US20050021043A1 - Apparatus for digitizing intramedullary canal and method - Google Patents

Apparatus for digitizing intramedullary canal and method Download PDF

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Publication number
US20050021043A1
US20050021043A1 US10/677,321 US67732103A US2005021043A1 US 20050021043 A1 US20050021043 A1 US 20050021043A1 US 67732103 A US67732103 A US 67732103A US 2005021043 A1 US2005021043 A1 US 2005021043A1
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United States
Prior art keywords
intramedullary canal
orientation
stem portion
bone
implant
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Abandoned
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US10/677,321
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English (en)
Inventor
Herbert Andre Jansen
Louis-Philippe Amiot
Sebastien Cossette
Sebastien Jutras
Benoit Pelletier
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Orthosoft ULC
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Orthosoft ULC
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Priority to US10/677,321 priority Critical patent/US20050021043A1/en
Assigned to ORTHOSOFT, INC. reassignment ORTHOSOFT, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: AMIOT, LUIS-PHILIPPE, COSSETTE, SEBASTIEN, JANSEN, HERBERT ANDRE, JUTRAS, SEBASTIEN, PELLETIER, BENOIT
Publication of US20050021043A1 publication Critical patent/US20050021043A1/en
Assigned to ORTHOSOFT INC. reassignment ORTHOSOFT INC. CHANGE OF NAME (SEE DOCUMENT FOR DETAILS). Assignors: ORTHOSOFT HOLDINGS INC.
Assigned to ORTHOSOFT HOLDINGS INC. reassignment ORTHOSOFT HOLDINGS INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: ORTHOSOFT INC.
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4632—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor using computer-controlled surgery, e.g. robotic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4657—Measuring instruments used for implanting artificial joints
    • A61F2002/4658—Measuring instruments used for implanting artificial joints for measuring dimensions, e.g. length
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4657—Measuring instruments used for implanting artificial joints
    • A61F2002/4668—Measuring instruments used for implanting artificial joints for measuring angles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4681—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor by applying mechanical shocks, e.g. by hammering
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4688—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor having operating or control means
    • A61F2002/4696—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor having operating or control means optical

Definitions

  • the present invention generally relates to computer-assisted hip replacement surgery and, more precisely, to hip replacement surgery with minimal preoperative procedures.
  • the artificial hip joint typically consists of a pelvic implant and a femoral implant.
  • the pelvic implant is a cup received in the acetabulum.
  • the femoral implant consists of a spherical portion received at an end of a longitudinal implant portion.
  • the longitudinal implant portion is introduced into the intramedullary canal of the resected femur, with the spherical portion being generally centered with respect to the previous position of the femoral head. Therefore, the femoral head (i.e., spherical portion of the femoral implant) and the cup (i.e., pelvic implant) coact to create the artificial hip joint.
  • CT computerized tomography
  • CT uses X-rays, which are known to be hazardous to health.
  • a method of doing surgical treatment with a position tracking system in computer-assisted surgery for guiding an operator in inserting a femoral implant of a hip joint implant in a femur as a function of a limb length and orientation of the femoral implant, comprising the steps of: obtaining a frame of reference of the femur, the frame of reference being trackable in space for position and orientation; providing a digital model of a femoral implant; calculating a desired implant position for the femoral implant with respect to the frame of reference of the femur, as a function of the limb length; and guiding an operator in altering the femur for a subsequent insertion of the femoral implant in the femur by providing information about a current implant position and orientation with respect to the desired implant position, the current implant position and orientation being calculated as a function of the digital model of the femoral implant and of a real-time tracking for position and orientation of at
  • a method of doing surgical treatment in computer-assisted surgery for guiding an operator in inserting a pelvic implant of a hip joint implant in an acetabulum of a pelvis as a function of a position and orientation of the pelvic implant with respect to the pelvis, comprising the steps of: creating a frame of reference of a pelvis by registering points on the pelvis, the frame of reference being trackable in space for position and orientation; creating a digital model of a surface of an exposed acetabulum of the pelvis by registering points on the surface of the acetabulum as a function of the frame of reference; providing a digital model of a pelvic implant; calculating an initial center of rotation of the acetabulum as a function of the digital model of the surface of the acetabulum; and guiding an operator in altering the acetabulum for a subsequent insertion of the pelvic implant in the acetabulum by providing information about a current implant position and orientation-with respect
  • a method for digitizing an intramedullary canal axis of a bone in computer-assisted surgery comprising the steps of: performing an opening in a bone to expose an intramedullary canal of the bone; providing a tool trackable in space for position and orientation and a frame of reference on the bone, said tool having a leading end thereof being positionable in a determined way with respect to a surface of the intramedullary canal; and obtaining the axis of the intramedullary canal with respect to the frame of reference by calculating and relating reference points in the intramedullary canal by inserting the leading end of the tool at given depths in the intramedullary canal and calculating a reference point of the intramedullary canal for each said given depths as a function of a position and orientation of said tool having the leading end positioned in said determined way.
