting guide is not properly positioned and oriented on the bone, the four cuts will be inaccurate and the femoral implant will not be implanted correctly, which may result in improper kinematics, biomechanics, or other undesirable performance. 
     SUMMARY 
     Instrumentation, systems and methods, including patient-matched instrumentation, systems and methods, for facilitating orthopaedic procedures including knee arthroplasty procedures are disclosed herein. Certain implementations constitute alignment guides for aligning instrumentation on a distal femur. Portions of the guide may have surfaces that are generally a negative of the patient&#39;s anatomy, or are designed and adapted to substantially conform to a portion of the patient&#39;s anatomy, such as portions of the distal femur. Such surfaces can be formed using data obtained from the specific patient by conventional imaging devices or other techniques, such as x-ray, CT scans, MRI scans, or ultrasound, and using computer aided-design and manufacturing techniques. 
     In some implementations, the alignment guide includes one or more patient-matched surfaces for contacting un-altered anatomy of a patient as well as one or more planar surfaces (which may or may not also be customized to the specific patient) for contacting altered anatomy (e.g., a planar resection of the distal femur) of the patient. 
     In one general aspect, a femoral cutting guide includes guide slots for guiding the movement of cutting tools relative to a distal portion of a femur, a surface feature adapted to at least partially conform to a resected surface of the distal portion of the femur, and either a posterior-facing surface adapted to conform to an anterior, unaltered surface of the distal portion of the femur or an anterior-facing surface adapted to conform to a posterior, unaltered surface of the distal portion of the femur. 
     Implementations may optionally include one or more of the following features. For example, the guide slots may include an anterior slot for guiding an anterior resection of the distal portion of the femur and a posterior slot for guiding posterior resections on one of a medial or lateral condyle of the distal portion of the femur. The guide slots may further include an anterior chamfer slot for guiding an anterior chamfer resection of the distal portion of the femur and a posterior chamfer slot for guiding a posterior chamfer resection of the distal portion of the femur. The guide slots may include at least two posterior slots for guiding posterior resections of the medial and lateral condyle of the distal portion of the femur. The surface feature may include a substantially planar face adapted to, at least partially, conform to the resected surface of the distal portion of the femur. The cutting guide includes a posterior-facing surface adapted to conform to an anterior, unaltered surface of the distal portion of the femur and an anterior-facing surface adapted to conform to a posterior, unaltered surface of the distal portion of the femur. The anterior, unaltered surface of the distal portion of the femur includes anterior sulcus and patello-femoral groove portions of the distal portion of the femur. The posterior, unaltered surface of the distal portion of the femur includes a posterior sulcus portion of the distal portion of the femur. The anterior and posterior facing surfaces extend generally superiorly from the surface feature, and the surface feature extends between the anterior and posterior facing surfaces. The posterior-facing surface and the anterior-facing surface are established in pre-surgical planning based on imaging data of the distal portion of the femur. The cutting guide may further include one or more apertures configured to guide the placement of provisional fixation pins for coupling the guide to the distal portion of the femur. 
     In another general aspect, a patient-specific femoral cutting guide includes an anterior portion, a posterior portion, and a substantially planar surface feature. The anterior portion including one or more surfaces adapted to substantially conform to an unaltered, anterior portion of a distal portion of a femur and at least one guide slot for guiding the movement of a cutting tool relative to the unaltered, anterior portion of the distal portion of the femur. The posterior portion including one or more surfaces adapted to substantially conform to an unaltered, posterior portion of the distal portion of the femur and at least one guide slot for guiding the movement of a cutting tool relative to the unaltered, posterior portion of the distal portion of the femur. The substantially planar surface feature extending between the anterior portion and the posterior portion and adapted to at least partially conform to a resected surface of the distal portion of the femur. 
