Surgical navigation systems and processes for high tibial osteotomy

• US 20020198451A1
• Filed: 02/27/2002
• Published: 12/26/2002
• Est. Priority Date: 02/27/2001
• Status: Abandoned Application

• Current Assignee: Smith & Nephew Incorporated (Smith & Nephew PLC)
• Original Assignee: Smith & Nephew Incorporated (Smith & Nephew PLC)
• Inventors: Carson, Christopher P.
• Application Number:
  US10/084,291
• Publication Number:
  US 20020198451A1
• Time in Patent Office: Days
• US Class Current: 600/424
• CPC Class Codes: A61B 17/70 Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
• CPC Class Codes: A61B 2034/102 Modelling of surgical devices, implants or prosthesis
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/107 Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/2055 Optical tracking systems
• CPC Class Codes: A61B 2034/2068 using pointers, e.g. pointers having reference marks for determining coordinates of body points
• CPC Class Codes: A61B 2034/2072 Reference field transducer attached to an instrument or patient
• CPC Class Codes: A61B 2034/252 indicating steps of a surgical procedure
• CPC Class Codes: A61B 2034/254 being adapted depending on the stage of the surgical procedure
• CPC Class Codes: A61B 2034/256 having a database of accessory information, e.g. including context sensitive help or scientific articles
• CPC Class Codes: A61B 2090/376 using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2090/3916 Bone tissue
• CPC Class Codes: A61B 2090/3983 Reference marker arrangements for use with image guided surgery
• CPC Class Codes: A61B 34/10 Computer-aided planning, simulation or modelling of surgical operations
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 34/25 User interfaces for surgical systems
• CPC Class Codes: A61B 90/10 for stereotaxic surgery, e.g. frame-based stereotaxis
• CPC Class Codes: A61B 90/36 Image-producing devices or illumination devices not otherwise provided for
• CPC Class Codes: A61F 2/38 for elbows or knees
• CPC Class Codes: A61F 2/3859 Femoral components
• CPC Class Codes: A61F 2/389 : Tibial components A61F2/3868 takes precedence
• CPC Class Codes: A61F 2/4657 : Measuring instruments used for implanting artificial joints for surgical instruments A61B90/06
• CPC Class Codes: A61F 2/4684 : Trial or dummy prostheses
• CPC Class Codes: A61F 2002/30616 : Sets comprising a plurality of prosthetic parts of different sizes or orientations
• CPC Class Codes: A61F 2002/30892 : parallel
• CPC Class Codes: A61F 2002/4632 : using computer-controlled surgery, e.g. robotic surgery

Abstract

Systems and processes for tracking anatomy, instrumentation, and references, and rendering images and data related to them in connection with surgical operations, particularly high tibial osteotomy (“HTO”). These systems and processes are accomplished by using a computer to intraoperatively obtain images of body parts and to register, navigate, and track surgical instruments.

Claims

1. A process for performing high tibial osteotomy surgical operations on portions of a tibia, comprising:

(a) obtaining at least one image of a body part forming a portion of a knee joint with an imager, wherein the body part and the imager are each attached to a fiducial capable of being tracked by at least one position sensor;

(b) registering a surgical instrument adapted to assist the surgeon in shaping bone during high tibial osteotomy, which instrument is attached to a fiducial capable of being tracked by at least one position sensor;

(c) using a computer which receives signals from the at least one sensor, tracking position and orientation of the surgical instrument relative to the body part;

(d) generating and displaying on a monitor associated with the computer a visual image of the instrument properly positioned and oriented relative to the body part;

(e) navigating the surgical instrument relative to the body part and attaching the surgical instrument to the body part according to the image; and

(f) modifying the body part using the surgical instrument attached to the body part; and

(g) assessing performance of the knee joint using images displayed on said monitor.

2. The process of claim 1, further comprising registering a body part by intraoperatively designating at least one point on the body part with a probe, wherein the probe is attached to a fiducial capable of being tracked by said at least one position sensor.

3. The process of claim 1, wherein the body part comprises one of a femur and a tibia.

4. The process of claim 1, wherein the imager comprises one of a C-arm fluoroscope, a CT scanner, and an MRI machine.

5. The process of claim 1, wherein the fiducials comprise one of active fiducials, passive fiducials and hybrid active/passive fiducials.

6. The process of claim 1, wherein the position tracking sensors comprise one of infrared sensors, electromagnetic sensors, electrostatic sensors, light sensors, sound sensors, and radiofrequency sensors.

7. The process of claim 1, wherein the surgical instrument comprises a pivot pin and a cutting jig.

8. The process of claim 1, further comprising:

(a) discontinuing tracking of the surgical instrument using the fiducial attached to a drill sleeve; and

(b) initiating tracking of the surgical instrument using the fiducial attached to the body part on which the surgical instrument is installed.

9. The process of claim 1, further comprising:

(a) performing soft tissue balancing tests while the computer continues to track the fiducials;

(b) using data generated by the computer to assess alignment and stability of the surgical instrument and the knee joint; and

(c) changing the angle of the surgical instrument to adjust alignment and stability of the knee joint.

