Patent Grant
9775725
Field of the Inventions
The present application is directed to systems and methods for joint replacement, in particular to systems and methods for knee joint replacement that utilize a surgical orientation device or devices.
Description of the Related Art
Joint replacement procedures, including knee joint replacement procedures, are commonly used to replace a patient's joint with a prosthetic joint component or components. Such procedures often use a system or systems of surgical tools and devices, including but not limited to cutting guides (e.g. cutting blocks) and surgical guides, to make surgical cuts along a portion or portions of the patient's bone(s).
Current systems and methods often use expensive, complex, bulky, and/or massive computer navigation systems which require a computer or computers, as well as three dimensional imaging, to track a spatial location and/or movement of a surgical instrument or landmark in the human body. These systems are used generally to assist a user to determine where in space a tool or landmark is located, and often require extensive training, cost, and room.
Where such complex and costly systems are not used, simple methods are used, such as “eyeballing” the alignment of rods with anatomical features, including leg bones. These simple methods are not sufficiently accurate to reliably align and place prosthetic implant components and the bones to which such components are attached.
Accordingly, there is a lack of devices, systems and methods that can be used to accurately position components of prosthetic joints without overly complicating the procedures, crowding the medical personnel, and/or burdening the physician or health-care facility with the great cost of complex navigation systems.
Therefore, in accordance with at least one embodiment, a femoral jig assembly can comprise a distal guide assembly configured to be positioned adjacent to distal condyles of a femur, a microblock assembly releasably attachable to the distal guide assembly, the microblock assembly comprising a microblock member and a translating member configured to be moved relative the microblock member, and a cutting block assembly releasably attachable to the microblock assembly.
In accordance with another embodiment, a surgical orientation system can comprise a surgical orientation device comprising a first portable housing configured to be coupled with a knee bone by way of one or more orthopedic fixtures, a first sensor located within the first housing, the first sensor configured to monitor the orientation of the housing in a coordinate system and to generate a signal corresponding to the orientation of the surgical orientation device relative to the coordinate system, and a display module configured to display an indication of a change in one or more angle measurements relative to the coordinate system based at least in part on the signal, and a reference device comprising, a second portable housing configured to connect to a knee bone by way of one or more orthopedic fixtures, and a second sensor located within the second housing, the second sensor configured to monitor the orientation of the second housing relative to the coordinate system, the second sensor configured to generate orientation data corresponding to the monitored orientation of the reference device. The surgical orientation system can further comprise an orthopedic fixture configured to be connected to a knee bone and with the surgical orientation device and reference sensor such that the surgical orientation device and reference device are separately moveable relative to each other, wherein at least one of the surgical orientation device and reference device is further configured to determine the spatial location of the mechanical axis of the leg.
In accordance with another embodiment, an orthopedic system can comprise a portable surgical orientation device having an associated three-dimensional coordinate reference system and an interactive user interface configured to display one or more angle measurements corresponding to an offset from a flexion-extension angle or a varus-valgus angle of a mechanical axis of a femur, the surgical orientation device having a first sensor, a reference device having a second sensor, wherein each of the first and second sensors have at least one of a three-axis accelerometer and a three-axis gyroscope, at least one of the first and second sensors being configured to monitor an orientation of the surgical orientation device in the three-dimensional coordinate reference system and to generate orientation data corresponding to the monitored orientation of the surgical orientation device. The orthopedic system can further comprise a coupling device, an interface support member, and a femoral jig assembly comprising a microblock assembly and a cutting block assembly, the femoral jig assembly being releasably attachable to the orientation device via the coupling device, the second sensor via the interface support member, and distal condyles of a femur via the microblock assembly.
In accordance with another embodiment, an orthopedic system capable of monitoring orientation within a three-dimensional coordinate reference system can comprise a portable surgical orientation device having a user interface configured to indicate angular displacement of a mechanical axis of a femur in an anterior-posterior plane or in a medial-lateral plane, the surgical orientation device having a first sensor, and a reference device having a second sensor, wherein at least one of the first and second sensors comprises a three-axis accelerometer and a three-axis gyroscope, at least one of the first and second sensors being configured to monitor the orientation of the surgical orientation device in the three-dimensional coordinate reference system and to generate orientation data corresponding to the monitored orientation of the surgical orientation device. The orthopedic system can further comprise a fixture comprising a first member configured to couple with the surgical orientation device, a second member configured to couple with the reference device, and a base member configured to be secured to a portion of a distal femur, wherein at least one of the first member and the second member is movably coupled with the base member.
In accordance with another embodiment, an orthopedic system for monitoring orientation in a three-dimensional coordinate reference system can comprise a base member attachable to a proximal aspect of a tibia, at least one adjustment device connected to and moveable relative to the base member, and at least one probe for referencing a plurality of anatomical landmarks, the anatomical landmarks referencing a mechanical axis of the leg. The at least one adjustment device can be moveable in at least one degree of freedom to orient a cutting guide relative to a proximal feature of the tibia, such that the cutting guide is oriented at a selected angle relative to the mechanical axis. The orthopedic system can further comprise a first orientation device comprising an interactive user interface configured to display one or more angle measurements corresponding to an offset from a posterior slope angle or a varus-valgus angle of the mechanical axis the first orientation device having a first sensor, the first orientation device being coupled to or integrally formed with the at least one adjustment device, and a second orientation device having a second sensor, the second orientation device being coupled to or integrally formed with the base member, wherein each of the first and second sensors have at least one of a three-axis accelerometer and a three-axis gyroscope, at least one of the first and second sensors being configured to monitor orientation of the first orientation device in the three-dimensional coordinate reference system and to generate orientation data corresponding to the monitored orientation of the first orientation device.
In accordance with another embodiment, an implant alignment device can comprise an orthopedic fixture having a base configured to couple with a distal portion of a femur or a proximal portion of a tibia, a moveable portion configured to move relative to the base, and a guide member configured to couple with the moveable portion, a reference device coupled to or integrally formed with the base or moveable portion of the orthopedic fixture, the reference device configured to sense changes in orientation of a long axis of the femur or tibia relative to a fixed reference frame, and a surgical orientation device coupled to or integrally formed with the base or moveable portion of the orthopedic fixture to enable positioning of the guide member in a prescribed orientation relative to the proximal tibia or distal femur.
In accordance with another embodiment, an orientation system can comprise an orthopedic positioning jig comprising a first member and a second member that is movable in two degrees of freedom relative to the first member and that is constrained in one degree of freedom, a first orientation device configured as a tilt meter coupled with the first member and a second orientation device configured as a tilt meter coupled with the second member, the first and second orientation devices operably coupled to indicate angular orientation of a natural or surgically created anatomical feature.
In accordance with another embodiment, a method for performing total knee arthroplasty on a knee joint of a patient can comprise preparing a distal portion of a femur for receiving a knee implant, comprising placing the knee joint in flexion and exposing the distal end of the femur, coupling a first orthopedic fixture to a distal portion of the femur, the first orthopedic fixture comprising a surgical orientation device, the surgical orientation device comprising an orientation sensor and an interactive user interface configured to display an indication of a change in one or more angle measurements corresponding to a flexion-extension angle or a varus-valgus angle of a mechanical axis of the femur, the first orthopedic fixture further comprising a reference device, the reference device comprising a reference sensor. The method can further comprise monitoring the orientation of the reference sensor while swinging the leg to obtain information regarding the location of the mechanical axis of the leg, adjusting a varus/valgus and flexion/extension angle of a portion of the first orthopedic fixture by monitoring the first surgical orientation device and moving the reference device relative to the surgical orientation device, attaching a cutting block to the first orthopedic fixture, the cutting block being oriented relative the adjusted varus/valgus and flexion/extension angle, and resecting the distal end of the femur.
In accordance with another embodiment, a method for performing total knee arthroplasty on a knee joint of a patient can comprise attaching a base member of an orthopedic fixture to a proximal aspect of a tibia such that movement of the tibia produces corresponding movement of the base member, the orthopedic fixture comprising at least one member moveable relative the base member, the moveable member comprising a probe for referencing a plurality of anatomical landmarks, attaching a portable surgical orientation device to the moveable member, the portable surgical orientation device comprising an interactive user interface, the surgical orientation device having a first sensor, attaching a reference device to the base member, the reference device having a second sensor, moving the moveable member and probe to contact anatomical locations on the leg, directing the surgical orientation device to determine the spatial location or orientation of the mechanical axis based on the anatomical locations, and moving the moveable member such that a cutting guide is oriented at a selected angle relative to the mechanical axis.
In accordance with another embodiment, a method for resolving angular orientation can comprise coupling with a bone an orthopedic positioning jig comprising a first member and a second member that is movable in two degrees of freedom and constrained in one degree of freedom, the orthopedic fixture having a cutting guide and a first orientation device configured as a tilt meter coupled with the first member and a second orientation device configured as a tilt meter coupled with the second member, and moving the first member relative to the second member to indicate angular orientation of the cutting guide relative to an axis of interest.
In accordance with another embodiment, a method of preparing for orthopedic surgery can comprise determining the orientation of a mechanical axis of a bone or joint, coupling an orthopedic orientation assembly with an extremity of a patient, the orientation assembly having a positioning device, a reference device and a surgical orientation device coupled with the positioning device, and maintaining an alignment between the reference sensor and the surgical orientation device while moving the surgical orientation device to collect data indicative of orientation.
In accordance with another embodiment, a method of determining an anatomical feature during a knee procedure can comprise coupling an orientation system with a distal aspect of a femur, the orientation system comprising a housing, an orientation sensor disposed within the housing, and a user interface operably coupled with the orientation sensor, interacting with the user interface to begin an analysis of potential sources of error in the orientation system after coupling the orientation system to the distal femoral aspect, and moving the orientation system to collect data indicative of the anatomical feature relevant to the knee procedure.
Although certain preferred embodiments and examples are disclosed below, it will be understood by those skilled in the art that the inventive subject matter extends beyond the specifically disclosed embodiments to other alternative embodiments and/or uses of the invention, and to obvious modifications and equivalents thereof. Thus it is intended that the scope of the inventions herein disclosed should not be limited by the particular disclosed embodiments described herein. Thus, for example, in any method or process disclosed herein, the acts or operations making up the method/process may be performed in any suitable sequence, and are not necessarily limited to any particular disclosed sequence. For purposes of contrasting various embodiments with the prior art, certain aspects and advantages of these embodiments are described where appropriate herein. Of course, it is to be understood that not necessarily all such aspects or advantages may be achieved in accordance with any particular embodiment. Thus, for example, it should be recognized that the various embodiments may be carried out in a manner that achieves or optimizes one advantage or group of advantages as taught herein without necessarily achieving other aspects or advantages as may be taught or suggested herein.
In addition, in this description, a “module” includes, but is not limited to, software or hardware components which perform certain tasks. Thus, a module may include object-oriented software components, class components, procedures, subroutines, data structures, segments of program code, drivers, firmware, microcode, circuitry, data, tables, arrays, etc. Those with ordinary skill in the art will also recognize that a module can be implemented using a wide variety of different software and hardware techniques.
The following sections describe in detail systems and methods for a total knee joint replacement procedure. The knee joint often requires replacement in the form of prosthetic components due to strain, stress, wear, deformation, misalignment, and/or other conditions in the joint. Prosthetic knee joint components are designed to replace a distal portion or portions of a femur and/or a proximal portion or portions of a tibia.
Prior to replacing the knee joint with prosthetic components, surgical cuts commonly called resections are generally made with a cutting tool or tools along a portion or portions of both the proximal tibia and distal femur. These cuts are made to prepare the tibia and femur for the prosthetic components. After the cuts are made, the prosthetic components can be attached and/or secured to the tibia and femur.
The desired orientation and/or position of these cuts, and of the prosthetic components, can be determined pre-operatively and based, for example, on a mechanical axis running through an individual patient's leg. Once the desired locations of these cuts are determined pre-operatively, the surgeon can use the systems and methods described herein to make the cuts accurately. While the systems and methods are described in the context of a knee joint replacement procedure, the systems and/or their components and methods can similarly be used in other types of medical procedures, including but not limited to shoulder and hip replacement procedures.
With reference to
A. Surgical Orientation Devices & Systems
The surgical orientation device 14 can be used to measure and record the location of anatomical landmarks used in a total knee procedure, such as the location of the mechanical axis of a leg (and femur). “Surgical orientation device” is a broad term and is to be given its ordinary and customary meaning to a person of ordinary skill in the art (i.e. it is not to be limited to a special or customized meaning) and includes, without limitation, any device that can be used to provide orientation information or perform orientation calculations for use in a surgical or other procedure. The mechanical axis of a leg, as defined herein, generally refers to an axial line extending from the center of rotation of a proximal head of a femur (e.g. the center of the femoral head) through, ideally, the approximate center of the knee, to a center, or mid-point, of the ankle (see, for example,
Referring to
With continued reference to
The surgical orientation device 14 can further comprise at least one user input device 28. The at least one user input device 28 can comprise a plurality of buttons located adjacent the display 26. The buttons can be activated, for example, by a finger, hand, and/or instrument to select a mode or modes of operation of the surgical orientation device 14, as discussed further below. In a preferred arrangement, the at least one user input device 28 can comprise three buttons located underneath the display 26 as illustrated in
As discussed further herein, the surgical orientation device 14 can include a user interface with which a user can interact during a procedure. In one embodiment, the display 26 and at least one user input device 28 can form a user interface. The user interface can allow a surgeon, medical personnel, and/or other user to operate the surgical orientation device 14 with ease, efficiency, and accuracy. Specific examples and illustrations of how the user interface can operate in conjunction with specific methods are disclosed further herein.
The attachment structures 32 can be formed, for example, from protruding portions of the back side of the surgical orientation device 14, and can extend partially, or entirely, along the back side of the surgical orientation device 14. The attachment structures 32 can receive corresponding, or mating, structures from the first coupling device 18, so as to couple, or lock, the first coupling device 18 to the surgical orientation device 14.
In general, the electronic control unit 1102 can receive input from the sensor(s) 1104, the external memory 1112, the user input devices 1114 and/or the I/O ports 1118, and can control and/or transmit output to the optional visible alignment indicators 1106, the display 1110, the external memory 1112, the other output devices 1116 and/or the I/O ports 1118. The electronic control unit 1102 can be configured to receive and send electronic data, as well as perform calculations based on received electronic data. In certain embodiments, the electronic control unit 1102 can be configured to convert the electronic data from a machine-readable format to a human readable format for presentation on the display 1110. The electronic control unit 1102 can comprise, by way of example, one or more processors, program logic, or other substrate configurations representing data and instructions, which can operate as described herein. In some embodiments, the electronic control unit 1102 can comprise a controller circuitry, processor circuitry, processors, general purpose single-chip or multi-chip microprocessors, digital signal processors, embedded microprocessors, microcontrollers and/or the like. The electronic control unit 1102 can have conventional address lines, conventional data lines, and one or more conventional control lines. In some embodiments, the electronic control unit 1102 can comprise an application-specific integrated circuit (ASIC) or one or more modules configured to execute on one or more processors. In some embodiments, the electronic control unit 1102 can comprise an AT91SAM7SE microcontroller available from Atmel Corporation.
The electronic control unit 1102 can communicate with internal memory and/or the external memory 1112 to retrieve and/or store data and/or program instructions for software and/or hardware. The internal memory and the external memory 1112 can include random access memory (“RAM”), such as static RAM, for temporary storage of information and/or read only memory (“ROM”), such as flash memory, for more permanent storage of information. In some embodiments, the external memory 1112 can include an AT49BV160D-70TU Flash device available from Atmel Corporation and a CY62136EV30LL-45ZSXI SRAM device available from Cypress Semiconductor Corporation. The electronic control unit 1102 can communicate with the external memory 1112 via an external memory bus.
