Multiple bone prediction for orthopedic procedures

Abstract

The surgical planning system may be configured to predict a relationship between two or more bones, including adjacent and / or non-adjacent bones, of a patient. The system may be configured to select a representative bone model associated with the bone in response to comparing the representative bone model with a patient bone model associated with the patient's bone. The system may be configured to determine at least one patient characteristic based on a relationship between the representative bone model and / or the patient bone model and another bone model that may be associated with the adjacent or non-adjacent bone. A method for planning a surgical procedure is also disclosed.

Description

[Technical Field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims priority to U.S. Provisional Application No. 18 / 353,270, filed July 17, 2023, which claimed priority to U.S. Provisional Application No. 63 / 399,190, filed August 18, 2022, and U.S. Provisional Application No. 63 / 406,562, filed September 14, 2022, each of which is incorporated by reference in its entirety.

[0002] The present disclosure is directed to surgical planning, and more particularly to improved surgical planning systems and methods for planning orthopedic surgical procedures. [Background technology]

[0003] Joint arthroplasty is a type of orthopedic surgical procedure performed to repair or replace a diseased joint. Prior to performing joint arthroplasty, surgeons may desire to establish a surgical plan regarding preparing the surgical site, selecting an implant, and placing the implant at the surgical site in order to improve outcomes. The surgical plan may include obtaining images of the surgical site and determining the location of the implant based on the images. Summary of the Invention [Means for solving the problem]

[0004] The present disclosure relates to improved surgical planning systems and methods.

[0005] The presently disclosed surgical planning systems and methods may be utilized in several embodiments for planning orthopedic surgical procedures, including pre-operatively, intra-operatively, and / or post-operatively, to create, edit, execute, and / or review surgical plans. The surgical planning systems and methods may be utilized for planning and performing orthopedic surgical procedures to restore joint function.

[0006] The surgical planning system may include, among other things, a processor configured to classify a representative patient population into a plurality of anatomical body size categories and to perform a range of motion simulation for each of the plurality of anatomical body size categories. A memory device of the system may be operatively coupled to the processor and configured to store range of motion data derived from the range of motion simulation for each of the plurality of anatomical body size categories.

[0007] A computer-implemented surgical planning method may include, inter alia, classifying a representative patient population into a plurality of anatomical body size categories via a processor of a surgical planning system; performing range of motion simulations for each of the plurality of anatomical body size categories; and storing range of motion data derived from the range of motion simulations for each of the plurality of anatomical body size categories in a memory device of the surgical planning system.

[0008] According to one embodiment, a surgical planning system may include, among other things, a processor operatively connected to a storage system. The storage system may be configured to store a plurality of three-dimensional bone models associated with one or more bones of a representative patient population. The plurality of bone models may include a first set associated with a first bone and a second set associated with a second bone. The processor may be configured to select a first representative bone model from the first set of bone models in response to comparing the first representative bone model with a first patient three-dimensional bone model associated with the first bone of the patient. The first representative bone model may be associated with a second representative bone model of the second set of bone models. The first patient bone model and the second patient three-dimensional bone model may establish a first spatial relationship. The second patient bone model may be associated with a second bone of the patient. The first representative bone model and the second representative bone model may establish a second spatial relationship. The processor may be configured to determine at least one patient characteristic associated with the first bone and / or second bone of the patient in response to comparing the first spatial relationship with the second spatial relationship.

[0009] A computer-implemented surgical planning method according to one embodiment may include, inter alia, accessing a first patient bone model of the patient from memory. The first patient model may be associated with a first bone of the patient. The method may also include accessing a second patient bone model of the patient from memory. The second patient bone model may be associated with a second bone of the patient. The method may also include selecting an anatomical model from a plurality of anatomical models based on the first patient bone model and the second patient bone model. The plurality of anatomical models may be associated with one or more bones and / or one or more joints of a representative patient population, which may include at least the first bone and the second bone. The method may also include determining one or more characteristics related to the patient's posture based on the selected anatomical model.

[0010] According to one embodiment, a surgical planning system may include, among other things, a processor and a memory operatively coupled to the processor. The processor may be configured to receive image data including a first two-dimensional image and a second two-dimensional image of a first bone and a second bone of a patient. The processor may be configured to determine a first profile of the first bone and the second bone along a first reference plane associated with the first image. The processor may be configured to determine a second profile of the first bone and the second bone along a second reference plane associated with the second image. The processor may be configured to determine an orientation of the first bone and the second bone based on a representative anatomical model associated with another patient, which may include projecting a first silhouette of the representative anatomical model onto the first profile along the first reference plane and projecting a second silhouette of the representative anatomical model onto the second profile along the second reference plane. The processor may be configured to determine one or more posture characteristics associated with a posture of the patient based on the determined orientation. The processor may be configured to establish a surgical plan associated with the first bone and / or the second bone based on the one or more posture characteristics.

[0011] According to one embodiment, a surgical planning system may include, among other things, a processor operatively connected to a memory. The processor may be configured to access a first three-dimensional bone model from the memory. The first bone model may be associated with the first bone. The processor may be configured to access a partial three-dimensional bone model of the first bone of the patient. The partial bone model may represent a smaller portion of the first bone compared to the first representative bone model. The processor may be configured to establish a registered position of the first bone model by at least partially registering the partial bone model of the first bone to the first bone model.

[0012] A surgical planning system according to one embodiment may include, among other things, a processor operatively connected to a storage system. The storage system may be configured to store a plurality of three-dimensional bone models associated with one or more bones and / or associated with one or more joints of a representative patient population. The processor may be configured to select a first representative three-dimensional bone model from a first set of bone models associated with a first bone of the representative patient population. The processor may be configured to at least partially register a partial three-dimensional bone model of the first bone of the patient to the first representative bone model. The partial bone model may represent a smaller portion of the first bone compared to the first bone model.

[0013] A computer-implemented surgical planning method according to one embodiment may include, inter alia, selecting a first representative three-dimensional bone model associated with a first bone. The method may include selecting a partial three-dimensional bone model of the first bone of the patient. The partial bone model may represent a smaller portion of the first bone compared to the first representative bone model. The method may include establishing a registered position of the first representative bone model by at least partially registering the partial bone model of the first bone to the first representative bone model. The method may include analyzing the first bone based on the registered position of the first representative bone model.

[0014] According to one embodiment, a surgical planning system may include, among other things, a processor operatively connected to a memory. The processor may be configured to access a first three-dimensional bone model from the memory. The first bone model may be associated with the first bone. The processor may be configured to access a fragmentary three-dimensional bone model of the first bone of the patient. The fragmentary bone model may include one or more bone fragment portions associated with one or more corresponding bone fragments of the first bone. The processor may be configured to establish registration of the fragmentary bone model by at least partially registering the one or more bone fragment portions to a volume of the first bone model.

[0015] A surgical planning system according to one embodiment may include, among other things, a processor operatively connected to a storage system. The storage system may be configured to store a plurality of three-dimensional bone models associated with one or more bones and / or associated with one or more joints of a representative patient population. The processor may be configured to select a first three-dimensional bone model from a first set of bone models associated with a first bone of the representative patient population. The processor may be configured to establish registration of the fragmentary bone model by at least partially registering one or more bone fragment portions of the fragmentary three-dimensional bone model of the first bone of the patient to the first bone model. The one or more bone fragment portions may be associated with one or more corresponding bone fragments of the first bone.

[0016] A computer-implemented surgical planning method according to one embodiment may include, inter alia, selecting a first three-dimensional bone model associated with a first bone. The method may include selecting a fragmentary three-dimensional bone model of the first bone of the patient. The fragmentary bone model may include one or more bone fragment portions associated with one or more corresponding bone fragments of the first bone. The method may include establishing a registration state of the fragmentary bone model by at least partially registering the one or more bone fragment portions of the fragmentary bone model to a volume of the first bone model. The method may include analyzing the first bone based on the registration state of the fragmentary bone model.

[0017] The embodiments, examples, and alternatives in the above paragraphs, in the claims, in the following description, and in the drawings, including any of their various aspects and any of their corresponding features, may be considered independently or in any combination. Each feature described in connection with one embodiment is applicable to all embodiments, except where the features are incompatible.

[0018] The various features and advantages of the present disclosure will become apparent to those skilled in the art from the following detailed description. The drawings that accompany the detailed description can be briefly described as follows. [Brief explanation of the drawings]

[0019] [Figure 1] 1 illustrates a schematic diagram of an exemplary surgical planning system; [Figure 2] 2 illustrates a schematic diagram of an exemplary embodiment of the surgical planning system of FIG. 1; [Figure 3] 1A and 1B illustrate schematically an exemplary cloud-based database accessible by a surgical planning system. [Figure 4] 2A-2C are schematic illustrations of additional exemplary aspects of the surgical planning system of FIG. 1; [Figure 5]1A-1C schematically illustrate exemplary anatomical body size classifications that can be assigned by a surgical planning system. [Figure 6] 1 illustrates a schematic diagram of a method for establishing an anatomical body classification database for a surgical planning system. [Figure 7] 1 illustrates a schematic diagram of a method for establishing a range of motion database for a surgical planning system. [Figure 8] 2A-2C are schematic illustrations of additional exemplary aspects of the surgical planning system of FIG. 1; [Figure 9] 1A and 1B illustrate a method for planning an orthopedic surgical procedure for a respective patient using a surgical planning system. [Figure 10] 1 illustrates an exemplary user interface of a surgical planning system. [Figure 11] 10A-10C schematically illustrate another exemplary method for planning an orthopedic surgical procedure for a respective patient using a surgical planning system. [Figure 12] 1 illustrates another exemplary user interface of a surgical planning system. [Figure 13A] 10A and 10B schematically illustrate yet another exemplary method for planning an orthopedic surgical procedure for a respective patient using a surgical planning system. [Figure 13B] 10 illustrates yet another exemplary user interface of a surgical planning system. [Figure 14] 1A and 1B schematically illustrate an exemplary method for post-operatively updating one or more databases associated with a surgical planning system. [Figure 15] 1 illustrates a set of posture types related to anatomical structures. [Figure 16A] 1 illustrates an anatomical model associated with a set of posture types of anatomy. [Figure 16B] 1 illustrates an anatomical model associated with a set of posture types of anatomy. [Figure 16C]1 illustrates an anatomical model associated with a set of posture types of anatomy. [Figure 16D] An anatomical model in a recumbent position is disclosed. [Figure 17A] 16A-16C illustrate the scapular angles associated with each corresponding posture type. [Figure 17B] 16A-16C illustrate the scapular angles associated with each corresponding posture type. [Figure 17C] 16A-16C illustrate the scapular angles associated with each corresponding posture type. [Figure 18A] 17A-17C illustrate the scapular angles associated with each corresponding posture type, with the corresponding model having the humerus and forearm in an elevated position. [Figure 18B] 17A-17C illustrate the scapular angles associated with each corresponding posture type, with the corresponding model having the humerus and forearm in an elevated position. [Figure 18C] 17A-17C illustrate the scapular angles associated with each corresponding posture type, with the corresponding model having the humerus and forearm in an elevated position. [Figure 19] One clinical example utilizing the techniques disclosed herein is disclosed. [Figure 20] One clinical example utilizing the techniques disclosed herein is disclosed. [Figure 21] A shoulder joint model is disclosed that includes a humeral implant engaged relative to a glenoid implant in association with various postures and various scapular angles. [Figure 22] A shoulder joint model is disclosed that includes a humeral implant engaged relative to a glenoid implant in association with various postures and various scapular angles. [Figure 23] A shoulder joint model is disclosed that includes a humeral implant engaged relative to a glenoid implant in association with various postures and various scapular angles. [Figure 24]Another shoulder joint model is disclosed that includes a humeral implant engaged against a glenoid implant in relation to posture and scapular angle. [Figure 25] Another shoulder joint model is disclosed that includes a humeral implant engaged against a glenoid implant in relation to posture and scapular angle. [Figure 26] Another shoulder joint model is disclosed that includes a humeral implant engaged against a glenoid implant in relation to posture and scapular angle. [Figure 27] A method for planning a surgical procedure for a respective patient using a surgical planning system is disclosed. [Figure 28] A patient shoulder joint model is disclosed. [Figure 29] A patient shoulder joint model is disclosed. [Figure 30] A patient shoulder joint model is disclosed. [Figure 31] A patient shoulder joint model is disclosed. [Figure 32] A patient shoulder joint model is disclosed. [Figure 33] A method for planning a surgical procedure for a respective patient using a surgical planning system is disclosed. [Figure 34] An anatomical model is disclosed. [Figure 35] An anatomical model is disclosed. [Figure 36] An anatomical model is disclosed. [Figure 37A] An anatomical model is disclosed. [Figure 37B] An anatomical model is disclosed. [Figure 38A] An anatomical model is disclosed. [Figure 38B] An anatomical model is disclosed. [Figure 39]Another method for planning a surgical procedure for a respective patient using a surgical planning system is disclosed, in which a portion of the bone may be omitted from the image data. [Figure 40] A patient shoulder joint model is disclosed. [Figure 41] A patient shoulder joint model is disclosed. [Figure 42] A patient shoulder joint model is disclosed. [Figure 43] A patient shoulder joint model is disclosed. [Figure 44] A patient shoulder joint model is disclosed. [Figure 45] A patient shoulder joint model is disclosed. [Figure 46A] An anatomical model relating to a patient's scapula is disclosed. [Figure 46B] An anatomical model relating to a patient's scapula is disclosed. [Figure 47A] An anatomical model relating to the patient's humerus is disclosed. [Figure 47B] An anatomical model relating to the patient's humerus is disclosed. [Figure 48A] An anatomical model relating to a patient's knee joint is disclosed. [Figure 48B] An anatomical model relating to a patient's knee joint is disclosed. [Figure 48C] An anatomical model relating to a patient's knee joint is disclosed. [Figure 49A] Another anatomical model relating to a patient's knee joint is disclosed. [Figure 49B] Another anatomical model relating to a patient's knee joint is disclosed. [Figure 50A] Yet another anatomical model relating to a patient's knee joint is disclosed. [Figure 50B] Yet another anatomical model relating to a patient's knee joint is disclosed. [Figure 51A] An anatomical model relating to a patient's hip joint is disclosed. [Figure 51B] An anatomical model relating to a patient's hip joint is disclosed. [Figure 52] Yet another method for planning a surgical procedure for a respective patient using a surgical planning system is disclosed. [Figure 53] A shoulder joint model projected onto a profile related to the patient's anatomy is disclosed. [Figure 54] A shoulder joint model projected onto a profile related to the patient's anatomy is disclosed. [Figure 55] A method is disclosed for planning a surgical procedure for a respective patient using a surgical planning system, including placement of bone fragments. [Figure 56A] Various arrangements of bone fragments are disclosed. [Figure 56B] Various arrangements of bone fragments are disclosed. [Figure 56C] Various arrangements of bone fragments are disclosed. [Figure 57A] Various arrangements of bone fragments are disclosed. [Figure 57B] Various arrangements of bone fragments are disclosed. [Figure 58A] Various arrangements of bone fragments are disclosed. [Figure 58B] Various arrangements of bone fragments are disclosed. [Figure 58C] Various arrangements of bone fragments are disclosed. [Figure 59A] Various arrangements of bone fragments are disclosed. [Figure 59B] Various arrangements of bone fragments are disclosed. [Figure 59C] Various arrangements of bone fragments are disclosed. [Figure 60] Various arrangements of bone fragments are disclosed. DETAILED DESCRIPTION OF THE INVENTION

[0020] Like reference numbers and designations in the various drawings indicate like elements.

[0021] The present disclosure is directed to improved surgical planning systems and methods for planning orthopedic procedures, including pre-operatively, intra-operatively, and / or post-operatively, for creating, editing, executing, and / or reviewing surgical plans. The surgical planning systems and methods may be utilized to plan and perform orthopedic procedures to restore joint function. These and other features of the present disclosure are described in further detail in the following paragraphs of this detailed description.

[0022] A surgical planning system according to one embodiment may include a processor. The processor may be configured to classify a representative patient population into a plurality of anatomical body size categories. The processor may be configured to perform a range of motion simulation for each of the plurality of anatomical body size categories. A storage system may be operatively connected to the processor and configured to store range of motion data that may be derived from the range of motion simulation for each of the plurality of anatomical body size categories.

[0023] In any embodiment, the range of motion simulation may be configured to simulate motion-related characteristics associated with a virtual joint that may be derived from a representative patient population. The virtual joint may include one or more bones and may include virtual surgical implants positioned relative to the one or more bones.

[0024] In any embodiment, the movement-related characteristic may include abduction, adduction, extension, flexion, internal rotation, external rotation, or any combination thereof.

[0025] In any embodiment, the processor may be configured to identify a collision point that may mark a maximum range of motion associated with the motion-related characteristic.

[0026] In any embodiment, the processor may be configured to identify an angular arc and a collision mode associated with the collision point.

[0027] In any embodiment, the processor may be configured to adjust the position of the virtual surgical implant relative to the one or more bones in multiple offset directions.

[0028] In any embodiment, the processor may be configured to identify a second angular arc and a second impact mode associated with the second impact point based on the adjusted position of the virtual surgical implant.

[0029] In any embodiment, the processor may be configured to receive image data related to a patient. The processor may be configured to generate a three-dimensional model of the patient's bones or joints based on the image data. The processor may be configured to assign one of a plurality of anatomical body size categories to the three-dimensional model of the bones or joints. The processor may be configured to display range of motion data related to the assigned anatomical body size category.

[0030] In any embodiment, the processor may be configured to receive input of the patient's activities of daily living goals. The processor may be configured to adjust the position of the virtual surgical implant within the three-dimensional model to achieve the activities of daily living goals.

[0031] In any embodiment, the processor may be configured to query a surgical outcome database of the surgical planning system for postoperative surgical outcome data. The processor may be configured to assign one of a plurality of anatomical body size classifications to the anatomical structure associated with the postoperative surgical outcome data. The processor may be configured to update range of motion data associated with the assigned anatomical body size classification based on the postoperative surgical outcome data.

[0032] A computer-implemented surgical planning method according to one embodiment may include classifying a representative patient population into a plurality of anatomical body size categories via a processor of a surgical planning system. The method may include performing range of motion simulations for each of the plurality of anatomical body size categories. The method may include storing range of motion data derived from the range of motion simulations for each of the plurality of anatomical body size categories in a storage system of the surgical planning system.

[0033] In any embodiment, the range of motion simulation may be configured to simulate motion-related characteristics associated with a virtual joint that may be derived from a representative patient population. The virtual joint may include one or more bones and may include virtual surgical implants positioned relative to the one or more bones.

[0034] In any embodiment, performing a range of motion simulation may include identifying collision points that may mark a maximum range of motion associated with a motion-related characteristic within the virtual joint.

[0035] In any embodiment, performing a range of motion simulation may include identifying an angular arc and impact mode associated with the impact point.

[0036] In any embodiment, performing a range of motion simulation may include adjusting the position of the virtual surgical implant relative to one or more bones in multiple offset directions.

[0037] In any embodiment, performing the range of motion simulation may include identifying a second angular arc and a second impact mode associated with the second impact point based on the adjusted position of the virtual surgical implant.

[0038] In any embodiment, the movement-related characteristic may include abduction, adduction, extension, flexion, internal rotation, external rotation, or any combination thereof.

[0039] In any embodiment, the method may include receiving image data associated with a patient. The method may include generating a three-dimensional model of a bone or joint of the patient based on the image data. The method may include assigning one of a plurality of anatomical body size categories to the three-dimensional model of the bone or joint. The method may include displaying range of motion data related to the assigned anatomical body size category.

[0040] In any embodiment, the method may include receiving input of a patient's activity of daily living goals. The method may include adjusting the position of the virtual surgical implant within the three-dimensional model to achieve the activity of daily living goals.

[0041] In any embodiment, the method may include querying a surgical outcome database of a surgical planning system for post-operative surgical outcome data. The method may include assigning one of a plurality of anatomical body size classifications to an anatomical structure associated with the post-operative surgical outcome data. The method may include updating range of motion data associated with the assigned anatomical body size classification based on the post-operative surgical outcome data.

[0042] According to one embodiment, a surgical planning system may include a processor operatively connected to a storage system. The storage system may be configured to store a plurality of three-dimensional bone models associated with one or more bones of a representative patient population. The plurality of bone models may include a first set associated with a first bone and a second set associated with a second bone. The processor may be configured to select a first representative bone model from the first set of bone models in response to comparing the first representative bone model with a first patient three-dimensional bone model associated with the first bone of the patient. The first representative bone model may be associated with a second representative bone model of the second set of bone models. The first patient bone model and the second patient three-dimensional bone model may establish a first spatial relationship. The second patient bone model may be associated with a second bone of the patient. The first representative bone model and the second representative bone model may establish a second spatial relationship. The processor may be configured to determine at least one patient characteristic associated with the first bone and / or the second bone of the patient in response to comparing the first spatial relationship with the second spatial relationship.

[0043] In any embodiment, at least one patient characteristic may be associated with the patient's posture.

[0044] In any embodiment, the processor may be configured to establish an implant plan based on at least one patient characteristic.

[0045] In any embodiment, the first bone and the second bone may be adjacent bones.

[0046] In any embodiment, the first bone and the second bone may be non-adjacent bones.

[0047] In any embodiment, the processor may be configured to perform a range of motion simulation based on at least one patient characteristic.

[0048] In any embodiment, the processor may be configured to receive image data related to the patient, and to generate a first patient bone model and a second patient bone model based on the image data.

[0049] In any embodiment, the processor may be configured to determine a deviation between the first spatial relationship and the second spatial relationship based on one or more landmarks associated with the first bone and / or the second bone, and the processor may be configured to determine at least one patient characteristic based on the deviation.

[0050] In any embodiment, the processor may be configured to compare the first representative bone model with the first patient bone model in response to at least partially matching the volume of the first representative bone model with the volume of the first patient bone model. The processor may be configured to compare the second representative bone model with the second patient bone model in response to at least partially matching the volume of the second representative bone model with the volume of the second patient bone model.

[0051] In any embodiment, the processor may be configured to adjust the position of the first patient bone model and / or the position of the second patient bone model based on at least one patient characteristic.

[0052] In any embodiment, the processor may be configured to register the first patient bone model and / or the second patient bone model from the local frame of reference to a global frame of reference based on at least one patient characteristic, and to establish a surgical plan associated with the first patient bone model and / or the second patient bone model within the global frame of reference.

[0053] In any embodiment, the processor may be configured to analyze a representative patient population within the statistical shape model.

[0054] In any embodiment, the processor may be configured to create a plurality of anatomical body size classifications based on a plurality of predefined modes in the statistical shape model that characterize anatomical variations in a representative patient population and further based on a plurality of standard deviations of anatomical variances contained within each of the plurality of predefined modes. The processor may be configured to assign the anatomical body size classifications to the bone models. The storage system may be configured to store the anatomical body size classifications.

[0055] In any embodiment, the processor may be configured to select the first representative bone model in response to changing one or more of the predefined modes.

[0056] In any embodiment, the processor may be configured to assign an anatomical body size classification associated with the first representative bone model to the first patient bone model. The processor may be configured to assign an anatomical body size classification associated with the second representative bone model to the second patient bone model. The processor may be configured to perform a range of motion simulation for the assigned anatomical body size classification.

[0057] In any embodiment, the predefined modes may include a posture-related posture mode. The processor may be configured to assign an anatomical body size classification to the bone model based on the posture mode. The processor may be configured to determine one or more posture parameters related to the patient's posture based on the anatomical body size classification associated with the first representative bone model and / or the second representative bone model.

[0058] In any embodiment, the processor may be configured to establish an implant plan based on one or more pose parameters.

[0059] A computer-implemented surgical planning method according to one embodiment may include accessing a first patient bone model of the patient from memory. The first patient model may be associated with a first bone of the patient. The method may include accessing a second patient bone model of the patient from memory. The second patient bone model may be associated with a second bone of the patient. The method may include selecting an anatomical model from a plurality of anatomical models based on the first patient bone model and the second patient bone model. The plurality of anatomical models may be associated with one or more bones and / or one or more joints of a representative patient population, which may include at least the first bone and the second bone. The method may include determining one or more characteristics related to the patient's posture based on the selected anatomical model.

[0060] In any embodiment, the step of selecting the anatomical model may occur in response to at least partially fitting the anatomical model to the first patient bone model and to the second patient bone model.

[0061] In any embodiment, the method may include establishing an implant plan associated with the first bone and / or the second bone of the patient in response to determining the one or more characteristics.

[0062] In any embodiment, the method may include analyzing a representative patient population within a statistical shape model.

[0063] In any embodiment, the method may include identifying a plurality of predefined modes within a statistical shape model of a representative patient population. The predefined modes may include a posture-related posture mode. The method may include establishing a plurality of standard deviations of anatomical variances contained within each of the plurality of predefined modes. Selecting an anatomical model may occur in response to changing one or more of the predefined modes within the statistical shape model.

[0064] According to one embodiment, a surgical planning system may include a processor and a memory operatively coupled to the processor. The processor may be configured to receive image data including a first two-dimensional image and a second two-dimensional image of a first bone and a second bone of a patient. The processor may be configured to determine a first profile of the first bone and the second bone along a first reference plane associated with the first image. The processor may be configured to determine a second profile of the first bone and the second bone along a second reference plane associated with the second image. The processor may be configured to determine an orientation of the first bone and the second bone based on a representative anatomical model associated with another patient, which may include projecting a first silhouette of the representative anatomical model onto the first profile along the first reference plane and projecting a second silhouette of the representative anatomical model onto the second profile along the second reference plane. The processor may be configured to determine one or more posture characteristics associated with a posture of the patient based on the determined orientation. The processor may be configured to establish a surgical plan associated with the first bone and / or the second bone based on the one or more posture characteristics.

[0065] In any embodiment, the processor may be configured to determine a first acquisition orientation associated with the first image based on comparing the goodness of fit between the first silhouette and the first profile. The processor may be configured to determine a second acquisition orientation associated with the second image based on comparing the goodness of fit between the second silhouette and the second profile. The processor may be configured to determine one or more pose characteristics based on the first acquisition orientation and the second acquisition orientation.

[0066] In any embodiment, the processor may be configured to determine a first acquisition orientation in response to iteratively adjusting a projection of a first silhouette onto the first profile along the first reference plane, and to determine a second acquisition orientation in response to iteratively adjusting a projection of a second silhouette onto the second profile along the second reference plane.

[0067] In any embodiment, the first and second reference planes may be perpendicular to each other.

[0068] In any embodiment, the first bone may be associated with the patient's scapula, and the second bone may be associated with the patient's humerus.

[0069] According to one embodiment, a surgical planning system may include a processor operatively connected to a memory. The processor may be configured to access a first representative three-dimensional bone model from the memory. The first bone model may be associated with the first bone. The processor may be configured to access a partial three-dimensional bone model of the first bone of the patient. The partial bone model may represent a smaller portion of the first bone compared to the first representative bone model. The processor may be configured to establish a registered position of the first bone model by at least partially registering the partial bone model of the first bone to the first bone model.

[0070] In any embodiment, the processor may be configured to establish an implant plan in response to establishing the registered position of the first bone model.

[0071] In any embodiment, the processor may be configured to determine one or more posture parameters related to a posture of the patient based on the registered position of the first bone model. The processor may be configured to establish an implant plan based on the one or more posture parameters.

[0072] In any embodiment, the processor may be configured to receive image data associated with the patient, the image data omitting a portion of the first bone, and generate a partial bone model based on the image data.

[0073] In any embodiment, the first bone may be the humerus. The partial bone model may omit a distal portion of the humerus. The first bone model may include a distal portion of the humerus.

[0074] In any embodiment, the processor may be configured to determine an axis associated with the first bone based on the registered position of the first bone model.

[0075] A surgical planning system according to one embodiment may include a processor operatively connected to a storage system. The storage system may be configured to store a plurality of three-dimensional bone models associated with one or more bones and / or associated with one or more joints of a representative patient population. The processor may be configured to select a first representative three-dimensional bone model from a first set of bone models associated with a first bone of the representative patient population. The processor may be configured to at least partially register a partial three-dimensional bone model of the first bone of the patient to the first representative bone model. The partial bone model may represent a smaller portion of the first bone compared to the first bone model.

[0076] In any embodiment, the processor may be configured to receive image data related to the patient, where the image data may omit a portion of the first bone, and to generate a partial bone model based on the image data.

[0077] In any embodiment, a partial bone model may be associated with the long bone. The partial bone model may include a diaphyseal portion associated with the diaphyseal portion of the long bone and a head portion associated with the head of the long bone. The processor may be configured to at least partially register the diaphyseal portion of the partial bone model with the diaphyseal portion of the first representative bone model. The processor may be configured to substantially align a center point of the head portion of the partial bone model with a center point of the head portion of the first representative bone model. The processor may be configured to at least partially register the partial bone model with the first representative bone model by rotating the head portions of the partial bone models about their respective center points.