  • an apparatus for obtaining an axis of an intramedullary canal of an exposed bone with a position tracking system in computer-assisted surgery comprising: a detectable device trackable in space for position and orientation; a stem portion secured to the detectable device so as to be tracked for position and orientation, the stem portion having a leading end insertable in an intramedullary canal of the bone through an opening in the bone, and being adapted to be handled by a following end thereof; and a tip portion at the leading end of the stem portion, the tip portion being positionable in a determined way with respect to a surface of the intramedullary canal, such that reference points with respect to the intramedullary canal are calculable as a function of the position and orientation of the detectable device, said reference points being related to define an axis of the intramedullary canal.
  • a computer-assisted surgery system for guiding an operator in inserting a femoral implant of a hip joint implant in a femur as a function of a limb length and orientation of the femoral implant with respect to the femur, comprising: a reference tool securable to the femur and trackable in space for position and orientation; a registration tool trackable in space for position and orientation and handled by the operator to register surface information; a bone altering tool trackable in space for position and orientation; a sensing apparatus, for tracking any one of the tools for position and orientation; a controller connected to the sensing apparatus, the controller being provided to: i) register a frame of reference of the femur by at least one of calculating surface information provided by the registration tool as a function of the position and orientation of the registration tool provided by the sensing apparatus, and retrieving in a database a model of the femur; ii) calculate a desired implant position with respect to the
  • a computer-assisted surgery system for guiding an operator in inserting a pelvic implant of a hip joint implant in an acetabulum as a function of an orientation of the pelvic implant with respect to the pelvis, comprising: a reference tool securable to the femur and trackable in space for position and orientation; a registration tool trackable in space for position and orientation and handled by the operator to register surface information; a bone altering tool trackable in space for position and orientation; a sensing apparatus, for tracking any one of the tools for position and orientation; a controller connected to the sensing apparatus, the controller being provided to: i) register a frame of reference of the pelvis by calculating surface information provided by the registration tool as a function of the position and orientation of the registration tool provided by the sensing apparatus; ii) register a digital model of a surface of an exposed acetabulum of the pelvis with respect to the frame of reference by calculating surface information provided by the registration tool as a function of the
  • FIG. 1 is a front elevation view of leg bones involved in a hip replacement method in accordance with the present invention
  • FIG. 2 is a block diagram of a computer-assisted surgery system in accordance with the present invention.
  • FIG. 3 is a flow chart of a method of hip replacement surgery in accordance with the present invention.
  • FIG. 4 is a front elevation view of a canal digitizer in accordance with the present invention.
  • FIG. 5A is a longitudinal cross-section view of the canal digitizer
  • FIG. 5B is a side elevation view of a handle portion of the canal digitizer
  • FIG. 6 is a front elevation view of fingers of the canal digitizer
  • FIG. 7 is a front elevation view of one of the fingers having a stopper.
  • FIG. 8 is a front elevation view of the fingers of the canal digitizer centering the canal digitizer.
  • FIG. 1 is provided as reference for the description of the steps of the hip replacement surgery method described herein.
  • the bones are the pelvis 10 , the femur 20 , the tibia 30 and the fibula 40 .
  • parts of these bones will each be referenced by numerals from the same numeric decade.
  • parts of the pelvis e.g., the acetabulum 11
  • a computer-assisted surgery system is generally shown at 50 (hereinafter CAS system 50 ) and generally consists of a CAS controller 52 connected to sensor apparatus 54 .
  • the sensor apparatus 54 tracks for position and orientation tools 56 , to be described in detail with the description of the hip replacement surgery method of the present invention.
  • the controller 52 is typically a PC unit that has user interfaces by which a surgeon will receive or send information that will guide him during the hip replacement surgery. For instance, monitors, keyboard, mouse, and foot pedals are a few of the user interfaces that can be provided with the controller 52 .
