Methods and systems for treating femoroacetabular impingement

Abstract

Treating femoroacetabular impingement. At least one example is a method including: monitoring, by a treatment controller, a location of a first portion of a hip joint in three-dimensional coordinate space; tracking, by the treatment controller, an amount of bone resected from the first portion of the hip joint by tracking, by the treatment controller, a distal end of a resection device in the three-dimensional coordinate space; and controlling, by the treatment controller, a resection rate of the resection device based on the location of the distal end of the resection device relative to a planned resection amount associated with the first portion of the hip joint.

Description

[Technical Field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims the benefit of U.S. Provisional Application No. 63 / 047,319, entitled "Planning and Robotic Assistance for Treatment of Femoroacetabular Impingement," filed July 2, 2020. The provisional application is incorporated herein by reference as if reproduced in full below. [Background technology]

[0002] Femoroacetabular impingement (FAI) is a cause of damage to the labrum or articular cartilage of the hip joint. FAI can result from bony overgrowth of the femoral neck (called a cam deformity), bony overgrowth around the acetabular rim (called a pincer deformity), or a combination of the two. Treatment of FAI involves using mechanical resection devices to remove bone and create an anatomical profile that does not result in impingement during typical range of motion. Treatment can be performed for the cam deformity, the pincer deformity, or both.

[0003] One of the challenges in treating FAI is the difficulty of determining the appropriate location and amount of bone to be removed to reduce impingement. While multiple x-rays from various angles can characterize the overgrowth around the joint from a specific perspective, it is difficult to characterize the three-dimensional (3D) nature of the anatomical structures using only two-dimensional (2D) x-ray images. Given this, one technique is to acquire magnetic resonance imaging (MRI) or computed tomography (CT) images to view the anatomical structures from a 3D perspective. CT images can be used to construct a 3D bone model, allowing the surgeon to view the entire cam and pincer deformity, but the 3D bone model does not provide the surgeon with information about the amount of bone that needs to be removed to alleviate the impingement. Furthermore, during arthroscopic treatment, it is difficult to determine the amount of bone removed around the femoral head and neck through arthroscopic video. Therefore, surgeons must rely heavily on intraoperative fluoroscopy to provide 2D images for determining the bone silhouette. By taking these fluoroscopic images at various orientations, an attempt is made to determine if the collision has been resolved.

[0004] Because over-resection can lead to femoral neck and / or acetabular fractures, under-resection is common. In fact, when repeat arthroscopic hip surgery is considered, under-resection is the cause in approximately 64% of cases. Summary of the Invention

[0005] Treating femoroacetabular impingement. One example is a method of treating femoroacetabular impingement, the method including: monitoring, by a treatment controller, a location of a first portion of a hip joint in three-dimensional coordinate space; tracking, by the treatment controller, an amount of bone resected from the first portion of the hip joint by tracking, by the treatment controller, a distal end of a resection device in three-dimensional coordinate space; and tracking, by the treatment controller, a distal end of a resection device associated with the first portion of the hip joint. Planned resection areaand controlling the ablation rate of the ablation device based on the location of the distal end of the ablation device relative to the target.

[0006] In an exemplary method, the first part of the hip joint can be at least one selected from the group including the femur and the acetabulum.

[0007] In an exemplary method, controlling the cutting rate may be performed by adjusting the cutting rate so that the distal end of the cutting device has less bone to be removed. Planned resection area The method may further include reducing the rotational speed of a cutter of the excision device when the cutter is over a portion of the tissue.

[0008] In an exemplary method, controlling the cutting rate may be achieved by adjusting the cutting rate so that the distal end of the cutting device has more bone to be removed. Planned resection area The method may further include increasing the rotational speed of a cutter of the excision device when the cutter is over a portion of the excision area.

[0009] In an exemplary method, controlling the ablation rate comprises: Planned resection area The method may further include controlling a rotational speed of a cutter of the resecting device based on a location of the distal end of the resecting device relative to the remaining bone to be removed. Planned resection area The method may further include changing the rotational speed of a cutter of the resection device to zero in response to the distal end of the resection device being adjacent to the bone outside of the resection device. Planned resection area The method may further include changing a rotational speed of a cutter of the resecting device to zero in response to the distal end of the resecting device adjacent the bone in an area below the bone.

[0010] An exemplary method includes creating a three-dimensional model of at least a portion of a first portion of the hip joint based on the plurality of images; and, based on the three-dimensional model, Planned resection area and then creating a three-dimensional model and Planned resection areato the treatment controller. The plurality of images may be selected from a group including x-ray images, computed tomography images, ultrasound images, and magnetic resonance imaging images. In some cases, prior to monitoring the first portion of the hip joint, the exemplary method may include registering a first member of the hip joint and correlating the first member to the model.

[0011] A second exemplary method of treating femoroacetabular impingement includes monitoring, by a treatment controller, a location of a first portion of a hip joint in three-dimensional coordinate space; tracking, by the treatment controller, an amount of bone resected by tracking a distal end of a resection device in three-dimensional coordinate space; generating, by the treatment controller, a simulated fluoroscopic image showing the first portion of the hip joint after the amount of bone has been removed; and displaying the simulated fluoroscopic image on a display device.

[0012] A second exemplary method may further include creating a three-dimensional model of at least a portion of the first portion of the hip joint based on the plurality of images, where creating the three-dimensional model is before resecting bone, and providing the three-dimensional model to a treatment controller. Generating a simulated fluoroscopic image may further include creating the simulated fluoroscopic image based on the three-dimensional model and the amount of bone resected.

[0013] In a second exemplary method, the plurality of images may be selected from a group including x-ray images, computed tomography images, and magnetic resonance imaging images.

[0014] In an exemplary second method, generating the simulated fluoroscopic image may further include generating a plurality of simulated fluoroscopic images, each image at a different angle relative to the hip joint.

[0015] A second exemplary method is shown in which a first portion of a hip joint is associated with Planned resection areaThe method may further include controlling a cutting rate of the ablation device based on a location of the distal end of the ablation device relative to the predetermined amount of bone to be removed. Planned resection area The method may further include reducing the rotational speed of the cutter of the resecting device when the distal end of the resecting device is over a portion of the bone that is greater than a predetermined amount of bone to be removed. Planned resection area The method may further include increasing a rotational speed of a cutter of the excision device when the cutter is over a portion of the cutting edge. Planned resection area The method may further include controlling a rotational speed of a cutter of the resecting device based on a location of the distal end of the resecting device relative to the remaining bone to be removed. Planned resection area The method may further include changing the rotational speed of a cutter of the resection device to zero in response to the distal end of the resection device being adjacent to the bone outside of the resection device. Planned resection area The method may further include changing a rotational speed of a cutter of the resecting device to zero in response to the distal end of the resecting device adjacent the bone in an area below the bone.

[0016] Another example is a system for treating femoroacetabular impingement, the system comprising: a treatment controller; a stereoscopic camera coupled to the treatment controller; a display device coupled to the treatment controller; an ablation controller communicatively coupled to the treatment controller; an ablation device operably coupled to the ablation controller, the ablation device including a handpiece, an elongated outer tube coupled to the handpiece and extending from the handpiece, and a cutter disposed on a distal end of the elongated outer tube; and an optical tracking array coupled to the ablation device and within an optical field of view of the stereoscopic camera. The treatment controller monitors a location of a first portion of the hip joint in three-dimensional coordinate space and tracks an amount of bone resected from the first portion of the hip joint by tracking the distal end of the ablation device in three-dimensional coordinate space. Planned resection areaand controlling the ablation rate of the ablation device based on the location of the distal end of the ablation device relative to the target.

[0017] In an exemplary system, when the treatment controller monitors the location of the first portion of the hip joint, the treatment controller may be further configured to monitor at least one selected from the group including the femur and the acetabulum.

[0018] In an exemplary system, when the treatment controller controls the ablation rate, the treatment controller determines whether the distal end of the ablation device has less than a predetermined amount of bone to be removed. Planned resection area The cutting device may be further configured to reduce the rotational speed of the cutter of the excision device when the cutting device is over a portion of the cutting device.

