Patent Description:
The present disclosure generally relates to a surgical punch tool for use in orthopedic implant surgical procedures.

The use of computers, robotics, and imaging to aid orthopedic surgery is well known in the art. There has been a great deal of study and development of computer-aided navigation and robotics systems used to guide surgical procedures. For example, a precision freehand sculptor (PFS) employs a robotic surgery system to assist the surgeon in accurately cutting a bone into a desired shape. In interventions such as total knee replacement, computer-aided surgery techniques have been used to improve the accuracy and reliability of the surgery.

A cut guide can be used in an orthopedic surgery to assist a surgeon in cutting or modifying some portions of a target bone. For example, in joint replacement surgeries, such as total hip replacement (THR) or total knee replacement (TKR), a cut guide can be temporarily attached to the target bone such as a femur or a tibia. An orthopedic surgical cutting tool can be used together with the cut guide to allow the surgeon to selectively cut portions of the ends of the target bone and replace them with endoprosthetic implants. Positioning a cut guide for use in preparing the target bone can be a time-consuming and complicated process, which is critical to positive outcomes for the patient. <CIT> describes components, devices, systems and methods are provided for a pneumatic surgical instrument having a distal end of a probe configured to penetrate bone, resect or microfracture bone. <CIT> describes a surgical instrument for use during a surgical procedure to implant a stemless humeral component to replace the humeral head of a patient's humerus.

There is provided a surgical punch tool that includes a stationary base component having a planar bottom side, one or more posts extending from the planar bottom side, one or more sharp pins each associated with a corresponding post, and a movable actuation portion configured to move each sharp pin from a non-actuated position within the corresponding post to an actuated position extending through the base component and from the corresponding post.

In some embodiments, the base component further includes a plurality of channels configured to receive and guide the actuation portion.

In some embodiments, the surgical punch tool further comprises one or more devices configured to provide a biasing force opposing movement of the actuation portion towards the base component. In some embodiments, the surgical punch tool further comprises one or more devices configured to provide a biasing force promoting movement of the actuation portion towards the base component. In some embodiments, the one or more devices comprise at least one spring. In some embodiments, the surgical punch tool further includes a catch configured to secure the sharp pins in the non-actuated position, and a release mechanism configured to release the catch from securing the sharp pins in the non-actuated position.

In some embodiments, the actuation portion comprises an impact face configured to receive an impact force that causes the sharp pins to move from the non-actuated position to the actuated position.

In some embodiments, each of the one or more posts extends from the base by about <NUM> to about <NUM>. In some embodiments, each of the one or more posts has a diameter of about <NUM> to about <NUM>. In some embodiments, each of the one or more sharp pins extends from the base by about <NUM> to about <NUM> in the actuated position. In some embodiments, each of the one or more sharp pins has a diameter of about <NUM> to about <NUM>. In some embodiments, the one or more sharp pins comprise a first sharp pin and a second sharp pin, and a center of the first sharp pin is about <NUM> (<NUM> inches) to about <NUM> (<NUM> inches) away from a center of the second sharp pin.

The example embodiments as described above can provide various advantages over prior techniques. For example, the techniques as taught herein can more quickly and precisely position a cut guide during a surgical implant procedure. As such, the techniques taught herein provide better patient outcomes resulting from reduced operation times and better placed implants.

Further features and advantages of at least some of the embodiments of the present disclosure, as well as the structure and operation of various embodiments of the present disclosure, are described in detail below with reference to the accompanying drawings.

The accompanying drawings, which are incorporated in and form a part of the specification, illustrate the embodiments of the present disclosure and together with the written description serve to explain the principles, characteristics, and features of the present disclosure. Only the device shown in <FIG> is an embodiment of the invention as claimed. In the drawings:.

The terminology used in the description is for the purpose of describing the particular versions or embodiments only, and is not intended to limit the scope.

As used in this document, the singular forms "a," "an," and "the" include plural references unless the context clearly dictates otherwise. As used in this document, the term "comprising" means "including, but not limited to.

The embodiments of the present teachings described below are not intended to be exhaustive or to limit the teachings to the precise forms disclosed in the following detailed description. Rather, the embodiments are chosen and described so that others skilled in the art may appreciate and understand the principles and practices of the present teachings.

Robotically assisted surgeries, such as Total Knee Arthroplasty (TKA), provide a surgeon with the advantage of planning the procedure and viewing the projected outcome of the procedure prior to performing bone resection. One of the challenges to providing a robotically assisted option is optimizing the workflow efficiency by maintaining continuity with conventional instrumentation. For example, during the manual portion of existing robotically assisted TKA procedures, a set of post holes (e.g., four post holes) are drilled into the patient's femur. A distal cut guide is then fastened to the femur using these post holes to cut the initial distal cut into the femur. A drill guide can then be fastened to the distal cut guide, and two (or more) additional holes can be drilled. The drill guide and distal cut guide can then be removed, and a multi-cut guide block, such as a <NUM>-in-<NUM> cut block, can be attached using the two additional drill holes.

