Systems, devices and methods for navigated bone resection

Abstract

Examples relate to a method, system and device for guiding a surgical procedure. An example method of performing a surgical procedure on a bone comprises obtaining a surgical plan including a position and orientation of a cut plane for a resection of the bone, providing first navigation data to guide insertion into the bone of a guide wire perpendicular to the orientation of the cut plane, subsequent to insertion of the guide wire, providing second navigation data to guide a position of a cut block along the guide wire, wherein the cut block comprises at least one reference cut surface configured to position a resection tool during the surgical procedure, based on the second navigation data, affixing the cut block to the bone such that the at least one reference cut surface is aligned with the cut plane, and performing a resection of the bone guided by the at least one reference cut surface.

Description

SYSTEMS, DEVICES AND METHODS FOR NAVIGATED BONE RESECTIONTECHNICAL FIELD

[0001] The present disclosure relates generally to methods, systems, and apparatuses related to navigation of a cut plane for a surgical procedure using a computer-assisted surgical system that includes various hardware and software components that work together to enhance surgical workflows. The disclosed techniques may be applied to, for example, shoulder, hip, and knee arthroplasties, as well as other surgical interventions.BACKGROUND

[0002] During a shoulder arthroplasty procedure, such as a Total Shoulder Arthroplasty (TSA), damaged areas of bone forming one or both sides of the shoulder joint is removed and replaced with implant(s) designed to replicate the functionality of the shoulder joint. Accurate positioning of implants during the surgical procedure may have a significant effect on the success of the procedure and patient outcomes.

[0003] Shoulder arthroplasty procedures have conventionally been performed using a free hand technique or using manual instrumentation by referencing anatomical landmarks for implant placement. As such, accuracy may rely on the skill of a practitioner performing the procedure. Preparation of the humerus, and in particular accurate control of the humeral neck cut trajectory and resection depth influences implant placement and therefore effects joint stability. However, replicating a pre-operative plan on humeral implant placement with intra-operative guidance is not currently supported.

[0004] Surgical systems that use patient-specific instrumentation (PSI), such as custom-made bone cutting guides, patient-specific instruments and other smart surgical planning tools have been applied to preparation of the humerus, but may increase costs and extend a period before the surgery can be performed due to the time taken to prepare the customized cutting-jig. Even within a computer-assisted surgical setting, shoulder arthroplasty procedures do not include automated, computer-assisted humerus preparation processes.

[0005] Surgeons would benefit greatly from real-time guidance and / or navigation tools that provide for navigation of the humeral neck cut trajectory in line with a pre-operative plan.BRIEF DESCRIPTION OF THE DRAWINGS

[0006] By way of illustration, specific examples will now be described, with reference to the accompanying drawings, in which:

[0007] FIG. 1 depicts an operating theatre including an illustrative computer-assisted surgical system (CASS) in accordance with one or more features of the present disclosure;

[0008] FIG. 2A depicts illustrative control instructions that a surgical computer provides to other components of a CASS in accordance with an embodiment;

[0009] FIG. 2B depicts illustrative control instructions that components of a CASS provide to a surgical computer in accordance with an embodiment;

[0010] FIG. 3 depicts a device for guiding a cut plane for a resection of a bone in accordance with an embodiment;

[0011] FIG. 4 depicts the device of FIG. 3 mounted to an surgical tool for use with the CASS of FIG. 1 in accordance with embodiments;

[0012] FIG. 5A-5D illustrate steps of a method of guiding a position of a cut plane using the device of FIG. 3 in accordance with an embodiment; and

[0013] FIG. 6 illustrates a method of computer-assisted guidance of performing a resection of a bone in accordance with an embodiment.DETAILED DESCRIPTION

[0014] This disclosure is not limited to the particular systems, devices and methods described, as these may vary. The terminology used in the description is for the purpose of describing the particular versions or examples only and is not intended to limit the scope.

[0015] As used in this document, the singular forms “a,” “an,” and “the” include plural references unless the context clearly dictates otherwise. Unless defined otherwise, all technical and scientific terms used herein have the same meanings as commonly understood by one of ordinary skill in the art. Nothing in this disclosure is to be construed as an admission that the examples described in this disclosure are not entitled to antedate any public or other disclosure. As used in this document, the term “comprising” means “including, but not limited to.”

