Apparatus and methods for making intraoperative orthopedic measurements

• US 7,001,346 B2
• Filed: 11/14/2002
• Issued: 02/21/2006
• Est. Priority Date: 11/14/2001
• Status: Active Grant

• Current Assignee: Michael R White
• Original Assignee: Michael R White
• Inventors: White, Michael R.
• Primary Examiner(s): Hindenburg, Max F.
• Assistant Examiner(s): SZMAL, BRIAN SCOTT
• Application Number:
  US10/294,831
• Publication Number:
  US 20030105470A1
• Time in Patent Office: 1,195 Days
• Field of Search: 600/587, 600/595, 600/426, 600/591, 600/429, 606/61, 606/62, 606/69, 606/86, 606/72, 606/73, 606/1, 606/83, 606/232, 606/130, 606/87, 606/96, 337/00, 73/17.9, 623/16.11, 623/13.14, 128/898, 433/7, 433/18, 433/173, 433/24, 411/28, 411/79
• US Class Current: 600/587
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/2072 Reference field transducer attached to an instrument or patient
• 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 90/06 Measuring instruments not otherwise provided for

Abstract

Apparatus and methods for making intraoperative orthopedic measurements are provided. Using telemetry devices attached to a patient, relative measurements of the positions and orientations of the patient'"'"'s bones may be determined. Using the relative measurements of the positions and orientations of the patient'"'"'s bones, a differential measurement may be determined in connection with the orthopedic medical procedure.

Claims

1. A method for making orthopedic measurements during an orthopedic medical procedure, the method comprising:

attaching a plurality of telemetry devices to a patient'"'"'s body;

prior to a first portion of the orthopedic medical procedure, while moving the patient'"'"'s body through a first range of motion, tracking movement of the plurality of telemetry devices relative to each other, and calculating the position of at least one anatomical feature of the patient'"'"'s body relative to the plurality of telemetry devices based on the movement of the plurality of telemetry devices;

after the first portion of the orthopedic medical procedure, while moving the patient'"'"'s body through a second range of motion, tracking movement of the plurality of telemetry devices relative to each other, and calculating the position of the at least one anatomical feature relative to the plurality of telemetry devices based on the movement of the plurality of telemetry devices; and

determining a differential measurement in connection with the first portion of the orthopedic medical procedure, wherein the differential measurement is based at least in part on the calculated position of the at least one anatomical feature before the first portion of the orthopedic medical procedure and on the calculated position of the at least one anatomical feature after the first portion of the orthopedic medical procedure.

2. The method of claim 1, further comprising providing on a display an output that corresponds to the differential measurement.

3. The method of claim 1, wherein a first one of the plurality of telemetry devices is a first electromagnetic receiver, wherein a second one of the plurality of telemetry devices is a second electromagnetic receiver, and wherein a third one of the plurality of telemetry devices is a magnetic field generator.

4. The method of claim 1, wherein the plurality of telemetry devices consists of a first telemetry device and a second telemetry device, wherein the first telemetry device is an electromagnetic receiver, and wherein the second telemetry device is a magnetic field generator.

5. The method of claim 1, wherein the plurality of telemetry devices are a plurality of radio frequency telemetry devices.

6. The method of claim 1, wherein the orthopedic medical procedure is a hip joint replacement procedure, and wherein the differential measurement is a leg length difference.

7. The method of claim 1, wherein the orthopedic medical procedure is a hip joint replacement procedure, and wherein the differential measurement is an offset.

8. The method of claim 1, wherein the step of tracking movement of the plurality of telemetry devices prior to the first portion of the orthopedic medical procedure comprises:

receiving and recording a first set of multiple relative positions and orientations of the plurality of telemetry devices.

9. The method of claim 8, wherein the step of calculating the position of the at least one anatomical feature prior to the first portion of the orthopedic medical procedure comprises:

best fitting the first set of multiple relative positions and orientations of the plurality of telemetry devices to a mathematical equation representing a kinematic model of the at least one anatomical feature.