[0078] In any embodiment, the processor may be configured to select a second representative three-dimensional bone model from a second set of bone models associated with the second bone. The processor may be configured to establish a registered position of the second representative bone model by at least partially registering the second representative bone model to a second three-dimensional bone model of the patient's second bone. The processor may be configured to select a first representative bone model from the first set of bone models based on the registered position of the second representative bone model.

[0079] In any embodiment, the first bone and the second bone may be adjacent bones.

[0080] In any embodiment, the processor may be configured to analyze a representative patient population within the statistical shape model.

[0081] In any embodiment, the processor may be configured to create a plurality of anatomical body size classifications based on a plurality of predefined modes in the statistical shape model that characterize anatomical variations in a representative patient population and further based on a plurality of standard deviations of anatomical variances contained within each of the plurality of predefined modes. The processor may be configured to assign the anatomical body size classifications to the bone models. The storage system may be configured to store the anatomical body size classifications.

[0082] In any embodiment, the processor may be configured to select the first representative bone model and / or the second representative bone model in response to changing one or more of the predefined modes.

[0083] In any embodiment, the processor may be configured to establish an implant plan in response to registering the partial bone model to the first representative bone model.

[0084] In any embodiment, the partial bone model and the second bone model may be associated with an anatomical model of the patient. The first representative bone model and the second representative bone model may be associated with a representative anatomical model of another patient. The processor may be configured to select a representative anatomical model from a set of anatomical models associated with the first bone and the second bone. The processor may be configured to at least partially register the representative anatomical model with the patient's anatomical model.

[0085] In any embodiment, the processor may be configured to select the representative anatomical model in response to determining a minimum volumetric deviation within a first set of volumetric deviations, which may be established between the patient's anatomical model and each corresponding representative anatomical model in the set of anatomical models in response to changing one or more of the predefined modes in the statistical shape model.

[0086] A computer-implemented surgical planning method according to one embodiment may include selecting a first representative three-dimensional bone model associated with a first bone. The method may include selecting a partial three-dimensional bone model of the first bone of the patient. The partial bone model may represent a smaller portion of the first bone compared to the first representative bone model. The method may include establishing a registered position of the first representative bone model by at least partially registering the partial bone model of the first bone to the first representative bone model. The method may include analyzing the first bone based on the registered position of the first representative bone model.

[0087] In any embodiment, the method may include establishing an implant plan based on the registered position of the first representative bone model.

[0088] In any embodiment, the method may include accessing a plurality of three-dimensional bone models associated with one or more bones and / or associated with one or more joints of a representative patient population. The method may include selecting a first representative bone model from a first set of bone models associated with a first bone of the representative patient population.

[0089] In any embodiment, the method may include selecting a second representative three-dimensional bone model from a second set of bone models associated with a second bone of a representative patient population. The method may include establishing a registration position of the second representative bone model by at least partially registering the second representative bone model to the three-dimensional bone model of the second bone of the patient. The method may include selecting a first representative bone model from the first set of bone models in response to establishing the registration position of the second representative bone model.

[0090] In any embodiment, the method may include analyzing a representative patient population within a statistical shape model.

[0091] In an embodiment, the method may include identifying a plurality of predefined modes within a statistical shape model of a representative patient population.

[0092] In any embodiment, the method may include establishing a plurality of standard deviations of the anatomical variance contained within each of the plurality of predefined modes. The step of selecting the first representative bone model and / or the second representative bone model may occur in response to changing one or more of the predefined modes within the statistical shape model.

[0093] In any embodiment, the first bone may be the humerus. The second bone may be the scapula. The partial bone model may omit a distal portion of the humerus. The first representative bone model may include a distal portion of the humerus.

[0094] According to one embodiment, a surgical planning system may include a processor operatively connected to a memory. The processor may be configured to access a first three-dimensional bone model from the memory. The first bone model may be associated with the first bone. The processor may be configured to access a fragmentary three-dimensional bone model of the first bone of the patient. The fragmentary bone model may include one or more bone fragment portions associated with one or more corresponding bone fragments of the first bone. The processor may be configured to establish registration of the fragmentary bone model by at least partially registering the one or more bone fragment portions to a volume of the first bone model.

[0095] In any embodiment, the processor may be configured to establish an implant plan based on the registration status of the fragmentary bone model, and the implant plan may be associated with at least one implant configured to fixate one or more bone fragments.

[0096] In any embodiment, the processor may be configured to receive image data related to the patient. The processor may be configured to generate a fragmentary bone model based on the image data.

[0097] In any embodiment, the first bone may be a long bone. The fragmentary bone model may include a diaphyseal portion associated with a diaphyseal portion of the long bone. The processor may be configured to establish registration of the fragmentary bone model by at least partially registering the diaphyseal portion of the fragmentary bone model to the diaphyseal portion of the first bone model.

[0098] A surgical planning system according to one embodiment may include a processor operatively connected to a storage system. The storage system may be configured to store a plurality of three-dimensional bone models associated with one or more bones and / or associated with one or more joints of a representative patient population. The processor may be configured to select a first three-dimensional bone model from a first set of bone models associated with a first bone of the representative patient population. The processor may be configured to establish registration of the fragmentary bone model by at least partially registering one or more bone fragment portions of the fragmentary three-dimensional bone model of the first bone of the patient to the first bone model. The one or more bone fragment portions may be associated with one or more corresponding bone fragments of the first bone.

[0099] In any embodiment, the processor may be configured to establish an implant plan based on the registration status of the fragmentary bone model.

[0100] In any embodiment, the processor may be configured to select a second three-dimensional bone model from a second set of bone models associated with a second bone of a representative patient population. The processor may be configured to establish a registered position of the second bone model by at least partially registering the second bone model to the three-dimensional bone model of the second bone of the patient. The processor may be configured to select a first bone model from the first set of bone models in response to establishing the registered position of the second bone model.

[0101] In any embodiment, the processor may be configured to analyze a representative patient population within the statistical shape model.

[0102] In any embodiment, the processor may be configured to create a plurality of anatomical body size classifications based on a plurality of predefined modes in the statistical shape model that characterize anatomical variations in a representative patient population and further based on a plurality of standard deviations of anatomical variances contained within each of the plurality of predefined modes. The processor may be configured to assign the anatomical body size classifications to the bone models. The storage system may be configured to store the anatomical body size classifications.

[0103] In any embodiment, the processor may be configured to establish an implant plan based on the registration status of the fragmentary bone model, and the implant plan may be associated with at least one implant configured to fixate one or more bone fragments.

[0104] In any embodiment, the processor may be configured to select a second three-dimensional bone model from a second set of bone models associated with a second bone of a representative patient population. The processor may be configured to establish a registered position of the second bone model by at least partially registering the second bone model to the three-dimensional bone model of the second bone of the patient. The processor may be configured to select a first bone model from the first set of bone models based on the registered position of the second bone model.

[0105] In any embodiment, the first bone may be the humerus.

[0106] In any embodiment, one or more bone fragments may be associated with the proximal portion of the humerus.

[0107] A computer-implemented surgical planning method according to one embodiment may include selecting a first three-dimensional bone model associated with a first bone. The method may include selecting a fragmentary three-dimensional bone model of the first bone of the patient. The fragmentary bone model may include one or more bone fragment portions associated with one or more corresponding bone fragments of the first bone. The method may include establishing a registration state of the fragmentary bone model by at least partially registering the one or more bone fragment portions of the fragmentary bone model to a volume of the first bone model. The method may include analyzing the first bone based on the registration state of the fragmentary bone model.

[0108] In any embodiment, the method may include establishing an implant plan based on the registered state of the fragmentary bone model, and the implant plan may include positioning at least one implant model adjacent to one or more bone fragment portions of the fragmentary bone model in the registered state.

[0109] In any embodiment, the first bone may be a long bone. The fragmentary bone model may include a diaphyseal portion associated with a diaphyseal portion of the long bone. The method may include establishing registration of the fragmentary bone model by at least partially registering the diaphyseal portion of the fragmentary bone model to the diaphyseal portion of the first bone model.

[0110] In any embodiment, the method may include accessing a plurality of three-dimensional bone models associated with one or more bones and / or associated with one or more joints of a representative patient population. The method may include selecting a first bone model from a first set of bone models associated with a first bone of the representative patient population.

[0111] In any embodiment, the method may include selecting a second three-dimensional bone model from a second set of bone models associated with a second bone of a representative patient population. The method may include establishing a registered position of the second bone model by at least partially registering the second bone model to a bone model of the second bone of the patient. The method may include selecting a first bone model from the first set of bone models in response to establishing the registered position of the second bone model.

[0112] In any embodiment, the method may include analyzing a representative patient population within a statistical shape model.

[0113] In any embodiment, the method may include identifying a plurality of predefined modes within a statistical shape model of a representative patient population. The method may include establishing a plurality of standard deviations of anatomical variances contained within each of the plurality of predefined modes. The step of selecting the first bone model may occur in response to changing one or more predefined modes within the statistical shape model.

[0114] 1 illustrates an exemplary surgical planning system 10 (hereinafter referred to as "system 10"). System 10 may be used to plan orthopedic surgical procedures, including pre-operative, intra-operative, and / or post-operative, to create, edit, review, refine, and / or execute surgical plans. System 10 may be utilized for various orthopedic surgical procedures, such as, for example, arthroplasty to repair a joint, as well as for other surgical procedures.

[0115] Shoulder arthroplasty may be referenced periodically throughout this disclosure to illustrate or highlight particular features of system 10. However, it will be understood that the teachings of the present disclosure are not intended to be limited to any particular joint in the human musculoskeletal system and, therefore, may be applicable to the shoulder, knee, hip, ankle, wrist, etc. Moreover, the teachings of the present disclosure are not intended to be limited to arthroplasty procedures and, therefore, may be applicable to repairing fractures and / or other deformities within the scope of the present disclosure.

[0116] System 10 may include, among other things, at least one host computer 12, one or more client computers 14, one or more imaging devices 16, a cloud-based storage system 18, and a network 20. System 10 may include more or fewer subsystems within the scope of this disclosure.

[0117] Host computer 12 may be configured to execute one or more software programs. In some embodiments, host computer 12 may be two or more computers configured in cooperation to process software instructions serially or in parallel.

[0118] Host computer 12 may be in communication with network 20, which may itself include one or more computing devices. Network 20 may be, for example, a private local area network (LAN), a private wide area network (WAN), the Internet, or a mesh network.

[0119] The host computer 12 and each client computer 14 may include one or more of a computer processor, memory, storage means, network devices, input / output devices, and input / output interfaces. Input devices may include a keyboard, mouse, etc. Output devices may include a monitor, speakers, printer, etc. Memory may include, for example, UVPROM, EEPROM, FLASH, RAM, ROM, DVD, CD, hard drive, or other computer-readable medium capable of storing data and / or other information related to the surgical planning and implementation techniques disclosed herein. The host computer 12 and each client computer 14 may be a desktop computer, laptop computer, smartphone, tablet, virtual machine, or any other computing device. Interfaces may facilitate communication with other systems and / or other components of the network 20.

[0120] Each client computer 14 may be configured to communicate with the host computer 12 either directly, such as via a direct client interface 22, or through the network 20. In other embodiments, the client computers 14 are configured to communicate directly with each other via a peer-to-peer interface 24.

[0121] Each client computer 14 may be coupled to one or more imaging devices 16. Each imaging device 16 may be configured to capture or acquire one or more images 26 of the patient's anatomy present within a scan field (e.g., window) of the imaging device 16. The imaging device 16 may be configured to capture or acquire two-dimensional (2D) and / or three-dimensional (3D) grayscale and / or color images 26. A variety of imaging devices 16 may be utilized to acquire one or more images 26 of the patient, including, but not limited to, an X-ray machine, a computed tomography (CT) machine, or a magnetic resonance imaging (MRI) machine.

[0122] The client computers 14 may also be configured to execute one or more software programs, such as those associated with various surgical planning tools. Each client computer 14 may be operable to access and locally and / or remotely execute a planning environment 28 for creating, editing, executing, refining, and / or reviewing one or more surgical plans 36 during the pre-operative, intra-operative, and / or post-operative phases of a surgical procedure. The planning environment 28 may be a standalone software package or may be incorporated into another surgical tool. The planning environment 28 may be configured to communicate with the host computer 12 either through the network 20 or directly through a direct client interface 22.

[0123] The planning environment 28 may be further configured to interact with one or more of the imaging devices 16 to capture or obtain images 26 of the patient's anatomy. The planning environment 28 may provide a display or visualization of one or more images 26, bone models 30, implant models 32, transmission models 34, and / or surgical plans 36 via one or more graphical user interfaces (GUIs). Each image 26, bone model 30, implant model 32, transmission model 34, surgical plan 36, and other data and / or information may be stored in one or more files or records according to a particular data structure.

[0124] The planning environment 28 may include various modules for performing desired planning functions. For example, as discussed further below, the planning environment 28 may include a data module for accessing, acquiring, and / or storing data related to the surgical plan 36, a display module for displaying the data (e.g., in one or more GUIs), a spatial module for modifying the data displayed in the display module, and a comparison module for determining one or more relationships between a selected bone model and a selected implant model. However, more or fewer modules may be utilized and / or one or more modules may be combined to provide the disclosed functionality.

[0125] Storage system 18 may be operable to store or otherwise provide data to or from other computing devices of system 10, such as host computer 12 and / or one or more client computers 14. Storage system 18 may be, for example, a storage area network device (SAN) configured to communicate to host computer 12 and / or to client computer 14 over network 20. Although shown as a separate device of system 10, in some embodiments storage system 18 may be internally incorporated into or directly coupled to host computer 12 and / or client computer 14. Storage system 18 may be configured to store one or more of computer software instructions, data, database files, configuration information, etc.

[0126] In some embodiments, system 10 may be a client-server architecture configured to execute computer software on host computer 12, which may be accessible by client computer 14 using either a thin client application or a web browser that may be executed on client computer 14. Host computer 12 may load computer software instructions into memory from local storage or from storage system 18 and may execute the computer software using one or more computer processors.

[0127] The system 10 may further include one or more databases 38. The databases 38 may be stored at a central location, such as on the storage system 18. In another embodiment, the one or more databases 38 may be stored at the host computer 12 and / or may be distributed databases provided by one or more of the client computers 14. Each database 38 may be a relational database configured to associate one or more images 26, bone models 30, implant models 32, and / or transmission models 34 with each other and / or with corresponding surgical plans 36. Each surgical plan 36 may be associated with a corresponding patient anatomy. Each image 26, bone model 30, implant model 32, transmission model 34, and surgical plan 36 may be assigned a unique identifier or database entry for storage on the storage system 18. Each database 38 may be configured to store data and other information corresponding to the images 26, bone models 30, implant models 32, transfer models 34, and surgical plans 36 in one or more database records or entries, and / or may be configured to link or otherwise associate one or more files corresponding to the corresponding images 26, bone models 30, implant models 32, transfer models 34, and surgical plans 36. The various data stored in the databases 38 may correspond to the corresponding patient anatomy from previous surgical cases and may be arranged into one or more predetermined categories, such as gender, age, race, defect classification, procedure type, anatomical size classification, surgeon, facility or organization, etc.

[0128] Each image 26 and bone model 30 may include data and other information obtained from one or more medical devices or tools, such as imaging device 16. Bone model 30 may include one or more digital images and / or coordinate information related to the patient's anatomy, as obtained or derived from images 26 captured or otherwise obtained by imaging device 16.

[0129] Each implant model 32 and transfer model 34 may include coordinate information associated with a predetermined design or associated with a design established or modified by the planning environment 28. The predetermined design may correspond to one or more components. The planning environment 28 may incorporate and / or interface with one or more modeling packages, such as a computer-aided design (CAD) package, to render the models 30, 32, 34 as two-dimensional (2D) and / or three-dimensional (3D) volumes or constructs, which may overlay one or more of the images 26 within the display screen of the GUI.

[0130] The implant models 32 may correspond to implants and components of various shapes and sizes. Each implant may include one or more components, including screws, anchors, grafts, etc., that may be placed at a surgical site. Each implant model 32 may correspond to a single component or may include two or more components that may be configured to establish an assembly. Each implant and associated components may be formed from a variety of materials, including metallic and / or non-metallic materials. Each bone model 30, implant model 32, and transfer model 34 may correspond to 2D and / or 3D geometric shapes and may be utilized to generate wireframe, mesh, and / or solid constructs within the GUI.

[0131] Each surgical plan 36 may be associated with one or more of the images 26, bone models 30, implant models 32, and / or transfer models 34. The surgical plan 36 may include various parameters associated with the images 26, bone models 30, implant models 32, and / or transfer models 34. For example, the surgical plan 36 may include parameters related to bone density and bone quality associated with the patient's anatomy captured in the images 26. The surgical plan 36 may include parameters including spatial information related to the relative positioning and coordinate information of the selected bone models 30, implant models 32, and / or transfer models 34.

[0132] The surgical plan 36 may define one or more corrections to the bone model 30 and information related to the position of the implant model 32 and / or transfer model 34 relative to the original and / or corrected bone model 30. The surgical plan 36 may include coordinate information related to the corrected bone model 30 and the relative position of the implant model 32 and / or transfer model 34 within one or more predetermined data structures. The planning environment 28 may be configured to perform one or more corrections to the various models either automatically or in response to user interaction with a user interface. Corrections to each bone model 30, implant model 32, transfer model 34, and / or surgical plan 36 may be stored in one or more of the databases 38 either automatically and / or in response to user interaction with the system 10.

[0133] One or more surgeons and / or other staff users may be presented with the planning environment 28 via the client computers 14 and may simultaneously access the images 26, bone models 30, implant models 32, transmission models 34, and surgical plans 36 stored in the database 38. Each user may interact with the planning environment 28 to create, view, refine, and / or modify various aspects of the surgical plan 36. Each client computer 14 may be configured to store local instances of the images 26, bone models 30, implant models 32, transmission models 34, and / or surgical plans 36, which may be synchronized with the database 38 in real time or periodically. The planning environment 28 may be a standalone software package executing on the client computers 14 or may be provided as one or more web-based services executing on the host computer 12, for example.

[0134] The above-described system 10 may be configured to pre-plan a surgical procedure. The pre-operative planning provided by the system 10 may include features such as, but not limited to, constructing a virtual model of the patient's anatomy, classifying the virtual model, identifying landmarks within the virtual model, selecting and orienting virtual implants within the virtual model, etc.

[0135] 2 with continuing reference to FIGURE 1, system 10 may include a computing device 40 including at least one processor 42 operatively coupled to a memory 44 that may store computer-executable instructions. Computing device 40 may be considered representative of any computing device disclosed herein, including, but not limited to, host computer 12 and / or client computer 14. Processor 42 may be configured to execute one or more of planning environments 28 for creating, editing, executing, refining, and / or reviewing one or more surgical plans 36 and any associated bone models 30, implant models 32, and transfer models 34 during pre-operative, intra-operative, and / or post-operative phases of a surgical procedure.

[0136] The processor 42 may be a custom or commercially available processor, a central processing unit (CPU), or generally any device for executing software instructions. The memory 44 may include any one or combination of volatile and / or non-volatile memory elements. The processor 42 may be operatively coupled to the memory 44 and configured to execute one or more programs stored in the memory 44 based on various inputs received from other devices or data sources.

[0137] Planning environment 28 may include at least a data module 46, a display module 48, a spatial module 50, and a comparison module 52. Although four modules are shown, it will be understood that more or fewer modules may be utilized and / or one or more modules may be combined to provide the disclosed functionality.

[0138] The data module 46 may be configured to access, retrieve, and / or store data and other information corresponding to one or more images 26 of the patient's anatomy, bone model 30, implant model 32, transfer model 34, and / or surgical plan 36 in a database 38. The data and other information may be stored in the one or more databases 38 as one or more records or entries 54. In some embodiments, the data and other information may be stored in one or more files accessible by referencing one or more objects or memory locations referenced by the entries 54.

[0139] The memory 44 may be configured to access, load, edit, and / or store one or more instances of the images 26, bone models 30, implant models 32, transmission models 34, and / or surgical plans 36 in response to one or more instructions from the data module 46. The data module 46 may be configured to cause the memory 44 to store local instances of the images 26, bone models 30, implant models 32, transmission models 34, and / or surgical plans 36, which may be synchronized with entries 54 stored in the database 38.

[0140] The data module 46 may be configured to receive data and other information corresponding to at least one or more images 26 of the patient's anatomy from various sources, such as, for example, the imaging device 16. The data module 46 may be further configured to instruct the imaging device 16 to capture or acquire the images 26 automatically or in response to user interaction.

[0141] The display module 48 may be configured to display data and other information related to the one or more surgical plans 36, including one or more of the images 26, bone model 30, implant model 32, and / or transfer model 34, in at least one graphical user interface (GUI) 56. The computing device 40 may incorporate or be coupled to the display device 58. The display module 48 may be configured to cause the display device 58 to display information in the user interface 56. A surgeon or other user may interact with the user interface 56 in the planning environment 28 to view one or more images 26 of the patient's anatomy and / or of any associated bone model 30, implant model 32, and transfer model 34. A surgeon or other user may interact with the user interface 56 via the planning environment 28 to create, edit, execute, refine, and / or review one or more surgical plans 36.

[0142] User interface 56 may include one or more display windows 60 and one or more objects 62 that may be presented within display windows 60. Display windows 60 may include any number of windows, and objects 62 may include any number of objects within the scope of this disclosure.

[0143] A surgeon or user may interact with the user interface 56, including the objects 62 and / or display windows 60, to retrieve, display, edit, store, etc., various aspects of the corresponding surgical plan 36, which may include information from a selected image 26, bone model 30, implant model 32, and / or transmission model 34. The objects 62 may include graphics such as menus, tabs, buttons, drop-down lists, directional indicators, etc. The objects 62 may be organized within one or more menu items associated with each corresponding display window 60. Geometric objects, including the selected image 26, bone model 30, implant model 32, transmission model 34, and / or other information related to the surgical plan 36, may be displayed in one or more display windows 60. Each transmission model 34 may include one or more surgical instruments used to implant an implant selected as part of the surgical plan 36.

[0144] The surgeon may interact with the objects 62 to specify various aspects of the surgical plan 36. For example, the surgeon may select one tab to view or specify aspects of the surgical plan 36 for one portion of the joint, such as the glenoid, and may select another tab to view or specify aspects of the surgical plan 36 for another portion of the joint, such as the humerus. The surgeon may also take various measurements of the joint (e.g., alignment, angle, tissue density, etc.) as part of specifying aspects of the surgical plan 36.

[0145] The surgeon may interact with menu items to select and specify various aspects of the bone model 30, implant model 32, and / or transfer model 34 from the database 38. For example, the display module 48 may be configured to display one or more bone models 30 along with corresponding images 26 of the patient's anatomy and implant model 32 selected in response to user interaction with the user interface 56. The user may interact with drop-down lists of objects 62 in the display window 60 to specify the implant type, resection angle, and implant size. The resection angle menu item may be further associated with a resection plane.

[0146] The user may also interact with various buttons to change (e.g., increase or decrease) the resection angle. The user may interact with buttons adjacent to the selected implant model 32 to change (e.g., increase or decrease) the size of components of the selected implant model 32. The buttons may be overlaid onto or located adjacent to the display window 60.

[0147] The user may also interact with a directional indicator to move a portion of the selected implant model 32 in different directions (e.g., up, down, left, right) within one display window 60. The surgeon may, for example, use a mouse or other input device to drag or otherwise move the selected implant model 32 to a desired location within the display window 60. The surgeon may interact with one of the drop-down lists to specify the type and / or size of a component of the selected implant model 32.

[0148] The display module 48 may be configured to overlay one or more of the bone model 30, implant model 32, and transfer model 34 onto one or more images 26 in one or more display windows 60. The implant model 32 may include one or more components that establish an assembly. At least a portion of the implant model 32 may be configured to be at least partially received within the volume of a selected one of the bone models 30. In some embodiments, the implant model 32 may have an articular surface sized to engage an articular surface of an opposing bone or implant.

[0149] The display windows 60 may be configured to display the image 26, bone model 30, implant model 32, and / or transfer model 34 in various orientations. The display module 48 may be configured to display two-dimensional (2D) representations of the selected bone model 30, implant model 32, and / or transfer model 34 in some display windows 60 and, for example, to display 3D representations of the selected bone model 30, implant model 32, and / or transfer model 34 in other display windows 60. The surgeon may interact with the user interface 56 to move (e.g., up, down, left, right, rotate, etc.) the selected bone model 30, selected implant model 32, and / or selected transfer model 34 in 2D and / or 3D space. Other embodiments for displaying the 2D and / or 3D representations in the various display windows 60 are further contemplated within the scope of the present disclosure.

[0150] The display module 48 may further be configured such that a selected image 26, bone model 30, implant model 32, and / or transmission model 34 may be selectively displayed or hidden (e.g., toggled) within one or more display windows 60 in response to user interaction with the user interface 56, which may provide the surgeon with improved flexibility in reviewing aspects of the surgical plan 36. For example, the surgeon may interact with a drop-down list of objects 62 to selectively display or hide components of a selected implant model 32 within one display window 60.

[0151] The selected bone model 30 may correspond to a bone associated with a joint, including any of the example joints disclosed herein. The display module 48 may be configured to display, for example, a cross-sectional view of the selected bone model 30 and the selected implant model 32 in one or more display windows 60. The cross-sectional view of the bone model 30 may be presented or displayed along with an associated image 26 of the patient's anatomy.

[0152] The spatial module 50 may be configured to establish one or more resection planes along the selected bone model 30. The volume of the selected implant model 32 may be at least partially received within the volume of the selected bone model 30 along the resection planes. The resection planes may be defined by resection angles.

[0153] The spatial module 50 may further be configured to cause the display module 48 to display the resected portion of the selected bone model 30 in a single display window 60 in a manner distinct from the remainder of the bone model 30 on either side of the resection plane. For example, the resected portion of the bone model 30 may be hidden from view in the display window 60 so that the corresponding portions of the patient's anatomy 26 are shown. In other embodiments, the resected portion of the selected bone model 30 may be displayed in a darker shade. The spatial module 50 may determine the resected portion by, for example, comparing the coordinates of the bone model 30 with the location of the resection plane. A user may interact with one or more buttons associated with the object 62 to toggle between the volume of the selected bone model 30 in its previous state and the volume in its modified (e.g., resected) state.

[0154] Planning environment 28 may further be configured so that changes in one display window 60 are synchronized with each of the other windows 60. The changes may be synchronized automatically and / or manually across display windows 60 in response to user interaction.

[0155] The surgeon may utilize various instruments and devices to perform each surgical plan 36, including preparing the surgical site and securing one or more implants to bone or other tissue to restore function to the corresponding joint. Each of the transfer models 34 may be associated with a corresponding surgical instrument or device (e.g., a transfer guide, etc.) or with a corresponding implant model 32.

[0156] The surgical plan 36 may be associated with one or more positioning objects, such as guide pins (e.g., guide wires or Kirschner wires) sized to be anchored in tissue to position and orient various instruments, devices, and / or implants. The display module 48 may be configured to display virtual positions and virtual axes in one or more display windows 60. The virtual positions may be associated with specified positions of the positioning objects relative to the patient's anatomy (as represented by the image 26). The virtual axes may extend through the virtual positions and may be associated with specified orientations of the positioning objects relative to the patient's anatomy. The spatial module 50 may be configured to set the virtual positions and / or virtual axes in response to the placement of the bone models 30 and their corresponding implant models 32 relative to the associated patient's anatomy. The virtual positions and / or virtual axes may be automatically set and / or adjusted based on the position and orientation of the selected implant model 32 relative to the selected bone model 30 and / or in response to user interaction with the user interface 56.

[0157] The spatial module 50 may be further configured to determine one or more collision or contact points relative to the patient's anatomy. The contact points may be associated with one or more landmarks or other surface features along the bone model 30 and / or along other portions of the patient's anatomy. Each contact point may be established along an articular or non-articular surface of a joint. The spatial module 50 may be configured to set the contact points based on a virtual position, a virtual axis, and / or the position and orientation of each corresponding implant model 32 relative to the patient's anatomy. The spatial module 50 may be configured to cause the display module 48 to display the contact points in one or more display windows 60. In some embodiments, the contact points may be automatically set and / or adjusted based on the position of the implant model 32 and / or in response to user interaction with the user interface 56. The virtual positions, virtual axes, and / or contact points may be stored in one or more entries 54 in the database 38 and associated with each corresponding surgical plan 36.

