Method of preparing a femur and tibia in knee arthroplasty

• US 8,632,552 B2
• Filed: 03/14/2013
• Issued: 01/21/2014
• Est. Priority Date: 01/14/2000
• Status: Expired due to Term

• Current Assignee: Bonutti Skeletal Innovations LLC (Acacia Research Corporation)
• Original Assignee: Bonutti Skeletal Innovations LLC (Acacia Research Corporation)
• Inventors: Bonutti, Peter M.
• Primary Examiner(s): Philogene, Pedro
• Application Number:
  US13/802,886
• Publication Number:
  US 20130197542A1
• Time in Patent Office: 313 Days
• Field of Search: 623/20.15, 623/20.14, 623/16.11, 623/22.11, 623/901, 128/898, 606/86.R, 606/130, 606/91, 606/102, 606/87, 600/424, 600/587, 600/595, 703/11, 703/258
• US Class Current: 606/130
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/155 Cutting femur
• CPC Class Codes: A61B 17/157 Cutting tibia
• CPC Class Codes: A61B 17/158 Cutting patella
• CPC Class Codes: A61B 17/1604 Chisels; Rongeurs; Punches; Stamps
• CPC Class Codes: A61B 17/1666 for the acetabulum
• CPC Class Codes: A61B 17/1668 for the upper femur A61B17/164 takes precedence
• CPC Class Codes: A61B 17/1675 for the knee
• CPC Class Codes: A61B 17/1703 using imaging means, e.g. by X-rays
• CPC Class Codes: A61B 17/1717 for applying intramedullary nails or pins
• CPC Class Codes: A61B 17/1721 for applying pins along or parallel to the axis of the femoral neck
• CPC Class Codes: A61B 17/1746 for the acetabulum
• CPC Class Codes: A61B 17/1764 for the knee
• CPC Class Codes: A61B 17/809 with bone-penetrating elements, e.g. blades or prongs bone staples A61B17/0642; intramedullary nails with a plate at an end A61B17/7233
• CPC Class Codes: A61B 17/8095 Wedge osteotomy devices
• CPC Class Codes: A61B 2017/00004 (bio)absorbable, (bio)resorbable or resorptive
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/0268 for the knee
• CPC Class Codes: A61B 2017/1602 Mills
• 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 2034/105 : 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 2046/201 : for extremities, e.g. having collection pouch
• CPC Class Codes: A61B 2046/205 : Adhesive drapes
• CPC Class Codes: A61B 2046/236 : with means for collecting drain fluid, e.g. drain tubes
• CPC Class Codes: A61B 2090/064 : for measuring force, pressure or mechanical tension
• CPC Class Codes: A61B 2090/366 : using projection of images directly onto the body
• CPC Class Codes: A61B 2090/376 : using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2217/005 : with suction drainage system
• CPC Class Codes: A61B 2217/007 : with irrigation system
• 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 34/30 : Surgical robots
• CPC Class Codes: A61B 42/00 : Surgical gloves; Finger-stalls specially adapted for surgery; Devices for handling or treatment thereof
• CPC Class Codes: A61B 46/00 : Surgical drapes
• CPC Class Codes: A61B 90/13 : guided by light, e.g. laser pointers
• CPC Class Codes: A61B 90/30 : Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
• CPC Class Codes: A61B 90/361 : Image-producing devices, e.g. surgical cameras
• CPC Class Codes: A61B 90/37 : Surgical systems with images on a monitor during operation
• CPC Class Codes: A61F 2/0077 : Special surfaces of prostheses, e.g. for improving ingrowth A61F2/30767 takes precedence
• CPC Class Codes: A61F 2/30721 : Accessories
• CPC Class Codes: A61F 2/30724 : Spacers for centering an implant in a bone cavity, e.g. in a cement-receiving cavity
• CPC Class Codes: A61F 2/30767 : Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
• CPC Class Codes: A61F 2/30771 : applied in original prostheses, e.g. holes or grooves
• CPC Class Codes: A61F 2/34 : Acetabular cups
• CPC Class Codes: A61F 2/38 : for elbows or knees