[0016] The described technology generally relates to surgical processes, for example, shoulder arthroplasty procedures including, without limitation, a total shoulder arthroplasty (TSA) procedure. In any preceding or subsequent example, a surgical process may include a method forguiding a position of a cut plane for resection of a bone according to a surgical plan, such as when performing a humeral neck cut. A surgical workflow according to any preceding or subsequent example may include obtaining a surgical plan including a position and orientation of a cut plane for a resection of the bone, providing first navigation data to guide insertion into the bone of a guide wire perpendicular to the orientation of the cut plane, subsequent to insertion of the guide wire, providing second navigation data to guide a position of a cut block along the guide wire, wherein the cut block comprises at least one slot configured to position a resection tool during the surgical procedure, based on the second navigation data, affixing the cut block to the bone such that the at least one slot is aligned with the cut plane, and performing a resection of the bone guided by the at least one slot.

[0017] In any preceding or subsequent example, surgical processes may be or may include a surgical workflow for computer-assisted or navigated arthroplasty procedures. A surgical workflow may include registering the patient’s anatomy intra-operatively in order to create a three- dimensional (3D) representation of the a bone to be resected. The patient’s anatomy may be automatically landmarked and measured in order to characterize the anatomy

[0018] There are multiple benefits to computer-assisted surgery, which has led to its widespread adoption and promoted technological advancement. Benefits may include more accurate implant size, position, and orientation , improved range of motion, improved soft tissue balance, reduced risk of injury to soft tissues, reduced outliers, quicker recovery, and / or reduced post-operative pain. Overall, computer-assisted arthroplasty may allow for more accurate and precise bone cuts, implant placement, and / or better joint alignment which, ultimately, facilitates improved patient outcomes.

[0019] FIG. 1 depicts an example computer-assisted surgical system (CASS) 100 according to any preceding or subsequent example that uses computers, robotics, and imaging technology to aid surgeons in performing orthopedic surgery procedures such as knee arthroplasty (e.g., total knee arthroplasty (TKA)) or total hip arthroplasty (THA). For example, surgical navigation systems can aid surgeons in locating patient anatomical structures, guiding surgical instruments, and implanting medical devices with a high degree of accuracy. Surgical navigation systems such as the CASS 100 often employ various forms of computing technology to perform a wide variety of standard and minimally invasive surgical procedures and techniques. Moreover, these systems allow surgeons to more accurately plan, track, and navigate the placement of instruments and implants relative to the body of a patient, as well as conduct pre-operative and intra-operative body imaging.

[0020] An Effector Platform 105 positions surgical tools relative to a patient during surgery. For example, for a shoulder surgery, the Effector Platform 105 may include an End Effector 105B that holds surgical tools or instruments during their use. The End Effector 105B may be a handheld device or instrument used by the surgeon (e.g., a hand piece of a surgical system) or, alternatively,the End Effector 105B can include a device or instrument held or positioned by a Robotic Arm 105 A.

[0021] Effector Platform 105 can include a Limb Positioner 105C for positioning the patient’s limbs during surgery. Resection Equipment 110 (not shown in FIG. 1) performs bone or tissue resection using, for example, mechanical, ultrasonic, or laser techniques. Examples of Resection Equipment 110 may include drilling devices, burring devices, oscillatory sawing devices, vibratory impaction devices, reamers, ultrasonic bone cutting devices, radio frequency ablation devices, and laser ablation systems. In any preceding or subsequent example, the Resection Equipment 110 is held and operated by the surgeon during surgery. In other examples, the Effector Platform 105 may be used to hold the Resection Equipment 110 during use.

[0022] Effector Platform 105 can also include a cutting guide or jig 105D that is used to guide saws or drills used to resect tissue during surgery. Such cutting guides 105D can be separate structures that can be matingly and / or removably attached to the Effector Platform 105 or Robotic Arm 105 A.

[0023] A Tracking System 115 uses one or more sensors to collect real-time position data that locates the patient’s anatomy and surgical instruments. For example, for TSA procedures, the Tracking System may provide a location and orientation of the End Effector 105B during the procedure. In any preceding or subsequent example, the Tracking System 115 may use a tracker array attached to the End Effector 105B to determine the location and orientation of the End Effector 105B. The position of the End Effector 105B may be inferred based on the position and orientation of the Tracking System 115 and a known relationship in three-dimensional space between the Tracking System 115 and the End Effector 105B. Any suitable tracking system can be used for tracking surgical objects and patient anatomy in the surgical theatre. For example, a combination of infrared (IR) and visible light cameras can be used in an array.

[0024] In addition to optical tracking, certain features of objects can be tracked by registering physical properties of the object and associating them with objects that can be tracked, such as fiducial marks fixed to a tool or bone. For example, a surgeon may perform a manual registration process whereby a tracked tool and a tracked bone can be manipulated relative to one another. By impinging the tip of the tool against the surface of the bone, a three-dimensional surface can be mapped for that bone that is associated with a position and orientation relative to the frame of reference of that fiducial mark. By optically tracking the position and orientation (pose) of the fiducial mark associated with that bone, a model of that surface can be tracked with an environment through extrapolation.