[0158] The comparison module 52 may be configured to generate or set one or more parameters associated with the implementation of the surgical plan 36. The parameters may include one or more settings or dimensions associated with each corresponding transfer model 34. The parameters may be based on a virtual position, a virtual axis, and / or a contact point CP. The comparison module 52 may be configured to determine one or more settings or dimensions associated with each corresponding transfer model 34 relative to the patient's anatomy, the bone model 30, the implant model 32, the virtual position, the virtual axis, and / or the contact point CP. The dimensions and settings may be used to create a physical instance of each corresponding transfer model 34. The settings may be used to specify the position and orientation of each corresponding transfer model 34 relative to the implant model 32 and / or the bone model 30. The settings may be used to configure one or more transfer members (e.g., objects) and associated instruments or devices in relation to the transfer model 34. The comparison module 52 may be configured to generate settings and / or dimensions for contacting one or more predetermined locations at or along the bone model 30 or the patient's anatomy at the installation position when the transfer model 34 is coupled to its corresponding implant model 32. The predetermined locations may include one or more contact points. The settings and dimensions may be communicated using various techniques, including one or more graphics in the user interface 56 or an output file. The settings and / or dimensions may be stored in one or more entries 54 in the database 38 associated with the transfer model 34.

[0159] A user may interact with a list of objects 62 associated with one display window 60 to select a transmission model 34 from the database 38. The display module 48 may be configured to display the selected transmission model 34 in various positions and orientations within the display window 60. The spatial module 50 may be configured to set an initial position of the selected transmission model 34 according to a virtual position, a virtual axis, and / or a contact point.

[0160] The user may interact with the user interface 56 to set or adjust the position and / or orientation of the selected transfer model 34. The user may interact with the directional indicators of the object 62 to move the selected transfer model 34 and / or virtual location in different directions (e.g., up, down, left, right) within the display window 60. The surgeon may drag or otherwise move the selected transfer model 34 and / or virtual location to a desired position within the display window 60, for example, using a mouse or other input device. The user may interact with the rotation indicators of the object to adjust the position and / or orientation of the transfer model 34 about a virtual axis relative to the selected bone model 30 and / or implant model 32. The user may interact with the tilt indicators of the object 62 to adjust the orientation of the selected transfer model 34 and associated virtual axis at its virtual location relative to the selected bone model 30 and / or implant model 32. The user may interact with other buttons and / or directional indicators to articulate or otherwise move the transfer model 34. The transfer models 34 can be articulated or otherwise moved independently or synchronously, which may be triggered manually in response to user interaction and / or automatically in response to positioning the transfer models 34 relative to the bone model 30 and / or implant model 32. Movement of the transfer models 34 may automatically adjust the corresponding contact points.

[0161] Various transmission members may be utilized in conjunction with the planning environment 28 to implement the surgical plan 36. Each transmission member may be associated with a corresponding transmission model 34. The transmission members may be incorporated into transmission guides, implants, and / or assemblies to position and orient the corresponding implants prior to securing or otherwise attaching the implants at the surgical site.

[0162] 3 with continued reference to FIGURE 2, a computing device 40 including a processor 42 may be operatively coupled to a storage system, such as storage system 18. Computing device 40 may interface with storage system 18 over network 20 to access various databases 38 stored on storage system 18 for purposes of establishing and implementing a surgical plan 36.

[0163] The databases 38 of storage system 18 may include a patient profile database 64, a surgeon profile database 65, a surgical outcomes database 66, a range of motion database 68, and an anatomical body size classification database 70. Additional databases may be stored in and accessed from storage system 18 within the scope of the present disclosure. Moreover, although shown as separate databases, one or more of the databases may be combined or linked together. For example, the anatomical body size classification database 70 may be combined or linked to the surgical outcomes database 66, to the range of motion database 68, or to both.

[0164] The patient profile database 64 may include information that is part of the indexed and stored records or entries associated with one or more current patients associated with the system 10. Information stored on the patient profile database 64 may include, for each patient, gender, age, race, height, weight, defect category, procedure type, surgeon, facility or organization, major joint, activities of daily living / lifestyle goal profile (e.g., desired post-operative range of motion for abduction, adduction, external rotation, internal rotation, extension, flexion, external rotation combined with 60° abduction, internal rotation with 60° abduction, etc.), current surgical plan information, etc. The patient profile database 64 may also store or link to images 26 for a given patient.

[0165] Surgeon profile database 65 may contain information that is part of the indexed and stored records or entries associated with one or more surgeon users associated with system 10. Information stored on surgeon profile database 65 may include the surgeon's name, facility or organization, historical data regarding the types of previous surgeries the surgeon has planned using system 10, data regarding the types of implants included in the surgeon's pre-operative surgical plan, data regarding the actual implants utilized in the surgeon's previous surgeries, etc. In some embodiments, surgeon profile database 65 may interface with patient profile database 64 to link each surgeon from surgeon profile database 65 to that surgeon's patients listed in patient profile database 64.

[0166] The surgical outcomes database 66 may include information that is part of the indexed and stored records or entries associated with one or more prior patients associated with the system 10. The surgical outcomes database 66 may be created based on information recorded by the surgeon and / or other staff users after performing each surgical procedure and at each follow-up visit to document the progress of prior patients. Information stored on the surgical outcomes database 66 may include, for each prior patient, gender, age, race, height, weight, defect category, procedure type, specific implant used, surgeon, facility or organization, major joint, visual analog pain score, ASES score, achieved activities of daily living / lifestyle profile (e.g., desired achieved postoperative range of motion for abduction, adduction, external rotation, internal rotation, extension, flexion, external rotation combined with 60° abduction, internal rotation with 60° abduction, etc.), surgical planning information, etc. The surgical outcomes database 66 may additionally store or link to pre- and post-operative images 26 for each previous patient.

[0167] The range of motion database 68 may include information that is part of indexed and stored records or entries associated with one or more current and previous patients associated with the system 10. The range of motion database 68 may store range of motion data derived from range of motion simulations performed by the computing device 40 for each surgical plan 36. The range of motion data may include information related to simulated joint movements (e.g., abduction / adduction, flexion / extension, internal rotation / external rotation, etc.), identified contact or collision points for various implant positions, angular arcs and collision modes (e.g., implant-to-implant, implant-to-bone, bone-to-bone, etc.) for various implant positions, adjusted centers of rotation of the implants at multiple incremental and offset orientations for various implant positions, etc.

[0168] The anatomical size classification database 70 may store a plurality of anatomical size classifications that characterize the anatomical variations within a representative patient population for one or more intended surgical procedures (e.g., total shoulder, reverse shoulder arthroplasty, etc.), as well as the anatomical variance within the anatomical variations. In some embodiments, the representative patient population may be derived by analyzing image data associated with a plurality of previous patients who have already undergone the intended surgical procedure, such as images from previous patients stored on the surgical outcomes database 66 and / or any other imaging source. Each of the plurality of anatomical size classifications is a numerical classification of the anatomical size of a bone or joint of a representative patient population.

[0169] 4 with continued reference to FIGS. 1-3, computing device 40 may interface with statistical shape modeler 72 to create anatomical body size classification database 70. Statistical shape modeler 72 may be a software package stored in memory 44 of computing device 40 or stored in storage system 18 and may be executed by processor 42.

[0170] The statistical shape modeler 72 may receive multiple sets of image data 74 associated with the bone or joint of interest. In some embodiments, the image data sets 74 consist of tens of thousands of sets of image data. Each set of image data 74 may include 2D and / or 3D anatomical images specific to a previous patient of a representative patient population for the bone or joint of interest and associated with a given type of surgery. The statistical shape modeler 72 may analyze the multiple sets of image data 74 to construct a statistical shape model 75.

[0171] As input, statistical shape modeler 72 may receive multiple predefined modes 76 to be used to analyze multiple sets of image data 74. Each of modes 76 is a descriptor configured to characterize anatomical variations within a bone or joint associated with statistical shape model 75. Exemplary modes 76 that may be provided to the statistical shape modeler 72 may include, but are not limited to, glenoid size, scapula size, amount of tilt, number of versions, predicted amount of glenoid and sagittal neck length, glenoid angle relative to scapular neck, critical shoulder angle, acromion and / or coracoid prediction, humeral head size, humeral head varus / valgus, femoral and / or tibial varus / valgus, femoral and / or tibial internal / external rotation, subscapularis, deltoid, and / or supraspinatus integrity, ML and AP widths, intercondylar notch depth, tibial slope, knee Q angle, ACL / PCL stability, MCL / LCL stability, amount of flexion, amount of extension, quality and quantity of soft tissue surrounding the joint, patellar tracking angle, bone density, bony subluxation rate, anatomical landmarks, joint space, preoperative range of motion, any combination of the above, etc.

[0172] In some embodiments, at least seven different modes may be utilized by statistical shape modeler 72 to characterize statistical shape model 75. However, more or fewer modes may be provided within the scope of the present disclosure.

[0173] In some embodiments, the modes 76 may not be pre-defined. Rather, the statistical shape modeler 72 may be programmed to utilize artificial intelligence (e.g., neural networks) or machine learning to estimate the modes best associated with the bones or joints modeled in the statistical shape model 75.

[0174] As another input, the statistical shape modeler 72 may receive multiple predetermined standard deviations 78 to be used to analyze multiple sets of image data 74. Each standard deviation 78 may represent the anatomical variance contained within each of multiple predefined modes 76 (e.g., distance between features, feature orientation, relative features, etc.). The standard deviations 78 may be used to verify percentile coverage of a representative patient population represented within the statistical shape model 75. In some embodiments, at least seven different standard deviations (e.g., −3, −2, −1, 0, 1, 2, and 3) may be utilized by the statistical shape modeler 72 to further characterize all anatomical variance contained within the anatomical structures described within the statistical shape model 75. However, more or fewer standard deviations may be utilized within the scope of the present disclosure.

[0175] Statistical shape modeler 72, in response to instructions from processor 42, may combine multiple standard deviations 78 with multiple predefined modes 76 to assign multiple anatomical size classifications 80N, where N is any number, to bones or joints associated with statistical shape model 75 to classify the anatomical size of the entire patient population represented in statistical shape model 75. Each anatomical size classification 80N may then be stored in anatomical size classification database 70 of storage system 18.

[0176] 5 illustrates an exemplary anatomical body type classification 80 assigned to a particular bone model 30 derived from statistical shape model 75. In one embodiment, bone model 30 is a 3D model of the scapula of the shoulder joint. However, other bones and joints can also be classified in a similar manner.

[0177] 4 may analyze bone model 30 with respect to each of a plurality of modes 761-767 to characterize any anatomical differences within bone model 30 compared to other similar bones / joints associated with statistical shape model 75. Of course, more or fewer modes are possible.

[0178] The statistical shape modeler 72 may further characterize any anatomical variance contained within each of the plurality of predefined modes 761-767 by analyzing each of the modes against a plurality of standard deviations 781-787. Of course, more or fewer standard deviations are possible.

[0179] 5, bone model 30 has been assigned the numeric value 0213120 as its anatomical size classification 80. This numeric value represents a standard deviation of 0 within a first mode 761, a standard deviation of 2 within a second mode 762, a standard deviation of 1 within a third mode 763, a standard deviation of 3 within a fourth mode 764, a standard deviation of 1 within a fifth mode 765, a standard deviation of 2 within a sixth mode 766, and a standard deviation of 0 within a seventh mode 767. Anatomical size classification 80 is a unique numerical identifier used to describe the anatomical structure associated with bone model 30.

[0180] With continued reference to FIGS. 1-5 , FIG. 6 generally illustrates a method 84 for creating the above-described anatomical body classification database 70. Method 84 may be performed as part of a surgical planning procedure. Fewer or additional steps may be performed within the scope of the present disclosure, and the order of steps described below is not intended to limit the present disclosure. System 10 may be configured to perform each step of method 84 via any of its associated computing devices and modules. In an exemplary embodiment, computing device 40 of host computer 12 may be programmed to perform method 84. However, other embodiments are also contemplated within the scope of the present disclosure.

[0181] A statistical shape model 75 representing a patient population with pathological anatomy associated with the intended surgical procedure may be constructed in step 86. A plurality of modes 76 may be identified in the statistical shape model 75 in step 88. The modes 76 may characterize anatomical variations in the statistical shape model 75.

[0182] Next, in step 90, multiple standard deviations 78 of the anatomical variance contained within each mode 76 may be established. The standard deviations 78 may be used to validate percentile coverage of a representative patient population associated with the statistical shape model 75.

[0183] The standard deviation 78 may be combined with the mode 76 to create multiple unique anatomical body size classifications 80 in step 92. In step 94, the anatomical body size classifications 80 may be aggregated to form the anatomical body size classification database 70. Thus, the anatomical body size classification database 70 may represent a large variance within a representative patient population that may affect implant function.

[0184] As a further part of the method 84, an appropriately sized implant model 32 may be selected and positioned in a default starting position and orientation relative to the bone or joint associated with each of the plurality of anatomical body types 80 in step 96. Accordingly, the default starting position and orientation of the implant model 32 may also be linked to the anatomical body type 80 and stored as part of the anatomical body type database 70 in step 97.

[0185] Once established, anatomical body classification database 70 may enable additional features, processes, and / or capabilities to be implemented within or performed by system 10 to enhance surgical planning. Exemplary embodiments of such features are described in detail below.

[0186] FIG. 7 illustrates a method 98 for augmenting range of motion database 68 with information contained in, for example, anatomical body classification database 70. Method 98 may be performed as part of a surgical planning procedure. Fewer or additional steps may be performed within the scope of the present disclosure, as compared to those described below, and the order of steps described is not intended to limit the present disclosure. System 10 may be configured to perform each step of method 98 via any of its associated computing devices and modules. In an exemplary embodiment, computing device 40 of host computer 12 may be programmed to perform method 98. However, other embodiments are also contemplated within the scope of the present disclosure.

[0187] First, in step 100, one or more motion simulations may be performed for each anatomical body size classification 80 stored in the anatomical body size classification database 70. The motion simulations may be performed in a range of motion modeler 101, which may be a software package stored in memory 44 or in storage system 18 of the computing device 40 and executed by the processor 42 (see, e.g., FIG. 8 ). When performing the motion simulations, the range of motion modeler 101 may receive each of the anatomical body size classifications 80 (and each associated bone model 30 and implant model 32, including default implant starting positions and orientations) as input from the anatomical body size classification database 70.

[0188] The range of motion simulation actually performed in step 100 depends, among other criteria, on the type of bone or joint being analyzed. Examples of the types of movements that may be simulated as part of step 100 of method 98 include, but are not limited to, abduction / adduction, flexion / extension, internal / external rotation, etc.

[0189] Contact or collision points may be identified in step 102 to identify range of motion endpoints for each range of motion simulation performed on each anatomical body type 80. The angular arc and collision mode (e.g., implant-to-implant, implant-to-bone, bone-to-bone, etc.) for each contact point may be recorded in step 104.

[0190] The centers of rotation of the implant models 32 positioned within the bone model 30 for each anatomical body type 80 may be adjusted in step 106. In some embodiments, this step may include adjusting each implant model 32 in at least three offset directions (e.g., medial, medial, and posterior) relative to its corresponding bone model 30 to simulate different positions of the implant models 32.

[0191] In step 108, the center of rotation of the implant model 32 for each anatomical body type 80 may be adjusted in multiple increments relative to the corresponding bone model 30 to record the angular arc and impact mode associated with the adjusted position. All range of motion data derived from the simulations performed in steps 100-108 may then be stored in the range of motion database 68 in step 110.

[0192] FIG. 9 schematically illustrates a method 112 for planning an orthopedic surgical procedure for a respective patient using system 10. Method 112 may be performed as part of a surgical planning procedure to prepare a surgical plan for the patient. Fewer or additional steps than those described below may be performed within the scope of the present disclosure, and the order described for the steps is not intended to limit the present disclosure. System 10 may be configured to perform each step of method 112 via any of its associated computing devices and modules. In an exemplary embodiment, one or more computing devices 40 of client computer 14 may be programmed to perform method 112. However, other embodiments are also contemplated within the scope of the present disclosure.

[0193] Image data relating to the target bone or joint of the patient may be received at step 114. The image data may be received directly from the imaging device 16 or may be obtained by accessing records or entries associated with the patient from the patient profile database 64.

[0194] A 3D model 30 (FIG. 2) of the target bone or joint may be generated in step 116. Planning environment 28 of computing device 40 may incorporate and / or interface with one or more modeling packages, such as a computer-aided design (CAD) package, to render the 3D model of the target bone or joint.

[0195] Next, in step 118, computing device 40 may query anatomical body size classification database 70 to find internally stored bone models with similar anatomical body size classifications. An anatomical body size classification 80 ( FIG. 4 ) that is closest to the anatomical structure contained in 3D model 30 ( FIG. 2 ) may then be assigned to 3D model 30 in step 120 and displayed on the range of motion user interface of computing device 40 in step 122. As part of displaying the anatomical body size classification 80, a confidence level indicator may be displayed within the range of motion user interface to visually indicate the similarity between the assigned anatomical body size classification 80 and the anatomical structure being analyzed. The confidence level indicator may be displayed as a percentage or any other visual indicator.

[0196] The range of motion database 68 may be queried at step 124 to obtain range of motion data associated with the assigned anatomical size classification 80. The range of motion data associated with the assigned anatomical size classification 80, including information such as angular arc and impact mode, may be displayed on a range of motion user interface at step 126.

[0197] In step 128, the surgeon or other staff user of system 10 may select, via query, the patient's desired activity of daily living goals. The positioning of the implant model 32 may be automatically adjusted relative to the bone model based on the activity of daily living selected in step 130. System 10 may then output a recommended implant size / type and position and orientation to meet the selected activity of daily living in step 132.

[0198] The surgeon may be prompted to modify the recommended implant type, positioning, and / or orientation according to his or her clinical judgment at step 134. Method 112 may end at step 136 in response to receiving the surgeon's approval of the surgical plan. As part of this step, a comparison of the simulated range of motion stored in ROM database 68 with the range of motion achieved by the surgeon's planned position and orientation may be presented to the user within the graphical user interface. This step may further include informing the surgeon within the graphical user interface of any potential impact the proposed changes may have based on past surgical outcome data associated with previous patients with similar anatomical body classifications.

[0199] 10 illustrates an exemplary range of motion user interface 105 that may be provided during the above-described method 112. The range of motion user interface 105 may be presented within the planning environment 28, for example.

[0200] The range of motion user interface 105 may include a range of motion dashboard 107, a display window 109, and a control panel 111. The range of motion dashboard 107 may present various range of motion data to the user. The range of motion dashboard 107 may include a plurality of selectable buttons 113 associated with predicted baseline joint motions for the patient. The predicted baseline joint motions that may be represented by buttons 113 may include, but are not limited to, desired post-operative range of motion for abduction, adduction, external rotation, internal rotation, extension, flexion, external rotation combined with 60 degrees of abduction, and internal rotation combined with 60 degrees of abduction.

[0201] The range of motion dashboard 107 may further include a bar graph 115 to illustrate range of motion data for each of the underlying joint motion predictions. For example, the bar graph 115 may provide a visual indication of the range of motion achieved for a selected underlying joint motion prediction for one or more AMCs 80 (FIG. 4) that are closest to the patient's anatomy for which the surgical plan is being generated.

[0202] The display window 109 may include a 3D window 117 and multiple 2D windows 119. A virtual bone model 121 of the patient's anatomy may be displayed in the 3D window 117 and in the 2D window 119. The positioning of both virtual guide pins 123 and virtual implants 125 required to achieve a desired predicted joint motion may be displayed relative to the virtual bone model 121 to provide the user with information regarding aspects of the optimal approach to the planned surgical procedure.

[0203] The display window 109 may be operated using a control panel 111. For example, the control panel 111 may include a number of toggles, buttons, sliders, etc. that allow a user to modify various settings, such as the positioning of the virtual guide pins 123 and / or virtual implants 125 relative to the virtual bone model 121. In one embodiment, a backside sheet volume 127 and a color-coded backside sheet map 129 may be provided on the display window 109 and may automatically update as adjustments are made to the virtual positions of the virtual guide pins 123 and virtual implants 125 relative to the virtual bone model 121. The information presented in the display window 109 may also be automatically updated as a user page through each of the buttons 113.

[0204] FIG. 11 schematically illustrates another method 138 for planning an orthopedic surgical procedure for a respective patient using system 10. Method 138 may be implemented as part of a surgical planning procedure to prepare a surgical plan for the patient. Fewer or additional steps may be implemented within the scope of the present disclosure, as compared to those described below, and the order of the steps described is not intended to limit the present disclosure. System 10 may be configured to perform each step of method 138 via any of its associated computing devices and modules. In an exemplary embodiment, one or more computing devices 40 of client computer 14 may be programmed to perform method 138. However, other embodiments are also contemplated within the scope of the present disclosure.

[0205] Image data relating to the target bone or joint of the patient may be received at step 140. The image data may be received directly from the imaging device 16 or may be obtained by accessing records or entries associated with the patient from the patient profile database 64.

[0206] A 3D model of the target bone or joint may be generated in step 142. Planning environment 28 of computing device 40 may incorporate and / or interface with one or more modeling packages, such as a computer-aided design (CAD) package, to render the 3D model of the target bone or joint.

[0207] Next, in step 144, the computing device 40 may query the anatomical body size classification database 70 to find internally stored bone models having an anatomical body size classification 80 similar to the anatomical body size classification 80 of the patient's bone or joint. The anatomical body size classification 80 that is closest to the anatomical structure contained in the 3D model may then be assigned to the 3D model in step 146 and displayed on the surgical outcomes user interface of the computing device 40 in step 148. As part of displaying the anatomical body size classification 80, a confidence level indicator may be displayed within the graphical user interface to visually indicate the similarity between the assigned anatomical body size classification and the anatomical structure being analyzed. The confidence level indicator may be displayed as a percentage or any other visual indicator.

[0208] The surgical outcome database 66 may be queried to obtain the surgical outcome data most relevant to the assigned anatomical body size classification at step 150. The surgical outcome data associated with the assigned anatomical body size classification 80 may be displayed on the surgical outcome user interface at step 152. The surgical outcome data displayed to the user may be automatically updated in response to a user prompt, such as when the user changes the planned procedure type.

[0209] In one embodiment, the surgical outcomes database 66 may be queried to find previous surgeries involving patients with average bone densities comparable to the estimated average bone density of the bones associated with the patient's anatomy. This comparison can be used, for example, to recommend specific surgical implants that are not incompatible with the average bone density of the bone under study.

[0210] Next, in step 154, one or more survival prediction indices may be determined by utilizing data from the surgical outcomes database 66 for comparable anatomical body size classifications 80 and a plurality of variables related to the surgical plan for the patient's surgery. The variables may include factors such as the type of surgical implant, the size of the surgical implant, the orientation of the surgical implant, the type of surgical procedure, the back seat configuration of the surgical implant, the orientation of the fasteners, or any combination thereof. The variables are inputs to the system 10 such that they may be selected by the surgeon or staff user within the surgical outcomes user interface.

[0211] The determined survival prediction indexes may be displayed on the surgical outcome user interface in step 156. Each survival prediction index may represent a percentile confidence level that the surgical plan will result in a successful surgical outcome over at least a predetermined time period. For example, based on the comparable anatomical body class 80 data and relevant variables selected / set by the surgeon, system 10 may determine and display a three-year post-operative survival prediction index of 40% for comparable patients undergoing standard total shoulder arthroplasty and a three-year post-operative survival prediction index of 85% for comparable patients undergoing reverse shoulder arthroplasty, thereby indicating to the surgeon that a more successful patient outcome is likely to be achieved by performing a reverse shoulder arthroplasty rather than a standard total shoulder arthroplasty.

[0212] After displaying the displayed survival prediction index in step 156, system 10 may prompt the surgeon to make any corrections to the variables associated with the current surgical plan in step 158. If corrections are received as input to system 10, an updated survival prediction index may be displayed in step 160.

[0213] System 10 may output a recommended procedure type, implant size / type, and implant position / orientation to best match for comparable anatomical body classifications in step 162. The surgeon may be prompted to modify the recommended implant type, positioning, and / or orientation according to their clinical judgment in step 164. Method 138 may end after receiving the surgeon's approval of the surgical plan in step 166.

[0214] 12 illustrates an exemplary surgical outcome user interface 141 that may be provided during the above-described method 138. The surgical outcome user interface 141 may be presented within the planning environment 28, for example.

[0215] The surgical outcome user interface 141 may include a graphical list 143 for displaying the anatomical body type classification 80 that is most similar to the anatomical body type classification of the patient's bone or joint, a display window 145, and a control panel 147.

[0216] The graphical list 143 may include a graph 149 of ASES score versus time for each of the listed comparable anatomical body size categories 80. Although two anatomical body size categories 80 are shown as listed in FIG. 12, the graphical list 143 may provide a greater or lesser number of anatomical body size categories 80 within the scope of this disclosure.

[0217] The graphical list 143 may further include a confidence level indicator 151 that may be displayed adjacent to each comparable anatomical body size classification 80. The confidence level indicator 151 may be a percentage or any other visual indicator to visually indicate the similarity between the assigned anatomical body size classification and the anatomical structure being analyzed. The user may select the desired comparable anatomical body size classification 80 using, for example, an input selector 153.

[0218] Display window 145 may include a 3D window 155 and multiple 2D windows 157. A virtual bone model 159 of the patient's anatomy may be displayed in 3D window 155 and in 2D window 157. Virtual guide pins 161 and virtual implants 163 associated with a selected comparable anatomical body classification 80 may be displayed against virtual bone model 159 to provide the user with information about how previous surgical procedures have been performed on patients with comparable anatomical body classifications 80.

[0219] The display window 145 may be manipulated using a control panel 147. For example, the control panel 147 may include a number of toggles, buttons, sliders, etc. that allow a user to modify various settings, such as the positioning of the virtual guide pins 161 and / or virtual implants 163 relative to the virtual bone model 159. In one embodiment, a backside sheet volume 165 and a color-coded backside sheet map 167 may be displayed on the display window 145 and may automatically update when adjustments are made to the virtual positions of the virtual guide pins 161 and virtual implants 163 relative to the virtual bone model 159.

[0220] The surgical outcome user interface 141 may further include a schedule consultation button 199. A user may press or otherwise activate the schedule consultation button 199 to arrange a consultation with a surgeon who performed a previous procedure for a comparable anatomical body type 80. After activation of the schedule consultation button 199, the user and the associated surgeon may be presented with a series of prompts for coordinating and conducting the consultation. The consultation may be conducted via chat room, telephone, video conference, etc. If desired, the identities of the requesting surgeon and / or consulting surgeon may be maintained confidential during the consultation.

[0221] FIG. 13A schematically illustrates yet another method 168 for planning an orthopedic surgical procedure for a respective patient using system 10. Method 168 may be implemented as part of a surgical planning procedure to prepare a surgical plan for the patient. Fewer or additional steps than those described below may be implemented within the scope of the present disclosure, and the order described for the steps is not intended to limit the present disclosure. System 10 may be configured to perform each step of method 168 via any of its associated computing devices and modules. In an exemplary embodiment, computing device 40 of host computer 12 may be programmed to perform method 168. However, other embodiments are also contemplated within the scope of the present disclosure.

[0222] Method 168 may begin, at step 170, in response to receiving a pre-operative surgical plan approved by a respective corresponding surgeon. Surgeon profile database 65 may then be queried, at step 172, for data regarding the surgeon's previous surgeries planned using system 10 for the procedure indicated by the approved pre-operative surgical plan. The data analyzed from surgeon profile database 65 may include the types and quantities of implants actually used in the surgeon's previous surgeries and the types and quantities of implants included as part of the pre-operative surgical plan for each of the surgeon's relevant previous surgeries.

[0223] In step 174, system 10 may determine whether the surgeon has deviated from their past preoperative surgical plan by less than a predetermined percentage of their previous surgical procedures, for example, based on a comparison of the preoperative and postoperative data analyzed in step 172. In some embodiments, the predetermined percentage may be defined as 5% of previous surgical procedures. However, other thresholds may be established within the scope of this disclosure. In one embodiment, a "deviation" is assumed to occur when the surgeon changes a pre-planned procedure type, changes a pre-planned implant type, or uses a size deviation of more than one size during a previous surgical procedure.

[0224] If a YES flag is returned at step 174, a first surgical kit containing only the implants and instruments necessary to perform the approved pre-operative surgical procedure may be recommended at step 176. Alternatively, if a NO flag is returned at step 174, a second surgical kit containing more implants and instruments than the first surgical kit may be recommended at step 178. An order to assemble the associated surgical kit may then be issued at step 180.

[0225] 13B illustrates an exemplary deviation user interface 169 that may be provided during the above-described method 168. The deviation user interface 169 may be presented within the planning environment 28, for example.

[0226] Deviation user interface 169 may be configured to present various surgery-related information for a selected surgeon related to the frequency with which the surgeon deviated from their previous preoperative surgical plan. Deviation user interface 169 may provide a case list 171 of the surgeon's previous surgeries and various bar graphs 173A-173F designed to convey deviation-related information to the user. For example, bar graph 173A may illustrate the percentage of previous surgeries performed as planned, bar graph 173B may illustrate the percentage of implants implanted as planned during previous surgeries, bar graph 173C may illustrate planned implants versus implanted implants, bar graph 173D may illustrate deviation type, bar graph 173E may illustrate different implant families used in previous surgeries, and bar graph 173F may illustrate different sizes of implants used during previous surgeries. Other deviation-related information may alternatively or additionally be conveyed to the user via deviation user interface 169.