[0019] In an exemplary system, when the treatment controller controls the resection rate, the treatment controller determines whether the distal end of the resection device has more than a predetermined amount of bone to be removed. Planned resection area The method may be further configured to increase the rotational speed of a cutter of the excision device when the cutter is over a portion of the excision device.

[0020] In an exemplary system, when the treatment controller controls the ablation rate, the treatment controller: Planned resection area The treatment controller may be further configured to control a rotational speed of a cutter of the resection device based on a location of the distal end of the resection device relative to the remaining bone to be removed. Planned resection area The treatment controller may be further configured to change the rotational speed of the cutter of the resection device to zero in response to the distal end of the resection device adjacent the bone outside of the treatment device. Planned resection area The cutting device may be further configured to change the rotational speed of a cutter of the cutting device to zero in response to the distal end of the cutting device adjacent the bone in an area below the cutting edge.

[0021] In an exemplary system, the treatment controller, before controlling the resection rate, receives a three-dimensional model of at least a portion of the first portion of the hip joint based on the plurality of images; and, based on the three-dimensional model, Planned resection area and receiving the signal.

[0022] A second exemplary system may include a treatment controller, a stereoscopic camera coupled to the treatment controller, a display device coupled to the treatment controller, an ablation controller communicatively coupled to the treatment controller, an ablation device operably coupled to the ablation controller, the ablation device including a handpiece, an elongated outer tube coupled to the handpiece and extending from the handpiece, and a cutter disposed on a distal end of the elongated outer tube, and an optical tracking array coupled to the ablation device and within an optical field of view of the stereoscopic camera. The treatment controller may be configured to monitor a location of a first portion of the hip joint in three-dimensional coordinate space, track an amount of resected bone by tracking the distal end of the ablation device in three-dimensional coordinate space, generate a simulated fluoroscopic image showing the first portion of the hip joint without the amount of resected bone, and display the simulated fluoroscopic image on the display device.

[0023] In a second exemplary system, when the treatment controller generates a simulated fluoroscopic image, the treatment controller may be further configured to generate multiple simulated fluoroscopic images, each image at a different angle relative to the hip joint.

[0024] In an exemplary system, a treatment controller is associated with a first portion of the hip joint. Planned resection area The treatment controller may be further configured to control the resection rate of the ablation device based on the location of the distal end of the ablation device relative to the predetermined amount of bone to be removed. Planned resection areaThe treatment controller may be further configured to reduce the rotational speed of the cutter of the resection device when the distal end of the resection device is over a portion of the bone that has more than a predetermined amount of bone to be removed. Planned resection area The treatment controller may be further configured to increase a rotational speed of a cutter of the ablation device when the cutter is over a portion of the treatment area. Planned resection area The treatment controller may be further configured to control a rotational speed of a cutter of the resection device based on a location of the distal end of the resection device relative to the remaining bone to be removed. Planned resection area The treatment controller may be further configured to change the rotational speed of the cutter of the resection device to zero in response to the distal end of the resection device adjacent the bone outside of the treatment device. Planned resection area The cutting device may be further configured to change the rotational speed of a cutter of the cutting device to zero in response to the distal end of the cutting device adjacent the bone in an area below the cutting edge. [Brief explanation of the drawings]

[0025] For a detailed description of exemplary embodiments, reference will now be made to the accompanying drawings.

[0026] [Figure 1] 1 shows three views of an exemplary femoroacetabular joint. [Figure 2] 1 illustrates a system according to at least some embodiments. [Figure 3] 1 illustrates an exemplary user interface, according to at least some embodiments. [Figure 4A] 10 illustrates the distal end of an excision device relative to a planned excision portion, according to at least some embodiments. [Figure 4B] 10 illustrates the distal end of an excision device relative to a planned excision portion, according to at least some embodiments. [Figure 4C] 10 illustrates the distal end of an excision device relative to a planned excision portion, according to at least some embodiments. [Figure 4D] 10 illustrates the distal end of an excision device relative to a planned excision portion, according to at least some embodiments. [Figure 5] 1 illustrates an exemplary user interface, according to at least some embodiments. [Figure 6] 1 illustrates a partial block diagram and partial flow diagram of a system for treating femoroacetabular impingement, according to at least some embodiments. [Figure 7] 1 illustrates a method according to at least some embodiments. [Figure 8] 1 illustrates a method for controlling the ablation rate of an ablation device according to at least some embodiments. [Figure 9] 1 illustrates a computer system according to at least some embodiments.

[0027] definition Various terms are used to refer to specific system components. Different companies may refer to components by different names—this document does not intend to distinguish between components that differ in name but not function. In the following discussion and claims, the terms “including” and “comprising” are used in an open-ended manner and, therefore, should be interpreted as “including, but not limited to.” Also, the terms “couple” or “couples” are intended to mean either an indirect or direct connection. Thus, when a first device is coupled to a second device, the connection may be via a direct connection or via an indirect connection via other devices and connections. DETAILED DESCRIPTION OF THE INVENTION

[0028] The following discussion is directed to various embodiments of the present invention. While one or more of these embodiments may be preferred, the disclosed embodiments should not be construed or otherwise used as limiting the scope of the present disclosure, including the claims. In addition, those skilled in the art will understand that the following description has broad applicability, and that the discussion of any embodiment is intended only as an example of that embodiment and is not intended to imply that the scope of the present disclosure, including the claims, is limited to that embodiment.

[0029] Various examples are directed to methods and systems for treating femoroacetabular impingement. Specifically, various examples include tracking the amount of bone resected from a portion of the hip joint by tracking the distal end of a resection device in three-dimensional coordinate space at the location of the hip joint, and tracking the amount of bone resected from a portion of the hip joint associated with the portion of the hip joint. Planned resection area and controlling the resection rate of the resection device based on the location of the distal end of the resection device relative to the femur. The hip joint portion may be the femur, the acetabulofemoral joint, or both. For ease of reading, the hip joint will hereinafter be referred to simply as the "hip joint." In another example, based on tracking the amount of bone resected from the hip joint portion, exemplary methods and systems generate simulated fluoroscopic images showing the hip joint portion as it would appear in an actual fluoroscopic image, taking into account resections at any intermediate stages of the intraoperative procedure, to assist the surgeon in determining whether sufficient bone has been removed to address femoroacetabular impingement. The description first turns to a discussion of femoroacetabular impingement to orient the reader.

[0030] FIG. 1 shows three views of an exemplary hip joint. Specifically, in each view of FIG. 1, an exemplary hip joint 100 is visible, including a portion of a femur 102 and a portion of an acetabulum 104. The visible portion of the femur 102 includes a greater trochanter 106 at the upper end of the femur 102, a femoral neck 108 extending from the femur 102, and a femoral head 110 on the distal end of the femoral neck 108. The femoral head 110 is spherical and thus forms the ball of the hip joint. The acetabulum 104 defines a spherically shaped inner surface that forms a glenoid cavity 112, shown partially cut away in the left and center views of FIG. 1. The femoral head 110 rotates within the glenoid cavity 112, the outer edge of which is defined by an acetabular rim 114 (center view).

[0031] Femoroacetabular impingement can cause irritation and / or damage to the labrum or articular cartilage of the hip joint. Femoroacetabular impingement can result from bony overgrowth around the acetabular rim 114, resulting in a pincer deformity 116 (left image). In other cases, femoroacetabular impingement can result from bony overgrowth from the femur 102, particularly the femoral neck 108 proximal to the femoral head 110, resulting in a cam deformity 118 (center image). In still other cases, both a pincer deformity 116 and a cam deformity 118 can be present (right image).

