System and method for cavity generation for surgical planning and initial placement of a bone prosthesis

• US 5,824,085 A
• Filed: 09/30/1996
• Issued: 10/20/1998
• Est. Priority Date: 09/30/1996
• Status: Expired due to Term

• Current Assignee: Curexo Technology Corporation
• Original Assignee: Integrated Surgical Systems, Inc.
• Inventors: Zuhars, Joel, Mittelstadt, Brent, Kazanzides, Peter, Williamson, Willie Jr., Sahay, Alind
• Primary Examiner(s): Buiz, Michael Powell
• Assistant Examiner(s): REIP, DAVID OWEN
• Application Number:
  US08/724,497
• Time in Patent Office: 750 Days
• Field of Search: 606/79, 606/80, 606/86, 606/89, 623/16, 623/22, 623/23, 623/66, 128/898, 128/920, 128/922, 128/923, 364/413.13, 395/80, 395/924
• US Class Current: 128/898
• CPC Class Codes: A61B 17/8847 for removing cement from a bone cavity using surgical bone chisels, drills, mills, rasps, reamers or scrapers A61B17/16; using laser A61B18/20; using ultrasonic surgical instruments A61N7/00
• CPC Class Codes: A61B 2090/3762 using computed tomography systems [CT]
• CPC Class Codes: A61B 34/10 Computer-aided planning, simulation or modelling of surgical operations
• CPC Class Codes: A61B 34/30 Surgical robots
• CPC Class Codes: A61F 2/30942 for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques
• CPC Class Codes: A61F 2/3662 Femoral shafts
• CPC Class Codes: A61F 2/46 Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
• CPC Class Codes: A61F 2002/2825 Femur
• CPC Class Codes: A61F 2002/30616 Sets comprising a plurality of prosthetic parts of different sizes or orientations
• CPC Class Codes: A61F 2002/3069 Revision endoprostheses
• CPC Class Codes: A61F 2002/30943 using mathematical models
• CPC Class Codes: A61F 2002/30948 using computerized tomography, i.e. CT scans
• CPC Class Codes: A61F 2002/30952 using CAD-CAM techniques or NC-techniques
• CPC Class Codes: A61F 2002/4633 for selection of endoprosthetic joints or for pre-operative planning
• CPC Class Codes: G05B 19/4099 Surface or curve machining, making 3D objects, e.g. desktop manufacturing
• CPC Class Codes: G05B 2219/36248 Generate automatically machining, stitching points from scanned contour
• CPC Class Codes: G05B 2219/36251 Superpose scanned or finished object image on workpiece model for best fitting
• CPC Class Codes: G05B 2219/45094 Milling robot
• CPC Class Codes: G05B 2219/45123 Electrogoniometer, neuronavigator, medical robot used by surgeon to operate
• CPC Class Codes: G05B 2219/45168 Bone prosthesis
• CPC Class Codes: Y10S 623/914 : Bone

Abstract

Methods, systems and apparatus for planning the position of a prosthesis in a long bone in orthopaedic surgical procedures, such as hip replacement surgery, knee replacement surgery, long bone osteotomies, and the like. A bone model is generated from a scanned image of a bone, a prosthesis model is selected from a library of prosthesis models and then a cavity model is formed based on the prosthesis model and/or the bone model. The cavity model may then be positioned over the bone model, either interactively by the surgeon or automatically through an algorithm based on clinical parameters, to determine a reasonable location for implantation of a prosthesis within the bone. The cavity model allows the surgeon to optimize placement of the implant within the bone, and it provides important clinical information to the surgeon, such as areas in which press fits are provided, extension areas for possible subsidence and access areas for allowing the surgeon to insert the implant into the cavity.

Claims

1. A method for planning the position of a prosthesis within a bone, said prosthesis having a proximal and a distal portion, said method comprising:

providing a model of the prosthesis and a model of the bone; and

generating based on the prosthesis model a first cavity model intended to accommodate the prosthesis within the bone,

said cavity model comprising an access region, a proximal cavity region, a distal cavity region, and a distal extension region,

said distal cavity region dimensioned to provide an interference fit between said prosthesis model and said bone, and

said distal extension region extending beyond the distal end of the prosthesis to provide room for subsidence of the prosthesis within the bone.

2. A method as in claim 1, further comprising positioning the cavity model within the bone model.

3. A method as in claim 2, wherein the positioning step comprises automatically positioning the cavity model within the bone model based on measurements of the bone model and prothesis fit criteria.

4. A method as in claim 3 wherein the fit criteria include minimizing bone cutting, maximizing bone contact and minimizing gaps between the bone and the prosthesis.

5. A method as in claim 3 further comprising selecting a group of implants and determining a quantitative value for each implant within the group based on the fit criteria.

6. A method as in claim 3 wherein the measurements of the bone model include marking the top of a medial arc portion of the bone model and measuring inner and outer profiles of a distal canal region of the bone model.