In general, the sensor(s) 1104 can be configured to provide continuous real-time data to the surgical orientation device 14. The electronic control unit 1102 can be configured to receive the real-time data from the sensor(s) 1104 and to use the sensor data to determine, estimate, and/or calculate an orientation or position of the surgical orientation device 14. The orientation information can be used to provide feedback to a user during the performance of a surgical procedure, such as a total knee joint replacement surgery, as described in more detail herein.
In some arrangements, the one or more sensors 1104 can comprise at least one orientation sensor configured to provide real-time data to the electronic control unit 1102 related to the motion, orientation, and/or position of the surgical orientation device 14. For example, the one ore more sensors 1104 can comprise at least one gyroscopic sensor, accelerometer sensor, tilt sensor, magnetometer and/or other similar device or devices configured to measure, and/or facilitate determination of, an orientation of the surgical orientation device 14. In some embodiments, the sensors 1104 can be configured to provide measurements relative to a reference point(s), line(s), plane(s), and/or gravitational zero. Gravitational zero, as referred to herein, refers generally to an orientation in which an axis of the sensor is perpendicular to the force of gravity, and thereby experiences no angular offset, for example tilt, pitch, roll, or yaw, relative to a gravitational force vector. In some embodiments, the sensor(s) 1104 can be configured to provide measurements for use in dead reckoning or inertial navigation systems.
In some embodiments, the sensor(s) 1104 can comprise one or more accelerometers that measure the static acceleration of the surgical orientation device 14 due to gravity. For example, the accelerometers can be used as tilt sensors to detect rotation of the surgical orientation device 14 about one or more of its axes. The one or more accelerometers can comprise a dual axis accelerometer (which can measure rotation about two axes of rotation) or a three-axis accelerometer (which can measure rotation about three axes of rotation). The changes in orientation about the axes of the accelerometers can be determined relative to gravitational zero and/or to a reference plane registered during a tibial or femoral preparation procedure as described herein. In one embodiment, the sensor(s) 1104 can comprise a three-axis gyroscopic sensor and a three-axis accelerometer sensor.
In some embodiments, a multi-axis accelerometer (such as the ADXL203CE MEMS accelerometer available from Analog Devices, Inc. or the LIS331DLH accelerometer available from ST Microelectronics.) can detect changes in orientation about two axes of rotation. For example, the multi-axis accelerometer can detect changes in angular position from a horizontal plane (e.g., anterior/posterior rotation) of the surgical orientation device 14 and changes in angular position from a vertical plane (e.g., roll rotation) of the surgical orientation device 14. The changes in angular position from the horizontal and vertical planes of the surgical orientation device 14 (as measured by the sensor 1104) can also be used to determine changes in a medial-lateral orientation (e.g., varus/valgus rotation) of the surgical orientation device 14.
In some arrangements, the sensor(s) 1104 comprise at least one single- or multi-axis gyroscope sensor and at least one single- or multi-axis accelerometer sensor. For example, the sensor(s) 1104 can comprise a three-axis gyroscope sensor (or three gyroscope sensors) and a three-axis accelerometer (or three accelerometer sensors) to provide positional and orientational measurements for all six degrees of freedom of the surgical orientation device 14. In some embodiments, the sensor(s) 1104 can provide an inertial navigation or dead reckoning system to continuously calculate the position, orientation, and velocity of the surgical orientation device 14 without the need for external references.
In some embodiments, the sensors 1104 can comprise one or more accelerometers and at least one magnetometer. The magnetometer can be configured to measure a strength and/or direction of one or more magnetic fields in the vicinity of the surgical orientation device 14 and/or the reference sensor. The magnetometer can advantageously be configured to detect changes in angular position about a horizontal plane. In some embodiments, the sensor(s) 1104 can comprise one or more sensors capable of determining distance measurements. For example a sensor located in the surgical orientation device 14 can be in electrical communication (wired or wireless) with an emitter element mounted at the end of a measurement probe. In some embodiments, the electronic control unit 1102 can be configured to determine the distance between the sensor and emitter (for example, an axial length of a measurement probe corresponding to a distance to an anatomical landmark, such as a malleolus).
In some embodiments, the one or more sensors 1104 can comprise a temperature sensor to monitor system temperature of the electrical system 1100. Operation of some of the electrical components can be affected by changes in temperature. The temperature sensor can be configured to transmit signals to the electronic control unit 1102 to take appropriate action. In addition, monitoring the system temperature can be used to prevent overheating. In some embodiments, the temperature sensor can comprise a NCP21WV103J03RA thermistor available from Murata Manufacturing Co. The electrical system 1100 can further include temperature, ultrasonic and/or pressure sensors for measuring properties of biological tissue and other materials used in the practice of medicine or surgery, including determining the hardness, rigidity, and/or density of materials, and/or determining the flow and/or viscosity of substances in the materials, and/or determining the temperature of tissues or substances within materials.
In some embodiments, the sensor(s) 1104 can facilitate determination of an orientation of the surgical orientation device 14 relative to a reference orientation established during a preparation and alignment procedure performed during orthopedic surgery.
The one or more sensor(s) 1104 can form a component of a sensor module that comprises at least one sensor, signal conditioning circuitry, and an analog-to-digital converter (“ADC”). In some embodiments, the components of the sensor module can be mounted on a stand-alone circuit board that is physically separate from, but in electrical communication with, the circuit board(s) containing the other electrical components described herein. In some embodiments, the sensor module can be physically integrated on the circuit board(s) with the other electrical components. The signal conditioning circuitry of the sensor module can comprise one or more circuit components configured to condition, or manipulate, the output signals from the sensor(s) 1104. In some embodiments, the signal conditioning circuitry can comprise filtering circuitry and gain circuitry. The filtering circuitry can comprise one more filters, such as a low pass filter. For example, a 10 Hz single pole low pass filter can be used to remove vibrational noise or other low frequency components of the sensor output signals. The gain circuitry can comprise one or more operational amplifier circuits that can be used to amplify the sensor output signals to increase the resolution potential of the sensor(s) 1104. For example, the operational amplifier circuit can provide gain such that a 0 g output results in a midrange (e.g., 1.65 V signal), a +1 g output results in a full scale (e.g., 3.3 V) signal and a −1 g output results in a minimum (0 V) signal to the ADC input.
In general, the ADC of the sensor module can be configured to convert the analog output voltage signals of the sensor(s) 1104 to digital data samples. In some embodiments, the digital data samples comprise voltage counts. The ADC can be mounted in close proximity to the sensor to enhance signal to noise performance. In some embodiments, the ADC can comprise an AD7921 two channel, 12-bit, 250 Kiloseconds per Sample ADC. In an arrangement having a 12-bit ADC, the 12-bit ADC can generate 4096 voltage counts. The ADC can be configured to interface with the electronic control unit 1102 via a serial peripheral interface port of the electronic control unit 1102. In some embodiments, the electronic control unit 1102 can comprise an on-board ADC that can be used to convert the sensor output signals into digital data counts.
With continued reference to
The power supply 1108 can comprise one or more power sources configured to supply DC power to the electronic system 1100 of the surgical orientation device 14. In certain embodiments, the power supply 1108 can comprise one or more rechargeable or replaceable batteries and/or one or more capacitive storage devices (for example, one or more capacitors or ultracapacitors). In some embodiments, power can be supplied by other wired and/or wireless power sources. In preferred arrangements, the power supply 1108 can comprise two AA alkaline, lithium, or rechargeable NiMH batteries. The surgical orientation device 14 can also include a DC/DC converter to boost the DC power from the power supply to a fixed, constant DC voltage output (e.g., 3.3 volts) to the electronic control unit 1102. In some embodiments, the DC/DC converter comprises a TPS61201DRC synchronous boost converter available from Texas Instruments. The electronic control unit 1106 can be configured to monitor the battery level if a battery is used for the power supply 1108. Monitoring the battery level can advantageously provide advance notice of power loss. In some embodiments, the surgical orientation device 14 can comprise a timer configured to cause the surgical orientation device 14 to temporarily power off after a predetermined period of inactivity and/or to permanently power off after a predetermined time-out period.
As discussed above, the display 1110 (e.g. display 26 seen in
With continued reference to
The I/O ports 1118 of the electronic control unit 1102 can comprise a JTAG port and one or more serial communication ports. The JTAG port can be used to debug software installed on the electronic control unit 1102 during testing and manufacturing phases. The JTAG port can be configured such that it is not externally accessible post-manufacture. The serial communication ports can include a Universal Serial Bus (“USB”) port and/or one or more universal asynchronous receiver/transmitters (“UART”) ports. At least one of the UART ports can be accessible externally post-manufacture. The external UART port can be an infrared (“IR”) serial port in communication with an infrared (“IR”) transceiver. The IR serial port can be used to update the software installed on the electronic control unit 1102 post-manufacture and/or to test the operation of the electronic control unit 1102 by outputting data from the electronic control unit 1102 to an external computing device via an external wireless connection. Other types of I/O ports are also possible.
In alternate embodiments, components of the reference device 16 illustrated in
Referring to
Multi-axis accelerometers can be conceptualized as having a separate accelerometer sensor for each of its axes of measurement, with each sensor responding to changes in static acceleration in one plane. In certain embodiments, each accelerometer sensor is most responsive to changes in tilt (i.e., operates with maximum or optimum accuracy and/or resolution) when its sensitive axis is substantially perpendicular to the force of gravity (i.e., when the longitudinal plane of the accelerometer sensor is parallel to the force of gravity) and least responsive when the sensitive axis is parallel to the force of gravity (i.e., when the longitudinal plane of the accelerometer sensor is perpendicular to the force of gravity).
As illustrated, the sensor board 46 can be mounted at an approximately 22-degree angle relative to a plane extending longitudinally through the housing 22, which can be parallel to or co-planar with an anterior-posterior axis of the main board 48. In some embodiments, the sensor board 46 can be mounted at an approximately 0 degree angle relative to a plane extending longitudinally through the housing 22, which can be parallel to or correspond to an anterior-posterior axis of the main board 46. As shown in
In a preferred arrangement, the surgical orientation device 14 described above can advantageously be disposed of after use. Once the surgical orientation device 14 has been used during a total knee replacement procedure or other medical procedure, the surgical orientation device 14 can be discarded, so as to inhibit and/or prevent contamination during subsequent procedures and reduce the need for sterilization.
In other embodiments, the surgical orientation device 14 can alternatively have a disposable outer housing 22, such that the internal components of the surgical orientation device (e.g. sensors 50, batteries 52, etc.) can be reused, while the outer housing 22 is discarded. For example, with reference to
Further description of embodiments of a surgical orientation device 14 and its sensor(s) can be found in U.S. Patent Application No. U.S. Patent Publication No. 2010/0063508, the contents of which are incorporated herein by reference in their entirety.
B. Device for Coupling the Surgical Orientation Device to Another Orthopedic Fixture
Referring to
The first coupling device 18 can include an orientation device interface 58 attached to an interface support member 60. The orientation device interface 58 can be designed to connect with the attachment structures 32 of the surgical orientation device 14 described above, thereby facilitating a secure but releasable attachment between the surgical orientation device 14 and the femoral jig assembly 12. In one embodiment, the orientation device interface 58 can be inserted into the grooves or channels 36 along the back portion of the surgical orientation device 14 described above.
With continued reference to
While the first coupling device 18 described above can be used to attach and/or couple the surgical orientation device 14 with the femoral jig assembly 12, other methods and devices for attaching and/or coupling the components of the femoral preparation system 10 are also possible.
Additionally, in a preferred arrangement, the femoral jig assembly 12 and the first coupling device 18 of the femoral system 10 can be biocompatible for short term exposure to the inner anatomy of the knee or other body joint, and can be sterilized by autoclave and/or gas (“autoclavable components”). Other components of the femoral system 10 including but not limited to the reference device 16 described below may optionally have autoclavable components as well. The autoclavable components can operate without lubricants. Materials for the autoclavable components can be selected and treated to prevent galling and provide smooth operation consistent with expectations for a high quality surgical instrument. In general, the autoclavable components can be made robust to withstand normal and abusive use, especially rough handling during cleaning and/or sterilization.
The components of the femoral system 10 can optionally be etched with part numbers, revisions levels, and company name and logo. Other markings can also be added to provide clarity.
C. Reference Sensor Device
Referring to
In a preferred arrangement, the reference sensor device 16 can be configured for portable hand-held use. With reference to
The electronic control unit 1102 of the surgical orientation device 14 can be configured to receive information from the reference sensor 64 (e.g., a receiver of infrared, RF, Bluetooth™, or other wireless technology) and to combine that information with information from the sensor(s) 50 located within the surgical orientation device 14 to calculate an overall, or aggregate, movement and orientation of the reference sensor 64 relative to an axial line or plane, for example as illustrated in
Referring to
D. Device for Coupling the Reference Sensor Device to Another Orthopedic Fixture
Referring to
For example, the femoral jig assembly 12 can comprise a second coupling device 20. The second coupling device 20 can be attached to the reference sensor housing 66. In one embodiment, the second coupling device 20 can be securely but releasably attached to the sensor housing 66 by common attachment structures. In another embodiment the second coupling device 20 can be formed as a structural part of the sensor housing 66. The second coupling device 20 can include the same or similar type of jig attachment features 62 that are on the first coupling device 18. The jig attachment features 62 can mate with corresponding attachment features of a microblock assembly to form a secure but releasable attachment with the femoral jig assembly 12 (see, e.g. the microblock assembly 90 illustrated in
While the second coupling device 20 described above can be used to attach and/or couple the reference sensor device 16 with the femoral jig assembly 12, other methods and devices for attaching and/or coupling the components of the femoral preparation system 10 are also possible.
E. Orthopedic Assembly for Femoral Preparation
Referring to
Referring to
Referring to
Referring to
Both the microblock member 116 and the translating member 118 can include translation receiving features 124. The translation receiving features 124 can allow both the microblock member 116 and the translating member 118 to receive the translation structures 120, with first ends 126 of the translation structures 120 attached to the translating member 118 and second ends 128 of the translation structures 120 attached to the microblock member 116. The second ends 128 of the translation structures 120 can include a translation adjustment feature 130 (e.g. slot or socket for receiving a tool such as a screwdriver) that can be used to move the first ends 126 of the corresponding translation structure 120 to cause a desired directional movement of translating member 118 (e.g., in a varus/valgus direction or in a flexion/extension direction when the microblock assembly 90 is attached to the distal end portion of a femur). At least one of the translation receiving features 124 of the translating member 118 can be adapted to allow movement of the translating member 118 in a varus/valgus direction when the microblock assembly 90 is attached to the distal end portion of a femur. Additionally, at least another one of the translation receiving features 124 of the translating member 118 can be adapted to allow movement of the translating member 118 in a flexion/extension direction when the microblock assembly 90 is attached to the distal end portion of a femur. The design described above can allow the translation structure(s) 120 to move at least a portion of the microblock assembly 90 (and any other components attached to the microblock assembly 90) in a varus/valgus direction and/or in a flexion/extension direction. The translation structure's ability to move at least a portion of the microblock assembly 90 can be controlled by the translation adjustment features 130.