[0032] The bone overgrowth from the femoral neck 108 can extend from the femoral neck 108 in any radial direction relative to the central longitudinal axis of the femoral neck 108, but in most cases the bone overgrowth is more pronounced on the superior and anterior surfaces. The bone overgrowth from the acetabular rim 114 can extend from the acetabular rim 114 anywhere around the glenoid fossa 112, but in most cases the bone overgrowth is more pronounced on the superior surface and extends toward the femoral neck 108. The key point is that pincer and cam deformities can be disposed anywhere around the femoral neck 108 and / or acetabular rim 114. Fluoroscopic images only show a silhouette of the hip joint; therefore, in the related art, during surgery, many surgeons generate fluoroscopic images from multiple angles as they attempt to measure the amount of bone remaining to be removed to correct impingement.

[0033] Figure 2 illustrates a system according to at least some embodiments. Specifically, Figure 2 illustrates a planning computer 200, a cloud computer 202, a device cart 204, an exemplary patient showing the patient's hip joint 100, and a resection device 206 in operative relationship to the hip joint 100. Each will be addressed in turn.

[0034] In the exemplary system, the planning computer 200 and the cloud computer 202 may be used during pre-operative planning to perform various pre-operative tasks. In some examples, software for pre-operative planning aspects runs on the cloud computer 202 and is accessed by the planning computer 200, which may be any suitable computer, such as a desktop, laptop, tablet computer, or smartphone device. For example, the planning computer 200 and / or the cloud computer 202 may receive multiple images of the hip joint 100. The images may be x-ray images, computed tomography (CT) images, ultrasound images, magnetic resonance imaging (MRI) images, or a combination. In the exemplary system, the planning computer 200 and / or the cloud computer 202 may create a three-dimensional model of the exterior surface of the femur 102, a three-dimensional model of the acetabulum 104, or both, from the images. With respect to the femur 102, the three-dimensional model may include the top or superior portion of the femur 102. With respect to the acetabulum 104, the three-dimensional model may include only the relevant portion of the acetabulum 104 (eg, only a portion of the hip joint 100 in question).

[0035] Using planning computer 200 and / or cloud computer 202, in the exemplary system, a surgeon may create a resection plan for a subsequent surgical procedure or modify an automatically generated resection plan; in either case, the resection plan may be used to plan the resection of the hip joint 100 associated with the hip joint 100. Planned resection area This results in the following. Planned resection area is the length of bone to be removed from the femoral neck 108. portion , of bone to be removed from the acetabular rim 114 portion , or both. Planned resection area may take any suitable form, for example: Planned resection area may be represented by two three-dimensional models of the hip joint 100: a first three-dimensional model that is a pre-operative surface model including the bony overgrowth, and a second three-dimensional model that is a planned post-operative surface model with the bony overgrowth removed. Planned resection area is a three-dimensional representation of the bone to be removed directly from the origin of the pre-operative surface model of the target portion of the hip joint 100. portion In still further cases, Planned resection area is a three-dimensional representation of the bone to be removed compared to the planned post-operative surface model of the target portion of the hip joint 100. portion Three-dimensional surface models and Planned resection area Regardless of the precise nature of the 3D surface model, once established preoperatively, Planned resection area may be transferred to a treatment controller (discussed further below) for use during the intraoperative portion of the exemplary method.

[0036] 2 , the exemplary system further includes a device cart 204. The device cart 204 may be used in a surgical setting during the intraoperative portion of the exemplary method. The device cart 204 may include a treatment controller 208, a stereoscopic camera 210 coupled to the treatment controller 208, a display device 212 coupled to the treatment controller 208, and a resection controller 214 communicatively coupled to the treatment controller 208. Other devices and controllers may be present as part of the device cart 204, such as an endoscope light source and video controller 216 (hereinafter simply video controller 216) and a peristaltic pump system 218 that may be used to control inflow and outflow within the hip joint 100. While the exemplary device cart 204 shows only a single display device 212 used by the treatment controller 208, in practice a second display device may be present to show video images produced by an endoscope or arthroscope (not shown). The second display device may take any suitable form, such as a replica display or a head-mounted display implementing an Augmented Reality (AR) or Virtual Reality (VR) system. In still other cases, the display device 212 may be shared by the treatment controller 208 and video controller 216 associated with the arthroscope.

[0037] The stereoscopic camera 210 may take any suitable form. In some cases, the stereoscopic camera 210 is designed and constructed to receive light in the infrared (IR) frequency band, while in other cases, the stereoscopic camera 210 may be capable of operating with light in the visible range, or both. In either case, when stereoscopic, the stereoscopic camera 210 may be used by the treatment controller 208 to monitor the location of various devices and structures in the operating room in three-dimensional coordinate space. That is, exemplary systems either operate based on ambient light in the operating room or shine light (e.g., IR frequencies) toward the surgical procedure. Light of interest is reflected by reflectors in the reference array, and based on the reflected light, the treatment controller 208 can determine the location of the reference array (and their attached devices / structures). In still yet other examples, the fiducials in the reference array may actively emit light at relevant frequencies for capture by the stereoscopic camera 210. For example, prior to resection, the surgeon may mechanically and rigidly couple the femoral reference array 220 to the femur 102, such as by coupling the femoral reference array 220 to the greater trochanter 106 of the femur 102. Once the femoral reference array 220 is attached and the femur 102 is correlated or registered to the three-dimensional model of the femur 102, the treatment controller 208 may monitor the location of the femoral reference array 220, and therefore the femur 102, within the three-dimensional coordinate space of the operating room.

[0038] As another example of monitoring the location of various devices and structures in three-dimensional coordinate space, prior to resection, the surgeon may mechanically and rigidly couple an acetabular reference array 222 to the acetabulum 104. The acetabular reference array 222 may be coupled at any suitable location, such as the superior iliac spine 224 or the inferior iliac spine 226, or both. Once the acetabular reference array 222 is coupled to the acetabulum 104 and the acetabulum 104 is correlated or registered to the three-dimensional model of the acetabulum 104, the treatment controller 208 may monitor the location of the acetabular reference array 222, and therefore the acetabulum 104, in three-dimensional coordinate space. While FIG. 2 illustrates a system in which the treatment controller 208 monitors the location of both the femur 102 and the acetabulum 104, in some cases, only one portion of the hip joint 100 may be monitored, such as monitoring only the femur 102 when only a cam deformity is to be resected, or monitoring only the acetabulum 104 when only a pincer deformity is to be resected.

[0039] 2 , treatment controller 208 may monitor the location of ablation device 206 operably coupled to ablation controller 214 using stereoscopic camera 210. More specifically, in an exemplary system, treatment controller 208 may monitor the location of the distal end of ablation device 206 to track the amount of bone removed during ablation. The exemplary ablation device 206 includes a motor drive unit (MDU) or handpiece 230, an elongated outer tube 232 coupled to and extending from handpiece 230, and a cutter 234 on the distal end of elongated outer tube 232. In one example, ablation device 228 is a mechanical ablation device in which cutter 234 is a burr, although any suitable mechanical ablation device may be used. To track the distal end of ablation device 228 (e.g., cutter 234), an optical tracking array 236 is coupled to ablation device 228 in the optical field of view of stereoscopic camera 210. By monitoring the location of cutter 234 in three-dimensional coordinate space, treatment controller 208 can perform several advantageous tasks. For example, treatment controller 208 can track the amount of bone resected, and treatment controller 208 can control the resection rate of resection device 206. Each will be addressed in turn.

[0040] FIG. 3 illustrates an exemplary user interface, according to at least some embodiments. Specifically, the exemplary user interface 300 may be displayed on the display device 212 (also FIG. 2) of the device cart 204 (FIG. 2) during an intraoperative procedure to treat femoroacetabular impingement. While the exemplary user interface 300 is shown in the context of resecting bone from a femur to treat a cam deformity, the display techniques and associated features are equally applicable to resecting bone from an acetabulum to treat a pincer deformity. Accordingly, FIG. 3 illustrates a portion of a femur 102. The illustrated portion of the femur 102 may be rendered from a three-dimensional model created during preoperative planning (e.g., by the planning computer 200 and / or the cloud computer 202). FIG. 3 illustrates a portion of the femur 102. Planned resection area 302. Specifically, Planned resection area 302 is rendered over the representation of the femur 102 to give a visual indication of the location and amount of bone to be removed. Planned resection area 302 shows two exemplary regions of varying ablation by two patterns of cross-hatching, although in practice one or more regions may be Planned resection area An exemplary denser cross-hatching may be: The part that needs to be removed more and less dense crosshatching indicates Less should be removed Equivalently stated, in areas with denser cross-hatching, the depth of bone to be removed is greater than the depth of bone to be removed in areas with less dense cross-hatching. Planned resection area The regions may be shown in a color-coded format. For example, regions with more bone to be removed may be shown in "warmer" colors (e.g., red and pink) and regions with less bone to be removed may be shown in "cooler" colors (e.g., blue and green).

