Device and method for posterior resection in robotic-assisted partial knee replacement

Abstract

Devices, systems, and methods for controlling the gap height of posterior resection in partial knee replacement surgery may include: A) using robotic surgical planning software to adjust the extension gap to fit the flexion gap to manually position a manual posterior cutting guide; B) using a surgical navigation system to determine the femoral rotation axis to correctly manually position the manual posterior cutting guide; C1) using shims to adjust the position of the manual posterior cutting guide; C2) using robotically guided femoral and tibial partial cutting guide blocks to position the robotically configured posterior cutting guide relative to the distal end of the femur; and D) using robotically guided femoral and tibial partial cutting guide blocks to guide the pin holes for the robotically configured posterior cutting guide relative to the distal end of the femur.

Description

Technical Field

[0001] The present disclosure relates to devices and methods for use in performing knee replacement surgery (e.g., total knee replacement surgery or partial knee replacement surgery). In certain examples, these devices and methods can be used to perform posterior resection. Background Art

[0002] Imaging of anatomical features may be useful in preparing for and performing surgery. For example, patient-specific instruments may be derived from patient imaging, and a robotic surgical system may be configured to track the patient's anatomy based on registration with the patient imaging.

[0003] Patient-specific instruments have been successfully used for many surgical procedures. By creating a three-dimensional (3D) model of the patient's anatomy from medical images, the surgery can be customized using virtual 3D surgical planning for the specific patient. Virtual 3D surgical planning can be used to create patient-specific cutting guides and instruments that fit the specific patient's anatomy in a unique way, thereby accurately reproducing the planned surgery compared to joint replacements using conventional or standard instruments.

[0004] In a robotic surgical system, the shape of the anatomical structure in the patient's imaging can be registered with another reference frame, such as the physical space of the operating room where the robotic surgical system is located. During surgery, a robotic surgical arm can be used to hold a variety of instruments in place at a desired orientation relative to the anatomical structure and the operating room, so that the movement of the instruments in the operating room relative to the anatomical structure can be tracked on the anatomical imaging based on the movement of the robotic surgical arm. Therefore, the instruments need to be accurately mounted on the robotic surgical arm.

[0005] Both patient-specific surgery and robotic surgery have been applied to knee replacement. Total and partial knee replacements can be complex procedures that utilize multiple different instruments that are switched during the procedure and cause the anatomy to be repositioned throughout the procedure, increasing the time and cost of the procedure. U.S. Patent No. US10,136,952 to Couture et al. and U.S. Publication No. US2018 / 0116740 to Gogarty et al. describe cutting guides and tools for use in knee replacement. Summary of the invention

[0006] The inventors of the present invention have particularly recognized that the problem to be solved with conventional partial knee replacements relates to positioning the aligned knee joint to receive a prosthetic device that engages the tibia and femur. Thus, the resection depths of the tibia and femur must be coordinated to ensure a gap height to properly position the prosthetic device throughout knee flexion. Gap height is difficult to maintain in conventional surgery because different guides and instruments are moved in and out of the surgical site for different resections (e.g., distal and posterior cuts of the femur and proximal and sagittal cuts of the tibia).

[0007] The inventors of the present invention have also particularly recognized that the problems to be solved by using traditional partial knee replacements include the need to attach multiple instruments to correctly resect the tibia and femur, especially in partial knee replacements where only the posterior portion of one condyle is resected. Each of these instruments needs to be properly aligned with the knee joint to particularly ensure the proper gap height. Using too many instruments can be annoying for the surgeon due to the increased complexity of the surgery and the prolonged surgery time. In addition, due to the complexity of having to attach multiple instruments to the robotic surgical arm and the need to separately register each of these instruments, surgeries requiring multiple instruments have traditionally been unsuitable for robot-assisted surgery.

[0008] The present subject matter can provide solutions to these and other problems, for example by providing solutions that allow surgeons or surgical planners to plan gap height control for posterior resection of a unicompartmental knee arthroplasty. These solutions may include one or more of the following options: A) using robotic surgical planning software to adjust the extension gap to accommodate the flexion gap to manually position a manual posterior cutting guide or facilitate robotic placement of a posterior cutting guide; B) using a surgical navigation system to determine the femoral rotation axis to correctly manually position a manual posterior cutting guide or facilitate robotic placement of a posterior cutting guide; C1) using shims to adjust the position of a manual posterior cutting guide; C2) using robotically guided femoral and tibial partial cutting guide blocks to position a robotically configured posterior cutting guide relative to the distal end of the femur; and D) using robotically guided femoral and tibial partial cutting guide blocks to guide pin holes for a robotically configured posterior cutting guide relative to the distal end of the femur.

[0009] In one example, a method for aligning a posterior resection guide with a distal femoral surface may include: with a knee joint in flexion, positioning a posterior resection guide near a proximal resection surface of the tibia and a posterior surface of the femur; displaying a representation of the distal end of the femur on a graphical display, with an alignment axis displayed on the representation; engaging a tracking device to the posterior resection guide; tracking an anterior tip of the posterior resection guide on the graphical display; and rotating the posterior resection guide to align the anterior tip with the alignment axis on the graphical display.

[0010] In another example, a system for performing a femoral resection for a partial knee replacement may include: a surgical robot comprising an articulated arm configured to move within a coordinate system of the surgical robot; a femoral resection guide instrument comprising: a connector for connecting to the articulated arm; an extension arm extending from the connector; and a resection block attached to the extension arm; and a finishing guide for performing a posterior resection of the distal femur, wherein the finishing guide can be positioned by the surgical robot to determine the thickness and rotation of the posterior cut.

[0011] In another example, a method for resecting the distal femur for partial knee replacement may include: attaching a resection guide instrument to an articulated arm of a robotic surgical system; moving the resection guide device to the anterior or posterior side of the distal end of the femur; resecting the distal end of the femur to form a distal resection surface; moving the resection guide instrument to the distal resection surface; drilling a hole in the distal resection surface through a guide hole in the resection guide instrument; inserting a pin into the drilled hole; attaching a finishing guide to the inserted pin; and using the finishing guide to guide a cutting instrument to resect the posterior side of the femur near the distal resection surface.

[0012] In another example, a method for aligning a posterior resection guide with a distal resected femoral surface may include: positioning the posterior resection guide near the distal resected femoral surface; inserting a flange of the posterior resection guide between the posterior surface of the femur and the proximal resected surface of the tibia; moving the posterior resection guide in a medial-lateral direction to observe the edge thickness between the anterior edge of the posterior resection guide relative to the edge of the distal resected femoral surface; and setting a shim near the flange to change the edge thickness.

[0013] In yet another example, a system for performing femoral resection for partial knee replacement may include: a surgical robot, a tracking system, a tracker, a finishing guide, and a controller. The surgical robot may include an articulated arm configured to move within a coordinate system of the surgical robot. The tracking system may be configured to determine the position of one or more trackers in the coordinate system. The tracker may be configured to be tracked by the tracking system. The finishing guide may be configured to be connected to the articulated arm to perform posterior resection of the distal femur. The controller for the surgical robot may include: a communication device configured to receive data from the surgical robot and the tracking system and send data to the surgical robot and the tracking system; a display device for outputting visual information from the surgical robot and the tracking system; and a non-transitory storage medium in which computer-readable instructions are stored, the instructions including: marking a digital position at the distal end and the posterior surface of the distal end of the femur using a tracker; displaying the digital position of the distal end and the posterior surface on the display device; drawing a target axis extending through the distal end and the posterior surface on the display device; projecting the target axis onto the anterior surface of the femur; and moving the articulated arm to align the finishing guide along the target axis. BRIEF DESCRIPTION OF THE DRAWINGS

[0014] Figure 1 is a schematic diagram of an operating room including a robotic-assisted surgery system including a robotic arm, a computing system, and a tracking system.

[0015] Figure 2 yes Figure 1 Schematic diagram of a robotic arm that includes a resection instrument configured to provide a cutting guide function and serve as a platform for mounting components for other surgical steps that may be used, for example, to perform a partial knee replacement.

[0016] Figure 3A is a perspective view of a posterior resection guide inserted between the femur and tibia of a patient's knee joint.

[0017] Figure 3B It is inserted between the femur and tibia. Figure 3A Anterior view of the posterior resection guide.

[0018] Figure 3C is a perspective view of a pointer connected to a tracking device.

[0019] Figure 3D The target axis is shown on the distal end of the femur F.