[0227] FIG. 14 schematically illustrates a method 182 for post-operatively updating one or more databases 38 associated with system 10. Method 182 may be performed after creating a surgical plan for a patient using system 10, or after executing the surgical plan during the actual surgical procedure. Fewer or additional steps may be performed within the scope of the present disclosure, as compared to those described below, and the described order of steps is not intended to limit the present disclosure. System 10 may be configured to perform the steps of method 182 via any of its associated computing devices and modules. In an exemplary embodiment, computing device 40 of host computer 12 may be programmed to perform method 182. However, other embodiments are also contemplated within the scope of the present disclosure.

[0228] System 10 may receive post-operative patient outcome data from a user in step 184. In some embodiments, the post-operative patient outcome data may be manually entered by a surgeon or other staff member after performing an intra-operative surgical procedure on a patient according to a pre-operative surgical plan previously created within system 10. In other embodiments, the post-operative patient outcome data may be automatically communicated to system 10 after performing a surgical procedure as part of a closed feedback loop that may be implemented, for example, via a neural network. The post-operative outcome data may include information such as the size and type of implant used during the currently completed surgical procedure, the location and orientation of the implants used, implant failure data, data related to the achievement or non-achievement of pre-operative activities of daily living goals, etc.

[0229] An anatomical body size classification 80 may be assigned to each anatomical structure associated with the post-operative patient outcome data in step 186. This may be accomplished, for example, by querying the anatomical body size classification database 70 to find an internally stored bone model having an anatomical body size classification similar to the anatomical body size classification of the anatomical structure represented in the post-operative patient outcome data.

[0230] At step 188, the surgical outcomes database 66 may be updated with information contained within the post-operative patient outcome data. For example, the surgical outcomes database 66 may be updated with the size and type of implants used during the currently completed surgical procedure, the location and orientation of the implants used, etc.

[0231] The size, type, location, and orientation of the implant indicated in the post-operative patient outcome data may be entered into range of motion database 68 in step 190. One or more motion simulations may then be performed for the anatomical structures and implants associated with the post-operative patient outcome data in step 192. Contact or collision points may be identified in step 194 to identify range of motion endpoints for each range of motion simulation performed. The angular arc and collision mode (e.g., implant-to-implant, implant-to-bone, bone-to-bone, etc.) for each contact point may be recorded in step 196.

[0232] The implant's center of rotation associated with the postoperative patient outcome data may be adjusted in step 198. In step 200, the implant's center of rotation may be adjusted relative to the corresponding bone model in multiple increments to record the angular arc and impact mode associated with the adjusted position. All range of motion data derived from the simulations performed in steps 190-200 may then be stored in range of motion database 68 in step 202.

[0233] Referring to FIG. 15, as disclosed in Moroder, P., et al. (2020). The influence of posture and scapulothoracic orientation on the choice of humeral component retrotorsion in reverse total shoulder arthroplasty. J Shoulder Elbow Surg (2020) 29, 1992-2001, each patient's anatomical structure may be associated with a corresponding posture. A range of postures may be assigned to a set of posture types (e.g., A, B, C) for the anatomical structure. FIG. 15 discloses a set of posture types (e.g., A, B, C). Posture type A may represent a perfect posture. Posture types B and C may deviate from posture type A.

[0234] Using the techniques disclosed herein, one or more characteristics related to a patient's posture can be determined. While three posture types are disclosed, it will be understood that fewer or more than three posture types can be used in accordance with the teachings disclosed herein. A patient's posture can affect the relative position between two or more bones, including non-adjacent and / or adjacent bones, and / or between joints. A patient's posture can affect the relative position between opposing articular surfaces of adjacent bones. Using the techniques disclosed herein, the position and orientation of one or more implants for treating a patient can be established based on the determined posture characteristics.

[0235] 16A-16C disclose anatomical models 229 (shown as model 229-1, model 229-2, and model 229-3). Each of anatomical models 229-1-229-3 may be associated with a corresponding patient. Anatomical model 229 may include one or more bone models 230, which may be associated with any bone of the anatomy. Bone models 230 may be representative of bones associated with the shoulder joint, such as the scapula and / or humerus, and one or more bones of the associated limb, such as the ulna and / or radius of the forearm. The scapula may be associated with scapula model 230S. The humerus may be associated with humerus model 230H. The ulna and radius may be associated with ulna model 230U and radius model 230R. The anatomical model 229 and / or associated bone model 230 may be established and positioned using any of the techniques disclosed herein.

[0236] 17A-17C, with continued reference to FIGS. 15 and 16A-16C, anatomical models 229-1-229-3 may be correlated with corresponding patient postures. Various techniques may be utilized to characterize the patient's posture. Planning system 10 (FIGS. 1-2) may be configured to determine one or more characteristics associated with the patient's posture based on the orientation of one or more bone models 230 of anatomical model 229. Bone models 230 of humerus 230H, ulna 230U, and / or radius 230R may be positioned at a resting (e.g., starting) angle relative to scapula model 230S, including during image acquisition.

[0237] Anatomical models 229-1 through 229-3 may establish one or more angles α, which may be related to the posture of the patient's anatomy. Various techniques may be utilized to define angle α. A first bone model 230 associated with a first bone of the patient may extend along a first reference plane REF1. A second bone model 230 associated with a second bone of the patient may extend along a second reference plane REF2. The first reference plane REF1 and the second reference plane REF2 may intersect to establish angle α. In an embodiment, angle α may be established with respect to first reference plane REF1 and with respect to axis X of the patient. Angle α may be related to the posture of the patient.

[0238] A scapular angle may be established relative to the patient's scapula. The scapular angle may include one or more components (e.g., a set of angles) relative to the patient's anatomy. In embodiments, the scapular angle may be defined based on scapular internal rotation, scapular upward rotation, and / or scapular internal tilt. The scapular angle may be determined when the patient is standing or positioned in a resting position (e.g., horizontal position). In embodiments, the first bone model 230 may be a scapula model 230S relative to the patient's scapula. The second bone model 230 may be a humerus model 230H relative to the patient's humerus. Angle α may be defined as the angle between the scapular spine and the axis of the humeral shaft relative to the patient's medial plane. The spine of the scapula model 230S may extend along a first reference plane REF1. The shaft of the humerus model 230H may extend along a second reference plane REF2. The spatial module 50 and / or another portion of the planning system 10 may be configured to determine the first reference plane REF1 and / or the second reference plane REF2 and the associated angle α. In an embodiment, a surgeon or clinical user may specify the first reference plane REF1 and / or the second reference plane REF2 by interacting with the user interface 56.

[0239] The anatomical model 229 may include one or more bone models 230 positioned relative to an axis X. The axis X may be a vertical axis associated with a patient in an upright position (e.g., standing) and may be normalized to a coordinate system. The anatomical model 229 may include two or more bone models 230 positioned relative to one another to establish the scapular angle. The axis X may extend along one or more bone models 230. The axis X may be established along the intersection of the patient's planes of motion (e.g., the sagittal and coronal planes). A first reference plane REF1 may extend along another bone model 230, such as along the spine of the scapula model 230S. The first reference plane REF1 may intersect with the patient's axis X to establish the scapular angle. The orientation of the first reference plane REF1 may be established based on the internal rotation, upward rotation, and / or anterior tilt of the scapula. In embodiments, the scapular angle may be a set of values ​​defined for scapular internal rotation, scapular upward rotation, and / or scapular anteversion. For purposes of this disclosure, the terms "about," "substantially," and "approximately" mean ±10% of the stated value or stated relationship, unless otherwise specified. The humerus model 230H, ulna model 230U, and / or radius model 230R may be substantially perpendicular or lateral to the patient's axis X. In the embodiment of FIGS. 17A-17C, the ulna model 230U and radius model 230R may be substantially parallel to axis X.

[0240] The scapular angles of anatomical models 229-1 through 229-3 may be the same or different from one another. The postures of corresponding anatomical models 229-1 through 229-3 may be characterized by a set of posture types (e.g., A, B, C). Each posture type may be assigned a range of values ​​for one or more posture parameters (e.g., characteristics), such as scapular angle. In an embodiment, posture type A may be associated with scapular internal rotation of approximately 32 degrees ± 6 degrees, scapular upward rotation of approximately -3 degrees ± 6 degrees, and scapular internal (e.g., forward) tilt of approximately 23 degrees ± 11 degrees. Posture type B may be associated with scapular internal rotation of approximately 42 degrees ± 3 degrees, scapular upward rotation of approximately -12 degrees ± 7 degrees, and scapular internal tilt of approximately 24 degrees ± 8 degrees. Posture Type C may be associated with scapular internal rotation of approximately 53 degrees ± 5 degrees, scapular upward rotation of approximately -15 degrees ± 13 degrees, and scapular internal tilt of approximately 33 degrees ± 7 degrees.

[0241] The scapular angles in Figures 17A-17C may be associated with the posture types in Figures 15 and / or 16A-16C. Anatomical model 229-1 in Figure 17A may be associated with posture type A in Figures 15 and 16A. Anatomical model 229-2 in Figure 17B may be associated with posture type B in Figures 15 and 16B. Anatomical model 229-3 in Figure 17C may be associated with posture type C in Figures 15 and 16C. In embodiments, anatomical model 229-1 may be associated with posture type A and / or may be associated with scapular angles having values ​​within any of the ranges disclosed for posture type A. Anatomical model 229-2 may be associated with posture type B and / or may be associated with scapular angles having values ​​within any of the ranges disclosed for posture type B. Anatomical model 229-3 may be associated with posture type C and / or may be associated with scapular angles having values ​​within any of the ranges disclosed in association with posture type C.

[0242] 18A-18C with continuing reference to FIGS. 17A-17C, a patient's posture may limit the range of motion of a limb, such as the humerus and associated forearm. Anatomical models 229-1-229-3 may be associated with an instance of humerus model 230H′, ulna model 230U′, and radius model 230R′ in an elevated position. The range of motion may be characterized by a reference (e.g., scapular) plane REF1 and / or by an associated scapular angle. Upward movement of the humerus may generally be limited approximately at reference plane REF1.

[0243] Image data associated with the anatomical model 229 and bone model 230 may be acquired at acquisition orientations associated with one or more imaging devices 16 (FIGS. 1-2). Each imaging device 16 may be associated with an acquisition frame of reference. The acquisition frames of reference of two or more imaging devices 16 may be the same or different. The patient may be positioned relative to a reference point in the acquisition frame of reference, which may differ between patients based on anatomical size, posture, pathological conditions, etc. The bone model 230 may be in a resting (e.g., starting) position of the patient at the time of acquisition. The resting position may relate to an upright (e.g., vertical) or recumbent (e.g., horizontal or supine) position of the patient at the time of acquisition of the associated image data. FIG. 16D discloses an anatomical model 229-4. The anatomical model 229-4 may include one or more bone models 230, which may be associated with any bone of the anatomy. Anatomical model 229-4 may be associated with a patient's recumbent (e.g., horizontal) position (e.g., on an imaging device bed) at the time of acquisition of the associated image data. Anatomical model 229-4 may be associated with the same patient as one of anatomical models 229-1 through 229-3, such as anatomical model 229-2. The orientation of one or more bones, such as the scapula and humerus, of a patient in an upright position may be determined based on a transformation associated with the patient's recumbent position. In embodiments, the orientation of scapula 230S and / or humerus 230H of anatomical model 229-2 (FIG. 16B) may be established based on a transformation applied to the orientation of scapula 230S and / or humerus 230H of anatomical model 229-4 (FIG. 16D). The orientation of the scapula may be non-perpendicular to the axes of the acquisition frame of reference. The orientation of the scapula in the acquisition frame of reference may be characterized by the patient's posture. The transformation may take into account the effects on the patient's anatomy in a recumbent position, such as muscle tissue relaxation, etc. In embodiments, the transformation may include one or more predefined transformation angles. The predefined transformation angles may include three rotation angles relative to the axes of the reference system. The predefined transformation angles may be established for one or more imaging positions, such as a recumbent position and / or an upright position.A predefined set of transformation angles may be established for each corresponding bone of the anatomical structure, and the spatial module 50 may be configured to apply the transformation to each corresponding bone model 330 to transform the bone model 330 from a recumbent position to an upright position, or vice versa.

[0244] By incorporating information related to a patient's posture into the systems and methods disclosed herein, such as system 10 (FIGS. 1-2), a surgical (e.g., pre-operative) plan may be established and / or aspects of a patient-related range of motion (ROM) may be determined and / or verified using any of the techniques disclosed herein. System 10 may establish a pre-operative plan 36 based on one or more determined postural characteristics (e.g., parameters) related to the patient's posture. The position and / or orientation of one or more implants specified in pre-operative plan 36 may be determined based on the determined postural characteristics. By incorporating postural information into the systems and methods disclosed herein, a surgeon or clinical user may plan the placement of one or more implants taking into account the resting (e.g., starting) angle of the scapula ("scapula"). Implants may be assigned a default starting position and / or orientation relative to adjacent bones. System 10 may determine an offset to adjust the default starting position and / or orientation of the implant based on the determined postural characteristics. Postural information may be used to determine range of motion, including activities of daily living.

[0245] The system 10 may be configured to determine one or more posture parameters related to the patient's posture. The system 10 may be configured to adjust the implant plan based on the one or more posture parameters. The implant plan may include any of the parameters disclosed herein, such as implant type, implant size, and implant location.

[0246] Referring to Figures 19-20, patient posture can affect posterior rotation, as disclosed in Moroder, P., et al. (2022). Patient Posture Affects Simulated ROM in Reverse Total Shoulder Arthroplasty: A Modeling Study Using Preoperative Planning Software. Clin Ortop Relat Res (2022) 480:619-631. Figures 19-20 show a clinical example of a shoulder arthroplasty patient. The orientation of the implant relative to the humerus may be adjusted to change posterior rotation from 0 degrees to a value equal to internal rotation of the scapula (IRO). Orienting the implant toward internal rotation of the scapula may allow for a greater range of motion and / or reduce the likelihood of implant impingement.

[0247] In embodiments, a posture transformation may be established. The posture transformation may be based on a posture classification and / or one or more measured posture parameters, including any of the posture parameters disclosed herein. The posture parameters may include one or more landmarks of the scapula, the distance or relative position between two or more landmarks, the scapular angle, and / or one or more bony dimensions of the anatomical structure (e.g., humerus length). In embodiments, the posture transformation may be used to adjust or otherwise configure the position and / or orientation of planned implants to treat the patient, which may improve range of motion and activities of daily living.

[0248] One or more range of motion parameters may be utilized to establish the postural transformation. In embodiments, the parameters may be associated with one or more activities of daily living and / or lifestyle goals (e.g., desired post-operative range of motion for abduction, adduction, external rotation, internal rotation, upward rotation, extension, flexion, external rotation combined with 60° abduction, internal rotation combined with 60° abduction, etc.). Defined values ​​for one or more activities of daily living and / or lifestyle goals may be utilized as criteria for establishing the postural transformation.

[0249] System 10 may be configured to perform a range of motion simulation based on one or more parameters related to the patient's posture. Storage system 18 may be configured to store range of motion data derived from the range of motion simulation. The parameters may include a scapular angle associated with the patient's scapula.

[0250] The method may include performing a range of motion simulation based on one or more parameters related to the patient's posture. The method may include storing range of motion data derived from the range of motion simulation in storage system 18 of surgical planning system 10. The parameters may include a scapular angle associated with the patient's scapula.

[0251] 21-25 with continuing reference to FIG. 2, planning system 10 may be configured to display a selected anatomical model 329 in one or more display windows 360 of graphical user interface 356. Anatomical model 329 may include one or more bone models 330, each of which may be associated with a corresponding joint. Display module 48 may be configured to display anatomical model 329 in display window 360. Spatial module 50 may be configured to adjust the position of one or more bone models 330 relative to each other and / or other portions of anatomical model 329 and / or the frame of reference.

[0252] 21-26 disclose anatomical models 329 associated with one or more patients. Anatomical models 329 may include a first anatomical model 329-1 (FIGS. 21-23) and / or a second anatomical model 329-2. Anatomical models 329 may include a shoulder model 329SM and one or more implant models 332 associated with various anatomical postures and scapular angles. Shoulder model 329SM may include a scapula model 330S and a humerus model 330H.

[0253] The spatial module 50 may be configured to position one or more implant models 332 relative to each other and / or relative to the anatomical model 329. The implant models 332 may include a first (e.g., glenoid) implant model 332G and a second (e.g., humerus) implant model 332H. The implant models 332G, 332H may engage with each other. The scapula model 330S, the anatomical model 329, the glenoid implant model 332G, and / or the humerus implant model 332H may be associated with various postures and scapular angles. Various parameters may be associated with scapular angles, such as abduction, adduction, flexion, extension, external rotation, internal rotation, upward rotation, abduction and internal rotation, and abduction and external rotation. A value may be assigned to each parameter, and the values ​​may be displayed to the user. The sum of the values ​​may be displayed to the surgeon or clinical user in the user interface 356 (see, for example, FIGS. 22 and 25). A pose transformation may be applied to adjust the default starting position and / or orientation of the implant 332 based on the determined parameters.

[0254] The user interface 356 may include a first display window 360-1 and a second display window 360-2. The display module 48 may be configured to cause the user interface 356 to display different anatomical views in the display windows 360-1, 360-2. In an embodiment, the display module 48 may be configured to cause the first display window 360-1 to display an anterior (or posterior) view of the anatomical model 329-1. The display module 48 may be configured to cause the second display window 360-2 to display a lateral view of the anatomical model 329-1. The spatial module 50 may be configured to position the bone models 330 relative to each other and / or relative to a frame of reference based on a determined posture of the patient. The surgeon or clinical user may select one or more bone models 330 by interacting with the display window 360 and / or with another portion of the user interface 356. The display module 48 may be configured to establish a visual contrast between the selected bone model 330 and any remaining bone models 330 and / or other portions of the anatomical model 329 .

[0255] 22 with continuing reference to FIGS. 2 and 21 , the spatial module 50 may be configured to adjust the position of selected bone models 330 relative to each other and / or relative to other portions of the anatomical model 329-1. The user interface 356 may include one or more (e.g., interactive) objects 362. The objects 362 may be located on the control panel 311. The objects 362 may include a button 362B, a radial button 362R, and / or a text box 362T. The text box 362T may be configured to display one or more values ​​associated with the anatomical model 329-1. A surgeon or clinical user may adjust one or more values ​​displayed in the text box 362T in response to selection of the corresponding text box 362T, button 362B, and / or radial button 362R. The buttons 362B, 362R may be associated with various properties (e.g., angular relationships) of the selected bone model 330, including any of the properties disclosed herein. In embodiments, the characteristics may include abduction, adduction, flexion, extension, external rotation, internal rotation, upward rotation, abduction and internal rotation, abduction and external rotation, and / or all movements. The text boxes 362T associated with all movements may be configured to display the sum of the values ​​in the text boxes 362T for each corresponding column. A surgeon or clinical user may adjust the position and / or orientation of one or more selected bone models 330 by specifying values ​​in one or more text boxes 362T. A surgeon or clinical user may adjust the position and / or orientation of one or more selected bone models 330 and any associated values ​​in the control panel 311 by interacting with the display window 360. The display window 360 and the control panel 311 may be dynamically linked such that changes to one cause corresponding changes to the other, including values ​​specified in the text boxes 362T.

[0256] 21-23, the anatomical model 329-1 may be associated with a scapular angle of 0 degrees (e.g., internal tilt). The spatial module 50 may be configured to assign default values ​​for each property associated with the object 362 of the control panel 311 based on the determined and / or selected scapular angle. The spatial module 50 may be configured to position the selected bone models 330 relative to each other based on the assigned values. A posture type (e.g., Type A) may be assigned to the posture associated with the scapular angle and the anatomical model 329-1 of FIG. 21.

[0257] 23 with continuing reference to FIG. 22 , a surgeon or clinical user may adjust the position of a selected bone model 330, such as humerus model 330H, by interacting with one or more objects 362. The surgeon or clinical user may adjust the adduction of humerus model 330H from a first position (e.g., FIG. 22 ) to a second position (e.g., FIG. 23 ) by interacting with one or more objects 362. The spatial module 50 may be configured to allow unselected bone models 330 to remain fixed in positions while adjusting the selected bone model 330, thereby providing flexibility in determining one or more parameters of the pre-operative plan, such as the position and / or orientation of an implant relative to each corresponding implant model 332. The surgeon or clinical user may interact with the user interface 356 to observe the effect of various characteristics, including any disclosed herein, on range of motion and one or more activities of daily living and / or lifestyle goals.

[0258] 24-26 disclose an embodiment of a second anatomical model 329-2 within a display window 360 of a graphical user interface 356. The pose associated with the second anatomical model 329-2 may be different from the pose associated with the first anatomical model 329-1. The anatomical model 329-2 may be associated with a scapular angle of approximately 30 degrees (e.g., internal tilt). The pose associated with the scapular angle of FIG. 24 and the anatomical model 329-2 may be assigned a pose type (e.g., Type C).

[0259] The planning system 10 may be configured to establish a surgical plan 36 based on the corresponding determined posture and / or scapular angle of the patient. The planning system 10 may be configured to determine the posture and / or scapular angle based on an acquired position of the patient (e.g., upright or recumbent). The planning system 10 may be configured to apply a transformation to the acquired position of the patient to predict or otherwise determine the posture and / or scapular angle of the patient in an upright (e.g., standing) position. A surgeon or clinical user may interact with the planning system 10 to establish a surgical plan 36 based on the determined posture and / or scapular angle, which may achieve one or more activities of daily living and / or lifestyle goals and / or evaluate range of motion for planned implant positioning to improve patient mobility.

[0260] FIG. 27 discloses a method for a surgical procedure in a flowchart 382. The method 382 may be used to pre-operatively plan, perform, evaluate, and / or verify aspects of various surgical procedures, such as arthroplasty to restore function to shoulders, ankles, knees, hips, and other joints. The method 382 may be used in conjunction with any planning system and method, virtual anatomical model, and / or bone model, as disclosed herein, such as planning system 10. The method 382 may be used to determine a patient's posture. The method 382 may be used to establish the position and / or orientation of one or more implants based on the orientation of an anatomical structure, such as the orientation of the scapula. The orientation of the anatomical structure may be related to the patient's posture. The method 382 may be used to determine a patient's posture. In embodiments, the planning method 382 may be used to predict or otherwise determine the position, alignment, and / or angle of a bone based on the geometry of one or more other bones, including adjacent and / or non-adjacent bones, of the patient. Method 382 may be configured to predict or otherwise determine bone position, alignment, and / or angle based on the bone's relationship to a (e.g., global) frame of reference and / or to one or more planes and / or axes of motion of the patient. Fewer or additional steps may be performed within the scope of the present disclosure compared to those described below, and the described order of steps is not intended to limit the present disclosure. System 10, and any associated modules, may be configured to perform features of any method disclosed herein, including method 382. See System 10.

[0261] 2 and 27, in step 382A, a digital image of a patient's anatomy may be captured or otherwise obtained by an imaging device 16 (FIGS. 1-2), including any imaging device disclosed herein, such as a computed tomography (CT) or magnetic resonance imaging (MRI) device. The digital image may include image data that may be captured or otherwise obtained to establish one or more images 26 of the anatomy, such as by the imaging device 16. The data module 46 may receive the image data directly from the imaging device 16 or may obtain the image data by accessing records or entries associated with the patient from database 38 (FIG. 2) and / or patient profile database 64 (FIG. 3). The digital image may include any anatomy disclosed herein, such as the anatomy represented by bone model 330 and / or anatomical model 329 of FIGS. 21-23. The imaging device 16 may be associated with an acquisition frame of reference. The acquisition frame of reference may be associated with an axis and a set of coordinate values. The images 26 may be referenced to the capture frame of reference of each corresponding imaging device 16 .

[0262] 28 with continuing reference to FIGS. 2 and 27, the image 26 may be related to an anatomical model 329 and / or a bone model 330. The spatial module 50 may be configured to relate the anatomical model 329 to an acquisition frame of reference. Although FIG. 28 discloses the anatomical model 329 relative to a set of implant models 332, it will be understood that the implant models 332 may be positioned relative to the anatomical model 329 after establishing a revised instance of the anatomical model 329 associated with the surgical plan 36. The data module 46 may be configured to store in the memory 44 one or more instances of the anatomical and bone models, such as the anatomical model 329 and / or the bone model 330, and associated coordinate values.

[0263] Digital images may be captured for various imaging positions of the patient relative to the imaging device 16. The patient acquisition position may be generally horizontal. In embodiments, the patient acquisition may be generally vertical. Images of the patient may be captured with the patient standing. The patient's posture in an upright position may deviate from perfect posture. Images may be captured with the imaging device positioned upright.

[0264] In step 382B, the digital image 26 may be segmented using a variety of techniques, such as applying automatic, semi-automatic, or manual segmentation to the image 26. The system 10 may be configured to segment the image 26.

[0265] In step 382C, one or more anatomical and / or bone models may be generated. The stem 10 may be configured to generate one or more anatomical models 29, such as anatomical model 329. The anatomical model 329 may include one or more bone models 330. The anatomical model 329 may include information specifying the placement of the bone models 330 relative to one another.

[0266] The anatomical model 329 may include a shoulder model 329SM. The shoulder joint model 329SM may be associated with the first anatomical model 329-1 of Figures 21 to 23. The bone models 330 may include a scapula model 330S associated with the patient's scapula and a humerus model 330H associated with the patient's humerus.

[0267] In an embodiment, a 3D mesh of the scapula and humerus may be reconstructed to establish a scapula model 330S and a humerus model 330H. The scapula model 330S may be established with respect to a local (e.g., scapula) frame of reference. The local frame of reference may be associated with a set of coordinate values. The spatial module 50 may be configured to associate the scapula frame of reference with a scanning (e.g., acquisition) position of the scapula relative to the imaging device 16.

[0268] Various techniques may be utilized to orient the anatomical structures, including the scapula. The anatomical structures, including the scapula, may remain in a local (e.g., acquisition) orientation for planning. The acquisition orientation may be relative to the acquisition frame of reference of the imaging device 16. In embodiments, the Z-axis of the acquisition frame of reference may be horizontal for the imaging device 16 and other acquisition systems that may acquire image data of a patient in a horizontal (e.g., recumbent) position. The Z-axis of the acquisition frame of reference may be vertical for acquisition systems that may acquire image data of a patient in an upright position (e.g., vertical or standing position). Patient postural characteristics, such as scapular angle, may differ between the horizontal and upright positions.

[0269] In step 382D, the anatomical model and / or bone model may be reoriented (e.g., registered) from a first frame of reference to a different second frame of reference. In embodiments, the anatomical model and / or bone model may be reoriented based on the patient's posture and related posture characteristics. By reorienting the patient's anatomical model and / or bone model based on posture, implant planning may be improved to achieve range of motion and activities of daily living and / or lifestyle goals. The acquisition position of the patient's anatomical structures, including the scapula, may be determined directly from digital images. The disclosed systems and methods may normalize and / or realign the scapula to the scapular plane in a three-dimensional (3D) computer-aided design (CAD) model. One or more patient-related measurements and / or other information may be captured preoperatively to manually and / or optically determine the patient's preoperative posture. In other embodiments, reorienting (e.g., registering) the anatomical model and / or bone model from the first frame of reference to the second frame of reference in step 382D may be performed without determining the patient's posture.

[0270] The spatial module 50, or another portion of the planning system 10, may be configured to reorient (e.g., register) at least one or more of the anatomical model and / or bone model from a first frame of reference to a second frame of reference. The first frame of reference may be a local frame of reference or an acquired frame of reference. The second frame of reference may be any frame of reference disclosed herein, such as a global frame of reference. The spatial module 50 may be configured to reorient the bone models 330 in the global frame of reference based on selected representative bone models 30 that may be associated with different patients. The spatial module 50 may be configured to register one or more bone models 330 of the patient from the first frame of reference to the second frame of reference in response to adjusting one or more coordinate values ​​associated with each corresponding bone model 330 based on the patient's posture, including any posture parameters disclosed herein. The comparison module 52 may be configured to determine posture parameters associated with the patient's posture. The spatial module 50 may be configured to register the patient bone models 330 in the global frame of reference based on the determined posture parameters.

[0271] The planning system 10 may be configured to normalize one or more datasets within a global frame of reference, including any anatomical model, bone model, implant model, and / or database disclosed herein. Step 382D may include reorienting the scapula model 330S from its orientation at the time of acquisition within the acquisition frame of reference to the global frame of reference. The scapula model 330S may be reoriented using any of the techniques disclosed herein. The orientation of the scapula model 330S within the global frame of reference may be related to the anatomical position of the scapula when the patient is upright, and such anatomical position may be affected by the patient's posture.