[0025] The registration process that registers the CASS 100 to the relevant anatomy of the patient can also involve the use of anatomical landmarks, such as landmarks on a bone or cartilage. For example, the CASS 100 can include a 3D model of the relevant bone or joint and the surgeon canintraoperatively collect data regarding the location of bony landmarks on the patient’s actual bone using a probe that is connected to the CASS. Alternatively, the CASS 100 can construct a 3D model of the bone or joint without pre-operative image data by using location data of bony landmarks and the bone surface that are collected by the surgeon using a CASS probe or other means.

[0026] A Tissue Navigation System (not shown in FIG. 1) provides the surgeon with intraoperative, real-time visualization for the patient’s bone, cartilage, muscle, nervous, and / or vascular tissues surrounding the surgical area.

[0027] The Display 125 provides graphical user interfaces (GUIs) that display images collected by the Tissue Navigation System as well other information relevant to the surgery. For example, the Display 125 overlays image information collected from various modalities (e.g., CT, MRI, X- ray, fluorescent, ultrasound, etc.) collected pre-operatively or intra-operatively to give the surgeon various views of the patient’s anatomy as well as real-time conditions.

[0028] Surgical Computer 150 provides control instructions to various components of the CASS 100, collects data from those components, and provides general processing for various data needed during surgery.

[0029] Part of the flexibility of the CASS design described above with respect to FIG. 1 is that additional or alternative devices can be added to the CASS 100 as necessary to support particular surgical procedures. In some examples, the CASS 100 includes a robotic arm 105 A that serves as an interface to stabilize and hold a variety of instruments used during the surgical procedure. The robotic arm 105A may have multiple degrees of freedom (e.g., like a SPIDER2 device) and have the ability to be locked in place (e.g., by a press of a button, voice activation, a surgeon removing a hand from the robotic arm, or other method).

[0030] A tool or an end effector 105B may be attached or integrated into a robotic arm 105 A and may include, without limitation, a burring device, a scalpel, a cutting device, a retractor, a joint tensioning device, or the like. In examples in which an end effector 105B is used, the end effector may be positioned at the end of the robotic arm 105 A such that any motor control operations are performed within the robotic arm system. In other examples, motor control operation may reside within the end effector 105B itself.

[0031] The robotic arm 105A or the end effector 105B can include a trigger or other means to control the power of a saw or drill. Engagement of the trigger or other means by the surgeon can cause the robotic arm 105 A or end effector 105B to transition from a motorized alignment mode to a mode where the saw or drill is engaged and powered on. Additionally, the CASS 100 can include a foot pedal (not shown) that causes the system to perform certain functions when activated. For example, the surgeon can activate the foot pedal to instruct the CASS 100 to place the robotic arm 105 A or end effector 105B in an automatic mode that brings the robotic arm orend effector into the proper position with respect to the patient’s anatomy in order to perform the necessary resections. The CASS 100 can also place the robotic arm 105A or end effector 105B in a collaborative mode that allows the surgeon to manually manipulate and position the robotic arm or end effector into a particular location. The collaborative mode can be configured to allow the surgeon to move the robotic arm 105 A or end effector 105B medially or laterally, while restricting movement in other directions. As discussed, the robotic arm 105 A or end effector 105B can include a cutting device (saw, drill, and burr) or a cutting guide or jig 105D that will guide a cutting device. In any preceding or subsequent example, movement of the robotic arm 105 A or robotically controlled end effector 105B can be controlled entirely by the CASS 100 without any, or with only minimal, assistance or input from a surgeon or other medical professional. In still any preceding or subsequent example, the movement of the robotic arm 105 A or robotically controlled end effector 105B can be controlled remotely by a surgeon or other medical professional using a control mechanism separate from the robotic arm or robotically controlled end effector device, for example using a joystick or interactive monitor or display control device.

[0032] The robotic arm 105 A may also be used to help stabilize the surgeon’s hand during surgery. In this application, control of the robotic arm 105 A may impose certain restrictions to prevent soft tissue damage from occurring. For example, in any preceding or subsequent example, the Surgical Computer 150 tracks the position of the robotic arm 105 A as it operates. If the tracked location approaches an area where tissue damage is predicted, a command may be sent to the robotic arm 105 A causing it to stop. Alternatively, where the robotic arm 105 A is automatically controlled by the Surgical Computer 150, the Surgical Computer may ensure that the robotic arm is not provided with any instructions that cause it to enter areas where soft tissue damage is likely to occur. The robotic arm 105 A may stabilize the surgeon while using traditional instrumentation and provide certain restrictions or limitations to allow for proper placement of implant components (e.g., guide wire placement, chamfer cutter, sleeve cutter, plan cutter, etc.).