[0041] FIG. 3 illustrates an exemplary femur 102 and Planned resection area Also shown in connection with 302 is a depiction of the cutter 234 of the resection device 206 (FIG. 2). Specifically, according to an exemplary system, the treatment controller 208 (FIG. 2) is designed and constructed to monitor the location of the resection device 206 in three-dimensional coordinate space by tracking the optical tracking array 236 (FIG. 2). By knowing the location of the cutter 234 relative to each face of the optical tracking array 236 (e.g., by a registration process), the treatment controller 208 can determine the location and / or the position of the three-dimensional model of the portion of the hip joint (here, the femur 102). Planned resection area The example treatment controller 208 can then calculate the location of the cutter 234 relative to the example femur 102 and Planned resection area In connection with 302, a representation of a portion of the resection device 206 (eg, the cutter 234 and elongate shaft as shown) may be rendered.

[0042] Furthermore, in the exemplary system, the treatment controller 208 (FIG. 2) may track the amount of bone removed or resected by the cutter 234 of the resection device 206 (FIG. 2). That is, the exemplary treatment controller 208: Planned resection area To monitor the location of the cutter 234 relative to 302, the cutter 234 Planned resection area 302 and the ablation device 206 is operable, the treatment controller 208 Planned resection area 302. In some cases, the treatment controller 208 is provided with values indicating the bone resection rate as a function of contact time prior to the intraoperative procedure. In still other cases, the treatment controller 208 is provided with values indicating the bone resection rate as a function of the cutter 234 rotational speed and contact time prior to the intraoperative procedure. In other embodiments, the treatment controller 208 assumes that any collision or overlap between the cutter 234 location in the rendering and voxels of the bone model will result in bone removal. In yet another approach, the treatment controller 208 performs the noted overlap check, but updates to the bone model occur only when the cutter 238 is rotating. Regardless of the precise nature of the predetermined resection rate, it is possible to determine whether the cutter 234 is Planned resection area To interact with 302, the treatment controller 208 tracks the amount of bone removed using a predetermined ablation rate.

[0043] According to an exemplary system, the treatment controller 208 (FIG. 2) can be designed and constructed to update the user interface 300 as bone is resected. At a high level, as bone is removed, the user interface 300 Planned resection area The visual indication in 302 may be updated to indicate the remaining bone to be removed. Planned resection area Considering again 302, as bone is removed, the treatment controller 208 may make the color "cooler" Planned resection area The area may initially change color in the visual representation of 302. The part that needs to be removed moreIf the bone is shown in "warmer" colors, as bone is removed the remaining bone may be shown in progressively "cooler" colors (e.g. pink becomes blue, blue becomes green). Planned resection area When all bone from the area has been removed, the treatment controller 208 may show the exposed bone as white on the screen, which Planned resection area The cutter 234 may be positioned adjacent to an area where too much bone has been removed, thereby matching the remaining portion of the bone outside of the cutter 234. When too much bone has been removed, the exposed bone may appear in a different, alarming, or warning color (e.g., red). In still other cases, additional audible and visual changes may be implemented when the cutter 234 is adjacent to an area where too much bone has been removed. Planned resection area First, the treatment controller 208 Planned resection area 302. Once the bone is removed, Planned resection area The remaining resection should be removed portion 3, which is displayed on the display device 212 (FIG. 2) to show the remaining ablation to be removed. portion Here, the specification states that cutter 234 and Planned resection area 302 to control the ablation rate based on the physical relationship between the

[0044] 4A, 4B, 4C, and 4D illustrate, according to at least some embodiments, Planned resection area 4A shows the distal end of the ablation device relative to the portion An exemplary embodiment with two regions: Planned resection area 302 shows the change in resection portion The regions are indicated by two patterns of cross-hatching. As noted above, exemplary denser cross-hatching indicates areas where a greater amount should be removed, and less dense cross-hatching indicates areas where a lesser amount should be removed. Planned resection area Also shown is cutter 234 of ablation device 206 adjacent 302. By monitoring the location of cutter 234 in three-dimensional coordinate space, treatment controller 208 (FIG. 2) also Planned resection areaBased on the location of cutter 234 relative to 302, the cutting speed of cutting device 206 can be controlled. Planned resection area 302 is shown to be the same, indicating that resection has just begun. However, FIG. 4D shows that all bone planned to be removed has been removed (hence the absence of cross-hatching). Planned resection area Some bone mass was removed, including the lower right area of Planned resection area The intermediate state of 302 is shown.

[0045] In some exemplary cases, controlling the ablation rate includes: Planned resection area 4A and 4C, the rotational speed of the cutter 234 may be controlled based on the location of the cutter 234 relative to 302. Planned resection area Consider the first movement of cutter 234 relative to 302. In FIG. 4A, cutter 234: Planned resection area 302, and in FIG. 4C, cutter 234 Planned resection area 4C is moved outside the boundaries of 302, which means that cutter 234 in FIG. 4C is adjacent to bone that should not be removed. According to at least some embodiments, treatment controller 208 (FIG. 2) Planned resection area In other words, in the exemplary system, the treatment controller 208 is designed and constructed to: Planned resection area 302, and the treatment controller 208 determines whether the cutter 234 is Planned resection area When adjacent to the outer bone of 302, the ablation device is turned off (eg, by communication with ablation controller 214 (FIG. 2)).

[0046] Furthermore Planned resection area Consider the exemplary case of controlling the cutting rate based on the location of cutter 234 relative to 302, now as shown by FIGS. 4A and 4D: Planned resection area Consider the movement of cutter 234 relative to 302. In FIG. 4A, cutter 234 is positioned in an area where bone still needs to be removed. Planned resection area 302, and in FIG. 4D , the cutter 234 is adjacent to an area of bone where all bone planned to be removed has been removed, meaning that the cutter 234 is now adjacent to bone that should not be removed. According to at least some embodiments, the treatment controller 208 ( FIG. 2 ) is designed and constructed to reduce the rotational speed of the cutter 234 to zero in response to the cutter 234 being adjacent to bone that should not be removed. In other words, in the exemplary system, the treatment controller 208: Planned resection area 302, and the treatment controller 208 determines whether the cutter 234 is Planned resection area When adjacent to the bone below 302, the ablation device is turned off (eg, by communication with ablation controller 214 (FIG. 2)).

[0047] The cutter 234 is positioned to cut bone that should not be removed (e.g., Planned resection area Outside 302 or Planned resection area In addition to turning off the ablation device 206 when adjacent to the surgical site (below 302), further exemplary embodiments provide tactile feedback to the surgeon and / or audible feedback to the surgeon to Planned resection area 302 to provide an indication of the location of the cutter 234. With respect to tactile / audible feedback, as shown in FIGS. 4A and 4B: Planned resection area Consider the movement of cutter 234 relative to 302. In FIG. 4A, cutter 234 moves in areas requiring more bone to be removed. Planned resection area 302, in FIG. 4B, cutter 234 is adjacent to an area requiring less bone to be removed. According to at least some embodiments, treatment controller 208 (FIG. 2) is designed and constructed to vary the rotational speed of cutter 234 in response to cutter 234 being adjacent to an area with a different amount of bone to be removed. For example, cutter 234 is adjacent to an area requiring more bone to be removed. Planned resection areaWhen adjacent a portion of 302 (e.g., FIG. 4A), treatment controller 208 may instruct resection controller 214 (FIG. 2) to drive cutter 234 at a first rotational speed. However, when cutter 234 is adjacent a portion that has less bone to be removed, Planned resection area 302 (FIG. 4B), the treatment controller 208 can instruct the resection controller to drive the cutter 234 at a second rotational speed that is slower than the first rotational speed. Conversely, when the cutter 234 is moving relative to the cutter 234, the second rotational speed is slower than the first rotational speed. Planned resection area When adjacent a portion of 302 (e.g., FIG. 4B), treatment controller 208 directs resection controller 214 (FIG. 2) to drive cutter 234 at a first rotational speed so that cutter 234 is adjacent a portion having more bone to be removed. Planned resection area 302 (FIG. 4A), the treatment controller 208 can command the ablation controller 214 to drive the cutter 234 at a second rotational speed that is faster than the first rotational speed. Such a speed control mechanism can: Planned resection area 302. Similarly, and given that changes in rotational speed may also produce changes in the audible sound made by the resection device 206, such a speed control mechanism may therefore Planned resection area Audible feedback may be provided to the surgeon regarding the location of cutter 234 within 302. In such an example, the cutting rate may be higher if cutter 234 is adjacent to a location where more bone should be removed.

