Method and surgery system that include planning planned pose of implant cup

Abstract

To provide a system for facilitating arthroplasty procedures.SOLUTION: A system for facilitating arthroplasty procedures includes a robotic device, a reaming tool configured to interface with the robotic device, and a processing circuit communicable with the robotic device. The processing circuit is configured to: obtain a surgical plan including a first planned position of an implant cup and a second planned position of an implant augment that are relative to a bone of a patient; determine a planned bone modification configured to prepare the bone to receive the implant cup in the first planned position and receive the implant augment in the second planned position; generate one or more virtual objects based on the planned bone modification; and control the robotic device to constrain the cutting tool with the one or more virtual objects, while the cutting tool interfaces with the robotic device and is operated to modify the bone in accordance with the planned bone modification.SELECTED DRAWING: Figure 1A

Description

[Technical field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application was filed on August 9, 2019, the entire disclosure of which is incorporated by reference herein. The benefit of and priority to U.S. Provisional Patent Application No. 62 / 893,384, filed on claims. [Background technology]

[0002] The present disclosure relates generally to a surgical system for orthopaedic surgery, and more particularly to a total hip arthroplasty procedure. This document relates to a surgical system for complete and partial hip arthroplasty procedures, colloquially known as hip replacement. Hip arthroplasty, performed by replacing parts of the hip joint anatomy with prosthetic components, It is widely used to treat osteoarthritis of the hip and other injuries to a patient's hip joint. do.

[0003] One possible tool for use in total hip arthroplasty procedures is the robotic assisted surgical system. Robotic surgery systems typically use a surgical instrument to create a patient's anatomy. A robotic device used to monitor the position of the robotic device relative to the patient's anatomy and a tracking system configured to monitor and control the robotic device. Robotic surgery systems include a computing system that is In this study, the surgical task is performed autonomously and the surgical device is operated to complete the surgical task. and / or providing force feedback to the user to enhance the surgeon's dexterity and precision. It provides other clues to promote safe and accurate surgical procedures.

[0004] A surgical plan is typically established prior to performing a surgical procedure with a robotic surgical system. Based on the surgical plan, the surgical system may select surgical tools during a portion of the surgical procedure. The guidance and / or control of the surgical tool is in accordance with the surgical plan. The surgeon is responsible for protecting the patient and assisting the surgeon during the procedure. Summary of the Invention

[0005] One implementation of the present disclosure is a system for facilitating an arthroplasty procedure. The system includes: a robotic device; and a reaming tool configured to interface with the robotic device. and a processing circuit for communicating with the robotic device. First planned position of the implant cup relative to the bone and implant augmentation and forming a surgical plan including a second planned location of the first bone. The implant cup is received in the first planned position and the implant augment is placed in the second planned position. determining a planned bone modification that the patient is configured to undergo, and based on the planned bone modification, selecting one or more The cutting tool interacts with the robotic device and performs the planned bone modification. You can constrain the cutting tool by one or more virtual objects while working to modify the bones. The present invention is configured to control a robotic device.

[0006] Another implementation of the present disclosure is a method for attaching an implant cup to a bone of a patient. and a second planned position of the implant augment. Obtaining a surgical plan and forming bone to place an implant cup in a first planned location. and configured to receive an implant augment in the second planned position. determining a planned bone modification; and determining one or more virtual objects based on the planned bone modification. and a surgical tool that interfaces with the robotic device according to the planned bone modification. To better facilitate bone modification, we use one or more virtual objects to control the robotic device. This includes: [Brief description of the drawings]

[0007] [Figure 1A] FIG. 2 is a perspective view of the femur and pelvis. [Figure 1B] FIG. 1B is a perspective view of a hip joint formed by the femur and pelvis of FIG. 1A. [Figure 1C] FIG. 1 is an exploded perspective view of a femoral component and an acetabular component for a total hip replacement procedure. [Figure 1D] 1C with respect to the femur and pelvis of FIG. 1A, respectively; [Diagram 2] 1 is an illustration of a surgical system, in accordance with an exemplary embodiment. [Diagram 3] 1 is a flowchart of a process for facilitating an arthroplasty procedure, in accordance with an illustrative embodiment. [Figure 4] 4 is a first illustration of a graphical user interface that can be used with the process of FIG. 3 in accordance with an example embodiment. [Diagram 5] 4 is a second illustration of a graphical user interface that can be used with the process of FIG. 3 in accordance with an example embodiment. [Figure 6] 4 is a third example of a graphical user interface that can be used with the process of FIG. 3 in accordance with an exemplary embodiment. [Figure 7] 4 is a fourth example of a graphical user interface that can be used with the process of FIG. 3 in accordance with an exemplary embodiment. [Figure 8] 4 is a flowchart illustrating a detailed view of steps of the process of FIG. 3 in accordance with an exemplary embodiment. [Figure 9] 4 is a first visualization of a registration region on a pelvis that can be used with the process of FIG. 3 according to an exemplary embodiment. [Figure 10] 4 is a second visualization of a registration region on a pelvis that can be used with the process of FIG. 3 according to an exemplary embodiment. [Figure 11] 5 is a fifth example of a graphical user interface that can be used with the process of FIG. 3 in accordance with an exemplary embodiment. [Figure 12] 6 is a sixth example of a graphical user interface that can be used with the process of FIG. 3 in accordance with an exemplary embodiment. [Figure 13] 4 is a representation of an implant augment and probe as used in the process of FIG. 3, according to an exemplary embodiment. [Figure 14] 14 is a representation of the fixation of the implant augment of FIG. 13 to bone as in the process of FIG. 3 according to an exemplary embodiment. [Figure 15] 4 is a representation of a cup fitting step of the process of FIG. 3 in accordance with an exemplary embodiment. [Figure 16] 4 is a representation of a cement hardening step of the process of FIG. 3 in accordance with an exemplary embodiment. [Figure 17] 1 is a flowchart of a process for facilitating a knee arthroplasty procedure including tibial or femoral augmentation, according to an exemplary embodiment. [Figure 18] 18 is a first illustration of a tibial template and probe as used in the process of FIG. 17, according to an exemplary embodiment. [Figure 19] 18 is a second illustration of a tibial template and probe as used in the process of FIG. 17, according to an exemplary embodiment. [Figure 20] 18 is a first illustration of a femoral trial and probe as used in the process of FIG. 17, according to an exemplary embodiment. [Figure 21] 18 is a second illustration of a femoral trial and probe as may be used in the process of FIG. 17, according to an exemplary embodiment. [Figure 22] FIG. 1 is a perspective view of a tibial implant and a tibial augment according to an exemplary embodiment. [Figure 23] FIG. 2 is a perspective view of a pair of femoral implants and femoral augments according to an exemplary embodiment. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0008] The presently preferred embodiments of the invention are illustrated in the drawings. For ease of understanding, an effort has been made to use the same or similar reference numerals throughout the drawings. Although the specification primarily refers to a robotic arm for orthopedic hip replacement, the present invention is not limited to the above-described embodiments. The subject matter discussed includes, for example, knee or shoulder braces, as well as braces used for surgical and non-surgical applications. Other types of robotic systems, including those used on other joints in the body, such as the hip and ankle joints. It should be understood that the present invention is applicable to the above-mentioned systems.

[0009] The hip joint is the joint between the femur and the pelvis and is involved in both static (e.g. standing) and Its main function is to support the weight of the body in dynamic (e.g., walking) postures. 1A illustrates the bones of a hip joint 10, including a pelvis 12 (partially shown) and a proximal end of a femur 14. The proximal end of the femur 14 includes a femoral head 16 disposed on a femoral neck 18. The femoral neck 18 connects the femoral head 16 to the femoral shaft 20. Thus, the femoral head 16 fits into a recess in the pelvis 12 called the acetabulum, thereby , forming the hip joint 10. Both the acetabulum 22 and the femoral head 16 act as shock absorbers and articulators. It is covered by articular cartilage which helps the joints join together.

[0010] Over time, the hip joint 10 may degenerate (e.g., due to osteoarthritis) Pain and loss of functionality result. As a result, total hip arthroplasty or A hip replacement procedure such as hip resurfacing may be required. During a hip replacement, the surgeon In a total hip arthroplasty, the surgeon replaces part of the patient's hip joint 10 with an artificial component. The femoral head 16 and neck 18 are removed, and the natural bone is separated into the head 26a, neck 26b, and stem. 1C). As shown, the stem 26c of the femoral component 26 is inserted into the intramedullary canal of the femur 14 to form a cavity that the surgeon has created. Alternatively, if the disease is confined to the surface of the femoral head 16, the surgeon may The femoral head is then resurfaced (e.g., using a cylindrical reamer) and the prosthetic implant is then attached to the femoral head. By choosing a less invasive approach, a femoral head cup (not shown) is engaged. There is a saying.