[0020] Figure 4A is a side view of a partial knee resection guide placed against the resected distal end of the femur.

[0021] Figure 4B is used for Figure 4A A perspective view of the tool base of a partial knee resection guide attached to an extension arm.

[0022] Figure 4C yes Figure 4A A perspective view of a posterior resection guide of claim 1, which may be configured to include an attachment portion for coupling to a resection instrument.

[0023] Figure 4D yes Figure 4C A side view schematic diagram of a posterior resection guide showing the attachment portion.

[0024] Figure 5A is a front view of a robotically configured posterior cutting guide showing a coupling portion for connecting to a robotically guided resection instrument.

[0025] Figure 5B is a front view of a resection block for a robotically guided resection instrument configured to be coupled to Figure 5A Posterior cutting guide for the robot configuration.

[0026] Figure 6 is a schematic diagram of a surgical planning user interface for determining and configuring extension gap resection and flexion gap resection for a partial knee arthroplasty.

[0027] Figure 7 is a schematic diagram of a robotic surgical system incorporating the resection guide instrument of the present invention and a finishing guide adapter interacting with a tracking system.

[0028] Figure 8 is a block diagram of an example machine on which any one or more of the techniques discussed herein may be implemented and with which any of the devices discussed herein may be used, according to some embodiments. DETAILED DESCRIPTION

[0029] Figure 1A surgical system 100 is shown for operating on a surgical area 105 of a patient 110 in accordance with at least one example of the present disclosure. In one example, the surgical area 105 may include a joint, and in another example, the surgical area 105 may be a bone. The surgical area 105 may include any surgical area of ​​the patient 110, including but not limited to the shoulder, knee, head, elbow, thumb, spine, etc. The surgical system 100 may also include a robotic system 115 having one or more robotic arms (e.g., robotic arm 120). As shown, the robotic system 115 may utilize only a single robotic arm. The robotic arm 120 may be a 6-degree-of-freedom (DOF) robotic arm, such as the one from Medtech company, Zimmer Biomet Holdings, Inc. In some examples, the robotic arm 120 is controlled in coordination with the surgeon's input on the end effector or surgical instrument (e.g., surgical instrument 125). In other examples, the robotic arm 120 can operate autonomously. Figure 1 Although not shown in FIG. 1 , one or more positionable surgical support arms may be incorporated into surgical system 100 to assist in positioning and stabilizing instruments or anatomical structures during various procedures.

[0030] Each robotic arm 120 can rotate axially and radially and can receive a surgical instrument or end effector 125 at a distal end 130. The surgical instrument 125 can be any surgical instrument suitable for use by the robotic system 115, including, for example, a guide tube, a holder device, a clamping device such as a clamp, a deburring device, a reaming device, an impactor device such as a humeral head impactor, an indicator, a probe, a cutting guide, an instrument guide, an instrument holder, or a universal instrument adapter device described herein, etc. The surgical instrument 125 can be positioned by the robotic arm 120, which can include a plurality of robotic joints (e.g., joints 135) that allow the surgical instrument 125 to be positioned at any desired location near or within a given surgical area 105. As described below, the robotic arm 120 can be used with Figure 3A-3D The posterior resection guide 300 is used together with the resection guide instrument 200 ( Figure 2 ) to perform a partial knee replacement. The robotic arm 120 may also be used with Figure 4A-4D As well as Figure 5A and Figure 5B In addition, Figure 6 The surgical planning interface can be used in conjunction with the robotic arm 120.

[0031] The robotic system 115 may also include a computing system 140 that can operate the robotic arm 120 and the surgical instrument 125. The computing system 140 may include at least a memory, a processing unit, and a user input device, as will be described herein. The computing system 140 and the tracking system 165 may also include a human-machine interface device 145 for providing the surgeon with images to be used during surgery. The computing system 140 is illustrated as a separate stand-alone system, but in some examples, the computing system 140 may be integrated into the robotic system 115. The human-machine interface device 145 may provide images, including but not limited to images of bones, glenoid fossa, knee, joints, and the like. The human-machine interface device 145 may include an associated input mechanism, such as a touch screen, a foot pedal, or other input device compatible with the surgical environment.

[0032] The computing system 140 can receive preoperative medical images, intraoperative medical images, and postoperative medical images. These images can be received in any manner, and the images can include, but are not limited to, computed tomography (CT) scans, magnetic resonance imaging (MRI), two-dimensional X-rays, three-dimensional X-rays, ultrasound, etc. In one example, these images can be sent via a server as a file attached to an email. In another example, the images can be stored on an external storage device (e.g., a memory stick) and connected to a USB port of the robotic system to be uploaded to the processing unit. In other examples, the computing system 140 can access these images from a remote storage device or server over a network.

[0033] After receiving one or more images, computing system 140 can generate one or more virtual models related to surgical area 105. As a selection, computer system 140 can receive a virtual model of the anatomical structure of the patient prepared remotely. Specifically, a virtual model of the anatomical structure of patient 110 can be created by defining anatomical structure points in an image and / or by fitting a statistical anatomical structure model to image data. The virtual representation of this virtual model and implant can be used to perform calculations related to the expected position, height, depth, tilt angle or torsion angle (version angle) of implants, handles, acetabular cups, glenoid cups, total ankle prostheses, total knee prostheses and partial knee prostheses, surgical instruments, etc. to be used in surgical area 105. In another type of surgery, a virtual model can be used to determine the resection position on the femur and tibia to implement partial knee replacement. In a specific example, a virtual model can be used to determine the gap height for femoral posterior resection relative to the tibia resected proximally. Virtual models can also be used to determine bone size, implant size, bone fragment size, bone fragment arrangement, etc. Any model generated, including a three-dimensional model, may be displayed on the human-machine interface device 145 for reference during surgery or used by the robotic system 115 to determine the motion, action, and operation of the robotic arm 120 or surgical instrument 125. Known techniques for creating virtual skeletal models may be utilized, for example, as discussed in U.S. Pat. No. 9,675,461, entitled “Deformable articulating template,” or U.S. Pat. No. 8,884,618, entitled “Method of generating a patient-specific bone shell,” both to Mohamed Rashwan Mahfouz, as well as other techniques known in the art.

[0034] The computing system 140 may also communicate with a tracking system 165, which may be operated by the computing system 140 as a standalone unit. The surgical system 100 may utilize a Polaris optical tracking system. In addition, the tracking system 165 may include a tracking system shown and described in U.S. Publication No. 2017 / 0312035, entitled "Surgical System Having Assisted Navigation" by Brian M. May, the entire contents of which are incorporated herein by reference. The tracking system 165 may monitor a plurality of tracking elements (e.g., tracking element 170) fixed to an object of interest to track the positions of a plurality of objects within a surgical area. The tracking system 165 may be used to create a virtual three-dimensional coordinate system within a surgical area to track a patient's anatomical structure, a surgical instrument, or a portion of a robotic system 115. The tracking element 170 may be a tracking frame including a plurality of IR reflective tracking balls or similar optically tracked marker devices. In one example, the tracking element 170 may be placed on or near one or more bones of the patient 110. In other examples, tracking elements 170 can be placed on the robotic arm 120, surgical instrument 125, and / or implant to accurately track positions in a virtual coordinate system associated with the surgical system 100. In each case, the tracking element 170 can provide positional data, such as patient position, bone position, joint position, robotic arm position, implant position, etc.

[0035] The robotic system 115 may include a variety of additional sensors and guides. For example, the robotic system 115 may include one or more force sensors, such as a force sensor 180. The force sensor 180 may provide additional force data or information to the computing system 140 of the robotic system 115. The surgeon may use the force sensor 180 to collaboratively move the robotic arm 120. For example, the force sensor 180 may be used to monitor impact forces or implantation forces during certain operations, such as inserting an implant handle into a humeral canal. Monitoring forces may help prevent negative outcomes through force fitting components. In other examples, the force sensor 180 may provide information about soft tissue tension in tissue surrounding a target joint. In some examples, the robotic system 115 may also include a laser pointer 185 that may generate a laser beam or array for aligning an implant during surgery.

