Source: http://www.google.com/patents/US20070123912?dq=7,403,220
Timestamp: 2017-09-26 17:12:37
Document Index: 446931616

Matched Legal Cases: ['art.\n45', 'art.\n46', 'art.\n51', 'art.\n55', 'art.\n58', 'art.\n65', 'art.\n68', 'Application No. 60', 'Application No. 60', 'arts 10', 'arts 10']

Patent US20070123912 - Surgical navigation systems and processes for unicompartmental knee arthroplasty - Google Patents
Systems and processes for tracking anatomy, instrumentation, trial implants, implants, and references, and rendering images and data related to them in connection with surgical operations, for example unicompartmental knee arthroplasties (“UKA”). These systems and processes are accomplished by using...http://www.google.com/patents/US20070123912?utm_source=gb-gplus-sharePatent US20070123912 - Surgical navigation systems and processes for unicompartmental knee arthroplasty
Publication number US20070123912 A1
Application number US 11/645,295
Also published as CA2579719A1, EP1799140A1, US20050113846, WO2006044367A1
Publication number 11645295, 645295, US 2007/0123912 A1, US 2007/123912 A1, US 20070123912 A1, US 20070123912A1, US 2007123912 A1, US 2007123912A1, US-A1-20070123912, US-A1-2007123912, US2007/0123912A1, US2007/123912A1, US20070123912 A1, US20070123912A1, US2007123912 A1, US2007123912A1
Patent Citations (99), Referenced by (56), Classifications (36)
Surgical navigation systems and processes for unicompartmental knee arthroplasty
US 20070123912 A1
42. A system for performing unicompartmental knee arthroplasty surgical operations on portions of a knee joint, comprising:
(a) a locator for obtaining data corresponding to structure of a body part forming a portion of a knee joint, wherein the body part and the locator are each associated with a fiducial;
(b) a unicompartmental knee arthroplasty surgical instrument associated with a fiducial;
(c) at least one position sensor for tracking positions of the fiducials;
(d) a computer for receiving signals from the at least one position sensor and for tracking a position of a virtual construct based at least in part on the position of the fiducial associated with the body part and the data; and
(e) a monitor for displaying at least a representation of the position of the virtual construct.
43. The system of claim 42, wherein the locator comprises a C-arm fluoroscope, a CT scanner, MRI equipment, ultrasound equipment, laser scanning equipment, or a probe.
44. The system of claim 42, wherein the locator comprises a probe, and wherein the probe is used to designate at least one landmark on the body part.
45. The system of claim 44, wherein the at least one landmark defines an axis of the body part.
46. The system of claim 42, wherein the body part comprises a femur, a tibia or a patella.
47. The system of claim 42, wherein the fiducials comprise active fiducials, passive fiducials, or hybrid active/passive fiducials.
48. The system of claim 47, wherein the position sensor comprises an infrared sensor, an electromagnetic sensor, an electrostatic sensor, a light sensor, a sound sensor, a radio frequency sensor, or a physical sensor.
49. The system of claim 42, wherein the unicompartmental knee arthroplasty surgical instrument comprises a cutting block or a rod.
50. The system of claim 42, wherein the computer generates numerical data based at least in part on the position of the fiducial associated with the body part.
51. The system of claim 50, wherein the numerical data is used to assess performance of a knee implant.
52. The system of claim 51, wherein the numerical data is used to assess performance of a trial knee implant.
53. The system of claim 51, wherein the numerical data is used to evaluate modifying tissues associated with the knee joint.
54. The system of claim 42, wherein the virtual construct comprises an axis of the body part.
55. The system of claim 54, wherein the virtual construct comprises a mechanical axis of the femur.
56. The system of claim 54, wherein the virtual construct comprises a mechanical axis of the tibia.
57. The system of claim 42, wherein the virtual construct comprises at least one landmark of the body part.
58. A system for performing unicompartmental knee arthroplasty surgical operations on portions of a knee joint, comprising:
(d) a computer for receiving signals from the at least one position sensor and for generating numerical data based at least in part on the position of the fiducial associated with the body part and the data; and
(e) a monitor for displaying at least the numerical data.
59. The system of claim 58, wherein the numerical data is used to assess performance of a knee implant.
60. The system of claim 59, wherein the numerical data is used to assess performance of a trial knee implant.
61. The system of claim 59, wherein the numerical data is used to evaluate modifying tissues associated with the knee joint.
62. The system of claim 61, wherein the tissue comprises at least one ligament.
63. The system of claim 58, wherein the computer tracks a position of a virtual construct based at least in part on the position of the fiducial associated with the body part and the data.
64. The system of claim 63, wherein the virtual construct comprises an axis of the body part.
65. The system of claim 63, wherein the virtual construct comprises a mechanical axis of the femur.
66. The system of claim 63, wherein the virtual construct comprises a mechanical axis of the tibia.
67. The system of claim 63, wherein the virtual construct comprises a landmark of the body part.
68. The system of claim 58, wherein the locator comprises a C-arm fluoroscope, a CT scanner, MRI equipment, ultrasound equipment, laser scanning equipment, or a probe.