     Implementations can optionally include one or more of the following features. For example, the relative position of the anterior portion relative to the posterior portion is adjustable. The relative position of the anterior portion relative to the posterior portion is adjustable in a manner that is substantially parallel to the resected surface of the distal portion of the femur when the cutting guide is positioned on the distal portion of the femur. 
     In another general aspect, a method of resectioning a distal femur includes positioning a surface feature of a cutting guide against a first resected surface of the distal femur, positioning a posterior-facing surface of the cutting guide against an anterior, unaltered surface of the distal femur, positioning an anterior-facing surface of the cutting guide against a posterior, unaltered surface of the distal femur, and using the cutting guide to guide one or more cutting tools relative to the distal femur to form one or more resections of the distal femur. 
     Implementations can optionally include one or more of the following features. For example, using the cutting guide to form one or more resections of the distal femur includes using an anterior slot for guiding an anterior resection of the distal femur, using posterior slots for guiding posterior resections on the medial and lateral condyles of the distal femur, using anterior chamfer slots for guiding anterior chamfer resections of the distal femur, and using posterior chamfer slots for guiding posterior chamfer resections. The method may include using one or more fixation pins to secure the cutting guide in a particular location relative to the distal femur. Positioning the surface feature of the cutting guide against the first resected surface of the distal femur establishes a superior-inferior positioning of the cutting guide and varus-valgus orientation and angulation when viewed in a sagittal plane of the guide. Positioning the posterior-facing surface of the cutting guide against the anterior, unaltered surface of the distal femur and positioning the anterior-facing surface of the cutting guide against the posterior, unaltered surface of the distal femur establishes the anterior-posterior and medial-lateral positioning of the guide relative to the distal femur and the internal and external rotation of the guide relative to the distal femur. The surface feature includes a substantially planar face adapted to at least partially conform to the first resected surface of the distal femur. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1-3  are various views of an unresected, distal femur. 
         FIGS. 4-6  are various views of a distal cutting guide positioned on the distal femur of  FIGS. 1-3 . 
         FIGS. 7-9  are various views of the distal femur of  FIGS. 1-3  after resection. 
         FIG. 10  is a top plan view of an exemplary implementation of a patient-matched cutting guide. 
         FIG. 11  is a left plan view of the cutting guide of  FIG. 10 . 
         FIG. 12  is a top perspective view of the cutting guide of  FIG. 10 . 
         FIG. 13  is a bottom plan view of the cutting guide of  FIG. 10 . 
         FIG. 14  is a lateral view of the cutting guide of  FIG. 10  positioned on the resected distal femur of  FIGS. 7-9 . 
         FIG. 15  is a posterior plan view of the cutting guide of  FIG. 10  positioned on the resected distal femur of  FIGS. 7-9 . 
         FIG. 16  is a distal view of the cutting guide of  FIG. 10  positioned on the resected distal femur of  FIGS. 7-9 . 
         FIG. 17  is an anterior view of the cutting guide of  FIG. 10  positioned on the resected distal femur of  FIGS. 7-9 . 
         FIGS. 18-21  are various views of the distal femur of  FIG. 1  after resections have been made to various portions of the distal femur. 
         FIG. 22  is a side view of an implant positioned on the resected distal femur. 
         FIG. 23  is a side view of the implant of  FIG. 22 . 
         FIG. 24  is another implementation of a patient-matched cutting guide. 
         FIG. 25  is a side view of the patient-matched cutting guide of  FIG. 24 . 
         FIGS. 26-27  are schematics of an exemplary method and system for planning for and executing an orthopaedic procedure. 
     
    
    
     DETAILED DESCRIPTION OF THE DRAWINGS 
       FIGS. 1-3  show a distal femur  10  before resection. Distal femur  10  includes a lateral condyle  8  and a medial condyle  9  and a patello-femoral groove  11  located between the lateral condyle  8  and the medial condyle  9 , as shown in  FIG. 1 . Distal femur  10  also includes an anterior sulcus  38  and a posterior sulcus  36 , as shown in  FIG. 3 . 