  • a database of the controller 52 is illustrated separately as database 58 , and is typically the hard disk drive of the controller 52 .
  • a discussion of the preferred system configuration will follow the description of the method 100 .
  • a method for hip replacement surgery in accordance with the present invention is generally shown at 100 .
  • the method 100 is referred to in the singular, various choices of procedure will be given to the surgeon, as will be set forth in the forthcoming description, according to the preferences of the surgeon.
  • a plurality of methods can be derived from the method 100 according to the decisions of the surgeon.
  • Step 102 preparative steps for surgery are effected.
  • general patient information can be entered into the CAS system 50 ( FIG. 2 ) for opening a patient file.
  • a general patient profile can be entered, consisting of the name, birth date, identification number, sex and the like, as well as more specific data pertaining to the surgery, such as leg length discrepancy (with the identification of the longer leg), if applicable.
  • leg length discrepancy is measured using X-rays of the hip joint. More precisely, the leg length discrepancy is measured from the vertical comparison between the lesser trochanters. These X-rays are typically taken during the diagnostic stages leading to surgery, so they are usually available for hip joint surgery.
  • the calibration of the various surgical tools to be used is done.
  • a calibration base and method as set forth in International Publication No. WO 01/67979 A1 by Jutras et al., can be used for the calibration.
  • correspondence between the tracking of the tools 56 and the display on the CAS controller 52 can be verified in further calibration steps included in Step 102 .
  • the general patient information can be entered preoperatively. Moreover, the entering of the general patient information is straightforward such that the surgeon need not be involved. However, in order to minimize the preoperative procedures, all steps of method 100 can be performed at the beginning of the surgical session, during short time span preceding the surgery.
  • Step 102 Surgery is initiated between Step 102 and subsequent Decision 104 -, by the surgeon exposing the hip joint. No computer assistance is required thereat.
  • dislocation (A) of the femur 20 shows some level of difficulty, and involves risks such as fracture of the femur 20 (e.g., at the neck 22 ), and damage (e.g., hyperextension) to ligaments and muscle.
  • Resection (B) of the femoral head 21 can be preferred by surgeons as a safer procedure.
  • Procedure (A) will initially be described in detail, followed by a description of procedure (B).
  • Step 106 following the choice of (A) dislocating the femur 20 from the pelvis 10 , the femoral head 21 is removed from the acetabulum 11 . Therefore, both the acetabulum 11 and the femoral head 21 are exposed.
  • Step 108 tracking references (included in the tools 56 ) are secured to the pelvis 10 and the femur 20 . Therefore, both the pelvis 10 and the femur 20 can be tracked for position and orientation in space simultaneously as a function of their respective tracking references, by the CAS system 50 of FIG. 2 .
  • the tracking references will remain anchored to their respective bones throughout the computer-assisted steps of surgery. It is pointed out that Step 108 could have been performed prior to Step 106 in procedure (A), although it is preferred that the tracking references not interfere with the dislocation of the femur 20 .
  • the CAS system 50 must thus be adapted to track at least two tracking references simultaneously, and in real-time.
  • the tracking reference may take the form of a marked point on one of the bone elements.
  • a tracking reference of the type being screwed to the bone element, can be secured to the pelvis 10 to be tracked for position and orientation, while the femur 20 is solely marked with a point (e.g., from a physical or visual marker).
  • the marked point is registered when the pelvis 10 and the femur 20 are in a known and reproducible posture. Thereafter, to update the position and orientation information relating to the femur 20 during surgery, the known and reproducible posture is reproduced and the marked point is digitized with a registration pointer.
  • the femur 20 may be marked with three nonlinear points to be used to position the portable tracking reference thereon.
  • position and orientation information for the femur 20 can be obtained by positioning the portable tracking reference with respect to the three nonlinear points.
  • the portable tracking reference is advantageous in that no screw holes are performed in the bone element.
  • the method 100 will be described with a tracking reference anchored to the femur 20 in accordance with a preferred embodiment of the present invention. Yet it is appreciated that the above described alternatives could be used instead of the anchored tracking reference of the femur 20 .
  • Step 110 digitization of a center of the femoral head 21 is performed.
  • a registration pointer from the tools 56 ) having its tip tracked in space is used to register points on the surface of the femoral head 21 . Therefore, points of contact between the tip and a given surface can be registered as a function of the tracking reference (Step 108 ).