In one embodiment and referring to
Referring to
Referring to
Referring to
Referring to
Referring to
Referring to
A. Attaching an Orthopedic Assembly on a Femur
Referring to
In one technique for locating a distal point of the mechanical axis of the femur 140, a distal end portion 142 of the femur is exposed using any conventional surgical technique. The tibia 144 and the femur 140 can then be placed in approximately 90 degrees of flexion as shown in
A small hole 146 for receiving a portion of the midline pin 102 can then be drilled using any conventional surgical technique at an appropriate anatomical location within the distal end portion 142. The anatomical location can be the center of the intercondylar notch, a location near the insertion of the anterior cruciate ligament (“ACL”), an entry point to the intramedullary canal, or other suitable anatomical landmark or combination of landmarks within the distal end portion 142. In one embodiment, the small hole 146 can be drilled at the approximate center of the intercondylar notch as shown in
The method can further comprise installing the femoral jig assembly 12 onto the distal end portion 142 by inserting the midline pin 102 into the small hole 146 as shown in
The method can further include an optional step of adjusting the anterior probe 94 by placing the anterior probe 94 on the anterior cortex 138 of the femur 140. The anterior probe 94 can be adjusted via push button, screw, or other mechanism to assist in referencing the anterior cortex 138 as shown in
Once the femoral jig assembly 12 is placed by the midline pin 102 in an approximate neutral varus/valgus orientation or angle and by the anterior probe 94 in the approximate desired flexion angle, the method can further include verifying the rotational positioning of the femoral jig assembly 12 in an effort to ensure that the femoral jig assembly 12 is in the desired position. In one embodiment, the desired position may be less than about 15 degrees rotation relative to a Whitesides line or epicondylar axis. In another embodiment, the desired position may range from about 0 degrees to about 30 degrees relative to a Whitesides line or epicondylar axis. This verification process can be completed by obtaining the information provided by the reference markings 108 of the modular paddle 96. The reference markings 108 can inform the user of an offset distance 150 (see, eg.,
Once the microblock assembly 90 is attached to the distal femoral condyles 148, the method can include noting the indicia of distance provided by the reference markings 108 and the location of the midline pin 102 in relation to the reference markings 108 in order to establish the AP Offset Data discussed above. The AP Offset Data can then be entered into the surgical orientation device 14. In some embodiments, this process of obtaining and entering AP Offset Data into the surgical orientation device 14 can be avoided if a fixed offset distance is provided by the configuration of the femoral preparation system 10.
Referring to
Referring to
In the method thus far, a distal point corresponding to the mechanical axis of the femur can be approximated by using a portion of the femoral jig 12 to locate the center of the femur. In addition to the above anatomy that can approximate this location, a clinician can employ a method that considers the most distal point of the sulcus of the trochlea to correspond to the distal portion of the mechanical axis. In some embodiments, the IMU is offset a certain distance from the center of the distal femur. This offset can be accounted for by using the AP Offset Data, as discussed above. This offset can be communicated to the surgical orientation device 14 so that the system can factor it in its calculation of the mechanical axis. For example, in certain embodiments, the reference sensor 16 encloses the IMU 1105 and is spaced a variable distance anterior to the center of the distal femur. This distance can be entered into the surgical orientation device 14 to eliminate a bias error that would be created by this offset. In other embodiments, instrumentation can be provided that eliminates the variability of this distance, such that the distance between the IMU (e.g., incorporated into the reference sensor 16) and the center of the femur is constant. In that case, the surgical orientation device 14 or a system employing the surgical orientation device 14 can be configured to automatically eliminate this bias error.
B. Calculating the Location of the Mechanical Axis Using an Orientation Device
Referring to
In order to determine the coordinates of the pivot point of the femoral head 154 (i.e. the pivot point of the mechanical axis), the leg can be moved (e.g. swung). For example, the leg can be moved in several different directions and/or planes (see arrows in
The acceleration and angular rate sensed by the reference sensor device 16 and/or surgical orientation device 14 during the leg movement can be processed while the leg is moved about its pivot point. The reference sensor device 16 and/or surgical orientation device 14 can provide an output vector representing the center of the rotation with respect to the inertial sensor axes of the reference sensor device 16 and/or surgical orientation device 14.
The IMU data can be input to a microprocessor in the reference sensor device 16 and/or surgical orientation device 14. In a preferred embodiment, the microprocessor can be located on the reference sensor device 16, and output from the microprocessor of the reference sensor device 16 can be transmitted via an RF wireless link to the surgical orientation device 14. The leg can be moved about its pivot point while inertial data is being processed by the microprocessor. An algorithm implemented on the microprocessor can process the inertial data in real time and determine if the leg is static or dynamically moving. Data from both states can be used by the algorithm to determine the pivot point.
The method of calculating the location and/or orientation of the mechanical axis described herein, and for calculating in general the location and/or orientation of any axis based on a pivot point, can provide accurate determination of pivot point location and radius of curvature without the burdensome and sometimes near impossible restraints of external measurements encountered in medical procedures. For example, the method can permit calculation of pivot points in blind situations where the end joint is typically hidden or unobservable, such as for the case of the head of a femur.
Examples of three possible leg movement trajectories for calculating the IMU data are: (i) a horizontal swing from the leg's position of origin to the surgeon's right and then back again; (ii) a horizontal swing from the origin to the surgeon's left and then back again; and (iii) a vertical swing upward and then back again. In some protocols, at least one horizontal movement and at least one vertical movement are included to provide IMU data. During each swing trajectory the IMU data can be stored for future processing.
In some embodiments, the mechanical axis can be detected by moving and/or swinging the leg when it is attached to the surgical orientation device 14 and the reference sensor device 16 on a horizontal plane (e.g. a plane along the operating table), starting from a known fixed position and orientation (“home position”, which can be close to the surface of the horizontal plane) and obtaining IMU data. The arrows shown in
The reference sensor device 16 and/or surgical orientation device 14, which can be coupled to the leg during such movements, can have axes angled with respect to an axis of the sensor(s) disposed in the reference device 16 and/or in the surgical orientation device 14. For example, as illustrated in
As the leg is swung, the sensors inside the reference sensor device 16 and/or surgical orientation device 14 can detect movement of the reference sensor device 16 and/or surgical orientation device 14, collect IMU data on this movement, and transmit the IMU data to, for example, the surgical orientation device 14. From receiving all of the IMU data transmitted from the sensors inside both the surgical orientation device 14 and reference sensor device 16, the reference sensor device 16 and/or surgical orientation device 14 can then calculate, and in some cases display, the location of the center of rotation of the femur 140, the center of the femoral head 154, and/or the femoral mechanical axis.
In a preferred arrangement, where the surgical orientation device 14 is disposable and the reference sensor device 16 is reusable, the reference sensor 16 can be configured to take measurements as the femur is moved to calculate the center of femoral rotation, while the surgical orientation device 14 can be configured to receive information from the reference sensor device 16 and/or to display information on display 26. In such an arrangement, the surgical orientation device 14 can comprise a multi-axis accelerometer, and the reference sensor device can comprise both a multi-axis accelerometer and a multi-axis gyroscope. In this manner, the more expensive components necessary to make such calculations can be incorporated into the re-usable reference sensor device 16. However, in other embodiments the surgical orientation device 14, rather than the reference sensor device 16, can include the additional components and/or sensors necessary to calculate the center of femoral rotation.
Various formulae, which can be derived from basic centripetal acceleration physics coupled with optimal estimation or Kalman filtering techniques, can be used during the process described above to perform the calculations in the reference sensor device 16 or surgical orientation device 14.
C. Error Correction Technique to Remove Biases
In some embodiments, prior to determining the location and/or orientation of the center of rotation of the mechanical axis, an error correction technique can be used to remove biases in the surgical orientation device 14 and/or reference sensor device 16. For example, an error correction technique can include assessing 1) static bias; 2) gyroscopic bias; and 3) accelerometer bias in the surgical reference sensor device 16 and/or surgical orientation device 14.
1. Static Bias Determination
In a preferred embodiment, static bias determination can comprise acquiring data from the IMU of the reference sensor device 16 and/or surgical orientation device 14 in a static condition. This static condition can provide a baseline for the reference sensor device 16 and/or surgical orientation device 14 and can permit determination of biases for internal sensor(s).
For example, once a user is ready to commence the method of determining the center point of rotation of the mechanical axis as described above, the user can press a user input 28 on the surgical orientation device 14. Once the user input 28 is pressed, the surgical orientation device 14 can indicate that the user should hold the surgical orientation device 14 motionless. The user can be required to hold the surgical orientation device 14 motionless for a given period of time. In a preferred embodiment, the user can be required to hold the surgical orientation device 14 motionless for approximately three seconds, though other times or ranges or times are also possible. For example, in some embodiments the user can be required to hold the surgical orientation device motionless for at least one but no more than three seconds. By holding the surgical orientation device motionless, any static biases can be determined, and can subsequently be removed (e.g. subtracted) during data acquisition.
In some embodiments, if the user does not hold the surgical orientation device 14 still for a long enough period, a fail condition can be displayed on the surgical orientation device 14, and the user can be required to start over again by pressing the user input 28.
Inclusion of a gravitation vector can be used for more accurate final results. For example, initial orientation of the reference sensor device 16 and/or surgical orientation device 14 during static bias determination can be used to create an initial gravity vector transformation matrix relating the orientation of the IMU to the inertial gravity vector. Angular rate data can be used to propagate the attitude of the reference sensor device 16 and/or surgical orientation device 14 and update the inertial gravity vector transformation matrix during subsequent motion.
2. Gyroscope and Accelerometer Bias Determination
Removing gyroscope and accelerometer biases can help to correct for errors that may arise from starting and stopping in a rotated orientation. A gyroscope bias determination can comprise, for example, propagating a direction cosine matrix (DCM) using rate sensors in the surgical orientation device 14 and/or reference sensor device 16. An accelerometer bias determination can comprise, for example, propagating a direction cosine matrix from the gyro bias to remove a gravity component of the accelerometers.
In order to determine gyroscope and accelerometer bias in the surgical orientation device 14 and/or reference sensor device 16, the leg (with surgical orientation device 14 and/or reference sensor device 16 attached) can be moved by an operator or other means in such a way that sufficient rate and acceleration data is achieved for all axes. In a preferred arrangement, during this data acquisition phase, and/or any other phase for error correction or data collection during an orthopedic method, the reference sensor device 16 and/or surgical orientation device 14 can determine, without user intervention, what phase of data collection it is in, static or dynamic. In contrast, in some embodiments the user can press a user input 28, for example, to tell the reference sensor device 16 and/or surgical orientation device 14 that it is in a static or dynamic state.
During gyroscope and accelerometer bias determination, the leg can be moved (e.g. swung through at least different two planes), and an average angular rate of leg movement of at least 30 degrees per second can be provided to acquire data, though other rates are also possible. For example, in some embodiments an average angular rate of at least 20 degrees can suffice. In yet other embodiments an average angular rate of at least 10 degrees can suffice.
In a preferred arrangement, the leg can be moved in more than one plane, or for example in a loop configuration, and a beginning and ending attitude of the leg after leg movement is complete can be within 15 degrees on any axis, though other beginning and ending attitudes are also possible. In a preferred arrangement, the leg can be swung and returned back to its home position within approximately 2 cm in the abduction plane, though other ranges and values are also possible.
In a preferred embodiment, the surgical orientation device 14 and/or reference sensor device 16 can advantageously detect when motion (e.g. swinging) of the leg has stopped, and can detect if the leg has returned to its home (i.e. starting) position. For example, the surgical orientation device 14 and/or reference sensor device 16 can include a 1 Hz filter to prevent false stopping detection. The surgical orientation device 14 and/or reference sensor device 16 can average the rate of motion over half a second to determine whether the movement of the leg, and consequently the movement of the surgical orientation device 14 and/or reference sensor device 16, has come to a stop.
By moving (e.g. swinging) the leg in the manner described above and returning it to a home position, gyroscope and accelerometer biases can be accounted for in the surgical orientation device 14 and/or reference sensor device 16. With these biases accounted for, the method of determining the center of rotation of the mechanical axis can be made more accurate.
D. Additional Detail for Determining the Mechanical Axis
Provided below is additional detail that describes the methodology behind the surgical orientation device 14 and/or reference device 16 and how it is used to make certain calculations:
At least one purpose of the surgical orientation device 14 and/or reference device 16 and systems described herein is to provide guidance to the surgeon as to how to position a cutting block on the bone in order to achieve a cutting plane that is perpendicular to the load bearing axis of the bone (or some number of degrees off of that perpendicular plane if desired). A jig, such as that described above, can be fixed to the bone to be cut and the reference sensor device 16 and surgical orientation device 14 can be attached to that jig (one device is attached to a fixed portion of the jig to act as a reference to the bone's orientation and the other device is attached to an articulating arm of the jig to provide the surgeon a means to find and set the desired cutting plane). The articulating arm of the jig can be constrained to only be moved in two dimensions—pitch and yaw (not rotation). These two axes form a plane that can be adjusted to guide the placement of the cutting block which guides the saw to cut the bone on that plane.
Embodiments of a general approach can include determining the yaw (or varus/valgus (V/V)) and pitch (extension/flexion) angles required to bring the surgical orientation device 14 and/or reference device 16 from its initial orientation (provided by the other device, i.e. surgical orientation device 14 and/or reference device 16) to its present orientation.
In some embodiments, both sensors can begin aligned generally to the same gravity vector (so that small angle assumptions apply). The present orientation of the fixed sensor in the surgical orientation device 14 and/or reference device 16 can be considered the initial orientation of the navigation sensor. The sensor in the surgical orientation device 14 and/or reference device 16 can be free to move in pitch and yaw from the initial orientation, but roll is considered fixed X,Y, and Z coordinate axes for both sensors can be generally aligned. Both sensors can be calibrated with offset and gain and corrected for misalignment.
The surgical orientation device 14 and/or reference sensor device 16 can both be 3 axis accelerometers and either one can play the role of a fixed sensor. They can report the X, Y and Z components of the local gravity vector within the sensors coordinate system. For example, the fixed sensor can be the reference sensor device 16 and reports X1, Y1, Z1. The navigation sensor can be the surgical orientation device 14 Unit and reports X2, Y2, Z2.
At least one purpose of the system described herein is to provide an apparatus and method to determine the relative coordinates of a center pivot point on a rigid linkage that overcomes the requirement for direct physical measurement. The acceleration and angular rate sensed by the surgical orientation device 14 and/or reference device 16 can be processed while the link is moved by some means about its pivot point. The apparatus can provide an output vector representing the center of the linkage rotation with respect to the inertial sensor axes.
A method can start with the step of attaching the surgical orientation device 14 and/or reference device 16 to the linkage in a rigid manner. The data required from the surgical orientation device 14 and/or reference device 16 can be acceleration and angular rate. The data is input to a microprocessor. In a preferred embodiment, the microprocessor is located on the link and output from the processor is transmitted via RF wireless link, though this collocation is not a necessary condition. The link can be moved about its pivot point while inertial data is being processed by the microprocessor. The algorithm implemented on the microprocessor can process the inertial data in real time and determines if the link is static or dynamically moving. Data from both states is used by the algorithm to determine the center of the link rotation. This result is output by the microprocessor to the user.
The method and apparatus can provide accurate determination of pivot point location and radius of curvature without requiring any external measurements. This allows determination of effective link pivot point in blind situations where the end joint is hidden or unobservable. An example of this is determination of the pivot point location a human femur. Below are formulae which are derived from basic centripetal acceleration physics coupled with optimal estimation or Kalman filtering techniques to determine pivot point location.
The instantaneous translational velocity of a point on a rigid body is related to the link length and angular rate by
Further, the translational velocity can be computed by integrating acceleration over the same time interval as shown here
Both of these can be further integrated into a position vector, R, which represents the mechanical axis of the system, or the radial arm to the center of rotation. The unknown vector R is the key desired output from the apparatus. The vector R is found thru optimal estimation of the system. One cost function that can be used for estimation is
where e is the residual value computed from the difference between the measured value and the expected values. For this method and apparatus, the measured value is the translational velocity and/or position determined by integration of the accelerometer. The expected value is the translational velocity and/or position determined by multiplying the estimated link vector by the measured angular rate data and the time interval across which that rate data is obtained in some cases. W is a matrix of weighting values that is typically all evenly weighted at unity.
One method is to vary an estimated vector, R, in such a way that the cost function is minimized.
There are many types of optimal estimator formulation. One can use a Gauss-Newton in this description. Other methodology can also be used. Kalman filter estimators and other optimal (or even sub-optimal) methods are valid also.
