US20120172882A1 - Apparatus for preoperative planning of artificial knee joint replacement operation and jig for supporting operation - Google Patents

Apparatus for preoperative planning of artificial knee joint replacement operation and jig for supporting operation Download PDF

Info

Publication number
US20120172882A1
US20120172882A1 US13/408,227 US201213408227A US2012172882A1 US 20120172882 A1 US20120172882 A1 US 20120172882A1 US 201213408227 A US201213408227 A US 201213408227A US 2012172882 A1 US2012172882 A1 US 2012172882A1
Authority
US
United States
Prior art keywords
marrow
femur
rod
jig
knee joint
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
US13/408,227
Inventor
Takashi Sato
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Lexi Co Ltd
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Individual filed Critical Individual
Priority to US13/408,227 priority Critical patent/US20120172882A1/en
Assigned to LEXI CORPORATION, LTD., WRIGHT MEDICAL JAPAN K.K. reassignment LEXI CORPORATION, LTD. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: SATO, TAKASHI
Publication of US20120172882A1 publication Critical patent/US20120172882A1/en
Assigned to MICROPORT ORTHOPEDICS JAPAN K.K. reassignment MICROPORT ORTHOPEDICS JAPAN K.K. CHANGE OF NAME (SEE DOCUMENT FOR DETAILS). Assignors: WRIGHT MEDICAL JAPAN K.K.
Assigned to LEXI CORPORATION, LTD. reassignment LEXI CORPORATION, LTD. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: MICROPORT ORTHOPEDICS JAPAN K.K.
Priority to US14/452,020 priority patent/US20140364856A1/en
Abandoned legal-status Critical Current

Links

Images

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1764Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the knee
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10Computer-aided planning, simulation or modelling of surgical operations
    • GPHYSICS
    • G06COMPUTING; CALCULATING OR COUNTING
    • G06TIMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T11/002D [Two Dimensional] image generation
    • G06T11/003Reconstruction from projections, e.g. tomography
    • G06T11/006Inverse problem, transformation from projection-space into object-space, e.g. transform methods, back-projection, algebraic methods
    • GPHYSICS
    • G06COMPUTING; CALCULATING OR COUNTING
    • G06TIMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T7/00Image analysis
    • G06T7/97Determining parameters from multiple pictures
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/14Surgical saws ; Accessories therefor
    • A61B17/15Guides therefor
    • A61B17/154Guides therefor for preparing bone for knee prosthesis
    • A61B17/155Cutting femur
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72Intramedullary pins, nails or other devices
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/101Computer-aided simulation of surgical operations
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/101Computer-aided simulation of surgical operations
    • A61B2034/105Modelling of the patient, e.g. for ligaments or bones
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/108Computer aided selection or customisation of medical implants or cutting guides
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/25User interfaces for surgical systems
    • GPHYSICS
    • G06COMPUTING; CALCULATING OR COUNTING
    • G06TIMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2207/00Indexing scheme for image analysis or image enhancement
    • G06T2207/10Image acquisition modality
    • G06T2207/10072Tomographic images
    • G06T2207/10081Computed x-ray tomography [CT]
    • GPHYSICS
    • G06COMPUTING; CALCULATING OR COUNTING
    • G06TIMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2207/00Indexing scheme for image analysis or image enhancement
    • G06T2207/10Image acquisition modality
    • G06T2207/10072Tomographic images
    • G06T2207/10088Magnetic resonance imaging [MRI]
    • GPHYSICS
    • G06COMPUTING; CALCULATING OR COUNTING
    • G06TIMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2207/00Indexing scheme for image analysis or image enhancement
    • G06T2207/30Subject of image; Context of image processing
    • G06T2207/30004Biomedical image processing
    • G06T2207/30008Bone
    • GPHYSICS
    • G06COMPUTING; CALCULATING OR COUNTING
    • G06TIMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2211/00Image generation
    • G06T2211/40Computed tomography