10. The method of claim 9, wherein the orthopedic medical procedure is a hip joint replacement procedure.

11. The method of claim 10, wherein the at least one anatomical feature is the center of rotation of the hip joint.

12. The method of claim 11, wherein the mathematical equation is for a sphere.

13. The method of claim 9, wherein the first portion of the orthopedic medical procedure is the replacement of the patient'"'"'s hip joint with a prosthetic joint.

14. The method of claim 8, wherein the step of tracking movement of the plurality of telemetry devices after the first portion of the orthopedic medical procedure comprises:

receiving and recording a second set of multiple relative positions and orientations of the plurality of telemetry devices.

15. The method of claim 14, wherein the step of calculating the position of the at least one anatomical feature after the first portion of the orthopedic medical procedure comprises:

best fitting the second set of multiple relative positions and orientations of the plurality of telemetry devices to a mathematical equation representing a kinematic model of the at least one anatomical feature.

16. The method of claim 15, wherein the orthopedic medical procedure is a hip joint replacement procedure, and wherein the first portion of the orthopedic medical procedure is the replacement of the patient'"'"'s hip joint with a prosthetic joint.

17. The method of claim 1, wherein the orthopedic medical procedure is a hip joint replacement procedure, and wherein the differential measurement is cup prosthesis angle.

18. The method of claim 1, wherein the orthopedic medical procedure is a hip joint replacement procedure, and wherein the differential measurement is range of motion.

19. The method of claim 1, wherein the step of determining the differential measurement does not require holding the patient'"'"'s body in any particular orientation.

20. The method of claim 1, further comprising:

comparing the differential measurement with an ideal measurement.

21. The method of claim 20, wherein the orthopedic medical procedure is a hip joint replacement procedure, and wherein the first portion of the orthopedic medical procedure is the replacement of the patient'"'"'s hip joint with a first prosthetic joint, the method further comprising:

selecting a second prosthetic joint;

after a second portion of the orthopedic medical procedure, while moving the patient'"'"'s body through a third range of motion, tracking movement of the plurality of telemetry devices relative to each other, and calculating the position of the at least one anatomical feature relative to the plurality of telemetry devices based on the movement of the plurality of telemetry devices; and

determining a new differential measurement in connection with the second portion of the orthopedic medical procedure, wherein the new differential measurement is based at least in part on the calculated position of the at least one anatomical feature before the first portion of the orthopedic medical procedure and on the calculated position of the at least one anatomical feature after the second portion of the orthopedic medical procedure, wherein the second portion of the orthopedic medical procedure is the replacement of the first prosthetic joint with the second prosthetic joint, and wherein the step of selecting the second prosthetic joint includes adjusting the first prosthetic joint such that the new differential measurement matches the ideal differential measurement.

22. The method of claim 1, wherein the method does not include using a medical image.

23. The method of claim 22, wherein the medical image consists of one image from the group consisting of the following:

computed tomography scan, magnetic resonance image, ultrasound image, x-ray image, and fluoroscopic image.

24. The method of claim 1, wherein the method does not include physically registering the positions and orientations of the plurality of telemetry devices with respect to a medical image.

25. The method of claim 1, wherein the method does not include physically registering the positions and orientations of the plurality of telemetry devices with respect to the at least one anatomical feature.

26. The method of claim 1, wherein the first range of motion is different than the second range of motion.

27. An apparatus for making orthopedic measurements during an orthopedic medical procedure, the apparatus comprising:

a plurality of telemetry devices attached to a patient'"'"'s body; and

a processing device coupled to each telemetry device of the plurality of telemetry devices via a respective communication link, the processing device comprising;

a storage device; and

a processor connected to the storage device, the storage device storing a processing device program for controlling the processor, wherein the processor is operative with the processing device program to;

track movement of the plurality of telemetry devices relative to each other when the patient'"'"'s body is moved through a first range of motion prior to a first portion of the orthopedic medical procedure;

calculate the position of at least one anatomical feature of the patient'"'"'s body relative to the plurality of telemetry devices based upon the movement of the plurality of telemetry devices prior to the first portion of the orthopedic medical procedure;

track movement of the plurality of telemetry devices relative to each other when the patient'"'"'s body is moved through a second range of motion after the first portion of the orthopedic medical procedure;

calculate the position of the at least one anatomical feature of the patient'"'"'s body relative to the plurality of telemetry devices based upon the movement of the plurality of telemetry devices after the first portion of the orthopedic medical procedure; and

determine a differential measurement in connection with the first portion of the orthopedic medical procedure, wherein the differential measurement is based at least in part on the calculated position of the at least one anatomical feature before the first portion of the orthopedic medical procedure and on the calculated position of the at least one anatomical feature after the first portion of the orthopedic medical procedure.