7. A method as in claim 2, further comprising cutting the bone to form a cavity having the position and dimensions of the cavity model in the bone model.

8. A method as in claim 7 wherein the bone cutting step comprises generating a file of cutting parameters, transferring the file to automated cutting apparatus, and cutting the bone cavity based on the cutting parameter file.

9. A method as in claim 1, wherein the bone model is generated from a scanned image of the bone.

10. A method as in claim 1, wherein the prosthesis model is selected from a library of prosthesis models corresponding to different types of prostheses.

11. A method as in claim 1, where the first cavity model is generated by a set of rules which generate cavity dimensions based on the prosthesis model in the absence of the bone model.

12. A method as in claim 10 or 11, wherein the first cavity model comprises an actual cavity and an access region, the method further comprising generating an access region model based on the model of the prosthesis to provide access to the actual cavity.

13. A method as in claim 12, wherein the access region model generating step includes determining a cross-sectional area of a proximal portion of the model of the prosthesis and trimming said cross-sectional area based on a recession angle and a lateral trimming distance.

14. The method of claim 13 further comprising generating a distal cavity extension model by determining the cross-sectional area of the distal cavity region and extending the distal cavity region by a distance based on fit criteria, said fit criteria including cortical bone thickness and contact between the cortical bone and the model of the prosthesis.

15. A method as in claim 12, wherein the actual cavity comprises a proximal cavity region, a distal cavity region and a distal cavity extension, the method further comprising providing a model of a broach and generating a proximal cavity region model based on the prosthesis model and the broach model.

16. The method of claim 15 wherein the proximal cavity region model is generated by applying an interference pattern function to the prosthesis and broach models.

17. A method as in claim 1, wherein the first cavity model is generated by a set of rules which generate cavity dimensions based on both implant model information and bone model information.

18. A method as in claim 1, wherein the bone is a long bone taken from a group consisting essentially of the femur, the tibia, the humerus, the ulna and the radius.

19. A method as in claim 1, wherein the positioning step comprises:

observing images of the bone model and the cavity model on a display; and

adjusting the image of the bone model relative to the image of the cavity model as they appear on the display.

20. A method as in claim 19, wherein the images include at least one of the group consisting of 3D images, axial cross-sectional images, and transverse cross-sectional images.

21. A method as in claim 1 further comprising adjusting the dimensions of the first cavity model to produce a second cavity model and repositioning the second cavity model by observing images of the bone model and the second cavity model on the display and adjusting the relative positions of the images as they appear on the display.

22. A method for planning the position of a prosthesis within a bone, said method comprising:

providing a model of the prosthesis and a model of the bone;

generating based on the prosthesis model a first cavity model intended to accommodate the prosthesis within the bone;

wherein the first cavity model comprises an actual cavity and an access region, the method further comprising generating an access region model based on the model of the prosthesis to provide access to the actual cavity; and

wherein the access region model generating step includes determining a cross-sectional area of a proximal portion of the model of the prosthesis and trimming said cross-sectional area based on a recession angle and a lateral trimming distance.

25. A method as in any of claims 22 to 24, wherein the prosthesis model is selected from a library of prosthesis models corresponding to different types of prostheses.

26. A method as in any of claims 22 to 24, where the first cavity model is generated by a set of rules which generate cavity dimensions based on the prosthesis model in the absence of the bone model.

23. A method for planning the position of a prosthesis within a bone, said method comprising:

providing a model of the prosthesis and a model of the bone;

generating based on the prosthesis model a first cavity model intended to accommodate the prosthesis within the bone;

wherein the positioning step comprises automatically positioning the cavity model within the bone model based on measurements of the bone model and prothesis fit criteria; and

wherein the measurements of the bone model include marking the top of a medial arc portion of the bone model and measuring inner and outer profiles of a distal canal region of the bone model.

24. A method for planning the position of a prosthesis within a bone, said method comprising:

providing a model of the prosthesis and a model of the bone;

generating based on the prosthesis model a first cavity model intended to accommodate the prosthesis within the bone; and

adjusting the dimensions of the first cavity model to produce a second cavity model and repositioning the second cavity model by observing images of the bone model and the second cavity model on the display and adjusting the relative positions of the images as they appear on the display.

27. A method for planning the position of a prosthesis within a bone, said prosthesis having a proximal and a distal portion, said method comprising:

providing a model of the bone;

providing a first cavity model intended to accommodate the prosthesis within the bone, said cavity model comprising an access region, a distal cavity region dimensioned to provide an interference fit between a prosthesis model and the bone, and a distal extension region extending beyond the distal cavity region; and

positioning the cavity model in the bone model.

28. A method as in claim 27, further comprising positioning the cavity model within the bone model.

29. A method as in claim 27, wherein the bone model is generated from a scanned image of the bone.

30. A method as in claim 27, wherein the bone is a long bone taken from a group consisting essentially of the femur, the tibia, the humerus, the ulna and the radius.