Definitions

  • the present invention relates to an apparatus for preoperative planning of an artificial knee joint replacement operation and a jig for supporting the operation in order to plan an artificial knee joint replacement operation for the knee of the human body using a tomographic image for medical use and perform the operation.
  • tomographic image diagnostic apparatuses such as X-ray CT scanners and MRI apparatuses have spread.
  • the use of these apparatuses allows for the observation and diagnosis of parts of the body.
  • osteoarthritis of the knee has been increasing with aging not only in Japan but also in other countries.
  • the operation in which the affected part of the knee joint is replaced with an artificial joint made of metal or ceramics is wide spread today.
  • the important consideration is that an artificial joint having the optimal shape and size for a patient is placed at the optimal angle and the optimal position.
  • a template in which a two-dimensional shape of the artificial joint is drawn on a transparent film is superimposed on a simple X-ray image from the two-dimensional front and lateral side.
  • the size, position, and orientation for placing the artificial joint as well as the extent and position of bone cutting are measured on the simple X-ray image film using a ruler at present.
  • the accuracy as to the installation position and orientation of the artificial joint has a great effect on the durability of the artificial joint.
  • the accuracy is the most important element to allow patients after the operation to go about their normal lives without ill effects every day for a long period of 10 or 20 years.
  • Patent document 1 Jpn. Pat. Appln. KOKAI Publication No. 2004-008707.
  • the method of using an alignment rod in the marrow (hereinafter referred to as a “rod in the marrow”) which is inserted into the bone is generally used.
  • the angle of distal bone cutting surface which specifies the varus-valgus angle and the flexion-extension angle of the component is determined from a difference between the axis of the rod and the mechhanical axis of the femur by inserting the rod in the marrow.
  • the angle of the rod in the marrow can be adjusted to target installation angle of the component to some extent with an instrument in determining the varus-valgus angle.
  • the flexion-extension angle cannot be adjusted and is completely dependent on the insertion angle of the rod in the marrow. In other words, this means that the installation angle of the femur component is dependent on the insertion angle of the rod in the marrow.
  • the installation angle in the rotation direction of the femur component which is very important in clinical practice is determined in the distal bone cutting surface.
  • the rotation angle is inevitably inaccurate.
  • An objective of the present invention is to provide an apparatus for preoperative planning of an artificial knee joint replacement operation and a jig for supporting the operation in which the position and angle of the distal bone cutting surface can be accurately determined using the alignment rod in the marrow while differences in patients are properly reflected and the exact surgery can be performed by recreating the content determined from the reference points of the femur knee joint using a jig for exclusive use which is attached to the alignment rod in the marrow during the operation.
  • an apparatus for preoperative planning of an artificial knee joint replacement operation comprising: means for inputting an image which inputs a two-dimensional tomographic image of the lower limb including the knee joint; means for reconstructing an image which reconstructs a three-dimensional image of the femur and tibia from the image input by the means for inputting an image; means for determining femur side artificial joint which determines the artificial joint to be replaced from the three-dimensional image of the knee joint of the femur obtained by the means for reconstructing an image; means for determining tibia side artificial joint which determines the artificial joint to be replaced from the three-dimensional image of the knee joint of the tibia obtained by the means for reconstructing an image; and means for parameter determination which determines various parameters used in artificial knee joint replacement using an alignment rod in the marrow which is inserted into the femur based on the artificial joint determined by the means for determining femur side artificial joint and a reference point of the knee joint.
  • a jig for an artificial knee joint replacement operation comprising: a contact portion which contacts the reference point of the knee joint of the femur; a mounting portion which mounts the alignment rod in the marrow to be inserted into the marrow of the femur; and an arm portion which connects the contact portion with the mounting portion and can adjust the attaching position and angle of the mounting portion.
  • a jig for an artificial knee joint replacement operation comprising: a contact portion which contacts the reference point of the knee joint of the femur; a mounting portion which mounts the alignment rod in the marrow to be inserted into the marrow of the femur; and a connection portion which connects the contact portion with the mounting portion and can adjust the attaching angel of an external jig which is mounted on the alignment rod in the marrow.
  • FIG. 1 is a block diagram illustrating a hardware configuration of the personal computer in which a program for preoperative planning of an artificial knee joint replacement operation is installed.
  • FIG. 2 is a flowchart illustrating the content for processing of the program for preoperative planning.
  • FIG. 3 is a diagram illustrating a three-dimensional shape data of the femur, artificial joint, and rod in the marrow are displayed on a display screen.
  • FIG. 4 is a diagram illustrating a three-dimensional shape data of the femur, artificial joint, and rod in the marrow are displayed on a display screen.
  • FIG. 5 is a diagram illustrating an image in which the position of the rod in the marrow against the femur and artificial joint is displayed.
  • FIG. 6 is a diagram illustrating the angle between a mechhanical axis of femur and a distal bone axis.
  • FIG. 7 is a diagram illustrating the position of the bone section of the patellofemoral joint along the flat surface perpendicular to an axis of the rod in the marrow.
  • FIG. 8 is a cross-sectional view of the bone in accordance with the position in FIG. 7 .
  • FIG. 9 is a diagram illustrating the offset between a forward tangent and the coordinate center of the rod.
  • FIG. 10 is a diagram illustrating the case where some of the stored various parameters according to the embodiment are read and are displayed on a display screen.
  • FIG. 11A is a perspective view illustrating the appearance structure of a target device.
  • FIG. 11B is a side view illustrating the appearance structure of the target device.
  • FIG. 12A is a perspective view illustrating the appearance structure of a rod keeper.
  • FIG. 12B is a diagram illustrating the rod keeper in the used state.
  • FIG. 13A is a perspective view illustrating the appearance structure of a jig for determining the rotation angle.
  • FIG. 13B is a side view illustrating the appearance structure of the jig for determining the rotation angle.
  • FIG. 14A is a perspective view illustrating the appearance structure of another jig for determining the rotation angle.
  • FIG. 14B is a side view illustrating the appearance structure of another jig for determining the rotation angle.
  • FIG. 1 is a hardware configuration of a personal computer (hereinafter referred to as a “PC”) 10 in which a program for preoperative planning of an artificial knee joint replacement operation is installed.
  • a CPU 11 which manages various processing controls is connected to a northbridge 12 via a front side bus (FSB).
  • FSB front side bus
  • the northbridge 12 is further connected to a main memory 13 via a memory bus (MB) and is connected to a graphic controller 14 and a graphic memory 15 via an AGP graphics interface. In addition, it is also connected to a southbridge 16 and mainly performs input-output control thereof.
  • MB memory bus
  • AGP graphics interface AGP graphics interface
  • the southbridge 16 is connected to a PCI bus 17 , a keyboard/mouse 18 , a video encoder 19 , a hard disk drive (HDD) 20 , a network interface 21 , and a multi-disk drive 22 and mainly performs input-output control of these peripheral circuits and the northbridge 12 .
  • a PCI bus 17 a PCI bus 17 , a keyboard/mouse 18 , a video encoder 19 , a hard disk drive (HDD) 20 , a network interface 21 , and a multi-disk drive 22 and mainly performs input-output control of these peripheral circuits and the northbridge 12 .
  • HDD hard disk drive
  • OS operating system
  • application programs various application programs
  • data files as well as the program for preoperative planning of an artificial knee joint replacement operation
  • the video encoder 19 generates an RGB video signal which is an image signal of an analog value from an image signal of a given digital value, outputs it, and then drives a display portion constituted of a color thin-film transistor (TFT) liquid crystal display panel (not shown herein) to display.
  • RGB video signal which is an image signal of an analog value from an image signal of a given digital value
  • TFT color thin-film transistor
  • the multi-disk drive 22 can reproduce and record an optical disk media in accordance with for example, the Compact Disc (CD) standard and the Digital Versatile Disc (DVD) standard.
  • the three-dimensional shape data of the patient's lower limb can be input into the hard disk drive 20 by reproducing and reading the optical disk media in which an X-ray of the patient, a laminagram captured by X-ray computed tomography, or the like are recorded in order to record the data therein.
  • FIG. 2 shows the content of processing of the present invention which is mainly performed by the CPU 11 when a medical practitioner who is the user of the PC 10 starts the program for preoperative planning stored in the hard disk drive 13 .
  • the three-dimensional bone shape data of a patient's lower limb produced from a two-dimensional tomographic image data slice captured by an X-ray CT scanner or an MRI apparatus is read and stored in the hard disk drive 20 .
  • the three-dimensional bone shape data of the lower limb which is produced based on a series of two-dimensional tomographic image of the lower limb of the human body on the program
  • major landmarks such as the center of the bone head, the center of the posterior condylar of the knee joint, the tibia intercondylar eminence, or the medial or lateral border points of the tibia distal articular surface are set as three-dimensional reference points.
  • the coordinate system of the femur and tibia is set using those reference points. It does not matter whether a three-dimensional positional relationship between the femur and tibia, namely, alignment in itself is in a standing position or a decubitus position.
  • the center of the straight line connecting the center of the medial and lateral posterior condylar portions is the origin.
  • the rightward of the human body along the straight line is the X-axis.
  • the vector product of a vector connecting the origin with the center of the bone head and a vector of the X-axis is the Y-axis. Therefore, as for the Y-axis, the front side of the body is defined as positive.
  • the Z-axis will be determined from the X-axis and the Y-axis.
  • the line connecting the center of the line connecting the medial or lateral border points of the tibia distal articular surface with the center of the tibia intercondylar eminence is the Z-axis.
  • the proximal direction, namely, the upper direction is defined as positive.
  • the Y-axis is the line connecting the tibia posterior cruciate ligament attachment site with the tuberositas tibiae.
  • the front side of the body is defined as positive.
  • the X-axis is determined from Y-axis and the Z-axis.
  • the three-dimensional shape data of the artificial joint is separately prepared and stored in the hard disk device 20 .
  • original coordinate systems of a femur prosthesis and a tibia prosthesis are respectively set.
  • a proximal direction or a vertical direction is the Z-axis
  • the direction of the front side of the body is the Y-axis
  • the rightward relative to the body side is the X-axis.
  • the coordinate system as to the tibia prosthesis is defined in the same manner.
  • GUI graphical user interface
  • This process is performed by designating the folder used in the general PC program in which the three-dimensional shape data of the lower limb is stored. Further, as for the three-dimensional shape data of the femur and the three-dimensional shape data of the tibia, the three-dimensional positional relationship (three-dimensional alignment) between the three-dimensional shape data of the femur and the three-dimensional shape data of the tibia in the standing position in the loaded state and/or the decubitus position in the non-loaded state is correctly placed in advance.
  • the selected three-dimensional shape data of the femur of the lower limb is read into the main memory 13 from the folder of the hard disk drive 20 (step S 101 ).
  • the image obtained by observing the three-dimensional shape data from an appropriate viewpoint is displayed on the display screen (step S 102 ).
  • the three-dimensional image which is perspectively projected or the three-dimensional shape data can be two-dimensionally displayed in the cross-section in the flat surface parallel to the coordinate axis.
  • the three-dimensional shape data of the artificial joint for the femur joint with an appropriate size and shape is selected (step 103 ).
  • the data is read from the hard disk drive 20 and displayed on the display screen (step 104 ).
  • the three-dimensional shape data of the artificial joint for the femur is appropriately moved in parallel and rotationally moved by operation of the keyboard/mouse 18 and placed in the optimal position to the three-dimensional shape data of the femur.
  • optical position used herein is a position which is optimal in orthopedic surgery and proposed by societies and each of the artificial joint manufacturers. Further, it is the relative installed position of the artificial joint for each of the femur and tibia. This position is the optimal position to place the artificial joint during the operation and the bone is cut based on the installed position (step S 105 ).
  • the distal articular surface of the femur component (artificial joint) and the proximal articular surface of the tibia component are perpendicular to the mechhanical axis on the coronal section.
  • the angle (flexion-extension angle) on the sagittal section there is no constant consensus in both components.
  • the medical practitioner needs to decide the angle properly in accordance with the shape of the joint of individual patients.
  • the rotation angle in the axial direction it is recommended that the X-axis of a femur component be set parallel to the transepicondylar axis (hereinafter referred to as the TEA).
  • the medical practitioner who is the user of the program may set the installed position in an interactive mode on the program.
  • the automatable portion may be automatically placed using the reference points.
  • step S 106 the three-dimension shape data of the artificial joint for the tibia joint with an appropriate size is selected.
  • the date is read from the hard disk drive 20 and displayed on the display screen (step S 107 ).
  • the three-dimensional shape data of the artificial joint for the tibia is appropriately moved in parallel and rotationally moved by operation of the keyboard/mouse 18 and placed in the optimal position to the three-dimensional shape data of the tibia (step S 108 ).
  • the medical practitioner who is the user of the program may set the installed position in an interactive mode on the program.
  • the automatable portion may be automatically placed using the reference points.
  • respective artificial joints are easily placed in three-dimensionally ideal positions for bones of lower limb and thus the quantitive installation parameter and the bone cutting parameter can be obtained.