69. The system of claim 58, wherein the fiducials comprise active fiducials, passive fiducials, or hybrid active/passive fiducials.
70. The system of claim 69, wherein the position sensor comprises an infrared sensor, an electromagnetic sensor, an electrostatic sensor, a light sensor, a sound sensor, a radio frequency sensor, or a physical sensor.
71. The system of claim 58, wherein the unicompartmental knee arthroplasty surgical instrument comprises a cutting block or a rod.
This document is a continuation application of U.S. patent application Ser. No. 10/963,862, entitled “Surgical Navigation Systems and Processes for Unicompartmental Knee Arthroplasty” and filed Oct. 13, 2004, which is a continuation-in-part application U.S. patent application Ser. No. 10/084,278, entitled “Surgical Navigation Systems and Processes for Unicompartmental Knee Arthroplasty,” filed Feb. 27, 2002 and now issued as U.S. Pat. No. 6,827,723, which claims the benefit of U.S. Provisional Patent Application No. 60/271,818, filed Feb. 27, 2001 and entitled “Image Guided System for Arthoplasty,” and U.S. Provisional Patent Application No. 60/355,899, filed on Feb. 11, 2002 and entitled “Surgical Navigation Systems and Processes,” all of which are hereby incorporated in their entirety by this reference.
Systems and processes according to the present invention can also use the position tracking information and, if desired, data relating to shape and configuration of surgical related items and virtual constructs or references in order to produce numerical data which may be used with or without graphic imaging to perform tasks such as planning proper positioning and sizing of implants, visualizing resection planes or reamer cutting tracks based on sensed position of the cutting block, reamer, or other surgical instrument or item, assessing performance of trial prosthetics statically and throughout a range of motion, appropriately modifying tissue such as ligaments to improve such performance and similarly assessing performance of actual prosthetic components which have been placed in the patient for alignment and stability.
2. Locating and registering body structure such as designating points on the femur and tibia using a probe associated with a fiducial in order to provide the processing functionality information relating to the body part such as rotational axes.
3. Navigating and positioning surgical instrumentation associated with a fiducialin order to modify bone, at least partially using images generated by the processing functionality corresponding to what is being tracked and/or has been tracked, and/or is predicted by the system, and thereby resecting bone effectively, efficiently and accurately.
4. Navigating and positioning trial components such as femoral components and tibial components, some or all of which may be installed using impactors with a fiducial and, if desired, at the appropriate time discontinuing tracking the position and orientation of the trial component using the impactor fiducial and starting to track that position and orientation using the body part fiducial on which the component is installed.
5. Assessing alignment and stability of the trial components and joint, both statically and dynamically as desired, using images of the body parts in combination with images of the trial components while conducting appropriate rotation, anterior-posterior drawer and flexion/extension tests and automatically storing and calculating results to present data or information which allows the surgeon to assess alignment and stability.
6. Releasing tissue such as ligaments if necessary and adjusting trial components as desired for acceptable alignment and stability.
7. Installing implant components whose positions may be tracked at first via fiducials associated with impactors for the components and then tracked via fiducials on the body parts in which the components are installed.
8. Assessing alignment and stability of the implant components and joint by use of some or all tests mentioned above and/or other tests as desired, releasing tissue if desired, adjusting if desired, and otherwise verifying acceptable alignment, stability and performance of the prosthesis, both statically and dynamically.
FIG. 40 is a schematic view of a of a particular embodiment of systems and processes according to the present invention employing modular fiducials.
FIG. 41 is a schematic view of a screen face according to embodiments of the present invention showing the edge of a resection plane virtual construct.
FIG. 42 is a schematic view of a screen face according to embodiments of the present invention showing a cutting track virtual construct.
In a preferred embodiment, orientation of the elements on a particular fiducial varies from one fiducial to the next so that sensors according to the present invention may distinguish between various components to which the fiducials are attached in order to correlate for display and other purposes data files or images of the components. In a preferred embodiment of the present invention, some fiducials use reflective elements and some use active elements, both of which may be tracked by preferably two, sometimes more infrared sensors whose output may be processed in concert to geometrically calculate position and orientation of the item to which the fiducial is attached. In some preferred embodiments, fiducials are only temporarily attached to the body part, surgical instrument or other item. In still other preferred embodiments of the present invention, the fiducials are modular, allowing the surgeon or other user to position individual reflective elements on the body part, surgical instrument or other item such that the fiducial is positioned for maximum visibility by the sensors. FIG. 40 shows schematically the use of modular fiducials 200 on a body part, item and instrument. Exemplary fiducials useable in various embodiments of the present invention are also disclosed in United States Patent Applications U.S. Ser. No. 10/679,158, entitled “Surgical Positioners” and filed Oct. 3, 2003, U.S. Ser. No. 10/689,103, entitled “Surgical Navigation System Component Fault Interfaces and Related Processes” and filed Oct. 20, 2003, and U.S. Ser. No. 10/897,857, entitled “Surgical Navigation System Component Fault Interfaces and Related Processes” and filed Jul. 23, 2004, all of which are herein expressly incorporated by this reference.