     In some implementations, a distal femoral resection may be performed using conventional or non-conventional techniques and apparatus. For example, as shown in  FIGS. 4-6 , a patient-matched distal femoral cutting guide  12  may be navigated relative to the distal femur  10  and (optionally) pinned to the distal femur  10  to guide a reciprocating or oscillating saw or other cutting device to make the distal femoral planar resection along cut line  14 . In some implementations, the cutting guide  12  includes pin holes  16  for drilling appropriate pin holes in the distal femur  10  to set implant rotation and/or for facilitating attachment of a different guide, such as a four-in-one cutting guide. In other implementations, a non-patient-matched cutting guide may be used to guide the distal femoral planar resection. In still other implementations, a patient-matched or non-patient-matched cutting guide may be used to make other resections initially before a distal resection (e.g., anterior-cut first techniques). 
       FIGS. 7-9  show the distal femur  10  after distal resection to define a resected surface  18  on the distal femur  10 . In the particular implementation shown, resected surface  18  is substantially planar and extends substantially in a transverse plane relative to the distal femur  10  (e.g., as opposed to sagittal or coronal planes). As shown in  FIGS. 7-9 , distal portions of the medial condyle  9  and lateral condyle  8  are removed by the distal resection, while other portions of the distal femur  10  (e.g., anterior and posterior sulcus portions  38  and  36 ) are preserved and remain unaltered, at least at this stage of this implementation. 
     In the particular implementation shown, after the distal resection  18  has been made, a four-in-one cutting guide may be positioned on the distal femoral resection  18  to guide additional resections of the distal femur  10 , such as one or more of a posterior resection, an anterior resection, and anterior and posterior chamfer resections. Such resections may prepare the distal femur to receive a femoral implant such as the implant  40  shown in  FIG. 23 , which has bone-engaging surfaces  42  matching the distal, anterior  25 , posterior  21  and chamfer resections  19 ,  23  created on the distal femur  10 . 
       FIGS. 10-13  show an implementation of a patient-matched four-in-one cutting guide  20 . Patient-matched cutting guide  20  includes a plurality of guide slots  22 ,  24 ,  26 , and  28  and/or other guide surfaces for guiding the movement of cutting tools, such as reciprocating and oscillating saw blades, with respect to the distal femur  10 . For example, referring also to  FIGS. 14 and 18 , cutting guide  20  includes an anterior guide slot  22  for guiding an anterior resection  25  along a line  25   a , posterior guide slots  24  for guiding posterior resections  21  along a line  21   a  on the medial and/or lateral condyles, anterior chamfer guide slots  26  ( FIG. 11 ) for guiding anterior chamfer resections  23  along a line  23   a , and posterior chamfer guide slots  28  ( FIG. 11 ) for guiding posterior chamfer resections  19  along a line  19   a . In some implementations, cutting guide  20  may include multiples of each guide slot to accommodate different size options for different sizes of implants. The cutting guide  20  shown also includes pin receiving holes  34  to facilitate securing the guide  20  to the patient&#39;s anatomy via, for example, provisional fixation pins. 
       FIGS. 14-17  show various views of the patient-matched cutting guide  20  positioned and oriented on distal femur  10 . The cutting guide  20  of  FIG. 10 , when properly positioned and oriented on the patient&#39;s distal femur, establishes the positions and orientations of the four resections mentioned above. 
     In the particular implementation shown, the cutting guide  20  is configured to interact with both un-altered and altered anatomy on the distal femur  10  to determine the position and orientation of the cutting guide  20  with respect to the distal femur  10 . 
     For instance, the cutting guide  20  includes a planar surface feature  32  that mates against and/or substantially conforms to the resected surface  18  of the femur  10 . Positioning the planar surface feature  32  of the guide  20  against the resected surface  18  establishes the position and orientation of the guide  20  with respect to the femur  10  in certain degrees of freedom. For example, in this particular implementation, the mating of the planar surface feature  32  with the resected surface  18  establishes the superior-inferior positioning of the guide  20 , as well as varus-valgus orientation and angulation when viewed in a sagittal plane of the guide  20 . 