This disclosure describes an improved workflow for positioning and attaching the multi-cut guide block onto the patient's femur. To achieve the improved workflow, this disclosure teaches using a robotically assisted cutting tool to do the initial distal cut in, for example, a femur, eliminating the distal cutting guide. After the distal cut is complete, a punch tool that can be used to produce holes for mounting a multi-cut guide to eliminate the drill guide, thereby reducing the surgical workflow and instrumentation required for the procedure.

In the proposed workflow, the distal cut in the femur is prepared by burring or otherwise cutting the bone under robotic assistance. After preparation of the distal cut (using the robotically controlled cutting device), the surgeon can prepare additional divots located proximate to the position of attachment pins on the multi-cut guide block. For example, the surgeon can prepare two additional divots on the distal cut, a first divot on the medial condyle and a second divot on the lateral condyle. A punch tool can be positioned on the distal cut surface, the punch tool including two reference posts configured to sit within the prepared divots. The surgeon can impact the punch tool to create, for example, two holes positioned to receive the mounting pins on the multi-cut guide block and perform additional bone resection using the mounted multi-cut guide block.

<FIG> is an illustration of a system <NUM> for performing a surgical procedure using a robotic system. The system <NUM>, which is outside the scope of the claims of this application can include a surgical cutting tool <NUM> with an associated optical tracking frame <NUM> (also referred to as tracking array <NUM>), a display device <NUM>, an optical tracking system <NUM>, and patient tracking frames <NUM> (also referred to as tracking arrays <NUM>). <FIG> further illustrates an incision <NUM> through which a knee replacement surgery can be performed.

In certain implementations, the illustrated robotic surgical system <NUM> can include a hand-held, computer-controlled surgical robotic system, such as the NAVIO® Surgical System from Blue Belt Technologies, Inc. of Pittsburgh, PA. NAVIO is a registered trademark of Blue Belt Technologies, Inc. The illustrated robotic system uses an optical tracking system coupled to the robotic controller to track and control a hand-held surgical instrument. For example, the optical tracking system <NUM> tracks the tracking array <NUM> coupled to the surgical tool <NUM> and tracking arrays <NUM> coupled to the patient to track a location of the instrument relative to the target bone (e.g., femur and tibia for knee procedures).

<FIG> is a block diagram depicting an example system <NUM> for performing a robotically assisted surgical procedure, which is outside the scope of the claims of this application. In certain implementations, the system <NUM> can include a control system <NUM>, a tracking system <NUM>, and a surgical instrument <NUM>. Optionally, the system <NUM> also can include a display device <NUM> and a database <NUM>. In some examples, these components can be combined to provide navigation and control of the surgical instrument <NUM>, which can include navigation and control of a cutting tool or a point probe, among other things, used during an orthopedic prosthetic implant surgery (or similar surgery).

The control system <NUM> can further include one or more computing devices configured to coordinate information received from the tracking system <NUM> and provide control to the surgical instrument <NUM>. In an example, the control system <NUM> can include a planning module <NUM>, a navigation module <NUM>, a control module <NUM>, and a communication interface <NUM>. In certain examples, the planning module <NUM> can provide pre-operative planning services that allow clinicians the ability to virtually plan a procedure prior to reshaping the target joint during the surgical procedure on the patient. A portion of the planning process performed within the planning module can include operations similar to those discussed in <CIT> titled "Computer-assisted Surgery Planner and Intra-Operative Guidance System," to Digioia et al. , which discusses yet another approach to pre-operative planning.

In some examples, such as a TKA, the planning module <NUM> can be used to manipulate a virtual model of the implant in reference to a virtual implant host model. The virtual model of the implant host (illustrating the joint to be replaced) can be created through use of a point probe or similar instrument tracked by the optical tracking system <NUM>. In certain implementations, the planning module <NUM> can collect data from surfaces of the target joint to recreate a virtual model of the patient's actual anatomical structure. Particularly in a joint replacement surgery, this method can increase the accuracy of the planning process by using data collected after the joint has been exposed and without intra-operative imaging. Collecting surface data from the target bone(s) also can allow for iterative reshaping of the target bone to ensure proper fit of the prosthetic implants and optimization of anatomical alignment.