[0011] Similarly, if the natural acetabulum 22 of the pelvis 12 becomes worn or degenerated, the surgeon may use a reamer. The acetabulum 22 is resurfaced by a hemispherical shaped cavity that may include a liner 28b. The acetabular portion is replaced with a prosthetic acetabular member 28 including a cap 28a (shown in FIG. 1C). To attach the material 28, the surgeon connects a cup 28a to the distal end of the impactor tool. The cup was then impacted by repeatedly striking the proximal end of the impactor tool against the mallet. 28a is implanted into the reamed acetabulum 22. The acetabulum member 28 is fitted with a liner 28b. If the cup 28a includes a liner 28b, the surgeon may insert the liner 28b into the cup 28a after implanting the cup 28a. Depending on where the surgeon positions the patient for the surgery, the surgeon may To ream 2, a straight reamer or offset reamer may be used, allowing for a relaxed A straight or offset impactor is used to implant the acetabular cup 28a. For example, surgeons using a posterolateral approach may use straight reaming and While some surgeons prefer to use an offset lateral approach, others who use an anterolateral approach prefer to use an offset lateral approach. Sometimes they prefer threading and inlay.

[0012] In some cases, it may be desirable to support or otherwise facilitate the reconstruction of the acetabulum 22. To facilitate fixation of the cup 28a to the pelvis 12 in the correct position and orientation, Runt augments are used. In some scenarios, the use of augments is preferred. In one embodiment, the implant augmentation can be used to prevent traumatic injury (e.g. In favorable post-traumatic hip reconstructions where a traumatic injury (e.g., a car accident) has caused injury to the pelvis12, In another embodiment, the implant augmentation can be In other cases of acetabular bone loss, i.e., bone loss caused by such As another example, an implant augmentation may be advantageous for filling the space. The implant is intended to replace a previously implanted hip prosthesis due to deterioration of the adjacent bone or other complications. For revision hip arthroplasty procedures, where the prosthesis is removed and replaced with a new implant It may be advantageous to

[0013] Modern surgical procedures involving implant augmentation typically require the surgeon to be in the correct position during surgery. The skill and experience of the surgeon to manually place the implant augment in a position that looks and feels right Such procedures can be difficult and can extend surgical time. In addition, currently available robotics for hip arthroplasty The implant-assisted surgical device does not provide for the placement of implant augments. The disclosed systems and methods are for implant augmentation during a hip arthroplasty procedure. Facilitates bone formation and placement of implant augments, thereby reducing bone loss, trauma, Hip arthroplasty procedures in cases of sexual assault, revision hip replacements, or other related scenarios Computer-assisted planning of implant placement and robotic-assisted surgical strategy to facilitate The systems and methods described herein provide a method for improving patient outcomes. It can improve the quality of the hip joint, reduce the surgical time, and improve the augmented hip joint prosthesis. The burden on the surgeon for surgical procedures can be reduced.

[0014] Referring now to FIG. 2, a surgical system for orthopaedic surgery, in accordance with an exemplary embodiment, is shown. Illustrated is a surgical system 200. Generally, the surgical system 200 facilitates the planning and execution of a surgical plan. As shown in FIG. The system 200 treats the legs 202 of a patient 204 who is seated or lying on a table 205. In the example shown in FIG. 2, leg 202 is configured for a total knee arthroscopy procedure. 206 and 207, between which the prosthetic knee implant will be implanted. The scenario shown in FIG. 2 is explained below with reference to FIGS. For example, the methods described herein with reference to FIGS. 1A-1D and 3-16 may be used. In such other scenarios, the surgical system 200 may be configured to perform a surgical procedure on the patient's hip joint, i.e., the patient's femur. It is configured to treat the bone 14 and the pelvis 12 (illustrated in FIGS. 1A-1D). In yet another scenario, the surgical system 200 may be used to treat a patient's shoulder, i.e., the shoulder joint. Facilitate replacement and / or augmentation of articular components (e.g., humeral components, articular (facilitating placement of the cavity member, and graft or implant augment) A variety of other anatomical regions and procedures are possible. To facilitate the procedure, a surgical system The system 200 includes a robotic device 220, a tracking system 222, and a computing system. Includes stem 224.

[0015] The robotic device 220, under the control of a computing system 224, monitors the patient's health. The robotic device is configured to modify a body structure (e.g., a femur 206 of a patient 204). One embodiment of the device 220 is a haptic device. haptic, relating to a human interactive device that provides feedback to the user Refers to sensory and tactile fields. Feedback may include tactile sensations, such as vibrations. Feedback may also include providing a force to the user, such as a positive force or resistance to movement. One use of haptics may be to provide a user of a device with guidance or control over the operation of the device. For example, the haptic device may provide a visual aid to a surgeon to perform a surgical procedure. The surgical tool may be coupled to a surgical tool that can be manipulated by a surgeon. The operation involves the use of haptics to provide feedback to the surgeon during manipulation of surgical tools. The information may be guided or restricted through the

[0016] Another embodiment of the robotic device 220 is an autonomous or semi-autonomous robot. collects information about the situation, determines the course of action, and automatically performs the course of action. This will allow the ability of robotic devices to act independently or semi-independently of human control. For example, in such an embodiment, the tracking system 222 and the computing The robotic device 220 in communication with the operating system 224 can perform the following tasks without direct human intervention: The system can then autonomously complete the sequence of femoral cuts described above.

[0017] The robotic device 220 includes a base 230, a robotic arm 232, and a surgical tool 233. 4, communicatively coupled to the computing system 224 and the tracking system 222 The base 230 supports the robotic arm 232 and surgical tool 234 to the patient 204 and the surgical instrument 236. 205. The robot arm 205 can be repositioned as needed relative to the 232. The base 230 supports the robot arm 2, which is described below. 32 and the power systems, computational elements, motors, and other electrical components necessary for the functioning of the surgical tool 234. It may also include a computer or mechanical system.

[0018] The robotic arm 232 supports a surgical tool 234 and a computing system 2 24. In some embodiments, the force is The robotic arm 232 allows the user to manipulate surgical tools and provides force to the user. In such an embodiment, the robot arm 232 has joint 2 The joints 236 and the base 238 allow the user to move through acceptable postures. The robot arm 232 and the surgical tool 234 can be freely translated and rotated as needed. and the robot controller 222 as instructed by the computing system 224. Force feedback to restrict or prevent any movement of the arm 232 and surgical tool 234. The actuator may include a motor, actuator, or other mechanism configured to provide the desired motion. As will be described, the robotic arm 232 allows the surgeon to perform surgery within the controlled object. It allows one to have complete control over the tool 234 and to draw along the boundaries of the object. Force feedback (e.g., vibration, a force that prevents or resists penetration through a boundary) In some embodiments, the robotic arm is adapted to move the robotic arm as needed. 206, positioning, and / or cutting at the femur 206 or acetabulum. In order to complete the task, the computing system 224 The surgical tool is configured to automatically move the surgical tool to the new pose without any user interaction.

[0019] The surgical tools 234 are used to cut, score, grind, drill, partially remove, and / or remove bone. The surgical tool 234 is configured to reshape and / or otherwise modify the , which may be any suitable tool and may be interchangeably connected to the robotic device 220. For example, as shown in FIG. 2, the surgical tool 2 may be one of a number of tools that can be used to perform the surgical procedure. 34 is a spherical burr. The surgical tool may be, for example, parallel to the tool axis or perpendicular to the tool axis. The surgical tool 234 may be a sagittal saw having a directly aligned blade. The implant component is screwed into the bone, glued to the bone or to another implant component (e.g. The in-situ assembly may be fixed (e.g., cemented) or otherwise attached to a desired location. The implant member (e.g., cup 28a, implant augment, etc.) may be attached to the implant member. In some embodiments, the hand may be a holding arm or other support configured to hold the hand. The surgical tool 234 facilitates fixation of the cup 28a to the pelvis 12 in the planned position and orientation. A mating tool configured to provide a forward mating force to cup 28a.

[0020] The tracking system 222 tracks the patient's anatomy (e.g., femur 206 and tibia 208) and The robotic device 220 (i.e., the surgical tool 234 and / or the robotic arm 23 2) to enable control of a surgical tool 234 coupled to the robotic arm 232. , determining the position and orientation of the correction or other result made by the surgical tool 234, and On the display of the computing system 224, the bones (e.g., (e.g., femur 206, tibia 208, pelvis 12, humerus, scapula, etc., as may be applicable) , to allow visualization of the surgical tool 234 and / or the robotic arm 232. More specifically, the tracking system 222 is configured to track the object with respect to a coordinate frame of reference. Determine the position and orientation (i.e., posture) of the body (e.g., surgical tool 234, femur 206). The pose of the object is tracked (i.e., continuously determined) during the surgical procedure. According to an embodiment, the tracking system 222 may be a non-mechanical tracking system (e.g., an optical tracking system). a machine tracking system (e.g., a robot arm 232 that measures the relative angles of the joints 236) measurement-based tracking, or both non-mechanical and mechanical tracking systems The navigation system may be any type of navigation system, including any combination of the above.