  • step S 109 the three-dimensional shape data of the rod in the marrow which is pre-installed is read from the hard disk drive 20 (step S 109 ).
  • the data is displayed on the display screen (step S 110 ).
  • a mark indicating the depth is pre-installed into the three-dimensional shape data of the rod in the marrow.
  • the coordinate system of the rod is defined.
  • the long axis is the Z-axis and the front side is the Y-axis.
  • the vector product of the Y-axis and the Z-axis is the X-axis.
  • the coordinate system is set as a matter of convenience and another definition may be used.
  • the three-dimensional shape data of the rod in the marrow which is read can be parallelly moved to distal and proximal, medial or lateral side, and forward and backward.
  • the data can be rotated in the internal-external rotational direction, in the varus-valgus direction, or in the flexion-extension direction.
  • the three-dimensional shape data of the alignment rod in the marrow is rotationally moved and moved in parallel by operation of the keyboard/mouse 18 and then appropriately placed in the marrow of the three-dimensional shape data of the femur (step S 111 ).
  • the rod in the marrow is placed in an appropriate position in the marrow.
  • the insertion position, orientation, and depth of the rod in the marrow are three-dimensionally arranged at an optimal angle and position.
  • the term “optimal angle and position” used herein is the angle and position in which the insertion point, varus-valgus angle, and insertion depth are adjusted so that the insertion depth in the marrow is as large as practicable under the condition according to the flexion-extension installation angle of the selected artificial joint.
  • the position is that the Z-axis of the rod in the marrow exists in the flat surface parallel to the XZ flat surface as described hereinafter.
  • FIG. 3 is a diagram illustrating a three-dimensional shape data of the femur, artificial joint, and rod in the marrow are displayed on a display screen at this time.
  • FIG. 3 shows the state in which the optimal position of an artificial joint CP is selected and placed in a knee joint part of a femur FM and a rod in the marrow IM is inserted into the femur FM.
  • the three-dimensional shape data of the rod in the marrow IM is moved to the femur FM and the artificial joint CP by operation of the keyboard/mouse 18 (step S 111 ). Then, the end of the placement into the optimal position is determined by, for example, the presence or absence of the instruction of a “determination” button during GUI display (step S 112 ).
  • step S 111 the process is returned to the processing of step S 111 and the position movement of the rod in the marrow IM by the operation is repeated. It is waited till the rod in the marrow IM is moved to the optimal position in the marrow of the femur FM.
  • the optimal placement of the rod in the marrow IM means that the angle and position according to the installation angle of the artificial joint CP to be intended, namely, the Z-axis matched with the axis of the rod in the marrow IM, becomes parallel to the XZ in-plane of the coordinate system of the artificial joint CP for femur.
  • the medical practitioner i.e., the user
  • the optimal placement is achieved.
  • FIGS. 4 and 5 exemplify an image in which the position of the rod in the marrow IM for the femur FM and the artificial joint CP is displayed along the two-dimensional flat surface based on the three-dimensional shape data by switching the displayed state in the process of obtaining the proper arrangement.
  • FIG. 4 the cross section observed from the side surface passing through the central axis (Z-axis) of the rod in the marrow IM in the screen and the cross section observed from the front side are shown together with the original three-dimensional shape.
  • FIG. 5 the positional relationship between the artificial joint CP and the rod in the marrow IM based on the whole femur FM is extracted from the display screen in the GUI environment shown in FIGS. 3 and 4 , which is exemplified.
  • FIG. 5 shows the state in which the rod in the marrow IM in the curved marrow of the femur FM is inserted into the innermost part (upper part in the human body in a standing position).
  • the optimal placement state of the rod in the marrow IM is obtained.
  • this is determined in step S 111 and the angle (varus-valgus angle) between the Z-axis (i.e., the axis of the rod in the marrow IM) and the Z-axis of the artificial joint CP is calculated in the coronal surface (step S 113 ).
  • FIG. 6 exemplifies the varus-valgus angle and corresponds to the angle between a mechhanical axis FA and a distal bone axis FP in the femur coordinate system.
  • the angle is about 7 degrees (7.68 degrees in the drawing). It may vary more greatly depending on individual differences.
  • the rotation angle is determined.
  • the femoral posterior condylar tangent which are referenced during the operation and the X-axis of the artificial joint CP are projected on the flat surface perpendicular to the axis of the rod in the marrow IM.
  • the angle between them (hereinafter referred to as the “posterior condylar tangent-artificial joint angle”) is calculated (step S 114 ).
  • the medical practitioner who is the user of the program can figure out which side and how many degrees the X-axis of the artificial joint CP should be rotated around the rod in the marrow IM from the state parallel to the axis of the posterior condylar tangent during the operation.
  • the cross-sectional image of the bone in the proximal part within a few millimeters from the proximal edge of the patellofemoral joint is displayed on the flat surface (this is a flat surface “R”) perpendicular to the axis of the rod in the marrow IM.
  • the tangent of the two points in the bimodal portion of the front cortex is determined by digitizing two points.
  • the angle (hereinafter referred to as the “front tangent-artificial joint angle”) between the tangent and the X-axis of the artificial joint is determined.
  • the offset distance from the coordinate center of rod to the flat surface R is calculated (step S 115 ).
  • FIG. 7 shows the flat surface R.
  • FIG. 8 is a front tangent TL on the flat surface R.
  • the position of the front tangent TL is located at the side which is directly visible during the operation. Since the position is not affected by the presence of cartilage, it can be used as one of the reference points which can be recognized very easily.
  • FIG. 9 is a diagram illustrating the offset (17.24 mm in the figure) between the front tangent TL and the coordinate center of the rod.
  • the planning for an artificial joint replacement operation before the operation is carried out and various necessary parameters are calculated and stored (step S 116 ).
  • the optimal bone cutting can be performed using these various parameters at the time of the actual operation using a surgical instrument.
  • FIG. 10 is a diagram illustrating the case where some of the various stored parameters are read and are displayed on a display screen. That is, the parameter values which should be calculated by the program for preoperative planning includes the followings:
  • the data of the insertion point of the rod in the marrow ⁇ Y value from the flat portion (approximated by the flat surface) within about 30 mm from the proximal edge of the femoropatellar joint at the front portion of the femur distal portion for placing the target device to the insertion point of the rod in the marrow, namely, the distance when projected on the YZ flat surface of the femur coordinate system;
  • the insertion depth of the rod namely, the length from the insertion point to the tip of the rod
  • the jig referred to as the target device is used as a first jig for the flat portion located proximal to the upper end of the patellar surface of femur in order to determine the insertion point of the rod in the marrow.
  • FIGS. 11A and 11B illustrate the shape of a target device 30 which is used at this time.
  • FIG. 11A is a perspective view and FIG. 11B is a side view.
  • the target device 30 includes a contact portion 31 , an arm portion 32 , and a mounting portion 33 .
  • the contact portion 31 is the site which contacts the front tangent.
  • the arm portion 32 is fixedly connected to the contact portion 31 .
  • the mounting portion 33 which can be moved parallel to arrow I in the drawing which becomes perpendicular to the axis of the arm portion 32 and becomes parallel to the front tangent, is attached to the tip of the arm portion 32 .
  • the mounting portion 33 has a rod mounting portion 34 which can be moved parallel to the axis of the mounting portion 33 and an arrow direction II perpendicular to the arrow I.
  • the bottom of the contact portion 31 namely, the offset (distance) from the position of the front tangent being contacted is scaled, for example, by millimeters and stamped.
  • the offset from the front tangent can be adjusted by adjusting a screw 35 .
  • the mounting angle can also be adjusted.
  • the rod in the marrow or a marker for the insertion position with the same shape as that of the rod in the marrow is attached to the rod mounting portion 34 .
  • the insertion point can be determined by measuring the distance from an approximated flat surface which has been calculated as described in (1) to the insertion point of the rod in the marrow in the intercondylar portion and by marking it.
  • An insertion inlet is formed by drilling the marked insertion position with a drill bit (not shown). Then, the rod in the marrow IM is inserted into the marrow of the femur FM from the insertion inlet at the pre-calculated depth.
  • a rod keeper 40 as shown in FIG. 12A may be used so that the rod in the marrow IM is not moved carelessly.
  • the rod keeper 40 shown in FIG. 12A has a two-stage cylindrical shape with different outer diameters.
  • the central axis portion is hollow to pass the rod in the marrow IM.
  • a spike 41 a is protruded downward from the lower bottom side of a large diameter side cylindrical portion 41 .
  • the spike 41 a is driven in the insertion inlet of the femur FM (shown as a three-dimensional model herein) in the state that the rod in the marrow IM is passed through.
  • a plurality of screw holes for example, three screw holes 43 are passed through a small diameter side cylindrical portion 42 of the rod keeper 40 so as to form an equal central angle from the center of the axis position in the radial direction.
  • screws (not shown) are threadably mounted on each of the screw holes 43 and thus the rod in the marrow IM inserted from the insertion inlet of the femur FM can be held without wobble.
  • a conventional jig for bone cutting (not shown) is attached to the rod in the marrow IM.
  • the jig for bone cutting is previously adjusted to the valgus angle as described in (4) which has been previously calculated for the rod in the marrow IM.
  • the horizontal axis of the flat surface portion which is referred to as a distal ablation paddle of the jig is matched with the X-axis of the rod in the marrow IM and the X-axis of the artificial joint CP.
  • FIGS. 13A and 13B show the structure of a jig for determining the rotation angle 50 which is mounted from a distal position of the jig for bone cutting together with the rod keeper 40 and other jigs.
  • FIG. 13A is a perspective view and FIG. 13B is a side view.
  • a pair of paddles 52 is provided on the lower end side of a mounting portion 51 which passes through the rod in the marrow IM so as to be integral with the connection portion 53 .
  • the paddles 52 contact the medial and lateral posterior condylar portions of the femur FM.
  • the connection portion 53 is slidably attached to the mounting portion 51 so that the distance of the pair of paddles 52 with the rod axis portion can be adjusted as indicated by an arrow IV in the drawing.
  • a rotational portion 54 which is rotatably provided on the mounting portion 51 and is passed through the rod in the marrow IM is provided.
  • the rotational portion 54 is located at the front side of the side of the mounting portion 51 , a pointer 54 a is radially attached to the rotational portion 54 , and a scale 51 a is formed at the side of the mounting portion 51 .
  • the jig for determining the rotation angle 50 is mounted from the distal position of the jig for bone cutting.
  • the angle of the rotational portion 54 is adjusted to the mounting portion 51 so that the angle between the jig for bone cutting and the jig for determining the rotation angle 50 is equal to the “posterior condylar tangent-artificial joint angle” calculated by the program for preoperative planning. Then, the rod in the marrow IM and the jig for bone cutting are rotated.
  • the rotation angle of the artificial joint CP is realized by this rotation.
  • the condylar portion of the femur is drilled so that two points on the horizontal axis of the jig for bone cutting (matched with the X-axis of the artificial joint CP) becomes perpendicular to the flat surface of the jig and small bone holes are produced.
  • the distal bone cutting is performed using conventional instrument.
  • the rotation angle is determined in reference to two bone holes which have been previously made on the distal bone cutting surface and posterior bone cutting is performed.
  • the cartilage may remain in the posterior condylar of the femur. Because of the uneven thickness, when the posterior condylar tangent is used to determine the rotation angle, the exact control may become difficult.
  • the “front tangent-artificial joint angle” is used as another method for determining the rotation angle.
  • a special jig for determining the rotation angle which measures how many degrees the front tangent is rotated about the rod axis from a more distal position of the jig for bone cutting is used.
  • FIGS. 14A and 14B show the structure of a jig for determining the rotation angle 60 which is mounted from a distal position of the jig for bone cutting together with the rod keeper 40 and other jigs.
  • FIG. 14A is a perspective view and FIG. 14B is a side view.
  • the contact portion 64 is provided on the upper end side of a mounting portion 61 which passes through the rod in the marrow IM via a connection portion 62 and the arm portion 63 .
  • the contact portion 64 is the piece which contacts the front tangent as with the contact portion 31 of the target device 30 in FIG. 11 .
  • the arm length (distance between the mounting portion 61 and the contact portion 64 ) is optionally variable for the connection portion 62 as indicated by an arrow V in FIG. 14B .
  • the connection portion 62 is slidably attached to the mounting portion 61 so that the distance (height) with the rod axis portion can be adjusted as indicated by an arrow VI in the drawing.
  • a rotational portion 65 which is rotatably provided on the mounting portion 61 and is passed through the rod in the marrow IM is provided.
  • the rotational portion 65 is located at the front side of the side of the mounting portion 61 , a pointer 65 a is radially attached to the rotational portion 65 , and a scale 61 a is formed at the side of the mounting portion 61 .
  • the correct rotation angle of the jig for bone cutting is obtained by measuring how many degrees the front tangent exposed at the time of the operation is rotated about the rod axis and allowing the angle between the angle of the rotation and the front tangent of the jig for bone cutting to be equal to the “front tangent-artificial joint angle” obtained by the program for preoperative planning.
  • the present invention is not to be construed as being limited to the embodiments. Various variations can be made in implementation without departing from the spirit of the invention. Further, the function to be performed in the embodiments may be carried out in all the possible appropriate combinations. Various stages are included in the embodiments and various inventions may be extracted from a plurality of the disclosed constituent features in an appropriate combination. For example, when the effect can be obtained even if some constituent features are deleted from all the constituent features shown in the embodiments, the structure from which these constituent features are deleted can be extracted as the invention.