  • the points on the surface of the femoral head 21 are known as a function of the tracking of the respective tracking reference of the femur 20 .
  • the CAS controller 52 is equipped with software that will enable it to calculate the center of a sphere (i.e., the femoral head 21 ) from the collected points. Moreover, the center calculation software is adapted to perform a validation of the center calculation with the standard and maximum deviations. A rejection criterion for the validation of the center calculation can be recorded, for instance, during the setting of parameters in Step 102 .
  • Step 110 is preferred for obtaining a 3D model from which the femoral center of rotation will be calculated
  • other equivalent methods are contemplated for obtaining the femoral center of rotation.
  • photogrammetric scans can be used to rapidly create 3D models, or preoperative computerized tomography images can be gathered, from which the femoral head geometry can be established.
  • the diameter of the sphere (i.e., of the femoral head 21 ) can be displayed, as such information can guide the surgeon in the choice of a femoral implant.
  • the femoral center of rotation and the diameter of the femoral head 21 can be used to correct displays on the CAS controller 52 .
  • CT images can be shown on the display unit of the CAS controller 52
  • the method 100 is preferably free of CT images. Accordingly, general visual images of the pelvis 10 and of the femur 20 can be displayed for general reference, but these images can be scaled as a function of the center of rotation and diameters, calculated in Step 110 for the femur 20 in procedure (A), and to be calculated in Step 114 for the pelvis 10 .
  • Step 112 with the center of the femoral head 21 now identified in procedure (A) as a function of the tracking reference (Step 108 ), resection of the femoral head 21 is performed.
  • Step 114 digitization of the acetabular center of rotation is performed, by taking reference points on the surface of the acetabulum 11 , and using the center calculation software of the CAS controller 52 , set forth in Step 110 to find the acetabular center of rotation.
  • the acetabular center of rotation is therefore known as a function of the tracking reference on the pelvis 10 . It is noted that in procedure (A) the digitization of the acetabular center of rotation (Step 114 ) is done independently from the digitization of the femoral center of rotation (Step 110 ).
  • Step 116 consists in the digitization of the acetabular and femoral coordinate systems, i.e., the acetabular and femoral frames of reference.
  • the acetabular coordinate system is digitized with the registration pointer.
  • three points are taken on the pelvis 10 to create the acetabular coordinate system.
  • FIG. 1 there is one point on the iliac crest 12 of the operated side, one point on the contra lateral iliac crest 13 , and one point on one of the two pubic tubercles 14 of the pelvis 10 .
  • the points digitized on the iliac crests 12 and 13 are taken at the outermost anterior point of the iliac crests 12 and 13 .
  • the points digitized on the iliac crests 12 and 13 are preferably taken directly on the soft tissue covering the bone pelvis on the iliac crests, as the soft tissue is relatively thin thereon.
  • the point on the pubic tubercle 14 completes a first plane, the frontal plane.
  • a second plane, the transverse plane is perpendicular to the frontal plane and includes the points on the iliac crests.
  • a third plane, the sagittal plane, is perpendicular to the frontal and transverse planes.
  • Supplemental information regarding the frontal plane can be obtained for various postures of a patient.
  • trackable references can be used to gather information about sitting, standing and walking postures. This information can be used to adjust the orientation of the frontal plane, as these postures can provide information not available from the typical lying posture in which a patient is during surgery. This information can influence the anteversion positioning of the implants.
  • the femoral coordinate system is digitized in Step 116 by providing five points of reference on the leg to the CAS controller 52 , which is equipped with software that will create the femoral coordinate system.
  • a first point is taken on the tip of the greater trochanter 23 of the femur 20 , and will be defined as a starting point of an anatomical axis of the femur 20 .
  • points are taken on the medial and lateral epicondyles 24 and 25 of the femur 20 , respectively.
  • an aligned midpoint of the medial and lateral malleoli points is said to define a plane (i.e., sagittal plane) with the anatomical axis, with an axis of the knee being normal to the sagittal plane.
  • the frontal plane is perpendicular to the sagittal plane, with the anatomical axis lying therein.
  • the transverse plane is perpendicular to the sagittal and frontal planes, and can be positioned at any height.
  • the projection values described herein are based on the acetabular and the femoral coordinate systems.
  • the projection values would be related to the alternative acetabular and femoral coordinate system.