[0048] In addition to, or instead of, audible feedback based on the speed of the cutter 234, the treatment controller 208 may: Planned resection areaThe treatment controller 208 may have a sound generating device or speaker that generates an audible sound based on the location of the cutter 234 relative to the instrument. In still further embodiments, the speed control aspect may be disabled, and the rotational speed of the cutter 234 is left solely to the discretion of the surgeon (e.g., based on the surgeon interacting with a foot pedal or button on the handpiece). In such cases, the treatment controller 208 may still Planned resection area The location of the cutter 238 may be tracked relative to the Planned resection area When outside or below the threshold, the treatment controller 208 may provide an audible and / or visual warning, but the rotational speed of the cutter 238 remains unchanged.

[0049] Exemplary tactile and / or audible feedback to the surgeon also includes: Planned resection area 4A, 4B, and 4C, the cutter 234 may be used to notify the surgeon of the proximity of the cutter 234 to the outer boundary of the endoscopic device 302. Planned resection area Consider the movement of cutter 234 relative to 302. In FIG. 4A, cutter 234 is Planned resection area 302, Planned resection area In FIG. 4B, the cutter 234 is adjacent to the center of Planned resection area 4C, the cutter 234 is moved from near the center near the boundary of the Planned resection area 302. According to at least some embodiments, the treatment controller 208 (FIG. 2) Planned resection area The cutter 234 is designed and constructed to change its rotational speed in response to movement of the cutter 234 toward the boundary of 302. For example, the cutter 234 may be Planned resection area When the cutter 234 is near the center of 302, the treatment controller 208 may command the ablation controller 214 (FIG. 2) to drive the cutter 234 at a rotational speed. Planned resection area As the cutter 234 moves closer to the boundary of 302, the treatment controller 208 may instruct the ablation controller to drive the cutter 234 at progressively slower rotational speeds as a function of how close the cutter 234 is to the boundary. In some cases, the treatment controller 208 may then instruct the ablation controller 208 to drive the cutter 234 at progressively slower rotational speeds as a function of how close the cutter 234 is to the boundary.Planned resection area The velocity of the cutter 234 may be reduced to zero when crossing the boundary of Planned resection area As one moves away from the boundary of 302, the treatment controller 208 may command the ablation controller to drive the cutter 234 at progressively faster rotational speeds as a function of how far the cutter 234 is from the boundary. Planned resection area 302. Similarly, and given that changes in rotational speed may also produce changes in the audible sound made by the resection device 206, such a speed control mechanism may therefore Planned resection area Audible ("speakerless") feedback may be provided to the surgeon regarding the location of cutter 234 within 302. Similar audible feedback may be implemented with a sound generating element or speaker. The specification now turns to generating simulated fluoroscopic images to assist the surgeon in determining whether enough bone has been removed.

[0050] FIG. 5 illustrates an exemplary user interface, according to at least some embodiments. Specifically, the user interface 500 may be displayed on the display device 212 (also FIG. 2) of the device cart 204 (FIG. 2) during an intraoperative procedure to treat femoroacetabular impingement. While the exemplary user interface 500 is shown in the context of resecting bone from a femur to treat a cam deformity, the display techniques and associated features are equally applicable to resecting bone from an acetabulum to treat a pincer deformity. The user interface 500 of FIG. 5 illustrates a virtual or simulated fluoroscopic image 502 including a portion of the femur 102 having a cam deformity 504. According to an exemplary case, the simulated fluoroscopic image may be rendered from a three-dimensional model created (e.g., by the planning computer 200 and / or the cloud computer 202) during preoperative planning and taking into account the amount of bone removed.

[0051] As mentioned above, in the exemplary embodiment, treatment controller 208 (FIG. 2) Planned resection area The cutter 234 is designed and constructed to monitor the location of the cutter 234 relative to the hip joint and track the amount of bone resected. Based on tracking the amount of bone resected, the treatment controller 208 can be designed and constructed to generate simulated fluoroscopic images 502 showing the hip joint as it will appear after the amount of bone has been removed. According to an exemplary embodiment, the treatment controller 208 can generate simulated fluoroscopic images from any of a variety of perspectives and any of a variety of hip flexions, all to assist the surgeon in determining whether enough bone has been removed to address femoroacetabular impingement. In some cases, the surgeon may use the simulated fluoroscopic images 502 alone, without actual fluoroscopic imaging. In other cases, the surgeon may use the simulated fluoroscopic images 502 as an initial guide, then verify with intraoperative fluoroscopic imaging.

[0052] 5, a single fluoroscopic image is shown, and thus the simulated fluoroscopic image 502 of FIG. 5 may be equivalently described as being a single X-ray image. However, in still further cases, the exemplary treatment controller 208 (FIG. 2) may render and display a series of images, thus generating simulated fluoroscopic imaging, including showing movement of the femur 102 relative to the acetabulum 140, to indicate potential impingement problems from any suitable perspective.

[0053] Figure 6 illustrates a partial block diagram and partial flow diagram of a system for treating femoroacetabular impingement. Specifically, Figure 6 is conceptually organized into a preoperative planning aspect 600 and an intraoperative treatment aspect 602. From a system perspective, Figure 6 illustrates, in block diagram form, the planning computer 200 and / or cloud computer 202, the treatment controller 208, the display device 212, the stereoscopic camera 210, the resection controller 214, the resection device 206, and the femoral reference array 220. In other cases, the reference array may be an acetabular reference array.

[0054] The planning computer 200 and / or cloud computer 202 are provided with a plurality of images during the pre-operative planning aspect 600. While FIG. 6 shows the plurality of images provided as designated CT scan images by block 604, any suitable image type or combination of image types may be provided to the planning computer 200 and / or cloud computer 202. The exemplary planning computer 200 and / or cloud computer 202 may execute bone modeling software 606 and resection planning software 608. The bone modeling software 606 is designed and constructed to create a three-dimensional model of at least a portion of the hip joint based on the plurality of images (from block 604), using any suitable form of three-dimensional model, as discussed above. The resection planning software 608 Planned resection area Prior to the intraoperative procedure aspect 602, the planning computer 200 and / or cloud computer 202 creates a three-dimensional model of the bone and the planned resection, as indicated by arrow 609. portion may be transferred to the treatment controller 208. Planned resection area The transfer may take any suitable form, such as transfer using an Ethernet connection, a direct-coupled serial communication protocol, a wireless point-to-point connection (e.g., Bluetooth), or a memory device (e.g., a Universal Serial Bus (USB) solid-state drive).