[0272] Various techniques may be used to reorient the anatomical model and / or bone model. The spatial module 50 and / or another portion of the system 10 may be configured to register the bone model from a first (e.g., local or acquired) frame of reference to a second (e.g., global) frame of reference based on one or more posture parameters associated with the patient's posture. The one or more posture parameters may be used to establish a transformation between the first and second frames of reference. The one or more posture parameters may include a scapular angle associated with the scapula (see, e.g., FIGS. 17A-17C). Various techniques may be used to establish the transformation, such as one or more parametric equations and / or matrices.

[0273] In step 382D-1, a global frame of reference may be defined (see, e.g., FIG. 30). The planning system 10 may define the global frame of reference using any of the techniques disclosed herein. The global frame of reference may be associated with a set of coordinate values. The global frame of reference may represent an anatomical position of the patient, which may be different from an acquisition position associated with the image data acquired by the imaging device 16. The anatomical position may correspond to the patient's posture in an upright (e.g., standing) position. The global frame of reference may be established with respect to a Z-axis (0,0,1), a Y-axis (0,1,0), and an X-axis (1,0,0). The Z-axis of the global frame of reference may correspond to the vertical direction. The X-axis and Y-axis of the global frame of reference may extend in corresponding horizontal directions along a horizontal plane. The global frame of reference may be associated with an upright position of the patient. In embodiments, the global frame of reference may be established with respect to one or more planes of motion of the patient, including any of the planes of motion disclosed herein. The X, Y, and Z axes may be established along the patient's respective planes of motion. Using the techniques disclosed herein, activities of daily living and / or lifestyle goals may be established and / or assessed based on the patient's posture. The planning system 10 may be configured to establish and / or assess the patient's implant position and orientation, range of motion, and / or activities of daily living / lifestyle goals relative to a global frame of reference. In embodiments, the range of motion modeler 101 ( FIG. 8 ) may determine the range of motion relative to the global frame of reference. Various databases disclosed herein, including the surgical outcome database 66, range of motion database 68, and / or anatomical body size classification database 70 ( FIG. 3 ), may be normalized to the global frame of reference.

[0274] The spatial module 50 may be configured to register a scapular frame of reference associated with the scapula module 330S to a global frame of reference, which may include translating and / or rotating the scapula model 330S. The scapular frame of reference may be established relative to a set of landmarks, such as three or more landmarks, of the scapula model 330S associated with the scapula.

[0275] With reference to FIG. 29, with continuing reference to FIGS. 2 and 27-28, a scapular axis SA may be established. The scapular axis SA may extend through a reference point along the articular surface of the scapula model 330S. The articular surface may be related to the glenoid cavity of the scapula. The scapular axis SA may extend between a first point P1 (e.g., the center of the glenoid cavity) and a second point P2 (e.g., the scapular triangle) on the scapula model 330S.

[0276] 28 and 31 with continued reference to FIGS. 2 and 27-28, an anatomical (e.g., scapular) plane REF-A may be established. The scapular plane REF-A may be fitted through the scapular model 330S. The scapular plane REF-A may be determined by landmarks or may be a best fit of the scapular plane. The scapular plane REF-A (FIG. 31) may be established along the scapular axis SA and may extend between a first point P1 at the glenoid center and a second point P2 at the scapular triangle. The scapular plane REF-A may extend through a third point P3. The third point P3 may be established at the inferior angle of the scapula. The spatial module 50 may be configured to determine the scapular axis SA and / or one or more anatomical landmarks along the scapular model 330S, including the first point P1, the second point P2, and / or the third point P3. The spatial module 50 may be configured to determine the scapular plane REF-A such that the scapular plane REF-A extends along the scapular axis SA.

[0277] With reference to FIG. 30 with continuing reference to FIGS. 2 and 27-29, the scapula model 330S may be associated with a first (e.g., local, scapular, or acquired) frame of reference. The scapula frame of reference may have an origin PL. The spatial module 50 may be configured to apply a predefined transformation to the scapula model 330S to reorient the scapula model 330S from the first frame of reference to a different second frame of reference. The first frame of reference may be a local frame of reference. The second frame of reference may be the global frame of reference established in step 382D-1. The system 10 may establish a surgical plan 36 associated with the bone model 330 with respect to the global frame of reference. The surgical plan 36 may include an implant plan associated with the implant. The implant plan may include the type of implant, the dimensions of the implant, and / or the position and / or orientation of the implant relative to the implant model.

[0278] With reference to FIG. 31 with continuing reference to FIGS. 2 and 27-30, registering the scapula model 330S in step 382D may include adjusting the orientation of the scapula model 330S. In an embodiment, the spatial module 50 may apply a predefined transformation such that the scapula model 330S may be translated and / or rotated, thereby aligning (e.g., registering) the scapula frame of reference of the scapula model 330S with respect to the global frame of reference. The origin PL of the scapula frame of reference may be established at a first point P1 at the center of the glenoid cavity of the scapula model 330S. In the embodiment of FIG. 31, the alignment may be performed such that the first point P1 at the center of the glenoid cavity may be positioned at the origin P0 of the global frame of reference. The system 10 may be configured to perform a predefined transformation of the humerus model 330H from the local (e.g., humeral) frame of reference to the global frame of reference using any of the techniques disclosed herein with respect to the scapula model 330. In embodiments, the spatial module 50 may be configured to apply the same predefined transformation associated with the glenoid bone model 330G to the humerus model 330H such that the relative position between the glenoid bone model 330G and the humerus model 330H remains the same between the frames of reference. The orientation of the scapula model 330S and the humerus model 330H relative to the global frame of reference may represent the patient's posture in the anatomical position.

[0279] The system 10 may be configured to register one or more implant models 32 in a global frame of reference according to any of the techniques disclosed herein. In the embodiment of FIG. 30, the system 10 may be configured to register the position of one or more implant models 332 in the global frame of reference. The implant models 332 may be positioned along the glenoid head and / or along the humeral head of the associated bone models 330S, 330H. The implant models 332 may be registered simultaneously with the registration of the scapula model 330S and / or humerus model 330H. In other embodiments, the implant models 332 may be positioned relative to the glenoid model 330S and humerus model 330H after the scapula model 330S and / or humerus model 330H have been registered in the global frame of reference.

[0280] Still other techniques may be used to reorient the anatomical model and / or bone model from one frame of reference to another. The planning system 10 may be configured to determine the position of the bone relative to each corresponding bone model based on the geometry of one or more other bones, including adjacent and / or non-adjacent bones of the patient, and based on the associated bone model and / or anatomical model. In embodiments, the planning system 10 may be configured to determine the position, alignment, and / or angle of the bone relative to each corresponding bone model based on the geometry of one or more other bones, including adjacent and / or non-adjacent bones of the patient, and based on the associated bone model and / or anatomical model. In embodiments, the planning system 10 may be configured to determine the position, alignment, and / or angle of the bone relative to each corresponding bone model based on the relationship of the bone to a (e.g., global) frame of reference and / or based on the relationship of the bone to one or more planes and / or axes of motion of the patient. In step 382D-2, the anatomical and / or bone model may be reoriented from the first frame of reference to the second frame of reference based on one or more predetermined correlations to anatomical landmarks and / or to anatomical models of one or more other patients. Planning system 10 may be configured to establish a surgical plan in response to comparing the anatomical and / or bone model of the patient with anatomical and / or bone models of one or more other patients and / or patient populations. The patient population may exclude the patient.

[0281] System 10 may be configured to reorient bone model 330, such as scapula model 330S, and / or anatomical model 329 based on the relationship between two or more adjacent and / or non-adjacent bones of the anatomy. System 10 may be configured to determine the position of the bone relative to bone model 330 based on the geometry of another bone, including an adjacent bone, such as the humerus, relative to the scapula, and / or including a non-adjacent bone, such as the clavicle, and / or including one or more ribs (e.g., minor ribs) of the patient.

[0282] Step 382D-2 may include reorienting (X, Y, Z) the scapular plane REF-A (see, e.g., FIG. 31 ) of scapular model 330S based on one or more predetermined correlations. The predetermined correlations may be established with respect to anatomical landmarks and / or with respect to SSM / numerical configuration classifications. The SSM / numerical configuration classifications may be established using any technique disclosed herein, such as by statistical shape modeler 72. Planning system 10 may be configured to establish a transformation for each anatomical build classification 80 and associated parameters of the transformation based on the predetermined correlations, which may be used to register associated bone models and / or anatomical models from one frame of reference to another.

[0283] In embodiments, a global (e.g., common) frame of reference may be established in step 382D-1 using any of the techniques disclosed herein. The scapula model 330S may be registered to the global frame of reference using one or more defined landmarks, including any of the anatomical landmarks disclosed herein. The system 10 may be configured to determine the position of one or more landmarks along the scapula and / or other parts of the anatomy. Using the landmarks, a transformation from the scapula frame of reference to a global coordinate system may be defined (e.g., see FIG. 30). The orientation of the scapula model 330S and humerus model 330H relative to the global frame of reference may represent the patient's anatomical position. Landmarks along the scapula may include the center of the glenoid cavity (e.g., point P1 in FIG. 29), the inferior angle of the scapula (e.g., point P3 in FIGS. 29 and 31), and / or the scapular triangle (e.g., point P2 in FIG. 29).

[0284] Various techniques may be utilized to determine the landmarks, including any of those disclosed herein. A surgeon or clinical user may specify landmarks for each corresponding bone model 330, including scapula model 330S, by interacting with display window 360 and / or other portions of user interface 356 (e.g., FIGS. 21-23 ). In embodiments, spatial module 50 may be configured to determine landmarks along scapula model 330S and / or other bone models 330 of anatomical model 329.

[0285] 2 and 4 with continued reference to FIGS. 27-28 , the scapula model 330S may be registered within a global frame of reference based on a statistical shape model (SSM) 75 and based on the assigned numerical configuration classification 80. One or more corresponding SSMs 75 may be established for the scapula, humerus, and / or other bones of the anatomy. In embodiments, anatomical SSMs 75 may be established for two or more bones of the anatomy, including non-adjacent and / or adjacent bones, such as the scapula and humerus. A statistical shape modeler 72 may be configured to analyze the set of image data 74 to construct the corresponding SSMs 75. The statistical shape modeler 72 may be configured to determine the location of each landmark within the SSM 75, which may be utilized to transform the bone model 30 from the local frame of reference to the global frame of reference. In an embodiment, statistical shape modeler 72 may assign anatomical build classifications 80 to one or more bone models 330, including scapula model 330S (eg, FIGS. 27-28).

[0286] The statistical shape modeler 72 may query the anatomical body size classification database 70 to find internally stored bone models 30 having similar anatomical body size classifications 80. Coordinate information of the bone models 30 associated with the anatomical body size classification database 70 may be normalized to a global frame of reference. In embodiments, normalizing the coordinate information may include applying a transformation from the acquisition frame of reference to the associated bone models 30 using any of the techniques disclosed herein.

[0287] The comparison module 52 and / or the statistical shape modeler 72 may be configured to select a representative bone model 30 from a set of representative bone models 30 associated with the statistical shape model 75. The statistical shape model 75 and the patient bone model 330 may be associated with a common bone of an anatomical structure, such as the scapula or humerus. The comparison module 52 and / or the statistical shape modeler 72 may be configured to assign an anatomical body size classification 80 of the selected representative bone model 30 to the patient bone model 330. Each corresponding representative bone model 30 in the set of representative bone models 30 may be assigned a corresponding anatomical body size classification 80 based on the statistical shape model 75. The comparison module 52 and / or the statistical shape modeler 72 may be configured to assign the anatomical body size classification 80 of the selected representative bone model 30 to the bone model 330.

[0288] The statistical shape modeler 72 may be configured to assign to the bone model 330 an anatomical body size classification 80 associated with another patient that most closely resembles the anatomical structure encompassed by the bone model 330. The anatomical body size classification database 70 may include stored information specifying one or more landmarks of the bone model 30 associated with the assigned anatomical body size classification 80. The bone model 30 associated with the assigned anatomical body size classification 80 may be registered within a global frame of reference.

[0289] In embodiments, establishing a surgical plan 36 for a patient may include selecting a representative bone model 30 from a set of representative bone models 30 each associated with a corresponding statistical shape model 75. The statistical shape models 75 and the representative bone models 30 may be associated with anatomically common bones. Establishing the surgical plan 36 may include comparing the patient bone model 330 with the selected representative bone model 30 associated with the SSM 75. The surgical plan 36 may be established based on the bone model 330 within a global frame of reference.

[0290] The landmarks on the bone model 330 may be paired to associated landmarks on the bone model 30 of the assigned anatomical body type 80. The patient's bone model 330 may be reoriented such that the pair of landmarks on the representative bone model 30 and the landmarks on the patient's bone model 330 may be substantially aligned within a global frame of reference. The patient's posture may be determined based on the positions of the landmarks on the representative bone model 30.

[0291] In embodiments, instances of bone models 30 of assigned anatomical body type classifications 80 in the global frame of reference may be substantially aligned with the patient bone models 330 in the local frame of reference to determine values ​​for one or more correction angles. The correction angles may include three rotation angles relative to the axes of the frame of reference. Based on the determined values ​​of the correction angles, a transformation may be established. The spatial module 50 may be configured to register the bone models 330 in the global frame of reference by applying the transformation to each corresponding bone model 330 of the patient. In other embodiments, the patient bone models 330 may be registered in the global frame of reference by substantially aligning the patient bone models 330 with selected bone models 30 of another patient in the global frame of reference.

[0292] Statistical shape modeler 72 may be configured to utilize SSM 75 to assign an anatomical body mass classification (AMC) 80 to the anatomical model and / or to the bone model based on one or more bones of the anatomical structure, such as the scapula. Each AMC 80 may be established for multiple bones of the anatomical structure, including adjacent bones of the joint, such as the scapula and humerus, and / or including non-adjacent bones. In embodiments, statistical shape modeler 72 may be configured to determine the position of a bone relative to bone model 30 based on the geometry of another (e.g., adjacent) bone, including adjacent bones, such as the humerus, relative to the scapula, and / or including non-adjacent bones, such as the clavicle, or including one or more ribs (e.g., minor ribs) of the patient. In embodiments, system 10 may be configured to determine the angle of the ribs relative to a reference, such as the Z-axis of a reference system. System 10 may be configured to determine a pose based on the determined rib angles. In other embodiments, each AMC 80 may be established for a single bone of the patient, such as the scapula or humerus. The statistical shape modeler 72 may be configured to determine the position of the bone relative to the skeletal anatomy based on one or more characteristics of the bone and associated landmarks.

[0293] Multiple AMC80 NThe patient's posture may be used to establish the anatomical body size classification 80. The patient's posture may be defined with respect to one or more parameters, including any parameter disclosed herein, such as scapular angle (e.g., the angle in FIGS. 17A-17C ). The statistical shape modeler 72 may be configured to establish the anatomical body size classification 80 based on one or more predefined modes (e.g., variation modes) 76. The posture-related parameters may establish one or more predefined modes 76, including any posture parameters disclosed herein, such as scapular angle. The posture-related predefined modes 76 may include relationships between two or more adjacent and / or non-adjacent bones. The statistical shape modeler 72 may be configured to receive the posture-related predefined modes 76 as input. The statistical shape modeler 72 may be configured to assign AMCs 80 to corresponding anatomical structures and to associated bone models 30, respectively, based on the posture-related predefined modes 76. In other embodiments, the predefined modes 76 may omit the patient's posture.

[0294] An AMC 80 may be selected based on the (e.g., best) fit between the bone model 30 associated with the AMC 80 and the patient bone model 330. Landmarks on the bone model 30 associated with the selected AMC 80 may be used to determine the patient's posture. In embodiments, landmarks associated with the selected AMC 80 may be used to determine various posture characteristics, such as the scapular angle relative to a global frame of reference. The patient bone model 330 may be reoriented from the acquisition posture to the global frame of reference by applying a transformation based on the determined posture.

[0295] The disclosed systems and methods may be utilized to orient a model of the scapula to substantially match the patient's preoperative posture and may be utilized to determine and / or verify range of motion. Various embodiments may be utilized in accordance with the teachings disclosed herein, including determining range of motion based on posture information.

[0296] The system 10 may be configured to superimpose a representative bone model 30 corresponding to the assigned anatomical body size classification 80 onto the patient's respective corresponding bone model 330 (see, e.g., bone models 430H-1 and 430H-2 in FIG. 35 , bone models 530S-1 and 530S-2 in FIGS. 42-43 , and bone models 530H-1 and 530H-2 in FIG. 45 ). A surgeon or clinical user may turn on (and off) the visibility of the superimposed bone model 30 associated with the SSM 75 by interacting with the user interface 356. The superimposed bone model 30 associated with the SSM 75 may provide a pre-morbid representation of the patient's anatomy, which the surgeon may use to evaluate and establish, edit, and / or approve a surgical plan.

[0297] In embodiments, step 382D may include replacing the patient bone model 330 with a bone model 30 corresponding to the anatomical body size classification 80 assigned to the patient bone model 330. The anatomical body size classification database 70 may include alignment information related to the position of the substitute bone model 30 within the global frame of reference. The substitute bone model 30 may serve as a pre-morbid representation of the patient's anatomy. The pre-morbid representation may omit osteophytes and / or other surface irregularities that may interfere with the range of motion of the associated bone. The surgeon may remove osteophytes and / or otherwise treat the surface irregularities during the surgical procedure. Analyzing the range of motion using the substitute bone model 30, including the global frame of reference, may provide a relatively accurate prediction of the post-operative range of motion with the surface irregularities removed or otherwise treated.

[0298] 32 with continuing reference to FIG. 27, in step 382E, the position and / or orientation of one or more implants may be determined based on the orientation of associated bone models, such as scapula model 330S. System 10 may be configured to determine the position of one or more implants, and the position of associated implant models 332, based on the orientation of anatomical model 329 and / or bone models 330, including scapula model 330S, within their respective corresponding frames of reference, including any of the frames of reference disclosed herein. Implant models 332 may include glenoid implant model 332G and / or humeral implant model 332H.

[0299] The spatial module 50 may be configured to position the implant model 332 and the bone model 330 relative to one another within the global frame of reference based on the implant positions specified in the surgical plan 36. The system 10 may be configured to determine optimal implant positions based on the patient's predicted posture. In embodiments, the posterior rotation of the humeral implant model 332H may be adjusted to improve clinical range of motion. The position and orientation of each implant model 332 relative to its corresponding bone model 330 may be established within the global frame of reference according to the assigned anatomical body size classification 80. The surgeon or clinical user may adjust the assigned position and / or orientation of the implant model 332 before approving the surgical plan 36. The determination of the implant positions in step 382E may be based on relationships between two or more adjacent and / or non-adjacent bones, which may be predicted or otherwise determined using any of the techniques disclosed herein, which may additionally or alternatively be performed to determine the patient's posture.

[0300] In step 382F, a range of motion associated with each corresponding implant model 332 may be determined. Step 382F may include performing a range of motion simulation based on one or more parameters that may be related to the patient's posture. In embodiments, the parameters may omit the patient's posture. The bone model 330 may be associated with the patient's scapula. The parameters may include a scapular angle associated with the scapula. The system 10 may be configured to perform the range of motion simulation based on the determined posture parameters, such as the humerus model 330H. The system 10 may be configured to determine the range of motion based on an anatomical size classification 80 assigned to the bone models 330, including the scapula model 330S and humerus model 330H of the scapula and / or humerus, using any of the techniques disclosed herein. The range of motion modeler 101 may be configured to perform a range of motion simulation of the bone models 330 in the global frame of reference based on the posture parameters and / or the assigned anatomical size classification 80.

[0301] Step 382F may include storing the range of motion data derived from the range of motion simulation in storage system 18 of system 10. Data module 46 may be configured to store the range of motion data in storage system 18.

[0302] FIG. 33 discloses a method for a surgical procedure in flowchart 482. Method 482 may be used to pre-operatively plan, perform, evaluate, and / or verify aspects of various surgical procedures, such as arthroplasty to restore function to shoulders, ankles, knees, hips, and other joints. Method 482 may be used in conjunction with any planning system and method, virtual anatomical model, and / or bone model, as disclosed herein, such as planning system 10. Method 482 may be used to determine the position and / or orientation of one or more implants based on the orientation of a patient's anatomical structures, such as the scapula and humerus. The orientation of the anatomical structures may be related to the patient's posture. Method 482 may be used to determine the patient's posture. In embodiments, planning method 482 may be used to predict or otherwise determine bone position, alignment, and / or angle based on the geometry of one or more other bones, including adjacent and / or non-adjacent bones, of the patient. Method 482 may be configured to predict or otherwise determine bone position, alignment, and / or angle based on the bone's relationship to a (e.g., global) frame of reference and / or to one or more planes and / or axes of motion of the patient. Fewer or additional steps may be performed within the scope of this disclosure compared to those described below, and the order of steps described is not intended to limit the disclosure. Method 482 may incorporate any step in method 382 disclosed herein, and vice versa. See system 10.

[0303] 2 with continued reference to FIG. 33, in step 482A, a digital image of a patient's anatomy may be captured by imaging device 16. Imaging device 16 may include any imaging device disclosed herein. Computing device 40 may be configured to receive image data related to the patient. In an embodiment, a shoulder CT scan or MRI may be acquired, such as by imaging device 16, to establish one or more images 26 of the anatomy. The images 26 may be correlated to an anatomical model 29. Computing device 40 may be configured to generate anatomical model 29 and / or bone model 30 of the patient and / or of one or more other patients based on the image data, including patients associated with a representative patient population. In step 482B, digital image 26 may be segmented using various techniques, such as applying automatic, semi-automatic, or manual segmentation.

[0304] In step 482C, the planning system 10 may be configured to generate one or more anatomical models 29. The anatomical models 29 may include one or more bone models 30. The bone models 30 may represent corresponding bones, including any bones disclosed herein, such as the scapula and humerus. The anatomical models 29 may include information specifying the placement of the bone models 30 relative to one another. A three-dimensional (3D) mesh of the associated bones (e.g., the scapula and humerus) may be reconstructed.

[0305] In step 482D, the orientation of one or more (e.g., a first) bones, such as the scapula, may be determined. The bones may be associated with an anatomical model, such as anatomical model 329 of FIG. 34. The anatomical model 329 of FIG. 34 may be associated with anatomical model 329 of FIG. 28. The bones may be associated with corresponding bone models, such as scapula model 330S. Various techniques for determining the orientation of the scapula may be utilized, including any of the techniques disclosed herein.

[0306] Step 482D may include defining a global frame of reference in step 482D- 1. The global frame of reference may be defined using any of the techniques disclosed herein.

[0307] The orientation of bones, such as the scapula, may be measured or otherwise determined using a variety of techniques, including any of the techniques disclosed herein. Planning system 10 may be configured to measure or otherwise determine the orientation of bones by performing any of the techniques disclosed in the steps of method 382.

[0308] Various techniques may be utilized for determining the orientation of the bone relative to the anatomical model in step 482D. With continued reference to FIGS. 2, 4, and 33, and with reference to FIGS. 35-36, an anatomical model 429 according to another embodiment is disclosed. Step 482D may include, in step 482D-2, determining the orientation of the (e.g., scapula) bone model 430 based on one or more predetermined correlations relative to anatomical landmarks and / or relative to the anatomical structures of one or more other patients and / or relative to the anatomical structures of a representative patient population. The representative patient population may exclude the patient. The predetermined correlations may be established relative to anatomical landmarks and / or relative to an SSM / numerical construct classification. The SSM / numerical construct classification may be established using any technique disclosed herein. In an embodiment, a global frame of reference may be established in step 482D-1 using any technique disclosed herein.

[0309] The storage system 18 may be configured to store two-dimensional and / or three-dimensional bone models 30 associated with one or more bones and / or associated with one or more joints of a representative patient population. The bone models 30 may include a first set of bone models 30 and a second set of bone models 30. The first set of bone models 30 may be associated with a first bone of the anatomy. The second set of bone models 30 may be associated with a second bone of the anatomy. The bone models 30 in the first set and the second set may be associated with a common anatomical model 29 of the patient.

[0310] The bone model 30 of a representative patient population and associated bones may be associated with one or more statistical shape models (SSMs) 75. In embodiments, two or more adjacent and / or non-adjacent bones associated with the bone model 30 may be associated with the same SSM 75. The planning system 10 may be configured to determine the position, alignment, and / or angle of the bones associated with each corresponding bone model based on the geometry of one or more other bones, including adjacent and / or non-adjacent bones, of the patient, and based on the associated bone model and / or anatomical model. Step 482D-2 may include analyzing the representative patient population within the SSM 75. The planning environment 28 may be configured to analyze the representative patient population within the associated SSM 75. The SSM 75 may be established based on a statistically significant number of historical cases to characterize the variability of the associated bones of the anatomy. In embodiments, the SSM 75 may be established based on at least 100-1,000 prior cases, or more rigorously, based on at least 10,000-20,000 prior cases. The statistical shape modeler 72 may be configured to create a plurality of anatomical body size classifications 80 based on a plurality of predefined modes (e.g., variability modes) 76 within the statistical shape model 75. The statistical shape modeler 72 may be configured to receive one or more predefined modes 76 as input. The predefined modes 76 may characterize anatomical variations within a representative patient population and a standard deviation 78 of the anatomical variance contained within each predefined mode 76. The statistical shape modeler 72 may be configured to assign the anatomical body size classifications 80 to the bone model 30. The storage system 18 may be configured to store the anatomical body size classifications 80. Step 482D-2 may include identifying a predefined mode 76 within the SSM 75 for the representative patient population.

[0311] The predefined modes 76 that may be provided to the statistical shape modeler 72 may include any of the predefined modes disclosed herein, including, but not limited to, bone size and / or bone portion (e.g., scapula, glenoid, humerus, humeral head, shaft, etc.), tilt, rotation, retroversion (e.g., humeral retroversion), glenoid projection and sagittal neck length, glenoid angle relative to the scapular neck, critical shoulder joint angle, acromion and / or coracoid projection, humeral head varus / valgus, anatomical landmarks, joint cavity, preoperative range of motion, any combination of the above, etc. In embodiments, the predefined modes 76 associated with the scapula and humerus may be the same or different. The number of predefined modes 76 may be selected based on the amount of variation associated with each mode and / or combinations of modes. The amount of variation of the modes may vary based on the selected anatomy. The predefined modes 76 may include a posture mode associated with the patient's posture. A posture mode may be established based on two or more adjacent and / or non-adjacent bones of the anatomy. In an embodiment, the predefined mode 76 may omit the posture of the patient.

[0312] 36 and 45 with continuing reference to FIGS. 2, 4, 33, and 35, a method 482 may include accessing, from memory, a first patient three-dimensional model 430S-1 / 530S-1 of the patient. The first patient model 430S-1 / 530S-1 may be associated with a first bone of the patient. The method 482 may include accessing, from memory, a second patient three-dimensional model 430H-1 / 530H-1 of the patient. The second patient model 430H-1 / 530H-1 may be associated with a different second bone of the patient. Statistical shape modeler 72 may be configured to select a first representative (e.g., scapula) three-dimensional bone model (e.g., 530S-2 of FIG. 45 ) and / or a second representative (e.g., humerus) three-dimensional bone model 430H-2 / 530H-2 associated with representative anatomical model 429-2 / 529-2 in response to changing one or more of predefined modes 76 in SSM 75. Selecting anatomical model 429-2 / 529-2 may occur in response to changing one or more of predefined modes 76 in SSM 75.

[0313] The statistical shape modeler 72 may be configured to assign an anatomical body size classification 80 associated with the first representative model 530S-2 to the first patient bone model 430S-1 / 530S-1. The statistical shape modeler 72 may be configured to assign an anatomical body size classification 80 associated with the second representative model 430H-2 / 530H-2 to the second patient bone model 430H-1 / 530H-1. The range of motion modeler 101 may be configured to perform a range of motion simulation with respect to the assigned anatomical body size classifications 80 of each corresponding bone. The statistical shape modeler 72 may be configured to assign an anatomical body size classification 80 to the bone models 430S-1 / 530S-1 and / or 430S-2 / 530S-2 based on a posture mode. The statistical shape modeler 72 and / or the comparison module 52 may be configured to determine one or more posture parameters associated with the patient's posture based on an anatomical body type classification 80 associated with the representative model of the scapula 430S-2 / 530S-2 and / or associated with the second representative model of the humerus 430H-2 / 530H-2, as associated with another patient in the representative patient population.

[0314] The orientation of the selected bone model 430 / 530 of the patient may be determined based on the SSM 75. In embodiments, the orientation of the scapula of the scapula model 530S in 3D space may be determined based on the SSM 75 relative to the scapula. In the embodiments of FIGS. 36 and 45, the scapula model 430S-1 / 530S-1 and the humerus model 430H-1 / 530H-1 may be associated with the patient's anatomical model 429-1 / 529-1. The scapula model 430S-2 / 530S-2 and the humerus model 430H-2 / 530H-2 may be representative bone models associated with the representative anatomical model 429-2 / 529-2 for another patient from a representative patient population.