28. The apparatus of claim 27, wherein the processor is further operative with the processing device program to provide on a display an output that corresponds to the differential measurement.

29. The apparatus of claim 27, wherein a first one of the plurality of telemetry devices is a first electromagnetic receiver, wherein a second one of the plurality of telemetry devices is a second electromagnetic receiver, and wherein a third one of the plurality of telemetry devices is a magnetic field generator.

30. The apparatus of claim 27, wherein the plurality of telemetry devices consists of a first telemetry device and a second telemetry device, wherein the first telemetry device is an electromagnetic receiver, and wherein the second telemetry device is a magnetic field generator.

31. The apparatus of claim 27, wherein the plurality of telemetry devices are a plurality of radio frequency telemetry devices, and wherein the communication link between each radio frequency telemetry device of the plurality of radio frequency telemetry devices and the processing device is a wireless communication link.

32. The apparatus of claim 27, wherein the orthopedic medical procedure is a hip joint replacement procedure, and wherein the differential measurement is a leg length difference.

33. The apparatus of claim 27, wherein the orthopedic medical procedure is a hip joint replacement procedure, and wherein the differential measurement is an offset.

34. The apparatus of claim 27, wherein the processor is operative with the processing device program to track the movement of the plurality of telemetry devices relative to each other prior to the first portion of the orthopedic medical procedure by receiving and recording a first set of multiple relative positions and orientations of the plurality of telemetry devices.

35. The apparatus of claim 34, wherein the processor is operative with the processing device program to calculate the position of the at least one anatomical feature prior to the first portion of the orthopedic medical procedure by best fitting the first set of multiple relative positions and orientations of the plurality of telemetry devices to a mathematical equation representing a kinematic model of the at least one anatomical feature.

36. The apparatus of claim 35, wherein the orthopedic medical procedure is a hip joint replacement procedure.

37. The apparatus of claim 36, wherein the at least one anatomical feature is the center of rotation of the hip joint.

38. The apparatus of claim 37, wherein the mathematical equation is for a sphere.

39. The apparatus of claim 35, wherein the first portion of the orthopedic medical procedure is the replacement of the patient'"'"'s hip joint with a prosthetic joint.

40. The apparatus of claim 34, wherein the processor is operative with the processing device program to track the movement of the plurality of telemetry devices relative to each other after the first portion of the orthopedic medical procedure by receiving and recording a second set of multiple relative positions and orientations of the plurality of telemetry devices.

41. The apparatus of claim 40, wherein the processor is operative with the processing device program to calculate the position of the at least one anatomical feature after the first portion of the orthopedic medical procedure by best fitting the second set of multiple relative positions and orientations of the plurality of telemetry devices to a mathematical equation representing a kinematic model of the at least one anatomical feature.

42. The apparatus of claim 41, wherein the orthopedic medical procedure is a hip joint replacement procedure, and wherein the first portion of the orthopedic medical procedure is the replacement of the patient'"'"'s hip joint with a prosthetic joint.

43. The apparatus of claim 27, wherein the orthopedic medical procedure is a hip joint replacement procedure, and wherein the differential measurement is cup prosthesis angle.

44. The apparatus of claim 27, wherein the orthopedic medical procedure is a hip joint replacement procedure, and wherein the differential measurement is range of motion.

45. The apparatus of claim 27, wherein the processor is operative with the processing device program to determine the differential measurement without the patient'"'"'s body being held in any particular orientation.

46. The apparatus of claim 27, wherein the processor is further operative with the processing device program to compare the differential measurement with an ideal measurement.