In certain implementations, the navigation module <NUM> can coordinate tracking the location and orientation of the implant, the implant host, and the surgical instrument <NUM> during the surgical procedure. In certain examples, the navigation module <NUM> also may coordinate tracking of the virtual models used during pre-operative or intra-operative planning within the planning module <NUM>. Tracking the virtual models can include operations such as alignment of the virtual models with the implant host through data obtained via the tracking system <NUM>. In these examples, the navigation module <NUM> can receive input from the tracking system <NUM> regarding the physical location and orientation of the surgical instrument <NUM> and an implant host. Tracking of the implant host can include tracking multiple individual bone structures, such as with tracking arrays <NUM>. For example, during a total knee replacement procedure, the tracking system <NUM> can individually track the femur and the tibia using tracking devices anchored to the individual bones (as illustrated in <FIG>).

In some examples, the control module <NUM> can process information provided by the navigation module <NUM> to generate control signals for controlling the surgical instrument <NUM>. The control module <NUM> also can work with the navigation module <NUM> to produce visual animations to assist the surgeon during an operative procedure. Visual animations can be displayed via a display device, such as display device <NUM>. In certain implementations, the visual animations can include real-time <NUM>-D representations of the implant, the implant host, and the surgical instrument <NUM>, among other things. In some examples, the visual animations are color-coded to further assist the surgeon with positioning and orienting the implant.

In certain implementations, the communication interface <NUM> can facilitate communication between the control system <NUM> and external systems and devices. The communication interface <NUM> can include both wired and wireless communication interfaces, such as Ethernet, IEEE <NUM> wireless, or Bluetooth, among others. As illustrated in <FIG>, the primary external systems connected via the communication interface <NUM> can include the tracking system <NUM> and the surgical instrument <NUM>. Although not shown, the database <NUM> and the display device <NUM>, among other devices, also can be connected to the control system <NUM> via the communication interface <NUM>. In some examples, the communication interface <NUM> can communicate over an internal bus to other modules and hardware systems within the control system <NUM>.

In some examples, the tracking system <NUM> can provide location and orientation information for surgical devices and parts of an implant host's anatomy to assist in navigation and control of semi-active robotic surgical devices. The tracking system <NUM> can include a tracker (e.g., tracking array <NUM>) that can include or otherwise provide tracking data based on at least three positions and at least three angles. The tracker can include one or more first tracking markers associated with the implant host and one or more second markers associated with the surgical device (e.g., surgical instrument <NUM>). The markers or some of the markers can be one or more of infrared sources, light emitting sources, radio frequency (RF) sources, ultrasound sources, and/or transmitters. As examples, the tracking system <NUM> can be an infrared tracking system, an optical tracking system, an ultrasound tracking system, an inertial tracking system, a wired system, and/or an RF tracking system. One illustrative tracking system can be the OPTOTRAK® <NUM>-D motion and position measurement and tracking system from Northern Digital, Inc. of Ontario, Canada, although those of ordinary skill in the art will recognize that other tracking systems of other accuracies and/or resolutions can be used. <CIT>, titled "<NPL>et al. , provides additional detail regarding the use of tracking systems, such as tracking system <NUM>, within a surgical environment.

<FIG> illustrate a sample target bone <NUM> (e.g., a patient's femur) and a multi-cut guide block <NUM>, which is outside the scope of the claims of this application. In certain implementations, the multi-cut guide block can be a <NUM>-in-<NUM> cut guide for use in TKA as manufactured by Smith & Nephew, Inc. of Memphis, TN. However, it should be noted that the <NUM>-in-<NUM> cut guide is provided and described by way of example only, and other types of multi-cut guides can be used with the techniques described herein.

As shown in <FIG>, the guide block <NUM> includes mounting pins <NUM>. To reduce rotation of the guide block <NUM> once mounted on the target bone <NUM>, multiple mounting pins <NUM> can be included. However, as guide block <NUM> is shown in <FIG> in a side-profile view, a second mounting pin is positioned behind and hidden by the visible mounting pin <NUM>. The guide block <NUM> also includes a flat bottom plane <NUM> configured to interface with a distal cut surface on the target bone <NUM>. In certain implementations, the position of the mounting pins <NUM> prevent rotational movement of the guide block <NUM> when inserted into mounting holes, and the interface between the bottom plane <NUM> and the cut bone prevents lateral movement of the guide block <NUM>.

Referring back to <FIG>, dashed lines <NUM> and <NUM> indicate areas of bone to be removed to accommodate the guide block <NUM>. For example, line <NUM> illustrates a hole configured to receive at least one of the mounting pins <NUM>, and line <NUM> illustrates the distal cut plane configured to interface with the bottom plane <NUM> of the guide block <NUM>.