Prior to the final estimation, noise and error removal and reduction from the raw sensor data can be performed. This includes rate sensor bias, bias stability, angle random walk, scale factor errors and mechanical misalignments. Also included are accelerometer bias, bias stability, velocity random walk, scale factor errors and mechanical misalignments. Possible errors introduced by inaccurate removal of gravitational influence are reduced. The amount of noise and error removal is proportional to the inherent capabilities of the sensors. As sensor technology gets better, certain portions of the algorithm may no longer be needed to achieve the same accuracy.
There can be two modes to the operation of the system, data acquisition and optimal estimation. During the data acquisition phase, data is acquired from the surgical orientation device 14 and/or reference device 16 in a static condition, i.e. motionless. This static condition provides a baseline for the sensor and allows determination of biases for all internal sensors. The surgical orientation device 14 and/or reference device 16 is then moved by an operator or other means in such a way that sufficient rate and acceleration data is achieved for all axes. Lack of sufficient motion in any axes can reduce the effectiveness of the final output. During the data acquisition phase, the apparatus can determine without user intervention what phase of data collection it is in, static or dynamic.
Correct inclusion of gravitation vector in the method can be important for accurate final results. Initial orientation of the surgical orientation device 14 and/or reference device 16 during the static phase of data acquisition is used to create an initial gravity vector transformation matrix relating the orientation of the surgical orientation device 14 and/or reference device 16 to the inertial gravity vector. Angular rate data can be used to propagate the attitude of the unit and update the inertial gravity vector transformation matrix during subsequent motion.
Once the data acquisition phase is determined to be complete, the second phase, optimal estimation, is entered. This phase is further broken down into three sub phases. These include gyro bias estimation, accelerometer bias estimation, and finally pivot point link vector estimation.
Some representative criteria for operation are now described that provide the most accurate pivot point estimation. During the static data collection, at least 1 second, but no more than 3 seconds of data can necessary in some embodiments. Longer periods of static data do not adversely affect the output. During the dynamic motion of the link, average angular rate in excess of 30 degrees per second are desired Beginning and ending attitude of the link after dynamic motion is complete should be within 15 degrees on any axis in some embodiments.
The output pivot point center location, computed in an X, Y, Z vector format, can be transformed into relative 2 dimensional angles (e.g. pitch and yaw) representing the angular misalignment of the surgical orientation device 14 and/or reference device 16 sensor axis with respect to the mechanical line of action for the rigid link.
There can be 4 major phases to the overall method:
Data Acquisition and Pre-Scaling
Static biases are removed from the data and the average body frame gravity vector is put back in the data
Optimal Estimation of Delta Theta (Rate Sensor) Bias
A bias is added to the rate sensor data in order to counter noise and other effects that result in the final orientation of the device being misaligned from the starting alignment, despite the fact that the user is required to return the unit back to the starting orientation.
Optimal Estimation of Delta Velocity (Accelerometer) Bias
A bias can be added to the accelerometer data in order to counter noise and other effects that result in the final velocity of the device being non-zero.
Optimal Estimation of Femur Vector and Resolution into Angles
Below are mathematical bases for each section.
Data Acquisition and Pre-Scaling
The acquisition and pre-scaling required can be dependent on the sensors selected for the device. One example of is described in the steps below.
Surgical orientation device 14 and/or reference device 16 raw data can be acquired from a combination of accelerometers and rate sensors.
Data can be scaled into delta theta (radians) and delta velocity (cm/s) using the data sample rate. There are alternate formulations that may work with the surgical orientation device 14 and/or reference device 16 data natively, but this makes integration and other repeated functions using this data less computationally intense when implemented on a microprocessor.
In some embodiments, the average of the raw data per each sensor and axis during static conditions can be determined.
In some embodiments, the Direction Cosine Matrix required for level to current orientation can be computed.
In some embodiments, the estimated average starting gravity vector in IMU body frame can be computed.
In some embodiments, the biases from all channels (rate and acceleration) can be removed.
In some embodiments, the body gravity vector can be added to the accelerometer channels.
Optimal Estimation of Delta Theta Bias
The purpose of this step can be to determine the optimum rate sensor corrections (in the form of a single constant bias for each sensor axis) that “force” the final attitude of the unit at the end of the maneuvers to be identical to the starting attitude.
Let the matrix Cip be the direction cosine matrix that represents the rotation from the initial attitude (i) to the propagated attitude (p) at a given instant in time, t. Cip includes the term Δθaxis.i, which is the rate sensor data from the IMU at each time step and Δθaxis.b a constant correction term. This final correction is determined in the following steps to augment the data in an optimal fashion to ensure that the calculated final attitude matches the initial attitude despite noises and other errors that alter the propagation from the correct solution.
Let
The surgeon can move the surgical orientation device 14 and/or reference device 16 in a prescribed set of motions and return the unit back to the starting attitude. The assumption is that sensor noises will result in an incorrect attitude at the end of the motions. Using Gauss-Newton or any variety of similar optimal estimation algorithm, the Δ
For determination of Δ
For determination of
This cost function can be minimized by altering the
We do not repeat the procedure here, but the prior Gauss-Newton flow chart is applicable to this estimator.
The output result is a set of data that represents the change in position in the inertial frame of the IMU based on the accelerometer data.
Optimal Estimation of Femur Vector
The purpose of this step is to determine the optimum vector from the surgical orientation device 14 and/or reference device 16 frame to its rigid body center of rotation. The accelerometer sensor data provides a linear acceleration estimate of velocity and motion. In a similar manner, the rate sensors on the surgical orientation device 14 and/or reference device 16 will provide estimates of position and motion if the rigid vector to the unit is known.
The accelerometer data provides a position vector at each time step
The rate sensor data can provide a position vector at each time step per the equation:
For determination of
This cost function can be minimized by altering the
We do not repeat the procedure here, but the prior Gauss-Newton flow chart is applicable to this estimator.
To use the previous method, we substitute
The output result is an optimal estimation of the vector from the IMU to the center of the rotation,
This vector is located in the body frame of the IMU.
Angles in pitch and yaw to the center of the joint can be computed based on this vector.
E. Adjusting an Angle of Resection
Once biases have been removed, and the reference sensor device 16 and/or surgical orientation device 14 has calculated the pivot point of the mechanical axis as described above and located the mechanical axis, the user can begin adjusting and orienting the cutting block 92 relative to the location of the mechanical axis. For example, the surgical orientation device 14 can display the varus/valgus and flexion/extension angle adjustments needed for the surgical orientation device 14 (and the femoral jig assembly 12) to reach neutral alignment with the mechanical axis that passes through the femoral head 154.
Advantageously, in some embodiments the reference sensor device 16 can enable the procedure to proceed without fixation of the leg being operated upon because the reference sensor device 16 can track the relative positions of the leg. For example, at least one of the reference sensor device 16 and the surgical orientation device 14 can communicate with the other, such that any relative movement of one of the devices can be tracked by the other, and the resulting overall orientation of the reference sensor device 16 and/or surgical orientation device 14 can be displayed on display 26 of the surgical orientation device 14. In some embodiments, the reference sensor device 16 can track movement of the leg (i.e. femur or tibia), such that if the leg moves during a procedure, the overall orientation of the surgical orientation device 14 can remain accurate.
With continued reference to
Any varus/valgus and flexion/extension angle adjustments of the femoral jig assembly 12 made by the adjusting the translation adjustment features 130 as discussed above can be reflected and displayed in approximately real time by the surgical orientation device 14. The varus/valgus and flexion/extension angle adjustments of the femoral jig assembly 12 can be made until the user is satisfied with the varus/valgus and flexion/extension angles of the femoral jig assembly 12 being reflected and displayed by the surgical orientation device 14. In some embodiments, when the surgical orientation device 14 and the femoral jig assembly 12 are aligned with the mechanical axis, the surgical orientation device 14 can provide a signal, such as for example a flashing green light on its display 26.
Furthermore, the surgical orientation device 14 can provide an indication of degrees of movement. For example, the surgical orientation device 14 can inform the user how many degrees (e.g. in half degree increments) the surgical orientation device 14 and the femoral jig assembly 12 are rotated past the mechanical axis of the leg in one or more planes. The surgical orientation device 14 can display this information in its display 26, and/or provide audio indications to the user.
After the femoral jig assembly 12 is aligned with the femoral mechanical axis and/or the cutting angles are selected, the method can include attaching the cutting block 92 and the distal guide assembly 88 to the microblock assembly 90 of the femoral jig assembly 12 as shown in
As discussed above, the distal femoral resection depth can be set by moving the articulating arm 98 in a desired position in relation to the cutting block 92 by adjusting the position adjustment features 104.
Referring to
Referring to
The method can further include using the cutting block 92 to perform the desired distal femoral resection using standard methods. For example, a cutting tool or tools can be moved through the at least one opening 134 of the cutting block 58, so as to prepare the distal femur for receiving a knee joint prosthetic. After a distal femoral resection is completed in accordance with the method described above, the proximal (i.e. upper) tibia can then be resected.
Referring to
The femoral jig assembly 12′ can be similar to the femoral jig assembly 12 described above, and have similar components. For example, the femoral jig assembly 12′ can comprise a distal guide assembly 88′, a microblock assembly 90′, and a cutting block 92′.
The distal guide assembly 88′ can comprise a modular paddle 96′, an articulating arm 98′, and a midline pin 102′. The modular paddle 96′ can comprise an extension 97′. As used in this specification, the term “modular paddle” or more generally “modular” includes structures that can form part of a kit, for example, of selectable parts. Various other kits, including any combination of the components described herein, can also be used or implemented in accordance with the methods described herein. The extension 97′ can comprise, for example, a generally L-shaped structure having a slot 99′ for receiving or for facilitating movement of the articulating arm 98′. The extension 97′ can comprise a marking or markings (not shown), similar to the markings 108 on the paddle 96 described above, for indicating an AP offset. For example, a series of lines can be provided along the slot 99′ such as on one or more of the distal, lateral, or medial surfaces of the extension 97′. These lines can be used to collect AP Offset Data, as discussed above to enable one or more orientation or reference devices coupled with the femoral jig assembly 12′ to account for the offset from the midline pin 102′ and the orientation or reference device.
The articulating arm 98′ can comprise or be coupled with a gripping structure 101′ located on an end of the articulating arm 98′ that extends through the slot 99′. The gripping structure 101′ can be configured to be gripped by a user's hand or fingers and moved, along with the rest of articulating arm 98′, in an anterior/posterior direction (see, e.g.
The microblock assembly 90′ can comprise a microblock member 116′ that includes a stabilizing bar 107′. The stabilizing bar 107′ can be formed integrally with or attached to the microblock member 116′. In other embodiments, the stabilizing bar 107′ can be integrally formed with or attached to the distal guide assembly 88′. The stabilizing bar 107′ can be used to help anchor and/or secure the jig assembly 12′ to the femur by providing a third anchoring location. For example, the microblock member 116′ can comprise openings 132′ on either side of the microblock member 116′ (e.g. medial and lateral) for receiving pins. The stabilizing bar 107′ enhances stability of the microblock member 116′ provided by the two openings 132′ to further reduce rotational movement of the jig assembly 12′ about an axis extending between the two openings 132′ on either side of the microblock member 116′. The stabilizing bar 107′ can be used to provide a third anchoring point, completing a triangular array of anchoring points (e.g., medial and lateral of an anterior-posterior mid-plane, adjacent to the condyles and proximal of the condyles) along the femur that add stability to the jig assembly 12′. In the illustrated embodiment, two anchor locations can be disposed distally of the cutting block 92′ and one can be positioned proximally thereof. For example, the stabilizing bar 107′ can extend around one side of the microblock assembly 90′ (i.e. depending on how the knee anatomy is structured and/or moved during a procedure). In some embodiments, the stabilizing bar 107′ can project posteriorly to attach to the distal femur (e.g. to the back side of the femur, or to a ledge, condyle, plateau or side of the femur). In one technique, during the procedure the patella is displaced to a lateral side of the knee joint and the stabilizing bar 107′ is coupled with and extends from a portion of the microblock assembly 90′ that will be disposed on a medial side of the knee joint during the procedure. The stabilizing bar 107′ can comprise a pin tube 109′ with an opening 111′ for receiving a pin (not shown) that extends through the femur and helps to anchor the jig assembly 12′ in place.
As discussed elsewhere herein, a variation on the femoral jig assembly 12′ enables procedures that do not require collecting AP offset data. For example, the arm 98′ can be configured not to be moveable, e.g., to be in a fixed anterior-posterior location relates to the midline pin 102′ during at least one phase of the procedure. In the embodiment of
Referring to
With continued reference to
The jig assembly 12″ can also include a midline guide 100″. The midline guide 100″ can be similar to midline guide 100 shown in
With continued reference to
Yet even further embodiments of femoral jig assemblies and methods for their use, as well as methods for determining a center of rotation of a head of the femur, can be found in, for example without limitation, paragraphs [305]-[333] and FIGS. 5 and 40-43 of U.S. patent application Ser. No. 12/509,388, which is incorporated by reference herein.
Embodiments of the invention similar to those described herein have recently been tested. In a comparison with a commercially available, FDA-cleared optical-based computer-assisted surgery system currently used in the United States operating rooms, 20 mechanical tibial mechanical axis registrations were conducted on 4 cadaver legs and 30 femoral mechanical axis registrations were conducted on 5 cadaver legs using each of an embodiment of the invention and the standard optical-based computer-assisted surgery system. (See tables below; registrations labeled N/A were not taken into account because they did not meet test criteria) The average difference between the distal femoral cutting block mechanical axis orientation calculated by the embodiment of the invention and that calculated by the optical-based computer assisted surgery system was no more than 1 degree for both varus/valgus and flexion/extension angles. Similarly, the average difference between the tibial cutting block mechanical axis orientation calculated by the embodiment of the invention and that calculated by the commercially-available optical-based computer assisted surgery system was no more than 1 degree for both varus/valgus and posterior slope angles. These results provide acceptable performance in a very compact and simple to use system. Also, these excellent results are produced by much less costly devices.
As discussed above, various components such as the electronic control unit 1102, the user input 26 and the display 26 of the surgical orientation device 14 can form an interactive user interface. The interactive user interface can include a graphical user interface having an interactive window displaying on-screen graphics on the surgical orientation device 14. The interactive user interface can provide the user with a plurality of screen displays illustrating steps to be performed in a surgical procedure and can guide the user through the performance of the steps. Each screen display can comprise one or more on-screen graphics. The on-screen graphics can comprise one or more visual cues or indicators to prompt the user as to what step or steps to take next during one of the procedural methods described above.
The visual cues referenced herein can comprise instructive images, diagrams, pictorial representations, icons, animations, visual cues, charts, numerical readings, measurements, textual instructions, warnings (visual and/or audible), or other data. The interactive user interface can be configured to alter attributes (e.g., color) of the on-screen graphics according to one or more data protocols. The interactive user interface can provide visual feedback to the user during performance of one or more surgical procedures. The interactive user interface can be configured to generate GUI images to be displayed to the user. As described above, the user can interact with the surgical orientation device 14 via one or more user input devices 1114 (e.g., buttons, switches, touch screen displays, scroll wheel, track ball, keyboard, remote controls, a microphone in conjunction with speech recognition software). The interactive user interface can further allow a user to confirm that a step has been completed (for example, by pressing a user input button). The interactive user interface can allow the user to enter data (e.g., a numerical value, such as a distance, an angle, and/or the like), verify a position of the surgical orientation device 14, turn an optional visible alignment indication system on and off, and/or turn the entire surgical orientation device 14 on and off
In certain embodiments, the interactive user interface can provide one or more drop-down lists or menus from which a user can make selections. For example, the user can make selections from a drop-down list using a scroll wheel, trackball, and/or a series of button presses. In some embodiments, the user interface provides a drop-down list of predicates that dynamically updates based on user input.