[0055] Referring further to FIG. 6 , and specifically now to the intraoperative treatment aspect 602, the exemplary treatment controller 208 is operably coupled to a display device 212 to display any of the exemplary user interfaces discussed above. Additionally, the treatment controller 208 is operably coupled to a stereo camera 210 to receive stereo images of the surgical field, including stereo images of the optical tracking array 236 ( FIG. 2 ) of the ablation device 206 and a reference array coupled to the bone, which in the exemplary case of FIG. 6 is the femoral reference array 220. Still further, the exemplary treatment controller 208 is operably coupled to an ablation controller 214 in any suitable form (e.g., Universal Serial Bus (USB), controller area network (CAN) bus). By connecting to the ablation controller 214, the treatment controller 208: Planned resection area The treatment controller 208 may control the rotational speed of the cutter of the ablation device 206 as a function of the location of the cutter relative to the Planned resection area and the rotational speed of the cutter of the resection device 206 may be controlled as a function of the location of the cutter relative to the speed desired by the surgeon (such as by interaction with a foot pedal). The slower rotational speed indicated by the location of the cutter and foot pedal may be the rotational speed actually implemented.

[0056] Operatively, the treatment controller 208 executes resection control software 610. The resection control software 610 is conceptually, although not necessarily physically, divided into three exemplary components: anatomical registration software 612, tissue resection software 614, and resection assessment software 616. The anatomical registration software 612 is used during the registration process. As an example, consider an intraoperative procedure to remove a cam deformity from the femoral neck. During the registration process, the treatment controller 208 correlates the three-dimensional model of the bone provided by the planning computer 200 and / or cloud computer 202 to the actual femur by tracking the femoral reference array 220 as the surgeon touches various points on the femur with a probe and corresponding probe reference array (the probe and corresponding probe reference array are not shown to avoid overcomplicating the illustration). Once the registration process is complete, the exemplary intraoperative treatment aspect 602 can proceed with bone resection.

[0057] 6 , during bone resection, the tissue resection software 614 performs various tasks. For example, the tissue resection software 617 may monitor the location of the hip joint portion in three-dimensional coordinate space (e.g., the femur using the femur reference array 220), monitoring using the stereoscopic camera 210. Similarly, the tissue resection software 617 may monitor the location of the cutter of the resection device 206 in three-dimensional coordinate space, monitoring using the stereoscopic camera 210 and the optical tracking array 236 ( FIG. 2 ) associated with the resection device 206. Based on the location of the hip joint portion and the location of the cutter of the resection device 206, the exemplary tissue resection software 614 may track the amount of bone resected from the hip joint portion. Additionally, the tissue resection software 614 may: Planned resection area The cutting rate of the cutting device 206 may be controlled based on the location of the cutter of the cutting device 306 relative to the target. Planned resection areaThis may take any of the forms described above, including reducing the ablation rate to zero (e.g., turning off the ablation device) when the tissue is outside or below the target tissue. Controlling the ablation rate may be implemented by tissue ablation software 614 of treatment controller 208 in communication with ablation controller 214, as shown by line 618.

[0058] 6 shows the resection assessment software 616 running after the tissue resection software 614 for ease of illustration, but in practice the resection assessment software 616 may run simultaneously or in parallel with the tissue resection software 614. The resection assessment software 616 receives the three-dimensional bone model, the planned resection model (including the remaining bone to be resected), and Planned resection area 3, the resection assessment software 616 may be designed and constructed to create the various user interfaces described above, such as user interface 300 that shows a visual indication of the cutter location relative to the hip joint. In addition to, or instead of, user interface 300 of FIG. 3, the resection assessment software 616 may create a user interface 500 that shows either a single virtual fluoroscopic image or a series of virtual fluoroscopic images including hip joint movement, with an image showing the underlying bone so that the image takes into account the amount of bone already resected.

[0059] 7 illustrates a method for treating femoroacetabular impingement, according to at least some embodiments. Some or all of the methods may be implemented by a processor executing software. Specifically, the exemplary method includes monitoring the location of a first portion of the hip joint in three-dimensional coordinate space (block 700). Concurrent with monitoring the location of the joint, the exemplary method includes monitoring the location of a cutter of a resection device in three-dimensional coordinate space (block 702). The exemplary method then includes tracking the amount of bone resected from the first portion of the hip joint (block 704). From there, the exemplary method: Planned resection areaand controlling the cutting rate of the resection device based on the location of the distal end of the resection device relative to the femoroacetabular impingement (Block 708). The method then repeats during an intraoperative procedure to treat the femoroacetabular impingement.

[0060] 8 illustrates a method for controlling the cutting rate of an ablation device according to at least some embodiments. Some or all of the method may be implemented by a processor running software. Specifically, FIG. 8 illustrates a method for controlling the cutting rate of an ablation device according to at least some embodiments. Some or all of the method may be implemented by a processor running software. In particular, FIG. 8 illustrates a method for controlling the cutting rate of an ablation device according to at least some embodiments. Planned resection area , and the surgeon has turned on the cutter (e.g., rotated the cutter element), so conceptually the method may begin at block 800. From turning on the cutter (again, block 800), the exemplary method begins with the cutter being Planned resection area At some point, the cutter may be positioned adjacent to the Planned resection area The outer bone of the periphery of Planned resection area If the bone is adjacent to the bone below (block 802 again), the exemplary method proceeds to stopping the cutter (block 804). Once the cutter is stopped, the exemplary method: Planned resection area Track the location of the cutter in relation to the Planned resection area The method then proceeds to determine when the cutter is again adjacent to the internal bone (block 806). Planned resection area When the cutter is again adjacent to the bone having the .DELTA..DELTA..times ...

[0061] Continuing with reference to Figure 8, this time the cutter: Planned resection area The process begins with determining whether the cutter is adjacent to the Planned resection area Assuming that the cutter is still adjacent to (the "yes" path out of decision block 802), the next exemplary decision is whether the cutter is Planned resection area The question is whether the boundary of the Planned resection area The boundary of Planned resection area Not only does it include the perimeter of Planned resection areaThe determination regarding approaching a boundary may be made by determining whether the cutter: Planned resection area This determination may take any suitable form, such as determining that the cutter is within a predetermined distance (e.g., 2 mm to 8 mm, inclusive) of the outer periphery of the cutter, or, if sufficient bone has been removed (e.g., FIG. 4D), determining that the cutter is within a predetermined distance from the inner periphery. Regardless of the precise nature of the boundary in question or the distance to the boundary, when the boundary is approached ("Yes" path from decision block 808), the exemplary method slows the cutter speed (block 810) to reduce the resection rate, or provides tactile / audible feedback to the surgeon that a boundary is being approached, or both. From there, the exemplary method determines that the cutter is within a predetermined distance of the inner periphery of the cutter. Planned resection area , and returns to the determination (again, block 802) as to whether the cutter is adjacent to Planned resection area (the "yes" path out of decision block 802), again the exemplary method determines whether the cutter is adjacent to Planned resection area A determination is made (again, block 808) as to whether the cutter is approaching a boundary. If the cutter is still approaching a boundary, further speed adjustments (block 810) may be made by the exemplary method.

[0062] With further reference to FIG. 8, where the cutter: Planned resection area ("No" path out of decision block 808). An exemplary method is for the cutter to Planned resection area A determination may be made as to whether the cutter is moving away from the boundary (block 812). The determination as to whether the cutter is moving away from the boundary may take any suitable form. For example, if the cutter is Planned resection area Moving a predetermined distance (e.g., 2 mm to 8 mm, inclusive) away from any boundary of the cutter may be an indication that the cutter is moving away from the boundary. Planned resection areaWhen the cutter's average distance to the nearest boundary of increases, such may be an indicator that the cutter is moving away from the boundary. Regardless of the precise nature of the boundary in question or the distance to the boundary, if the cutter is moving away from the boundary ("Yes" path from decision block 812), the exemplary method may increase the cutter speed (block 814) and then re-enter decision block 808. In summary, if the cutter is generally Planned resection area As the cutter moves away from the boundary, the cutter speed may increase to a predetermined speed, and as the cutter approaches the boundary, the cutter speed may decrease.

[0063] 9 illustrates an exemplary computer system 900. In one example, computer system 900 may correspond to planning computer 200, cloud computer 202, or treatment controller 208. The computer system may be connected (e.g., networked) to other computer systems within a local area network (LAN), an intranet, an extranet, or the Internet. Computer system 900 may be a personal computer (PC), a tablet computer, or any device capable of executing a set of instructions (sequential or otherwise) that specify actions to be taken by that device. Furthermore, while only a single computer system is illustrated, the term "computer" should also be taken to include any collection of computers that individually or collectively execute a set of instructions (or multiple sets) to perform any one or more of the methodologies discussed herein.