<FIG> illustrate before and after diagrams of a target bone <NUM> being prepared for a surgical procedure, which is outside the scope of the claims of this application. In this example, the distal surface of the target bone <NUM> is resected. Using, for example, a surface preparation tool <NUM>, the surgeon can resect the target bone <NUM> to remove area <NUM>, thereby defining the distal cut plane (e.g., corresponding to line <NUM> in <FIG>) through the cortical portion of the target bone. However, rather than drill the entire hole (corresponding to line <NUM> in <FIG>), the surgeon can use the surface preparation tool to create one or more divots <NUM> into the cancellous portion of the target bone <NUM>. The size and shape of a divot <NUM> can be determined based on, for example, the size and shape of the protruding posts of the punch tool (described in more detail in the discussion of <FIG> below). A recessed portion of a divot <NUM> can be in a shape of a cylinder, a cube, a rectangular prism, a triangular prism, a pyramid, a cone, or other three-dimensional shapes. The size and shape of a divot <NUM> also can be determined based on the location of a landing site for the punch tool and/or guide block, or based on the anatomical, mechanical, and physical properties of the bone and soft tissue at the landing site.

The location of the distal cut plane and the divots <NUM> can be defined according to the surgical plan as determined by, for example, the planning module <NUM> as described above. In order to achieve proper bone resection, thereby accurately forming the distal cut plane and the divots <NUM>, the surface preparation tool <NUM> can be monitored by the tracking system <NUM> (as described above), and operation of a cutting burr or other cutting interface of the surface preparation tool can be controlled by the control module <NUM> in response to the currently tracked position of the surface preparation tool. It should be noted that a spherical cutting burr is shown in <FIG> by way of example only, and other shapes, such as a cylindrical or conical cutting burr, can be used for the resection of target bone <NUM>.

In certain implementations, surface preparation tool <NUM> can include a rotary device including a cutting burr, a surgical drill, a surgical mill, a surgical saw, or other surgical equipment capable of creating the recessed portion on the target bone <NUM>. The surface preparation tool <NUM> can be operated semi-manually by an operator, such as a surgeon, while it is connected to and monitored by an automated computer-controlled system, such as a precision freehand sculptor (PFS) or other robotic surgical system.

<FIG> illustrate the punch tool <NUM> as described herein. As shown in <FIG>, the punch tool <NUM> is in a non-actuated position. The punch tool <NUM> can include a stationary base component <NUM>. In certain implementations, the base <NUM> can include a planar bottom <NUM> configured to sit against the distal cut plane of the target bone (e.g., target bone <NUM> as described above) as well as posts <NUM>. In some examples, the posts <NUM> can be configured to extend from the base <NUM> by about <NUM>. In other examples, the posts <NUM> can be configured to extend about <NUM> to about <NUM> from the base <NUM>. Similarly, in some implementations, the posts <NUM> can have a diameter of about <NUM>. In some examples, the posts <NUM> can have a diameter of about <NUM> to about <NUM>. Based upon the size of the posts <NUM>, the divots (e.g., divots <NUM> as described above) can be sized to accept the posts <NUM>. For example, if the posts <NUM> are extend form the base <NUM> by about <NUM>, and the posts are about <NUM> in diameter, the divots can be sized about <NUM> deep and <NUM> in diameter.

The punch tool <NUM> can further include an actuation portion <NUM>. The actuation portion <NUM> can be sized to fit within channels <NUM> on the base <NUM>, the channels configured to guide the movement of the actuation portion. In certain implementations, the punch tool <NUM> can further include springs <NUM> or another device configured to provide a biasing force opposing the movement of the actuation portion <NUM>. It should be noted that springs <NUM> are shown as coil springs by way of example only.

The actuation portion <NUM> can include an impact face <NUM>. To actuate the punch tool <NUM>, a surgeon can apply an impact force (e.g., via a slap hammer) to the impact face <NUM>. Such an applied force can move the actuation portion <NUM> into an actuated position, as shown by <FIG>.

As shown in <FIG>, when actuated, two sharp pins <NUM> are exposed from the punch tool <NUM>. The sharp pins <NUM> are configured to exit the base <NUM> of the punch tool <NUM> through the posts <NUM>, thereby penetrating the target bone adjacent to the divots prepared in the target bone. The sharp pins <NUM> can then penetrate the cancellous bone exposed as a result of the distal cut, thereby forming two holes in the cancellous bone.