[0315] The anatomical body size classification database 70 may include coordinate information associated with the position of each bone model 30 within a global frame of reference and / or within each corresponding acquisition frame of reference. Using the scapula SSM 75, a bone model 30 associated with the anatomical body size classification database 70 may be selected that most closely matches the anatomical structure contained in the bone model 430 / 530 of each corresponding bone. The selected bone model 30 may be associated with each corresponding AMC 80. One or more posture parameters associated with the selected bone model 30 may be predetermined, such as scapular angle.

[0316] The comparison module 52 may be configured to select a first representative bone model 530S-2 from the first set of bone models 30 in response to comparing the first representative bone model 530S-2 with a first patient bone model 430S-1 / 530S-1 associated with a first bone of the patient, such as the scapula. The first representative model 530S-2 may be associated with a second representative model 430H-2 / 530H-2 of a second set of bone models 30. The first patient model 430S-1 / 530S-1 and the second patient model 430H-1 / 530H-1 may establish a first spatial relationship with each other. The second patient model 430H-1 / 530H-1 may be associated with a second bone of the patient, such as the humerus. The first representative bone model 530S-2 and the second representative bone model 430H-2 / 530H-2 may establish a second spatial relationship. The first and second bones can be adjacent or non-adjacent bones, including any bones disclosed herein, and the first and second spatial relationships can be based on one or more landmarks associated with the first and / or second bones, including any landmarks disclosed herein.

[0317] The comparison module 52 may be configured to determine at least one or more patient characteristics associated with the first bone and / or the second bone of the patient in response to comparing the first spatial relationship with the second spatial relationship. The patient characteristics may be related to the patient's posture. The comparison module 52 may be configured to establish an implant plan based on the patient characteristics. The spatial module 50 may be configured to determine a deviation (e.g., spatial) between the first spatial relationship established by the patient bone models 430S-1 / 530S-1, 430H-1 / 530H-1 and a second spatial relationship established by the representative bone models 530S-2, 430H-2 / 530H-2 associated with another patient of a representative patient population. The comparison module 52 may be configured to determine the patient characteristics based on the spatial deviation.

[0318] The comparison module 52 may be configured to cause the spatial module 50 to compare the first representative bone model 430S-2 / 530S-2 with the patient bone model 430S-1 / 530S-1 in response to at least partially or substantially matching the volumes of the first representative bone model 530S-2 and the patient bone model 430S-1 / 530S-1 to one another. The comparison module 52 may be configured to cause the spatial module 50 to compare the second representative bone model 430H-2 / 530H-2 with the patient bone model 430H-1 / 530H-1 in response to at least partially or substantially matching the volumes of the representative bone model 430H-2 / 530H-2 and the patient bone model 430H-1 / 530H-1 to one another.

[0319] A transformation may be applied to the selected bone model 30. The spatial module 50 may be configured to apply the transformation. The transformation may be established by reorienting (e.g., adjusting) the selected bone model 30 to substantially align it with the patient's scapula model 430S-1 / 530S-1 (see, e.g., patient bone model 530S-1 and representative bone model 530S-2 in FIG. 42 ). Once completed, the orientation of the patient's scapula of the associated scapula model 430S-1 / 530S-1 may be calculated based on the transformation applied to the assigned bone model 30. In an embodiment, the spatial module 50 may be configured to adjust the position of the patient bone model 430S-1 and / or the position of the patient bone model 430H-1 based on the determined patient characteristics.

[0320] The spatial module 50 may be configured to register the first patient bone model 430S-1 / 530S-1 and / or the second patient bone model 430H-1 / 530H-1 from the local frame of reference to a global frame of reference based on the determined patient characteristics. The planning environment 28 may be configured to establish a surgical plan relative to the patient bone model 430S-1 / 530S-1 of the scapula and / or relative to the patient bone model 430H-1 / 530H-1 of the humerus within the global frame of reference.

[0321] Step 482D-2 may include selecting an anatomical three-dimensional model 429-2 / 529-2 from the plurality of three-dimensional anatomical models 29 based on the first patient model 430S-1 / 530S-1 and the second patient model 430H-2 / 530H-2. The anatomical model 29 may be associated with one or more bones and / or one or more joints of a representative patient population. The anatomical model 29 may be associated with a first bone and a second bone of the representative patient population. Selecting anatomical model 429-2 / 529-2 may be performed in response to at least partially matching bone models 530S-2, 430H-2 / 530H-2 of anatomical model 429-2 / 529-2 to corresponding patient bone models 430S-1 / 530S-1, 430H-1 / 530H-1 of anatomical model 429-1 / 529-1, respectively, within the same frame of reference.

[0322] In step 482E, the patient's posture relative to the anatomical model 429 may be determined. The posture may be determined based on the orientation of the scapular model 430S / 530S relative to the anatomical model 429 / 529. Step 482E may include determining one or more characteristics related to the patient's posture based on the selected anatomical model 429-2 / 529-2. In an embodiment, step 482E may be omitted.

[0323] Method 482 may include predicting or otherwise determining the position, alignment, and / or angle of a bone (e.g., humerus) relative to a corresponding bone model based on the geometry of one or more other bones (e.g., scapula), including adjacent and / or non-adjacent bones of the patient, and based on the associated bone model and / or anatomical model. In step 482F, an initial anatomical position of another (e.g., second) bone of the anatomical structure relative to anatomical model 429, such as the humerus relative to humerus model 430H / 530H, may be determined. Various techniques, including any of the techniques disclosed herein, such as the technique disclosed in step 482D, may be utilized to determine the initial anatomical position of the humerus. The initial anatomical position of the other bone (e.g., humerus) may be determined based on the pose determined in step 482E. In embodiments, the initial anatomical position of the humerus may be based on the bone's relationship to a (e.g., global) frame of reference and / or to one or more of the patient's planes and / or axes of motion, and determining the patient's posture may be omitted. While the technique of step 482F primarily references the humerus relative to the scapula, it will be understood that this technique may be utilized with respect to any two anatomically adjacent and / or non-adjacent bones. In embodiments, step 482D may be utilized to determine the orientation of the humerus, and step 482E may be utilized to determine the orientation of the scapula.

[0324] Step 482F may include determining an initial anatomical position of another bone model 430 / 530, such as humerus model 430H-1 / 530H-1, based on the anatomical SSM 75 associated with two or more anatomical bones (e.g., the scapula and humerus). Step 482F-1 may include determining an initial anatomical position of the humerus model 430H-1 / 530-1 relative to the selected bone model 30 associated with the AMC 80 assigned to the scapula model 430S-1 / 530-1. The bone model 430H-2 / 530H-2 assigned to the humerus model 430H-1 / 530H-1 may be associated with the same patient as the bone model 530S-2 assigned to the scapula model 430S-1 / 530S-1. The initial anatomical position may be determined based on the relative positions of the corresponding bone models.

[0325] The humerus model 430H-1 / 530H-1 may be associated with the same patient as the scapula model 430S-1 / 530S-1. The representative humerus model 430H-2 / 530H-2 may be associated with a different patient, including a real patient associated with a past case or a virtual patient. The humerus model 430H-2 / 530H-2 may be assigned based on the SSM 75 using any of the techniques disclosed herein. In an embodiment, the planning system 10 may determine one or more landmarks associated with the bone based on the assigned bone model 430H-2 / 530-2 associated with the SSM 75.

[0326] 35-36 with continuing reference to FIGS. 2, 4, and 33, one or more portions of a bone may be omitted from image data associated with image 26. A distal portion of a long bone, such as the humerus, may be included in the image and / or in the humerus model of the anatomical structure (see, e.g., humerus model 330H in FIG. 34). Another portion of the bone, such as the distal (or proximal) portion of humerus model 430H, may be omitted from the image data and / or from the humerus model. Planning system 10 may be configured to determine an initial anatomical location of another adjacent and / or non-adjacent bone (e.g., the humerus) within anatomical model 429 based on the completeness of the acquired information.

[0327] Determining the initial anatomical location of another bone, such as the humerus, in step 482F-1 may include determining the geometry and / or orientation of an omitted portion of the bone in step 482F-2. Step 482F-2 may include determining the geometry and / or orientation of the omitted portion based on an SSM 75 associated with the bone. System 10 may be configured to predict or calculate the distal portion of the humerus based on the humerus SSM 75. In embodiments, the SSM 75 may be associated with two or more adjacent and / or non-adjacent bones of the anatomy, such as the scapula and humerus. In embodiments, the humerus SSM 75 may be utilized to select a representative bone model 430H-2 associated with the anatomical body classification database 70 that is closest to the anatomy associated with the patient's (e.g., partial) bone model 430H-1. The planning system 10 may be configured to replace the patient's humerus model 430H-1 with a bone model 430H-2 corresponding to the assigned AMC 80. The representation of the omitted portion of the bone may be established by a selected bone model 30 associated with the statistical shape model 75, such as the humerus model 430H-2.

[0328] The planning system 10 may be configured to associate the patient anatomical model 429-1 with two or more instances of bone models 430 associated with the same bone of the anatomy to establish a representation of an omitted portion of the bone, such as a patient bone model 430H-1 and a representative bone model 430H-2. The planning system 10 may be configured to determine the geometry and / or orientation of the omitted portion using any of the techniques disclosed herein. Step 482F-2 may include determining the geometry and / or orientation of the omitted (e.g., distal) portion of the humerus based on the representative humerus model 430H-2.

[0329] 36 and 37A-37B with continued reference to FIGS. 2 and 33, the spatial module 50 may be configured to orient the humerus models 430H-1, 430H-2 relative to one another. The spatial module 50 may be configured to align the bone models 430H-1, 430H-2 relative to one another using any of the techniques disclosed herein. The spatial module 50 may be configured to reorient or otherwise move the bone models 430H-1, 430H-2 together with respect to the other bone models 430 and / or with respect to a reference point (e.g., the origin) of a reference system to determine the initial anatomical positions of the associated bones (see, e.g., FIGS. 38A-38B). The spatial module 50 may be configured to reorient or otherwise move the bone models 430H-1, 430H-2 by applying a predetermined transformation. In embodiments, the spatial module 50 may be configured to reorient or otherwise move the representative bone model 430H-2, rather than the patient bone model 430H-1, to determine the initial anatomical position of the humerus. In embodiments, the planning system 10 may be configured to determine one or more landmarks associated with the omitted portion of the bone based on the assigned representative bone model 430H-2 associated with the SSM 75.

[0330] System 10 may be configured to calculate an initial anatomical position of an adjacent or non-adjacent bone, such as the humerus. In the embodiment of Figures 37A-37B and 38A-38B, system 10 may be configured to rotate the shaft of humerus model 430H about the center of the humeral head to align the shaft with the Z-axis of the global reference frame. System 10 may be configured to apply external or internal rotation to align the humeral epicondylar axis with the coronal plane of scapula model 430S.

[0331] Display module 48 may be configured to display a representation of the omitted portion in a display window 460 of user interface 456. Display module 48 may be configured to display humerus models 430H-1, 430H-2 superimposed on one another in display window 460. In embodiments, a surgeon or clinical user may interact with user interface 456 to selectively view first humerus model 430H-1 and / or second humerus model 430H-2 in display window 460.

[0332] The system 10 may be configured to automatically generate a pre-operative surgical plan 36 ( FIG. 2 ) based on the anatomical scapular posture and / or based on the anatomical humerus position. The pre-operative plan 36 may specify various parameters (e.g., implant type, size, and orientation). The surgical plan 36 may include an implant plan associated with one or more implants to treat the patient.

[0333] In step 482G, the position and / or orientation of one or more implant models 432 may be determined. The implant models 432 may include a first (e.g., glenoid) implant model 432G and / or a second (e.g., humerus) implant model 432H. The implant models 432G, 432H may be configured to engage with one another. The system 10 may be configured to determine an optimal implant position based on the predicted posture, which may be determined in step 482E. The system 10 may be configured to establish an implant plan based on one or more posture parameters, which may be determined using any of the techniques disclosed herein. Step 482G may include establishing an implant plan associated with the patient's first bone and / or second bone in response to determining patient-related characteristics, such as posture. Step 482G may include applying a correction factor to the default implant position and / or orientation based on the determined posture characteristics. The correction factor may be established based on a particular posture value (e.g., scapular angle). Determining the implant position in step 482G may be based on the relationship between two or more adjacent and / or non-adjacent bones, which may be predicted or otherwise determined using any of the techniques disclosed herein, which may additionally or alternatively be done to determine the patient's posture.

[0334] In step 482H, a range of motion associated with one or more bones of the anatomical structure may be determined. The range of motion may be based on the position and / or orientation of implant model 432 determined in step 482F. In embodiments, the retroversion of the humeral implant associated with humeral implant model 432H may be adjusted to improve the clinical range of motion. Range of motion modeler 101, and / or another portion of planning environment 28, may be configured to perform range of motion simulations based on one or more patient characteristics, which may be determined using any of the techniques disclosed herein. Based on the anatomical scapular posture, the initial anatomical humeral position, and / or the selected implant (e.g., type, size, and orientation), system 10 may be configured to predict or calculate range of motion results for the current patient associated with patient anatomical model 429-1.

[0335] Other techniques may be used to determine the geometry and / or orientation of the omitted portion of the bone and / or to determine the initial anatomical position of the bone. The planning system 10 may be configured to predict or otherwise determine the geometry and / or orientation of the omitted portion of the bone, including the distal or proximal portion of a long bone, such as the humerus. In embodiments, the system 10 may be configured to determine the geometry and / or orientation of the bone, as related to the omitted bone information or as related to incomplete bone information, based on its relationship to another bone, adjacent and / or non-adjacent, such as the scapula. The predicted geometry and / or orientation of the omitted portion of the bone may be used to determine the patient's pre-morbid anatomy. The predicted geometry and / or orientation of the omitted portion of the bone may be used to determine the patient's posture, including the pre-morbid length of the long bone, such as the humerus, and the position and / or orientation of an associated joint, such as the patient's elbow. Information regarding the predicted geometry and / or orientation may be utilized to establish an implant plan relative to the patient's bone, including adjusting the default starting position and / or orientation of the implant.

[0336] FIG. 39 discloses a method for a surgical procedure in flowchart 582. Method 582 may be used to pre-operatively plan, perform, evaluate, and / or verify aspects of various surgical procedures, such as arthroplasty to restore function to shoulders, ankles, knees, hips, and other joints. Method 582 may be used in conjunction with any planning system and method, virtual anatomical model, and / or bone model as disclosed herein, such as planning system 10. Method 582 may be used to predict or otherwise determine the geometry and / or orientation of an omitted portion of a bone, including a distal or proximal portion of a long bone, such as the humerus. The orientation of the bone may be related to the patient's posture. In embodiments, method 582 may be used to predict or otherwise determine the position, alignment, and / or angle of the bone relative to the omitted portion based on the geometry of one or more other bones, including adjacent and / or non-adjacent bones of the patient, which may additionally or alternatively be done to determine the patient's posture. Fewer or additional steps may be performed within the scope of the present disclosure compared to those described below, and the order in which the steps are described is not intended to limit the present disclosure. Method 582 may incorporate any step in methods 382 and / or 482 disclosed herein, and vice versa. In an embodiment, a step of method 582 may be incorporated into step 482F of method 482 (FIG. 33). See system 10.

[0337] 40 with continuing reference to FIGURES 2 and 39, a method 582 may include accessing one or more three-dimensional bone models 530 from a memory, such as database 38 and / or storage device 18. The bone models 530 may be associated with real patients or virtual patients, including patients from a representative patient population.

[0338] Method 582 may include receiving image data associated with a patient that may include portions of the patient's bones omitted. Planning environment 28 may be configured to receive image data associated with a patient that may include portions of the bones omitted. Such portions may be omitted due to the field of view of an associated imaging device 16, bone trauma, etc.

[0339] 41 and 45, with continuing reference to FIGS. 2 and 39, bone model 530 may include a first bone model 530S-1 associated with a first bone of the patient. Bone model 530 may include a second bone model 530H-1 associated with a second bone of the patient (see, e.g., FIG. 45). The first and second bones may be adjacent or non-adjacent bones, including any bones disclosed herein, such as the scapula and humerus. In the embodiment of FIG. 41, bone model 530 may be a first (e.g., scapula) bone model 530S-1 associated with the patient's scapula. In other embodiments, bone model 530 may be a second (e.g., humerus) bone model 530H-1 associated with the patient's humerus (e.g., FIG. 45). Humerus model 530H-1 may be a partial three-dimensional bone model associated with a portion of the patient's humerus, such as the proximal (or distal) humerus.

[0340] The method 582 may include generating a partial humerus model 530H-1 based on image data, which may omit portions of corresponding bones of the patient. The spatial module 50 may be configured to generate the partial bone model 530H-1 based on the image data. The comparison module 52 may be configured to select the scapula model 530S-1 and / or the partial humerus model 530H-1 associated with the first and second bones of the patient.

[0341] 41 and 44-45 with continuing reference to FIGS. 2 and 39, planning environment 28 may be configured to compare bone models 530S-1, 530H-1 to one or more bone models 30 associated with other patients, including patients from a representative patient population. Bone model 530 may include a first representative three-dimensional bone model 530S-2 and / or a second representative three-dimensional bone model 530H-2 associated with another patient. Bone model 530S-2 may be associated with a scapula. Bone model 530H-2 may be associated with a humerus. Partial bone model 530H-1 of a patient may represent a smaller portion of the second bone compared to representative bone models 530H-2 of other patients.

[0342] In step 582A, one or more bone models 530 of the patient's anatomy, including the patient's bone models 530S-1, 530H-1 and / or the representative bone models 530S-2, 530H-2, may be registered or otherwise aligned to a global frame of reference. The global frame of reference may be defined in step 582A-1. Any of the techniques disclosed herein may be used to define the global frame of reference, and the bone models 530 may be aligned to the global frame of reference.

[0343] Referring to FIG. 42 with continuing reference to FIGS. 2, 4, 39, and 41, in step 582B, a representative bone model 530S-2 may be selected from a set of bone models 30 associated with a first bone of the anatomy. The set of bone models 30 may be associated with a first bone of a representative patient population, such as the scapula. The comparison module 52 may be configured to select the representative bone model 530S-2 from the set of bone models 30 associated with the first bone of the anatomy. Various techniques may be used to select one or more (e.g., initial or refined) representative bone models 530S-2 from the set of bone models 30. The method 582 may include analyzing the representative patient population within a statistical shape model 75. In an embodiment, the statistical shape modeler 72 may be configured to analyze the representative patient population within the statistical shape models 75 associated with each corresponding bone using any of the techniques disclosed herein.

[0344] In embodiments, step 582B may include selecting a (e.g., initial) representative bone model 530S-2 associated with the SSM 75. The SSM 75 may be associated with the scapula and / or the humerus. Step 582B may include selecting the representative bone model 530S-2 from a set of bone models 30 associated with corresponding bones of a representative patient population, such as the scapula. The representative scapula model 530S-2 may be associated with another patient or may represent a virtual anatomical structure. The representative scapula model 530S-2 may be selected based on various parameters, such as the relative size between the patient scapula model 530S-1 and the representative scapula model 530S-2.

[0345] 42-43 with continuing reference to FIGS. 2, 4, and 39, the statistical shape modeler 72, and / or another portion of the planning system 10, may be configured to modify one or more predefined variation modes 76 to minimize or otherwise reduce volumetric deviations between the patient scapula model 530S-1 and the selected representative scapula model 530S-2. The statistical shape modeler 72 may be configured to select the representative scapula model 530S-2 in response to modifying one or more of the predefined modes 76. The predefined modes 76 may include a first variation mode 76 (e.g., mode 761 of FIG. 5). Each first variation mode 76 may be associated with a corresponding bone size. In embodiments, statistical shape modeler 72 may be configured to modify the first variation mode 76 to select a representative scapula model 530S-2 that may be substantially equivalent to or otherwise approximate the geometry (e.g., size) of patient scapula model 530S-1. In embodiments, step 582B may include modifying one or more modes 76, such as the first mode, in step 582B-1 to minimize or otherwise reduce a volumetric deviation between patient scapula model 530S-1 and representative scapula model 530S-2 selected from the set of bone models 30 associated with SSM 75. Statistical shape modeler 72 may be configured to iteratively select bone models 30 / 530S-2 from the set of bone models 30 and further determine the corresponding volumetric deviations.

[0346] The statistical shape modeler 72 and / or the spatial module 50 may be configured to determine a volumetric deviation between the patient scapula model 530S-1 and each of the selected representative scapula models 530S-2 within the set of bone models 30 associated with the scapula SSM 75. The statistical shape modeler 72 and / or the comparison module 52 may be configured to select the representative scapula model 530S-2 from the set of bone models 30 based on the determined volumetric deviation.

[0347] Various techniques may be utilized to determine the minimum volumetric deviation between the patient bone model 530 and the set of bone models 30 associated with each corresponding bone SSM 75. In an embodiment, the statistical shape modeler 72 may be configured to evaluate one or more bone models 30 against the patient bone model 530S-1 in response to a change in the first variation mode 76 over a predefined range of standard deviations 78 associated with the first mode 76 (e.g., a standard deviation of -3.0 to 3.0). For each value of the first mode 76, the spatial module 50 may be configured to determine the deviation between one or more dimensions of a corresponding orientation constraint box (OBB) (shown in dashed lines in FIG. 40) of the patient bone model 530S-1 and a selected one of the representative bone models 530S-2 (e.g., FIG. 42). The OBB may have a two-dimensional or three-dimensional geometry. The comparison module 52 may be configured to select a representative bone model 530S-2 from the set of bone models 30 associated with a standard deviation 78 value that may minimize or otherwise reduce differences between OBB dimensions, including the first dimension D1 (e.g., maximum length) and / or the second dimension D2 (e.g., maximum width) of the bone models 530S-1, 530S-2. In an embodiment, the maximum length may be established in the superior / inferior direction of the anatomical structure. In an embodiment, the comparison module 52 may be configured to identify a subset of bone models 30 having deviations below a predefined threshold, which may be utilized for subsequent selection and / or adjustment based on one or more predefined modes 76 (see, e.g., step 582D-1).

[0348] 42 with continuing reference to 2 and 39, in step 582C, the representative (e.g., second) bone model 530S-2 may be registered or otherwise substantially aligned or matched with the patient (e.g., first) bone model 530S-1 to establish registration of the representative bone model 530S-2. The spatial module 50 may be configured to at least partially register the representative bone model 530S-2 with the patient bone model 530S-1 to establish registration (e.g., position) of the representative bone model 530S-2. The spatial module 50 may be configured to register the selected representative bone model 530S-2 with the patient bone model 530S-1 using any of the techniques disclosed herein.

[0349] Various techniques may be utilized to register or otherwise adjust the position of the representative bone model 530S-2 relative to the patient bone model 530S-1. Referring to FIG. 41 with continued reference to FIGS. 2 and 39, step 582C may include aligning a common anatomical point or points (e.g., landmarks) PL between the patient bone model 530S-1 and the representative bone model 530S-2 in step 582C-1. The anatomical points PL may include any anatomical points disclosed herein (see, e.g., points P1-P3 in FIG. 29). The anatomical points PL may include a set of points, such as points P1, P2, and P4. The first point P1 may be established at the center of the glenoid fossa. The second point P2 may be established at the scapular triangle. The point P4 may be established at the scapular angle.

[0350] Referring to FIG. 42 with continuing reference to FIGS. 2, 39, and 41, in step 582C-2, the position and / or orientation of the representative bone model 530S-1 may be adjusted based on the goodness of fit between the volume of the patient bone model 530S-1 and the volume of the representative bone model 530S-2 to establish a registration (e.g., position) of the representative bone model 530S-2. The spatial module 50 may be configured to match the volume of the patient's scapula model 530S-1 and the volume of the selected representative bone model 530S-2 to each other. The spatial module 50 may be configured to determine a transformation that establishes a best-fit mapping between the defined anatomical points PL (FIG. 41). The best-fit mapping may be established using a least-squares method. The spatial module 50 may be configured to approximate the shapes of the bone models 530S-1, 530S-2 to each other and / or to fit the volumes of the bone models to each other by applying an iterative closest point (ICP) technique.

[0351] 43 with continuing reference to FIGS. 2, 39, and 41-42, the fit between the patient bone model 530S-1 and the representative bone model 530S-2 may be improved by refining (e.g., minimizing) the registration (e.g., position) of the representative bone model 530S-2. In step 582D, a subsequent (e.g., refined) selection and / or alignment of the representative bone model 530S-2 from the set of bone models 30 may be performed. The representative bone model 530S-2 selected and / or aligned in step 582D may be the same or different from the representative bone model 530S-2 previously selected from the set of bone models 30 in step 582B.

[0352] Various techniques may be utilized to perform subsequent selection and / or position adjustment. Step 582D may include modifying one or more other variation modes 76 associated with the SSM 75 in step 582D-1, including any modes 76 disclosed herein. In an embodiment, a first mode 76 of the SSM 75 may be associated with a position of an anatomical structure. The remaining modes 76 of the SSM 75 may be associated with a shape of an anatomical shape and may be constrained to the (e.g., registered) position of the anatomical shape associated with the first mode 76. In an embodiment, the statistical shape modeler 72 may be configured to modify the first (e.g., eight) variation modes 76 of the SSM 75. It will be appreciated that more or fewer than eight variation modes 76 may be utilized. Modifying fewer of the variation modes 76 of the SSM 75 may reduce computation time, while modifying a greater number of variation modes 76 may improve accuracy. In an embodiment, the first eight variation modes 76 may be associated with approximately 85 percent of the variation of the SSM 75. The order of the modes 76 may be correlated with the relative variation of the SSM 75 (e.g., the first mode is assigned the greatest variation, and the last mode is assigned the least variation). The variation modes 76 associated with a first bone (e.g., the scapula) may be the same as the variation modes 76 associated with a second bone (e.g., the humerus). The statistical shape modeler 72 may be configured to modify the same or different numbers of modes 76 for associated bones of the anatomical structure. The statistical shape modeler 72 may be configured to restrict subsequent selection to a subset of bone models 30 based on a limited range (e.g., within ±1 SD) of standard deviation 78 from the corresponding mode value of a previously selected representative bone model 530S-2. The statistical shape modeler 72 may utilize various techniques for evaluating the modes 76, such as the Simplex Nelder-Mead optimization (e.g., amoeba search) technique.In an embodiment, step 582D-1 may include changing only the variation mode 76 associated with the position and / or orientation of the representative bone model 530S-2 previously selected in step 582B, including any variation mode disclosed herein.

[0353] The comparison module 52 may be configured to select a representative bone model 530S-2 from the set (or subset) of bone models 30 in response to determining a (e.g., smallest) volumetric deviation within the set of volumetric deviations. The set of volumetric deviations may be established between the patient's scapula model 530S-1 and each corresponding representative bone model 530S-2 selected from the set of bone models 30 in response to the statistical shape modeler 72 changing one or more of the predefined modes 76 within the SSM 75.

[0354] Referring to FIG. 44 with continuing reference to FIGS. 2, 39, and 41-43, in step 582E, a second (e.g., initial) representative bone model 530H-2 associated with a second bone may be selected or otherwise identified. The selected representative bone models 530S-2, 530H-2 may be associated with the same anatomical model 529-2 and / or with the same patient. Step 582E may include accessing multiple three-dimensional bone models 30 associated with one or more bones and / or one or more joints of a representative patient population. Step 582E may include selecting the representative bone model 530H-2 from a set of representative bone models 30 associated with a respective corresponding bone of the representative patient population, such as the humerus. The comparison module 52 may be configured to select the representative bone model 530H-2 from the set of representative bone models 30.

[0355] The comparison module 52 may be configured to select a representative bone model 530H-2 based on the selected representative model 530S-2 associated with the first bone. The selected representative bone model 530H-2 may include an omitted portion of a second bone. The patient's partial bone model 530H-1 may omit a distal portion of the humerus. The representative bone model 539H-2 may include a distal portion of the humerus.

[0356] Comparison module 52 may be configured to select or otherwise identify representative bone model 530H-2 from the set of representative bone models 30 associated with the representative patient population based on the selected representative bone model 530S-2 (e.g., in steps 582B and / or 582D), or vice versa. Comparison module 52 may be configured to select representative bone model 530H-2 from the set of bone models 30 in response to establishing the registration status (e.g., position) of selected representative bone model 530S-2.

[0357] Step 582E may include selecting a representative bone model 530H-2 from the set of representative bone models 30 in response to (e.g., initially) selecting the representative bone model 530S-2 in step 582B, establishing a registration state for the selected representative bone model 530S-2 in step 582C, and / or refining the position and / or selection of the representative bone model 530S-2 from the set of representative bone models 30 in step 582D.

[0358] 45 with continuing reference to FIGS. 2, 39, and 41-44, in step 582F, the patient's partial bone model 530H-1 may be at least partially aligned (e.g., registered) with the selected representative bone model 530H-2 to establish a registration (e.g., position) of the patient bone model 530H-1. The partial bone model 530H-1 may be associated with a long bone, such as the humerus. The bone models 530H-1, 530H-2 may each include a corresponding diaphyseal portion 530HD associated with the diaphysis of the long bone and / or a head portion 530HH associated with the head of the long bone. The spatial module 50 may be configured to at least partially register or otherwise align the diaphyseal portion 530HD-1 of the partial bone model 530H-1 with the diaphyseal portion 530HD-2 of the representative bone model 530H-2 to establish registration of the partial bone model 530H-1.