  • Step 108 the first step of the surgical procedure following the decision to proceed with the resection (B) is Step 108 , wherein tracking references are secured to the pelvis 10 and to the femur 20 .
  • Step 200 consists in a registration of a relative position between the pelvis 10 and the femur 20 , as a function of the tracking references on each.
  • the leg is simply left in a straight position, and a relative position is acquired between tracking references secured to their respective bones.
  • Step 112 of resecting the femoral head 21 from the femur follows Step 200 . Accordingly, the acetabulum 11 of the pelvis 10 is exposed, and Step 114 , consisting in the digitization of the acetabular center of rotation, follows. As mentioned previously, the digitization of the acetabular center of rotation is as a function of the tracking reference secured to the pelvis 10 .
  • Step 202 includes the calculation of the femoral center of rotation.
  • an assumption is made that the acetabular center of rotation, calculated in the previous Step 114 in procedure (B), coincides with the femoral center of rotation.
  • the position of the femoral center of rotation is calculated as a function of the relative position between the pelvis 10 and the femur 20 , obtained in Step 200 .
  • Step 116 follows, with the digitization of acetabular and femoral coordinate systems, i.e., acetabular and femoral frames of reference.
  • Procedure (C) is the preferred embodiment and will most likely involve at least one fewer step. Some surgeons may prefer the procedure (D) as it involves work on the femur 20 , which has just been resected to lose its femoral head 21 (Step 112 ).
  • Procedure (C) will initially be described, followed by a description of procedure (D).
  • Step 152 is the first step of procedure (C), and consists in the preparation of the acetabulum for insertion of the pelvic implant.
  • the preparation of the acetabulum is performed by a reamer (from amongst the tools 56 of the CAS system 50 ).
  • the previous acetabular center of rotation is known as a function of the tracking reference secured to the pelvis 10 , as it was acquired in previous.
  • Step 114 Preferably, the reamer is tracked for position and orientation, such that an axis of actuation of the cup tool on the reamer is displayed on the CAS controller 52 .
  • the diameter of the pelvic implant chosen by the surgeon will be used to display a position of the new acetabular center of rotation in comparison to the digitized acetabular center of rotation (Step 114 ).
  • the distance between the centers of rotation can be displayed numerically (e.g., in mm) as a function of the acetabular coordinate system digitized in previous Step 116 .
  • the anteversion and inclination of the actuation axis of the reamer, both as a function of the acetabular coordinate system can be given numerically (e.g., in degrees) to guide the surgeon in the reaming.
  • the pelvic implant is secured at this point to the pelvis 10 , it is possible to adjust the position and orientation of the pelvic implant.
  • the tracked impactor may be reconnected to the pelvic implant to serve as a lever in manipulating the pelvic implant with the tracked impactor, allowing position and orientation information (e.g., anteversion and inclination) to be calculated from the tracking of the impactor.
  • position and orientation information e.g., anteversion and inclination
  • points on the circular edge of the pelvic implant may be digitized to define a plane, with the normal to this plane being used to calculate the anteversion and the inclination, as suggested previously to obtain this information for the acetabulum.
  • This alternative approach is well suited for pelvic implants having screw holes for additional fixation, through which the implants can be altered in position and orientation.
  • Step 158 consists in the preparation of the femur 20 for the insertion of the femoral implant. More precisely, an axis of the intramedullary canal 27 is digitized as a function of the tracking reference secured to the femur 20 by relating points in the canal 27 . The intramedullary canal 27 is exposed by the resection of the femoral head 21 performed in Step 112 . In an embodiment of the present invention, the points in the canal 27 are digitized by the insertion and tracking of a pointer (from amongst the tools 56 ) in the canal 27 , to various depths.
  • a tool such as an awl
  • the awl can be inserted in the intramedullary canal to a depth wherein the inner diameter of the intramedullary canal is generally equivalent to the awl.
  • the awl can be considered to be generally centered in the intramedullary canal, whereby the axis of the awl can be registered as being the axis of the intramedullary canal.
  • Step 158 also includes the rasping of the intramedullary canal 27 in view of the insertion of the femoral implant therein.
  • the rasp is part of the tools 56 of the CAS system 50 , and is therefore tracked for position and orientation.
  • the tooling portion of the rasp, which will alter the intramedullary canal 27 , and the femoral implant both have a predetermined geometry. It is preferred to have rasps each having a tooling end with a generally similar geometry to the bone-engaging portion of the femoral implants.