[0021] In the embodiment shown in FIG. 2, the tracking system 222 includes an optical tracking system. Thus, the tracking system 222 includes a first reference tree 240 coupled to the tibia 208, a second reference tree 240 coupled to the femur, A second reference tree 241 is connected to the bone 206, a third reference tree 242 is connected to the base 230, and 242, one or more fiducials coupled to the surgical tool 234, and the three-dimensional location of the fiducials (i.e., a detection device configured to detect markers on the reference trees 240-242 246. The reference trees 240, 241 may be modified to include other bones (e.g., For example, the device may be coupled to a pelvis 12 and a femur 206 in a hip arthroplasty procedure. The device 246 may be a light detector, such as a camera or an infrared sensor. 0 to 242 are clearly visible to the photodetector and / or using data from the photodetector By an image processing system, for example, infrared radiation (e.g., an element of the tracking system 222 The radar is constructed to be easily detectable by the high reflectivity of the radiation emitted by the radar. The stereoscopic array of cameras on the detection device 246 detects the position of each fiducial. This allows the position to be determined in 3D space through a triangulation approach. The fiducials have a geometric relationship to the corresponding objects, so that tracking of the fiducials enables tracking of the objects. (For example, tracking the second reference tree 241 allows the tracking system 222 to The tracking system 222 determines this geometric relationship, allowing the bones 206 to be tracked. In the reference tree 240-242, A unique sequence of criteria (i.e., the criteria in the first criteria tree 240 are aligned to the second criteria tree 2 41) makes it possible to distinguish between the reference trees. , thus enabling objects to be tracked against each other.

[0022] The tracking system 222 of FIG. 2 or some other application for surgical navigation and tracking. The prosthesis is used to modify anatomical features or otherwise facilitate a surgical procedure. The surgical system 200 may be configured to manipulate the patient's anatomy such that a surgical tool 234 is used to perform the procedure. The position of the surgical tool 234 relative to the femur 206 can be determined. In addition, the tracking system 222 of FIG. Using another approach, the surgical system 200 determines the relative orientation of the tracked bones. It is possible.

[0023] The computing system 224 generates a surgical plan and performs one or more bone modifications; and / or a robotic device according to a surgical plan to facilitate implantation of one or more prosthetic components. The computing system is configured to control the client device 220. The system 224 includes a robotic device 220, a tracking system 222, and a computing system. The tracking system 222 and the robotic device 224 are connected to the robotic device 222 to facilitate electronic communication between the tracking system 222 and the robotic device 224. 220. Additionally, the computing system 224 is communicatively coupled to the patient's physician. Medical history or other patient profile information, medical imaging, surgical planning, and information related to the surgical procedure and, for example, by accessing an electronic health record device, Computers may be connected to a network to perform a variety of performance-related functions. The operating system 224 includes a processing circuit 260 and an input / output device 262. include.

[0024] The input / output device 262 includes a number of input / output devices as necessary for the functions and processes described herein. The input device is configured to receive user input and display output. The input / output devices 262 include a display 264 and a keyboard 266. Ray 264 may be used for, for example, surgical planning, medical imaging, settings for surgical system 200, and other purposes. options, status information related to the tracking system 222 and the robotic device 220 information, and tracking visualization based on data provided by the tracking system 222. A graphical user interface generated by the processing circuitry 260 containing the information The keyboard 266 is configured to display these graphical user interfaces. and receiving user input to the interface to control one or more functions of the surgical system 200. It is configured to:

[0025] The processing circuitry 260 includes a processor and a memory device. processor, application specific integrated circuit (ASIC), and one or more field programmable a FPGA, a group of processing components, or other suitable It may be implemented as an electronic processing component. The various processing and functionalities described in this application are implemented using the memory, memory unit, storage device, etc. One or more devices that store data and / or computer code for completing or facilitating a function Devices (e.g. RAM, ROM, flash memory, hard disk storage, etc.) The memory device may be a volatile or non-volatile memory, or The memory device may include a volatile memory or a non-volatile memory. component, object code component, script component, or Any other suitable means for supporting the various activities and information structures described in this application. According to an exemplary embodiment, the memory device may include a programmable memory. 2. The processor 200 may be communicatively connected to the processor via a sensing circuit 260 and configured as described herein. (e.g., processing circuitry 260 and / or processor 260 for performing one or more processes) (by) computer code.

[0026] More specifically, the processing circuitry 260 facilitates the generation of a pre-operative surgical plan prior to a surgical procedure. According to some embodiments, the pre-operative surgical planning is configured to It is developed using a three-dimensional representation of the patient's anatomy, also called a "virtual bone model." A "virtual bone model" may include a virtual representation of cartilage or other tissues in addition to bone. To obtain the above, the processing circuit 260 may include a patient The imaging data includes imaging data of the anatomical structures of the femur 206, the pelvis 12, etc. , computed tomography (CT), magnetic resonance imaging (MRI), and / or ultrasound using any suitable medical imaging to image the relevant anatomical features, including The imaging data may then be segmented to obtain a virtual bone model. (i.e., regions within the image that correspond to different anatomical features are distinguished). For example, as described in more detail below, MRI-based scan data of the hip joint may include circumferential The ligaments, cartilage, previously implanted prosthetic components, and other tissues were differentiated from the imaged tissue. It may be segmented to obtain a three-dimensional model of the hip joint.

[0027] Instead, the virtual bone model is generated by extracting the 3D model from a database or library of bone models. In one embodiment, the user may select the appropriate model. In another embodiment, the input / output device 262 may be used to select the rule. The processing circuitry 260 determines the appropriate The stored instructions may be executed to select a suitable model from the database. The generated bone model(s) may then be modified based on specific patient characteristics, as described herein. The present invention generates virtual bone models for use in surgical planning and performance as described in the document.

[0028] A pre-operative surgical plan may then be generated based on the virtual bone model. The sensing circuit 260 receives input from a user via an input / output device 262. may be generated automatically by a process, or by some combination of the two (e.g. The matching circuit 260 limits some features of the plan generated by the user and allows the user to modify (e.g., generate a plan that can be used to measure the As described in, a surgical plan is generated and / or based on distraction force measurements collected during surgery. In some embodiments, the surgical plan may be modified or revised, for example, as described in more detail below. As described above, a qualitative intraoperative assessment of implant fixation (loose or fixed) and and / or may be modified based on intraoperative bone defect mapping after primary implant removal. .

[0029] Pre-operative surgical planning is performed using the surgical system 200 to determine the desired cuts, holes, surfaces, burrs, or This includes other modifications to the patient's anatomy that will be performed, such as for a total knee arthroscopy procedure. To this end, preoperative planning involves the design of a prosthesis on the femur that will be attached to the femur during the surgical procedure. The distal surface is positioned in the proper relative orientation and position to be engaged with the corresponding surface of the brace. The front surface, the rear chamfer surface, the rear surface, the front surface, and the front chamfer surface Along with the cut, a prosthesis is inserted on the tibia to engage the prosthesis that will be attached to the tibia during the surgical procedure. This may include any necessary cutting to create the appropriate surface(s) for the desired shape. As for the hip arthroplasty procedure, the surgical plan includes the cup 28(a) and, in appropriate cases, One or more surfaces may be shaped on the acetabular region of the pelvis 12 to receive the implant augmentation. The processing circuitry 260 may therefore include any burrs necessary to perform the surgical plan. receiving, accessing, and / or storing a model of a prosthesis to facilitate generation of the good.

[0030] The processing circuitry 260 controls the robotic device 220 according to the surgical plan. The control object may be any of a variety of types of robots. This may take a variety of forms depending on the device (e.g., haptic, autonomous, etc.). In some embodiments, the control object may be configured to allow the robotic device to move within the control object. Controlling the tracking device (i.e., manually using feedback from the tracking system 222) Defines commands for the robot to autonomously guide one or more cuts in a surgical plan. In this configuration, the control object facilitates surgical navigation and guides the surgeon to follow the surgical plan. (e.g., without active control or force feedback of the robotic device) 264 for visualization of the surgical plan and the robotic device on the display 264. In an embodiment in which the touch device 220 is a haptic device, the control object is The object may be a tactile object as described above.

[0031] In an embodiment in which the robotic device 220 is a haptic device, the processing circuitry 260 The present invention generates one or more haptic objects based on a preoperative surgical plan to guide the surgical tool during the surgical procedure. The system is designed to assist the surgeon during the implementation of the surgical plan by enabling constraints on the rule 234. The haptic object may be shaped in one, two, or three dimensions. For example, a haptic object may be a line, a plane, or a three-dimensional volume. The surface may be curved and / or have a flat surface and may have any shape, e.g. For example, the haptic object may be funnel-shaped. A boundary of a three-dimensional haptic object may be generated to represent a variety of desired outcomes. The above may represent one or more modifications, such as cuts, to be made on the surface of the bone. The planar haptic object represents one or more modifications, such as cuts, to be made on the surface of the bone. The curved haptic object may support the cup 28a and / or the implant augment. The resulting bone surface may be depicted as it is modified to receive the

[0032] In an embodiment in which the robotic device 220 is a haptic device, the processing circuitry 260 is further configured to generate a virtual tool representation of the surgical tool 234. , which represent positions on the physical surgery tool 234 and are associated with positions on the physical surgery tool 234. The surgical tool 234 includes one or more tactile interaction points (HIPs). In embodiments where the HIP is at the center of a spherical burr, as shown, the HIP may represent the center of a spherical burr. If the tool 234 is irregularly shaped, for example with respect to a sagittal saw, the virtual representation of the sagittal saw may be A number of HIPs may be included. Haptic forces on the surgical tool (e.g., positive forces on movement) Using multiple HIPs to generate feedback or resistance , incorporated herein by reference, Dec. 28, 2011. The "System and Method for Providing S U.S. Patent Application No. 1, entitled "Ustantially Stable Haptics" In one embodiment of the present invention, a sagittal saw is The virtual tool depicted includes eleven HIPs. As used herein, "HIP" refers to Any reference to "one or more HIPs" is deemed to include a reference to "one or more HIPs." In addition, the relationship between the HIP and the haptic object determines how the surgical system 200 constrains the surgical tool 234. This makes it possible to