[0359] Various techniques may be used to register the patient's partial bone model 530H-1. Step 582F may include, in step 582F-1, aligning one or more landmarks or other points of the partial bone model 530H-1 with respect to the representative bone model 530H-2. The landmarks may include a center point 530CP of the head portion 530HH. Step 582F-1 may include substantially aligning a center point 530CP-1 of the head portion 530HH-1 of the partial bone model 530HH-1 with a center point 530CP-2 of the head portion 530HH-2 of the representative bone model 530HH-2. Step 582F may include, in step 582F-2, which may follow step 582F-1, rotating the patient's partial bone model 530H-1 with respect to the representative bone model 530H-2. Step 582F-2 may include rotating the head portion 530HH-1 of the partial bone model 530H-1 about the corresponding center point 530CP to at least partially register the partial bone model 530H-1 with respect to the representative bone model 530H-2. In an embodiment, the spatial module 50 may be configured to approximate the shapes of the bone models 530H-1, 530H-2 to each other and / or to fit their volumes to each other by applying an iterative closest point (ICP) technique.

[0360] The relationship between two or more bones of an anatomical structure may be utilized to improve the overall fit between the patient bone models 530S-1, 530H-1 and the representative bone models 530S-2, 530H-2. The selected representative bone models 530S-2, 530H-2 may be associated with a corresponding representative anatomical (e.g., shoulder) model 529-2 of the patient. By registering the selected representative bone models 530S-2, 530H-2 with the patient bone models 530S-1, 530H-1, the registration (e.g., position) of the representative anatomical model 529-2 with respect to the patient (e.g., shoulder) anatomical model 529-1 may be established. In an embodiment, the planning environment 28 may be configured to register or otherwise substantially align the representative anatomical model 529-2 with respect to the patient anatomical model 529-1 to improve the overall fit between the patient bone models 530S-1, 530-2 and the corresponding representative bone models 530S-2, 530H-2, respectively.

[0361] In step 582G, subsequent (e.g., refined) selection and / or alignment of the representative bone models 530S-2, 530H-2 associated with the representative anatomical model 529-2 may be performed to improve the overall fit between the patient anatomical model 529-1 and the representative anatomical model 529-2. The representative anatomical model 529-2 selected in step 582G may be the same or different from the representative anatomical model 529-2 associated with the representative bone models 530S-2, 530H-2 previously selected in steps 582B, 582D, and / or 582E.

[0362] Various techniques may be utilized to select and / or position the representative anatomical model 529-2. An anatomical SSM 75 may be established for an anatomical group consisting of two or more adjacent and / or non-adjacent bones of an anatomical structure. In an embodiment, an anatomical SSM 75 may be established for the shoulder, including the scapula and humerus. One or more modes of variation 76 and associated standard deviations 78 may be established for the anatomical SSM 75. The modes of variation 76 and / or standard deviations 78 may be the same or different for the modes of variation 76 and / or standard deviations 78 of individual bones associated with the anatomical bone group. The statistical shape modeler 72 may be configured to assign AMCs 80 to one or more anatomical models 29 according to the anatomical SSM 75.

[0363] In step 582G-1, a representative anatomical model 529-2 may be selected and / or repositioned in response to changing one or more of the predefined modes 76 in the statistical shape model 72 associated with the anatomical SSM 75. The statistical shape modeler 72 may be configured to jointly (e.g., simultaneously) fit the bone models 530S-2, 530H-2 of the representative anatomical model 529-2 to the bone models 530S-1, 530H-1 of the patient anatomical model 529-1. The statistical shape modeler 72 may be configured to reposition and / or select the representative anatomical model 529-2 from the set of anatomical models 29 in response to changing one or more of the predefined modes 76 associated with the anatomical SSM 75. The comparison module 52 may be configured to select an anatomical model 529-2 from the set of anatomical models 29 in response to determining a (e.g., minimum) volumetric deviation within the set of volumetric deviations between the aligned patient bone models 530S-1, 530H-1 of the associated anatomical model 529-1 and one or more corresponding anatomical models 529-2 in the set of anatomical models 29. The set of volumetric deviations may be established between the patient anatomical model 529-1 and each of the corresponding representative anatomical models 529-2 in the set of anatomical models 29 in response to the statistical shape modeler 72 changing one or more predefined modes 76 of the anatomical SSM 75.

[0364] In embodiments, the statistical shape modeler 72 may be configured to modify the variation mode 76 and associated standard deviation 78 to perform iterative positioning of a previously selected anatomical model 529-2 and / or to select a representative anatomical model 529-2 within the set of anatomical models 29. The statistical shape modeler 72 may be configured to calculate corresponding distances between surfaces of the patient anatomical model 529-1 and surfaces of the representative anatomical model 529-2. The comparison module 52 and / or the statistical shape modeler 72 may determine a value (e.g., standard deviation) of the mode 76 that may minimize or otherwise reduce the distance between surfaces of the bone models 530S-2, 530H-2 of the selected representative anatomical model 529-2 and surfaces of the bone models 530S-1, 530H-1 of the patient anatomical model 529-1.

[0365] The bones associated with the patient's partial bone model 530H-1 may be analyzed based on the registration status (e.g., position) of the representative bone model 530H-2. In step 582H, one or more posture parameters associated with the patient's posture may be determined based on the registration status of the representative bone model 530H-2. The planning environment 28 may be configured to establish an implant plan in response to establishing the registration status of the representative bone model 530H-2 with respect to the patient's partial bone model 530H-1. The implant plan may be established using any of the techniques disclosed herein. The implant plan may be established based on the determined posture parameters. The method 582 may include establishing the implant plan based on the registration status of the partial bone model 530H-2.

[0366] The geometry and / or orientation of other omitted portions of the anatomy may be predicted or otherwise determined. In the embodiment of FIGS. 46A-46B, planning system 10 may acquire local image data associated with one or more bones of the anatomy, such as a portion of the scapula associated with scapula model 630S-1. Scapula model 630S-1 may be correlated to patient anatomical model 629-1. A portion of the scapula, such as a distal portion of the scapula, including the inferior angle, may be omitted from the image data. Additionally, the patient's humerus may be omitted from the image data. Using the techniques disclosed herein, including method 582, a representative anatomical model 629-2, including associated scapula model 630S-2 and humerus model 630H-2, may be selected, allowing the omitted portions of the scapula and associated humerus to be predicted or otherwise determined.

[0367] In the implantation of FIGS. 47A-47B, planning system 10 may acquire local image data associated with a portion of the humerus associated with humerus model 730H-1. Humerus model 730S-1 may be correlated to patient anatomical model 729-1. A portion of the humerus, such as a distal portion of the humerus, may be omitted from the image data. Additionally, the patient's scapula may be omitted from the image data. Using techniques disclosed herein, including method 582, a representative anatomical model 729-2, including associated scapula model 730S-2 and humerus model 730H-2, may be selected, and the omitted portion of the humerus and associated scapula may be predicted or otherwise determined.

[0368] 48A-48C with continued reference to FIG. 2, the techniques disclosed herein, including any steps of method 582, may be utilized to determine one or more axes and / or other aspects associated with a patient's anatomy. The axes may correspond to corresponding bones, joints, and / or limbs of the anatomy, including any of the shoulder, ankle, hip, knee, elbow, and / or associated bones disclosed herein. In the embodiment of FIG. 48A, the planning system 10 may acquire local image data associated with one or more bones of the anatomy. The local image data may omit portions of the anatomy, thereby reducing acquisition costs and radiation exposure to the patient.

[0369] The planning system 10 may establish an anatomical model 829 including one or more bone models 830. In the embodiment of FIG. 48A , the anatomical model 829 may be associated with a knee joint. The bone models 830 may include a first (e.g., femur) bone model 830FE, a second (e.g., tibia) bone model 830T, and / or a third (e.g., fibula) bone model 830FI. The image data may include localized portions of the anatomical structure, such as portions of the limb adjacent to the knee joint. One or more portions of the anatomical structure, such as the proximal portion of the femur associated with the femur model 830FE, the distal portion of the tibia associated with the tibia model 830T, and / or the distal portion of the fibula associated with the fibula model 830FI, may be omitted from the image data.

[0370] With continued reference to FIGS. 2, 4, and 48A , and with reference to FIG. 48B , anatomical model 829 may be a first anatomical model 829-1 associated with a patient. A representative anatomical model 829-2 associated with the anatomical structure may be selected or otherwise identified. Representative anatomical model 829-2 and associated bone model 830 may include portions of bone omitted from first anatomical model 829-1. Representative anatomical model 829-2 may be selected or otherwise identified from a set of representative anatomical models 29 ( FIG. 2 ) using any of the techniques disclosed herein. Planning system 10 may be configured to select representative anatomical model 829-2 from a set of representative anatomical models 29 associated with corresponding bones of a representative patient population, such as the femur, tibia, and / or fibula. In embodiments, planning system 10 may be configured to select representative anatomical model 829-2 using any of the techniques disclosed herein, including statistical shape modeler 72. Representative anatomical model 29 may be correlated to a statistical shape model (SSM) 75 (FIG. 4).

[0371] The planning system 10 may be configured to register or otherwise substantially align the anatomical models 829-1, 829-2 and / or the associated bone model 830 with one another using any of the techniques disclosed herein. In the embodiment of FIG. 48A , one or more anatomical points (e.g., landmarks) PL may be identified. The anatomical points PL may include a set of points, such as points P5-P7. The anatomical points PL may be identified using any of the techniques disclosed herein, including manually in response to user interaction with the user interface 856 and / or automatically by the planning system 10. The planning system 10 may be configured to substantially align anatomical points PL that may be common between the patient bone model 830 and the representative anatomical models 829-1, 829-2 with one another to establish registration (e.g., position) of the representative anatomical model 829-2. The planning system 10 may be configured to minimize the distance between corresponding pairs of anatomical points PL. One or more predefined variation modes 76 of the statistical shape model 75 associated with the anatomical shape may be modified to match or otherwise approximate the shape of the anatomical structure.

[0372] Using the registered representative anatomical model 829-2, one or more aspects of the patient's anatomy may be determined. Using the bone models 830 associated with the representative anatomical model 829-2, the shape and / or orientation of bone portions omitted from the registered patient anatomical model 829-1 may be predicted or otherwise determined. The relative positions and / or distances between landmarks associated with the omitted portions of the anatomy may be determined. In embodiments related to the knee joint, extension and / or rotation may be determined using the representative anatomical model 829-2. In embodiments related to the ankle joint, internal / external rotation and / or varus / valgus of the bones may be determined using the representative anatomical model including the omitted portions of the corresponding bones.

[0373] 2 and 48A-48B, and with reference to FIG. 48C, the planning system 10 may be configured to determine, based on the registered positions of the bone models 330 of the representative anatomical model 829-2, one or more axes associated with each corresponding bone of an anatomical structure associated with the anatomical model 829, such as the anatomical axis and / or the mechanical axis of the corresponding bone or limb. The axes may include mechanical axis A1, anatomical axis A2, and / or anatomical axis A3. Anatomical axis A2 may be associated with the anatomical axis of the femur. Anatomical axis A3 may be associated with the anatomical axis of the tibia. Mechanical axis A1 may be the mechanical axis of the limb (e.g., leg), which may be established between the proximal femur and the distal tibia. The mechanical axis A1 may be utilized to determine one or more corrections to restore the mechanical axis of the bone and / or limb, including in knee arthroplasty or high tibial osteotomy (HTO) procedures, and / or to restore the position and / or orientation of an implant.

[0374] In the embodiment of FIGS. 49A-49B, the image data may omit the femur and portions of the tibia and fibula. Representative anatomical model 929-2 may include a femur model 930F-2 associated with the femur, a tibia model 930T-2 associated with the tibia, and a fibula model 930FI-2 associated with the fibula. Representative anatomical model 929-2 may include omitted portions of the bones of patient anatomical model 929-1. In the embodiment of FIGS. 50A-50B, the image data may omit the tibia and fibula and portions of the femur. Representative anatomical model 1029-2 may include a femur model 1030FE-2 associated with the femur, a tibia model 1030T-2 associated with the tibia, and a fibula model 1030FI-2 associated with the fibula. The representative anatomical model 1029-2 may include omitted portions of the bones of the patient anatomical model 1029-1. The bony aspects of the patient anatomical models 929-1, 1029-1, including landmarks and axes, may be predicted or otherwise determined using the representative anatomical models 929-2, 1029-2 according to any of the techniques disclosed herein.

[0375] Other joints may also benefit from the teachings disclosed herein. Figures 51A-51B disclose an anatomical model 1129 associated with a hip joint. The anatomical model 1129 may be associated with one or more bones of the pelvis. In embodiments, the anatomical model 1129 may include at least one hip bone model 1130HP associated with a corresponding hip bone, a sacrum model 1130SC associated with a corresponding sacrum, and a femur model 1130FE associated with a corresponding femur. The representative anatomical model 1129-2 may include omitted portions of the bones of the patient anatomical model 1129-1.

[0376] Using the representative anatomical model 1129-2, one or more landmarks and / or axes associated with aspects of the anatomy omitted from the patient's image data may be predicted or otherwise determined. In an embodiment, a (e.g., horizontal) axis A4 may be determined based on the predicted shape and position of the patient's omitted femur.

[0377] Other techniques may be used to determine the acquisition direction for various bones of the patient. In an embodiment, imaging device 16 (FIG. 2) may obtain one or more two-dimensional images 26 of the patient's anatomy. The images 26 may be at different orientations (e.g., perpendicular) relative to one another. System 10 may be configured to determine the acquisition direction based on a comparison of a three-dimensional anatomical model 29 and the patient's anatomical profile in the two-dimensional images 26. The anatomical model 29 may be associated with a patient other than the patient associated with the two-dimensional images 26.

[0378] FIG. 52 discloses a method for a surgical procedure in flowchart 1282. Method 1282 may be used to pre-operatively plan, perform, evaluate, and / or verify aspects of various surgical procedures, such as arthroplasty to restore function to shoulders, ankles, knees, hips, and other joints. Method 1282 may be used in conjunction with any planning system and method, virtual anatomical model, and / or bone model, as disclosed herein, such as planning system 10. Method 1282 may be used to determine the position and / or orientation of one or more implants based on captured orientations of a patient's anatomical structures, such as the scapula and humerus. The orientation of the anatomical structures may be related to the patient's posture. Fewer or additional steps may be performed within the scope of the present disclosure, compared to those described below, and the order of the steps described is not intended to limit the present disclosure. Method 682 may incorporate any steps in methods 382, ​​482, and / or 582 disclosed herein, and vice versa. Referring to system 10.

[0379] 2 and 4 with continued reference to FIG. 52, various techniques may be used to determine one or more patient characteristics, such as posture, based on the shoulder SSM 75. A 2D profile of the patient's anatomy may be captured within each X-ray image. The scapula SSM 75 may be used to select a bone model 30 associated with the anatomical body classification database 70 that may most closely match the anatomy captured within the X-ray image. The scapula and humerus bone models 30 may be selected by projecting the silhouette of the 3D model onto a 2D plane associated with each X-ray image. The scapula SSM 75 may select each bone model 30 having a silhouette that may best fit the 2D profile of the patient's anatomy within each 2D plane. The scapula SSM 75 may be configured to adjust the camera angle to adjust the projection of the silhouette. The adjusted camera angle associated with the best-fitting silhouette may represent the patient's posture at the acquisition location and / or anatomical location, or may be otherwise related to such patient posture. By utilizing the adjusted camera angles, in addition to and / or instead of determining the patient's posture, the relative anatomical positions, alignments, and / or orientations of adjacent and / or non-adjacent bones of the patient may be predicted or otherwise determined.

[0380] 53-54 with continuing reference to FIGS. 2 and 52, in step 1282A, a digital image of a patient's anatomy may be captured by imaging device 16. Imaging device 16 may include any imaging device disclosed herein. Data module 46 may be configured to receive image data related to the patient. In embodiments, one or more two-dimensional (e.g., X-ray) images 26 of the patient's anatomy may be obtained by imaging device 16. Data module 46 may be configured to receive image data including first and second two-dimensional images 26 of one or more bones of the patient. The two-dimensional images 26 may be substantially perpendicular to an acquisition frame of reference of imaging device 16 or may be otherwise transverse to one another.

[0381] 53-54, two-dimensional image 26 may include a first image 26-A and a second image 26-B associated with corresponding reference (e.g., image) planes REFP-A, REFP-B, respectively. Image planes REFP-A, REFP-B may be substantially perpendicular to one another with respect to an acquisition frame of reference of imaging device 16. One or more bones of the patient may be non-perpendicular to image planes REFP-A, REFP-B and / or with respect to an acquisition direction of imaging device 16.

[0382] In step 1282B, one or more profiles 1283 associated with the patient's anatomy may be generated for the image planes REFP-A, REFP-B. Each profile 1283 may be associated with a corresponding anatomical model 29 in the database 38 and / or with one or more bone models 30. The spatial module 50 may be configured to establish one or more profiles 1283 associated with one or more bones of the anatomy.

[0383] In the embodiment of FIG. 53 , the spatial module 50 may be configured to determine a first (e.g., bone) profile 1283S-A associated with a first bone of the patient, such as the scapula. The spatial module 50 may be configured to determine a second (e.g., bone) profile 1283H-A associated with a second bone of the patient, such as the humerus. The spatial module 50 may be configured to establish a third (e.g., anatomical) profile 1283-A that may be associated with two or more bones of the anatomy. The anatomical profile 1283-A may include bone profiles 1283S-A, 1283H-A. The bone profiles 1283S-A, 1283H-A and / or the anatomical profile 1283-A may be associated with corresponding bone models 30 and / or anatomical models 29, respectively. Spatial module 50 may be configured to establish profiles 1283S-A, 1283H-A, and 1283-A along a first image plane REFP-A associated with first image 26-A.

[0384] In the embodiment of FIG. 54 , the spatial module 50 may be configured to determine a fourth (e.g., bone) profile 1283S-B associated with a first bone of the patient, such as the scapula. The spatial module 50 may be configured to determine a fifth (e.g., bone) profile 1283H-B associated with a second bone of the patient, such as the humerus. The spatial module 50 may be configured to establish a sixth (e.g., anatomical) profile 1283-B that may be associated with two or more bones of the anatomy. The anatomical profile 1283-B may include bone profiles 1283S-B, 1283H-B. The bone profiles 1283S-B, 1283H-B and / or the anatomical profile 1283-B may be associated with corresponding bone models 30 and / or anatomical models 29, respectively. The spatial module 50 may be configured to establish profiles 1283S-B, 1283H-B, and 1283-B along a second image plane REFP-B associated with the second image 26-B. The bone profiles 1283S-A, 1283S-B may be associated with a common bone, such as the scapula, but may have different shapes. The bone profiles 1283H-A, 1283H-B may be associated with a common bone, such as the humerus, but may have different shapes. The anatomical profiles 1283-A, 1283-B may be associated with a pair of common bones, such as the scapula and humerus, but may have different shapes. The multiple sets of bone profiles 1283S-A / 1283S-B, 1283H-A / 1283H-B, and / or anatomical profiles 1283-A / 1283-B may have different geometries due to different acquisition positions of the imaging device 16 relative to the acquisition reference system.

[0385] The planning environment 28 may be configured to select an anatomical model 29 from the database 38. The anatomical model 29 may be associated with one or more bones of the anatomy. In an embodiment, the planning environment 28 may be configured to select an anatomical model 29 that is associated with bones contained within the patient image 26.

[0386] In step 1282C, an acquisition orientation of the patient's anatomy may be determined. Step 1282C may include selecting a (e.g., representative) anatomical model 1229 from a set of anatomical models 29 in database 38. The anatomical model 1229 may be associated with one or more bones of the anatomy, such as the scapula and humerus. In an embodiment, the anatomical model 1229 may include a first (e.g., scapula) bone model 1230S and a second (e.g., humerus) bone model 1230H. The representative anatomical model 1229 may be associated with another patient, such as a patient from a representative patient population.

[0387] System 10 may be configured to select a representative anatomical model 1229 using any of the techniques disclosed herein. In an embodiment, an anatomical (e.g., shoulder) SSM 75 may be established. The anatomical SSM 75 may be associated with an anatomical shoulder, including the scapula and humerus. The representative anatomical model 1229 may be associated with the anatomical SSM 75. Based on the shoulder SSM 75, system 10 may be configured to predict or otherwise determine the shape, position, and / or orientation of the scapula and humerus.

[0388] The system 10 may be configured to determine the orientation of the patient's first and second bones relative to the images 26-A, 26-B based on the representative anatomical model 1229. In step 1282C-2, one or more profiles 1283 of the patient's anatomy may be compared to the projections of the representative anatomical model 1229 and associated bone models 1230S, 1230H onto the image planes REFP-A, REFP-B. The spatial module 50 may be configured to establish one or more silhouettes 1285 associated with the anatomical model 1229 and / or associated with the bone models 1230H, 1230S.

[0389] Various techniques may be utilized to establish the silhouette 1285. The spatial module 50 may be configured to project a first silhouette 1285-A of the representative anatomical model 1229 along a first image plane REFP-A ( FIG. 53 ) onto a first profile 1283-A of the patient's anatomy. The spatial module 50 may be configured to project a second silhouette 1285-B of the representative anatomical model 1229 along a second image plane REFP-B ( FIG. 54 ) onto a second profile 1283-B of the patient's anatomy. The spatial module 50 may be configured to set an acquisition direction (e.g., camera angle or source) AO to establish the projection.

[0390] The comparison module 52 may be configured to compare the patient's anatomical profiles 1283-A, 1283-B with projections of the corresponding silhouettes 1285-A, 1285-B, respectively. The comparison module 52 may be configured to compare the patient's anatomical profiles 1283-A, 1283-B with projections of the corresponding silhouettes 1285-A, 1285-B, respectively.

[0391] The spatial module 50 may be configured to adjust (e.g., X, Y, Z) the projection of the silhouette 1285-A onto the first image plane REFP-A and / or the projection of the silhouette 1285-B onto the second image plane REFP-B by adjusting the acquisition direction AO. The comparison module 52 may be configured to determine a first goodness of fit between the first profile 1283-A and the first silhouette 1285-A. The comparison module 52 may be configured to determine a second goodness of fit between the second profile 1283-A and the second silhouette 1285-A. The comparison module 52 may be configured to determine an overall area deviation between the first goodness of fit and / or the second goodness of fit. The spatial module 50 may be configured to minimize or otherwise reduce the overall area deviation below a predetermined threshold by adjusting the acquisition direction AO. The comparison module 52 may be configured to determine a minimum value for the overall area deviation. The comparison module 52 may be configured to determine the acquisition direction of the imaging device 16 based on the acquisition direction AO associated with the smallest overall area deviation.

[0392] The spatial module 50 may be configured to determine a first acquisition direction AO1 ( FIG. 53 ) of the imaging device 16 associated with the first image 26-A based on a comparison of the overall fit between the first silhouette 1285-A and the first profile 1283-A. The spatial module 50 may be configured to determine the first acquisition direction AO1 in response to iteratively adjusting a projection of the first silhouette 1283-A onto the first profile 1283-A along the first image plane REFP-A. The spatial module 50 may be configured to determine a second acquisition direction AO2 ( FIG. 54 ) of the imaging device 16 associated with the second image 26-B based on a comparison of the overall fit between the second silhouette 1285-B and the second profile 1283-B. The spatial module 50 may be configured to determine the second acquisition direction AO2 in response to iteratively adjusting a projection of the second silhouette 1285-B onto the second profile 1283-B of the patient's anatomical structure along the second image plane REFP-B. The system 10 may be configured to determine the shape, position, and orientation of the bones of the anatomical structure associated with the images 26-A, 26-B based on the determined acquisition directions AO1, AO2 and based on the overall fit between the patient's anatomical structure profiles 1283-A, 1283-B and the corresponding silhouettes 1285-A, 1285-B of the anatomical model 1229, respectively.

[0393] In step 1282D, the patient's posture may be determined. System 10 may be configured to determine one or more posture characteristics of the patient, including any posture characteristics disclosed herein, based on the determined acquisition orientation. System 10 may be configured to determine the one or more posture characteristics based on a first acquisition orientation AO1 associated with first image 26-A and / or a second acquisition orientation AO2 associated with second image 26-B.

[0394] The system 10 may be configured to communicate one or more planning parameters to the surgeon or clinical user based on the determined posture characteristics. A surgical plan 36 may be established based on the determined posture. The system 10 may be configured to automatically generate a pre-operative plan 36 based on the determined posture. The system 10 may be configured to establish a surgical plan 36 associated with a first bone and / or a second bone of the patient's anatomy based on the one or more determined posture characteristics. In step 1282E, an implant position may be determined based on the determined posture characteristics. The implant position may be associated with the implant model 32. The implant position may be determined using any technique disclosed herein. The system 10 may be configured to generate one or more indicators (e.g., suggestions) based on the detected posture, and the indicators may be communicated to the surgeon or clinical user. In embodiments, the surgeon or clinical user may establish a pre-operative surgical plan 36, which may include selection of various parameters, including implant type, size, position, and / or orientation, based on the indicators. The surgeon may establish, modify, revise, and / or approve the surgical plan 36, including the selection of implant type, size, location, and / or orientation, based on the determined postural characteristics.

[0395] In step 1282F, a range of motion may be determined based on the position and / or orientation of the implant model 32 relative to the implant location determined in step 1282E. The range of motion may be determined using any technique disclosed herein. The system 10 may be configured to calculate or otherwise determine the shoulder joint range of motion for the pre-operative plan based on parameters specified by the surgeon and / or the system 10. Each selected bone model 1230 may be associated with a corresponding AMC 80. The range of motion may be determined using the selected bone model 1230 and / or the associated AMC 80.

[0396] One or more bones in a patient's anatomy may fracture due to trauma. The fracture may generate one or more bone fragments. In some scenarios, some bone fragments may be relatively small and therefore unavailable for bone reconstruction. Using the techniques disclosed herein, the pre-fracture state of a bone may be determined in order to reduce or otherwise position bone fragments to reconstruct the bone in a fracture repair technique. The bone fragments may be positioned relative to the volume of a three-dimensional model of the bone, which may serve as a template. Using the disclosed techniques, prediction of the type of fracture and selection of treatment options may be aided. Using the disclosed techniques, various bones and joints of the anatomy may be treated, including any of the bones and joints disclosed herein, including long bones such as the humerus, tibia, femur, etc.

[0397] FIG. 55 discloses a method for a surgical procedure in a flowchart 1382. The method 1382 may be used to pre-operatively plan, perform, evaluate, and / or verify aspects of various surgical procedures, such as arthroplasty to restore function to shoulders, ankles, knees, hips, and other joints. The method 1382 may be used in conjunction with any planning system and method, virtual anatomical model, and / or bone model, as disclosed herein, such as planning system 10. The method 1382 may be used to register one or more bone fragments for bone reconstruction in a fracture repair technique. The method 1382 may be used to determine the position and / or orientation of one or more implants for fixation of the bone fragments. Fewer or additional steps may be performed within the scope of the present disclosure, as compared to those described below, and the described order of the steps is not intended to limit the present disclosure. Method 1382 may incorporate any steps in methods 382, ​​482, 582, and / or 1282 disclosed herein, and vice versa. Referring to system 10.

[0398] 2 with continued reference to FIG. 55, in step 1382A, one or more anatomical models 29 and / or bone models 30 may be generated. System 10 may be configured to generate anatomical models 29 and / or bone models 30 using any of the techniques disclosed herein.

[0399] 56A-56C with continuing reference to FIGS. 2 and 55, in embodiments, anatomical model 29 may include a three-dimensional anatomical model 1329 (shown at 1329-1) associated with a patient. Anatomical model 1329-1 may include at least one (e.g., fragmentary) three-dimensional bone model 1330-1 associated with a bone of the patient. Fragmentary bone model 1330-1 may be associated with any bone and joint disclosed herein, including long bones such as the humerus. Data module 46 may be configured to access fragmentary bone model 1330-1. Anatomical model 1329-1 may include other bone models, such as scapula model 530S-1 (see, e.g., FIGS. 41-43). Each bone model 1330 may include a main body (e.g., diaphysis) portion 1330M that may extend between a proximal portion 1330P and a distal portion 1330D. The main body portion 1330M may be associated with the shaft of a long bone, such as the humerus.

[0400] The patient bone model 1330-1 may include one or more three-dimensional bone fragment portions 1330F-1. The bone fragment portion 1330F-1 may be associated with one or more corresponding bone fragments of the bone. The patient's main body portion 1330M-1 may be associated with a non-bone fragment portion (e.g., a remnant) of the bone. The bone fragment portion 1330F-1 may be associated with a proximal portion 1330P-1 of the humerus, including the humeral head portion. The main body portion 1330M-1 may be associated with a distal portion of the humerus, including the humeral shaft. The system 10 may be configured to receive image data associated with the patient. The system 10 may be configured to generate the fragmentary bone model 1330-1 based on the image data.