In at least one embodiment, a module for creating an interactive user interface can comprise a computer readable medium having computer readable program code embodied therein. The computer readable program code can include computer readable program code configured to display one or more of a plurality of GUI images on the user interface of the surgical orientation device 14, the GUI images comprising instructive images related to the performance of a surgical procedure. The computer readable program code can be configured to receive instructions from a user identifying the surgical procedure to be performed. The computer readable program code can be configured to show the user steps to be performed in the identified process for the identified surgical procedure. The computer readable program code can be configured to guide the user in performance of the steps. For example, the computer readable program code can be configured to receive from the user an instruction to continue to the next step in the procedure, to receive orientation data from a sensor mounted within the surgical orientation device, and to display the orientation data on the user interface of the surgical orientation device.
In at least one embodiment, the surgical orientation device 14 can include a display module configured to display information and at least one sensor module configured to monitor the position and orientation of the surgical orientation device 14 and the reference sensor device 16 in a three-dimensional coordinate reference system, and to generate orientation data corresponding to the monitored positions and orientations of the surgical orientation device 14 and the reference sensor device 16.
The surgical orientation device 14 can further comprise a control module configured to receive orientation data from the at least one sensor module and convert it to objective signals for presentation on a display module. The control module can be configured to display a set of GUI images or other on-screen graphics on the display module, the GUI images or on-screen graphics representing the orientation data received from the sensor module and also representing instructive images related to the performance of the joint replacement surgery.
In at least one embodiment, the surgical orientation device 14 can receive orientation data from a sensor module, receive input commands from a user input module to store orientation data from a user input module, convert the orientation data to a human readable format for presentation on a display device, and display on the display device on-screen graphics or GUI images for communicating information to a user based on the input commands and the orientation data, the information comprising instructive images for performing a joint replacement surgery and one or more visual indicators of a current orientation of the display device with respect to a fiducial, or reference, orientation.
For example,
Further embodiments of user interfaces, for use for example in an orthopedic method, can be found in paragraphs [0377]-[430] and FIGS. 58A-61K of U.S. patent application Ser. No. 12/509,388, which is incorporated by reference herein.
Referring to
A. Orthopedic Assembly for Angular Adjustment
The tibial jig assembly 212 can comprise an orthopedic assembly for use in preparing a tibia for a prosthetic component, and in particular for making angular adjustments relative to an anatomical feature. Referring to
Referring to
In a preferred arrangement, the orientation device interface 230 and the reference sensor device interface 228 can be coupled with portions of the tibial jig assembly 212 that are capable of moving relative to each other. For example, the orientation device interface 230 can be disposed on a movable portion of the tibial jig assembly 212, such as the posterior slope assembly 216, whereas the reference sensor device interface 228 can be disposed on a generally stationary portion of the tibial jig assembly 212, such as the mounting bar assembly 220.
1. Device for Adjusting a Posterior/Anterior Slope of a Cutting Block
In a preferred arrangement, the tibial jig assembly 212 can comprise a component for adjusting a posterior/anterior slope of the surgical orientation device 14 and/or a cutting block. For example, as seen in
2. Device for Adjusting a Varus/Valgus Slope of a Cutting Block
In a preferred arrangement, the tibial jig assembly 212 can also comprise a component for adjusting the varus/valgus slope of a cutting block. For example, as seen in
3. Device for Securing an Orthopedic Fixture Against the Tibia
In a preferred arrangement, the tibial jig assembly 212 can also comprise a device for securing an orthopedic fixture against the tibia. For example, as seen in
Secure engagement of the mount bar assembly 220 with the lower leg of the patient can be enhanced by providing a spring (not shown) that, in use, wraps around the posterior side of the leg and couples to medial and lateral sides of the mounting bar 266. The spring can be secured to tabs 286 of the mounting bar 266 seen in
As illustrated in
The movement of the posterior slope assembly 216 and the varus-valgus assembly 218 can be controlled by suitable mechanisms, such as for example those illustrated in
As described above, the surgical orientation device 14 and reference sensor device 16 can be attached to the tibial jig assembly 212. Preferably, the surgical orientation device 14 can be locked in place relative the tibial jig assembly 212. For example, referring to
In one arrangement, the release device 288 can also be used to actuate a locking device 299 disposed at a proximal end of the tibial assembly 212. The locking device 299 includes a push button 299A that is slideably received in a channel 299B extending posteriorly from an anterior surface of the posterior slope assembly 216. See
The tibial plateau anchor 226A includes an anchor pin 226B, an arm 226C that can extend anteriorly of the anchor pin 226B, and a locking device 226D that can be releasably secured to the proximal end of the mounting bar 268A. The anchor pin 226B can take any suitable configuration but preferably includes a rigid pin that extends in a distal-proximal direction when the jig assembly 212A is in use. The free (distal) end of the anchor pin 226B can include teeth that engage with the tibial plateau. In one technique the distal end of the anchor pin 226B is embedded in the tibial plateau by an amount sufficient to stabilize the tibial jig assembly 212A. In another embodiment, the arm 226C is secured to the tibial plateau by two screws (not shown) that are drive through through-holes H that extend proximal to distal through posterior end of the arm 226C. Preferably the through-holes H include at least two through-holes H that are angled relative to each other so that the arm 226C cannot slide proximally off of the screws.
An end of the arm 226C opposite the through-holes H extends anteriorly to an anterior location that would correspond to the position of the mounting bar 268A, i.e., just in front of the anterior face of the tibia in use. The arm 226C can be slidably coupled with the locking device 226D at a joint 226E. The joint 226E can be a ring having an inner perimeter matching the outer perimeter of the arm 226C. The arm 226C can have other features that facilitate mounting to the tibia, such as those described in connection with the midline probe assembly 226.
The locking device 226D can take any suitable configuration, but preferably is adapted to connect to the mounting bar 268A by a release device 226F. The release device 226F includes a finger actuatable lever 226G that has a hook 226H at a distal end and a toggle 2261 at a proximal end. The hook 226H is adapted to be received in a recess formed in the proximal end of the mounting bar 268A. The locking device 226D can also include a plurality of pins 226J that can be received in corresponding recesses 226K in the proximal end of the mounting bar 268A.
B. Orthopedic Assembly for Landmark Acquisition
The distal tube assembly 300 can comprise an elongate member 306, a first clamping device 308 disposed at a proximal end of the elongate member 306, and a second clamping device 310 located at the distal end of the elongate member 306. The first clamping device 308 can include a cam member 314, and can be used to releasably fasten the distal tube assembly 300 to the posterior slope assembly 216. The second clamping device 310 can include a knob 316 and slot 318. The knob 316 can be used to tighten and/or adjust a position of a probe assembly positioned within the slot 318.
Referring to
C. Resection Guide for Resecting an Anatomical Feature
D. Cutting Block Assembly for Resecting an Anatomical Structure
The cutting block assembly 224 can comprise an adjustment mechanism 330 for distal-proximal adjustment of a cutting block 332. For example, the adjustment mechanism 330 can include a fastening device 334. The fastening device 334 can comprise, for example, a threaded rod or other type member that permits rotational movement of the adjustment mechanism 330. The fastening device 334 can be inserted into a recess 299C (see
In some embodiments, the fastening device 334 can be secured by a spring loaded locking member that is actuated by the actuating member 290 as discussed above.
In one embodiment, the cutting block assembly 224 can include a cutting block 332 and a positioning device coupled with the cutting block 332. The positioning device can comprise a coupling member for connecting the cutting block assembly 224 to another portion of the tibial jig assembly 212, a cantilevered member 333 and a fine adjustment device. The coupling member can be an elongate member such as a rod. In one embodiment, cylindrical grooves can be formed along the length of the coupling member for engagement with a locking member. In one embodiment, the fine adjustment device can include a slot 335 formed in the cantilevered member along which the cutting block 332 can be moved. Preferably the cutting block 332 can also be attached to the cantilevered member in a way that permits the cutting block 332 to rotate about an axis extending perpendicular to the cantilevered member (e.g., about a vertical axis). See
The cantilevered member can be shaped to facilitate positioning the cutting block 332 around other features of a jig. For example, the locking device 226D of the tibial jig assembly 212A can be positioned directly between the location where the rod of the fastening device 334 is received in the posterior slope assembly 216 and the location where the cutting block 332 is desired to be positioned. The cantilever member of the adjustment mechanism 330 can be curved to extend laterally or medially around the locking device 226. See
E. Midline Probe Assembly
Referring to
The midline reference probe assembly 226 can be coupled with a proximal face of the mounting bar assembly 220 and can be positioned at an appropriate anatomical location at the proximal tibia, for example at a point just posterior to the insertion of the anterior cruciate ligament (ACL), or at another suitable anatomical landmark. For example, a tip 341 of the midline reference probe assembly 226 can be resting over the insertion point of the anterior cruciate ligament in the knee, and/or a soft point on the top of the tibia commonly referred to as the A/P point of the mechanical axis. This point is generally located along a tibial spine on top of the tibia, and marks the location of a point along the mechanical axis of the leg. Indicia of distance on an upper surface of the midline reference probe assembly 226 (e.g. via markings 340) can be noted and a corresponding A/P offset position can be set in the landmark acquisition assembly 214 (e.g. via markings 327 described above) See
Referring to
In some embodiments, the user can activate the surgical orientation device 14, such as by pressing one of the user inputs 28 on the surgical orientation device 14, during each landmark acquisition. Once activated, the, surgical orientation device 14 can register (e.g. record) the orientation of the surgical orientation device 14 as a reference position (e.g. a first reference position). For example, the surgical orientation device 14 can register and/or calculate the current orientation of the surgical orientation device 14 based on data collected from the sensor(s) inside the surgical orientation device 14. The orientation of the surgical orientation device 14 in a first reference position can be used to identify and register the orientation of a coronal plane which contains the mechanical axis of the leg, as well as to determine a first reference point for identifying the location and/or orientation of a sagittal plane containing this same mechanical axis.
The user can then swing the probe member 306 over to the other (e.g. medial) side of the leg, such that the reference probe 306 is located adjacent the other malleolus. During each landmark acquisition, the user can palpate the ankle. Once the location of the other (e.g. medial) malleolus is identified, the user can press one of the user inputs 28 on the surgical orientation device 14 to cause the surgical orientation device 14 to determine the orientation of the surgical orientation device 14 in a second reference position. For example, the surgical orientation device 14 can register and/or calculate the current orientation of the surgical orientation device 14 based on data collected from the sensor(s) inside the surgical orientation device 14.
The orientation of the surgical orientation device 14 in the second reference position can again be used to identify the orientation of a coronal plane extending through the tibia that contains the mechanical axis of the leg, and/or can be used to locate a second reference point for identifying the location and/or orientation of a sagittal plane containing the same mechanical axis.
When using the surgical orientation device 14 to determine the first and second reference positions, output of the sensor(s) in the surgical orientation device 14 can be monitored in a manner that minimizes error in the reading. For example, a transient phase can be eliminated in the output of the sensors to arrive at an accurate estimation of the given anatomical landmark.
Once information about both the first and second reference positions has been acquired and registered in the surgical orientation device 14, the surgical orientation device 14 can determine (e.g. calculate) the location of a desired plane between the lateral malleolus and the medial malleolus. The desired plane can correspond to the sagittal plane containing the mechanical axis. The desired plane can vary, depending on factors such as the patient's specific anatomy and the surgeon's training and experience. For example, the desired plane can be located midway between the lateral malleolus and medial malleolus, or 55% toward the medial malleolus from the lateral malleolus, or at some other predetermined location.
The user can use one or more user inputs 28 to direct the surgical orientation device 14 to calculate the location of and/or orientation of the sagittal plane. Once the surgical orientation device 14 has calculated where the sagittal plane is, the surgical orientation device 14 can provide location feedback to the user, for example in the form of a visual signal or signals on the display 26, indicating that the location of the sagittal plane has been calculated.
In some embodiments a laser can be provided on the surgical orientation device 14 to confirm the position. The tibial assembly 212 can be configured to interact with the laser to provide a confirmation of alignment. In one embodiment, the laser can emit a cross-hair laser pattern in which a first component is directed through slots and a second component impinges on indicia on the probe member 306 distally and/or on the midline reference probe assembly 226 proximally as a confirmation of appropriate positioning of the midline reference probe assembly 226. Embodiments of laser use are described, for example, in U.S. Patent Publication No. 2010/0063508, the contents of which are incorporated by reference in their entirety.
Referring to
For example, the posterior slope assembly 216 and varus/valgus assembly 218 can each be independently adjusted to change the angle of the cutting block 332, and subsequently, the angle of the intended resection. During this adjustment, the surgical orientation device 14 can provide a reading or readings on its display 26 indicating whether the surgical orientation device 14 (and likewise the cutting block 332) is aligned with the sagittal plane and/or coronal plane containing the mechanical axis.
Referring to
Referring to
As discussed above, in at least one embodiment, the surgical orientation device 14 can display on-screen graphics or GUI images for communicating information to a user based on input commands and orientation data. The images can be instructive for performing a joint replacement surgery.
For example,
For example,
Further embodiments of user interfaces, for use for example in an orthopedic method, can be found in paragraphs [0377]-[430] and FIGS. 58A-61K of U.S. patent application Ser. No. 12/509,388, which is incorporated by reference herein.
Once all of the tibial and/or femoral cuts are made with the systems and/or methods described above, a knee joint prosthetic or prosthetics can be attached to the distal femur and/or proximal tibia. The knee joint prosthetic devices can comprise a replacement knee joint. The replacement knee joint can be evaluated by the user to verify that alignment of the prosthetic components in the replacement knee joint does not create any undesired wear, interference, and/or damage to the patient's anatomy, or to the prosthetic components themselves.
While the systems and methods presented herein are described in the context of a knee joint replacement procedure, the systems and/or their components and methods can similarly be used in other types of medical procedures, including but not limited to shoulder and hip replacement procedures.
Additionally, while the systems and methods presented herein are described in the context of individual components and assemblies, in some embodiments one or more of the assemblies can be provided in the form of a kit for use by a surgeon. For example, in some embodiments a kit can comprise each of the components of the femoral preparation system 10 and the tibial preparation system 210 described above. In some embodiments, a kit may comprise only the surgical orientation device 14 and reference sensor device 16. In some embodiments a kit may comprise only the femoral preparation system 10, or only the tibial preparation system 210. Various other combinations and kits are also possible.
Although these inventions have been disclosed in the context of certain preferred embodiments and examples, it will be understood by those skilled in the art that the present inventions extend beyond the specifically disclosed embodiments to other alternative embodiments and/or uses of the inventions and obvious modifications and equivalents thereof. In addition, while several variations of the inventions have been shown and described in detail, other modifications, which are within the scope of these inventions, will be readily apparent to those of skill in the art based upon this disclosure. It is also contemplated that various combinations or sub-combinations of the specific features and aspects of the embodiments can be made and still fall within the scope of the inventions. It should be understood that various features and aspects of the disclosed embodiments can be combined with or substituted for one another in order to form varying modes of the disclosed inventions. Thus, it is intended that the scope of at least some of the present inventions herein disclosed should not be limited by the particular disclosed embodiments described above.