[0033] Prior to the performance of the surgical procedure, the patient's anatomy (e.g., femur 206) may be pre-surgery-removed or removed from any pre-existing endodontic or endodontic materials. The bones are then registered to a virtual bone model of the patient's anatomy using a registration technique. The technology is incorporated herein by reference in its entirety. "Haptic Guidance System and As described in U.S. Patent No. 8,010,180 entitled "Dynamic Method for Reducing the Size of a Circular Cylinder," Instead, the registration is incorporated herein by reference in its entirety. No. 6,393,741, filed on July 30, 2012, which is incorporated herein by reference. U.S. patent application Ser. No. 13 / 562,163, entitled "Hic Imaging Device" 2D / 3D imaging using a handheld radiography imaging device, as described in Registration may be achieved by registering the surgical tool 234 to a virtual tool representation. 234, so that the surgical system 200 can The orientation of the surgical tool 234 (relative to the femur 206) can be determined and monitored. The recording allows for precise navigation, control, and / or force feedback during a surgical procedure. In some embodiments, additional information related to registration for hip arthroplasty procedures may be provided. The details are explained in detail below.

[0034] The processing circuit 260 detects the patient's bone (e.g., femur 206), the surgical tool 234, and one or more lines, planes, or corresponds to a real-world position in 3D space. The virtual position of the virtual object (e.g., virtual haptic object) may be monitored. For example, the virtual position of the virtual object may be monitored. If the structure moves during the surgical procedure as tracked by the tracking system 222, The processing circuit 260 moves the virtual bone model accordingly. The rule describes the actual (i.e., physical) anatomy of the patient and the location of the anatomy in real / physical space. and orientation. During the surgical planning associated with the cuts, modifications, etc. that will be made to the anatomy Other planned automated robotic device actions occurring during the procedure also move in response to the patient's anatomy. In some embodiments, the surgical system 200 substantially immobilizes the femur 206. 206. The femur 206 may be fitted with a clamp or brake to minimize the need to track and manipulate the motion of the femur 206. Includes lace.

[0035] For embodiments in which the robotic device 220 is a haptic device, the surgical system 200 configured to constrain the surgical tool 234 based on a relationship between the HIP and the haptic object. That is, the surgical tool 234 is adapted to virtually contact the haptic object and guide the hip joint. provided by the tracking system 222 to detect when a user is operating the When the data is used by the processing circuit 260, the processing circuit 260 The user can then receive haptic feedback (e.g., force, vibration) that communicates constraints on the movement of the wheel 234. In general, the term "constraint" refers to As used herein, the term is used to describe the tendency to regulate migration. However, the type of constraint imposed on the surgical tool 234 depends on the type of haptic object associated with it. The tactile objects may be molded in any desired shape or configuration. As mentioned above, three exemplary embodiments include a line, a plane, or a three-dimensional volume. In an embodiment, the HIP of the surgical tool 234 is constrained to move along a linear haptic object. For this reason, the surgical tool 234 is constrained. and a surgical tool 234 is positioned outside the volume bounded by the walls of the three-dimensional haptic object of the HIP. In another embodiment, the planar haptic object may be constrained by substantially preventing movement. The body substantially prevents movement of the HIP outside the plane and outside the boundaries of the planar tactile object. For example, the processing circuitry 260 may be limited by the planned In order to substantially restrict the surgical tool 234 to the plane required to make the desired distal cut, A plane corresponding to the planned planar distal cut required to generate a distal surface on the femur 206. A tactile object can be established.

[0036] For embodiments in which the robotic device 220 is an autonomous device, the surgical system 200 is configured to autonomously move and operate the surgical tool 234 according to the control object. For example, the control object may be the femur 206 on which the cut is to be made. In such a case, one or more motors, actuators, and / or other mechanisms of the robotic arm 232 and surgical tool 234, e.g., a closed loop To enable control, tracking data from the tracking system 222 is used to Move and actuate the surgical tool 234 as needed within the controlled object to perform the cut. It can be controlled so that

[0037] Referring now to FIG. 3, a method for planning and performing a hip arthroplasty procedure in accordance with an exemplary embodiment is shown. 3 shows a flow chart of a process 300 for performing the surgical procedure in the surgical system 20 of FIG. 0. In addition, FIGS. 4-16 show the following methods for implementing the process 300: Various systems, methods, graphical user interfaces, etc. are presented. To facilitate understanding, reference is made thereto. It should be understood that the present invention is not limited to the above-mentioned embodiments. In addition, Figures 3-16 are not intended to be limiting of the present invention. Although the present invention illustrates an embodiment of a process 300 for planning and performing a muscular musculoskeletal system (MSS), other anatomical structures, such as the shoulder or Other embodiments for planning and performing knee-related procedures are possible.

[0038] In step 301, a medical image of a hip joint is received to generate a virtual bone model of a pelvis. For example, medical images may be acquired using CT techniques, MRI techniques, or any other Images may then be acquired of the pelvis, femur, soft tissue, and other medical imaging modalities. An area of ​​the image corresponding to tissue and / or one or more previously implanted prosthetic components. They are segmented, ie, processed, to distinguish between the

[0039] In cases of revision hip arthroplasty (i.e., a previously implanted cup is shown in the image), The previously implanted cup is "fixed" (i.e., substantially rigidly attached to the pelvis) whether it is "loose" (i.e., at least partially separated from the pelvis) or "loose" (i.e., at least partially separated from the pelvis) If the previously planted cup is fixed, a determination may be made. For example, to facilitate registration in step 306, as described in The shape and position of the cup may be determined, and may be included in the virtual bone model of the pelvis. If the previously implanted cup is loose, the loose cup is included in the virtual bone model of the pelvis. The previously implanted cup may be dislodged and segmented so that the This may be caused by the cup material implanted in the cup and / or movement of the loose cup during imaging. To address distortions in certain CT or other images, various corrections may be introduced.

[0040] In some embodiments, step 301 may include processing circuitry 260 or other computing device. In another embodiment, step 301 may be accomplished automatically by a scheduling resource. Human input works in conjunction with automation to achieve segmentation and model generation. Used.

[0041] In step 302, the virtual bone model is A virtual model of the pelvis was generated and, in some cases, implanted before A virtual cup model is created for each component (e.g., primary cup, crush plate, compression screw, etc.). By virtual placement, the placement of the implant cup relative to the pelvis is planned. The Imaginary Cup Model is a representation of a cup impingement that will be implanted in a patient during a surgical procedure. A virtual representation of a bust. Various cup sizes, shapes, types, etc. may be possible. ,A different virtual cup model is available for each cup.,Desired rotation about the hip joint Provides a center of gravity (relative to the pelvis, relative to the patient's other hips, etc.) to maintain full range of motion The virtual cup model is placed to verify the posture of the virtual cup model. Various methods may be used via the surgical system 100 to facilitate a surgeon or other user in performing A software planning tool may be provided.

[0042] 4-5 are process diagrams for facilitating the planning of cup placement in step 302. The signal can be generated by the signal processing circuit 260 and displayed on the display 264. FIG. 4 illustrates a graphical user interface for receiving the Figure 5 shows a two-dimensional visualization of the planned cup orientation relative to the computed tomography images. 3D visualization of the planned cup orientation relative to the virtual bone model generated in 301 Both are described in more detail below.

[0043] In FIG. 4, a graphical user interface 400 includes a virtual implant cup 40 The first CT image 402 is overlaid with a representation of the virtual implant cup 40. The center point (center of rotation) 406 of the graph is also shown. The local user interface 400 is configured to display the relevant In the embodiment of FIG. 4, the graphical user interface The base 400 includes a virtual implant cup 404, a center point 406, and a previous center point 408. 4 also shows a second CT image 410 (e.g., taken in a different plane) overlaid on the first CT image. Advantageously, bone density can be visible in the CT images 402, 410. The graphical user interface 400 thereby enables the surgeon to The present invention also provides a method for determining the placement of a virtual implant cup 404 relative to the imaged bone at a It can be made easier.

[0044] In FIG. 5, the graphical user interface 400 displays a three-dimensional representation of a virtual bone model 502. Visualization and three-dimensional representation of the virtual implant cup 404 positioned relative to the virtual bone model 502. The graphical user interface 400 includes a visualisation of the original as determined from the image. The virtual implant cup 404 is shown with its anterior center point 408 indicating the center of rotation of the ideal hip joint. The graphical user interface 400 thereby allows the surgeon The virtual implant cup 404 is then placed in a position that is easy to see and adjust. do.

[0045] As shown in FIGS. 4-5, the graphical user interface 400 is a virtual bone model. 502. The graphical user interface 400 includes a control arrow 504 that allows the user to Various information that may be of interest, such as pelvic tilt, cup tilt, cup version, , main, combined versions, and rear range, mid-range, and forward range It also includes a data field 506 indicating distance. The base 400 thereby performs implant cup placement relative to the pelvis in step 302. Facilitate the planning of installation.