• CPC Class Codes: A61F 2/3836 : Special connection between upper and lower leg, e.g. constrained
• CPC Class Codes: A61F 2/3859 : Femoral components
• CPC Class Codes: A61F 2/3868 : with sliding tibial bearing
• CPC Class Codes: A61F 2/3872 : Meniscus for implantation between the natural bone surfaces
• CPC Class Codes: A61F 2/3877 : Patellae or trochleae
• CPC Class Codes: A61F 2/389 : Tibial components A61F2/3868 takes precedence
• CPC Class Codes: A61F 2/4609 : of acetabular cups
• CPC Class Codes: A61F 2/461 : of knees
• CPC Class Codes: A61F 2/4684 : Trial or dummy prostheses
• CPC Class Codes: A61F 2002/2817 : Bone stimulation by chemical reactions or by osteogenic or biological products for enhancing ossification, e.g. by bone morphogenetic or morphogenic proteins [BMP] or by transforming growth factors [TGF]
• CPC Class Codes: A61F 2002/2825 : Femur
• CPC Class Codes: A61F 2002/2835 : Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
• CPC Class Codes: A61F 2002/30079 : magnetic
• CPC Class Codes: A61F 2002/30326 : differing in height or in length
• CPC Class Codes: A61F 2002/30331 : made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
• CPC Class Codes: A61F 2002/30364 : Rotation about the common longitudinal axis
• CPC Class Codes: A61F 2002/30387 : Dovetail connection
• CPC Class Codes: A61F 2002/30398 : Sliding
• CPC Class Codes: A61F 2002/30433 : using additional screws, bolts, dowels, rivets or washers e.g. connecting screws
• CPC Class Codes: A61F 2002/30507 : using a threaded locking member, e.g. a locking screw or a set screw
• CPC Class Codes: A61F 2002/30761 : Support means for artificial cartilage, e.g. cartilage defect covering membranes
• CPC Class Codes: A61F 2002/30883 : dovetail-shaped
• CPC Class Codes: A61F 2002/30892 : parallel
• CPC Class Codes: A61F 2002/3092 : having an open-celled or open-pored structure
• CPC Class Codes: A61F 2002/30934 : Special articulating surfaces
• CPC Class Codes: A61F 2002/30975 : made of two halves
• CPC Class Codes: A61F 2002/3401 : with radial apertures, e.g. radial bores for receiving fixation screws
• CPC Class Codes: A61F 2002/3403 : Polar aperture
• CPC Class Codes: A61F 2002/3895 : unicompartimental
• CPC Class Codes: A61F 2002/4631 : the prosthesis being specially adapted for being cemented
• CPC Class Codes: A61F 2002/4635 : using minimally invasive surgery
• CPC Class Codes: A61F 2002/4677 : using a guide wire
• CPC Class Codes: A61F 2210/009 : magnetic
• CPC Class Codes: A61F 2220/0025 : Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
• CPC Class Codes: A61F 2220/0033 : made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
• CPC Class Codes: A61F 2220/0041 : using additional screws, bolts, dowels or rivets, e.g. connecting screws
• CPC Class Codes: A61F 2250/0037 : differing in height or in length
• CPC Class Codes: A61F 2310/00011 : Metals or alloys
• CPC Class Codes: A61F 2310/00017 : Iron- or Fe-based alloys, e.g. stainless steel
• CPC Class Codes: A61F 2310/00023 : Titanium or titanium-based alloys, e.g. Ti-Ni alloys
• CPC Class Codes: A61F 2310/00029 : Cobalt-based alloys, e.g. Co-Cr alloys or Vitallium
• CPC Class Codes: A61F 2310/00131 : Tantalum or Ta-based alloys
• CPC Class Codes: A61F 2310/00365 : Proteins; Polypeptides; Degradation products thereof
• CPC Class Codes: A61G 13/0045 : specially adapted for hand or wrist surgeries
• CPC Class Codes: A61G 13/0054 : specially adapted for back or spinal surgeries
• CPC Class Codes: A61G 13/0063 : specially adapted for knee surgeries
• CPC Class Codes: A61G 13/0072 : specially adapted for shoulder surgeries
• CPC Class Codes: A61G 13/0081 : specially adapted for hip surgeries
• CPC Class Codes: A61G 13/1245 : Knees, upper or lower legs
• CPC Class Codes: A61G 13/125 : Ankles or feet