[0033] The various services that are provided by medical professionals to treat a clinical condition are collectively referred to as an “episode of care.” For a particular surgical intervention, the episode of care can include three phases: pre- operative, intra-operative, and post-operative.

[0034] Data acquired during a pre-operative phase generally includes all information collected or generated prior to the surgery. Thus, for example, information about the patient may be acquired from a patient intake form or electronic medical record (EMR). Examples of patient information that may be collected include, without limitation, patient demographics, diagnoses, medical histories, progress notes, vital signs, medical history information, allergies, and lab results. The pre-operative data may also include images related to the anatomical area of interest. These images may be captured, for example, using Magnetic Resonance Imaging (MRI), Computed Tomography (CT), X-ray, ultrasound, or any other modality known in the art. In examples, pre-operative images or other input data may be used to develop a robust plan preoperatively that is then executed during surgery.

[0035] FIGS. 2A and 2B provide examples of data that may be acquired during the intra-operative phase of an episode of care. These examples are based on the various components of the CASS 100 described above with reference to FIG. 1; however, it should be understood that other types of data may be used based on the types of equipment used during surgery and their use. FIG. 2A shows examples of some of the control instructions that the Surgical Computer 150 provides to other components of the CASS 100, according to any preceding or subsequent example.

[0036] The various components included in the Effector Platform 105 are controlled by the Surgical Computer 150 providing position commands that instruct the component where to move within a coordinate system. In any preceding or subsequent example, the Surgical Computer 150 provides the Effector Platform 105 with instructions defining how to react when a component of the Effector Platform 105 deviates from a surgical plan. These commands are referenced in FIG. 2A as “haptic” commands. For example, the End Effector 105B may provide a force to resist movement outside of an area where resection is planned. Other commands that may be used by the Effector Platform 105 include vibration and audio cues.

[0037] Resection Equipment 110 is provided with a variety of commands to perform bone or tissue operations. As with the Effector Platform 105, position information may be provided to the Resection Equipment 110 to specify where it should be located when performing resection.

[0038] During the registration process, for example, the Display 125 can show a preoperatively constructed 3D bone model and depict the locations of the probe as the surgeon uses the probe to collect locations of anatomical landmarks on the patient. The Display 125 can include information about the surgical target area. For example, in connection with a TSA, the Display 125 can depict the mechanical and anatomical axes of the humerus. As the workflow progresses to preparation of bone cuts or resections, the Display 125 can depict the planned or recommended bone cuts before any cuts are performed.

[0039] In some examples, one or more surgical planning models may be incorporated into the CASS 100 and used in the development of the surgical plans provided to the surgeon 111. The term “surgical planning model” may refer to software that simulates the biomechanics, kinematic, and / or the like performance of anatomy under various scenarios to determine the optimal way to perform cutting and other surgical activities.

[0040] FIG. 2B shows examples of some of the types of data that can be provided to the Surgical Computer 150 from the various components of the CASS 100.

[0041] In general, the Surgical Computer 150 may serve as the central point where CASS data is collected. The exact content of the data will vary depending on the source. For example, each component of the Effector Platform 105 provides a measured position to the Surgical Computer 150. Thus, by comparing the measured position to a position originally specified by the SurgicalComputer 150 (see FIG. 2B), the Surgical Computer can identify deviations that take place during surgery.

[0042] Use of a point probe is described in U.S. Patent Application No. 14 / 955,742 entitled “Systems and Methods for Planning and Performing Image Free Implant Revision Surgery,” the entirety of which is incorporated herein by reference. Briefly, an optically tracked point probe may be used to map the actual surface of the target bone that needs a new implant. This is referred to as tracing or “painting” the bone. The collected points are used to create a three-dimensional model or surface map of the bone surfaces in the computerized planning system. The created 3D model of the remaining bone is then used as the basis for planning the procedure and necessary implant sizes. An alternative technique that uses X-rays to determine a 3D model is described in U.S. Patent Application Serial No. 16 / 387,151, filed April 17, 2019 and entitled “Three Dimensional Selective Bone Matching,” the entirety of which is incorporated herein by reference in the present disclosure.

