Surgical apparatus for implantation of a partial or total knee prosthesis

• US 20070270718A1
• Filed: 04/11/2006
• Published: 11/22/2007
• Est. Priority Date: 04/13/2005
• Status: Active Grant

• Current Assignee: Corin Limited (Corin Medical Ltd. /Management/)
• Original Assignee: Tornier Incorporated
• Inventors: Tornier, Alain, Ratron, Yves-Alain, Rochetin, Olivier
• Granted Patent: US 8,002,839 B2
• Time in Patent Office: Days
• US Class Current: 600/587
• CPC Class Codes: A61B 17/158 Cutting patella
• CPC Class Codes: A61B 2017/564 Methods for bone or joint treatment
• CPC Class Codes: A61B 2034/102 Modelling of surgical devices, implants or prosthesis
• CPC Class Codes: A61B 2034/108 Computer aided selection or customisation of medical implants or cutting guides
• 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 2090/363 Use of fiducial points
• CPC Class Codes: A61B 2090/3945 Active visible markers, e.g. light emitting diodes
• 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 5/064 using markers A61B5/062 takes precedence
• CPC Class Codes: A61B 5/4528 Joints A61B5/4533, A61B5/4538 take precedence
• CPC Class Codes: A61B 90/06 Measuring instruments not otherwise provided for
• CPC Class Codes: A61B 90/36 Image-producing devices or illumination devices not otherwise provided for
• CPC Class Codes: A61B 90/37 Surgical systems with images on a monitor during operation
• CPC Class Codes: A61F 2/38 for elbows or knees
• CPC Class Codes: A61F 2/3877 Patellae or trochleae
• CPC Class Codes: A61F 2/4657 Measuring instruments used for implanting artificial joints for surgical instruments A61B90/06
• CPC Class Codes: A61F 2002/4632 using computer-controlled surgery, e.g. robotic surgery
• CPC Class Codes: G01S 5/163 : Determination of attitude using inertial means G01C9/00; control of attitude G05D1/49

Abstract

This surgical apparatus comprises, on the one hand, means for spatial marking-out of the patella and femur of a patient to be operated on, and, on the other hand, means for simultaneous and relative representation of this patella provided virtually with a patellar implant of the prosthesis, and of this femur provided virtually with a femoral implant of the prosthesis, in a transverse plane passing both through the patella and through the trochlea of the aforementioned femoral implant. Using this apparatus, the surgeon can easily and quickly check the congruent position of the patellar implant with respect to the prosthetic femoral trochlea in order to reduce the risks of subsequent dislocations of the patella fitted with the prosthesis.

Claims

1. Surgical apparatus for implantation of a total or partial knee prosthesis comprising at least a patellar implant and a femoral implant, said apparatus having:

means for peroperative spatial marking-out of the bones of the patella and femur to be fitted with the prosthesis,

representation means for peroperative representation that are designed to show, in a transverse plane passing both through the patella and through an intercondylar trochlea of the femoral implant, a simultaneous and relative representation of the patella which is to be fitted with the prosthesis and is provided virtually with the patellar implant, and of the lower part of the femur which is to be fitted with the prosthesis and is provided virtually with the femoral implant.

2. Apparatus according to claim 1, wherein the transverse plane in which the patella and the femur are represented by the representation means corresponds to a substantially median plane of the patella.

3. Apparatus according to claim 1, wherein the apparatus includes a memory containing data relating to a preferential predetermined positioning of the patellar implant relative to the femoral implant for all the anatomically allowable configurations of flexion-extension of the knee, and wherein the representation means are designed to represent, in the transverse plane and in a simultaneous and relative manner, both the patella fitted virtually with the prosthesis, the femur fitted virtually with the prosthesis, and an image for assisting the surgeon, representative of at least one part of the patellar implant, this assistance image being positioned with respect to the virtual femoral implant, according to the knee'"'"'s flexion-extension configuration considered, as a function of the data on preferential positioning that are contained in the memory.

4. Apparatus according to claim 1, wherein the representation means are designed to represent the patella fitted virtually with the prosthesis, the femur fitted virtually with the prosthesis and, if appropriate, the image for helping the surgeon obtain different configurations of flexion-extension of the knee, the transverse plane in which these elements are represented by these means being fixed relative to the patella.

5. Apparatus according to claim 4, wherein the representation means are designed to represent said elements over a continuous course of flexion-extension of the knee, in particular over the course of maximum flexion-extension that is anatomically allowable.

6. Apparatus according to claim 1, wherein the apparatus comprises adjustment means for adjusting the virtual implantation of the patellar implant on the patella.

7. Apparatus according to claim 6, wherein, in the case where the patellar implant is to be fitted level with a posterior cutting of the patella, the adjustment means are designed to modify the distance between a predetermined point of the anterior face of the patella and the patellar sectioning line in the transverse plane, the angle value of the patellar sectioning line relative to a predetermined direction, and/or the position of the patellar implant along the patellar sectioning line.

8. Apparatus according to claim 6, wherein, in the case where a set of several patellar implants of different respective sizes is provided, the adjustment means are designed to change the size of the implant shown.

9. Apparatus according to claim 6, wherein the apparatus comprises:

selecting and memorizing means for selecting and memorizing at least one configuration of implantation of the patellar implant set by the adjustment means,

an ancillary used for resurfacing the anterior face of the patella and equipped with spatial marking means, and

means for comparing the resurfacing action effected by this ancillary with the data from the selecting and memorizing means.

10. Apparatus according to claim 1, wherein the apparatus additionally comprises other means for simultaneous and relative representation of the patella which is to be fitted with the prosthesis and is provided virtually with the patellar implant, and of the lower part of the femur which is to be fitted with the prosthesis and is provided virtually with the femoral implant, in a sagittal plane passing both through the patella and the trochlea of the femoral implant.

11. Surgical method for implantation of a partial or total knee prosthesis comprising at least a patellar implant and a femoral implant, wherein the following steps are carried out in succession in the peroperative period:

the bones of the patella and femur of a patient to be treated are spatially marked out,

the patella which is to be fitted with the prosthesis and is provided virtually with the patellar implant and the lower part of the femur which is to be fitted with the prosthesis and is provided virtually with the femoral implant are represented in a simultaneous and relative representation, this representation being effected in a transverse plane passing both through the patella and also through an intercondylar trochlea of the femoral implant,

the virtual implantation of the patellar implant on the patella and, if appropriate, the virtual implantation of the femoral implant on the femur is adjusted such that the posterior part of the patellar implant is received congruently in the femoral intercondylar trochlea,

the configuration of implantation of the patellar implant obtained according to the adjustment is selected and memorized, and

the real patellar implant is implanted on the patella of the patient according to the configuration of implantation that has been selected and memorized.

12. Method according to claim 11, wherein:

in relation to the femoral implant virtually implanted on the spatially marked-out femur, the position of the representation of the patellar implant virtually implanted on the spatially marked-out patella is compared with a representation of a preferred predetermined position of this patellar implant, in which position the patellar and femoral implants are positioned in a congruent manner, and

the virtual implantation of the patellar implant on the patella is adjusted in such a way that its representation coincides substantially with the representation of the preferential predetermined position.