Abstract

A method of preparing a femur and tibia in surgery on a knee joint using a navigation system and a robotic system. The navigation system tracks movement of the femur and tibia during the surgery. The navigation system may include a plurality of locating devices. The robotic system includes a base, a plurality of arms, and a cutting tool.

Claims

1. A method of preparing a femur and tibia in surgery on a knee joint using a navigation system and a robotic system comprising a base, a plurality of articulate arms movable relative to the base, and a cutting tool coupled to the plurality of articulate arms so that the cutting tool is capable of movement in at least five degrees of freedom relative to the base, said method comprising the steps of:

arranging the navigation system to track movement of the femur and tibia during the surgery;

cutting away material from the femur with the cutting tool of the robotic system and without the use of physical resection guides while the navigation system tracks movement of the femur wherein the navigation system cooperates with the robotic system to provide information associated with a position of the femur to the robotic system;

cutting away material from the tibia with the cutting tool of the robotic system and without the use of physical resection guides while the navigation system tracks movement of the tibia wherein the navigation system cooperates with the robotic system to provide information associated with a position of the tibia to the robotic system;

affixing a first member of a knee implant to the femur to replace at least a portion of the material cut away from the femur;

affixing a second member of the knee implant to the tibia opposite the first member to replace at least a portion of the material cut away from the tibia,

wherein the navigation system enables separate tracking of the femur and tibia so that positions of the femur and tibia can be determined when the femur and tibia move during the surgery, wherein movement of the cutting tool relative to the femur is represented on a display and movement of the cutting tool relative to the tibia is represented on the display.

2. The method as set forth in claim 1 wherein cutting away material from the femur includes cutting away material from only one of a medial and lateral condyle of the femur with the cutting tool of the robotic system and without the use of physical resection guides.

3. The method as set forth in claim 2 wherein affixing the first member to the femur includes affixing the first member to the only one condyle of the femur with the first member including a first articulating surface, wherein the other of the medial and lateral condyles is not provided with an affixed articulating surface.

4. The method as set forth in claim 3 including affixing a third member of the knee implant to a trochlear section of the femur to replace cut away material from the femur, the third member including an articulating surface.

5. The method as set forth in claim 4 wherein cutting away material from the femur includes cutting away material from the trochlear section of the femur so that a bridge of bone remains on the femur between the trochlear section and the only one condyle.

6. The method as set forth in claim 5 wherein the first and third members are separated by the bridge of bone when affixed to the femur.

7. The method as set forth in claim 3 wherein cutting away material from the femur includes forming a recess in the only one condyle of the femur with the cutting tool of the robotic system and without the use of physical resection guides such that the recess is peripherally surrounded by naturally occurring bone.

8. The method as set forth in claim 7 including positioning the first member in the recess formed in the only one condyle of the femur.

9. The method as set forth in claim 8 wherein cutting away material from the tibia includes forming a recess in the tibia with the cutting tool of the robotic system and without the use of physical resection guides such that the recess is peripherally surrounded by naturally occurring bone.

10. The method as set forth in claim 9 including positioning the second member in the recess formed in the tibia opposite the first member.

11. The method as set forth in claim 1 including:

forming a recess in one of the femur or tibia with the cutting tool of the robotic system and without the use of physical resection guides such that the recess is peripherally surrounded by naturally occurring bone; and

positioning one of the first member or the second member in the recess.

12. The method as set forth in claim 1 wherein cutting away material from the femur includes cutting away material from a medial condyle and a lateral condyle.

13. The method as set forth in claim 1 including making a minimally invasive incision to access the knee joint wherein the minimally invasive incision has a length that does not exceed thirteen centimeters.

14. The method as set forth in claim 1 including:

displacing a patella from a normal position to an offset position with an articulating surface of the patella facing the femur; and

cutting an articulating surface of the femur while maintaining the patella in the offset position with the articulating surface of the patella facing the femur.

15. The method as set forth in claim 1 including obtaining images of the knee joint and transmitting the images to a control unit.

16. The method as set forth in claim 15 wherein obtaining the images of the knee joint includes generating images of the knee joint during movement of a lower portion of a leg relative to an upper portion of the leg.

17. The method as set forth in claim 15 including displaying the transmitted images on the display for viewing during the surgery.

18. The method as set forth in claim 17 wherein displaying the transmitted images includes displaying relative movement between a distal end portion of the femur and a proximal end portion of the tibia.

19. The method as set forth in claim 1 including moving the tibia relative to the femur to display relative movement between a distal end portion of the femur and a proximal end portion of the tibia on the display before cutting away material from the femur and tibia.

20. The method as set forth in claim 19 including moving the tibia relative to the femur to display relative movement of the distal end portion of the femur and the proximal end portion of the tibia on the display after cutting away material from the femur and tibia.

21. The method as set forth in claim 1 including displaying a relationship between the first member and the second member on the display to evaluate the relationship between the first member and the second member.

22. The method as set forth in claim 1 including moving the tibia relative to the femur to display relative movement between the first member and the second member on the display after affixing the first member to the femur and affixing the second member to the tibia.

23. The method as set forth in claim 1 wherein cutting away material from the femur and tibia includes cutting away material from the femur and tibia while preserving at least a portion of a ligament of the knee joint.

24. The method as set forth in claim 1 wherein arranging the navigation system to track movement of the femur and tibia during the surgery includes attaching a first plurality of locating devices to the femur and attaching a second plurality of locating device to the tibia.