[0043] As noted above, in some examples, a 3D model is developed during the pre-operative stage based on 2D or 3D images of the anatomical area of interest. In such examples, registration between the 3D model and the surgical site is performed prior to the surgical procedure. The registered 3D model may be used to track and measure the patient’s anatomy and surgical tools intraoperatively.

[0044] During the surgical procedure, landmarks may be acquired to facilitate registration of this pre-operative 3D model to the patient’s anatomy.

[0045] Referring to Figure 3, a device 300 for guiding a cut plane for a resection of a bone. The device 300 comprises a first portion, or drill guide, 302 for coupling the device to a tracked surgical tool, such as End Effector 105B and a second portion 304 comprising a cut block. The drill guide 302 and the cut block 304 are connected via joint 310 configured to allow the cut block 304 to be disconnected from the drill guide 302. A channel is provided through the drill guide 302 to allow a guide wire to pass through the center of the device 300 as described in further detail below.

[0046] The cut block 304 includes one or more pin holes 306 that are used by a surgeon 111 to drill and screw or pin the cut block 304 into place before performing a resection of the patient tissue. The cut block 304 further includes at least one reference cut surface, illustrated as cut slot 308, to be used by the surgeon 111 to guide a position of a resection tool.

[0047] In Figure 4, the device 300 of Figure 3 assembled to the End Effector 105B is illustrated in use to prepare the cut block 304 to guide an orientation and depth of a humeral neck cut on humerus 402 according to a pre-operative plan. As illustrated in Figure 4, End Effector 105B includes a tracking array 406 of fiducial markers to allow a position and orientation of the End Effector 105B to be determined by the Tracking System 115, and the position information provided to Surgical Computer 150.

[0048] The Surgical Computer 150 may provide guidance information to a Surgeon 111, for example via display 125, to guide the surgeon 111 to drill a guide wire 404 into the humerus 402 at a trajectory perpendicular to the intended cut plane for the humeral neck cut, as prescribed in the pre-operative plan. The guide wire 404 passes through a channel 408 in the drill guide 302 of the device 300. The cut slot 308, or other reference cut surface provided by the cut block 304, is arranged to be perpendicular to an axis of the channel 408, such that the reference cut surface is perpendicular to the orientation of the guide wire 404 as it is inserted into the bone.

[0049] Thus, by guiding the orientation of the End Effector 105B during drilling of the guide wire 404 to be perpendicular to the desired cut plane, the orientation of the cut block 304 is fixed such that the reference cut surface is parallel to the desired cut plane. Further movement of the cut block 304 while mounted to the End Effector 105B is constrained to be along the axis of the guide wire 404, ensuring that the reference cut plane 308 remains parallel to the desired cut plane, in line with the pre-operative plan.

[0050] Once the guide wire 404 has been inserted into the humerus 402, navigation data to guide the position of the End Effector 105B along the axis of the guide wire 404 is provided by the Surgical Computer 150. The reference cut surface, or cut slot 308, has a fixed spatial relationship with the tracking array 406, such that a distance between the reference cut surface 308 and the tracking array 406 is fixed and known to the Surgical Computer 120. By tracking the position of the End Effector 105B, the Surgical Computer 150 may determine a distance between a current position of the cut block 304 and a target depth of the cut block 304 to align the reference cut surface 308 with the desired cut plane. Navigation data may be provided to the Surgeon 111, for example via display 125, to guide the position of the End Effector 105B in the remaining unconstrained dimension, along the axis of the guide wire 404, to arrive at the target depth.

[0051] Figures 5A-5D illustrate stages of a method of guiding a position of a cut plane for a resection of a bone using the device 300 of Figure 3. Figure 5 A illustrates a first stage of the method in which End Effector 105B, having the device 300 mounted thereto, is used to insert a guide wire 404 into a bone 402. As discussed above, the position and orientation of the End Effector 105B may be monitored via the Tracking System 115. Based on tracking data, the Surgical Computer 150 guides insertion of the guide wire 404 to be perpendicular to a desired cut plane 502, thereby fixing an orientation of the reference cut surface 308 to be parallel to the desired cut plane 502. In embodiments, the Surgical Computer 150 may provide navigation information, or directions, to a Surgeon 111 operating the End Effector 105B via display 125, or AR HMD 155.

[0052] Once the guide wire 404 has been inserted into the bone 402, further movement of the End Effector 105B, and therefore of the cut block 304, is limited to a single degree of freedom along the axis of the guide wire 404. As illustrated in Figure 5B, the End Effector 105B may be positioned along the axis of the guide wire 404 to align the reference cut surface 308 of the cut block 304 with the desired cut plane 502. Navigation information, or directions, may be providedto the Surgeon 111 to indicate a direction and / or distance along the axis of the guide wire 404 to move the End Effector 105B to target depth to align the reference cut surface 308 with the desired cut pane 502.