     The cutting guide  20  also includes two surfaces  30  and  31  that are adapted to at least substantially conform to the unique, un-altered geometry of the particular patient&#39;s anatomy (although in other implementations other numbers of such surfaces could be included). For instance, as shown in  FIGS. 10-13 , the cutting guide  20  includes a posterior facing surface  30  adapted to conform to anterior, un-altered anatomy of the patient&#39;s distal femur  10 . In this particular implementation, the anterior un-altered anatomy includes anterior sulcus  38  and patello-femoral groove  11  portions of the distal femur  10 . The cutting guide  20  shown in  FIGS. 10-13  also includes an anterior-facing surface  31  adapted to conform to posterior, un-altered anatomy of the patient&#39;s distal femur  10 , including posterior sulcus portion  36  of the distal femur  10 . In the particular implementation shown, positioning the anterior and posterior-facing surfaces  30 ,  31  to conform to the anterior and posterior portions of the anatomy establishes the position and orientation of the guide  20  in additional degrees of freedom. In the specific implementation shown, the anterior and posterior-facing surfaces  30 ,  31  establish the position and orientation of the guide  20  in degrees of freedom other than those established by the interaction of the planar surface feature  32  with the planar resection  18  on the distal femur  10 . Particularly, in this implementation, the anterior and posterior facing surfaces  30 ,  31  establish the anterior-posterior and medial-lateral positioning of the guide  20  relative to the distal femur  10 , as well as the internal/external rotation of the guide  20  relative to the distal femur  10 . 
     In the particular implementation shown, the anterior and posterior facing surfaces  30 ,  31  extend generally superiorly from the planar surface feature  32 , which extends between those surfaces  30 ,  31 . Additionally, as shown, unlike planar surface feature  32 , the anterior and posterior-facing surfaces  30 ,  31  are, at least in this particular implementation, non-planar and undulate to correspond to the undulating anatomy they are designed to interact with and conform to. 
     In other implementations, cutting guides do not necessarily need to include both anterior-facing patient-matched surface  31  and posterior-facing patient-matched surface  30 , and may include only one of such surfaces. In other implementations, cutting guides may include more than these two surfaces that are also configured to conform to the patient&#39;s un-altered anatomy. 
     In some implementations, instead of integrated pins, as were included in some conventional four-in-one cutting guides, the patient-matched cutting guide  20  includes at least two apertures  34  for receiving fixation pins to secure the guide to the distal femur  10 . The patient-matched surfaces  30 ,  31  position the cutting guide  20  relative to the resected surface  18  in only one way against the anatomy before the guide is secured. Instead of using two integrated pins, the apertures  34  should be aligned with the holes that were drilled in the distal femur using cutting guide  12 . The apertures  34  can provide a check that the cutting guide  20  is properly aligned and that all five cuts will be in alignment per the surgical plan. If the apertures  34  are not aligned with the holes created by the distal cutting block, it could indicate that the distal cutting block or the 4-in-1 cutting guide  20  was not secured in the proper location. Other holes can also be used to secure the cutting guide  20  to the bone. As compared with conventional cutting guides using integrated pins, the cutting guide  20  is properly positioned both before and after it is secured. As described above, with conventional four-in-one cutting guides, a force directed toward the center of the cutting guide  20  to secure the guide  20  to the bone  10  often created a moment that rotated the cutting guide  20  during impaction so that the final position of the guide  20  was different than planned position of the guide  20 , which caused inaccurate cuts. 