The sharp pins <NUM> can be sized based upon the size of the mounting pins on a corresponding multi-cut guide block (e.g., guide block <NUM> as described above). For example, the sharp pins <NUM> can be about <NUM> in diameter and protrude about <NUM> from the base <NUM> of the punch tool <NUM>. In some implementations, the diameter of the sharp pins <NUM> can be from about <NUM> to about <NUM>. Similarly, in some examples, the sharp pins can protrude about <NUM> to about <NUM> from the base <NUM> of the punch tool <NUM>.

Additionally, the spacing between the sharp pins <NUM> can be determined based upon the corresponding multi-cut guide block being used. For example, a multi-cut guide block can have its mounting pins spaced <NUM> (<NUM> inches) apart on center. A corresponding punch tool <NUM> can have similarly spaced sharp pins <NUM>, i.e., <NUM> (<NUM> inches) apart. In some implementations, a punch tool <NUM> can have the sharp pins <NUM> spaced about <NUM> (<NUM> inches) apart to about <NUM> (<NUM> inches) apart.

Depending upon the manufacturer of the cut guide, in some examples, each cut guide size in a family or similar product line can have the same sized mounting pins. In such an example, a single punch tool can be used with each size cut guide in the family. For example, each cutting guide in the JOURNEY II family as manufactured by Smith & Nephew, Inc. of Memphis, TN, has the same set of mounting pins. JOURNEY is a registered trademark of Smith & Nephew, Inc. Thus, a single sized punch tool can be used with each size of cut guide in the JOURNEY II family. In other implementations, each specific cut guide can have a dedicated and appropriately sized punch tool.

Additionally, the punch tool <NUM> can include a connection point <NUM> for attaching a handle to the punch tool for easier manipulation and positioning.

The punch tool <NUM> as described above can be manufactured from a material or set of materials that facilitate easy cleaning and sterilization through, for example, a steam sterilization process. In certain implementations, the punch tool <NUM> can be manufactured from titanium, stainless steel, and other similar materials that are commonly used to manufacture tools and guides for use during surgery. In some examples, the punch tool <NUM> can be designed to have a unibody or single-piece design that is not able to be disassembled. In such a design, similar to that as shown in <FIG>, an open central space can be included in the design to facilitate cleaning of, for example, the sharp pins <NUM> when in the retracted position (as shown in <FIG>). In other examples, the punch tool <NUM> can a multi-piece design configured to be taken apart for cleaning and sterilization.

It should be noted that the springs <NUM> as shown above are provided as a way to keep the punch tool <NUM> in a retracted position, thereby protecting a user from the sharp pins <NUM>. However, additional retraction mechanisms, such as a ball and detent, can be used to keep the punch tool <NUM> in a retracted position. Keeping the punch tool <NUM> in a retracted position also acts to protect the sharp pins <NUM>, thereby reducing the chance of misalignment or damage to the posts.

In an alternative design, the punch tool <NUM> can be designed such that the springs <NUM> are configured to promote movement of the actuation portion <NUM> toward the target bone. For example, the punch tool <NUM> can include a catch that secures the punch tool in the non-actuated position. Upon activation of a release mechanism, the springs can pull or otherwise apply a force to the actuation portion <NUM>, thereby causing the sharp pins <NUM> to penetrate the cancellous portion of the target bone. Such a design removes the need for a surgeon to apply a force to the punch tool <NUM> for actuation of the sharp pins <NUM>.

<FIG> illustrate a visual representation of a target bone being prepared to receive a multi-cut guide using a punch tool according to the techniques described herein.

As shown in <FIG>, the target bone <NUM> has been prepared using, for example, a rotary cutting tool or another similar surgical cutting tool according to the process as described above in regard to <FIG>. As such, target bone <NUM> has been prepared to include a distal plane cut <NUM> and divots <NUM>.

Referring to <FIG>, a punch tool <NUM> is positioned on the target bone <NUM>. A bottom surface of the punch tool (e.g., bottom <NUM> as described above) can be positioned such that it interfaces with the distal cut <NUM>. Additionally, the posts (e.g., posts <NUM>) of the punch tool <NUM> can be positioned within divots <NUM> of the target bone <NUM>. As shown in <FIG>, the punch tool <NUM> can include an attached handle <NUM> to aid in positioning and holding the punch tool in position.

Referring to <FIG>, the punch tool <NUM> has been activated, thereby resulting in sharp posts <NUM> extending into the target bone <NUM>, creating two holes in the target bone (corresponding to, for example, line <NUM> as described above in regard to <FIG>). Referring to <FIG>, the punch tool <NUM> can be removed from the target bone <NUM>. A multi-cut guide <NUM> can be positioned on the target bone <NUM> such that mounting pins <NUM> fit within the holes created by the sharp posts <NUM>, thereby ensuring that the multi-cut guide is securely and properly positioned on the target bone. The surgeon can further secure the cut guide <NUM> to the target bone <NUM> using, for example, <NUM>/<NUM> inch (<NUM>,<NUM>) holding pins. The target bone <NUM> can be further resected using a cutting tool such as an oscillating saw and the multi-cut guide <NUM>.