This application is a continuation of U.S. patent application Ser. No. 13/398,712, filed Feb. 16, 2012, which is a continuation of U.S. patent application Ser. No. 13/115,065, filed May 24, 2011, the entire contents of each is incorporated in its entirety by reference herein. U.S. patent application Ser. No. 13/115,065 is a continuation-in-part of U.S. patent application Ser. No. 12/509,388, filed Jul. 24, 2009, the entire contents of which is incorporated in its entirety by reference herein, and is also a continuation-in-part of U.S. patent application Ser. No. 13/011,815, filed Jan. 21, 2011, which claims benefit under 35 U.S.C. §119(e) to U.S. Provisional Patent Application No. 61/297,215, filed Jan. 21, 2010, U.S. Provisional Patent Application No. 61/297,212, filed Jan. 21, 2010, and U.S. Provisional Patent Application No. 61/369,390, filed Jul. 30, 2010, each of which is incorporated in its entirety by reference herein.
| Number | Name | Date | Kind |
|---|---|---|---|
| 3174080 | Eldon | Mar 1965 | A |
| 3670324 | Trevor, III | Jun 1972 | A |
| 4349018 | Chambers | Sep 1982 | A |
| 4421112 | Mains | Dec 1983 | A |
| 4436099 | Raftopoulos | Mar 1984 | A |
| 4459985 | McKay et al. | Jul 1984 | A |
| 4475549 | Oh | Oct 1984 | A |
| 4501266 | McDaniel | Feb 1985 | A |
| 4509393 | Castiglione | Apr 1985 | A |
| 4518855 | Malak | May 1985 | A |
| 4524766 | Petersen | Jun 1985 | A |
| 4529348 | Johnson et al. | Jul 1985 | A |
| 4567885 | Androphy | Feb 1986 | A |
| 4567886 | Petersen | Feb 1986 | A |
| 4621630 | Kenna | Nov 1986 | A |
| 4646729 | Kenna | Mar 1987 | A |
| 4716894 | Lazzeri et al. | Jan 1988 | A |
| 4718078 | Bleidorn et al. | Jan 1988 | A |
| 4738253 | Buechel et al. | Apr 1988 | A |
| 4759350 | Dunn et al. | Jul 1988 | A |
| 4823807 | Russell et al. | Apr 1989 | A |
| 4938762 | Wehrli | Jul 1990 | A |
| 4944760 | Kenna | Jul 1990 | A |
| 4945799 | Knetzer | Aug 1990 | A |
| 4952213 | Bowman et al. | Aug 1990 | A |
| 5002547 | Poggie et al. | Mar 1991 | A |
| 5053037 | Lackey | Oct 1991 | A |
| 5065612 | Ooka et al. | Nov 1991 | A |
| 5122146 | Chapman et al. | Jun 1992 | A |
| 5129908 | Petersen | Jul 1992 | A |
| 5141512 | Farmer et al. | Aug 1992 | A |
| 5213112 | Niwa et al. | May 1993 | A |
| 5249581 | Horbal et al. | Oct 1993 | A |
| 5251127 | Raab | Oct 1993 | A |
| 5279309 | Taylor et al. | Jan 1994 | A |
| 5296855 | Matsuzaki et al. | Mar 1994 | A |
| 5306276 | Johnson et al. | Apr 1994 | A |
| 5320625 | Bertin | Jun 1994 | A |
| 5324293 | Rehmann | Jun 1994 | A |
| 5325029 | Janecke et al. | Jun 1994 | A |
| 5329933 | Graf | Jul 1994 | A |
| 5342367 | Ferrante et al. | Aug 1994 | A |
| 5343391 | Mushabac | Aug 1994 | A |
| 5358526 | Tornier | Oct 1994 | A |
| 5376093 | Newman | Dec 1994 | A |
| 5395377 | Petersen et al. | Mar 1995 | A |
| 5417694 | Marik et al. | May 1995 | A |
| 5423827 | Mumme | Jun 1995 | A |
| 5431653 | Callaway | Jul 1995 | A |
| 5462548 | Pappas et al. | Oct 1995 | A |
| 5468244 | Attfield et al. | Nov 1995 | A |
| 5474088 | Zaharkin et al. | Dec 1995 | A |
| 5486177 | Mumme et al. | Jan 1996 | A |
| 5514143 | Bonutti et al. | May 1996 | A |
| 5529070 | Augustine et al. | Jun 1996 | A |
| 5540696 | Booth, Jr. et al. | Jul 1996 | A |
| 5540697 | Rehmann et al. | Jul 1996 | A |
| 5553198 | Wang et al. | Sep 1996 | A |
| 5576727 | Rosenberg et al. | Nov 1996 | A |
| 5584837 | Peterson | Dec 1996 | A |
| 5597379 | Haines et al. | Jan 1997 | A |
| 5611353 | Dance et al. | Mar 1997 | A |
| 5624444 | Wixson et al. | Apr 1997 | A |
| 5628750 | Whitlock et al. | May 1997 | A |
| 5645077 | Foxlin | Jul 1997 | A |
| 5653764 | Murphy | Aug 1997 | A |
| 5681316 | DeOrio et al. | Oct 1997 | A |
| 5683398 | Carls et al. | Nov 1997 | A |
| 5688282 | Baron et al. | Nov 1997 | A |
| 5720752 | Elliot et al. | Feb 1998 | A |
| 5724264 | Rosenberg et al. | Mar 1998 | A |
| 5748767 | Raab | May 1998 | A |
| 5769861 | Vilsmeier | Jun 1998 | A |
| 5776137 | Katz | Jul 1998 | A |
| 5788700 | Morawa et al. | Aug 1998 | A |
| 5824085 | Sahay et al. | Oct 1998 | A |
| 5840047 | Stedham | Nov 1998 | A |
| 5880714 | Rosenberg et al. | Mar 1999 | A |
| 5916219 | Matsuno et al. | Jun 1999 | A |
| 5919149 | Allen | Jul 1999 | A |
| 5935086 | Beacon et al. | Aug 1999 | A |
| 5976156 | Taylor et al. | Nov 1999 | A |
| 6027507 | Anderson et al. | Feb 2000 | A |
| 6036696 | Lambrecht et al. | Mar 2000 | A |
| 6056756 | Eng et al. | May 2000 | A |
| 6090114 | Matsuno et al. | Jul 2000 | A |
| 6094019 | Saiki | Jul 2000 | A |
| 6120509 | Wheeler | Sep 2000 | A |
| 6122538 | Sliwa, Jr. et al. | Sep 2000 | A |
| 6126608 | Kemme et al. | Oct 2000 | A |
| 6162191 | Foxin | Dec 2000 | A |
| 6167292 | Badano et al. | Dec 2000 | A |
| 6171310 | Giordano | Jan 2001 | B1 |
| 6195615 | Lysen | Feb 2001 | B1 |
| 6197032 | Lawes et al. | Mar 2001 | B1 |
| 6214013 | Lambrech et al. | Apr 2001 | B1 |
| 6214014 | McGann | Apr 2001 | B1 |
| 6216029 | Paltieli | Apr 2001 | B1 |
| 6246898 | Vesely et al. | Jun 2001 | B1 |
| 6258095 | Lombardo et al. | Jul 2001 | B1 |
| 6261247 | Ishikawa et al. | Jul 2001 | B1 |
| 6299646 | Chambat et al. | Oct 2001 | B1 |
| 6332089 | Acker et al. | Dec 2001 | B1 |
| 6348058 | Melken et al. | Feb 2002 | B1 |
| 6354011 | Albrecht | Mar 2002 | B1 |
| 6361506 | Saenger et al. | Mar 2002 | B1 |
| 6361507 | Foxlin | Mar 2002 | B1 |
| 6361508 | Johnson et al. | Mar 2002 | B1 |
| 6377839 | Kalfas et al. | Apr 2002 | B1 |
| 6381485 | Hunter et al. | Apr 2002 | B1 |
| 6383149 | DeMayo | May 2002 | B1 |
| 6395005 | Lovell | May 2002 | B1 |
| 6447448 | Ishikawa et al. | Sep 2002 | B1 |
| 6468280 | Saenger et al. | Oct 2002 | B1 |
| 6470207 | Simon et al. | Oct 2002 | B1 |
| 6471637 | Green et al. | Oct 2002 | B1 |
| 6473635 | Rasche | Oct 2002 | B1 |
| 6477400 | Barrick | Nov 2002 | B1 |
| 6477421 | Andersen et al. | Nov 2002 | B1 |
| 6478799 | Williamson | Nov 2002 | B1 |
| 6488713 | Hershnerger | Dec 2002 | B1 |
| 6499488 | Hunter et al. | Dec 2002 | B1 |
| 6514259 | Picard et al. | Feb 2003 | B2 |
| 6527443 | Vilsmeier | Mar 2003 | B1 |
| 6551325 | Neubauer et al. | Apr 2003 | B2 |
| 6585666 | Suh et al. | Jul 2003 | B2 |
| 6595997 | Axelson, Jr. et al. | Jul 2003 | B2 |
| 6595999 | Marchione et al. | Jul 2003 | B2 |
| 6607487 | Chang et al. | Aug 2003 | B2 |
| 6640128 | Vilsmeier et al. | Oct 2003 | B2 |
| 6679916 | Frankie et al. | Jan 2004 | B1 |
| 6685655 | DeMayo | Feb 2004 | B2 |
| 6685711 | Axelson et al. | Feb 2004 | B2 |
| 6711431 | Sarin et al. | Mar 2004 | B2 |
| 6712824 | Millard et al. | Mar 2004 | B2 |
| 6715213 | Richter | Apr 2004 | B2 |
| 6725080 | Melkent et al. | Apr 2004 | B2 |
| 6725173 | An | Apr 2004 | B2 |
| 6743235 | Rao | Jun 2004 | B2 |
| 6770078 | Bonutti | Aug 2004 | B2 |
| 6786877 | Foxlin | Sep 2004 | B2 |
| 6802864 | Tornier | Oct 2004 | B2 |
| 6820025 | Bachmann et al. | Nov 2004 | B2 |
| 6827723 | Carson | Dec 2004 | B2 |
| 6917827 | Kienzle, III | Jul 2005 | B2 |
| 6923817 | Carson et al. | Aug 2005 | B2 |
| 6928742 | Broers et al. | Aug 2005 | B2 |
| 6947783 | Immerz | Sep 2005 | B2 |
| 6986181 | Murphy et al. | Jan 2006 | B2 |
| 6997882 | Parker et al. | Feb 2006 | B1 |
| 7007699 | Martinelli et al. | Mar 2006 | B2 |
| 7021140 | Perkins | Apr 2006 | B2 |
| 7027477 | Sutter et al. | Apr 2006 | B2 |
| 7037310 | Murphy | May 2006 | B2 |
| 7048741 | Swanson | May 2006 | B2 |
| 7089148 | Bachmann et al. | Aug 2006 | B1 |
| 7094241 | Hodorek et al. | Aug 2006 | B2 |
| 7104998 | Yoon et al. | Sep 2006 | B2 |
| 7105028 | Murphy | Sep 2006 | B2 |
| 7194295 | Vilsmeier | Mar 2007 | B2 |
| 7209776 | Leitner | Apr 2007 | B2 |
| 7219033 | Kolen | May 2007 | B2 |
| 7273500 | Williamson | Sep 2007 | B2 |
| 7331932 | Leitner | Feb 2008 | B2 |
| 7344541 | Haines et al. | Mar 2008 | B2 |
| 7392076 | Moctezuma de la Barrera | Jun 2008 | B2 |
| 7396357 | Tornier et al. | Jul 2008 | B2 |
| 7444178 | Goldbach | Oct 2008 | B2 |
| 7468075 | Lang et al. | Dec 2008 | B2 |
| 7468077 | Rochetin | Dec 2008 | B2 |
| 7497029 | Plassky et al. | Mar 2009 | B2 |
| 7520880 | Claypool et al. | Apr 2009 | B2 |
| 7547307 | Carson et al. | Jun 2009 | B2 |
| 7559931 | Stone | Jul 2009 | B2 |
| 7578821 | Fisher et al. | Aug 2009 | B2 |
| 7611520 | Broers et al. | Nov 2009 | B2 |
| 7611522 | Gorek | Nov 2009 | B2 |
| 7621920 | Claypool et al. | Nov 2009 | B2 |
| 7623902 | Pacheco | Nov 2009 | B2 |
| 7726564 | Goldbach | Jun 2010 | B2 |
| 7776098 | Murphy | Aug 2010 | B2 |
| 7831292 | Quaid et al. | Nov 2010 | B2 |
| 7834847 | Boillot et al. | Nov 2010 | B2 |
| 7846092 | Murphy | Dec 2010 | B2 |
| 7857821 | Couture et al. | Dec 2010 | B2 |
| 7885705 | Murphy | Feb 2011 | B2 |
| 7970174 | Goldbach | Jun 2011 | B2 |
| 8057479 | Stone | Nov 2011 | B2 |
| 8057482 | Stone | Nov 2011 | B2 |
| 8078254 | Murphy | Dec 2011 | B2 |
| 8118815 | van der Walt | Feb 2012 | B2 |
| 8241296 | Wasielewski | Aug 2012 | B2 |
| 8265790 | Amiot et al. | Sep 2012 | B2 |
| 8267938 | Murphy | Sep 2012 | B2 |
| 8277455 | Couture et al. | Oct 2012 | B2 |
| 8282685 | Rochetin et al. | Oct 2012 | B2 |
| 8355773 | Leitner et al. | Jan 2013 | B2 |
| 8412308 | Goldbach | Apr 2013 | B2 |
| 8421854 | Zerkin | Apr 2013 | B2 |
| 8446473 | Goldbach | May 2013 | B2 |
| 8512346 | Couture | Aug 2013 | B2 |
| 8551108 | Pelletier et al. | Oct 2013 | B2 |
| 8588892 | Hladio et al. | Nov 2013 | B2 |
| 8690888 | Stein et al. | Apr 2014 | B2 |
| 8718820 | Amiot et al. | May 2014 | B2 |
| 8734432 | Tuma et al. | May 2014 | B2 |
| 8764758 | Echeverri | Jul 2014 | B2 |
| 8888786 | Stone | Nov 2014 | B2 |
| 8911447 | van der Walt et al. | Dec 2014 | B2 |
| 8974467 | Stone | Mar 2015 | B2 |
| 8974468 | Borja | Mar 2015 | B2 |
| 8998910 | Borja et al. | Apr 2015 | B2 |
| 9192392 | van der Walt et al. | Nov 2015 | B2 |
| 9262802 | Aghazadeh | Feb 2016 | B2 |
| 9271756 | van der Walt et al. | Mar 2016 | B2 |
| 9339226 | van der Walt et al. | May 2016 | B2 |
| 9375178 | Aghazadeh | Jun 2016 | B2 |
| 20020077540 | Kienzie, III | Jun 2002 | A1 |
| 20020103610 | Bachmann et al. | Aug 2002 | A1 |
| 20020107522 | Picard et al. | Aug 2002 | A1 |
| 20020133175 | Carson | Sep 2002 | A1 |
| 20020198451 | Carson | Dec 2002 | A1 |
| 20030019294 | Richter | Jan 2003 | A1 |
| 20030069591 | Carson et al. | Apr 2003 | A1 |
| 20030093080 | Brown et al. | May 2003 | A1 |
| 20030105470 | White | Jun 2003 | A1 |
| 20030120282 | Scouten et al. | Jun 2003 | A1 |
| 20030163142 | Paltieli et al. | Aug 2003 | A1 |
| 20030184297 | Jakab | Oct 2003 | A1 |
| 20030199882 | Gorek | Oct 2003 | A1 |
| 20030204965 | Hennessey | Nov 2003 | A1 |
| 20030229356 | Dye | Dec 2003 | A1 |
| 20040006393 | Burkinshaw | Jan 2004 | A1 |
| 20040019382 | Amirouche et al. | Jan 2004 | A1 |
| 20040034313 | Leitner | Feb 2004 | A1 |
| 20040039396 | Couture et al. | Feb 2004 | A1 |
| 20040068260 | Cossette et al. | Apr 2004 | A1 |
| 20040087962 | Gorek | May 2004 | A1 |
| 20040097952 | Sarin et al. | May 2004 | A1 |
| 20040102792 | Sarin et al. | May 2004 | A1 |
| 20040106916 | Quaid et al. | Jun 2004 | A1 |
| 20040147926 | Iversen | Jul 2004 | A1 |
| 20040149036 | Foxlin et al. | Aug 2004 | A1 |
| 20040152970 | Hunter et al. | Aug 2004 | A1 |
| 20040153066 | Coon et al. | Aug 2004 | A1 |
| 20040153079 | Tsougarakis et al. | Aug 2004 | A1 |
| 20040181144 | Cinquin et al. | Sep 2004 | A1 |
| 20040201857 | Foxlin | Oct 2004 | A1 |
| 20040230197 | Tornier et al. | Nov 2004 | A1 |
| 20040243148 | Wasielewski | Dec 2004 | A1 |
| 20050021037 | McCombs et al. | Jan 2005 | A1 |
| 20050021044 | Stone et al. | Jan 2005 | A1 |
| 20050107799 | Graf et al. | May 2005 | A1 |
| 20050113846 | Carson | May 2005 | A1 |
| 20050149040 | Haines et al. | Jul 2005 | A1 |
| 20050197814 | Aram et al. | Sep 2005 | A1 |
| 20050209605 | Grimm et al. | Sep 2005 | A1 |