[0036] To ensure that the computing system 140 moves the robotic arm 120 to the surgical area 105 and the patient 110 in a known and fixed relationship, the surgical area 105 and the patient 110 may be spatially registered to the computing system 140 via a registration process that registers the fiducial markers attached to the patient 110 with corresponding images of the markers recorded on the patient 110 preoperatively or just prior to surgery. For example, a plurality of fiducial markers may be attached to the patient 110, and an image of the patient 110 with the fiducial markers may be acquired or obtained and stored in a storage device of the computing system 140. Subsequently, the patient 110 with the fiducial markers (if not already there due to imaging) may be moved into the surgical area 105 and the robotic arm 120 may contact each fiducial marker. The engagement of each fiducial marker may be cross-referenced with or registered to the location of the same fiducial marker in the image. In another example, the patient 110 and the medical image of the patient can be registered in real space using a non-contact method, such as by using a laser rangefinder held by the robotic arm 120 and a surface matching algorithm that can match the scanned patient surface from the laser rangefinder with the patient surface in the medical image. In this way, the real-world three-dimensional geometry of the anatomical structures attached to the fiducial markers can be related to the anatomical structures in the image, and the movement of the instrument 125 attached to the robotic arm 120 based on the image will occur accordingly in the surgical field 105.

[0037] Subsequently, other instruments and devices attached to the surgical system 100 can be positioned by the robotic arm 120 in a known and desired orientation relative to the anatomy. For example, the robotic arm 120 can be coupled to Figure 2 The present invention provides a resection guide instrument 200 that can be used to guide resections on multiple bones (e.g., the proximal tibia and the distal femur) and allows other instruments (e.g., a finishing guide or a posterior cutting guide) to be attached to the robotic arm without having to continuously couple each instrument to the robotic arm and without having to individually register each attached instrument with a coordinate system. The robotic arm 120 can move the resection guide instrument 200 relative to the patient's anatomy so that the surgeon can perform the desired interaction with the patient at a specific location required by the surgical plan using the attached instrument after adding and removing another instrument to the guide instrument as needed.

[0038] Figure 2 yes Figure 1 Schematic diagram of a robotic arm 120, the robotic arm 120 includes a resection guide instrument 200, the resection guide instrument 200 can be used by the robotic arm 120 according to a surgical plan (e.g., a plan based on preoperative imaging or at least partially based on, for example, a reference Figure 3D The intraoperative planning described herein) is relative to the surgical area 105 ( Figure 1) is positioned in a desired orientation. The resection guide instrument 200 may include a tool base 202, an extension arm 204, and a guide block 206. The extension arm 204 may include a first segment 208 and a second segment 210, as well as additional segments in other examples. The guide block 206 may include a body 212, a guide surface 214, and an interface 216. In one example, the guide block 206 may be configured as a resection block for use in a partial knee replacement, and thus, the guide block 206 may be used to perform proximal resection of the tibial plateau and distal resection of the femoral condyle. In addition, a posterior resection guide such as 430 ( Figure 4C and Figure 4D ) and a posterior resection guide 500 ( Figure 5A ) may be coupled to guide block 206.

[0039] The robotic arm 120 may include a joint 135A that allows rotation about an axis 216A, a joint 135B that may allow rotation about an axis 216B, a joint 135C that may allow rotation about an axis 216C, and a joint 135D that may allow rotation about an axis 216D.

[0040] In order to compare with patient 110 ( Figure 1 ) of the anatomical structure positioning resection guide instrument 200, the surgical system 100 ( Figure 1 ) The robotic arm 120 may be manipulated automatically by the computing system 140 or by a surgeon manually manipulating the computing system 140 to move the resection guide instrument 200 to a desired position (e.g., a position required by the surgical plan) to align the instrument with the anatomical structure. For example, the robotic arm 120 may be manipulated along the axes 216A-216D to position the resection guide instrument 200 such that the guide block 206 is positioned in a desired position relative to the anatomical structure. In this way, steps of the surgical procedure may be performed, for example, by using the guide surface 214. However, subsequent steps of the surgical procedure may be performed using the resection guide instrument 200 without having to separate the instrument 200 from the robotic arm 120. For example, other instruments may be attached to the block 206 at the interface 216. The other instruments attached at the interface 216 may be used without having to re-register the additional instruments to the coordinate system because the size and geometry of the resection guide instrument 200 and the other instruments to be used therewith may be a desired size and geometry of the surgical system 100 ( Figure 1 ) is known so that the position of the guide block 206 and the instrument attached thereto can be calculated by the system 100 as the robotic arm 120 moves through the entire coordinate system.

[0041] The robotic arm 120 can be used, for example, by using a tracking element 170 ( Figure 1) are individually registered to the coordinate system of the surgical system 100. The fiducial markers can also be separately registered to the coordinate system of the surgical system 100 via engagement with a probe to which the tracking element 170 is attached. The resection guide instrument 200 can be registered to the coordinate system via coupling with a robotic arm. The tracking element 170 ( Figure 1 ) and tracking element 708 ( Figure 7 ) to align other components, such as indicator 326 ( Figure 3B and Figure 3C ) and posterior resection guide ( Figure 4C and Figure 4D ). In this way, some or all of the components of surgical system 100 can be individually registered to the coordinate system (with or without the aid of tracking elements), and the movement of these components can be continuously or intermittently tracked using tracking elements 170 if desired.

[0042] In certain robotic procedures, instruments may be individually and separately tracked using an optical navigation system, which ideally alleviates the need to accurately maintain the axis 212 and the position of the instrument along the axis 212 through the surgical procedure or surgical task because the optical navigation system can provide information to the surgical computer system to compensate for any changes. However, since the optical navigation system requires maintaining a line of sight of the instrument, it has significant advantages in situations where the instrument is not required to be navigated (or at least not frequently). The resection guide instrument 200 allows multiple instruments to be registered to the robotic system 115 without tracking each instrument individually. The robotic system 115 can know the precise position of the robotic arm 120, and the geometry and size of the resection guide instrument 200 can be registered to the robotic system 115. In this way, the position of the guide block 206 in the surgical space can be determined as the robotic arm 120 moves the guide block 206 within the surgical space. Furthermore, the robotic system 115 may be provided, for example, in a non-transitory computer readable storage medium, wherein the geometry and dimensions of the instrument are configured to be attached to the guide block 206, such that the position of the attached instrument may also be tracked as the robotic arm 120 moves. Thus, separate tracking or registration of the attached tool may be avoided, if desired.

[0043] Figure 3A-3D An apparatus and method for determining the femoral axis of rotation for partial knee replacement is shown. Figure 3A-3DShown is a device and method for using a surgical navigation system to determine the femoral rotation axis to properly manually position a posterior cutting guide or facilitate robot-guided posterior cutting guide placement, which in turn allows for appropriate rotational positioning of a femoral implant. In a specific example, the posterior excision cutting guide can be a device configured to be manually positioned and aligned. Typically, such a device is aligned using the surgeon's skill and experience by visually assessing the position of the device relative to the distally excised femur. Figure 3D A method for using a navigation system to determine an axis along the femur is shown, which can be used to align the posterior cutting guide manually or robotically.

[0044] Figure 3A 300 is a perspective view of a posterior resection guide 300 inserted between a femur F and a tibia T. A handle 302 may be connected to the posterior resection guide 300. In the example shown, the posterior resection guide 300 includes a unicondylar resection guide configured to guide resection along the posterior portion of a single condyle at the distal end of the femur F. The posterior resection guide 300 may include a body 304 and a flange 306. The body 304 may be configured to be coupled to the handle 302, for example, by including a socket or adapter that receives a mating component on the handle 302. The body 304 may additionally include features for guiding a cutting instrument or other instrument relative to the femur F. For example, the body 304 may include a posterior cutting guide surface 308, a beveled guide surface 310, an anterior nail guide hole 312, a posterior nail guide hole 314, and pin holes 316A, 316B, and 316C. The femur F includes a distal resection surface 318 , while the tibia T includes a proximal resection surface 320 .

[0045] The posterior resection guide 300 can be inserted between the femur F and the tibia T so that the flange 306 contacts the proximal resection surface 320 and the body 304 contacts the distal resection surface 318. A set of posterior resection guides 300 can be provided, wherein each posterior resection guide 300 has a body 304 of different sizes, which is configured to implant prosthetic components of different sizes into bones of different sizes. The posterior resection guide 300 can also be referred to as a finishing guide because other features of the body 304 can be used to finish the distal end of the femur F to receive a prosthetic device. For example, the cutting guide surface 310 can be used to implement a bevel that forms an inclined surface between the resection surface 318 and the surface on which the cutting guide surface 308 is formed. Moreover, the guide holes 312 and 314 can be used to drill holes to receive fixation features (e.g., nails) of a prosthetic device such as a unicompartmental prosthetic device. Pin holes 316A-316B may be used to insert pins or nails into resection surface 318 to temporarily secure posterior resection guide 300 to femur F while posterior resection guide 300 is used to modify the bone in order to stabilize the cut being made.