10. A process for performing high tibial osteotomy surgical operations on portions of a tibia comprising:

(a) obtaining at least one image of a body part forming a portion of a knee joint with an imager, wherein the body part and the imager are each attached to a fiducial capable of being tracked by at least one position sensor;

(b) registering a surgical instrument adapted to assist the surgeon in shaping bone during high tibial osteotomy, which instrument is attached to a fiducial capable of being tracked by at least one position sensor;

(c) using a computer which receives signals from the at least one sensor, tracking position and orientation of the surgical instrument relative to the body part;

(d) generating and displaying on a monitor associated with the computer a visual image of the instrument properly positioned and oriented relative to the body part;

(e) navigating the instrument relative to the body part and attaching the instrument to the body part according to the image;

(f) discontinuing tracking of the instrument using the fiducial attached to the instrument;

(g) initiating tracking of the instrument using the fiducial attached to the body part on which the instrument is installed;

(h) generating and displaying on the monitor a visual image of the instrument properly positioned and oriented relative to the body part;

(i) modifying the body part using the instrument attached to the body part; and

(j) assessing performance of the knee joint using images displayed on said monitor.

11. A process for performing high tibial osteotomy surgical operations on portions of a tibia comprising:

(a) obtaining at least one image of a body part forming a portion of a knee joint with an imager, wherein the body part and the imager are each attached to a fiducial capable of being tracked by at least one position sensor;

(b) registering a surgical instrument adapted to assist the surgeon in shaping bone during high tibial osteotomy, which instrument is attached to a fiducial capable of being tracked by at least one position sensor;

(c) using a computer which receives signals from the at least one sensor, tracking position and orientation of the instrument relative to the body part;

(d) generating and displaying on a monitor associated with the computer a visual image of the instrument properly positioned and oriented relative to the body part;

(e) navigating the instrument relative to the body part and attaching the instrument to the body part according to the image;

(f) discontinuing tracking of the instrument using the fiducial attached to the instrument;

(g) initiating tracking of the instrument using the fiducial attached to the body part on which the instrument is installed;

(h) generating and displaying on the monitor a visual image of the instrument properly positioned and oriented relative to the body part;

(i) performing soft tissue balancing tests while the computer continues to track the fiducials;

(j) using data generated by the computer to assess alignment and stability of the knee joint with the surgical instrument attached; and

(k) changing the angle of the surgical instrument to adjust alignment and stability.

(l) modifying the body part using the instrument attached to the body part; and

(m) assessing performance of the knee joint using images displayed on said monitor.

12. A system for performing high tibial osteotomy surgical operations on portions of a tibia comprising:

(a) an imager for obtaining an image of a tibia, wherein the imager and the tibia are each attached to a fiducial capable of being tracked by a position sensor;

(b) at least one position sensor adapted to track position of said fiducials;

(c) a computer adapted to store at least one image of the tibia and to receive information from said at least one sensor in order to track position and orientation of said fiducials and thus the tibia;

(d) a pivot pin adapted to be attached to a tibia using a drill sleeve in a high tibial osteotomy procedure, said drill sleeve attached to a fiducial, whereby the position of the pivot pin is capable of being tracked by said sensor and the position and orientation of the pin is capable of being tracked by said computer; and

(e) a monitor adapted to receive information from the computer in order to display at least one image of said pivot positioned and oriented relative to the tibia for navigation and positioning of the pin in the tibia.

13. A system for performing high tibial osteotomy surgical operations on portions of a tibia comprising:

(a) an imager for obtaining an image of a tibia, wherein the imager and the tibia are each attached to a fiducial capable of being tracked by a position sensor;

(b) at least one position sensor adapted to track position of said fiducials;

(c) a computer adapted to store at least one image of the tibia and to receive information from said at least one sensor in order to track position and orientation of said fiducials and thus the tibia;

(d) a cutting jig adapted to be positioned over a pivot pin in a high tibial osteotomy procedure, whereby the position of the cutting jig is capable of being tracked by said computer according to the position and orientation of the pivot pin; and

(e) a monitor adapted to receive information from the computer in order to display at least one image of said cutting jig positioned and oriented relative to the tibia for navigation and positioning of the cutting jig on the tibia.

14. A system for performing high tibial osteotomy surgical operations on portions of a tibia comprising:

(a) an imager for obtaining an image of a tibia, wherein the imager and the tibia are each attached to a fiducial capable of being tracked by a position sensor;

(b) at least one position sensor adapted to track position of said fiducials;

(c) a computer adapted to store at least one image of the tibia and to receive information from said at least one sensor in order to track position and orientation of said fiducials and thus the tibia;

(d) a pivot pin adapted to be attached to a tibia using a drill sleeve in a high tibial osteotomy procedure, said drill sleeve attached to a fiducial, whereby the position of the pivot pin is capable of being tracked by said sensor and the position and orientation of the pin is capable of being tracked by said computer;

(e) a cutting jig adapted to be positioned over a pivot pin, whereby the position of the cutting jig is capable of being tracked by said computer according to the position and orientation of the pivot pin; and

(f) a monitor adapted to receive information from the computer in order to display at least one image of at least one of said pivot pin and cutting jig, positioned and oriented relative to the tibia for navigation and positioning of the pin and the cutting jig on the tibia.