| 20050222574 | Giordano et al. | Oct 2005 | A1 |
| 20050234332 | Murphy | Oct 2005 | A1 |
| 20050251026 | Stone | Nov 2005 | A1 |
| 20050251148 | Friedrich | Nov 2005 | A1 |
| 20060015018 | Jutras et al. | Jan 2006 | A1 |
| 20060015120 | Richard et al. | Jan 2006 | A1 |
| 20060020177 | Seo et al. | Jan 2006 | A1 |
| 20060064105 | Raistrick et al. | Mar 2006 | A1 |
| 20060089657 | Broers et al. | Apr 2006 | A1 |
| 20060094958 | Marquart et al. | May 2006 | A1 |
| 20060122491 | Murray et al. | Jun 2006 | A1 |
| 20060142656 | Malackowski et al. | Jun 2006 | A1 |
| 20060142657 | Quaid et al. | Jun 2006 | A1 |
| 20060161051 | Terrill-Grisoni et al. | Jul 2006 | A1 |
| 20060217733 | Plassky et al. | Sep 2006 | A1 |
| 20060217734 | Sanford et al. | Sep 2006 | A1 |
| 20060241639 | Kuczynski et al. | Oct 2006 | A1 |
| 20060270949 | Mathie et al. | Nov 2006 | A1 |
| 20060282023 | Leitner | Dec 2006 | A1 |
| 20070032748 | McNeil et al. | Feb 2007 | A1 |
| 20070043287 | Degraaf | Feb 2007 | A1 |
| 20070043375 | Anissian | Feb 2007 | A1 |
| 20070073296 | Panchbhavi | Mar 2007 | A1 |
| 20070162142 | Stone | Jul 2007 | A1 |
| 20070179626 | de la Barrera et al. | Aug 2007 | A1 |
| 20070179628 | Rochetin | Aug 2007 | A1 |
| 20070219559 | Heavener et al. | Sep 2007 | A1 |
| 20070219561 | Lavallee et al. | Sep 2007 | A1 |
| 20070226986 | Park et al. | Oct 2007 | A1 |
| 20070249967 | Buly et al. | Oct 2007 | A1 |
| 20070270718 | Rochetin et al. | Nov 2007 | A1 |
| 20070270973 | Johnson et al. | Nov 2007 | A1 |
| 20070287911 | Haid et al. | Dec 2007 | A1 |
| 20080039868 | Tuemmler et al. | Feb 2008 | A1 |
| 20080058945 | Hajaj et al. | Mar 2008 | A1 |
| 20080071195 | Cuellar et al. | Mar 2008 | A1 |
| 20080103509 | Goldbach | May 2008 | A1 |
| 20080162074 | Schneider | Jul 2008 | A1 |
| 20080183179 | Siebel et al. | Jul 2008 | A1 |
| 20080195109 | Hunter et al. | Aug 2008 | A1 |
| 20080202200 | West | Aug 2008 | A1 |
| 20080211768 | Breen et al. | Sep 2008 | A1 |
| 20080243127 | Lang et al. | Oct 2008 | A1 |
| 20080249394 | Giori et al. | Oct 2008 | A1 |
| 20080262812 | Arata et al. | Oct 2008 | A1 |
| 20080275451 | McAllister et al. | Nov 2008 | A1 |
| 20080281328 | Lang et al. | Nov 2008 | A1 |
| 20080285805 | Luinge et al. | Nov 2008 | A1 |
| 20090000626 | Quaid et al. | Jan 2009 | A1 |
| 20090000627 | Quaid et al. | Jan 2009 | A1 |
| 20090012532 | Quaid et al. | Jan 2009 | A1 |
| 20090040224 | Igarashi et al. | Feb 2009 | A1 |
| 20090076507 | Claypool et al. | Mar 2009 | A1 |
| 20090076519 | Iversen | Mar 2009 | A1 |
| 20090088753 | Aram et al. | Apr 2009 | A1 |
| 20090138019 | Wasielewski | May 2009 | A1 |
| 20090171370 | Yoon et al. | Jul 2009 | A1 |
| 20090209884 | Van Vorhis et al. | Aug 2009 | A1 |
| 20090216247 | Collette | Aug 2009 | A1 |
| 20090234360 | Alexander | Sep 2009 | A1 |
| 20090247863 | Proulx et al. | Oct 2009 | A1 |
| 20090248044 | Amiot et al. | Oct 2009 | A1 |
| 20090264737 | Haechler et al. | Oct 2009 | A1 |
| 20090270864 | Poncet | Oct 2009 | A1 |
| 20090270865 | Poncet et al. | Oct 2009 | A1 |
| 20090270868 | Park et al. | Oct 2009 | A1 |
| 20090270869 | Colquhoun et al. | Oct 2009 | A1 |
| 20090270874 | Santarella et al. | Oct 2009 | A1 |
| 20090270875 | Poncet | Oct 2009 | A1 |
| 20090270928 | Stone et al. | Oct 2009 | A1 |
| 20090276054 | Clifford et al. | Nov 2009 | A1 |
| 20090281545 | Stubbs | Nov 2009 | A1 |
| 20090289806 | Thornberry | Nov 2009 | A1 |
| 20090292227 | Scholten et al. | Nov 2009 | A1 |
| 20090299416 | Haenni et al. | Dec 2009 | A1 |
| 20090299483 | Amirouche et al. | Dec 2009 | A1 |
| 20090306679 | Murphy | Dec 2009 | A1 |
| 20090312973 | Hatlestad et al. | Dec 2009 | A1 |
| 20090318836 | Stone et al. | Dec 2009 | A1 |
| 20090318930 | Stone et al. | Dec 2009 | A1 |
| 20090318931 | Stone et al. | Dec 2009 | A1 |
| 20090324078 | Wu et al. | Dec 2009 | A1 |
| 20100016705 | Stone | Jan 2010 | A1 |
| 20100023018 | Theofilos | Jan 2010 | A1 |
| 20100063509 | Borja et al. | Mar 2010 | A1 |
| 20100064216 | Borja et al. | Mar 2010 | A1 |
| 20100069911 | Borja et al. | Mar 2010 | A1 |
| 20100076505 | Borja | Mar 2010 | A1 |
| 20100100011 | Roche | Apr 2010 | A1 |
| 20100100154 | Roche | Apr 2010 | A1 |
| 20100113980 | Herr et al. | May 2010 | A1 |
| 20100121334 | Couture et al. | May 2010 | A1 |
| 20100137871 | Borja | Jun 2010 | A1 |
| 20100153081 | Bellettre et al. | Jun 2010 | A1 |
| 20100179605 | Branch et al. | Jul 2010 | A1 |
| 20100182914 | DelRegno et al. | Jul 2010 | A1 |
| 20100192662 | Yanni | Aug 2010 | A1 |
| 20100198067 | Mahfouz et al. | Aug 2010 | A1 |
| 20100198275 | Chana et al. | Aug 2010 | A1 |
| 20100204551 | Roche | Aug 2010 | A1 |
| 20100204575 | Roche et al. | Aug 2010 | A1 |
| 20100204955 | Roche et al. | Aug 2010 | A1 |
| 20100211077 | Couture et al. | Aug 2010 | A1 |
| 20100239996 | Ertl | Sep 2010 | A1 |
| 20100249533 | Pierce et al. | Sep 2010 | A1 |
| 20100249534 | Pierce et al. | Sep 2010 | A1 |
| 20100249535 | Pierce et al. | Sep 2010 | A1 |
| 20100249659 | Sherman et al. | Sep 2010 | A1 |
| 20100249665 | Roche | Sep 2010 | A1 |
| 20100249787 | Roche | Sep 2010 | A1 |
| 20100249788 | Roche | Sep 2010 | A1 |
| 20100249790 | Roche | Sep 2010 | A1 |
| 20100249791 | Roche | Sep 2010 | A1 |
| 20100250276 | Pierce et al. | Sep 2010 | A1 |
| 20100250284 | Roche et al. | Sep 2010 | A1 |
| 20100250571 | Pierce et al. | Sep 2010 | A1 |
| 20100256504 | Moreau-Gaudry et al. | Oct 2010 | A1 |
| 20100261998 | Stiehl | Oct 2010 | A1 |
| 20100268067 | Razzaque et al. | Oct 2010 | A1 |
| 20100298661 | McCombie et al. | Nov 2010 | A1 |
| 20100324457 | Bean et al. | Dec 2010 | A1 |
| 20100326187 | Stein | Dec 2010 | A1 |
| 20100326194 | Stein et al. | Dec 2010 | A1 |
| 20100326210 | Stein et al. | Dec 2010 | A1 |
| 20100326211 | Stein | Dec 2010 | A1 |
| 20100327848 | Stein | Dec 2010 | A1 |
| 20100327880 | Stein | Dec 2010 | A1 |
| 20100328077 | Stein | Dec 2010 | A1 |
| 20100328098 | Stein et al. | Dec 2010 | A1 |
| 20100331633 | Stein | Dec 2010 | A1 |
| 20100331663 | Stein | Dec 2010 | A1 |
| 20100331679 | Stein | Dec 2010 | A1 |
| 20100331680 | Stein | Dec 2010 | A1 |
| 20100331681 | Stein et al. | Dec 2010 | A1 |
| 20100331682 | Stein et al. | Dec 2010 | A1 |
| 20100331683 | Stein et al. | Dec 2010 | A1 |
| 20100331685 | Stein et al. | Dec 2010 | A1 |
| 20100331687 | Stein et al. | Dec 2010 | A1 |
| 20100331704 | Stein et al. | Dec 2010 | A1 |
| 20100331718 | Stein | Dec 2010 | A1 |
| 20100331733 | Stein | Dec 2010 | A1 |
| 20100331734 | Stein | Dec 2010 | A1 |
| 20100331735 | Stein | Dec 2010 | A1 |
| 20100331736 | Stein | Dec 2010 | A1 |
| 20100331737 | Stein et al. | Dec 2010 | A1 |
| 20100331738 | Stein et al. | Dec 2010 | A1 |
| 20100331894 | Stein | Dec 2010 | A1 |
| 20100332152 | Stein | Dec 2010 | A1 |
| 20110028865 | Luinge et al. | Feb 2011 | A1 |
| 20110032184 | Roche et al. | Feb 2011 | A1 |
| 20110093081 | Chana et al. | Apr 2011 | A1 |
| 20110213275 | Boos et al. | Sep 2011 | A1 |
| 20110218458 | Valin et al. | Sep 2011 | A1 |
| 20110218546 | De La Fuente Klein et al. | Sep 2011 | A1 |
| 20110275957 | Bhandari | Nov 2011 | A1 |
| 20120029389 | Amiot et al. | Feb 2012 | A1 |
| 20120053488 | Boutin et al. | Mar 2012 | A1 |
| 20120053594 | Pelletier et al. | Mar 2012 | A1 |
| 20120093377 | Tsougarakis et al. | Apr 2012 | A1 |
| 20120157887 | Fanson et al. | Jun 2012 | A1 |
| 20120172712 | Bar-Tal | Jul 2012 | A1 |
| 20120203140 | Malchau et al. | Aug 2012 | A1 |
| 20130079678 | Stein et al. | Mar 2013 | A1 |
| 20130079679 | Roche et al. | Mar 2013 | A1 |
| 20130079680 | Stein et al. | Mar 2013 | A1 |
| 20130079790 | Stein et al. | Mar 2013 | A1 |
| 20130079791 | Stein et al. | Mar 2013 | A1 |
| 20130079793 | Stein et al. | Mar 2013 | A1 |
| 20130190887 | Fanson et al. | Jul 2013 | A1 |
| 20130274633 | Hladio et al. | Oct 2013 | A1 |
| 20140005673 | Pelletier et al. | Jan 2014 | A1 |
| 20140031672 | McCaulley et al. | Jan 2014 | A1 |
| 20140052149 | van der Walt et al. | Feb 2014 | A1 |
| 20140114179 | Muller et al. | Apr 2014 | A1 |
| 20140134586 | Stein et al. | May 2014 | A1 |
| 20140135658 | Hladio et al. | May 2014 | A1 |
| 20140135744 | Stein et al. | May 2014 | A1 |
| 20140135773 | Stein et al. | May 2014 | A1 |
| 20140136143 | Stein et al. | May 2014 | A1 |
| 20140182062 | Aghazadeh | Jul 2014 | A1 |
| 20140275940 | Hladio et al. | Sep 2014 | A1 |
| 20140276000 | Mullaney et al. | Sep 2014 | A1 |
| 20140276864 | Aghazadeh | Sep 2014 | A1 |
| 20140330281 | Aghazadeh | Nov 2014 | A1 |
| 20140364858 | Li et al. | Dec 2014 | A1 |
| 20150018718 | Aghazadeh | Jan 2015 | A1 |
| 20150127009 | Berend et al. | May 2015 | A1 |
| 20150150569 | van der Walt et al. | Jun 2015 | A1 |
| 20150238204 | Stone | Aug 2015 | A1 |
| 20150272478 | Borja | Oct 2015 | A1 |
| 20160213383 | van der Walt et al. | Jul 2016 | A1 |
| 20160242934 | van der Walt et al. | Aug 2016 | A1 |
| Number | Date | Country |
|---|---|---|
| 2241359 | Dec 1999 | CA |
| 2 594 874 | Jul 2006 | CA |
| 2 537 711 | Aug 2007 | CA |
| 4 225 112 | Dec 1993 | DE |
| 29704393 | Aug 1997 | DE |
| 198 30 359 | Jan 2000 | DE |
| 0 557 591 | Sep 1993 | EP |
| 0 651 968 | May 1995 | EP |
| 1 817 547 | Apr 2012 | EP |
| 2 197 790 | Jun 1988 | GB |
| 07-184929 | Jul 1995 | JP |
| H08-240611 | Sep 1996 | JP |
| 2006-314775 | Nov 2006 | JP |
| 2007-503289 | Feb 2007 | JP |
| 2007-534351 | Nov 2007 | JP |
| WO 9960939 | Dec 1999 | WO |
| WO 0130247 | May 2001 | WO |
| WO 0200131 | Jan 2002 | WO |
| WO 0217798 | Mar 2002 | WO |
| WO 2004080323 | Sep 2004 | WO |
| WO 2004112610 | Dec 2004 | WO |
| WO 2005006993 | Jan 2005 | WO |
| WO 2006119387 | Nov 2006 | WO |
| WO 2007136784 | Nov 2007 | WO |
| WO 2008073999 | Jun 2008 | WO |
| WO 2008129414 | Oct 2008 | WO |
| WO 2009117833 | Oct 2009 | WO |
| WO 2010011978 | Jan 2010 | WO |
| WO 2010030809 | Mar 2010 | WO |
| WO 2011044273 | Apr 2011 | WO |
| WO 2012006172 | Jan 2012 | WO |
| WO 2012027815 | Mar 2012 | WO |
| WO 2012027816 | Mar 2012 | WO |
| WO 2012082164 | Jun 2012 | WO |
| WO 2012113054 | Aug 2012 | WO |
| WO 2013012561 | Jan 2013 | WO |
| WO 2013169674 | Nov 2013 | WO |
| WO 2013173700 | Nov 2013 | WO |
| WO 2013188960 | Dec 2013 | WO |
| WO 2014028227 | Feb 2014 | WO |
| WO 2016134168 | Aug 2016 | WO |
| Entry |
|---|
| BrainLAB, “Position Determination and Calibration in optical tracking systems”, FLORENUS the technology merchants, in 2 pages. |
| BrainLAB, “Tracking and imaging in Navigation”, FLORENUS, in 2 pages. |
| De Momi, et al., “In-vitro experimental assessment of a new robust algorithm for hip joint centre estimation”, Journal of Biomechanics, Feb. 26, 2009, vol. 42, pp. 989-995. |
| iASSIST Knee, Surgical Technique, Zimmer, Inc., 2012. |
| International Search Report and Written Opinion issued in International Application No. PCT/US2016/018508, dated Jun. 22, 2016, in 19 pages. |
| Perseus Intelligent Cutting Guide, Orthokey, Product Guide, in 8 pages. |
| Perseus Intelligent Cutting Guide, Smart Instruments for Knee Arthroplasty, Orthokey, in 2 pages. |
| Wentzensen et al., “Image-based hip navigation”, International Orthopaedics (SICOT), 2003, vol. 27 (Suppl. 1), pp. S43-S46. |
| Wolfstadt et al., “An intelligent instrument for improved leg length and hip offset accuracy in total hip arthroplasty”, Abstract Only. |
| Zheng et al., “Technical Principles of Computer Assisted Orthopaedic Surgery”, Suomen Ortopedia ja Traumatologia, Feb. 2008, vol. 31, pp. 135-147. |
| 510 (k) Summary for Total Knee Surgetics Navigation System, in 5 pages. |
| 510 (k) Summary of Safety and Effectiveness for BrainLAB knee, in 5 pages. |
| Anderson MD., Kevin, et al., “Computer Assisted Navigation in Total Knee Arthroplasty”, The Journal of Arthroplasty, 2005, vol. 20, No. 7, Suppl. 3, in 7 pages. |