[0064] The computer system 900 includes a processing device 902, a main memory 904 (e.g., read-only memory (ROM), flash memory, dynamic random access memory (DRAM), e.g., synchronous DRAM (SDRAM)), a static memory 906 (e.g., flash memory, static random access memory (SRAM)), and a data storage device 908 that communicate with each other via a bus 910.

[0065] Processing device 902 represents one or more general-purpose processing devices, such as a microprocessor, a central processing unit, or the like. More specifically, processing device 902 may be a complex instruction set computing (CISC) microprocessor, a reduced instruction set computing (RISC) microprocessor, a very long instruction word (VLIW) microprocessor, or a processor implementing other instruction sets or a combination of instruction sets. Processing device 902 may also be one or more special-purpose processing devices, such as an application specific integrated circuit (ASIC), a field programmable gate array (FPGA), a digital signal processor (DSP), a network processor, or the like. Processing device 902 is configured to execute instructions to perform any of the operations and steps discussed herein. When programmed with specific instructions, processing device 902, and thus computer system 900 as a whole, becomes a special-purpose device.

[0066] Computer system 900 may further include a network interface device 912. Computer system 900 may also include a video display 914 (e.g., display device 212 or a display device associated with planning computer 200 of FIG. 2 ), one or more input devices 916 (e.g., a keyboard and / or a mouse), and one or more speakers 918. In one illustrative example, video display 914 and input device 916 may be combined into a single component or device (e.g., an LCD touch screen).

[0067] The data storage device 908 may include a computer-readable storage medium 920 having stored thereon instructions 922 embodying any one or more of the methodologies or functions described herein (e.g., implementing any method and any function performed by any device and / or component described and illustrated herein). The instructions 922 may also reside, completely or at least partially, within the main memory 904 and / or the processing device 902 during execution thereof by the computer system 900. As such, the main memory 904 and the processing device 902 also constitute computer-readable media. The instructions 922 may further be transmitted or received over a network via the network interface device 912.

[0068] While the computer-readable storage medium 920 is shown in the illustrative example to be a single medium, the term "computer-readable storage medium" should be taken to include a single medium or multiple media (e.g., a centralized or distributed database and / or associated caches and servers) that store one or more sets of instructions. The term "computer-readable storage medium" should also be taken to include any medium that can store, encode, or carry a set of instructions for execution by a machine and that cause the machine to perform any one or more of the methodologies of the present disclosure. Thus, the term "computer-readable storage medium" should be taken to include, but is not limited to, solid-state memory, optical media, and magnetic media.