       FIGS. 18-21  show the distal femur  10  of  FIG. 1  after the various resections using the patient-matched cutting guide of  FIG. 10 . As shown in  FIGS. 18-21 , the anterior  25  and posterior  21  resections are substantially parallel, and the distal resection  18  is substantially perpendicular to the anterior and posterior resections  25 ,  21 . Other resection layouts, positions and orientations of resections are also possible and within the scope of the present disclosure. Following resection of the distal femur  10 , an implant, such as the implant  40  shown in  FIG. 22  may be positioned and secured to the resected distal femur  10 . The implant  40  includes a number of inner surfaces  42  ( FIG. 23 ) that substantially mate with and/or align with the resected surfaces  18 ,  19 ,  21 ,  23 ,  25  to help position the implant  40  on the distal femur  10 . 
       FIGS. 24-25  illustrate another cutting guide  120  according to an alternate implementation. Cutting guide  120  includes an anterior portion  126  and a posterior portion  128 , which can be two separate pieces. Anterior portion  126  and posterior portion  128  each include one or more patient matched surfaces  127 ,  129 . The anterior portion  126  also includes an anterior guide slot  122  for making an anterior cut  25  and the posterior portion  128  includes a posterior guide slot  124  for making a posterior cut  21 . Because the two portions  126  and  128  may be separate pieces, they may be separated/adjusted relative to one another in a manner that is parallel to the distal resected surface  18 . The relative position of each portion to the other can be adjusted in increments that correlate with various sized implants, which allows a surgeon to either position the cutting guide  120  against the posterior condyles and adjust the size and/or position by posterior referencing, or position the cutting guide  120  against the anterior sulcus  38  and adjust the size and/or position by anterior referencing. In this way, the surgeon can switch between posterior and anterior referencing intra-operatively, as well as up-size or downsize the implant intra-operatively. A connecting portion  131  connects anterior portion  126  and posterior portion  128  and allows for adjustment of position of the anterior portion  126  relative to the posterior portion  128 . Connecting portion  131  may have hash marks or other indices to indicate the amount of additional bone to be removed by separating anterior portion  126  and posterior portion  128 . Anterior portion  126  and posterior portion  128  may also have fixation openings or pin holes  134  to facilitate securing the guide  120  to the patient&#39;s anatomy via, for example, provisional fixation pins. 
     Also disclosed is a method of creating a patient-matched cutting guide. Imaging data taken by any known means such as x-ray, CT scans, MRI scans, ultrasound, etc. is used to obtain patient-specific data about the femur to be resected and other anatomy of potential relevance, such as imaging data of the femoral head and ankle to allow determination of a mechanical axis of the leg. In one implementation, the patient-specific data is used to build a model of the patient&#39;s anatomy. Then, the model is used to plan the distal resection. In some implementations, a patient-matched guide is built to guide the distal resection. Next, using the patient-specific data, as well as data about the planned distal resection (including orientation and position of that resection), cutting guide  20  or  120  may be created to conform to the un-altered anatomy of the patient, as well as the altered (resected) anatomy so that the planar face of the cutting guide fits properly on the resected surface after the distal resection has been made. In particular, the imaging data is used to create patient-matched surfaces  30  and/or  31  that will mate against the uncut bone to help guide the remaining resections and to create planar surface  32  that will mate against the distal resection. For example, in some implementations, cutting guide  12  (shown in  FIGS. 4-6 ), which is used to make the distal resection, is created using imaging data of the patient&#39;s specific anatomy and then the bone to be resected during the distal resection is subtracted from the image and the cutting guide  20  is created from such image. 
     According to another non-limiting method, a patient may contact a health care provider regarding joint pain, such as knee pain. The health care provider may then refer the patient to an imaging facility. A technician images the joint, such as by MRI, CT, X-ray, or ultrasound. In one implementation, the technician transmits the image data to a cutting block manufacturer and/or to the health care provider. The cutting block manufacturer manufactures the distal resection block and the four-in-one block using the image data. In some implementations, the cutting block manufacturer or its representative are located at a surgical site facility. For instance, the distal resection block and/or the four-in-one cutting block may be manufactured at or near the site facility where the joint replacement takes place. The health care provider and the cutting block manufacturer may communicate regarding the requirements of at least one of the cutting blocks. Communication may take place via a representative or agent, a telephone network, a computer network, or by any other suitable mode. In one implementation, the patient then visits a surgical site facility for joint replacement, and the health care provider confirms the cutting blocks are matched to the patient. The health care provider places the distal cutting block on the patient. The health care provider makes a distal cut. The health care provider places the patient matched four-in-one cutting block on the patient and makes additional cuts. The health care provider implants a joint prosthesis, such as a knee prosthesis. 