[0046] Figure 3B 300 is a front view of a posterior resection guide 300 inserted between a femur F and a tibia T. The position of the posterior resection guide 300 can be visually checked to determine the position of the body 304 relative to the distal resection surface 318 by evaluating the distance between the edge of the distal resection surface 318 and the body 304, which affects the thickness of the posterior cut. In an example, a shim can be positioned near the flange 306 to change the amount of bone removed along the posterior cut. For example, shims with a predetermined thickness can be used individually or stacked to change the distance between the edge of the body 304 and the resection surface 318. When properly sized, at least 2 mm of the edge of the bone is exposed between the edge of the distal resection surface 318 and the body 304. However, it is sometimes difficult to assess the position of the posterior resection guide 300 due to the pivoting effect caused by the engagement between the unresected condyle and the unresected portion of the proximal end of the tibia T between the multiple resection portions and due to the patient's tissue blocking visibility. In the present disclosure, the indicator 322 may be used to facilitate alignment of the posterior resection guide 300 , such as with the front tip 324 placed medially-laterally on the distal resection surface 318 .

[0047] Figure 3C 3 is a perspective view of the indicator 326. The indicator 326 may include a tip 328, a shaft 330, and a tracker device 332. The indicator 326 may include a device for contacting a specific location in the coordinate system of the robotic system 115 (or computing system 140) using the tracking device 332. The tracking device 332 may include a tracking array (e.g., Figure 1334 and the tracking element 170 of the surgical system 100, which can provide position information to the robotic system 115. The tracking device 332 can be inserted into the socket 334 and fixed to the socket 334 by a pin or the like to fix the position of the tracking device 332 relative to the tip 328. The tip 328 can include a tip of a shaft 330, which can be used to engage the patient's tissue to mark a position for the coordinate system of the robotic system 115. In other examples, other instruments with pre-configured or fixed geometric structures can be used in conjunction with the tracking device to mark a position for the coordinate system. For example, when the tracking device 332 provides a reading to the surgical system 100, the tip 328 can be pressed into the bone. Thus, the tracking device 332 can provide an indication of the position of the indicator axis 336 to the robotic system 115. The indicator 326 can further include a handle 338. The handle 338 can provide an ergonomic grip for the indicator 326 to allow operation by a surgeon. To improve the accuracy of the registration process, it is desirable to extend the indicator shaft 330 by a certain length to increase the position reading of the axis 336 taken at the tip 328. It is also desirable to position the handle 338 proximate the tip 328 to allow the surgeon to easily place the tip 328 in the desired position.

[0048] The posterior resection guide 300 may be engaged with an indicator 326 to track the position and orientation of the posterior resection guide 300 relative to the femur F. In particular, the indicator 326 may be used to align the posterior resection guide 300 with the target axis 340 ( Figure 3C ) to facilitate alignment of the posterior resection guide 300 to determine the appropriate gap height.

[0049] Figure 3D The target axis 340 is shown shown on the distal end of the femur F. In one example, the patient of the femur F and tibia T can be imaged using, for example, known techniques to determine the target axis 340 preoperatively. In other examples according to the present disclosure, the target axis 340 can be determined intraoperatively. The target axis 340 can be determined before the distal end of the femur F is resected to remove any condyles. For example, the target axis 340 can be determined before resecting either of the femur F and tibia T, or after resecting the tibia T to form the proximal resection surface 320 and with a shim 342 interposed between the femur F and the tibia T.

[0050] The target axis 340 may include a distal point 344 and a posterior point 346. The distal point 344 may be determined, identified, and marked with the tibia T positioned in extension relative to the femur F. A physical marker may be placed on the femur F or a digital marker may be placed on an image of the femur F using the robotic system 115 (or computing system 140) at the location where the tibial plateau of the tibia T contacts the condyle of the femur F. The marker may be drawn on the femur F or a scratching tool (e.g., a pin) may be used to scratch into the femur F. In addition, the indicator 326 may be used to digitally mark the location of the distal point 344 by engaging the tip 328 with the junction between the tibial plateau and the condyle. Next, the tibia T may be rotated relative to the femur F to a flexed position so that the posterior point 346 may be physically or digitally determined, identified, and marked using a method similar to marking the distal point 344. A line 348 may be extended between the distal point 344 and the posterior point 346 to facilitate projection of the location of the anterior point 350. The projection of line 348 can follow the anterior side of femur F to anterior point 350 to find the rotational (e.g., medial-lateral) position of the anterior tip 324 of the body 304 of the posterior resection guide 300, which allows for proper rotational placement of a femoral implant installed according to drilling, etc., using the posterior resection guide 300. For example, the tracker 326 can engage the tip 324 and the posterior resection guide 300 can be rotated medially-laterally until the tip 324 is positioned in extension of line 348, thereby indicating the proper position for the posterior resection guide 300. For example, a digital representation of the indicator axis 336 can be displayed on a user interface device (e.g., Figure 1 324) to facilitate alignment with a digitally generated version of the target axis 340 also shown on the user interface device. In addition, the physical device of the posterior resection guide 300 can be aligned with a physical line scored or drawn on the femur F. In other examples, a tracking device such as a tracker 326 can be directly coupled to the posterior resection guide 300, for example by being inserted into a socket or threaded hole, rather than simply engaging with the tip 324.

[0051] Figure 4A is a side view of the partial knee resection guide 400 resting against the resected distal end of the femur F. Figure 4B is a perspective view of the tool base 402 of the partial knee resection guide 400 attached to the extension arm 404. Figure 4A and Figure 4B In an example, the partial knee resection guide 400 can be configured in a manner similar to the cutting guides disclosed in U.S. Patent No. 10,136,952 to Couture et al. and U.S. Publication No. 2018 / 0116740 to Gogarty et al.

[0052] The partial knee resection guide 400 may include a tool base 402, an extension arm 404, and an adapter block 406, which may include a resection block ( 406 ) for resecting a distal portion of the femur F, a proximal point of the tibia T, and for mounting the posterior resection guide 300. Figure 3A-3B ) and its variants ( Figure 4C and Figure 5A ). The adapter block 406 may include both instruments and adapters for attaching other instruments to the extension arm 404 and, therefore, to the robotic arm 120. For example, the guide surface 408 may include a guide surface for guiding or otherwise engaging a cutting instrument, such as a reciprocating or oscillating saw blade, to cut bone, such as the upper portion of the tibia T and the distal portion of the femur F. The interface 410 ( Figure 4C ) may include features that facilitate attachment of other instruments to the adapter block 406, such as ports, plugs, sockets, threaded couplings, notches, etc. In an example, the interface 410 ( Figure 4C ) may include one or more through holes, threaded holes, dovetail grooves, pins, pawls, chuck mechanisms and collets and combinations thereof.

[0053] Tool base 402( Figure 4B ) may include a pedestal 412 from which the extension arm 404 may extend, mounting slots 414A and 414B, and fasteners 416A and 416B. The tool base 402 may be coupled to the robotic arm 120 by inserting the fasteners 416A and 416B through the mounting holes 414A and 414B into mating holes of the robotic arm 120. The slot 418 may receive an alignment feature on the robotic arm 120 to ensure that the tool base 402 is properly installed.

[0054] The extension arm 404 may include a first segment 420 and a second segment 422 and other segments for positioning the adapter block 406 relative to the tool base 402. The segments 420 and 422 may include elongated rigid members extending from the tool base 402 in an end-to-end manner. The segments 420 and 422 may be configured to hold the resection block 406 in a fixed position relative to the tool base 402. This positional relationship may be stored in a non-transitory computer-readable storage medium for the robotic system 115 or the computing system 140. The segments 420 and 422 may be tubular or solid bodies that are angled relative to each other to position the resection block 406 relative to the tool base 402, such as in a position that facilitates the surgeon's access to the resection block 406 while the robotic arm 120 does not obstruct the surgeon. In one example, the first segment 420 may extend vertically or substantially vertically from the tool base 412 to a front surface 423 ( Figure 4A). In other examples, segments 420 and 422 may include curved segments. In various examples, segments 420 and 422 may be located in the same plane or may be in planes that are inclined relative to each other. Additionally, other distal segments at the ends of segment 422 may taper downward toward the resection block 406 to reduce the occupied space against the resection block 506.