25. The method as set forth in claim 1 wherein arranging the navigation system to track movement of the femur and tibia during the surgery includes:

attaching a first plurality of emitters to the femur; and

attaching a second plurality of emitters to the tibia,

wherein the navigation system is an optical navigation system.

26. The method as set forth in claim 1 wherein arranging the navigation system to track movement of the femur and tibia during the surgery includes:

attaching a first plurality of reflectors to the femur; and

attaching a second plurality of reflectors to the tibia,

wherein the navigation system is an optical navigation system.

27. The method as set forth in claim 1 including moving the cutting tool relative to the femur and tibia wherein such movement includes one of user-controlled movement or robotically-controlled movement.

28. A method of preparing a femur and tibia in surgery on a knee joint using a navigation system and a robotic system comprising a base, a plurality of articulate arms movable relative to the base, and a cutting tool coupled to the plurality of articulate arms so that the cutting tool is capable of movement in at least five degrees of freedom relative to the base, said method comprising the steps of:

arranging the navigation system to track movement of the femur and tibia during the surgery;

cutting away material from the femur with the cutting tool of the robotic system using a first optical cutting guide that indicates a volume of material to be cut from the femur;

cutting away material from the tibia with the cutting tool of the robotic system using a second optical cutting guide that indicates a volume of material to be cut from the tibia;

affixing a first member of a knee implant to the femur to replace at least a portion of the material cut away from the femur; and

affixing a second member of the knee implant to the tibia opposite the first member to replace at least a portion of the material cut away from the tibia,

wherein the navigation system enables separate tracking of the femur and tibia so that positions of the femur and tibia can be determined when the femur and tibia move during the surgery, wherein movement of the cutting tool relative to the femur is represented on a display and movement of the cutting tool relative to the tibia is represented on the display.

29. A method of preparing a femur and tibia in surgery on a knee joint using a navigation system and a robotic system comprising a base, a plurality of articulate arms movable relative to the base, and a cutting tool coupled to the plurality of articulate arms so that the cutting tool is capable of movement in at least five degrees of freedom relative to the base, said method comprising the steps of:

arranging the navigation system to track movement of the femur and tibia during the surgery;

cutting away material from the femur with the cutting tool of the robotic system using a first optical cutting guide that indicates a volume of material to be cut from the femur wherein the navigation system cooperates with the robotic system to provide information associated with a position of the femur to the robotic system;

cutting away material from the tibia with the cutting tool of the robotic system using a second optical cutting guide that indicates a volume of material to be cut from the tibia wherein the navigation system cooperates with the robotic system to provide information associated with a position of the tibia to the robotic system;

affixing a first member of a knee implant to the femur to replace at least a portion of the material cut away from the femur;

affixing a second member of the knee implant to the tibia opposite the first member to replace at least a portion of the material cut away from the tibia,

wherein the navigation system enables separate tracking of the femur and tibia so that the positions of the femur and tibia can be determined when the femur and tibia move during the surgery, wherein movement of the cutting tool relative to the femur is represented on a display and movement of the cutting tool relative to the tibia is represented on the display.

30. A method of preparing a femur and tibia in surgery on a knee joint using a navigation system comprising a first plurality of locating devices and a second plurality of locating devices and a robotic system comprising a base, a plurality of articulate arms movable relative to the base, and a cutting tool coupled to the plurality of articulate arms so that the cutting tool is capable of movement in at least five degrees of freedom relative to the base, said method comprising the steps of:

attaching the first plurality of locating devices to the femur;

attaching the second plurality of locating devices to the tibia;

moving the tibia relative to the femur during the surgery while the first plurality of locating devices are attached to the femur and the second plurality of locating devices are attached to the tibia;

moving the cutting tool relative to the femur and tibia during the surgery;

cutting away material from the femur with the cutting tool while a first optical cutting guide is displayed to indicate a volume of material to be cut from the femur;

cutting away material from the tibia with the cutting tool while a second optical cutting guide is displayed to indicate a volume of material to be cut from the tibia;

affixing a first member of a knee implant to the femur to replace at least a portion of the material cut away from the femur; and

affixing a second member of the knee implant to the tibia opposite the first member to replace at least a portion of the material cut away from the tibia,

wherein attaching the first plurality of locating devices to the femur and attaching the second plurality of locating devices to the tibia enables separate tracking of the femur and tibia so that positions of the femur and tibia can be determined when the femur and tibia move during the surgery,

wherein movement of the cutting tool relative to the femur while cutting away material from the femur is represented on a display and movement of the cutting tool relative to the tibia while cutting away material from the tibia is represented on the display.