Abstract

Steps S101 and S102 of displaying images which input two-dimensional tomographic images of the lower limb including the knee joint and displays three-dimensional images of the femur and the tibia including the knee joint from the image input, steps S103 to S105 and S106 to S108 of determining artificial joint which determine the artificial joint to be replaced from the three-dimensional images of each knee joint of the femur and tibia, and steps S113 and S114 of parameter determination which determine various parameters used in an artificial knee joint replacement operation using an alignment rod in the marrow to be inserted into the femur based on the artificial joint and reference points of the knee joint determined in steps S103 to S105 of determining femur side artificial joint are performed by a computer.

Description

    CROSS REFERENCE TO RELATED APPLICATIONS
  • This is a Continuation Application of PCT Application No. PCT/JP2008/065900, filed Sep. 3, 2008, which was published under PCT Article 21(2) in Japanese.
  • This application is based upon and claims the benefit of priority from prior Japanese Patent Application No. 2007-256046, filed Sep. 28, 2007, the entire contents of which are incorporated herein by reference.
  • BACKGROUND OF THE INVENTION
  • 1. Field of the Invention
  • The present invention relates to an apparatus for preoperative planning of an artificial knee joint replacement operation and a jig for supporting the operation in order to plan an artificial knee joint replacement operation for the knee of the human body using a tomographic image for medical use and perform the operation.
  • 2. Description of the Related Art
  • In recent years, tomographic image diagnostic apparatuses such as X-ray CT scanners and MRI apparatuses have spread. The use of these apparatuses allows for the observation and diagnosis of parts of the body. In contrast, osteoarthritis of the knee has been increasing with aging not only in Japan but also in other countries. The operation in which the affected part of the knee joint is replaced with an artificial joint made of metal or ceramics is wide spread today. In the artificial knee joint replacement, the important consideration is that an artificial joint having the optimal shape and size for a patient is placed at the optimal angle and the optimal position.
  • As the operation planning for that, a template in which a two-dimensional shape of the artificial joint is drawn on a transparent film is superimposed on a simple X-ray image from the two-dimensional front and lateral side. Alternatively, the size, position, and orientation for placing the artificial joint as well as the extent and position of bone cutting are measured on the simple X-ray image film using a ruler at present.
  • In the manual measurement using the template and the ruler on the basis of the two-dimensional simple X-ray image, the measurement accuracy of the size and position is insufficient. In addition, it is difficult to figure out the installation position and the extent of bone cutting three-dimensionally and quantitatively. Therefore, considerable experience and accumulation of technique are needed.
  • Consequently, it has been difficult for all the orthopedists to immediately perform the exact and highly accurate operation planning and operation. Particularly, the accuracy as to the installation position and orientation of the artificial joint has a great effect on the durability of the artificial joint. In addition, the accuracy is the most important element to allow patients after the operation to go about their normal lives without ill effects every day for a long period of 10 or 20 years.
  • In the method using the two-dimensional template, it has been difficult to perform such processing.
  • On the other hand, in order to support an operator so that the operator can easily find an ideal bone cutting surface of the tibia in the artificial knee joint replacement, a technique which performs the three-dimensional simulation using the personal computer is considered as shown below (for example, Patent document 1: Jpn. Pat. Appln. KOKAI Publication No. 2004-008707).
  • Conventionally, when the installation angle of the component of the femur side (artificial joint) is determined during the operation, the method of using an alignment rod in the marrow (hereinafter referred to as a “rod in the marrow”) which is inserted into the bone is generally used. The angle of distal bone cutting surface which specifies the varus-valgus angle and the flexion-extension angle of the component is determined from a difference between the axis of the rod and the mechhanical axis of the femur by inserting the rod in the marrow.
  • At this time, the angle of the rod in the marrow can be adjusted to target installation angle of the component to some extent with an instrument in determining the varus-valgus angle. However, the flexion-extension angle cannot be adjusted and is completely dependent on the insertion angle of the rod in the marrow. In other words, this means that the installation angle of the femur component is dependent on the insertion angle of the rod in the marrow.
  • In the method of using the rod in the marrow, since there are differences in the bone shape among individuals, the insertion angle of the rod in the marrow varies depending on each case. Thus, it is difficult to reliably form a distal bone cutting surface at a prearranged angle.
  • Further, the installation angle in the rotation direction of the femur component which is very important in clinical practice is determined in the distal bone cutting surface. Thus, when the distal bone cutting surface in itself is inaccurate, the rotation angle is inevitably inaccurate.
  • In this respect, there is no description about the failure caused by the use of the rod in the marrow at the femur side in Patent document 1 in which the technique at the side of tibia is described.
  • BRIEF SUMMARY OF THE INVENTION
  • An objective of the present invention is to provide an apparatus for preoperative planning of an artificial knee joint replacement operation and a jig for supporting the operation in which the position and angle of the distal bone cutting surface can be accurately determined using the alignment rod in the marrow while differences in patients are properly reflected and the exact surgery can be performed by recreating the content determined from the reference points of the femur knee joint using a jig for exclusive use which is attached to the alignment rod in the marrow during the operation.
  • According to a first aspect of the present invention, there is provided an apparatus for preoperative planning of an artificial knee joint replacement operation, comprising: means for inputting an image which inputs a two-dimensional tomographic image of the lower limb including the knee joint; means for reconstructing an image which reconstructs a three-dimensional image of the femur and tibia from the image input by the means for inputting an image; means for determining femur side artificial joint which determines the artificial joint to be replaced from the three-dimensional image of the knee joint of the femur obtained by the means for reconstructing an image; means for determining tibia side artificial joint which determines the artificial joint to be replaced from the three-dimensional image of the knee joint of the tibia obtained by the means for reconstructing an image; and means for parameter determination which determines various parameters used in artificial knee joint replacement using an alignment rod in the marrow which is inserted into the femur based on the artificial joint determined by the means for determining femur side artificial joint and a reference point of the knee joint.
  • According to a second aspect of the present invention, there is provided a jig for an artificial knee joint replacement operation, comprising: a contact portion which contacts the reference point of the knee joint of the femur; a mounting portion which mounts the alignment rod in the marrow to be inserted into the marrow of the femur; and an arm portion which connects the contact portion with the mounting portion and can adjust the attaching position and angle of the mounting portion.
  • According to a third aspect of the present invention, there is provided a jig for an artificial knee joint replacement operation, comprising: a contact portion which contacts the reference point of the knee joint of the femur; a mounting portion which mounts the alignment rod in the marrow to be inserted into the marrow of the femur; and a connection portion which connects the contact portion with the mounting portion and can adjust the attaching angel of an external jig which is mounted on the alignment rod in the marrow.
  • BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING
  • FIG. 1 is a block diagram illustrating a hardware configuration of the personal computer in which a program for preoperative planning of an artificial knee joint replacement operation is installed.
  • FIG. 2 is a flowchart illustrating the content for processing of the program for preoperative planning.
  • FIG. 3 is a diagram illustrating a three-dimensional shape data of the femur, artificial joint, and rod in the marrow are displayed on a display screen.
  • FIG. 4 is a diagram illustrating a three-dimensional shape data of the femur, artificial joint, and rod in the marrow are displayed on a display screen.
  • FIG. 5 is a diagram illustrating an image in which the position of the rod in the marrow against the femur and artificial joint is displayed.
  • FIG. 6 is a diagram illustrating the angle between a mechhanical axis of femur and a distal bone axis.
  • FIG. 7 is a diagram illustrating the position of the bone section of the patellofemoral joint along the flat surface perpendicular to an axis of the rod in the marrow.
  • FIG. 8 is a cross-sectional view of the bone in accordance with the position in FIG. 7.
  • FIG. 9 is a diagram illustrating the offset between a forward tangent and the coordinate center of the rod.
  • FIG. 10 is a diagram illustrating the case where some of the stored various parameters according to the embodiment are read and are displayed on a display screen.
  • FIG. 11A is a perspective view illustrating the appearance structure of a target device.
  • FIG. 11B is a side view illustrating the appearance structure of the target device.
  • FIG. 12A is a perspective view illustrating the appearance structure of a rod keeper.
  • FIG. 12B is a diagram illustrating the rod keeper in the used state.
  • FIG. 13A is a perspective view illustrating the appearance structure of a jig for determining the rotation angle.
  • FIG. 13B is a side view illustrating the appearance structure of the jig for determining the rotation angle.
  • FIG. 14A is a perspective view illustrating the appearance structure of another jig for determining the rotation angle.
  • FIG. 14B is a side view illustrating the appearance structure of another jig for determining the rotation angle.
  • DETAILED DESCRIPTION OF THE INVENTION
  • Hereinafter, one embodiment of the present invention will be described with reference to drawings.
  • FIG. 1 is a hardware configuration of a personal computer (hereinafter referred to as a “PC”) 10 in which a program for preoperative planning of an artificial knee joint replacement operation is installed. A CPU 11 which manages various processing controls is connected to a northbridge 12 via a front side bus (FSB).
  • The northbridge 12 is further connected to a main memory 13 via a memory bus (MB) and is connected to a graphic controller 14 and a graphic memory 15 via an AGP graphics interface. In addition, it is also connected to a southbridge 16 and mainly performs input-output control thereof.
  • The southbridge 16 is connected to a PCI bus 17, a keyboard/mouse 18, a video encoder 19, a hard disk drive (HDD) 20, a network interface 21, and a multi-disk drive 22 and mainly performs input-output control of these peripheral circuits and the northbridge 12.
  • An operating system (OS), various application programs, various data files, as well as the program for preoperative planning of an artificial knee joint replacement operation, and data of the shapes of the rod in the marrow and various jigs associated with it and are pre-installed in the hard disk drive 20.
  • In this regard, the video encoder 19 generates an RGB video signal which is an image signal of an analog value from an image signal of a given digital value, outputs it, and then drives a display portion constituted of a color thin-film transistor (TFT) liquid crystal display panel (not shown herein) to display.