     One non-limiting example of a method of planning for and executing an orthopaedic procedure is shown in  FIG. 26 , which, in this particular implementation, is a knee arthroplasty procedure. As schematically shown by  FIG. 26 , the general steps may include imaging  1000 , processing  1200 , planning  1400 , manufacturing  1600  and performing the surgery  1800 , although, in other implementations, at least some of these steps may be optional and other steps could be included in addition to those shown in  FIG. 26 . 
     A wide variety of systems may be utilized in performing the procedure shown in  FIG. 26 .  FIG. 27  schematically shows one implementation of such a system for facilitating the steps of imaging, processing, planning and manufacturing.  FIG. 27  schematically illustrates imaging  2000 , computing  2200 , and manufacturing devices  2400 . 
     In some implementations, including the implementation shown in  FIG. 27 , steps such as image processing  1200  and surgical planning  1400  steps may be carried out, wholly or at least partially, using a computing device  2200 . The computing device  2200  may be part of or remote from the device or devices used to image  2000  the patient and the device or devices  2400  used to custom manufacture instrumentation, implants or other devices for carrying out the procedure, and may receive or access data reflecting the images obtained of the patient through any appropriate communication medium, including wireline, wireless, optical, magnetic, or solid state communication mediums. The computing device  2200  represented in  FIG. 27  includes a processor  2600  that can execute code stored on a computer-readable medium, such as a memory  2800 . The computing device  2200  may be any device that can process data and execute code that is a set of instructions to perform actions. Examples of the computing device  2200  include a database server, a web server, desktop personal computer, a laptop personal computer, a server device, a handheld computing device, a mobile device, or combinations thereof. 
     In some implementations, the processor  2600  may include a microprocessor, an application-specific integrated circuit (ASIC), a state machine, or other suitable processor. The processor  2600  may include one processor or any number of processors, and may access code stored in the memory  2800 . The memory  2800  may be any non-transitory computer-readable medium capable of tangibly embodying code. The memory  2800  may include electronic, magnetic, or optical devices capable of providing processor  2600  with executable code. Examples of the memory  2800  include random access memory (RAM), read-only memory (ROM), a floppy disk, compact disc, digital video device, magnetic disk, an ASIC, a configured processor, or other storage device. 
     In some implementations, including the implementation shown in  FIG. 27 , the computing device  200  may share and/or receive data with additional components through an input/output (I/O) interface  3000 . The I/O interface  3000  may include a USB port, an Ethernet port, a serial bus interface, a parallel bus interface, a wireless connection interface, or any suitable interface capable of allowing data transfers between the computing device and another component. The additional components may include components such as an information database  3200 . In other implementations, the computing device  2200  includes the information database  3200 . 
     In the implementations illustrated by  FIGS. 26 and 27 , the patient&#39;s anatomy of interest may be imaged  1000  using one or more non-invasive imaging technologies, such as, but not limited to, computed tomography (CT), magnetic resonance imaging (MRI), x-ray, digital x-ray, ultrasound or other imaging technologies. In implementations that utilize imaging technologies such as CT, MRI or others, one or more sets of parallel image slices of the patient&#39;s anatomy may be obtained, such as, but not limited to, a series of transverse slices, sagittal slices, coronal slices, other angulations of slices, or combinations of series thereof. In some implementations, multiple imaging technologies may be used for the same patient (e.g., x-ray for broader imaging of the overall patient, including other joints, and MRI for the joint of particular interest). The images of the patient&#39;s anatomy may, optionally, also include images of existing implant(s) or portions thereof. In some implementations, non-image based technologies may be utilized to obtain patient specific information about the patient&#39;s anatomy and geometries or other features associated therewith. 