47. The apparatus of claim 46, wherein the orthopedic medical procedure is a hip joint replacement procedure, wherein the first portion of the orthopedic medical procedure is the replacement of the patient'"'"'s hip joint with a first prosthetic joint, and wherein the processor is further operative with the processing device program to:

select a second prosthetic joint;

track movement of the plurality of telemetry devices relative to each other when the patient'"'"'s body is moved through a third range of motion after a second portion of the orthopedic medical procedure;

calculate the position of the at least one anatomical feature of the patient'"'"'s body relative to the plurality of telemetry devices based upon the movement of the plurality of telemetry devices after the second portion of the orthopedic medical procedure; and

determine a new differential measurement in connection with the second portion of the orthopedic medical procedure, wherein the new differential measurement is based at least in part on the calculated position of the at least one anatomical feature before the first portion of the orthopedic medical procedure and on the calculated position of the at least one anatomical feature after the second portion of the orthopedic medical procedure, wherein the second portion of the orthopedic medical procedure is the replacement of the first prosthetic joint with the second prosthetic joint, and wherein the processor is operative with the processing device program to select the second prosthetic joint by adjusting the first prosthetic joint such that the new differential measurement matches the ideal differential measurement.

48. The apparatus of claim 27, wherein the processor is operative with the processing device program to calculate the position of the at least one anatomical feature without using a medical image.

49. The apparatus of claim 48, wherein the medical image consists of one image from the group consisting of the following:

computed tomography scan, magnetic resonance image, ultrasound image, x-ray image, and fluoroscopic image.

50. The apparatus of claim 27, wherein the processor is operative with the processing device program to calculate the position of the at least one anatomical feature without physically registering the positions and orientations of the plurality of telemetry devices with respect to a medical image.

51. The apparatus of claim 27, wherein the processor is operative with the processing device program to calculate the position of the at least one anatomical feature without physically registering the positions and orientations of the plurality of telemetry devices with respect to the at least one anatomical feature.

52. The apparatus of claim 27, wherein the first range of motion is different than the second range of motion.

53. The apparatus of claim 27, wherein the processor is further operative with the processing device program to:

calculate the orientation of the at least one anatomical feature of the patient'"'"'s body at which an orthopedic measurement is most accurate; and

provide on a display an output that indicates when the at least one anatomical feature is in that calculated orientation.

54. An apparatus for attachment of a telemetry device to a bone of a patient in an orthopedic medical procedure, the apparatus comprising:

a U-shaped piece having a front face and a back face;

a bone screw; and

an anti-rotation pin, wherein the U-shaped piece has a hole extending therethrough from the front face to the back face for receiving the bone screw, and wherein the anti-rotation pin extends from the back face of the U-shaped piece.

55. The apparatus of claim 54, wherein an end portion of the anti-rotation pin that is inserted into the bone has three substantially triangular faces to prevent rotation of the U-shaped piece.

56. The apparatus of claim 54, wherein the U-shaped piece has a rectangular opening extending from the front face to the back face.

57. The apparatus of claim 56, wherein the rectangular opening in the U-shaped piece receives the telemetry device.

58. The apparatus of claim 54, wherein the telemetry device is encased within a telemetry device housing, and wherein the U-shaped piece is integral with the telemetry device housing.

59. The apparatus of claim 58, wherein U-shaped piece and the telemetry device housing are a one-piece plastic injection molding.

60. The apparatus of claim 54, wherein the telemetry device is an electromagnetic receiver, and wherein the U-shaped piece, the bone screw, and the anti-rotation pin are each constructed of a non-magnetic material.

61. An apparatus for attachment of a telemetry device to a bone of a patient in an orthopedic medical procedure, the apparatus comprising:

a U-shaped channel for receiving the telemetry device having two side portions and a base portion; and

a plurality of pins, wherein the base portion of the U-shaped channel has a plurality of holes to receive the plurality of pins, and wherein each pin of the plurality of pins has a sharpened end portion for insertion into the bone.

62. The apparatus of claim 61, further comprising a driver, wherein the driver is received within the confines of the U-shaped channel to drive the pins into the bone.

63. The apparatus of claim 61, wherein the two side portions of the U-shaped channel exert a force on the telemetry device to hold the telemetry device in place within the U-shaped channel.

64. The apparatus of claim 61, wherein the telemetry device is an electromagnetic receiver, and wherein the U-shaped channel and the pins are each constructed of a non-magnetic material.