  • the rasps can be provided in different sizes, with an equivalent femoral implant for each size of rasp.
  • the tracking of the rasp for position and orientation relative to the femoral coordinate system during alteration of the canal is used to calculate the current position and orientation of the femoral implant.
  • a plurality of guiding parameters are displayed to the surgeon to quantify the current position and orientation of the femoral implant, and are listed below.
  • the current leg length discrepancy can be displayed by the CAS system 50 as an overall leg length, or as a relative value between leg lengths, with the value 0 representing legs of equal length.
  • the offset is the distance between the acetabular center of rotation and the axis of the implant (i.e., the anatomical axis of the femur as defined previously) on the transverse plane, and is thus directly related to the size of the femoral implant. It is pointed out that a type of femoral implant contemplated for the above described method 100 can be provided in various sizes, and a size of femoral implant can have various femoral centers of rotation along the neck of the implant. A proper identification of the size of the femoral implant must therefore be provided as it will have an effect on both the offset and the limb length.
  • procedure (D) comprises Steps 152 , 154 and 156 , as performed in procedure (C). It is pointed out that in Step 154 , the actual pelvic implant center of rotation is obtained.
  • Steps 162 and 164 follow to end procedure (D).
  • a bone altering tool is included in the required tools 56 , such as a reamer and a rasp, for which uses have been described previously in Steps 152 and 158 , respectively.
  • the tools 56 include the pelvic (impactor) and the femoral implant, that can be tracked for position and orientation, to guide the operator during the insertion. It is pointed out that information relating to the tools (e.g., geometry, position of tip) is either known by the controller 52 (or retrievable from the database 58 ) or determinable using various steps of calibration.
  • the CAS system 50 can operate with active or passive tracking.
  • the sensor apparatus 54 is a NDI Polaris® optical tracking apparatus, with appropriate operating software in the controller 52 .
  • the Polaris® optical tracking apparatus passive detectable devices, such as retro-reflective spheres, are used in patterns to be tracked in space for position and orientation.
  • Each one of the tools 56 that requires to be tracked has an own detectable pattern.
  • the CAS system 50 must guide the surgeon throughout the method 100 , and relevant information is displayed to ensure the surgeon follows the proper Steps of operation. For instance, when leg length discrepancy values are given, the cranial-caudal convention can be displayed to explain the reading obtained. Animations can be initiated automatically to guide the surgeon, for example, in taking reference points on the various bones, such that the reference points are taken in a given order, or at the right locations.
  • the canal digitizer 300 is shown having an elongated shaft 302 , a handle portion 304 , a piston 306 , a detectable device base 308 , and a centering mechanism 309 .
  • the handle portion 304 has a pair of radial flanges 320 .
  • the detectable device base 308 projects outwardly from a distal one of the radial flanges 320 .
  • the proximal flange 320 is adjacent to the piston 306 , and is used as leverage by the tool handler to push the piston 306 inwardly.
  • a flared tip 322 is adjacent to the distal flange 320 , and will enable the digitizer 300 to be centered when abutting against walls of a canal, if the elongated shaft 302 is completely inserted in the canal.
  • the handle portion 304 also defines an inner cavity 324 , having a guiding channel 325 adjacent to the proximal flange 320 , for a purpose to be described hereinafter.
  • a flared adapter 323 can be optionally provided in sliding engagement on the shaft 302 .
  • the flared adapter 323 serves the same purpose as the flared tip 322 of the handle portion 304 , but is displaceable on the shaft 302 so as be used at various depths of insertion of the shaft 302 in the canal.
  • the centering mechanism 309 has a slender rod 326 , concentrically disposed in the shaft 302 .
  • the rod 326 is connected to the piston 306 at a proximal end thereof, and has a pair of fingers, 328 and 330 , pivotally mounted thereto at a distal end thereof, as best seen in FIG. 6 .
  • a spring 332 surrounds a proximal portion of the rod 326 , and interacts with a surface of the inner cavity 324 of the handle portion 304 such that the rod 326 is biased in the proximal direction, i.e., the piston 306 is held away from the handle portion 304 .
  • the piston 306 /centering mechanism 309 assembly is captive and free to translate in the straight portion 325 ′′, being held captive with respect to the handle portion 304 .
  • This assembly is preferred to facilitate the sterilization of the inner cavity 324 and of the interior of the shaft 302 .