[0046] In step 304, the virtual augment model is applied to the virtual implant cup. By virtually placing the implant augment, the placement of the implant augment is planned. For example, , in step 302, the implant cup is reliably and securely placed in the planned position. In some cases, an augmentation may be required to attach the virtual bone model 502 or The decision may be based on the visualization of the CT images in Figure 4. The options may be selected via a graphical user interface. 6 shows a virtual augmented model 600 and a selection of a desired arrangement of the virtual augmented model 600. 6 shows a view within a graphical user interface 400 that facilitates the selection of As shown, the virtual augment 600 is connected to the virtual bone model 502 and the and in position relative to the virtual implant cup 404. As shown in FIG. The virtual augment 600 displays the virtual bone model in the semi-transparent view and in the two CT image views. 502. Figures 6-7 are described in further detail below.

[0047] In most cases, implant augmentation is achieved by, e.g., replacing the implant cup. an outer surface of the implant cup having a substantially equal degree of curvature or radius to the outer surface; The augment thereby has an inner surface that substantially matches the implant cup. the implant cup is configured to be positioned adjacent the implant cup and to provide structural support for the implant cup. can be.

[0048] As shown in FIG. 6, the graphical user interface 400 may be used to When the lock to cup button 602 is selected, the virtual augment The object 600 is restricted to a predefined distance relative to the virtual cup 404. For example, The virtual augment 600 is approximately 2 mm from the virtual cup 404. This spacing may be located so that the augment is coupled to the cup. This provides a volume that can be filled with cement or other adhesive during the procedure to As shown in FIG. 6, the graphical user interface 400 is a virtual augmented reality (AVA) interface. You can choose to modify the rotation, version, and tilt of the object 600. , an array of control buttons 604 that store predefined intervals for the virtual cup 404; Thus, step 304 includes determining the planned placement of the implant augment. , which may include limiting the cup to a predefined interval relative to the planned position of the cup. .

[0049] As shown in FIG. 7, the graphical user interface 400 includes a virtual cup 40 7 shows a representation of the virtual augment 600 and virtual bone model 502 without the occlusion 4. As such, the graphical user interface 400 may be configured to allow the surgeon to receive the cup. This makes it easier to evaluate the contribution of the virtual augment 600 to the shaping of the surface for The CT view 704 is a virtual augmented reality (AVM) view of the patient's hip joint. The CT images show a two-dimensional view of the implant 600. The CT images show bone density, the previous implant cup, and other Implant components (e.g., screws, plates, etc. used to treat traumatic injuries) ), and / or other useful information. The interface 400 thereby provides an implant cup and an implant augmentation to the pelvis. The graphical user interface 400 also facilitates implant planning. This can facilitate the planning of screw trajectories for the inserts and augments, resulting in the The trajectory is considered / planned simultaneously. This means that the screws will not fit into each other or into any existing hardware. Augments and implants should be installed to avoid interference with the implant (e.g. trauma screws / plates). The screw trajectory can also be adjusted to ensure proper screw fixation. It may be visualized against bone density to ensure that this is achieved.

[0050] Steps 302 and 304 thereby determine the planned orientation and Such a plan can result in a planned position of the implant cup. The procedure (i.e., steps 301-304) may be performed pre-operatively and / or intra-operatively. The remaining steps of process 300 are performed intra-operatively, ie, during the surgical procedure.

[0051] In step 306, the patient's pelvis, surgical tool(s), robotic device, and A registration process is performed to register the relative positions of the probe and / or other tracked probes or devices. For example, the probe may be tracked by the tracking system 222 to determine the pelvic posture. The pelvis may be tracked and touched at various points on the pelvis. The method has been described above.

[0052] In the case of revision hip arthroplasty procedures, the previously implanted cup may be loose or fixed. Different registration workflows may be used depending on whether or not the user is registered. FIG. 8 shows an example 8 illustrates a flowchart of a process 800 for registration in a revision hip arthroplasty procedure according to an embodiment. Chart shown.

[0053] As illustrated in FIG. 8, if the front cup is fixed, in step 802, The implant liner (i.e., implanted in the previous procedure) is removed. In step 804, the pelvic bone is implanted through a previous implant cup fixed to the pelvis. The position is registered. For example, the tracked probe is aligned with the surface of the previous implant cup. Various locations on the previous implant cup may be touched to determine the force of the implant. In one embodiment, intraoperative imaging (e.g., If necessary, x-rays may be used. The bones are fixed and known from the medical images received in step 301. Such data may be used for registering existing hardware (e.g. Identify and register traumatic structures (screws / plates) to facilitate avoidance of such structures during the procedure. (e.g., by generating virtual control objects around specified locations of such structures) Tracked probes and / or intraoperative imaging may also be used to determine the location of the graft. In step 806, a revision implant may be installed. In some embodiments, the previous cup is removed, for example, as described in U.S. Pat. As described in the specification of 0180014891, the previous (primary, existing) imp To facilitate removal of the implant, haptic guidance is used. Browse our library of implant designs to determine relevant implant geometries and probe is used to identify the edges of the previous implant and to define the haptic boundary based on the probed edges. By generating, a virtual control object may be generated.

[0054] Also, as illustrated in FIG. 8, the front cup is loose (i.e., not secured) Prior to pelvic registration, the previous cup and liner are removed in step 808. In step 810, the pelvis is registered without the previous cup. The probe may be touched at various points around or within the area that has been removed from the skin.

[0055] To further facilitate registration of step 306 according to some embodiments, FIGS. FIG. 10 depicts the pelvic region that can be used for registration in various scenarios. FIG. 9 illustrates a virtual bone model 900 including a fixed cup, and FIG. 1 illustrates a virtual bone model 1000 with the loose wrap removed, leaving a generally smooth surface. 9 to 10 are area A 902, area B 1002, area C 1004, and area D 904. 1 includes the demarcation of several registration areas, as shown.

[0056] In the fixed cup scenario, the registration points (i.e., the positions of the probes tracked) The point that is touched and used for registration is the surface of the fixed cup that was previously implanted. The image may be taken within area A902, which corresponds to the surface. Such a point is particularly important since the area A902 is exposed during surgery to allow for reliable Other points may also be possible and accessible, for example within region D904 (ilium The images may be taken along the ridge of the hip bone and / or within region C904 (above the acetabulum).

[0057] In the loose cup scenario, the registration point is when the loose cup is removed from the patient. The image may be taken within a region B1002 corresponding to the exposed acetabular surface. For example, the registration point , may be taken around the edge of region B1002. The reliability of such points is Distinguish the bone surfaces in pre-op images from a loose cup that has been removed to expose the 2 surfaces. The accuracy of the segmentation in step 301 may be a factor. In some embodiments, the acetabular registration point is not used (registration points in area A 902 or area B 904 (without using area C1004 and / or area D904), additional acetabular registration points (e.g., By using the pelvis registration is achieved in a loose cup scenario.

[0058] The registration as performed in step 306 thereby registers the virtual bone model in virtual space. This facilitates the mapping of the actual posture of the pelvis in real space to the virtual position of the delta 502. The virtually planned orientation of the implant augment and virtual implant cup is then , the real pose in real space (e.g., relative to the coordinate system used by the tracking system 222) ) may also be associated with

[0059] The primary cup (i.e., the existing implant) is then removed using standard techniques. In some cases, removal of the primary cup may be considered a step in the original surgical plan. This can result in unpredictable defect cavities. The probe is touched at various locations on the surface of the defect cavity and traced / painted along the defect cavity. Thus, for example, by tracking the position of the probe, the contours (size, A tracked probe may be used to define the shape, pose, etc. of the virtual bone model. The model may then be updated to include a virtual representation of the defect cavity, resulting in a virtual bone model. The model will substantially match the actual shape of the bone after removal of the primary cup. The surgical plan is then For example, the size or orientation of the augment may be modified to take into account the defect cavity. It may be adjusted to compensate for gaps from the segmentation process or to reduce the original image (e.g. Intraoperative registration and bone model updating were also used to clarify areas of scattering in the CT images. This is also fine.

[0060] Other features that can be identified and registered during surgery, e.g. insufficient bone stock, cysts Similar updates may occur in response to identifying, for example, a resected The image is moved by the user to a position that indicates the location of a feature (e.g., a cyst) that is desired to be Based on the tracked position of the probe, a custom virtual control boundary is automatically generated during surgery. The robotic device 220 then creates a custom virtual control to ablate the identified feature. The control may be based on a control boundary.

[0061] Additionally, in some embodiments, following the initial resection (e.g., osteophyte resection), a virtual bone model is For example, a cutting accessory may be used to remove bone spurs or other features. To be used, a cutting accessory (e.g., attached to the robotic device 220) may be attached to the bone. Based on the tracked movement of the cutting accessory, the ablated portion may be determined. By removing a portion of the virtual bone model's location that corresponds to the feature that was cut, the cutting accessory The virtual bone model may be automatically updated to include the modifications made by the The model may thereby be updated to accurately represent the post-resection bone surface without reimaging. The surgical plan for the remaining steps of the procedure is updated based on the updated virtual bone model. Or other interventions may be planned (e.g., bone grafts to fill the void). degree).