[0053] Once the reference cut surface 308 is aligned with the desired cut plane, the cut block may be pinned to the bone 402 through pin holes 306. As illustrated in Figure 5C, the Surgeon 111 may insert, e.g. drill and screw, one or more pins 504 through the pin holes 306 and into the bone 402, fixing the cut block 304 in place relative to the bone 402. Cut block 304 is then demounted from the drill guide 302, as illustrated in Figure 5D, and the guide wire withdrawn from the bone 402.

[0054] The Surgeon is then able to perform a resection of the bone 402 at the desired cut plane 502, in accordance with the pre-operative plan, using the reference cut surface 308 to guide the Resection Equipment 110. Once the resection is completed, the bone 402 will have a resected surface prepared for attachment of implant, for example a humeral implant in the case of shoulder arthroplasty.

[0055] Referring to Figure 6, a flowchart of an exemplary surgical method 600 for guided resection of a bone 402 using device 300 is illustrated in accordance with an embodiment. In step 602 a surgical plan is obtained that includes a position and orientation of a cut plane for a resection of the bone 402 according to the surgical plan. In step 604, first navigation information is provided to guide the insertion of a guide wire 404 into the bone, the first navigation information guiding the orientation of a tracked surgical tool, such as an End Effector 105B, used to drill the guide wire 404 to be perpendicular to the orientation of the cut plane defined in the surgical plan, thereby resulting in the inserted guide wire being perpendicular to the desired cut plane.

[0056] In step 606, once the guide wire is in place, second navigation information is provided to guide a position of a cut block mounted to the tracked surgical tool, wherein the movement of the cut block is restricted to moving along the axis of the guide wire. As discussed above, the cut block includes at least one reference cut surface having an orientation that is fixed perpendicular to the guide wire while the cut block is mounted to the tracked surgical tool. The second navigation information guides movement of the cut block along the guide wire until the at least one reference cut surface of the cut block is aligned with the desired cut plane according to the surgical plan.

[0057] In step 608, the cut block is affixed to the bone, for example using one or more pins. The cut block may then be demounted from the tracked surgical tool and the guide wire withdrawn, leaving the cut block in place with the at least one reference cut surface aligned with the desired cut plane. In step 610, a resection of the bone can be performed guided by the at least one reference cut surface facilitating accurate alignment of the resection with the desired cut plane according to the surgical plan.

[0058] While the above description has primarily discussed the use of device 300, and method 600, in respect of a humeral neck cut forming part of a shoulder arthroplasty procedure, thedescribed techniques may be equally applied to resection of other joints, such as femoral neck cut as part of a hip arthroplasty procedure; distal femur cut and / or proximal tibia cut as part of a knee arthroplasty procedure; or tibia notch cut for an ankle arthroplasty procedure.

[0059] Although the systems and methods, as described herein, refer to the shoulder, a person of ordinary skill in the art will understand that similar systems and methods may be applied to other joints such as the knee, hip, ankle, etc.

[0060] While various illustrative embodiments incorporating the principles of the present teachings have been disclosed, the present teachings are not limited to the disclosed embodiments. Instead, this application is intended to cover any variations, uses, or adaptations of the present teachings and use its general principles. Further, this application is intended to cover such departures from the present disclosure that are within known or customary practice in the art to which these teachings pertain.

[0061] In the above detailed description, reference is made to the accompanying drawings, which form a part hereof. In the drawings, similar symbols typically identify similar components, unless context dictates otherwise. The illustrative embodiments described in the present disclosure are not meant to be limiting. Other embodiments may be used, and other changes may be made, without departing from the spirit or scope of the subject matter presented herein. It will be readily understood that various features of the present disclosure, as generally described herein, and illustrated in the Figures, can be arranged, substituted, combined, separated, and designed in a wide variety of different configurations, all of which are explicitly contemplated herein.

[0062] The present disclosure is not to be limited in terms of the particular embodiments described in this application, which are intended as illustrations of various features. Many modifications and variations can be made without departing from its spirit and scope, as will be apparent to those skilled in the art. Functionally equivalent methods and apparatuses within the scope of the disclosure, in addition to those enumerated herein, will be apparent to those skilled in the art from the foregoing descriptions. It is to be understood that this disclosure is not limited to particular methods, devices, or systems, which can, of course, vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting.

[0063] With respect to the use of substantially any plural and / or singular terms herein, those having skill in the art can translate from the plural to the singular and / or from the singular to the plural as is appropriate to the context and / or application. The various singular / plural permutations may be expressly set forth herein for sake of clarity.