| Ang, et al., An Active Hand-Held Instrument for Enhanced Microsurgical Accuracy, Medical Image Computing and Computer-Assisted Intervention, 2000, vol. 1935, pp. 878-887. |
| Arnold-Moore, et. al., Architecture of a Content Management Server for XML Document Applications, RMIT Multimedia Database Systems, Royal Melbourne Institute of Technology, Victoria Australia, in 12 pages. |
| ArthroCAD, Enhancing orthopedic outcomes through optimal alignment, 2012, Pages in 2 pages. |
| Bae et al., “Computer Assisted Navigation in Knee Arthroplasty”, Clinics in Orthopedic Surgery, 2011, vol. 3, pp. 259-267. |
| Bargren, MD., et al,, Alignment in Total Knee Arthroplasty, Correlated Biomechanical and Clinical Observations, Clinical Orthopaedics and Related Research, Mar. 1, 1983, Issue 173, pp. 178-183, Philadelphia. |
| Bathis, H. et al., “Alignment in total knee arthroplasty”, The Journal of Bone & Joint Surgery (Br), 2004, 86-B, pp. 682-687, British Editorial. |
| Bhandari, Design and Prototype of a Computer Assisted Surgical Navigation System for Total Knee Replacement Surgery, May 12, 2009, Pages in 294 pages. |
| Biomet Orthopedics, Inc, Vision Acetabular Surgical Techniques, website brochure, pp. 16 pages. |
| Biomet Orthopedics, Inc., Universal Ringlock® Acetabular Series, vol. website brochure, pp. 13 pages. |
| Brennan, et al., Quantification of Inertial Sensor-Based 3D Joint Angle Measurement Accuracy Using and Instrumented Gimbal, Gait & Posture, May 23, 2011, vol. 34, pp. 320-323. |
| Chauhan, et al., Computer-Assisted Knee Arthroplasty Versus a Conventional Jig-Based Technique, The Journal of Bone & Joint Surgery, 2004, vol. 86-B, pp. 372-377. |
| Cutti, et al., Motion Analysis of the Upper-Limb Based on Inertial Sensors: Part 1—Protocol Description, Journal of Biomechanics, Jan. 1, 2007, vol. 40, pp. S250. |
| Decking, MD., et al., Leg Axis After Computer-Navigated Total Knee Arthroplasty, The Journal of Arthroplasty, 2005, vol. 20, Issue 3, pp. 282-288. |
| Depuy, Johnson & Johnson, Co.,, Summit Cemented Hip System, website brochure, pp. 21 pages. |
| Digioia III, MD., et al., “Comparison of a Mechanical Acetabular Alignment Guide with Computer Placement of the Socket”, The Journal of Arthroplasty, Apr. 2002, vol. 17, No. 3, in 6 pages. |
| Eric Foxlin, Chapter 7. Motion Tracking Requirements and Technologies, Handbook of Virtual Environment Technology, 2002, vol. Kay Stanney, Ed., Issue Lawrence Erlbaum Ass. |
| Favre, et al., 3D Evaluation of the Knee Joint Using Ambulatory System: Application to ACL-Deficient Knees, Journal of Biomechanics, Jan. 1, 2007, vol. 40, pp. S251. |
| Favre, et al., A New Ambulatory System for Comparative Evaluation of the Three-Dimensional Knee Kinematics, Applied to Anterior Cruciate Ligament Injuries, Knee Surgery, Sports Traumatology, Arthroscopy, Jan. 19, 2006, vol. 14, pp. 592-604. |
| Favre, et al., Ambulatory Measurement of 3D Knee Joint Angle, Journal of Biomechanics, Jan. 28, 2008, vol. 41, Issue 1029-1035. |
| Fixed Reference Surgical Technique, SIGMA High Performance Instruments, DePuy Orthopaedics, Inc., 2008, Warsaw, IN, in 52pages. |
| Ganapathi et al., “Limb Length and Femoral Offset Reconstruction During THA Using CT-Free Computer Navigation”, The Journal of Bone and Joint Surgery, 2009, vol. 91-B, Supplement III, p. 399. |
| Goniometer, AllHeart.com, 2004, website: http://allheart.com/allheart, (1 page). |
| Haaker et al., “Computer-Assisted Navigation Increases Precision of Component Placement in Total Knee Arthroplasty”, Clinical Orthopaedics and Related Research, Apr. 2005, vol. 433, pp. 152-159. |
| Hofstetter, Ph.D., et al., “Computer-Assisted Fluoroscopy-Based Reduction of Femoral Fractures and Antetorsion Correction”, Computer Aided Surgery, 2000, vol. 5, pp. 311-325, Wiley-Liss, Inc. |
| Hsieh, Pang-Hsin, et al., “Image-guided periacetabular osteotomy: computer-assisted navigation compared with the conventional technique: A randomized study of 36 patients followed for 2 years”, Acta Orthopaedica, Aug. 1, 2006, 77:4, pp. 591-597. |
| International Preliminary Report for Application No. PCT/US2004/018244, dated Dec. 13, 2005, in 11 pages. |
| International Search Report and Written Opinion issued in PCT Application No. PCT/US2013/039770, dated Sep. 25, 2013. |
| International Preliminary Report on Patentability issued in PCT Application No. PCT/US2013/039770, dated Nov. 11, 2014. |
| International Search Report and Written Opinion issued in PCT Application No. PCT/US2013/041556, dated Sep. 13, 2013. |
| International Preliminary Report on Patentability issued in PCT Application No. PCT/US2013/041556, dated Nov. 18, 2014. |
| International Search Report and Written Opinion issued in PCT Application No. PCT/US2013/053182, dated Nov. 11, 2013. |
| International Search Report for Application No. PCT/US2004/018244, dated Feb. 15, 2005, in 4 pages. |
| International Search Report for International Application No. PCT/US2009/051769 dated Nov. 19, 2009, in 11 pages. |
| International Search Report for International Application No. PCT/US2009/051769 dated Nov. 19, 2009, in 3 pages. |
| International Search Report for International Application No. PCT/US2011/022162, dated Jun. 16, 2011, in 4 pages. |
| International Search Report for International Application No. PCT/US2009/056553, dated Nov. 4, 2009, in 12 pages. |
| International Preliminary Report on Patentability issued in PCT Application No. PCT/US2013/053182, dated Feb. 17, 2015, in 10 pages. |
| Jenny, et al., Computer-Assisted Implantation of Total Knee Prosthesis: A Case-Control Comparative Study with Classical Instrumentation, Computer Aided Surgery, 2001, vol. 6, pp. 217-220. |
| Konyves et al., “The importance of leg length discrepancy after total hip arthroplasty”, The Journal of Bone & Joint Surgery (Br), Feb. 2005, vol. 87-B, No. 2, pp. 155-157. |
| Leenders, MD., et al., “Reduction in Variability of Acetabular Cup Abduction Using Computer Assisted Surgery: A Prospective and Randomized Study”, Computer Aided Surgery, 2002, vol. 7, pp. 99-106. |
| Leung, et al., Intraobserver Errors in Obtaining Visually Selected Anatomic Landmarks During Registration Process in Nonimage-based Navigation-assisted Total Knee Arthroplasty, The Journal of Arthroplasty, 2005, vol. 20, Issue 5, pp. 591-601. |
| Liebergall, Meir, et al., “Computerized Navigation for the Internal Fixation of Femoral Neck Fractures”, The Journal of Bone & Joint Surgery Am, 2006, vol. 88, pp. 1748-1754. |
| Longo, et al., MIKA Surgical Technique, DJO Surgical, 2008, Austin Texas in 14 pages. |
| Luinge, Inertial Sensing of Human Movement, Twente University Press, Feb. 15, 1973, Pages in 88 pages. |
| MacKenzie, et al., A Two-Ball Mouse Affords Three Degrees of Freedom, Extended Abstracts of the CHI '97 Conference on Human Factors in Compounding Systems (as printed from the internet on Jun. 13, 2012 URL: http://www.yorku.ca/mack/CHI97a.htm), 1997, pp. 303-304. |
| Medical Research Ltd, Clinical Goniometer, http://www.mie-uk.com/Gonio, 1997, pp. 1 page. |
| Minimally Invasive TKA Genesis II Anterior Cut First, Surgical Technique, Smith & Nephew, Nov. 2003, Memphis TN, in 16 pages. |
| Noble et al., “Computer Simulation: How Can it Help the Surgeon Optimize Implant Position?”, Clinical Orthopaedics and Related Research, Dec. 2003, vol. 417, pp. 242-252. |
| Parratte, Sebastien, et al., “Validation and Usefulness of a Computer-Assisted Cup-Positioning System in Total Hip Arthroplasty. A Prospective, Randomized, Controlled Study”, The Journal of Bone & Joint Surgery Am, 2007, vol. 89, pp. 494-499. |
| Ritter, M.D., et al., Postoperative Alignment of Total Knee Replacement, Its Effect on Survival, Clinical Orthopaedics and Related Research, Feb. 1, 1994, Issue 299, pp. 153-156, Philadelphia. |
| Rocon, et al., Application of Inertial Sensors and Rehabilitation Robotics, Rehabilitation Robotics 2007, Jun. 1, 2007, pp. 145-150. |
| Sacks-Davis et. al., Atlas: A nested Relational Database System for Text Applications, IEEE Transations on Knowledge and Data Engineering, v.7, n.3, Jun. 1995, pp. 454-470. |
| Schep, et al., “Computer assisted orthopaedic and trauma surgery State of the art and future perspectives”, Injury Int. J. Care Injured 34, (website: www.elsevier.com/locate/injury), 2003 pp. 299-306. |
| Scott, M.S., et al., P.F.C. Sigma Knee System, Primary Surgical Technique Part 1 of 2, DePuy International Ltd., 2003, England, (up to p. 44), in 48 pages. |
| Scott, M.S., et al., P.F.C. Sigma Knee System, Primary Surgical Technique Part 2 of 2, DePuy International Ltd., 2003, England, Part A (up to p. 74), in 31 pages. (This reference was split in two due to size exceeding over 25MB). |
| Scott, M.S., et al., P.F.C. Sigma Knee System, Primary Surgical Technique Part 2 of 2, DePuy International Ltd., 2003, England, Part B (up to p. 104), in 31 pages. (This reference was split in two due to size exceeding over 25MB). |
| Sikorski et al., “Computer-Assisted Orthopaedic Surgery: Do We Need CAOS?”, The Journal of Bone & Joint Surgery (Br), Apr. 2003, vol. 85-B, No. 3, pp. 319-323. |
| Slomczykowski, et al., “Novel Computer-Assisted Fluoroscopy System for Intraoperative Guidance: Feasibility Study for Distal Locking of Femoral Nails”, Journal of Orthopaedic Trauma, 2001, vol. 15, No. 2, pp. 122-131, Lippincott Williams & Wilkins, Inc., Philadelphia. |
| Stulberg, et al., Computer-Assisted Total Knee Replacement Arthroplasty, Operative Techniques in Orthopaedics, Jan. 2000, vol. 10, Issue 1, pp. 25-39. |
| The Academy of Orthopaedic Surgeons, Academy News, http://www.aaos.org/wordhtml/2001news/b6-01.htm, Mar. 1, 2001, pp. 1 page. |
| Tilt Sensors: High Accuracy, Digital Series, Crossbow Technology, Inc., pp. 32-35. |
| Upadhyay et al., “Medical Malpractice in Hip and Knee Arthroplasty”, The Journal of Arthroplasty, 2007, vol. 22, No. 6, Suppl. 2, pp. 2-7. |
| Visser, et al., 3D Analysis of Upper Body Movements in Bilateral Amputee Gait Using Inertial Sensors, Journal of Biomechanics, Jan. 1, 2007, vol. 40, Issue S509. |
| Written Opinion for International Application No. PCT/US2009/051769, dated Nov. 19, 2009, in 7 pages. |
| Written Opinion for International Application No. PCT/US2011/022162, dated Jun. 16, 2011, in 9 pages. |
| Written Opinion of the ISR for Application No. PCT/US2004/018244, in 10 pages. |
| Wylde et al., “Prevalence and functional impact of patient-perceived leg length discrepancy after hip replacement”, International Orthopaedics, 2009, vol. 33, pp. 905-909. |
| Wylde et al., “Patient-perceived leg length discrepancy after total hip replacement: prevalence and impact on functional outcome”, International Orthopaedics, 2008, vol. 24, No. 2, pp. 210-216. |
| Zhou, et al., Use of Multiple Wearable Inertial Sensors in Upper Limb Motion Tracking, Medical Engineering & Physics, Jan. 1, 2008, vol. 30, pp. 123-133. |
| Zimmer NexGen Flexion Balancing Instruments, Surgical Technique, 2007, www.zimmer.com, in 44 pages. |
| Zorman, David, et al., “Computer-assisted total knee arthroplasty: comparative results in a preliminary series of 72 cases”, ActaOrthop. Belg., 2005, 71, pp. 696-702. |
| Number | Date | Country | |
|---|---|---|---|
| 20160278943 A1 | Sep 2016 | US |
| Number | Date | Country | |
|---|---|---|---|
| 61297215 | Jan 2010 | US | |
| 61297212 | Jan 2010 | US | |
| 61369390 | Jul 2010 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 13398712 | Feb 2012 | US |
| Child | 15052071 | US | |
| Parent | 13115065 | May 2011 | US |
| Child | 13398712 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 12509388 | Jul 2009 | US |
| Child | 13115065 | US | |
| Parent | 13011815 | Jan 2011 | US |
| Child | 12509388 | US |