[0062] In step 308, the acetabulum is reamed to form the pelvic surface and the planned The robotic device 220 is controlled to receive the cup in the posture. The virtual control object may be generated based on the planned pose of the cup (referred to herein as “cup”). For example, a cup virtual control object is a virtual control object that is attached to the outer surface of a cup. The cup virtual control may include a surface that corresponds to the cup and is aligned within the planned pose of the cup. Such surfaces of the body are suitable for planned bone modifications, e.g., alignment (e.g., reaming) procedures. Define the resulting configuration of the posterior bone and thus the cup implant in the planned position. Bone is formed to receive the nutrients.

[0063] In step 308, the robotic device 220 uses the cup virtual control object to In some embodiments, the robotic device 220 may be controlled by the surgical tool 2 34 to ream the pelvis and shape it into the planned position. To receive the cup, the robot performs autonomous movement guided by the cup virtual control object. In other embodiments, the robotic device 220 may be configured to operate the surgical tool 234 in a manner that allows the user to manipulate the surgical tool 234. Then, ream the pelvis and prepare the pelvis to receive the cup in the planned position. Providing the user with haptic feedback to constrain the surgical tool 234 within the cup virtual control object These and other possible control modalities are described above with reference to FIG. This is explained in detail in.

[0064] FIG. 11 illustrates, for example, an embodiment in which the robotic device 220 is a haptic device. To facilitate performance of step 308, the processing circuitry 260 may generate and a graphical user interface that can be displayed on the display 264. 11 shows an embodiment of a graphical user interface 1100. The graphical user interface 1100 is a Color-coded (e.g., green) or shaded areas indicate areas of bone that will be removed by The virtual bone model 502 has a region 1102 that is cut. The arrow 1104 indicates the location of the surgical tool 23. The tool indicator 1106 indicates the current orientation and center point of the surgical tool 234. Indicates that the tool is currently in operation (for example, that the reamer is rotating).

[0065] The processing circuit 260 receives the tracked posture of the pelvis and the surgical position from the tracking system 222. The tool 234 can be used to generate a graphical user interface 1100 in real time. For example, the cutting accessory (e.g., a cutting tool 234) may be configured to update the cutting accessory. As the tracking data shows, the Matool head passes through the corresponding area of ​​the bone. The divided or shaded area 1102 may decrease in size. Completion of the bone modification is indicated by the complete consumption (no reduction) of the colored or shaded region 1102. This corresponds to the following: not storing, erasing, etc.

[0066] Virtual control objects may also be represented by the graphical user interface 1100. In some cases, the processing circuitry 260 may be configured to control the surgical tool 234 as a virtual control object. The tracking system 222 detects violations of the constraints and bone modifications beyond the surgical plan. Different colour coding (e.g. red) can be provided to indicate areas where these data are do.

[0067] In step 310, the acetabulum is reamed to prepare the pelvic surface and implant. The robot is then positioned to receive the implant augment within the planned orientation of the augment. The remote device 220 is controlled.

[0068] For example, a virtual control object may be generated based on the planned pose of the augment. (Herein referred to as an "augmented virtual control object"). For example, The object corresponds to the exterior surface of the augment and is aligned within the planned orientation of the augment. Such surfaces of the augmented virtual control object may include surfaces that are aligned with the planned bone structure. Define the resulting configuration of the bones after the correction, e.g., the alignment process, and thus the planned The bone is prepared to receive the augmentation implant in the correct position.

[0069] In some embodiments, the cup virtual control object and the augmented virtual control object are separate. The virtual control object is a bone-forming object that first receives the cup and then forms a bone-forming object to receive the augmented reality cup. By receiving the instructions, the surgical plan is executed in series. In this case, the order may be reversed, resulting in the use of an augmented virtual control object. The robotic device 220 is controlled to first form bone to receive the augmentation. , and then to control the robotic device 220 to prepare the bone and receive the cup. , a cup virtual control object is applied.

[0070] In some such embodiments, the cup virtual control object and the augmented virtual control object Different bodies may require different approach orientations for surgical tools. The processing circuit 260 may then determine whether the first bone modification is complete (i.e., end of step 308). may be determined, for example, before starting the second bone modification (i.e., performing step 310). For example, a folding haptic boundary can be used to change the orientation required by the cup virtual control object. The surgical tool may be guided to the required orientation by the augmented virtual control object. Additionally, in some embodiments, the changes to the surgical tool 234 are made in steps 308 and 31. 0, for example, to form a cup region. A first reamer head having a diameter of 1.5 mm is used to prepare the bone to receive the augmentation. A second reamer head having a second (e.g., smaller) size is used. The physical user interface 1100 may be used to effect such modifications to the surgical tool 234. A prompt may be displayed.

[0071] In another embodiment, the cup virtual control object and the augmented virtual control object are a cup and The augmented reality may be combined into a single virtual control object that includes surfaces corresponding to both the augmented reality and the augmented reality. In such an embodiment, steps 308 and 310 may be performed in a unified (simultaneous) manner. It may be performed in

[0072] FIG. 12 illustrates a graphical representation of the display as it appears during step 310 in an exemplary embodiment. 1 shows a graphical user interface 1100. indicates the area of ​​bone that will be removed according to the surgical plan during step 310. 11 shows a virtual bone model 502 having a segmented (e.g., green) or shaded region 1102. To visualize the actual bone modifications made during step 308, The virtual bone model 502 has been modified by the path 260. The arrow 1104 indicates the position of the surgical tool 2. 34. In the illustrated embodiment, the arrow 1104 indicates the current heading and center point of the The tool indicator 11 has been changed in orientation relative to the orientation of the arrow 1104 so that 06 indicates that the surgical tool 234 is currently in motion (e.g., a reamer is rotating). (To do so).

[0073] To facilitate step 308, the processing circuit 260 may include a processor 262 for processing the tracked posture of the pelvis. and a surgical tool 234 from the tracking system 222 is used to provide a graphical user interface. The surgical tool 23 may be configured to update the face 1100 in real time. 4. The cutting accessory (e.g., the head of a reamer tool) passes through the corresponding area of ​​the bone. As the tracking data indicates, the colored or shaded areas 1102 vary in size. Completion of the planned bone modification is indicated by the colored or shaded area 1 This corresponds to a complete consumption of 102 (reduction to nothing, elimination, etc.).

[0074] Steps 308 and 310 thereby determine the orientation of the pose planned in step 302. and in step 304, the cup is placed in the planned position to receive the implant. This results in a bone (e.g., the pelvis) being formed.

[0075] In step 312, for example, as illustrated in the example embodiment of FIG. The augment is placed in the planned pose, and the actual and planned poses of the augment are compared. As shown in FIG. 13, the surgeon verifies the alignment between the surgical site and The augment 1300 has been manually placed adjacent to the bone in approximately the planned position. A navigation probe 1302 is shown touching a point on segment 1300. The navigation probe 1302 may be tracked by the tracking system 222, As a result, the tracking system 222 may detect other tracked objects, e.g., In this way, the position of the tip 1304 of the probe 1302 relative to the modified bone can be confirmed. The navigation probe 1302 can be touched to multiple points on the augment 1300. By tracking the navigation probe 1302 as it moves, the augmented reality 13 The attitude of the 00 may be determined by the tracking system 222 and the processing circuitry 260. In such an embodiment, the processing circuitry 260 may The augmented pose is compared to the planned pose of the augment from step 304. The processing circuit 260 displays the augmented 1300 on the display 264. Shows an indication that the tracked pose matches the planned pose of the augment and / or the tracked pose of the augment 1300 may be displayed to the augment 13 The actual position of the Augment 1300 has been revised to match the planned position of the 00. In another embodiment, the augment 1300 may provide guidance for correcting the The inserter tool may be coupled to the inserter tool so that the processing circuitry is Tracked posture of the inserter tool to facilitate navigation of the augment to the pose In some embodiments, the inserter tool can be a robotic device. The inserter tool is supported by the inserter 220 or another robotic arm, so that the inserter tool can The augment 1300 can be held in the inserted position.

[0076] In step 314, for example, as illustrated in the example embodiment of FIG. to hold the augment in its planned position while it is attached to the pelvis. The robotic device 220 is controlled. As shown in FIG. The holder is positioned as described with reference to FIG. The implant 1400 is coupled to the robot arm 232 and is fitted with a trial cup implant 140. 2. As opposed to the Augment 1300, the Trial Cup Impingement Push the runt 1402 forward, pushing the augment 1300 against the bone, thereby The robotic arm is adapted to hold the augment 1300 in a planned position relative to the bone. The augment 1300 may then be bonded to the bone. In this embodiment, one or more screws are inserted through the augment 1300 and into the bone. , a surgical drill 1404 to fix the augment 1300 to the bone in the planned position. (e.g., a telescopic drill) is used. The appropriate position is determined by the robotic device 220. The trial cup implant 1402 is held in place while the screws are inserted. Migration of the augment 1300 can be substantially prevented, thereby facilitating the surgical procedure. Reduces the number of surgeons or surgical assistants required to perform the procedure and improves visibility of the surgical field This improves the accuracy of the placement of the augment 1300 relative to the surgical plan. In this case, a trial cup implant is used, but in step 314, a final cup implant is used. An implant may also be used.