  • The multi-disk drive 22 can reproduce and record an optical disk media in accordance with for example, the Compact Disc (CD) standard and the Digital Versatile Disc (DVD) standard. The three-dimensional shape data of the patient's lower limb can be input into the hard disk drive 20 by reproducing and reading the optical disk media in which an X-ray of the patient, a laminagram captured by X-ray computed tomography, or the like are recorded in order to record the data therein.
  • In this regard, respective elements constituting a PC 10 are generally well-known techniques and therefore the description will not be repeated here.
  • Subsequently, the operation of the embodiment described above will be described.
  • FIG. 2 shows the content of processing of the present invention which is mainly performed by the CPU 11 when a medical practitioner who is the user of the PC 10 starts the program for preoperative planning stored in the hard disk drive 13.
  • In executing the program for preoperative planning, the three-dimensional bone shape data of a patient's lower limb produced from a two-dimensional tomographic image data slice captured by an X-ray CT scanner or an MRI apparatus is read and stored in the hard disk drive 20.
  • In this regard, as for the three-dimensional bone shape data of the lower limb which is produced based on a series of two-dimensional tomographic image of the lower limb of the human body on the program, major landmarks such as the center of the bone head, the center of the posterior condylar of the knee joint, the tibia intercondylar eminence, or the medial or lateral border points of the tibia distal articular surface are set as three-dimensional reference points. The coordinate system of the femur and tibia is set using those reference points. It does not matter whether a three-dimensional positional relationship between the femur and tibia, namely, alignment in itself is in a standing position or a decubitus position.
  • Although an absolute definition is not particularly necessary in the coordinate system, the following coordinate system is used as a matter of convenience herein. With reference to the femur coordinate system, the center of the straight line connecting the center of the medial and lateral posterior condylar portions is the origin. The rightward of the human body along the straight line is the X-axis. The vector product of a vector connecting the origin with the center of the bone head and a vector of the X-axis is the Y-axis. Therefore, as for the Y-axis, the front side of the body is defined as positive. The Z-axis will be determined from the X-axis and the Y-axis.
  • With reference to the tibia coordinate system, the line connecting the center of the line connecting the medial or lateral border points of the tibia distal articular surface with the center of the tibia intercondylar eminence is the Z-axis. The proximal direction, namely, the upper direction is defined as positive. The Y-axis is the line connecting the tibia posterior cruciate ligament attachment site with the tuberositas tibiae. The front side of the body is defined as positive. The X-axis is determined from Y-axis and the Z-axis.
  • Further, the three-dimensional shape data of the artificial joint is separately prepared and stored in the hard disk device 20. As with the femur and tibia, original coordinate systems of a femur prosthesis and a tibia prosthesis are respectively set.
  • Specifically, in the femur prosthesis, for example, a proximal direction or a vertical direction is the Z-axis, the direction of the front side of the body is the Y-axis, and the rightward relative to the body side is the X-axis. However, it is not necessary that the coordinate axis is absolutely placed in such a manner and another definition can be used. The coordinate system as to the tibia prosthesis is defined in the same manner.
  • Therefore, when the program for preoperative planning of FIG. 2 is started, a graphical user interface (GUI) is displayed. Then, the three-dimension shape data in the desired standing or decubitus position of the lower limb which is displayed on the GUI is selected.
  • This process is performed by designating the folder used in the general PC program in which the three-dimensional shape data of the lower limb is stored. Further, as for the three-dimensional shape data of the femur and the three-dimensional shape data of the tibia, the three-dimensional positional relationship (three-dimensional alignment) between the three-dimensional shape data of the femur and the three-dimensional shape data of the tibia in the standing position in the loaded state and/or the decubitus position in the non-loaded state is correctly placed in advance.
  • Subsequently, the selected three-dimensional shape data of the femur of the lower limb is read into the main memory 13 from the folder of the hard disk drive 20 (step S101). The image obtained by observing the three-dimensional shape data from an appropriate viewpoint is displayed on the display screen (step S102). In the display, the three-dimensional image which is perspectively projected or the three-dimensional shape data can be two-dimensionally displayed in the cross-section in the flat surface parallel to the coordinate axis.
  • Then, the three-dimensional shape data of the artificial joint for the femur joint with an appropriate size and shape is selected (step 103). The data is read from the hard disk drive 20 and displayed on the display screen (step 104).
  • Then, the three-dimensional shape data of the artificial joint for the femur is appropriately moved in parallel and rotationally moved by operation of the keyboard/mouse 18 and placed in the optimal position to the three-dimensional shape data of the femur.
  • The term “optimal position” used herein is a position which is optimal in orthopedic surgery and proposed by societies and each of the artificial joint manufacturers. Further, it is the relative installed position of the artificial joint for each of the femur and tibia. This position is the optimal position to place the artificial joint during the operation and the bone is cut based on the installed position (step S105).
  • More specifically, it is generally recommended that the distal articular surface of the femur component (artificial joint) and the proximal articular surface of the tibia component are perpendicular to the mechhanical axis on the coronal section. However, as for the angle (flexion-extension angle) on the sagittal section, there is no constant consensus in both components. Thus, the medical practitioner needs to decide the angle properly in accordance with the shape of the joint of individual patients. Further, as for the rotation angle in the axial direction, it is recommended that the X-axis of a femur component be set parallel to the transepicondylar axis (hereinafter referred to as the TEA). The medical practitioner who is the user of the program may set the installed position in an interactive mode on the program. The automatable portion may be automatically placed using the reference points.
  • Then, the three-dimension shape data of the artificial joint for the tibia joint with an appropriate size is selected (step S106). The date is read from the hard disk drive 20 and displayed on the display screen (step S107).
  • Then, as with the side of femur described above, the three-dimensional shape data of the artificial joint for the tibia is appropriately moved in parallel and rotationally moved by operation of the keyboard/mouse 18 and placed in the optimal position to the three-dimensional shape data of the tibia (step S108).
  • The medical practitioner who is the user of the program may set the installed position in an interactive mode on the program. The automatable portion may be automatically placed using the reference points.
  • As described above, in the present embodiment, respective artificial joints are easily placed in three-dimensionally ideal positions for bones of lower limb and thus the quantitive installation parameter and the bone cutting parameter can be obtained.
  • Then, the three-dimensional shape data of the rod in the marrow which is pre-installed is read from the hard disk drive 20 (step S109). The data is displayed on the display screen (step S110).
  • A mark indicating the depth is pre-installed into the three-dimensional shape data of the rod in the marrow. The coordinate system of the rod is defined. The long axis is the Z-axis and the front side is the Y-axis. The vector product of the Y-axis and the Z-axis is the X-axis. The coordinate system is set as a matter of convenience and another definition may be used.
  • The three-dimensional shape data of the rod in the marrow which is read can be parallelly moved to distal and proximal, medial or lateral side, and forward and backward. The data can be rotated in the internal-external rotational direction, in the varus-valgus direction, or in the flexion-extension direction.
  • On the display screen, the three-dimensional shape data of the alignment rod in the marrow is rotationally moved and moved in parallel by operation of the keyboard/mouse 18 and then appropriately placed in the marrow of the three-dimensional shape data of the femur (step S111).
  • That is, based on the shape data of the femur, the rod in the marrow is placed in an appropriate position in the marrow. In other words, the insertion position, orientation, and depth of the rod in the marrow are three-dimensionally arranged at an optimal angle and position. The term “optimal angle and position” used herein is the angle and position in which the insertion point, varus-valgus angle, and insertion depth are adjusted so that the insertion depth in the marrow is as large as practicable under the condition according to the flexion-extension installation angle of the selected artificial joint.
  • In fact, the position is that the Z-axis of the rod in the marrow exists in the flat surface parallel to the XZ flat surface as described hereinafter. As a result, when the rotation angle is accurately set, the angle of the rod in the marrow is matched with the artificial joint in the flexion-extensional direction.
  • FIG. 3 is a diagram illustrating a three-dimensional shape data of the femur, artificial joint, and rod in the marrow are displayed on a display screen at this time. FIG. 3 shows the state in which the optimal position of an artificial joint CP is selected and placed in a knee joint part of a femur FM and a rod in the marrow IM is inserted into the femur FM.
  • Then, the three-dimensional shape data of the rod in the marrow IM is moved to the femur FM and the artificial joint CP by operation of the keyboard/mouse 18 (step S111). Then, the end of the placement into the optimal position is determined by, for example, the presence or absence of the instruction of a “determination” button during GUI display (step S112).
  • Otherwise, the process is returned to the processing of step S111 and the position movement of the rod in the marrow IM by the operation is repeated. It is waited till the rod in the marrow IM is moved to the optimal position in the marrow of the femur FM.
  • As described above, in the optimal placement of the rod in the marrow IM, the optimal placement of the rod in the marrow IM means that the angle and position according to the installation angle of the artificial joint CP to be intended, namely, the Z-axis matched with the axis of the rod in the marrow IM, becomes parallel to the XZ in-plane of the coordinate system of the artificial joint CP for femur. When the medical practitioner (i.e., the user) repeats the processing of steps S111 and S112 on the program, the optimal placement is achieved.
  • FIGS. 4 and 5 exemplify an image in which the position of the rod in the marrow IM for the femur FM and the artificial joint CP is displayed along the two-dimensional flat surface based on the three-dimensional shape data by switching the displayed state in the process of obtaining the proper arrangement.
  • In FIG. 4, the cross section observed from the side surface passing through the central axis (Z-axis) of the rod in the marrow IM in the screen and the cross section observed from the front side are shown together with the original three-dimensional shape.
  • In FIG. 5, the positional relationship between the artificial joint CP and the rod in the marrow IM based on the whole femur FM is extracted from the display screen in the GUI environment shown in FIGS. 3 and 4, which is exemplified.
  • FIG. 5 shows the state in which the rod in the marrow IM in the curved marrow of the femur FM is inserted into the innermost part (upper part in the human body in a standing position).
  • Thus, the optimal placement state of the rod in the marrow IM is obtained. When the optimal placement is instructed by the user, this is determined in step S111 and the angle (varus-valgus angle) between the Z-axis (i.e., the axis of the rod in the marrow IM) and the Z-axis of the artificial joint CP is calculated in the coronal surface (step S113).