     Image processing  1200  is the next step in the implementation of  FIGS. 26 and 27 , in which at least some of the images may be processed to create an accurate 3-D model, other multi-dimensional representation, or other virtual construct representing the geometries and/or selected features of the patient&#39;s particular anatomy. In some implementations, such processing involves segmentation of the images (such as separation of at least one set of image slices) to distinguish the anatomy and other structures of interest from the surrounding anatomy and other structures appearing in the image. For example, the images associated with the femoral condyles may be segmented. 
     In various implementations, segmentation may be accomplished by manual, automated, or semi-automated processes. For instance, in some implementations, a technician or other user may (with the assistance of computer assisted design hardware and/or software or other functionality) manually trace the boundary of the anatomy and other structures of interest in each image slice. Alternatively, in some implementations, algorithms or other automated or semi-automated processes could be used to automatically identify the boundaries of interest. In some implementations, only key points on the anatomy or other structures of interest need be segmented. Image processing  1200  such as described above may be used to make a three dimensional model of the patient&#39;s anatomy and other features of interest. 
     The 3D model or other construct representing the patient&#39;s anatomy may be used for pre-surgical planning  1400  of the knee arthroplasty procedure. In some implementations, pre-surgical planning  1400  can include one or more of identifying a desired position and orientation of the distal resection and/or the patient-matched surfaces  30  and  31 . In various implementations, the planning may be carried out using manual, semi-automated or automated functionality. 
     The patient-matched guide  20  or  120  may include one or more surfaces that are specifically designed to mimic the patient&#39;s particular anatomy (or portions thereof) as determined, for instance, by the 3D model of the anatomy. For instance, in some implementations, the patient-matched surface or surfaces can be a negative mold of the patient&#39;s anatomy such that it uniquely conforms to the patient&#39;s anatomy in one particular position and orientation. In other words, the patient-matched surface or surfaces may facilitate achieving a desired position and/or orientation of the patient-matched guide  20  or  120  with respect to the patient&#39;s particular anatomy because the patient-matched surface will allow the patient-matched guide  20  or  120  to fully seat on the patient&#39;s particular anatomy only when the patient-matched guide  20  or  120  is in the desired position and/or orientation. 
     In some implementations, the geometries and other aspects of the patient-matched surface may be determined in the planning stage by applying a blank of the patient-matched guide  20  or  120  (e.g. a wire-frame or similar digital representation of a blank of the patient-matched instrument) to the 3-D model of the patient&#39;s anatomy such that the patient-matched guide  20  or  120  is in the desired position and orientation with respect to the patient&#39;s anatomy, and then removing from or adding to portions of the blank to create the patient-matched surface conforming to the surface of the patient&#39;s anatomy. In some implementations, earlier processes performed during the planning stage will determine, at least partially or wholly, the position and/or orientation of the blank relative to the 3-D model of the patient&#39;s anatomy. For instance, the planned resection position and orientation, in combination with the 3D model, could be used to define the particular shape and other attributes of the patient matched guide. 
     Once designed, the patient-matched guide  20  or  120  may be manufactured  1600  using any number of known technologies, including, but not limited to, selective laser sintering, 3D printing, stereo-lithography, or other rapid production or custom manufacturing technologies. In some implementations, the rapid production equipment can be remote from the systems involved in the planning and/or designing of the patient-matched instruments, and data or other information sufficient to manufacture the patient-matched instrument(s) can be exported from the planning/design systems to the manufacturing systems in any desirable format. 
     One of ordinary skill in the art will recognize that additions, deletions, substitutions or other modifications may be made to the non-limiting implementations described above without departing from the scope or spirit of the present invention.