Position/orientation tracking sensors and fiducials need not be confined to the infrared spectrum. Any electromagnetic, electrostatic, light, sound, radio frequency or other desired technique may be used. Alternatively, each item such as a surgical implement, instrumentation component, trial component, implant component or other device may contain its own “active” fiducial such as a microchip with appropriate field sensing or position/orientation sensing functionality and communications link such as spread spectrum RF link, in order to report position and orientation of the item. Such active fiducials, or hybrid active/passive fiducials such as transponders can be implanted in the body parts or in any of the surgically related devices mentioned above, or conveniently located at their surface or otherwise as desired. Fiducials may also take the form of conventional structures such as a screw driven into a bone, or any other three dimensional item attached to another item, position and orientation of such three dimensional item able to be tracked in order to track position and orientation of body parts and surgically related items. Hybrid fiducials may be partly passive, partly active such as inductive components or transponders which respond with a certain signal or data set when queried by sensors according to the present invention.
Computing functionality 18 can process, store and output on monitor 24 and otherwise various forms of data which correspond in whole or part to body parts 10 and 12 and other components for item 22. For example, in the embodiment shown in FIG. 1, body parts 10 and 12 are shown in cross-section or at least various internal aspects of them such as bone canals and surface structure are shown using fluoroscopic images. These images are obtained using a C-arm attached to a fiducial 14. The body parts, for example, tibia 10 and femur 12, also have fiducials attached. When the fluoroscopy images are obtained using the C-arm with fiducial 14, a position/orientation sensor 16 “sees” and tracks the position of the fluoroscopy head as well as the positions and orientations of the tibia 10 and femur 12. The computer stores the fluoroscopic images with this position/orientation information, thus correlating position and orientation of the fluoroscopic image relative to the relevant body part or parts. Thus, when the tibia 10 and corresponding fiducial 14 move, the computer automatically and correspondingly senses the new position of tibia 10 in space and can correspondingly move implements, instruments, references, trials and/or implants on the monitor 24 relative to the image of tibia 10. Similarly, the image of the body part can be moved, both the body part and such items may be moved, or the on screen image otherwise presented to suit the preferences of the surgeon or others and carry out the imaging that is desired. Similarly, when an item 22, such as a cutting block, reamer, drill, saw, extramedullary rod, intramedullar rod, or any other type of item or instrument, that is being tracked moves, its image moves on monitor 24 so that the monitor shows the item 22 in proper position and orientation on monitor 24 relative to the femur 12: The item 22 can thus appear on the monitor 24 in proper or improper alignment with respect to the mechanical axis and other features of the femur 12, as if the surgeon were able to see into the body in order to navigate and position rod 22 properly.
Computer functionality 18 may also store and output virtual construct data based on the sensed position and orientation of items in the surgical field, such as surgical instruments. For example, as shown in FIG. 41, monitor 24 may output a resection plane 202 that corresponds to the resection plane defined by a cutting guide whose position and orientation is being tracked by sensors 16. In other embodiments, such as in the embodiment shown in FIG. 42, monitor 24 may output a cutting track 204 based on the sensed position and orientation of a reamer. Other virtual constructs may also be output on monitor 24, and can be displayed with or without the relevant surgical instrument, based on the sensed position and orientation of any surgical instrument or other item in the surgical field to assist the surgeon or other user to plan some or all of the stages of the surgical procedure.
In some preferred embodiments of the present invention, computer functionality may output on monitor 24 the projected position and orientation of an implant component or components based on the sensed position and orientation of one or more surgical instruments associated with fiducials. For example, the system may track the position and orientation of a cutting block as it is navigated with respect to a portion of a body part that will be resected. Computer functionality 18 may calculate and output on monitor 24 the projected placement of the implant in the body part based on the sensed position and orientation of the cutting block. If the surgeon or other user is dissatisfied with the projected placement of the implant, the surgeon may then reposition the cutting block to evaluate the effect on projected implant position and orientation.
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International Classification A61F2/38, A61F2/46, A61F2/30, A61B19/00
Cooperative Classification A61F2/389, A61B2017/00725, A61F2/3859, A61F2/38, A61F2002/30892, A61F2002/4632, A61F2/461, A61F2002/30616, A61F2002/3895, A61F2/4657, A61F2/4684, A61B90/36, A61B2034/102, A61B2034/2055, A61B2034/2072, A61B2034/108, A61B2034/105, A61B2034/254, A61B2034/252, A61B34/25, A61B2090/3916, A61B2090/3983, A61B2034/256, A61B2034/2068, A61B34/20, A61B34/10, A61B90/10
European Classification A61B19/52, A61B19/52H12, A61B19/20, A61F2/46B6