[0055] The cut-out block 406 may include a body 424 that provides a platform for the guide surface 408 and the interface 410. The body 424 may further include a Figure 4C ) holes 426A and 426B.

[0056] refer to Figure 4C , the guide surface 408 may include a flat surface against which the cutting instrument may be engaged to implement the cutting process. In the illustrated example, the guide surface 408 may include a notch defined on four sides, for example, the front body 424 may provide an upper side, a lower side, and a lateral side around the guide surface 408. However, in other examples, the guide surface 408 may include an unbounded ledge or a partially bounded ledge, such as a partial notch. The guide surface 408 may be positioned toward one side of the body 424 to increase visibility of the anatomical structure behind the resection block 406. For example, the guide surface 408 may be positioned near the top surface so that the surgeon can view the anatomical structure located above the top of the resection block 406 while allowing the lower portion of the body 424 to include holes 426A and 426B for the interface 410. The size of the guide surface 408 may be determined, for example, with a width suitable for resecting a single femoral condyle or half of the tibial plateau.

[0057] Holes 426A and 426B may include through holes extending from the front surface of body 424 all the way through to the rear surface of body 424. Thus, holes 426A and 426B may provide a port for inserting a pin through body 424 into the patient's anatomy. The pin may be used, for example, to anchor resection block 406 while bone cutting occurs to ensure a straight cut. Additionally, holes 426A and 426B may include a portion of interface 410.

[0058] The interface 410 and the guide surface 408 may also include a device for facilitating coupling another instrument to the resection block 406. In other examples, the interface 410 may include a socket with one or more sockets for receiving a mating component on an additional instrument. In the illustrated example, the interface 410 may include holes 426A and 426B. The holes 426A and 426B may include multiple contact points between the resection block 406 and the mating instrument to facilitate rotational alignment. In an example, one or more of the holes 426A and 426B may be threaded to receive a complementary threaded shaft or fastener. For example, the holes 426A and 426B may be threaded to receive a threaded fastener extending from an additional instrument, or may be a simple through hole to receive an alignment branch of an additional instrument.

[0059] Figure 4C is a perspective view of a posterior resection guide 430 including an attachment portion 432 . Figure 4D yes Figure 4C A schematic side view of the posterior resection guide 430. Figure 4C and Figure 4D .

[0060] The posterior resection guide 430 may be similar to Figure 3A and Figure 3B The posterior resection guide 430 is configured in the same manner as the posterior resection guide 300 of the present invention, except that the flange 306 is omitted and the attachment portion 432 is included. As such, the posterior resection guide 430 may include a body 433, a posterior cutting guide surface 434, a beveled guide surface 436, an anterior nail guide hole 438, and a posterior nail guide hole 440. The posterior resection guide 430 may include an attachment portion 432, which may include an upper extension 442, a coupling flange 444, and protrusions 446A and 446B. The attachment portion 432 may be used to couple the posterior resection guide 430 to the resection block 406. For example, the coupling flange 444 may be inserted into the guide surface 408 and / or the protrusions 446A and 446B may be inserted into the holes 426A and 426B, respectively. The coupling flange 444 and the protrusions 446A and 446B may be used alone or together in multiple examples of the posterior resection guide 430. In another example, one or both of coupling flange 444 and protrusions 446A and 446B may be omitted, and upper extension 442 may be inserted into a slot in body 424. Attachment portion 432 may be integral with body 433, or may be a separate component attached thereto.

[0061] The attachment portion 432 thus allows the posterior resection guide 430 to be coupled to the resection block 406, and therefore to the robotic arm 120. In this way, the posterior resection guide 430 can be robotically positioned relative to the femur F within the coordinate system of the robotic arm 120, thereby eliminating manual positioning of a posterior resection guide such as the posterior resection guide 300. The robotic system 115 can know the precise position of the robotic arm 120, and the geometry and size of the partial knee resection guide 400 can be registered to the robotic system 115 and the computing system 140. In this way, the position of the posterior resection guide 430 in the surgical space and the size and position of the features therein can be determined as the robotic arm 120 moves the posterior resection guide 430 within the surgical space. Therefore, the robotic arm 120 can align the posterior resection guide 430 to set the posterior resection guide 430 for the desired flexion gap. In order to eliminate interference with undesired contact with the femur F, the posterior resection guide 430 does not include a flange similar to the flange 306 ( Figure 3A ) flange. Therefore, based on the surgical plan or the surgeon's determination, the posterior resection guide 430 can be positioned at any position along the resected distal femoral surface to control the gap height between the resected proximal tibial surface and the resected posterior femoral surface without being limited by the thickness of the flange (e.g., flange 306). The robotic arm 120 can hold the posterior resection guide 430 in place while performing resection of the femur F. In one example, the robotic arm 120 can position the posterior resection guide 430 to align with the target axis 340 planned intraoperatively using the robotic system 115. A pin can be placed through the posterior resection guide 430 (e.g., at hole 448) into the femur F to stabilize the posterior resection guide 430 in place at the desired position, thereby implementing the posterior resection.

[0062] Figure 5A is a front view of a robotically configured posterior resection guide 500 showing a coupling portion for connecting to a robotically guided resection instrument. Figure 5B is a front view of a resection block for a robotically guided partial knee resection guide 502 configured to couple to Figure 5A A robotically configured posterior resection guide 500 is provided.

[0063] The posterior resection guide 500 may include a body 503 and a mounting flange 504. The posterior resection guide 500 may be mounted with Figure 3A and Figure 3B The posterior resection guide 500 may be configured in a similar manner to the posterior resection guide 300 of FIG. 5 , except that the flange 306 is omitted. Figure 4C and Figure 4DThe posterior resection guide 430 is configured in a similar manner, except that it includes a mounting flange 504 instead of an attachment portion 432 and has the addition of holes 514A and 514C.

[0064] The body 503 can be configured to couple to the partial knee resection guide 502, for example, by including a mounting flange 504 or other features configured to interact with the partial knee resection guide 502. The body 503 can additionally include features for guiding a cutting instrument or other instrument relative to the femur F. For example, the body 503 can include a posterior cutting guide surface 508, a beveled guide surface 308, an anterior nail guide hole 510, a posterior nail guide hole 512, and holes 514A, 514B, and 514C.

[0065] The partial knee resection guide 502 may include an extension arm 516 that may be connected to a Figure 4B and an adapter block 518, which may include a resection block for resecting the distal portion of the femur F, the proximal portion of the tibia T, and for mounting or aligning the posterior resection guide 500.

[0066] The adapter block 518 may include a body 520, a guide surface 522, holes 524A, 524B, and 524C, and holes 526A, 526B, and 526C. The holes 524A-524C and the holes 526A-526C may be configured to align with the holes 514A-514C, respectively. That is, when the posterior resection guide 500 is positioned on one side of the body 520, the holes 524A-524C may be aligned with the holes 514A-514C, and when the posterior resection guide 500 is positioned on one side of the body 520, the holes 526A-526C may be aligned with the holes 514A-514C.

[0067] In an example, fasteners may be used to couple the posterior resection guide 500 to the adapter block 518 at the holes 514A-514C, holes 524A-524C, and holes 526A-526C. In other examples, the adapter block 518 may be moved into position relative to the distal resected femoral surface, and pin holes may be drilled through the holes 524A-524C or holes 526A-526C, or the adapter block 518 may be moved away from the distal resected femur, pins may be placed into the pin holes, and the posterior resection guide 500 may be coupled to the pins using the holes 514A-514C, so that the resection of the femur F may be performed using the posterior resection guide 500. Such a procedure (e.g., using pins placed using the resection guide 502) has the advantage of not having to move the partial knee resection guide 502 away from the femur F to couple to the posterior resection guide 500, and then move it back into place. Furthermore, this process eliminates the tolerance stack-up of the placement of the resection guide 502 relative to the femur F plus the placement of the posterior resection guide 500 relative to the resection guide 502 .