[0069] The above discussion is meant to be illustrative of the principles and various embodiments of the present invention. Numerous variations and modifications will become apparent to those skilled in the art once the above disclosure is fully appreciated. It is intended that the following claims be interpreted to embrace all such variations and modifications. [Additional note 1] 1. A method for treating femoroacetabular impingement, said method comprising: monitoring, by a treatment controller, a location of the first portion of the hip joint in three-dimensional coordinate space; tracking, with the treatment controller, the amount of bone resected from the first portion of the hip joint by tracking the distal end of a resection device in the three-dimensional coordinate space; associated with the first portion of the hip joint by the treatment controller Planned resection area and controlling an ablation rate of the ablation device based on the location of the distal end of the ablation device relative to the target. [Additional note 2] 2. The method of claim 1, wherein the first part of the hip joint is at least one selected from the group consisting of the femur and the acetabulum. [Additional note 3] Controlling the resection rate may be achieved by adjusting the rate at which the distal end of the resection device has less bone to be removed. Planned resection area 2. The method of claim 1, further comprising reducing the rotational speed of the cutter of the excision device when the cutter is on a portion of the excision device. [Additional note 4] Controlling the cutting speed may be achieved by adjusting the cutting speed to allow the distal end of the cutting device to move closer to the cutting edge where more bone is to be removed. Planned resection area 2. The method of claim 1, further comprising increasing the rotational speed of a cutter of the excision device when the cutter is on a portion of the excision device. [Additional note 5] Controlling the ablation rate Planned resection area10. The method of claim 1, further comprising controlling a rotational speed of a cutter of the resection device based on a location of the distal end of the resection device relative to the remaining bone to be removed. [Additional note 6] Controlling the ablation rate Planned resection area 6. The method of claim 5, further comprising changing the rotational speed of the cutter of the resecting device to zero in response to the distal end of the resecting device being adjacent to a bone outside of the resecting device. [Additional note 7] Controlling the ablation rate Planned resection area 6. The method of claim 5, further comprising changing a rotational speed of the cutter of the resecting device to zero in response to the distal end of the resecting device being adjacent to bone in an area below the bone. [Additional note 8] generating a three-dimensional model of at least a portion of the first portion of the hip joint based on a plurality of images; Based on the three-dimensional model, Planned resection area and then the three-dimensional model and the Planned resection area 2. The method of claim 1, further comprising: providing the treatment controller with [Additional note 9] 9. The method of claim 8, wherein the plurality of images is selected from the group including X-ray images, computed tomography images, ultrasound images, and magnetic resonance imaging images. [Additional Note 10] 9. The method of claim 8, further comprising registering the first component of the hip joint and correlating the first component to the model before monitoring the first portion of the hip joint. [Additional Note 11] 1. A method for treating femoroacetabular impingement, said method comprising: monitoring, by a treatment controller, a location of the first portion of the hip joint in three-dimensional coordinate space; tracking, with the treatment controller, the amount of bone resected by tracking the distal end of the resection device in the three-dimensional coordinate space; generating, by the treatment controller, a simulated fluoroscopic image showing the first portion of the hip joint after the amount of bone has been removed; and displaying the simulated fluoroscopic image on a display device. [Additional Note 12] creating a three-dimensional model of at least a portion of the first portion of the hip joint based on a plurality of images, wherein creating the three-dimensional model is before resecting bone; providing the three-dimensional model to the treatment controller; 12. The method of claim 11, wherein generating the simulated fluoroscopic image further comprises creating the simulated fluoroscopic image based on the three-dimensional model and the amount of resected bone. [Additional Note 13] 13. The method of claim 12, wherein the plurality of images are selected from the group consisting of X-ray images, computed tomography images, and magnetic resonance imaging images. [Additional Note 14] 12. The method of claim 11, wherein generating the simulated fluoroscopic image further comprises generating a plurality of simulated fluoroscopic images, each image at a different angle relative to the hip joint. [Additional Note 15] associated with the first portion of the hip joint Planned resection area 12. The method of claim 11, further comprising controlling an ablation rate of the ablation device based on the location of the distal end of the ablation device relative to the target. [Additional Note 16] Controlling the resection rate may be performed by adjusting the distal end of the resection device to a predetermined amount of bone less than the predetermined amount of bone to be removed. Planned resection area 16. The method of claim 15, further comprising reducing the rotational speed of the cutter of the excision device when the cutter is on a portion of the excision device. [Additional Note 17] Controlling the resection rate may be performed by adjusting the distal end of the resection device to a predetermined amount of bone that is greater than the predetermined amount of bone to be removed. Planned resection area16. The method of claim 15, further comprising increasing the rotational speed of a cutter of the excision device when the cutter is on a portion of the excision device. [Additional Note 18] Controlling the ablation rate Planned resection area 16. The method of claim 15, further comprising controlling a rotational speed of a cutter of the resection device based on the location of the distal end of the resection device relative to the remaining bone to be removed. [Additional Note 19] Controlling the ablation rate Planned resection area 19. The method of claim 18, further comprising changing a rotational speed of the cutter of the resecting device to zero in response to the distal end of the resecting device being adjacent to a bone outside of the resecting device. [Additional Note 20] Controlling the ablation rate Planned resection area 19. The method of claim 18, further comprising changing a rotational speed of the cutter of the resecting device to zero in response to the distal end of the resecting device being adjacent to bone in an area below the bone. [Additional Note 21] 1. A system for treating femoroacetabular impingement, the system comprising: a treatment controller; a stereoscopic camera coupled to the treatment controller; a display device coupled to the treatment controller; an ablation controller communicatively coupled to the treatment controller; an ablation device operably coupled to the ablation controller, the ablation device including a handpiece, an elongated outer tube coupled to the handpiece and extending from the handpiece, and a cutter disposed on a distal end of the elongated outer tube; an optical tracking array coupled to the ablation device and within an optical field of view of the stereoscopic camera; the treatment controller: monitoring a location of the first portion of the hip joint in three-dimensional coordinate space; tracking the amount of bone resected from the first portion of the hip joint by tracking the distal end of the resection device in the three-dimensional coordinate space; associated the first portion of the hip joint Planned resection area and controlling an ablation rate of the ablation device based on a location of the distal end of the ablation device relative to the target. [Additional note 22] 22. The system of claim 21, wherein when the treatment controller monitors the location of the first portion of the hip joint, the treatment controller is further configured to monitor at least one selected from the group including the femur and the acetabulum. [Additional Note 23] When the treatment controller controls the resection rate, the treatment controller may adjust the resection rate to a value less than the predetermined amount of bone to be removed. Planned resection area 22. The system of claim 21, further configured to reduce the rotational speed of the cutter of the excision device when the cutter is on a portion of the excision device. [Additional note 24] When the treatment controller controls the resection rate, the treatment controller may control the resection rate to determine whether the distal end of the resection device has more than a predetermined amount of bone to be removed. Planned resection area 22. The system of claim 21, further configured to increase the rotational speed of a cutter of the excision device when the cutter is located on a portion of the excision device. [Additional note 25] When the treatment controller controls the ablation rate, the treatment controller Planned resection area 22. The system of claim 21, further configured to control a rotational speed of the cutter of the resection device based on a location of the distal end of the resection device relative to the remaining bone to be removed. [Additional note 26] When the treatment controller controls the ablation rate, the treatment controller Planned resection area26. The system of claim 25, further configured to change the rotational speed of the cutter of the resection device to zero in response to the distal end of the resection device being adjacent to a bone outside of the resection device. [Additional note 27] When the treatment controller controls the ablation rate, the treatment controller Planned resection area 26. The system of claim 25, further configured to change the rotational speed of the cutter of the resection device to zero in response to the distal end of the resection device being adjacent to bone in an area below the bone. [Additional note 28] receiving a three-dimensional model of at least a portion of the first portion of the hip joint in three dimensions based on a plurality of images; and Planned resection area 22. The system of claim 21, further configured to: [Additional note 29] 1. A system for treating femoroacetabular impingement, the system comprising: a treatment controller; a stereoscopic camera coupled to the treatment controller; a display device coupled to the treatment controller; an ablation controller communicatively coupled to the treatment controller; an ablation device operably coupled to the ablation controller, the ablation device including a handpiece, an elongated outer tube coupled to the handpiece and extending from the handpiece, and a cutter disposed on a distal end of the elongated outer tube; an optical tracking array coupled to the ablation device and within an optical field of view of the stereoscopic camera; the treatment controller: monitoring a location of the first portion of the hip joint in three-dimensional coordinate space; tracking the amount of bone resected by tracking the distal end of the resection device in the three-dimensional coordinate space; generating a simulated fluoroscopic image showing the first portion of the hip joint without the amount of bone resected; and displaying the simulated fluoroscopic image on the display device. [Additional note 30] 30. The system of claim 29, wherein when the treatment controller generates the simulated fluoroscopic image, the treatment controller is further configured to generate a plurality of simulated fluoroscopic images, each image at a different angle relative to the hip joint. [Additional note 31] the treatment controller is associated with the first portion of the hip joint; Planned resection area 30. The system of claim 29, further configured to control the ablation rate of the ablation device based on the location of the distal end of the ablation device relative to the target. [Additional note 32] When the treatment controller controls the resection rate, the treatment controller may adjust the resection rate to a value less than the predetermined amount of bone to be removed. Planned resection area 32. The system of claim 31, further configured to reduce the rotational speed of the cutter of the excision device when the cutter is on a portion of the excision device. [Additional note 33] When the treatment controller controls the resection rate, the treatment controller may control the resection rate to determine whether the distal end of the resection device has more than a predetermined amount of bone to be removed. Planned resection area 32. The system of claim 31, further configured to increase the rotational speed of the cutter of the excision device when the cutter is located on a portion of the excision device. [Additional note 34] When the treatment controller controls the ablation rate, the treatment controller Planned resection area 32. The system of claim 31, further configured to control a rotational speed of the cutter of the resection device based on a location of the distal end of the resection device relative to the remaining bone to be removed. [Additional note 35] When the treatment controller controls the ablation rate, the treatment controller Planned resection area 35. The system of claim 34, further configured to change the rotational speed of the cutter of the resection device to zero in response to the distal end of the resection device being adjacent to a bone outside of the resection device. [Additional note 36] When the treatment controller controls the ablation rate, the treatment controller Planned resection area 35. The system of claim 34, further configured to change the rotational speed of the cutter of the resection device to zero in response to the distal end of the resection device being adjacent to bone in an area below the bone.

Claims

1. 1. A system for treating femoroacetabular impingement, the system comprising: a treatment controller; a stereoscopic camera coupled to the treatment controller; a display device coupled to the treatment controller; an ablation controller communicatively coupled to the treatment controller; an ablation device operably coupled to the ablation controller, the ablation device including a handpiece, an elongated outer tube coupled to the handpiece and extending from the handpiece, and a cutter disposed on a distal end of the elongated outer tube; an optical tracking array coupled to the ablation device and within an optical field of view of the stereoscopic camera; the treatment controller: monitoring a location of a first portion of the hip joint in three-dimensional coordinate space; tracking the amount of bone resected from the first portion of the hip joint by tracking the distal end of the resection device in the three-dimensional coordinate space; controlling a resection rate of the resection device based on a location of the distal end of the resection device relative to a planned resection associated with the first portion of the hip joint; and The system is further configured, when the treatment controller controls the resection speed, to: 1) reduce the rotational speed of the cutter of the resection device when the distal end of the resection device is over a portion of the planned resection having less than a predetermined amount of bone to be removed; and / or 2) increase the rotational speed of the cutter of the resection device when the distal end of the resection device is over a portion of the planned resection having more than a predetermined amount of bone to be removed.

2. 10. The system of claim 1, wherein when the treatment controller monitors the location of the first portion of the hip joint, the treatment controller is further configured to monitor at least one selected from the group including the femur and the acetabulum.

3. 10. The system of claim 1, wherein when the treatment controller controls the resection rate, the treatment controller is further configured to control a rotational speed of the cutter of the resection device based on a location of the distal end of the resection device relative to remaining bone to be removed in the planned resection.

4. 4. The system of claim 3, wherein when the treatment controller controls the resection speed, the treatment controller is further configured to change the rotational speed of the cutter of the resection device to zero in response to the distal end of the resection device adjacent bone outside the planned resection portion.

5. 4. The system of claim 3, wherein when the treatment controller controls the resection speed, the treatment controller is further configured to change the rotational speed of the cutter of the resection device to zero in response to the distal end of the resection device adjacent bone in an area below the planned resection.

6. 2. The system of claim 1, wherein the treatment controller is further configured to, before controlling the resection rate, receive a three-dimensional model of at least a portion of the first portion of the hip joint in three dimensions based on a plurality of images, and receive a planned resection based on the three-dimensional model.

7. The treatment controller: generating a simulated fluoroscopic image showing the first portion of the hip joint without the amount of bone resected; displaying the simulated fluoroscopic image on the display device; and The system of claim 1 , further configured to:

8. 8. The system of claim 7, wherein when the treatment controller generates the simulated fluoroscopic image, the treatment controller is further configured to generate a plurality of simulated fluoroscopic images, each image at a different angle relative to the hip joint.

Images