[0077] In another embodiment, in step 314, the augment 1300 is attached to the holder arm. The robot device 2 is connected to the augment 1300 so as to adjust the position of the augment 1300. 20 may move the holder arm. In such an embodiment, for example, The surgeon is then guided to the planned position by providing visual feedback or haptic feedback to the surgeon. The robot device 220 is controlled to move the member 1300. In an embodiment, the surgical drill 1404 is robotically controlled (e.g., by a second robot). The robot is connected to an arm and autonomously inserts screws into the bone through the augment according to the surgical plan. In some embodiments, a pilot hole for screw insertion is provided. A cutting accessory of the surgical tool 234 may be used (autonomously or under haptic guidance). In some such embodiments, the screw insertion accessory then , to insert bone screws into the pilot holes and through the augments (autonomously or The surgical tool 234 may be mounted on the surgical tool 234 (under haptic guidance).

[0078] In step 316, the implant cup is positioned substantially within the planned orientation. The implant cup is placed (as planned in anticipation of step 320 described below). In some embodiments, see step 312. The cup is manually placed by the surgeon as described above for the augmentation. and checking its position using a navigation probe. The implant cup is mounted on a fitting arm coupled to the robotic device 220. For example, the virtual reality can be achieved autonomously or by providing haptic feedback to the user. The robotic device 220 is adapted to move the implant cup to the planned position. For example, as the implant cup approaches the planned position, i.e., close to the planned attitude, but substantially away from the planned position relative to the current position. Fold it (make it smaller) so that you can move the implant cup without it coming apart too far. The contact is controlled by constraining the position of the implant cup within a virtual control object (which moves and converges). Sensory feedback may be provided. The implant cup is thereby substantially It is positioned and oriented within a defined attitude.

[0079] In step 318, cement is placed between the cup and the augment. As described above with reference to step 304, the planned orientation of the augment is such that the cement It is included between the cup and the augment to allow for coupling of the cup to the augment. Steps 312-316 are spaced apart from the planned position of the cup so that By following the above, the actual positions of the cup and the augment can be calculated by the following equation: Thus, the process 300 creates a space for the cement between the cup and the auger. predictable, consistent, and favorable (planned, clinically validated) interactions between Promote the use of large amounts of cement.

[0080] In step 320, the cup fitting is facilitated to place the cup in the planned arrangement. The robot device is controlled to fix the object. 15 shows an example embodiment of a surgical system 200 arranged as follows. Then, the embedding device 1500 is mounted on the robot arm 232. align the implantation device 1500 with the planned orientation of the cup and so that end 1501 contacts the cup at a substantially planned location relative to the cup. 15 shows a fitting device for fitting the cup. A display that provides an indication that the Chair 1500 is properly positioned. When the surgical system 200 is in the state shown in FIG. The surgeon may provide blunt force to the proximal end 1502 of the implantation device 1500. A force is transmitted along the fitting device 1500 to fit the cup into the cup. The force drives the cup into the pelvis to substantially fix the cup relative to the pelvis. The information displayed on the robot arm 232 and the display device 264 is external. The surgeon determines whether the cup is in the planned position (i.e., as planned in step 302). This makes it easier to achieve a fit so that the pelvis is fixed to the pelvis.

[0081] In step 322, a scheduled cement curing time (e.g., 10 minutes) is determined. The robot device is controlled so that it continues to hold the cup in the same position. 1 illustrates step 322 in an example embodiment, and the holder arm 1400 is used to 1 shows an implant cup 1600 held in position relative to the implant augment 1300. The holder arm 1400 may be the same device as the embedding device 1500 or a different device. By automating this holding task, the surgeon or surgeon The assistant is advantageously freed from accomplishing other tasks related to the surgical procedure In addition, robot-assisted and tracked position during cement hardening can be used to It can be ensured that the planned geometric relationship between the In addition, the cement is hardened because relative movement is minimized as the cement hardens. The conformity of the coating and the integration of the cup and augment can be optimized.

[0082] Following step 322, for example, a liner may be positioned within the cup and the femoral insulator may be inserted within the cup. The implant is positioned, the soft tissue is repaired adjacent to the hip joint, and a secure surgical incision is completed. The surgical procedure may continue according to the established workflow. The method may be configured to support some or all of these additional steps in various embodiments. The process 300 may thereby perform augmentation according to a personalized surgical plan. and improving surgical efficiency and experience for the surgeon by providing accurate placement of the cup. This can improve the quality of life of patients, reduce the duration of surgical procedures, and improve patient outcomes. It can be improved.

[0083] 3-16 illustrate embodiments related to hip arthroplasty procedures and will be described with reference thereto. It should be understood that the systems and methods described herein may be adapted for shoulder arthroplasty procedures. For example, the workflow of process 300 may be followed to perform augmentation in the glenoid cavity. Mesh, bone grafts, or other support structures may be planned and attached. In embodiments, the augmentation can be tailored (e.g., with additional manufacturing) for a particular patient. Can be customized.

[0084] Referring now to FIG. 17, a method for performing an autopsy in a knee arthroplasty procedure in accordance with an exemplary embodiment is shown. 17, a flow chart of a process 1700 that facilitates use of the segment is shown. , which in some embodiments may be performed by the surgical system of FIG. In the surgical procedure, the tibia is prepared to be connected to the tibial implant and the femoral implant is The femur is then formed to be attached to the tibia to provide knee function. The bone implant and the femoral implant are articulated to each other. One goal of the study is to provide a relative position that ensures a full range of knee motion without pain or discomfort to the user. Another goal of the total knee arthroplasty procedure is to place tibial and femoral implants within the is the load from functional use of the knee (e.g., standing, walking, running, etc.). The tibial and femoral components are designed to withstand the forces of gravity (walking, riding a bike, etc.) The goal is to ensure that the femur is attached to the femur. (e.g. bone petals, revision knee procedures, etc.) to improve patient outcomes. To provide structural support and facilitate placement of the implant in a preferred position, Alternatively, it may be desirable to use one or more augmented components in addition to the femoral implant. There are times when this happens.

[0085] In step 1702 of the process 1700, a trial implant or template is The bone is physically positioned in a desired orientation relative to a bone (e.g., femur or tibia). In some cases, the bone may be subjected to one or more procedures during the knee arthroplasty procedure prior to step 1702. In step 1702, the trial is Determine whether the implant is in the desired (appropriate, clinically advantageous, etc.) position Various tests may be performed to determine whether the ligament balance test is performed. For example, a ligament balance test may be performed. .

[0086] When the trial implant is positioned within the desired orientation, step 1704 In the trial implant, the prosthetic device is used to touch or trace one or more lines or points on the trial implant. The pose of the tracked probe is tracked while the lobe is in use. The position and orientation of the tracked probe relative to the target position and orientation are as described above with reference to FIG. 18 to 21 are examples of the registration process of step 1704. Illustrate non-limiting embodiments.

[0087] As shown in FIGS. 18 and 19, a tibial template 1800 is positioned on the tibia 208. As shown in FIG. 18, the anterior curve 1804 of the tibial template 1800 The internal contour 1806 of the bone template 1800 and the anterior ridge 1802 of the tibial template 1800 808. As shown in FIG. 0, tibial alignment handle dimple 1902, anterior reference mark 1904, and anterior nail The probe is touched to various points on the tibial template 1800, including the holes 1906. Fixed in position in or relative to the bone template 1800 170 to collect points or lines on the selected device or devices. 4, any combination of lines and dots as shown in Figures 18-19 is used. Good too.

[0088] As shown in Figures 20-21, a femoral trial 2000 is used. The probe 1 is used to track the intercondylar notch 2002 of the femoral trial 2000. FIG. 21 shows the probe 1802 used to touch the peg hole 2100. To collect points and lines on the femoral trial 2000, in step 1704 In this case, any combination of lines and dots as shown in Figures 20-21 may be used. stomach.

[0089] In step 1706, a trial-in in virtual space is performed for the tracked pose of the bone. The pose of the plant (e.g., represented by a virtual model of the bones) is determined. The tracked state of the probe 1802 as various lines or points are touched in step 1704. Based on the position, the trial implant model is modeled in virtual space against the virtual bone model. The track may be oriented and positioned. The steps are designed to provide sufficient data for accurate determination of the clinical implant position. The points and lines used in step 1704 (and shown in Figures 18-21) are selected. .

[0090] In the embodiments described herein, an implant (i.e., a device that is placed in the patient after the procedure) is used. The trial implant is the planned position for the implant that will be placed in the implant position. In another embodiment, the trial implant orientation and the implant orientation are used. An offset or other adjustment may be made to the planned pose.

[0091] In step 1708, one or more bone modifications are planned (e.g., processing cycle The planned bone modification(s) are coupled to the augment. This allows bone to form to receive the augmentation and implant, resulting in The plant is positioned within the planned pose (e.g., determined in step 1706). For example, to accommodate bone loss or weakening on the first side of the bone. Augments may be used to correct for the position of the trial implant. In some cases, based on other pre-operative or intra-operative data, processing circuitry 26 0 (e.g., various sizes, types, shapes, etc. are available) In such cases, the corresponding section of bone is removed. The augment is firmly positioned to reinforce the connection between the implant and the bone. In step 1708, a surgical plan is performed to plan bone modifications. Various other updates, additions, etc. to may also be made.