  • the fingers 328 and 330 at the distal end of the rod 326 , are kept with their respective tips 329 and 331 separated from one another by a stopper 334 protruding from the finger 328 . Therefore, the fingers 328 and 330 define a slot 336 .
  • the fingers 328 and 330 are held by pivot 338 .
  • the tips 329 and 331 are both at a same distance from the pivot 338 .
  • the rod 326 has a given length, such that the fingers 328 and 330 at an end thereof do not interfere with the splitter 314 when the assembly of the piston 306 /centering mechanism 309 (including the rod 326 ) is screwingly inserted in the shaft 302 /handle portion 304 . Such interference would prevent the pin 327 from going past the elbow portion 325 ′ of the guiding channel 325 in the inner cavity 324 .
  • Another possible configuration is to provide an axial rotational degree of freedom between the piston 306 and the rod 326 . Therefore, an engagement of the fingers 328 and 330 with the splitter 314 would not prevent the engagement of the pin 327 of the piston 306 in the guiding channel 325 of the inner cavity 324 . This can be achieved by providing an annular groove 339 on an end of the rod 326 , and corresponding engagement pins 341 between the grooves 339 and the piston 306 .
  • the tracking system used with the digitizer 300 must know the relation between the detectable device on the base 308 and the tip of the shaft 302 .
  • the relation can be determined in calibration using a calibration base (as explained previously for the tools 56 of FIG. 2 ). Accordingly, when the digitizer 300 is stabilized in the canal, the position and orientation of the detectable device can be registered, and a center point of the canal can be calculated thereafter, where the tip of the shaft 302 is located.
US10/677,321 2002-10-04 2003-10-03 Apparatus for digitizing intramedullary canal and method Abandoned US20050021043A1 (en)

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US41580902P 2002-10-04 2002-10-04
US46580503P 2003-04-28 2003-04-28
US10/677,321 US20050021043A1 (en) 2002-10-04 2003-10-03 Apparatus for digitizing intramedullary canal and method

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US10/677,321 Abandoned US20050021043A1 (en) 2002-10-04 2003-10-03 Apparatus for digitizing intramedullary canal and method
US10/530,192 Active 2027-09-22 US7877131B2 (en) 2002-10-04 2003-10-06 Method for providing pelvic orientation information in computer-assisted surgery
US15/131,552 Active 2024-08-24 US10219865B2 (en) 2002-10-04 2016-04-18 Computer-assisted hip replacement surgery
US16/249,333 Active 2024-05-07 US11311339B2 (en) 2002-10-04 2019-01-16 Computer-assisted hip replacement surgery

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US15/131,552 Active 2024-08-24 US10219865B2 (en) 2002-10-04 2016-04-18 Computer-assisted hip replacement surgery
US16/249,333 Active 2024-05-07 US11311339B2 (en) 2002-10-04 2019-01-16 Computer-assisted hip replacement surgery

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US (5) US9339277B2 (de)
EP (4) EP1545368B1 (de)
JP (2) JP2006509609A (de)
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US20060100504A1 (en) 2006-05-11
WO2004030556A2 (en) 2004-04-15
EP1545368A2 (de) 2005-06-29
ATE452591T1 (de) 2010-01-15
WO2004030556A3 (en) 2004-07-29
EP1545368B1 (de) 2009-03-11
ATE424776T1 (de) 2009-03-15
EP1870053A3 (de) 2008-05-21
ATE523159T1 (de) 2011-09-15
EP2168526A1 (de) 2010-03-31
US7877131B2 (en) 2011-01-25
US20040230199A1 (en) 2004-11-18
EP2168526B1 (de) 2011-09-07
US11311339B2 (en) 2022-04-26
AU2003273680A1 (en) 2004-04-23
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ATE513526T1 (de) 2011-07-15
DE60330719D1 (de) 2010-02-04
US10219865B2 (en) 2019-03-05
JP2006501972A (ja) 2006-01-19
US9339277B2 (en) 2016-05-17
US20190307509A1 (en) 2019-10-10
AU2003273692A1 (en) 2004-04-23
JP2006509609A (ja) 2006-03-23
EP1545369A1 (de) 2005-06-29
US20160228192A1 (en) 2016-08-11
EP1545369B1 (de) 2011-06-22
EP1870053A2 (de) 2007-12-26
WO2004030559A1 (en) 2004-04-15

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