[0068] Figure 6It is a schematic diagram of a surgical planning user interface 600 for determining and configuring the flexion gap resection for partial knee replacement. The user interface 600 may include an input 602 for selecting the position of the knee joint such as extension or flexion. The flexion position may be used to determine the posterior resection of the femur. Input 604 may be used to select the total thickness of the knee implant, which includes the thickness of the femoral component, the tibial component and the spacer for positioning between them, all of which are used for a single condylar or partial knee joint system. Input 606 may be used to select the total thickness of the bone to be removed from the joint. Considering the amount of bone removed, the thickness of the implant and the laxity of the joint, output 608 may indicate the remaining space size in the joint. Input 610 may be used to select the total thickness of the natural knee joint. Alternatively, input 610 may be used to select the total thickness (all or part) of the implant for comparison. Therefore, element 612 may be used to select the imaginary thickness of the bone to be removed as input or to view the imaginary thickness of the bone to be removed and the remaining space size as output. In an example, elements 610 and 612 may be fixed to the natural knee joint or may be removed from the interface. In this way, elements 602-612 are discussed with reference to the medial side of the knee joint being considered and planned for replacement. However, elements 602-612 may be used in addition to consider and plan the outside of the knee joint being replaced. Therefore, user interface 600 may include components for planning a partial knee replacement or a total knee replacement on the outside or medial side of a joint individually. Input 602 may be changed to indicate the position of the knee joint for extension so that the amount of bone to be removed from the distal end of the femur may be planned. Therefore, by using user interface 600 to determine how much of the distal end of bone to be removed and how much of the posterior side of bone to be removed, the surgeon may obtain an indication of how much laxity will be in the joint after implanting the lacquer joint implant. The surgeon may subsequently change the amount of distal resection and posterior resection to obtain the desired laxity, and the surgeon may see how changing one parameter affects other parameters, so that the prosthetic device correctly placed and assembled may be planned accordingly. The surgeon can select any input or output to be fixed, such as posterior cuts, distal cuts, any device thickness, etc., while adjusting other settings to see how one selection affects the other selections. The user interface 600 can be used in conjunction with any of the processes described herein to plan a surgical procedure preoperatively, and the user interface can be used, for example, by using references to Figure 3D Methods are described to guide the procedure and adapt it intraoperatively.

[0069] Figure 7 A system 700 for implementing the techniques described herein is shown according to some embodiments. The system 700 may be combined with Figure 1 The system 700 may include a surgical system 100 coupled to a resection guide instrument 704 (eg, Figure 2The resection guide instrument 200 described herein may be provided with a robotic surgical device 702 (e.g., the robotic surgical device 115) that may interact with a tracking system 706. In other examples, the resection guide instrument described herein may be used without the use of a tracking system 706. The tracking system 706 may include a tracking element 708, a camera 710, and a registration device 711 (e.g., an indicator 326). The resection guide instrument 704 (e.g., the adapter 200) may include an attachment instrument 712 (e.g., the posterior resection guide 300, 430, and 500). The system 700 may include a display device 714 that may be used to display a user interface 716. The system 700 may include a control system 718 (e.g., Figure 1 702 , the robotic arm 120 may be positioned and tracked by the robotic arm 120 through the movement of the robotic arm 120. Once in the desired position, the surgeon may freely use the resection guide tool 704 and the attachment tool 712 without the need for the tracking system 706 required to reacquire the position information for the robotic surgical device and without the tracking system 718 losing the position of the robotic surgical device 702.

[0070] Figure 8 A block diagram of an example machine 1700 is shown, on which any one or more of the techniques discussed herein may be implemented, according to some embodiments. For example, the machine 1700 may include Figure 1The computing system 140 of the present invention. The machine 1700 may include an example of a controller for the robotic system 115, and the sensor 1721 may include the tracking elements 170 and 332. As such, the instructions 1724 may be implemented by the processor 1702 to generate and correlate position and orientation information to determine the position and orientation of the surgical instrument relative to the robotic arm 120. For example, position and geometry information of the partial knee resection guide 400 and the partial knee resection guide 502 related to the position of the adapter block 406 and the adapter block 518 relative to the extension arm 404 and the extension arm 516 via the connection with the robotic arm 120 may be stored in the main memory 1704 and accessible by the processor 1702. The processor 1702 may also receive input (e.g., at the input device 1712) related to the position of the tibia T and the indicator 326 relative to the robotic arm 120 via the tracking devices 170 and 332, which may be stored in the main memory 1704. The processor 1702 may further associate the position information of the posterior resection guide 430 and the posterior resection guide 500 with the position information of the arm 120 via the partial knee resection guide 400 and the partial knee resection guide 502 to associate the position of the adapter block 406 and the adapter block 518 with the coordinate system of the surgical system 100, for example by programming it with its shape, geometry, and size. In this way, as the adapter blocks 406 and 518 and the posterior resection guide 430 and the posterior resection guide 500 (when attached thereto) move, the machine 1700 may continuously track and update the position of the components relative to the robotic arm 120 via the movement of the robotic arm 120, and display the position and the position of the features (e.g., cutting guide features) included thereon on a display device 1710 (e.g., the user interface device 145), for example.

[0071] In alternative embodiments, machine 1700 can operate as a stand-alone device, or can be connected (e.g., networked) to other machines. In a networked deployment, machine 1700 can operate as a server, client, or both in a server-client network environment. In one example, machine 1700 can act as a peer in a peer-to-peer (or other distributed) network environment. Machine 1700 can be a personal computer (PC), a tablet computer, a set-top box (STB), a personal digital assistant (PDA), a mobile phone, a network device, a network router, a switch or a bridge, or any machine capable of executing instructions (sequentially or otherwise) specifying the action to be implemented by the machine. In addition, although only a single machine is shown, the term "machine" should also be understood to include any set of machines that implement a set (or multiple sets) of instructions to perform any one or more of the methods discussed herein, such as cloud computing, software as a service (SaaS), and other computer cluster configurations.

[0072] The machine (e.g., computer system) 1700 may include a hardware processor 1702 (e.g., a central processing unit (CPU), a graphics processing unit (GPU), a hardware processor core, or any combination thereof), a main memory 1704, and a static memory 1706, some or all of which may communicate with each other via an interconnection link (e.g., a bus) 1708. The machine 1700 may further include a display unit 1710, an alphanumeric input device 1712 (e.g., a keyboard), and a user interface (UI) navigation device 1714 (e.g., a mouse). In one example, the display unit 1710, the input device 1712, and the UI navigation device 1714 may be a touch screen display. The machine 1700 may additionally include a storage device (e.g., a drive unit) 1716, a signal generating device 1718 (e.g., a speaker), a network interface device 1720, and one or more sensors 1721, such as a global positioning system (GPS) sensor, a compass, an accelerometer, or other sensors. The machine 1700 may include an output controller 1728, such as a serial (e.g., universal serial bus (USB), parallel or other wired or wireless (e.g., infrared (IR), near field communication (NFC), etc.) connection to communicate or control one or more peripheral devices (e.g., printer, card reader, etc.).

[0073] The storage device 1716 may include a machine-readable medium 1722 on which is stored one or more sets of data structures or instructions 1724 (e.g., software) embodied or used by any one or more of the techniques or functionality described herein. The instructions 1724 may also reside, completely or at least partially, within the main memory 1704, within the static memory 1706, or within the hardware processor 1702 during a process implemented by the machine 1700. In one example, one or any combination of the hardware processor 1702, the main memory 1704, the static memory 1706, or the storage device 1716 may constitute a machine-readable medium.

[0074] Although machine-readable medium 1722 is illustrated as a single medium, the term "machine-readable medium" may include a single medium or multiple media (e.g., a centralized or distributed database and / or associated caches and servers) configured to store one or more instructions 1724. The term "machine-readable medium" may include any medium that can store, encode, or carry instructions implemented by machine 1700 and cause machine 1700 to implement any one or more of the techniques of this disclosure, or any medium that can store, encode, or carry data structures used by or associated with such instructions. Non-limiting examples of machine-readable media may include solid-state memory and optical and magnetic media.