[0064] It will be understood by those within the art that, in general, terms used herein are generally intended as “open” terms (for example, the term “including” should be interpreted as “including but not limited to,” the term “having” should be interpreted as “having at least,” the term “includes”should be interpreted as “includes but is not limited to,” et cetera). While various compositions, methods, and devices are described in terms of “comprising” various components or steps (interpreted as meaning “including, but not limited to”), the compositions, methods, and devices can also “consist essentially of or “consist of the various components and steps, and such terminology should be interpreted as defining essentially closed-member groups.

[0065] Various of the above-disclosed and other features and functions, or alternatives thereof, may be combined into many other different systems or applications. Various presently unforeseen or unanticipated alternatives, modifications, variations or improvements therein may be subsequently made by those skilled in the art, each of which is also intended to be encompassed by the disclosed embodiments.

[0066] Examples can be realized according to the following clauses:

[0067] Clause 1 : A method of performing a surgical procedure on a bone comprising obtaining a surgical plan including a position and orientation of a cut plane for a resection of the bone; providing first navigation data to guide insertion into the bone of a guide wire perpendicular to the orientation of the cut plane; subsequent to insertion of the guide wire, providing second navigation data to guide a position of a cut block along the guide wire, wherein the cut block comprises at least one reference cut surface configured to position a resection tool during the surgical procedure; based on the second navigation data, affixing the cut block to the bone such that the at least one reference cut surface is aligned with the cut plane; and performing a resection of the bone guided by the at least one reference cut surface.

[0068] Clause 2: The method of clause 1, wherein the bone comprises one of: a humerus; a femur; or a tibia.

[0069] Clause 3: The method of clause 1, wherein the cut plane comprises one of a humeral neck cut, or a femoral neck cut.

[0070] Clause 4: The method of any of clauses 1 to 3, wherein providing first navigation data comprises monitoring a position of a surgical tool operable to insert the guide wire, the first navigation data to guide an orientation of the surgical tool to insert the guide wire perpendicular to the orientation of the cut plane.

[0071] Clause 5: The method of clause 4, wherein the cut block is demountab ly attached to the surgical tool; and wherein providing second navigation data comprises, subsequent to insertion of the guide wire, monitoring the position of the surgical tool, the second navigation data to guide movement of the surgical tool and attached cut block to align the at least one slot with the cut plane, wherein the movement of the surgical tool is constrained to be along a length of the guide wire.

[0072] Clause 6: The method of clause 5 further comprising, subsequent to affixing the cut block to the bone, demounting the cut block from the surgical tool and removing the guide wire from the bone.

[0073] Clause 7: The method of any of clauses 4 to 6, wherein monitoring the position of the surgical tool comprises monitoring the position using an optical navigation system.

[0074] Clause 8: The method of any of clauses 1 to 7, wherein affixing the cut block to the bone comprises burring one or more holes in the bone and, for each of the one or more holes, inserting a pin through a pin hole of the cut block into the corresponding hole.

[0075] Clause 9: The method of any of clauses 1 to 8, wherein the at least one reference cut surface comprises at least one slot to guide the position of the resection tool.

[0076] Clause 10: A system for guiding a cut plane for a resection of a bone during a surgical procedure, the system comprising a surgical navigation system; a tracked surgical tool operable to insert a guide wire into the bone; and a cut block demountably attached to the tracked surgical tool, wherein the cut block comprises at least one reference cut surface configured to guide a position of a resection tool during the surgical procedure; and wherein the surgical navigation system to provide: first navigation data to guide an orientation of the tracked surgical tool to insert the guide wire perpendicular to a predetermined cut plane for the resection of the bone; and second navigation data to guide a position of the cut block along the guide wire such that the at least one reference cut surface is aligned with the predetermined cut plane.

[0077] Clause 11 : The system of clause 10, wherein the tracked surgical tool comprises an optical tracking array.

[0078] Clause 12: The system of clause 10 or clause 11, wherein the cut block comprises one of a plurality of standard size cut blocks; and wherein for each cut block of the plurality of standard size cut blocks, the at least one reference cut surface is located in a same position relative to the optical tracking array when the cut block is attached to the surgical tool.

[0079] Clause 13: The system of any of clauses 10 to 12, wherein the at least one reference cut surface comprises a slot to guide a position the resection tool during the surgical procedure.

[0080] Clause 14: The system of any of clauses 10 to 13, further comprising a drill guide coupled between the tracked surgical tool and the cut block, the drill guide configured to constrain movement of the cut block along the guide wire.