[0092] To facilitate explanation of step 1708, FIGS. 22-23 show an augmented knee joint. FIG. 22 illustrates a tibial implant 2200 and 22 shows a tibial augment 2202. If a tibial augment 2202 is desired, At step 1708, bone is removed from the tibia to be received by the tibia 208. The cut is planned to create space for the tibial augment 2202. 3 shows a femoral implant 2204 having a pair of femoral augments 2206. If a femoral augment 2206 of FIG. 23 is desired, bone is removed from the femur and the femoral In step 1708, the bone implants 2204 are spaced apart from each other to provide space for the pair of bone implants 2204. In another embodiment, the pairs of planar cuts used in a given procedure are Other types of implants may be used according to the surface contours of the corresponding implant(s) and augment(s). The type of cut and the resulting shape (e.g., the volume reamed by the burr) are used For example, different types of augmentations (e.g., cone augmentations, stem augmentations) may be used. For each of the endoscopically connected portions (e.g., a portion), a corresponding ablation shape may be performed in step 1708.

[0093] In step 1710, the trial implant is removed from the surgical field. At step 1712, the robotic device 220 performs a bone resection to facilitate the planned bone modification. For example, the robotic device 220 may be controlled by an external The surgeon uses a surgical tool coupled to the robotic device 220 to perform the planned bone modification. In another example, a user may provide haptic feedback to facilitate performing the steps. The robotic device 220 may be controlled to automatically perform the planned bone modifications. .

[0094] In step 1714, the trial confirmed in steps 1704 to 1706 is The implant is positioned consistently with the desired orientation of the augmented implant. In some embodiments, the augment and implant are attached. The implant is manually placed and the trial implant is The tracked probe is used to check the position. Hold the augment and / or implant in a given position and / or insert the augment into the patient's bone ( In the case of knee arthroplasty, augmentation and / or implantation of the femur or tibia Controlling drills or other tools to facilitate and / or automate plant integration The robot device 220 is controlled so as to

[0095] The process 1700 thereby provides intraoperative planning and the placement of the tibial or femoral implant. The present study provides a robotic-assisted knee arthroplasty procedure that includes placement of an augment for either the The process 1700, as well as various other systems and methods described herein, may be implemented in various ways. Adapted for various indications, various surgical procedures, various anatomical regions, etc. It should be understood that this may also be the case.

[0096] In some embodiments, a method is implemented using the systems and methods described herein. Data is collected that is relevant to the plans and procedures used. For example, among other possibilities, Implant type, bone density, ligament balance measurement, final implant placement (angle, anterior / posterior lateral alignment, medial / lateral alignment, alignment with respect to the joint line, mechanical and anatomical axial position, etc. Details may be collected during planning of the procedure. Post-operative outcomes may also be collected. Post-operative outcomes This in turn provides insight into improvements to the implementation and performance of the systems and methods described herein. It may be compared with other data.

[0097] The construction and arrangement of the systems and methods as shown in the various exemplary embodiments are provided for illustrative purposes only. Although several embodiments have been described in detail in this disclosure, many modifications are possible. It is possible to change the shape, size, dimensions, structure, shape, and proportions of various elements, parameters, etc. data values, material use, color, orientation, etc. For example, the position of an element may be reversed or The number or nature of the discrete elements or locations may be altered or varied. All such modifications are intended to be within the scope of the present disclosure. Thus, the order or sequence of any process or method steps may be varied or re-sequenced. The design, operation, and / or other features of the exemplary embodiments may be modified without departing from the scope of the present disclosure. Other substitutions, modifications, variations and omissions may be made in the conditions and sequences.

[0098] As used herein, the terms "approximately" and "about "about," "substantially," and similar terms Broad meaning in keeping with common and accepted use by those of ordinary skill in the art to which the disclosed subject matter pertains. These terms are intended to have precise numbers that provide a range of those characteristics. To allow for the explanation of the specific features described and claimed without limiting the range of values. It should be understood by those skilled in the art having reference to this disclosure that the present invention is intended to Thus, these terms are intended to cover insubstantial or insignificant modifications or alterations of the subject matter described. These should be construed as indicating that they are believed to be within the scope of the disclosure.

Claims

1. 1. A system for assisting in an arthroplasty procedure, comprising: A robotic device; a cutting tool configured to interface with the robotic device; and a processing circuit in communication with the robotic device, the processing circuit teeth, A first planned position of the implant relative to the patient's bone and the implant augmentation obtaining a surgical plan including a second planned location of the forming the bone to receive the implant within the first planned location and a planned augmentation structure configured to receive the implant augment within the planned position of the implant; Determine the bone correction, generating one or more virtual objects based on the planned bone modifications; The cutting tool is coupled to the robotic device to cut the bone according to the planned bone modification. The cutting tool is controlled by the one or more virtual objects while operating to modify the bone. controlling the robotic device to The system is configured as follows.

2. The one or more virtual objects include a virtual object including a reaming surface, 2. The method of claim 1, wherein the surface corresponds to both the implant and the implant augment. The system described in

3. The one or more virtual objects include a first virtual object including a cup surface corresponding to the implant. a second virtual object including an augmented surface corresponding to the object and the augmented implant; The system of claim 1 comprising a body.

4. The processing circuitry includes, in series: selecting the first virtual object and constraining the cutting tool with the first virtual object; selecting the second virtual object and constraining the cutting tool with the second virtual object; to constrain the cutting tool by the one or more virtual objects. configured to control a robotic device; The system of claim 3.

5. a holder arm configured to be coupled to the robotic device; The processing circuitry performs the implantation on the bone within the second planned location. Temporarily holding the implant augment in place to fix the implant augment to the bone. and controlling the robotic device to position the holder arm to assist in It is structured as follows: The system of claim 1 .

6. The processing circuit includes: acquiring an image of the bone and a previous implant bonded to the bone; Segmenting the image to distinguish between the bone and the previous implant; generating the surgical plan using the segmented image; obtaining the surgical plan by The system of claim 1 , configured as follows:

7. a tracking system configured to track the relative position of the bone and the robotic device. and the tracking system determines the position of the implant based on the measured position of the implant. The system of claim 6 , configured to register bone poses.

8. The processing circuit includes: generating a virtual bone model based on the segmented images; A virtual implant and a virtual representation of the previous implant are simulated for the virtual bone model. Imaginarily positioning the implant to define the first planned position of the implant; virtually positioning a virtual implant augment relative to the virtual implant; defining the second planned position of the implant augment; The system of claim 6 , configured as follows:

9. The processing circuitry controls the virtual implant augment and the virtual implant.

9. The system of claim 8, wherein the system is configured to require a predetermined interval between Tem.

10. The processing circuitry processes the virtual bone model, the virtual implant, and the virtual Configured to generate a graphical user interface that shows the implant augmentation The system of claim 8 .

11. 11. The method of claim 10, wherein the graphical user interface illustrates one or more screw trajectories. The system described.

12. a tracking system and a probe, the tracking system adapted to measure the position of the probe relative to the bone; configured to determine a position of The processing circuitry determines the inference based on the position of the probe relative to the bone. and configured to determine whether the implant augment is in the second planned position. It has been made The system of claim 1 .

13. A first planned position of the implant cup relative to the patient's bone and the implant augment obtaining a surgical plan including a second planned location of the operative stent; preparing the bone to receive the implant cup in the first planned location; A device configured to receive the implant augment in the second planned location. determining the defined bone modification; generating one or more virtual objects based on the planned bone modifications; and a surgical tool in communication with the robotic device according to the planned bone modification; a robotic device using the one or more virtual objects to assist in modifying the bone. and The method comprises:

14. Controlling the robotic device using the one or more virtual objects includes: The method of claim 13 , further comprising constraining the surgical tool by said virtual object.

15. The one or more virtual objects may include the implant cup and the implant augment. The method of claim 13 , further comprising: a virtual object including a reaming surface corresponding to the target.

16. The one or more virtual objects include a first virtual object including a cup surface corresponding to the implant cup. and a second virtual object including an augmented surface corresponding to the implant cup. The method of claim 13, comprising administering to said subject a therapeutically effective amount of

17. Controlling the robotic device includes: Selecting the first virtual object and using the first virtual object to constrain the surgical tool. Use determining that the bone is prepared to receive the implant cup; Selecting the second virtual object and using the second virtual object to constrain the surgical tool. Use 17. The method of claim 16, comprising:

18. The robotic device is adapted to position the implant in the bone within the second planned location. Assists in fixation of the implant augment to the bone.

14. The method of claim 13, comprising controlling the robotic device to:

19. Obtaining the surgical plan includes: acquiring an image of the bone and a previous implant coupled to the bone; Segmenting the image to distinguish between the bone and the previous implant; generating the surgical plan using the segmented image; The method of claim 13, comprising:

20. Obtaining the surgical plan includes:

14. The method of claim 13, further comprising: requiring a predetermined distance between the runt cup and the method.

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