[0075] The instructions 1724 may also be transmitted or received via the network interface device 1720 using a transmission medium over the communication network 1726 using any of a variety of transmission protocols (e.g., frame relay, Internet Protocol (IP), transmission control protocol (TCP), user datagram protocol (UDP), hypertext transfer protocol (HTTP), etc.). Exemplary communication networks may include a local area network (LAN), a wide area network (WAN), a packet data network (e.g., the Internet), a mobile telephone network (e.g., a cellular network), a plain old telephone (POTS) network, and a wireless data network (e.g., a wireless network known as a wireless network). The Institute of Electrical and Electronics Engineers (IEEE) 802.11 series of standards, known as 16 series of standards), IEEE 802.15.4 series of standards, peer-to-peer networks, etc. In one example, the network interface device 1720 may include one or more physical jacks (e.g., Ethernet, coaxial, or headphone jacks) or one or more antennas to connect to the communication network 1726. In one example, the network interface device 1720 may include multiple antennas to communicate wirelessly using at least one of single-input multiple-output (SIMO), multiple-input multiple-output (MIMO), or multiple-input single-output (MISO) technology. The term "transmission medium" shall be deemed to include any intangible medium capable of storing, encoding, or carrying instructions implemented by the machine 1700, and includes digital or analog communication signals or other intangible media to facilitate communication of such software.

[0076] The systems, devices, and methods discussed in this application can be used to perform robotic-assisted surgical procedures utilizing a robotic surgical arm that can be used to position the device relative to a patient to perform a joint replacement, such as a partial knee replacement. In particular, the systems, devices, and methods disclosed herein can be used to improve the accuracy of posterior cuts and other finishing cuts performed on the femur. The systems, devices, and methods disclosed herein can reduce or eliminate reliance on manual positioning of cutting guides by using a surgical guide system to orient the finishing guides directly through navigation or by positioning using a robotic surgical arm.

[0077] Example

[0078] Example 1 may include or use subject matter such as a method of aligning a posterior resection guide with a distal femoral surface, which may include, with a knee in flexion, positioning a posterior resection guide proximate a proximal resection surface of the tibia and a posterior surface of the femur, displaying a representation of the distal end of the femur on a graphical display, displaying an alignment axis on the representation, engaging a tracking device to the posterior resection guide, tracking an anterior tip of the posterior resection guide on the graphical display, and rotating the posterior resection guide to align the anterior tip with the alignment axis on the graphical display.

[0079] Example 2 can include or can optionally be combined with the subject matter described in Example 1 to optionally include performing a posterior resection of the femur using a guide surface on a posterior resection guide.

[0080] Example 3 may include or may optionally be combined with the subject matter described in any combination of one of Examples 1 or 2 to optionally include generating an alignment axis by aligning the center of the tibial plateau with the femoral condyle with the knee in extension, marking the distal end of the femur with a distal indicator, rotating the knee to a flexed state to project the center of the tibial plateau onto the posterior side of the femoral condyle, marking the posterior surface of the femur with a posterior indicator, and projecting the axis from the posterior indicator through the distal indicator to a location on the anterior side of the femur.

[0081] Example 4 may include or may optionally be combined with the subject matter described in one or any combination of Examples 1 to 3 to optionally include engaging the tracking device to the posterior resection guide by attaching the tracking device to the instrument, and engaging the geometric structural features of the instrument with the front tip of the posterior resection guide.

[0082] Example 5 can include or can optionally be combined with the subject matter of one or any combination of Examples 1 to 4 to optionally include engaging the tracking device to the posterior resection guide by mounting the tracking device to the posterior resection guide.

[0083] Example 6 may include or may optionally be combined with the subject matter described in one or any combination of Examples 1 to 5 to optionally include: positioning the posterior resection guide near the proximal resection surface of the tibia and the posterior surface of the femur by inserting a flange protruding from the posterior resection guide between the proximal resection surface and the posterior surface so that the posterior resection guide engages the distal femoral surface.

[0084] Example 7 may include or may optionally be combined with the subject matter described in one or any combination of Examples 1 to 6 to optionally include manually positioning the posterior resection guide near the distal femoral surface and manually rotating the posterior resection guide to align the anterior tip with the alignment axis on a graphical display.

[0085] Example 8 may include or use subject matter such as a system for performing a femoral resection for a partial knee replacement, which system may include: a surgical robot comprising an articulated arm configured to move within a coordinate system of the surgical robot; a femoral resection guide instrument comprising a connector for connecting to the articulated arm, an extension arm extending from the connector, and a resection block attached to the extension arm; and a finishing guide for performing a posterior resection of the distal femur, wherein the finishing guide can be positioned by the surgical robot to determine the thickness and rotation of the posterior cut.

[0086] Example 9 can include the subject matter of Example 8, or can optionally be combined therewith to optionally include a cut-out block that can include a cutting guide surface and a plurality of pin holes.

[0087] Example 10 can include or can optionally be combined with the subject matter of one or any combination of Examples 8 or 9 to optionally include a finishing guide that can be positioned by a surgical robot by placing pin holes using a resection block.

[0088] Example 11 can include or can be combined with the subject matter described in one or any combination of Examples 8 to 10 to optionally include a finishing guide, which can include a flange having a plurality of holes arranged in a pattern aligned with the pattern of the plurality of holes of the cut-out block.

[0089] Example 12 can include or can be combined with the subject matter of one or any combination of Examples 8-11 to optionally include a finishing guide that can be positioned by the surgical robot via engagement with the resection block.

[0090] Example 13 may include the subject matter described in one or any combination of Examples 8 to 12, or may be combined therewith to optionally include a finishing guide that may include a coupling flange configured to engage one or more holes in a plurality of pin holes or a slot formed by a cutting guide surface.

[0091] Example 14 may include the subject matter described in one or any combination of Examples 8 to 13, or may be combined therewith to optionally include a controller for a surgical robot, the controller may include a non-transitory storage medium having computer-readable instructions stored therein, the computer-readable instructions including: dimensional data of a femoral resection guide instrument, dimensional data of a finishing guide, and instructions for moving one end of an articulated arm according to a surgical plan to position the finishing guide to a specific position within a coordinate system.

[0092] Example 15 may include or use subject matter such as a method for resecting the distal femur for partial femoral arthroplasty, which may include attaching a resection guide instrument to an articulated arm of a robotic surgical system, moving the resection guide instrument to the anterior or posterior side of the distal end of the femur, resecting the distal end of the femur to form a distal resection surface, moving the resection guide instrument to the distal resection surface, drilling a hole in the distal resection surface through a guide hole in the resection guide instrument, inserting a pin into the drilled hole, attaching a finishing guide to the inserted pin, and using the finishing guide to guide a cutting instrument to resect the posterior side of the femur adjacent to the distal resection surface.

[0093] Example 16 may include or may optionally be combined with the subject matter described in Example 15 to optionally include moving a resection guide instrument to the proximal end of the tibia, and resecting the proximal end of the tibia to form a proximal resection surface.

[0094] Example 17 may include or may optionally be combined with the subject matter described in one or any combination of Examples 15 or 16 to optionally include making a bevel cut on the femur near the distal resection surface and the resected posterior side of the femur using an inclined guide surface of a finishing guide.

[0095] Example 18 may include or use subject matter such as a method for aligning a posterior resection guide with a distal resected femoral surface, which method may include: positioning the posterior resection guide near the distal resected femoral surface, inserting a flange of the posterior resection guide between the posterior surface of the femur and the proximal resected surface of the tibia, moving the posterior resection guide in a medial-lateral direction to observe the edge thickness of the anterior edge of the posterior resection guide relative to the edge of the distal resected femoral surface, and positioning a shim near the flange to change the edge thickness.

[0096] Example 19 may include or use subject matter such as a system for performing a femoral resection for a partial knee replacement, the system may include: a surgical robot including an articulated arm configured to move within a coordinate system of the surgical robot; a tracking system configured to determine a position of one or more trackers in the coordinate system; a tracker configured to be tracked by the tracking system; a finishing guide configured to be coupled to the articulated arm to perform a posterior resection of the distal femur; a controller for the surgical robot, the controller may include: a communication device configured to communicate from the surgical robot to the surgical robot; A person and a tracking system receive data and send data to a surgical robot and tracking system; a display device for outputting visual information from the surgical robot and tracking system; and a non-transitory storage medium storing computer-readable instructions, the instructions comprising: marking digital locations at the distal end and the posterior surface of the distal end of the femur using a tracker; displaying the digital locations of the distal end and the posterior surface on the display device; drawing a target axis extending through the distal end and the posterior surface on the display device; projecting the target axis onto the anterior surface of the femur; and moving the articulated arm to align the finishing guide along the target axis at the anterior surface.

[0097] Example 20 may include or optionally be combined with the subject matter described in Example 19 to optionally include a femoral resection guide instrument, which may include a connector for connecting to an articulated arm, an extension arm extending from the connector, and a resection block attached to the extension arm.