<FIG> illustrates a sample workflow, which is outside the scope of the claims of this application, that may be performed by a surgeon performing the surgical process using the punch tool techniques described herein. It is assumed that various initial steps for the surgical procedure have already been performed prior to actual bone resection, such as selecting an implant for implanting into the patient, initial incisions and soft tissue removal, bone surface mapping and imaging, and other similar steps covered, for example, in <CIT> as described above.

Based upon the patient's anatomy (e.g., the size and shape of the patient's femur) and the type of surgery being performed (e.g., a TKA), the surgeon can select <NUM> a cut guide for use during the procedure. As noted above, based upon the size and shape of the cut guide, each cut guide can have an associated punch tool, or a single punch tool can be adapted to work with a series of cut guides.

The surgeon can provide information related to the selected <NUM> cut guide to the surgical system (e.g., through the communication interface <NUM> as described above) and, based upon this information, the surgical system can update the surgery plan. It should be noted that the workflow process for the surgical system is described in greater detail in the following discussion of <FIG>.

Referring again to <FIG>, the surgeon can then resect <NUM> the target bone per the robotic-assisted cutting tool instructions. For example, the surgical system can determine an amount of bone to remove during the resection, and provide control signals to a robotically assisted cutting tool being operated by the surgeon. Depending upon the procedure being performed, the surgeon can be instructed to remove various portions of the target bone. For example, during a TKA, the surgeon can use the robotically assisted cutting tool to create <NUM> a distal plane. Similarly, the surgeon can create <NUM> the divots for receiving the punch tool. Following bone resection, the surgeon can attach <NUM> the punch tool to the target bone. The surgeon can check the position of the punch tool and, upon verifying the punch tool is properly positioned, can actuate <NUM> the punch tool. The surgeon can remove <NUM> the punch tool, thereby exposing the holes made by the punch tool. The surgeon can attach <NUM> the selected cut guide to the holes created by the punch tool, and continue <NUM> the procedure.

As noted above, in order to assist the surgeon during the procedure described herein as outlined in <FIG>, a surgical system, such as the control system described above in reference to <FIG>, can perform various functions as well. For example, <FIG> illustrates a sample workflow for a surgical system during a procedure using techniques and processes described herein.

Similar to <FIG>, the description of <FIG> assumes that various initial steps for the surgical procedure have already been performed by the surgical system prior to actual bone resection, such as receiving a selection of an implant for implanting into the patient, determining an initial surgical plan for the initial incisions and soft tissue removal, receiving information related to the bone surface mapping and imaging, determining a surgical plan for bone resection, and other similar steps covered, for example, in <CIT> as described above.

Referring to <FIG>, the surgical system, which is outside the scope of the claims of this application, can receive <NUM> an indication of a cut guide that the surgeon has selected. Based upon the cut guide to be used, the surgical system can optionally determine <NUM> a punch tool associated with the selected cut guide. Based upon the selected cut guide (and optionally the punch tool), the surgical system can update <NUM> the surgical plan to determine an amount and location of bone to be removed for the target bone to properly receive the cut guide. Based upon the updated surgical plan, the surgical system can provide the surgeon with a visual indication of the update (e.g., provide a display of the bone to be removed to accommodate the selected cut guide) and can control <NUM> the operation of a cutting device, ensuring that the surgeon is removing bone according to the surgical plan. As noted above, during control <NUM> of the cutting device, the surgical system also can track the movement and position of the cutting device to accurately monitor <NUM> the progress of the bone resection. The surgical system can continually map the amount of bone removed to determine <NUM> whether the cutting is complete. If the cutting is not complete, the surgical system can continue to control <NUM> operation of the cutting tool and monitor <NUM> the process of the bone resection. However, if the surgical system does determine that the cutting is complete, the surgical system can wait while the surgeon performs various manual steps (e.g., placing, actuating and removing the punch tool and placing the cut guide). Upon receiving <NUM> and indication that the surgeon has completed the manual steps, the surgical system can continue to monitor and assist with the surgical procedure.

It should be noted that, depending upon the capabilities of the tracking system associated with the surgical system, and the design of the punch tool and cut guide, the surgical system can continue to monitor the procedure during the manual steps. For example, if the punch tool and cut guide are configured to include trackable components such as a visual tracking sensor array, the surgical system can monitor the placement of the punch tool and/or the cut guide during the manual steps of the procedure as described herein.