[0081] Clause 15: A device for guiding a cut plane for resecting a bone, the device comprising a drill guide configured to connect to a tracked surgical tool, the drill guide comprising a channel for a guide wire, the channel to constrain movement of the drill guide along the guide wire; and acut block including at least one reference cut surface and at least one pin hole for pinning the cut block to a bone, the cut block demountably attached to the drill guide; wherein the at least one reference cut surface is perpendicular to the channel when the cut block is attached to the drill guide.

[0082] Clause 16: The device of clause 15, wherein the at least one reference cut surface comprises a cut slot.

[0083] Clause 17: The device of clause 15 or clause 16, the device comprising one or more pin holes for pinning the cut block to the bone.

Claims

Claims1. A method of performing a surgical procedure on a bone comprising: obtaining a surgical plan including a position and orientation of a cut plane for a resection of the bone; providing first navigation data to guide insertion into the bone of a guide wire perpendicular to the orientation of the cut plane; subsequent to insertion of the guide wire, providing second navigation data to guide a position of a cut block along the guide wire, wherein the cut block comprises at least one reference cut surface configured to position a resection tool during the surgical procedure; based on the second navigation data, affixing the cut block to the bone such that the at least one reference cut surface is aligned with the cut plane; and performing a resection of the bone guided by the at least one reference cut surface.

2. The method of claim 1, wherein the bone comprises one of: a humerus; a femur; or a tibia.

3. The method of claim 1, wherein the cut plane comprises one of a humeral neck cut, or a femoral neck cut.

4. The method of claim 1 , wherein providing first navigation data comprises monitoring a position of a surgical tool operable to insert the guide wire, the first navigation data to guide an orientation of the surgical tool to insert the guide wire perpendicular to the orientation of the cut plane.

5. The method of claim 4, wherein the cut block is demountably attached to the surgical tool; and wherein providing second navigation data comprises, subsequent to insertion of the guide wire, monitoring the position of the surgical tool, the second navigation data to guide movement of the surgical tool and attached cut block to align the at least one slot with the cut plane, wherein the movement of the surgical tool is constrained to be along a length of the guide wire.

6. The method of claim 5 further comprising, subsequent to affixing the cut block to the bone, demounting the cut block from the surgical tool and removing the guide wire from the bone.

7. The method of claim 4, wherein monitoring the position of the surgical tool comprises monitoring the position using an optical navigation system.

8. The method of claim 1, wherein affixing the cut block to the bone comprises burring one or more holes in the bone and, for each of the one or more holes, inserting a pin through a pin hole of the cut block into the corresponding hole.

9. The method of claim 1 , wherein the at least one reference cut surface comprises at least one slot to guide the position of the resection tool.

10. A system for guiding a cut plane for a resection of a bone during a surgical procedure, the system comprising: a surgical navigation system; a tracked surgical tool operable to insert a guide wire into the bone; and a cut block demountably attached to the tracked surgical tool, wherein the cut blockcomprises at least one reference cut surface configured to guide a position of a resection tool during the surgical procedure; and wherein the surgical navigation system to provide: first navigation data to guide an orientation of the tracked surgical tool to insert the guide wire perpendicular to a predetermined cut plane for the resection of the bone; and second navigation data to guide a position of the cut block along the guide wire such that the at least one reference cut surface is aligned with the predetermined cut plane.

11. The system of claim 10, wherein the tracked surgical tool comprises an optical tracking array.

12. The system of claim 10, wherein the cut block comprises one of a plurality of standard size cut blocks; and wherein for each cut block of the plurality of standard size cut blocks, the at least one reference cut surface is located in a same position relative to the optical tracking array when the cut block is attached to the surgical tool.

13. The system of claim 10, wherein the at least one reference cut surface comprises a slot to guide a position the resection tool during the surgical procedure.

14. The system of claim 10, further comprising a drill guide coupled between the tracked surgical tool and the cut block, the drill guide configured to constrain movement of the cut block along the guide wire.

15. A device for guiding a cut plane for resecting a bone, the device comprising: a drill guide configured to connect to a tracked surgical tool, the drill guide comprising achannel for a guide wire, the channel to constrain movement of the drill guide along the guide wire; and a cut block including at least one reference cut surface and at least one pin hole for pinning the cut block to a bone, the cut block demountably attached to the drill guide; wherein the at least one reference cut surface is perpendicular to the channel when the cut block is attached to the drill guide.

16. The device of claim 15, wherein the at least one reference cut surface comprises a cut slot.

17. The device of claim 15, the device comprising one or more pin holes for pinning the cut block to the bone.

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