[0098] Example 21 can include or optionally be combined with the subject matter of one or any combination of Examples 19 or 20 to optionally include a finishing guide that can be coupled to the cut-out block such that the articulated arm can position the finishing guide along the target axis.

[0099] Example 22 may include or may optionally be combined with the subject matter described in one or any combination of Examples 19 to 21 to optionally include a resection guide that may further include a plurality of first pin holes and a finishing guide that may further include a plurality of second pin holes, wherein the articulated arm may position the plurality of first pin holes so that holes may be drilled to receive pins that receive the plurality of second pin holes.

[0100] Example 23 may include the subject matter described in one or any combination of Examples 19 to 22, or may be combined therewith to optionally include a non-transitory storage medium having computer-readable instructions stored therein, the instructions also including dimensional data for a femoral resection guide instrument, dimensional data for a finishing guide, and instructions for moving one end of the articulated arm in accordance with a surgical plan to position the finishing guide to a specific position within a coordinate system.

[0101] Various annotations

[0102] The above detailed description includes reference to the accompanying drawings, which form a part of the detailed description. The accompanying drawings show, by way of illustration, specific embodiments in which the present invention may be implemented. These embodiments are also referred to herein as "examples". Such examples may include elements other than those shown or described. However, the inventors have also contemplated examples in which only those elements shown or described are provided. In addition, the inventors have also contemplated examples of any combination or arrangement of those elements (or one or more aspects thereof) shown or described in conjunction with a specific example (or one or more aspects thereof) or in conjunction with other examples (or one or more aspects thereof).

[0103] In the event of an inconsistency in usage between this document and any document incorporated by reference, the usage in this document controls.

[0104] In this document, the terms "a" or "an" are used as commonly used in patent documents to include one or more than one, independent of any other instances or uses of "at least one" or "one or more". In this document, unless otherwise indicated, the term "or" is used to represent a non-exclusive or, such that "A or B" includes "A but not B", "B but not A", and "A and B". In this document, the terms "including" and "wherein" are used as the plain English equivalents of the respective terms "comprising" and "wherein". Similarly, in the appended claims, the terms "including" and "comprising" are open-ended, i.e., systems, devices, articles, compositions, formulations, or methods that include elements other than those listed after the term in the claim are still considered to fall within the scope of the claim. In addition, in the appended claims, the terms "first", "second", and "third", etc. are used merely as labels and are not intended to impose numerical requirements on their objects.

[0105] The method examples described herein may be at least partially machine or computer implemented. Some examples may include a computer-readable medium or machine-readable medium encoded with instructions, which may be operable to configure an electronic device to perform the method described in the above examples. The implementation of this method may include code, such as microcode, assembly language code, high-level language code, etc. This code may include computer-readable instructions for implementing various methods. The code may form multiple parts of a computer program product. In addition, in one example, the code may be tangibly stored on one or more volatile, non-temporary or non-volatile tangible computer-readable media, such as during execution or at other times. Examples of these tangible computer-readable media may include, but are not limited to, hard disks, removable disks, removable optical disks (e.g., optical disks and digital video disks), cassettes, memory cards or memory sticks, random access memories (RAM), read-only memories (ROM), etc.

[0106] The above description is intended to be illustrative, not restrictive. For example, the above examples (or one or more aspects thereof) may be used in combination with each other. After reviewing the above description, other embodiments may be used, for example, by a person skilled in the art. An abstract is provided to comply with the provisions of 37 C.FR § 1.72 (b) so that the reader can quickly determine the nature of the technical disclosure. When submitting this document, it should be understood that it will not be used to interpret or limit the scope or meaning of the claims. In addition, in the above detailed description, a variety of features may be grouped together to simplify the present disclosure. This should not be interpreted as intending to make the disclosed features that are not claimed to be essential to any claim. On the contrary, the subject matter of the invention may be less than all the features of a particular disclosed embodiment. Therefore, the following claims are hereby incorporated into the detailed description as examples or embodiments, each claim existing independently as an independent embodiment, and it is expected that such embodiments may be combined with each other in a variety of combinations or arrangements. The scope of the present invention should be determined by reference to the appended claims and the full scope of the equivalent schemes assigned to these claims.

Claims

1. A system for performing femoral resection for partial knee replacement, the system comprising: a surgical robot comprising an articulated arm configured to move within a coordinate system of the surgical robot; A femoral resection guide instrument, comprising: a connector for connecting to the articulated arm; an extension arm extending from the connector; and a resection block attached to the extension arm, wherein the resection block comprises a guide surface for performing resection on the distal surface of a single condyle of a distal femur; and a finishing guide, wherein the finishing guide is configured to be separated from the femoral resection guide instrument and can be connected to the resection block of the femoral resection guide instrument for performing posterior resection of the distal femur, wherein the finishing guide can be attached to the femoral resection guide instrument or separated from the femoral resection guide instrument during surgery; wherein the finishing guide comprises a resection guide body, the resection guide body The guide body includes: a first surface for facing the bone; a second surface opposite to the first surface; a first resection surface, the first resection surface being configured to perform posterior femoral resection when the first surface is positioned to engage with the resected distal surface; and a second resection surface, the second resection surface being angled with the first resection surface and configured to perform a bevel cut when the first surface is positioned to engage with the resected distal surface; wherein the first resection surface and the second resection surface extend from the first surface through the resection guide body to the second surface; and wherein the first resection surface and the second resection surface are positioned at a fixed distance from each other.

2. The system of claim 1, wherein: The cut-off block includes: a cutting guide surface; and a plurality of pin holes.

3. The system of claim 2, wherein: The finishing guide is positionable by the surgical robot via placement of pin holes using the cutout block.

4. The system of claim 3, wherein: The finishing guide includes a flange having a plurality of holes arranged in a pattern that aligns with a pattern of the plurality of holes of the cutout block.

5. The system of claim 2, wherein: The finishing guide is positionable by the surgical robot via engagement with the resection block.

6. The system of claim 5, wherein: The finishing guide includes a coupling flange configured to engage a notch formed by the cutting guide surface and / or a protrusion configured to engage one or more of the plurality of pin holes.

7. The system of claim 1, wherein: The system also includes a controller for the surgical robot, the controller including a non-transitory storage medium having computer-readable instructions stored therein, the computer-readable instructions including: dimensional data of the femoral resection guide instrument; dimensional data of the finishing guide; and instructions for moving the end of the articulated arm according to the surgical plan to position the finishing guide to a specific position within the coordinate system.

8. The system of claim 1, wherein: The system also includes: a tracking system, which is configured to determine the position of one or more trackers in the coordinate system; a tracker, which is configured to be tracked by the tracking system; a controller for the surgical robot, the controller including: a communication device, which is configured to receive data from the surgical robot and the tracking system and send data to the surgical robot and the tracking system; a display device, which is used to output visual information from the surgical robot and the tracking system; and a non-transitory storage medium, in which computer-readable instructions are stored, the computer-readable instructions including: using the tracker to mark a digital position at the distal end and the posterior surface of the distal end of the femur; displaying the digital position of the distal end and the posterior surface on the display device; drawing a target axis extending through the distal end and the posterior surface on the display device; projecting the target axis onto the anterior surface of the femur; and moving the articulated arm to align the finishing guide along the target axis at the anterior surface.

9. The system of claim 8, wherein: The finishing guide can be coupled to the cutout block such that the articulated arm can position the finishing guide along the target axis.

10. The system of claim 8, wherein: The femoral resection guide instrument also includes a plurality of first pin holes located on the resection block; and the finishing guide also includes a plurality of second pin holes; wherein the articulated arm is capable of positioning the plurality of first pin holes so that holes can be drilled to receive pins, which receive the plurality of second pin holes.

11. The system of claim 8, wherein: The non-transitory storage medium stores computer-readable instructions, which also include: dimensional data of the femoral resection guide instrument; dimensional data of the finishing guide; and instructions for moving the end of the articulated arm according to the surgical plan to position the finishing guide to a specific position within the coordinate system.

12. The system of claim 2, wherein: The system also includes an attachment feature that attaches the finishing guide to the cut-off block such that the first cut-off surface is positioned a fixed and non-adjustable distance from the cutting guide surface.

13. The system of claim 12, wherein: The attachment feature includes a flange for insertion into a slot in the cutout block.

14. The system of claim 13, wherein: The notch is at least partially formed by the cutting guide surface.

15. The system of claim 12, wherein: The cut-out block further includes a guide hole; and the attachment feature includes a pin insertable into the guide hole.

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