  • FIG. 6 exemplifies the varus-valgus angle and corresponds to the angle between a mechhanical axis FA and a distal bone axis FP in the femur coordinate system. Usually, the angle is about 7 degrees (7.68 degrees in the drawing). It may vary more greatly depending on individual differences.
  • Subsequently, the rotation angle is determined. The femoral posterior condylar tangent which are referenced during the operation and the X-axis of the artificial joint CP are projected on the flat surface perpendicular to the axis of the rod in the marrow IM. The angle between them (hereinafter referred to as the “posterior condylar tangent-artificial joint angle”) is calculated (step S114).
  • The medical practitioner who is the user of the program can figure out which side and how many degrees the X-axis of the artificial joint CP should be rotated around the rod in the marrow IM from the state parallel to the axis of the posterior condylar tangent during the operation.
  • As preoperative preparation in another method for determining the rotation angle, the cross-sectional image of the bone in the proximal part within a few millimeters from the proximal edge of the patellofemoral joint is displayed on the flat surface (this is a flat surface “R”) perpendicular to the axis of the rod in the marrow IM. The tangent of the two points in the bimodal portion of the front cortex is determined by digitizing two points. The angle (hereinafter referred to as the “front tangent-artificial joint angle”) between the tangent and the X-axis of the artificial joint is determined. The offset distance from the coordinate center of rod to the flat surface R is calculated (step S115).
  • FIG. 7 shows the flat surface R. FIG. 8 is a front tangent TL on the flat surface R. The position of the front tangent TL is located at the side which is directly visible during the operation. Since the position is not affected by the presence of cartilage, it can be used as one of the reference points which can be recognized very easily.
  • FIG. 9 is a diagram illustrating the offset (17.24 mm in the figure) between the front tangent TL and the coordinate center of the rod.
  • As described above, the planning for an artificial joint replacement operation before the operation is carried out and various necessary parameters are calculated and stored (step S116). Thus, the optimal bone cutting can be performed using these various parameters at the time of the actual operation using a surgical instrument.
  • FIG. 10 is a diagram illustrating the case where some of the various stored parameters are read and are displayed on a display screen. That is, the parameter values which should be calculated by the program for preoperative planning includes the followings:
  • (1) the data of the insertion point of the rod in the marrow: ΔY value from the flat portion (approximated by the flat surface) within about 30 mm from the proximal edge of the femoropatellar joint at the front portion of the femur distal portion for placing the target device to the insertion point of the rod in the marrow, namely, the distance when projected on the YZ flat surface of the femur coordinate system;
  • (2) the insertion depth of the rod, namely, the length from the insertion point to the tip of the rod;
  • (3) the rotation angle of the X-axis of the rod based on the posterior condyler axis (PCA) of the femur and the front tangent-artificial joint angle;
  • (4) the angle (coronal surface) between the Z-axis of the rod and the Z-axis of the component (three-dimensional mechhanical axis); and
  • (5) the angle (sagittal surface) between the Z-axis of the rod and the Z-axis of the component (three-dimensional mechhanical axis).
  • At the time of the actual operation using a surgical instrument, the jig referred to as the target device is used as a first jig for the flat portion located proximal to the upper end of the patellar surface of femur in order to determine the insertion point of the rod in the marrow.
  • FIGS. 11A and 11B illustrate the shape of a target device 30 which is used at this time. FIG. 11A is a perspective view and FIG. 11B is a side view. The target device 30 includes a contact portion 31, an arm portion 32, and a mounting portion 33.
  • The contact portion 31 is the site which contacts the front tangent. The arm portion 32 is fixedly connected to the contact portion 31. Further, the mounting portion 33, which can be moved parallel to arrow I in the drawing which becomes perpendicular to the axis of the arm portion 32 and becomes parallel to the front tangent, is attached to the tip of the arm portion 32.
  • As shown in FIG. 11B, the mounting portion 33 has a rod mounting portion 34 which can be moved parallel to the axis of the mounting portion 33 and an arrow direction II perpendicular to the arrow I. The bottom of the contact portion 31, namely, the offset (distance) from the position of the front tangent being contacted is scaled, for example, by millimeters and stamped. In the rod mounting portion 34, the offset from the front tangent can be adjusted by adjusting a screw 35. As indicated by an arrow III, the mounting angle can also be adjusted.
  • The rod in the marrow or a marker for the insertion position with the same shape as that of the rod in the marrow is attached to the rod mounting portion 34. The insertion point can be determined by measuring the distance from an approximated flat surface which has been calculated as described in (1) to the insertion point of the rod in the marrow in the intercondylar portion and by marking it.
  • An insertion inlet is formed by drilling the marked insertion position with a drill bit (not shown). Then, the rod in the marrow IM is inserted into the marrow of the femur FM from the insertion inlet at the pre-calculated depth.
  • At this time, a rod keeper 40 as shown in FIG. 12A may be used so that the rod in the marrow IM is not moved carelessly.
  • The rod keeper 40 shown in FIG. 12A has a two-stage cylindrical shape with different outer diameters. The central axis portion is hollow to pass the rod in the marrow IM. A spike 41 a is protruded downward from the lower bottom side of a large diameter side cylindrical portion 41. As shown in FIG. 12B, the spike 41 a is driven in the insertion inlet of the femur FM (shown as a three-dimensional model herein) in the state that the rod in the marrow IM is passed through.
  • A plurality of screw holes, for example, three screw holes 43 are passed through a small diameter side cylindrical portion 42 of the rod keeper 40 so as to form an equal central angle from the center of the axis position in the radial direction. As shown in FIG. 12B, screws (not shown) are threadably mounted on each of the screw holes 43 and thus the rod in the marrow IM inserted from the insertion inlet of the femur FM can be held without wobble.
  • Thereafter, a conventional jig for bone cutting (not shown) is attached to the rod in the marrow IM. At this time, the jig for bone cutting is previously adjusted to the valgus angle as described in (4) which has been previously calculated for the rod in the marrow IM. The horizontal axis of the flat surface portion which is referred to as a distal ablation paddle of the jig is matched with the X-axis of the rod in the marrow IM and the X-axis of the artificial joint CP. When the flat surface is matched with the distal bone cutting surface to be intended, the intended distal bone cutting is performed.
  • FIGS. 13A and 13B show the structure of a jig for determining the rotation angle 50 which is mounted from a distal position of the jig for bone cutting together with the rod keeper 40 and other jigs. FIG. 13A is a perspective view and FIG. 13B is a side view.
  • In the jig for determining the rotation angle 50, a pair of paddles 52 is provided on the lower end side of a mounting portion 51 which passes through the rod in the marrow IM so as to be integral with the connection portion 53. The paddles 52 contact the medial and lateral posterior condylar portions of the femur FM. As shown in FIG. 13B, the connection portion 53 is slidably attached to the mounting portion 51 so that the distance of the pair of paddles 52 with the rod axis portion can be adjusted as indicated by an arrow IV in the drawing.
  • A rotational portion 54 which is rotatably provided on the mounting portion 51 and is passed through the rod in the marrow IM is provided. The rotational portion 54 is located at the front side of the side of the mounting portion 51, a pointer 54 a is radially attached to the rotational portion 54, and a scale 51 a is formed at the side of the mounting portion 51.
  • The jig for determining the rotation angle 50 is mounted from the distal position of the jig for bone cutting. The angle of the rotational portion 54 is adjusted to the mounting portion 51 so that the angle between the jig for bone cutting and the jig for determining the rotation angle 50 is equal to the “posterior condylar tangent-artificial joint angle” calculated by the program for preoperative planning. Then, the rod in the marrow IM and the jig for bone cutting are rotated.
  • The rotation angle of the artificial joint CP is realized by this rotation. At this point, the condylar portion of the femur is drilled so that two points on the horizontal axis of the jig for bone cutting (matched with the X-axis of the artificial joint CP) becomes perpendicular to the flat surface of the jig and small bone holes are produced. Thereafter, the distal bone cutting is performed using conventional instrument. The rotation angle is determined in reference to two bone holes which have been previously made on the distal bone cutting surface and posterior bone cutting is performed.
  • However, in some cases, the cartilage may remain in the posterior condylar of the femur. Because of the uneven thickness, when the posterior condylar tangent is used to determine the rotation angle, the exact control may become difficult.
  • As another method for determining the rotation angle, the “front tangent-artificial joint angle” is used. A special jig for determining the rotation angle which measures how many degrees the front tangent is rotated about the rod axis from a more distal position of the jig for bone cutting is used.
  • FIGS. 14A and 14B show the structure of a jig for determining the rotation angle 60 which is mounted from a distal position of the jig for bone cutting together with the rod keeper 40 and other jigs. FIG. 14A is a perspective view and FIG. 14B is a side view.
  • In the jig for determining the rotation angle 60, the contact portion 64 is provided on the upper end side of a mounting portion 61 which passes through the rod in the marrow IM via a connection portion 62 and the arm portion 63. The contact portion 64 is the piece which contacts the front tangent as with the contact portion 31 of the target device 30 in FIG. 11.
  • As for the arm portion 63 in which the contact portion 61 is formed at the end part, the arm length (distance between the mounting portion 61 and the contact portion 64) is optionally variable for the connection portion 62 as indicated by an arrow V in FIG. 14B. In addition, the connection portion 62 is slidably attached to the mounting portion 61 so that the distance (height) with the rod axis portion can be adjusted as indicated by an arrow VI in the drawing.
  • A rotational portion 65 which is rotatably provided on the mounting portion 61 and is passed through the rod in the marrow IM is provided. The rotational portion 65 is located at the front side of the side of the mounting portion 61, a pointer 65 a is radially attached to the rotational portion 65, and a scale 61 a is formed at the side of the mounting portion 61.
  • When the jig for determining the rotation angle with such a structure is used, any effect of cartilage is not caused. The correct rotation angle of the jig for bone cutting is obtained by measuring how many degrees the front tangent exposed at the time of the operation is rotated about the rod axis and allowing the angle between the angle of the rotation and the front tangent of the jig for bone cutting to be equal to the “front tangent-artificial joint angle” obtained by the program for preoperative planning.
  • In this regard, the present invention is not to be construed as being limited to the embodiments. Various variations can be made in implementation without departing from the spirit of the invention. Further, the function to be performed in the embodiments may be carried out in all the possible appropriate combinations. Various stages are included in the embodiments and various inventions may be extracted from a plurality of the disclosed constituent features in an appropriate combination. For example, when the effect can be obtained even if some constituent features are deleted from all the constituent features shown in the embodiments, the structure from which these constituent features are deleted can be extracted as the invention.