[0401] Various techniques may be used to reposition the bone fragment portion 1330F-1 relative to the main body portion 1330M-1 of the patient's fragmentary bone model 1330-1. In step 1382B, a second bone model 30 (FIG. 2) associated with another bone of the anatomical structure may be selected. The second bone model 30 may be associated with a non-adjacent or adjacent bone of the anatomical structure, such as the scapula. The bone model 30 may be associated with another patient, such as a patient from a representative patient population. The bone model 30 may be selected using any technique disclosed herein, including step 582B of method 582 (FIG. 39). In an embodiment, the selected bone model 30 may be the scapula model 530S-2 (see, e.g., FIGS. 42-43). The scapula model 530S-2 may be associated with the SSM 75. The statistical shape modeler 72 may be configured to analyze a representative patient population within the SSM 75, which may be associated with one or more bones of the anatomical model 1329-1, such as the scapula and / or humerus of the patient.

[0402] In step 1382C, the representative scapula model 530S-2 may be registered with respect to the scapula model 530S-1 associated with the patient to establish registration of the scapula model 530S-2 (see, e.g., FIGS. 42-43). The scapula model 530S-2 may be registered using any technique disclosed herein, such as steps 582C and / or 582D (FIG. 39) of method 582. Step 1392C may include at least partially registering the representative scapula model 530S-2 with respect to the patient's scapula model 530S-1 to establish registration (e.g., position) of the scapula model 530S-2.

[0403] 57A-57B with continuing reference to FIGS. 2 and 55, in step 1382D, a representative (e.g., initial or humerus) three-dimensional bone model 1330-2 associated with another bone of the anatomy may be selected or otherwise identified. Data module 46 may be configured to access the representative bone model 1330-2 from memory. The bone associated with the representative bone model 1330-2 may be the same bone as the patient's fragmented bone. The representative bone model 1330-2 may be associated with the humerus. Data module 46 may be configured to access the representative bone model 1330-2 from memory. System 10 may select or otherwise identify the representative bone model 1330-2 using any technique disclosed herein, including any technique associated with step 582E of method 582 (FIG. 39). The system 10 may be configured to select a representative bone mode 1330-2 from a set of three-dimensional bone models 30 associated with a bone, such as the humerus, of a patient and a representative patient population.

[0404] Step 1382D may include, in response to establishing the registration status of the representative bone model 530S-2, selecting a representative bone model 1330-2 from a set of bone models 30 associated with the same bone as the patient's fragmented bone (see, e.g., FIG. 44). The selected representative bone model 1330-2 may be associated with the same anatomical model 1329-2 as the representative bone model 530S-2, as may be associated for another patient in the representative patient population.

[0405] In step 1382E, the main body portion 1330M-1 and / or distal portion 1330D-1 of the fragmentary bone model 1330-1 may be at least partially registered or otherwise substantially aligned with the representative bone model 1330-2 to establish registration (e.g., position) of the fragmentary bone model 1330-1. The spatial module 50 may be configured to register or otherwise substantially align the fragmentary bone model 1330-1 with the representative bone model 1330-2 using any technique disclosed herein, including any technique associated with step 582F ( FIG. 39 ) of method 582. Step 1382E may include at least partially registering the main body portion 1330M-1 of the fragmentary bone model 1330-1 with the main body portion 1330M-2 of the representative bone model 1330-2 to establish registration of the fragmentary bone model 1330-1. The spatial module 50 may be configured to at least partially register the main body portion 1330M-1 of the fragmentary bone model 1330-1 with respect to the main body portion 1330M-2 of the representative bone model 1330M-2 to establish registration of the fragmentary bone model 1330-1. In embodiments, the spatial module 50 may be configured to substantially align first (e.g., epicondylar) axes AA of the distal portions 1330D-1, 1330D-2 of the bone models 1330-1, 1330-2. The spatial module 50 may be configured to substantially align the main body portion 1330M-1 of the fragmentary bone model 1330-1 with respect to the main body portion 1330M-2 of the representative bone model 1330-2 by rotating the main body portion 1330M-1 of the fragmentary bone model 1330-1 in a rotational direction R1 about the respective corresponding axis AA.

[0406] In step 1382F, the registration of the initially selected representative bone model 1330-2 to the registration of the patient's fragmentary bone model 1330-1 may be refined. The system 10 may be configured to refine the registration of the representative bone model 1330-2 to the registration of the fragmentary bone model 1330-1 using any technique disclosed herein. In embodiments, the representative bone model 1330-2 may be aligned and / or another representative bone model 1330-2 may be selected from a set of representative bone models 30 using any technique disclosed herein. The set of representative bone models 30 may be associated with the SSM 75. In embodiments, a representative anatomical model 1329-2 associated with a bone of the anatomy (e.g., the scapula and humerus) may be aligned and / or selected using any technique disclosed herein. The representative anatomical model 29 may be the same or different from the previously selected anatomical bone model 1329-2. System 10 may be configured to refine the selection of representative bone model 1330-2 based on the goodness of fit between patient anatomical model 1329-1 and another anatomical model 1329-2 selected from a set of anatomical models 29 that may be associated with anatomical SSM 75. In an embodiment, one or more steps of method 1382 may include analyzing a representative patient population within SSM 75, including step 1382C and / or step 1382F. The representative patient population may be analyzed within SSM 75 using any of the techniques disclosed herein.

[0407] In embodiments, one or more variation modes 76 of SSM 75 may be varied to minimize or otherwise reduce volumetric deviations between a representative anatomical model 1329-2 selected from set of anatomical models 29, a registered (e.g., aligned) position of patient anatomical model 1329-1 including scapula model 530S-1 ( FIG. 44 ), and a registered (e.g., aligned) position of fragmentary bone model 1330-1. System 10 may be configured to refine or otherwise align and / or select anatomical model 1329-2 and associated humerus model 1330-2 by varying variation mode 76 using any technique disclosed herein, such as step 482G of method 482 ( FIG. 33 ). Steps 1382B, 1382C, 1382D, and / or 1382F may include adjusting and / or selecting representative bone model 530S-2 (e.g., FIG. 42 ) and / or representative bone model 1330-2 in response to changing one or more of the predefined variation modes 76 in the associated SSM 75.

[0408] 58A-58C with continued reference to FIGS. 2, 4, and 55, various techniques may be utilized to position bone fragments. In step 1382G, one or more bone fragment portions 1330F-1 of the fragmentary bone model 1330-1 may be at least partially registered or otherwise substantially aligned with the volume of the representative bone model 1330-2 to establish registration (e.g., location) of the fragmentary bone model 1330-1′. FIGS. 58A-58C disclose the registration of the patient's fragmentary bone model 1330-1′ positioned relative to the representative bone model 1330-2. FIGS. 59A-59C disclose the registration of the patient's fragmentary bone model 1330-1′ with the representative bone model 1330-2 omitted.

[0409] Various techniques may be used to fit or otherwise position the bone fragment portions 1330F-1 of the patient bone model 1330-1 relative to the volume of the representative bone model 1330-2. The bone fragment portions 1330F-1 may be fitted automatically by the system 10 and / or manually in response to user interaction with the user interface 56. The spatial module 50 may be configured to at least partially register the volume of one or more bone fragment portions 1330F-1 of the fragmentary bone model 1330-1 relative to the volume of the representative bone model 1330-2 to establish registration of the fragmentary bone model 1330-1′.

[0410] The spatial module 50 may be configured to determine an overall volume of the bone fragment portions 1330F-1 of the fragmentary bone model 1330-1′ that may be located outside the volume of the representative bone model 1330-2. The comparison module 52 may be configured to select an arrangement of the bone fragment portions 1330F-1 that may minimize or otherwise reduce the overall volume of the bone fragment portions 1330F-1 of the fragmentary bone model 1330-1′ that may be located outside the volume of the representative bone model 1330-2.

[0411] Method 1382 may include analyzing the patient's fragmented bones based on the registration status of the fragmented bone model 1330-1'. In step 1382H, the patient's posture may be determined using any technique disclosed herein. In step 1382I, the position and / or orientation of one or more implant models 1332 may be determined using any technique disclosed herein (models 1332 shown in dashed lines in FIGS. 59A and 59C). Step 1382I may incorporate any technique related to step 482G (FIG. 33). System 10 may be configured to establish an implant plan associated with implant model 1332 based on the registration status of the fragmented bone model 1330-1'. The implant plan may be associated with at least one implant configured to fixate one or more bone fragments. Step 1382I may include establishing an implant plan based on the registration status of the fragmented bone model 1330-1'. Step 1382I may include positioning at least one implant model 1332 adjacent to one or more bone fragment portions 1330F-1 of the registered fragmentary bone model 1330-1'. Figure 60 discloses the implant model 1332 secured to the fragmentary bone model 1330-1' using one or more fastener models F associated with corresponding fasteners, such as compression screws.

[0412] In step 1382J, the range of motion may be determined using any technique disclosed herein. The range of motion may be correlated to the registration state of the fragmentary bone model 1330-1'. Step 1382J may incorporate any technique associated with step 482H (FIG. 33).

[0413] Although the techniques disclosed herein regarding posture refer to the patient's scapula, it will be understood that the teachings herein may be utilized to determine range of motion and / or establish or adjust preoperative planning for other bones and joints.

[0414] The surgical planning systems and methods proposed in this disclosure may be utilized to create and implement a personalized surgical plan, which may result in improved healing. The disclosed systems and methods may reduce the complexity of implementing the surgical plan, including reducing packaging and instrumentation. In certain embodiments, the systems and methods may utilize a feedback loop to continually refine the recommendations provided when developing a surgical plan. Thus, the proposed systems and methods offer improved capabilities compared to traditional planning systems.

[0415] Although different non-limiting embodiments are illustrated as having particular components or steps, embodiments of the present disclosure are not limited to those particular combinations. Some components or features from any of the non-limiting embodiments can be used in combination with features or components from any of the other non-limiting embodiments.

[0416] It will be understood that like reference numerals identify corresponding or similar elements throughout the several views. Further, while particular component arrangements are disclosed and illustrated in these exemplary embodiments, it will be understood that other arrangements may benefit from the teachings of the present disclosure.

[0417] The above description is intended to be illustrative and not to be taken in any limiting sense. Those skilled in the art will recognize that certain modifications may fall within the scope of the present disclosure. For these reasons, the following claims should be studied in determining the true scope and content of the present disclosure. [Explanation of symbols]

[0418] 10 Surgical Planning System 12 Host Computer 14 client computers 16 Imaging devices 18 Storage Systems 20 Network 22 Client Interface 24 Peer-to-Peer Interface 26 images 28 Planning Environment 29 Anatomical Models 30 bone models 32 Implant Model 34 Transmission Model 36 Surgical Planning 38 databases 40 Computing Devices 42 processors 44 memory 46 Data Module 48 Display Module 50 Spatial Module 52 Comparison Module 54 entries 56 Graphical User Interface (GUI) 58 Display Devices 60 Display Window 62 objects 64 Patient Profile Database 65 Surgeon Profile Database 66 Surgical Outcomes Database 68 Range of Motion (ROM) Database 70 Anatomical Body Classification (AMC) Database 72 Statistical Shape Modeler 74 Image data 75 Statistical Shape Models 76 Mode 78 standard deviations 80N Anatomical Body Classification (AMC) 101 Range of Motion (ROM) Modeler

Claims

1. 1. A surgical planning system comprising: a processor operatively connected to the storage system; the storage system is configured to store a plurality of three-dimensional bone models associated with one or more bones of a representative patient population, the plurality of bone models including a first set associated with a first bone and a second set associated with a second bone; The processor: selecting a first representative bone model from the first set of bone models in response to comparing the first representative bone model to a first patient three-dimensional bone model associated with the first bone of the patient, the first representative bone model being associated with a second representative bone model in the second set of bone models, the first patient bone model and the second patient three-dimensional bone model establishing a first spatial relationship, and the second patient bone model being associated with the second bone of the patient, the first representative bone model and the second representative bone model establishing a second spatial relationship; and determining at least one patient characteristic associated with the first bone and / or the second bone of the patient in response to comparing the first spatial relationship and the second spatial relationship.

2. The surgical planning system of claim 1 , wherein the at least one patient characteristic is associated with a posture of the patient.

3. The processor: The surgical planning system of claim 1 or 2, configured to establish an implant plan based on the at least one patient characteristic.

4. The surgical planning system of claim 1 , wherein the first bone and the second bone are adjacent bones.

5. The surgical planning system of claim 1 , wherein the first bone and the second bone are non-adjacent bones.

6. The processor: The surgical planning system of claim 1 , configured to perform a range of motion simulation based on the at least one patient characteristic.

7. The processor: receiving image data associated with the patient; 7. The surgical planning system of claim 1, configured to: generate the first patient bone model and the second patient bone model based on the image data.

8. The processor: determining a deviation between the first spatial relationship and the second spatial relationship based on one or more landmarks associated with the first bone and / or the second bone; and determining the at least one patient characteristic based on the deviation.

9. The processor: comparing the first representative bone model with the first patient bone model in response to at least partially matching a volume of the first representative model and a volume of the first patient bone model with each other; and / or 9. The surgical planning system of claim 1, further comprising: a) comparing the second representative bone model with the second patient bone model in response to at least partially matching a volume of the second representative bone model and a volume of the second patient bone model with each other.

10. The processor:

10. The surgical planning system of claim 1, configured to adjust a position of the first patient bone model and / or a position of the second patient bone model based on the at least one patient characteristic.

11. The processor: registering the first patient bone model and / or the second patient bone model from a local frame of reference to a global frame of reference based on the at least one patient characteristic; 11. The surgical planning system of claim 1, configured to: establish a surgical plan associated with the first patient bone model and / or the second patient bone model within the global frame of reference.

12. The processor: The surgical planning system of claim 1 , configured to analyze the representative patient population within a statistical shape model.

13. The processor: generating a plurality of anatomical size classifications based on a plurality of predefined modes within the statistical shape model that characterize anatomical variations within the representative patient population and based on a plurality of standard deviations of anatomical variances contained within each of the plurality of predefined modes; assigning the anatomical body type classification to the bone model; The surgical planning system of claim 12 , wherein the storage system is configured to store the anatomical body size classification.

14. The processor: The surgical planning system of claim 13 , configured to select the first representative bone model in response to changing one or more of the predefined modes.

15. The processor: assigning the anatomical body size classification associated with the first representative bone model to the first patient bone model and / or assigning the anatomical body size classification associated with the second representative bone model to the second patient bone model; 15. The surgical planning system of claim 13 or 14, configured to: and performing a range of motion simulation for the assigned anatomical body classification.

16. The predefined modes include attitude modes associated with attitudes; The processor: assigning the anatomical body type classification to the bone model based on the posture mode; and determining one or more posture parameters associated with the patient's posture based on the anatomical body size classification associated with the first representative bone model and / or the second representative bone model.

17. The processor: The surgical planning system of claim 16 , configured to establish an implant plan based on the one or more pose parameters.

18. 1. A computer-implemented surgical planning method comprising: accessing a first patient bone model of the patient from a memory, the first patient model being associated with a first bone of the patient; accessing a second patient bone model of the patient from the memory, the second patient bone model associated with a second bone of the patient; selecting an anatomical model from a plurality of anatomical models based on the first patient bone model and the second patient bone model, the plurality of anatomical models being associated with one or more bones and / or one or more joints of a representative patient population, the bones including at least the first bone and the second bone; and determining one or more characteristics associated with the patient's posture based on the selected anatomical model.

19. 20. The method of claim 18, wherein the step of selecting the anatomical model occurs in response to at least partially fitting the anatomical model to the first patient bone model and to the second patient bone model.

20. 20. The method of claim 18 or 19, further comprising the step of establishing an implant plan associated with the first bone and / or the second bone of the patient in response to the step of determining the one or more characteristics.

21. 21. The method of any one of claims 18 to 20, further comprising analyzing the representative patient population within a statistical shape model.

22. identifying a plurality of predefined modes within the statistical shape model of the representative patient population, the predefined modes including posture-related posture-related posture modes; establishing a plurality of standard deviations of the anatomical variances contained within each of the plurality of predefined modes; 22. The method of claim 21, wherein the step of selecting the anatomical model occurs in response to changing one or more of the predefined modes in the statistical shape model.

23. 1. A surgical planning system comprising: a processor and a memory operatively coupled to the processor; The processor: receiving image data including a first two-dimensional image and a second two-dimensional image of a first bone and a second bone of a patient; determining first profiles of the first bone and the second bone along a first reference plane associated with the first image; determining second profiles of the first bone and the second bone along a second reference plane associated with the second image; determining an orientation of the first bone and the second bone based on a representative anatomical model associated with another patient, including projecting a first silhouette of the representative anatomical model onto the first profile along the first reference plane and projecting a second silhouette of the representative anatomical model onto the second profile along the second reference plane; determining one or more posture characteristics associated with the patient's posture based on the determined orientation; and establishing a surgical plan associated with the first bone and / or the second bone based on the one or more posture characteristics.

24. The processor: determining a first acquisition direction associated with the first image based on comparing a goodness of fit between the first silhouette and the first profile; determining a second acquisition direction associated with the second image based on comparing a goodness of fit between the second silhouette and the second profile; and determining the one or more pose characteristics based on the first acquisition orientation and the second acquisition orientation.

25. The processor: determining the first acquisition direction in response to iteratively adjusting a projection of the first silhouette onto the first profile along the first reference plane; and / or 25. The surgical planning system of claim 24, configured to determine the second acquisition orientation in response to iteratively adjusting a projection of the second silhouette onto the second profile along the second reference plane.

26. 26. The surgical planning system of claim 23, wherein the first and second reference planes are perpendicular to each other.

27. 27. The surgical planning system of any one of claims 23 to 26, wherein the first bone is associated with a scapula of the patient and the second bone is associated with a humerus of the patient.

28. 1. A surgical planning system comprising: a processor operatively connected to the memory; The processor: accessing from the memory a first representative three-dimensional bone model, the first bone model being associated with a first bone; accessing a partial three-dimensional bone model of the first bone of the patient, the partial bone model representing a smaller portion of the first bone compared to the first representative bone model; and establishing a registration position of the first bone model by at least partially registering the partial bone model of the first bone to the first bone model.

29. The processor:

30. The surgical planning system of claim 28, configured to establish an implant plan in response to establishing the registered position of the first bone model.

30. The processor: determining one or more posture parameters associated with a posture of the patient based on the registered position of the first bone model; 30. The surgical planning system of claim 28 or 29, configured to: and establish an implant plan based on the one or more pose parameters.

31. The processor: receiving image data associated with the patient and omitting a portion of the first bone; and generating the partial bone model based on the image data.

32. the first bone is the humerus; 32. The surgical planning system of claim 28, wherein the partial bone model omits a distal portion of the humerus, and the first bone model includes the distal portion of the humerus.

33. The processor:

33. The surgical planning system of any one of claims 28 to 32, configured to determine an axis associated with the first bone based on the registered position of the first bone model.

34. 1. A surgical planning system comprising: a processor operatively connected to the storage system; the storage system is configured to store a plurality of three-dimensional bone models associated with one or more bones and / or associated with one or more joints of a representative patient population; The processor: selecting a first representative three-dimensional bone model from the first set of bone models associated with a first bone of the representative patient population; and at least partially registering a partial three-dimensional bone model of the first bone of the patient to the first representative bone model, the partial bone model representing a smaller portion of the first bone compared to the first bone model.

35. The processor: receiving image data associated with the patient and omitting a portion of the first bone; and generating the partial bone model based on the image data.

36. The partial bone model is associated with a long bone, the partial bone model including a diaphyseal portion associated with a diaphysis of the long bone and a head portion associated with a head of the long bone, and the processor: at least partially registering the diaphyseal portion of the partial bone model to the diaphyseal portion of the first representative bone model; and / or 36. The surgical planning system of claim 34 or 35, configured to substantially align a center point of the head portion of the partial bone model with a center point of the head portion of the first representative bone model, and further to at least partially register the partial bone model with the first representative bone model by rotating the head portions of the partial bone models about the corresponding center points.

37. The processor: selecting a second representative three-dimensional bone model from the second set of bone models associated with a second bone; establishing a registration position of the second representative bone model by at least partially registering the second representative bone model to a second three-dimensional bone model of the second bone of the patient; and selecting the first representative bone model from the first set of bone models based on the registered position of the second representative bone model.

38. 38. The surgical planning system of any one of claims 34 to 37, wherein the first bone and the second bone are adjacent bones.

39. The processor:

39. The surgical planning system of any one of claims 34 to 38, configured to analyze the representative patient population within a statistical shape model.

40. The processor: generating a plurality of anatomical size classifications based on a plurality of predefined modes within the statistical shape model that characterize anatomical variations within the representative patient population and based on a plurality of standard deviations of anatomical variances contained within each of the plurality of predefined modes; assigning the anatomical body type classification to the bone model; 40. The surgical planning system of any one of claims 34 to 39, wherein the storage system is configured to store the anatomical body size classification.

41. The processor:

41. The surgical planning system of claim 40, configured to select the first representative bone model and / or the second representative bone model in response to changing one or more of the predefined modes.

42. The processor:

42. The surgical planning system of any one of claims 34 to 41, configured to establish an implant plan in response to registering the partial bone model to the first representative bone model.

43. the partial bone model and the second bone model are associated with an anatomical model of the patient, and the first representative bone model and the second representative bone model are associated with a representative anatomical model of another patient, and the processor: selecting the representative anatomical model from a set of anatomical models associated with the first bone and the second bone; and at least partially registering the representative anatomical model to the anatomical model of the patient.

44. The processor:

44. The surgical planning system of claim 43, further configured to select the representative anatomical model in response to determining a minimum volumetric deviation within a first set of volumetric deviations, the first set of volumetric deviations being established between the anatomical model of the patient and a corresponding representative anatomical model in the set of anatomical models in response to changing one or more of the predefined modes in the statistical shape model.

45. 1. A computer-implemented surgical planning method comprising: selecting a first representative three-dimensional bone model associated with a first bone; selecting a partial three-dimensional bone model of the first bone of the patient, the partial bone model representing a smaller portion of the first bone compared to the first representative bone model; establishing a registration position of the first representative bone model by at least partially registering the partial bone model of the first bone to the first representative bone model; analyzing the first bone based on the registered position of the first representative bone model.

46. 46. ​​The method of claim 45, further comprising establishing an implant plan based on the registered position of the first representative bone model.

47. accessing a plurality of three-dimensional bone models associated with one or more bones and / or associated with one or more joints of a representative patient population; 47. The method of claim 45 or 46, further comprising selecting the first representative bone model from the first set of bone models associated with the first bone of the representative patient population.

48. selecting a second representative three-dimensional bone model from the second set of bone models associated with a second bone of the representative patient population; establishing a registration position of the second representative bone model by at least partially registering the second representative bone model to a three-dimensional bone model of the second bone of the patient; 48. The method of claim 47, further comprising: selecting the first representative bone model from the first set of bone models in response to establishing the registration position of the second representative bone model.

49. 49. The method of any one of claims 45 to 48, further comprising analyzing the representative patient population within a statistical shape model.

50. identifying a plurality of predefined modes within the statistical shape model of the representative patient population; establishing a plurality of standard deviations of the anatomical variances contained within each of the plurality of predefined modes; 50. The method of claim 49, wherein the step of selecting the first representative bone model and / or the second representative bone model is performed in response to changing one or more of the predefined modes in the statistical shape model.

51. the first bone is the humerus; the second bone is a scapula, 51. The method of any one of claims 45 to 50, wherein the partial bone model omits a distal portion of the humerus, and the first representative bone model includes the distal portion of the humerus.

52. 1. A surgical planning system comprising: a processor operatively connected to the memory; The processor: accessing a first three-dimensional bone model from the memory, the first bone model being associated with a first bone; accessing a fragmentary three-dimensional bone model of the first bone of the patient, the fragmentary bone model including one or more bone fragment portions associated with one or more corresponding bone fragments of the first bone; and establishing a registration state of the fragmentary bone model by at least partially registering the one or more bone fragment portions of the fragmentary bone model to a volume of the first bone model.

53. The processor:

53. The surgical planning system of claim 52, configured to establish an implant plan based on the registration of the fragmentary bone model, the implant plan associated with at least one implant configured to fixate one or more bone fragments.

54. The processor: receiving image data associated with the patient; and generating the fragmented bone models based on the image data.

55. the first bone is a long bone, the fragmentary bone model includes a diaphyseal portion associated with a diaphysis of the long bone, and the processor 55. The surgical planning system of any one of claims 52 to 54, configured to establish the registration of the fragmentary bone model by at least partially registering the diaphyseal portion of the fragmentary bone model to the diaphyseal portion of the first bone model.

56. 1. A surgical planning system comprising: a processor operatively connected to the storage system; the storage system is configured to store a plurality of three-dimensional bone models associated with one or more bones and / or associated with one or more joints of a representative patient population; The processor: selecting a first three-dimensional bone model from the first set of bone models associated with a first bone of the representative patient population; and establishing a registration state of the fragmentary three-dimensional bone model of the first bone of the patient by at least partially registering one or more bone fragment portions of the fragmentary three-dimensional bone model to the first bone model, wherein the one or more bone fragment portions are associated with one or more corresponding bone fragments of the first bone.

57. The processor:

57. The surgical planning system of claim 56, configured to establish an implant plan based on the registration of the fragmentary bone models.

58. The processor: selecting a second three-dimensional bone model from the second set of bone models associated with a second bone of the representative patient population; establishing a registration position of the second bone model by at least partially registering the second bone model to a three-dimensional bone model of the second bone of the patient; and selecting the first bone model from the first set of bone models in response to establishing the registered position of the second bone model.

59. The processor:

59. The surgical planning system of any one of claims 56 to 58, configured to analyze the representative patient population within a statistical shape model.

60. The processor: generating a plurality of anatomical size classifications based on a plurality of predefined modes within the statistical shape model that characterize anatomical variations within the representative patient population and based on a plurality of standard deviations of anatomical variances contained within each of the plurality of predefined modes; assigning the anatomical body type classification to the bone model; 60. The surgical planning system of claim 59, wherein the storage system is configured to store the anatomical body size classification.

61. The processor:

61. The surgical planning system of claim 59 or 60, configured to establish an implant plan based on the registration state of the fragmentary bone model, the implant plan being associated with at least one implant configured to fixate one or more bone fragments.

62. The processor: selecting a second three-dimensional bone model from the second set of bone models associated with a second bone of the representative patient population; establishing a registration position of the second bone model by at least partially registering the second bone model to a three-dimensional bone model of the second bone of the patient; and selecting the first bone model from the first set of bone models based on the registered position of the second bone model.

63. 63. The surgical planning system of any one of claims 56 to 62, wherein the first bone is the humerus.

64. 64. The surgical planning system of claim 63, wherein the one or more bone fragments are associated with a proximal portion of the humerus.

65. 1. A computer-implemented surgical planning method comprising: selecting a first three-dimensional bone model associated with the first bone; selecting a fragmentary three-dimensional bone model of the first bone of the patient, the fragmentary bone model including one or more bone fragment portions associated with one or more corresponding bone fragments of the first bone; establishing a registration state of the fragmentary bone model by at least partially registering the one or more bone fragment portions of the fragmentary bone model to the volume of the first bone model; analyzing the first bone based on the registration state of the fragmentary bone model.

66. 66. The method of claim 65, further comprising establishing an implant plan based on the registered state of the fragmentary bone model, including positioning at least one implant model adjacent to the one or more bone fragment portions of the fragmentary bone model in the registered state.

67. the first bone is a long bone, and the fragmentary bone model includes a diaphyseal portion associated with a diaphysis of the long bone; 67. The method of claim 65 or 66, further comprising establishing the registration of the fragmentary bone model by at least partially registering the diaphyseal portion of the fragmentary bone model to the diaphyseal portion of the first bone model.

68. accessing a plurality of three-dimensional bone models associated with one or more bones and / or associated with one or more joints of a representative patient population; 68. The method of any one of claims 65 to 67, further comprising selecting the first bone model from the first set of bone models associated with the first bone of the representative patient population.

69. selecting a second three-dimensional bone model from the second set of bone models associated with a second bone of the representative patient population; establishing a registration position of the second bone model by at least partially registering the second bone model to a bone model of the second bone of the patient; 69. The method of claim 68, further comprising: selecting the first bone model from the first set of bone models in response to establishing the registered position of the second bone model.

70. 70. The method of any one of claims 65 to 69, further comprising analyzing the representative patient population within a statistical shape model.

71. identifying a plurality of predefined modes within the statistical shape model of the representative patient population; establishing a plurality of standard deviations of the anatomical variances contained within each of the plurality of predefined modes; 71. The method of claim 70, wherein the step of selecting the first bone model occurs in response to changing one or more of the predefined modes in the statistical shape model.

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