It should be also noted that the above description is generally directed to positioning a femur cutting block by way of example only. The punch tool and associated processes for incorporating the punch tool into a surgical workflow can be applied to any surgical procedure where a bone surface is prepared or otherwise resected to a specific geometry for, for example, accepting an implant component.

Additionally, various alterations to the workflow as described herein are possible. For example, the handle or another component of the punch tool as described herein can be trackable using the tracking system. In such an embodiment, the surgeon can merely prepare the distal cut and, rather than use the divot and post combination as described herein, use the tracking system to determine proper placement of the punch tool prior to actuation.

<FIG> is a block diagram that illustrates an example of a machine in the form of a computer system <NUM> within which instructions, for causing the computer system to perform any one or more of the methods discussed herein, may be executed. In various embodiments, the machine can operate as a standalone device or may be connected (e.g., networked) to other machines. In a networked deployment, the machine may operate in the capacity of a server or a client machine in server-client network environment, or as a peer machine in a peer-to-peer (or distributed) network environment. The machine may be a personal computer (PC), a tablet PC, a set-top box (STB), a PDA, a cellular telephone, a web appliance, a network router, switch or bridge, or any machine capable of executing instructions (sequential or otherwise) that specify actions to be taken by that machine. Further, while only a single machine is illustrated, the term "machine" shall also be taken to include any collection of machines that individually or jointly execute a set (or multiple sets) of instructions to perform any one or more of the methodologies and/or processes discussed herein.

The example computer system <NUM> includes a processor <NUM> (such as a central processing unit (CPU), a graphics processing unit (GPU), or both), a main memory <NUM> and a static memory <NUM>, which communicate with each other via a bus <NUM>. The computer system <NUM> may further include a video display unit <NUM> (such as a liquid crystal display (LCD) or a cathode ray tube (CRT)), an alpha-numeric input device <NUM> (such as a keyboard), a user interface (UI) navigation device (or cursor control device) <NUM> (such as a mouse), a disk drive unit <NUM>, a signal generation device <NUM> (e.g., a speaker) and a network interface device <NUM>.

The disk drive unit <NUM> includes a machine-readable storage medium <NUM> on which is stored one or more sets of instructions and data structures (e.g., software) <NUM> embodying or used by any one or more of the methods or functions described herein. The instructions <NUM> may also reside, completely or at least partially, within the main memory <NUM>, static memory <NUM>, and/or within the processor <NUM> during execution thereof by the computer system <NUM>, the main memory <NUM> and the processor <NUM> also constituting machine-readable media. In an example, the instructions <NUM> stored in the machine-readable storage medium <NUM> include instructions causing the computer system <NUM> to receive a target bone representation including a data set representing the anatomic structure of the target bone. The instructions <NUM> can also store the instructions <NUM> that cause the computer system <NUM> to generate a cut guide positioning plan for positioning the cut guide onto or conforming to the target bone. The machine-readable storage medium <NUM> may further store the instructions <NUM> that cause the computer system <NUM> to produce the two or more divots sized, shaped or otherwise configured to receive and position the punch tool.

While the machine-readable storage medium <NUM> is shown in an example embodiment to be a single medium, the term "machine-readable storage medium" may include a single medium or multiple media (e.g., a centralized or distributed database, and/or associated caches and servers) that store the one or more instructions or data structures. The term "machine-readable storage medium" shall also be taken to include any tangible medium that is capable of storing, encoding or carrying instructions for execution by the machine and that cause the machine to perform any one or more of the methods of the present invention, or that is capable of storing, encoding or carrying data structures used by or associated with such instructions. The term "machine-readable storage medium" shall accordingly be taken to include, but not be limited to, solid-state memories, and optical and magnetic media. Specific examples of machine-readable media include non-volatile memory, including by way of example, semiconductor memory devices (e.g., erasable programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM)) and flash memory devices; magnetic disks such as internal hard disks and removable disks; magneto-optical disks; and CD-ROM and DVD-ROM disks. A "machine-readable storage medium" shall also include devices that may be interpreted as transitory, such as register memory, processor cache, and RAM, among others. The definition provided herein of machine-readable storage medium is applicable even if the machine-readable storage medium is further characterized as being "non-transitory. " For example, any addition of "non-transitory," such as non-transitory machine-readable storage medium, is intended to continue to encompass register memory, processor cache and RAM, among other memory devices.