Claims (7)

1-3. (canceled)
4. A jig for an artificial knee joint replacement operation, comprising:
a contact portion which contacts the reference points of the knee joint of the femur; a mounting portion which mounts the alignment rod in the marrow to be inserted into the marrow of the femur; and an arm portion which connects the contact portion with the mounting portion and can adjust the attaching position and angle of the mounting portion.
5. A jig for an artificial knee joint replacement operation, comprising: a contact portion which contacts the reference points of the knee joint of the femur; a mounting portion which mounts the alignment rod in the marrow to be inserted into the marrow of the femur; and a connection portion which connects the contact portion with the mounting portion and can adjust the attaching angle of an external jig which is mounted on the alignment rod in the marrow.
6. The jig for an artificial knee joint replacement operation according to claim 4, wherein the reference points of the femur is the posterior condylar tangent.
7. The jig for an artificial knee joint replacement operation according to claim 4, wherein the reference points of the femur is a tangent of two points in the bimodal portion of the cortex of cross-sectional images of the bone in the proximal part from the proximal edge of the patellofemoral joint on the flat surface nearly perpendicular to an axis of the alignment rod in the marrow and the arm portion or the connection portion can be adjusted corresponding to an offset distance between the axial position of the alignment rod in the marrow and the tangent.
8. The jig for an artificial knee joint replacement operation according to claim 5, wherein the reference points of the femur is the posterior condylar tangent.
9. The jig for an artificial knee joint replacement operation according to claim 5, wherein the reference points of the femur is a tangent of two points in the bimodal portion of the cortex of cross-sectional images of the bone in the proximal part from the proximal edge of the patellofemoral joint on the flat surface nearly perpendicular to an axis of the alignment rod in the marrow and the arm portion or the connection portion can be adjusted corresponding to an offset distance between the axial position of the alignment rod in the marrow and the tangent.
US13/408,227 2007-09-28 2012-02-29 Apparatus for preoperative planning of artificial knee joint replacement operation and jig for supporting operation Abandoned US20120172882A1 (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
US13/408,227 US20120172882A1 (en) 2007-09-28 2012-02-29 Apparatus for preoperative planning of artificial knee joint replacement operation and jig for supporting operation
US14/452,020 US20140364856A1 (en) 2007-09-28 2014-08-05 Apparatus for preoperative planning of artificial knee joint replacement operation and jig for supporting operation

Applications Claiming Priority (5)

Application Number Priority Date Filing Date Title
JP2007-256046 2007-09-28
JP2007256046A JP5171193B2 (en) 2007-09-28 2007-09-28 Program for preoperative planning of knee replacement surgery
PCT/JP2008/065900 WO2009041234A1 (en) 2007-09-28 2008-09-03 Preoperative plan making device for artificial knee joint replacement and operation assisting tool
US12/661,980 US8801715B2 (en) 2007-09-28 2010-03-26 Apparatus for preoperative planning of artificial knee joint replacement operation and jig for supporting operation
US13/408,227 US20120172882A1 (en) 2007-09-28 2012-02-29 Apparatus for preoperative planning of artificial knee joint replacement operation and jig for supporting operation

Related Parent Applications (1)

Application Number Title Priority Date Filing Date
US12/661,980 Division US8801715B2 (en) 2007-09-28 2010-03-26 Apparatus for preoperative planning of artificial knee joint replacement operation and jig for supporting operation

Related Child Applications (1)

Application Number Title Priority Date Filing Date
US14/452,020 Continuation US20140364856A1 (en) 2007-09-28 2014-08-05 Apparatus for preoperative planning of artificial knee joint replacement operation and jig for supporting operation

Publications (1)

Publication Number Publication Date
US20120172882A1 true US20120172882A1 (en) 2012-07-05

Family

ID=40511124

Family Applications (3)

Application Number Title Priority Date Filing Date
US12/661,980 Expired - Fee Related US8801715B2 (en) 2007-09-28 2010-03-26 Apparatus for preoperative planning of artificial knee joint replacement operation and jig for supporting operation
US13/408,227 Abandoned US20120172882A1 (en) 2007-09-28 2012-02-29 Apparatus for preoperative planning of artificial knee joint replacement operation and jig for supporting operation
US14/452,020 Abandoned US20140364856A1 (en) 2007-09-28 2014-08-05 Apparatus for preoperative planning of artificial knee joint replacement operation and jig for supporting operation

Family Applications Before (1)

Application Number Title Priority Date Filing Date
US12/661,980 Expired - Fee Related US8801715B2 (en) 2007-09-28 2010-03-26 Apparatus for preoperative planning of artificial knee joint replacement operation and jig for supporting operation

Family Applications After (1)

Application Number Title Priority Date Filing Date
US14/452,020 Abandoned US20140364856A1 (en) 2007-09-28 2014-08-05 Apparatus for preoperative planning of artificial knee joint replacement operation and jig for supporting operation

Country Status (9)

Country Link
US (3) US8801715B2 (en)
EP (1) EP2184027B8 (en)
JP (1) JP5171193B2 (en)
CN (2) CN101815477B (en)
DK (1) DK2184027T3 (en)
ES (1) ES2614403T3 (en)
PL (1) PL2184027T3 (en)
TW (1) TW200920305A (en)
WO (1) WO2009041234A1 (en)

Cited By (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8480679B2 (en) 2008-04-29 2013-07-09 Otismed Corporation Generation of a computerized bone model representative of a pre-degenerated state and useable in the design and manufacture of arthroplasty devices
US8483469B2 (en) 2008-04-30 2013-07-09 Otismed Corporation System and method for image segmentation in generating computer models of a joint to undergo arthroplasty
US8532361B2 (en) 2008-04-30 2013-09-10 Otismed Corporation System and method for image segmentation in generating computer models of a joint to undergo arthroplasty
US8617175B2 (en) 2008-12-16 2013-12-31 Otismed Corporation Unicompartmental customized arthroplasty cutting jigs and methods of making the same
US8617171B2 (en) 2007-12-18 2013-12-31 Otismed Corporation Preoperatively planning an arthroplasty procedure and generating a corresponding patient specific arthroplasty resection guide
US8715291B2 (en) 2007-12-18 2014-05-06 Otismed Corporation Arthroplasty system and related methods
US8737700B2 (en) 2007-12-18 2014-05-27 Otismed Corporation Preoperatively planning an arthroplasty procedure and generating a corresponding patient specific arthroplasty resection guide
US8734455B2 (en) 2008-02-29 2014-05-27 Otismed Corporation Hip resurfacing surgical guide tool
US8777875B2 (en) 2008-07-23 2014-07-15 Otismed Corporation System and method for manufacturing arthroplasty jigs having improved mating accuracy
US9402637B2 (en) 2012-10-11 2016-08-02 Howmedica Osteonics Corporation Customized arthroplasty cutting guides and surgical methods using the same
US9646229B2 (en) 2012-09-28 2017-05-09 Siemens Medical Solutions Usa, Inc. Method and system for bone segmentation and landmark detection for joint replacement surgery

Families Citing this family (30)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB0718417D0 (en) 2007-09-21 2007-10-31 Depuy Int Ltd Intramedullary rod instrument
JP5305474B2 (en) * 2008-03-31 2013-10-02 株式会社ビー・アイ・テック Cementless hip stem shape determination method
JP2011092405A (en) * 2009-10-29 2011-05-12 Lexi:Kk Program for preoperative plan of artificial knee joint replacement operation
JP5710497B2 (en) * 2009-11-24 2015-04-30 株式会社 レキシー Program for preoperative planning of hip replacement surgery
EP2389899B1 (en) * 2010-05-24 2015-04-29 Episurf IP Management AB Method of manufacturing a surgical kit for cartilage repair in a joint
EP2389905B1 (en) * 2010-05-24 2012-05-23 Episurf Medical AB Method of designing a surgical kit for cartilage repair in a joint
EP2389904B1 (en) * 2010-05-24 2013-07-24 Episurf IP Management AB Surgical kit for cartilage repair comprising implant and a set of tools
EP2583244B1 (en) * 2010-06-16 2019-07-24 A² Surgical Method of determination of access areas from 3d patient images
GB201019490D0 (en) * 2010-11-18 2010-12-29 Depuy Ireland Angular adjustment mechanism, surgical alignment guide and surgical instrument assembly
ES2598030T3 (en) * 2010-12-23 2017-01-24 Stryker European Holdings I, Llc Devices and methods to monitor the rotational orientation of bone fragments
EP2775966B1 (en) 2011-10-24 2015-09-16 Synvasive Technology, Inc. Knee balancing systems
US9622820B2 (en) * 2012-05-03 2017-04-18 Siemens Product Lifecycle Management Software Inc. Feature-driven rule-based framework for orthopedic surgical planning
EP3925655B1 (en) * 2012-12-31 2023-07-12 Clearstream Technologies Limited Catheter with markings to facilitate alignment
US9204937B2 (en) 2013-02-19 2015-12-08 Stryker Trauma Gmbh Software for use with deformity correction
US20140276872A1 (en) 2013-03-15 2014-09-18 Otismed Corporation Customized acetabular cup positioning guide and system and method of generating and employing such a guide
US9427240B2 (en) * 2013-03-21 2016-08-30 Von Zabern Surgical System and method for performing measurable and controled osteotomy
CN104095664B (en) 2013-04-12 2016-12-28 德普伊(爱尔兰)公司 Distal femur clamp assembly and the distal femur cutting device with this assembly
CN105361883A (en) * 2014-08-22 2016-03-02 方学伟 Method for determining lower limb biological force line in three-dimensional space for total knee arthroplasty
US10932855B2 (en) * 2014-09-24 2021-03-02 Depuy Ireland Unlimited Company Surgical planning and method
US10568650B2 (en) * 2015-03-25 2020-02-25 E. Marlowe Goble Knee instruments and methods
AU2016267279A1 (en) * 2015-05-28 2018-01-04 Biomet Manufacturing, Llc Flexibly planned kitted knee protocol
US10357255B2 (en) 2015-10-08 2019-07-23 Howmedica Osteonics Corp. Globalized total knee instrumentation
US10251705B2 (en) 2016-06-02 2019-04-09 Stryker European Holdings I, Llc Software for use with deformity correction
WO2018078723A1 (en) 2016-10-25 2018-05-03 株式会社 レキシー Surgery assistance system
US11234720B2 (en) 2018-03-07 2022-02-01 E. Marlowe Goble Knee instruments and methods
US10751199B2 (en) * 2018-10-09 2020-08-25 Adam Rosen Two-piece total knee rotation guide and femoral sizer system and method
CN109925052B (en) * 2019-03-04 2020-12-08 杭州三坛医疗科技有限公司 Target point path determination method, device and system and readable storage medium
CN109875684A (en) * 2019-04-16 2019-06-14 北京大学第三医院(北京大学第三临床医学院) A kind of prediction and real-time rendering method of mandibular angle bone cutting art
CN111888059B (en) * 2020-07-06 2021-07-27 北京长木谷医疗科技有限公司 Full hip joint image processing method and device based on deep learning and X-ray
CN113017829B (en) * 2020-08-22 2023-08-29 张逸凌 Preoperative planning method, system, medium and device for total knee arthroplasty based on deep learning

Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6173200B1 (en) * 1997-04-04 2001-01-09 T. Derek V. Cooke Method and apparatus for locating transepicondylar line in a joint that defines transverse action for a motion

Family Cites Families (13)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4703751A (en) * 1986-03-27 1987-11-03 Pohl Kenneth P Method and apparatus for resecting a distal femoral surface
US4841975A (en) * 1987-04-15 1989-06-27 Cemax, Inc. Preoperative planning of bone cuts and joint replacement using radiant energy scan imaging
CA2126627C (en) * 1993-07-06 2005-01-25 Kim C. Bertin Femoral milling instrumentation for use in total knee arthroplasty with optional cutting guide attachment
US5682886A (en) * 1995-12-26 1997-11-04 Musculographics Inc Computer-assisted surgical system
ATE431110T1 (en) * 2001-02-27 2009-05-15 Smith & Nephew Inc SURGICAL NAVIGATION SYSTEM FOR PARTIAL KNEE JOINT RECONSTRUCTION
US7547307B2 (en) * 2001-02-27 2009-06-16 Smith & Nephew, Inc. Computer assisted knee arthroplasty instrumentation, systems, and processes
AU2003219773B2 (en) 2002-02-14 2007-02-01 Biomet Spain Orthopaedics S.L. Method and instrumentation for patello-femoral joint replacement
JP2004008707A (en) 2002-06-11 2004-01-15 Osaka Industrial Promotion Organization Method and device for supporting artificial knee joint replacement, computer program, and recording medium
TW558689B (en) 2002-08-30 2003-10-21 Univ Taipei Medical Three-dimensional surgery simulation system and method
US20040172044A1 (en) * 2002-12-20 2004-09-02 Grimm James E. Surgical instrument and method of positioning same
US6932823B2 (en) 2003-06-24 2005-08-23 Zimmer Technology, Inc. Detachable support arm for surgical navigation system reference array
JP3990719B2 (en) * 2004-03-31 2007-10-17 株式会社新潟ティーエルオー Intramedullary rod for artificial knee joint replacement operation support and operation support system using the same
GB0504172D0 (en) 2005-03-01 2005-04-06 King S College London Surgical planning

Patent Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6173200B1 (en) * 1997-04-04 2001-01-09 T. Derek V. Cooke Method and apparatus for locating transepicondylar line in a joint that defines transverse action for a motion

Cited By (14)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8617171B2 (en) 2007-12-18 2013-12-31 Otismed Corporation Preoperatively planning an arthroplasty procedure and generating a corresponding patient specific arthroplasty resection guide
US8715291B2 (en) 2007-12-18 2014-05-06 Otismed Corporation Arthroplasty system and related methods
US8737700B2 (en) 2007-12-18 2014-05-27 Otismed Corporation Preoperatively planning an arthroplasty procedure and generating a corresponding patient specific arthroplasty resection guide
US8734455B2 (en) 2008-02-29 2014-05-27 Otismed Corporation Hip resurfacing surgical guide tool
US9408618B2 (en) 2008-02-29 2016-08-09 Howmedica Osteonics Corporation Total hip replacement surgical guide tool
US9646113B2 (en) 2008-04-29 2017-05-09 Howmedica Osteonics Corporation Generation of a computerized bone model representative of a pre-degenerated state and useable in the design and manufacture of arthroplasty devices
US8480679B2 (en) 2008-04-29 2013-07-09 Otismed Corporation Generation of a computerized bone model representative of a pre-degenerated state and useable in the design and manufacture of arthroplasty devices
US9208263B2 (en) 2008-04-30 2015-12-08 Howmedica Osteonics Corporation System and method for image segmentation in generating computer models of a joint to undergo arthroplasty
US8532361B2 (en) 2008-04-30 2013-09-10 Otismed Corporation System and method for image segmentation in generating computer models of a joint to undergo arthroplasty
US8483469B2 (en) 2008-04-30 2013-07-09 Otismed Corporation System and method for image segmentation in generating computer models of a joint to undergo arthroplasty
US8777875B2 (en) 2008-07-23 2014-07-15 Otismed Corporation System and method for manufacturing arthroplasty jigs having improved mating accuracy
US8617175B2 (en) 2008-12-16 2013-12-31 Otismed Corporation Unicompartmental customized arthroplasty cutting jigs and methods of making the same
US9646229B2 (en) 2012-09-28 2017-05-09 Siemens Medical Solutions Usa, Inc. Method and system for bone segmentation and landmark detection for joint replacement surgery
US9402637B2 (en) 2012-10-11 2016-08-02 Howmedica Osteonics Corporation Customized arthroplasty cutting guides and surgical methods using the same

Also Published As

Publication number Publication date
EP2184027A4 (en) 2015-08-26
EP2184027B8 (en) 2017-01-18
US20140364856A1 (en) 2014-12-11
TW200920305A (en) 2009-05-16
CN102697558B (en) 2015-07-29
US8801715B2 (en) 2014-08-12
WO2009041234A1 (en) 2009-04-02
JP2009082444A (en) 2009-04-23
PL2184027T3 (en) 2017-05-31
EP2184027A1 (en) 2010-05-12
DK2184027T3 (en) 2017-02-13
CN101815477B (en) 2014-03-05
CN102697558A (en) 2012-10-03
JP5171193B2 (en) 2013-03-27
US20110009868A1 (en) 2011-01-13
CN101815477A (en) 2010-08-25
ES2614403T3 (en) 2017-05-31
EP2184027B1 (en) 2016-11-09

Similar Documents

Publication Publication Date Title
US8801715B2 (en) Apparatus for preoperative planning of artificial knee joint replacement operation and jig for supporting operation
Victor et al. How precise can bony landmarks be determined on a CT scan of the knee?
US10441437B2 (en) System for determining the position of a knee prosthesis
JP5710497B2 (en) Program for preoperative planning of hip replacement surgery
JP2011092405A (en) Program for preoperative plan of artificial knee joint replacement operation
US20210030481A1 (en) Scanning Apparatus For Scanning An Anatomical Region
Krackow et al. Computer-assisted total knee arthroplasty: navigation in TKA
Stentz-Olesen et al. Validation of static and dynamic radiostereometric analysis of the knee joint using bone models from CT data
JP2009195490A (en) Program for preoperative plan of artificial hip joint replacement, and instrument for supporting the replacement
Oberst et al. Regression and correlation analysis of preoperative versus intraoperative assessment of axes during navigated total knee arthroplasty
Fu et al. Computer-assisted patellar resection for total knee arthroplasty
JP5933779B2 (en) Jig replacement surgery jig
Leardini et al. Accuracy of computer-assisted surgery
JP5710735B2 (en) Jig replacement surgery jig
JP2012045417A (en) Tool for artificial knee joint replacement surgery
Rahaman et al. OstAid: Digital Method for Preoperative Planning in High Tibial Osteotomy
Lin Electromagnetically Navigated Forearm Fracture Plating
CN114783566A (en) Augmented reality for preoperative planning

Legal Events

Date Code Title Description
AS Assignment

Owner name: WRIGHT MEDICAL JAPAN K.K., JAPAN

Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:SATO, TAKASHI;REEL/FRAME:028032/0898

Effective date: 20120321

Owner name: LEXI CORPORATION, LTD., JAPAN

Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:SATO, TAKASHI;REEL/FRAME:028032/0898

Effective date: 20120321

AS Assignment

Owner name: MICROPORT ORTHOPEDICS JAPAN K.K., JAPAN

Free format text: CHANGE OF NAME;ASSIGNOR:WRIGHT MEDICAL JAPAN K.K.;REEL/FRAME:033021/0266

Effective date: 20140515

AS Assignment

Owner name: LEXI CORPORATION, LTD., JAPAN

Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:MICROPORT ORTHOPEDICS JAPAN K.K.;REEL/FRAME:033028/0980

Effective date: 20140530

STCB Information on status: application discontinuation

Free format text: ABANDONED -- FAILURE TO RESPOND TO AN OFFICE ACTION