In various examples, the instructions <NUM> may further be transmitted or received over a communications network <NUM> using a transmission medium. The instructions <NUM> may be transmitted using the network interface device <NUM> and any one of a number of well-known transfer protocols (e.g., HTTP). Examples of communication networks include a LAN, a WAN, the Internet, mobile telephone networks, plain old telephone (POTS) networks, and wireless data networks (e.g., Wi-Fi and WiMAX networks). The term "transmission medium" shall be taken to include any intangible medium that is capable of storing, encoding or carrying instructions for execution by the machine, and includes digital or analog communications signals or other intangible media to facilitate communication of such software.

In the above detailed description, reference is made to the accompanying drawings, which form a part hereof. In the drawings, similar symbols typically identify similar components, unless context dictates otherwise. The illustrative embodiments described in the detailed description, drawings, and claims are not meant to be limiting. It will be readily understood that various features of the present disclosure, as generally described herein, and illustrated in the Figures, can be arranged, substituted, combined, separated, and designed in a wide variety of different configurations, all of which are explicitly contemplated herein.

The present disclosure is not to be limited in terms of the particular embodiments described in this application, which are intended as illustrations of various features. Functionally equivalent methods and apparatuses within the scope of the disclosure, in addition to those enumerated herein, will be apparent to those skilled in the art from the foregoing descriptions. The present disclosure is to be limited only by the terms of the appended claims. It is to be understood that this disclosure is not limited to particular methods, reagents, compounds, compositions or biological systems, which can, of course, vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting.

It will be understood by those within the art that, in general, terms used herein, and especially in the appended claims (for example, bodies of the appended claims) are generally intended as "open" terms (for example, the term "including" should be interpreted as "including but not limited to," the term "having" should be interpreted as "having at least," the term "includes" should be interpreted as "includes but is not limited to," et cetera). While various compositions, methods, and devices are described in terms of "comprising" various components or steps (interpreted as meaning "including, but not limited to"), the compositions, methods, and devices can also "consist essentially of" or "consist of" the various components and steps, and such terminology should be interpreted as defining essentially closed-member groups. It will be further understood by those within the art that virtually any disjunctive word and/or phrase presenting two or more alternative terms, whether in the description, or drawings, should be understood to contemplate the possibilities of including one of the terms, either of the terms, or both terms.

As will be understood by one skilled in the art, for any and all purposes, such as in terms of providing a written description, all ranges disclosed herein also encompass any and all possible subranges and combinations of subranges thereof. Any listed range can be easily recognized as sufficiently describing and enabling the same range being broken down into at least equal halves, thirds, quarters, fifths, tenths, et cetera. As a non-limiting example, each range discussed herein can be readily broken down into a lower third, middle third and upper third, et cetera. As will also be understood by one skilled in the art all language such as "up to," "at least," and the like include the number recited and refer to ranges that can be subsequently broken down into subranges as discussed above. Finally, as will be understood by one skilled in the art, a range includes each individual member. Thus, for example, a group having <NUM>-<NUM> cells refers to groups having <NUM>, <NUM>, or <NUM> cells. Similarly, a group having <NUM>-<NUM> cells refers to groups having <NUM>, <NUM>, <NUM>, <NUM>, or <NUM> cells, and so forth.

The term "about," as used herein, refers to variations in a numerical quantity that can occur, for example, through measuring or handling procedures in the real world; through inadvertent error in these procedures; through differences in the manufacture, source, or purity of compositions or reagents; and the like. Typically, the term "about" as used herein means greater or lesser than the value or range of values stated by <NUM>/<NUM> of the stated values, e.g., <NUM>%. The term "about" also refers to variations that would be recognized by one skilled in the art as being equivalent so long as such variations do not encompass known values practiced by the prior art. Each value or range of values preceded by the term "about" is also intended to encompass the embodiment of the stated absolute value or range of values. Whether or not modified by the term "about," quantitative values recited in the claims include equivalents to the recited values, e.g., variations in the numerical quantity of such values that can occur, but would be recognized to be equivalents by a person skilled in the art.

Various of the above-disclosed and other features and functions, or alternatives thereof, may be combined into many other different systems or applications. Various presently unforeseen or unanticipated alternatives, modifications, variations or improvements therein may be subsequently made by those skilled in the art, each of which is also intended to be encompassed by the disclosed embodiments.

Claim 1:
A surgical punch tool (<NUM>), comprising:
a stationary base component (<NUM>);
characterized in that the stationary base has a planar bottom side (<NUM>) having one or more posts (<NUM>) extending from the planar bottom side (<NUM>);
one or more sharp pins (<NUM>), wherein each pin (<NUM>) is associated with a corresponding post (<NUM>); and
a movable actuation portion (<NUM>) configured to move each sharp pin (<NUM>) from a non-actuated position within the corresponding post (<NUM>) to an actuated position extending through the base component (<NUM>) and from the corresponding post (<NUM>).