U.S. patent application number 16/262482 was filed with the patent office on 2019-08-08 for range of motion evaluation in orthopedic surgery.
The applicant listed for this patent is ORTHOsoft, Inc.. Invention is credited to Pierre Couture.
Application Number | 20190240046 16/262482 |
Document ID | / |
Family ID | 67476264 |
Filed Date | 2019-08-08 |
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United States Patent
Application |
20190240046 |
Kind Code |
A1 |
Couture; Pierre |
August 8, 2019 |
RANGE OF MOTION EVALUATION IN ORTHOPEDIC SURGERY
Abstract
A system and method may be used to evaluate soft tissue. A hip
joint evaluation may use an adjustable spacer, such as varying
sized physical spacers or an inflatable bladder, along with a
sensor to measure force, pressure, gap distance, or the like, for
example during a range of motion test. A method may include using a
maximum pressure during the range of motion test to determine a
maximum pressure during the range of motion test. The maximum
pressure may be output for display on a user interface.
Inventors: |
Couture; Pierre; (Montreal,
CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
ORTHOsoft, Inc. |
Montreal |
|
CA |
|
|
Family ID: |
67476264 |
Appl. No.: |
16/262482 |
Filed: |
January 30, 2019 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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62625706 |
Feb 2, 2018 |
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62697227 |
Jul 12, 2018 |
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62697220 |
Jul 12, 2018 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 2090/064 20160201;
A61B 2034/105 20160201; A61F 2002/4633 20130101; A61B 2034/2055
20160201; A61B 2034/252 20160201; A61B 34/30 20160201; A61B
2034/2048 20160201; A61B 2090/061 20160201; A61B 2034/102 20160201;
A61F 2/4607 20130101; A61F 2/4657 20130101; A61F 2002/467 20130101;
A61B 2034/108 20160201; A61F 2/4684 20130101 |
International
Class: |
A61F 2/46 20060101
A61F002/46; A61B 34/30 20060101 A61B034/30 |
Claims
1. A surgical device for evaluating soft tissue during a surgical
procedure comprising: a pump to: inflate an adjustable spacer in a
neck portion of a femoral trial for a hip replacement procedure;
and during a range of motion test, maintain a fixed distance in the
adjustable spacer by increasing or decreasing pressure in the
adjustable spacer; and a processor to: determine a maximum pressure
during the range of motion test; and output the maximum pressure
for display on a user interface.
2. The surgical device of claim 1, wherein the pump is further to
decrease the fixed distance during a repeated range of motion
test.
3. The surgical device of claim 1, wherein the processor is to use
a preoperative plan to determine the fixed distance.
4. The surgical device of claim 3, wherein the processor is further
to adjust the preoperative plan based on the maximum pressure.
5. The surgical device of claim 1, wherein the processor is further
to determine an implant based on the maximum pressure.
6. The surgical device of claim 1, wherein to determine the maximum
pressure, the processor is to use optical tracking of the neck
portion of the femoral trial.
7. The surgical device of claim 1, wherein the surgical device is a
robotic surgical device, wherein the processor operates a robotic
controller, wherein the pump is controlled by the processor, and
wherein the robotic surgical device includes a display, the display
configured to present the user interface including the maximum
pressure.
8. A method comprising: inserting a trial for a hip replacement
procedure, the trial including an adjustable spacer in a neck
portion; inflating the adjustable spacer to a fixed distance; using
a pressure sensor device, measuring pressure on the adjustable
spacer throughout a range of motion test with the trial in place
and the adjustable spacer inflated at the fixed distance;
determining a maximum pressure during the range of motion test; and
outputting the maximum pressure for display on a user
interface.
9. The method of claim 8, further comprising decreasing the fixed
distance and performing the range of motion test again.
10. The method of claim 8, further comprising using a preoperative
plan to determine the fixed distance.
11. The method of claim 10, further comprising adjusting the
preoperative plan based on the maximum pressure.
12. The method of claim 8, further comprising determining an
implant based on the maximum pressure.
13. The method of claim 8, further comprising determining the
maximum pressure using an iAssist device.
14. A non-transitory machine-readable medium including instructions
for controlling an adjustable spacer of a trial inserted into a
femur of a patient for a hip replacement procedure, which when
executed by a processor, cause the processor to: cause the
adjustable spacer to inflate to a fixed distance; receive pressure
measurements from a pressure sensor device, the pressure
measurements taken by the pressure sensor device on the adjustable
spacer throughout a range of motion test with the trial in place
and the adjustable spacer inflated at the fixed distance; determine
a maximum pressure during the range of motion test; and output the
maximum pressure for display on a user interface.
15. The machine-readable medium of claim 14, wherein the
instructions further cause the processor to cause the fixed
distance of the adjustable spacer to decrease, during a repeat of
the range of motion test.
16. The machine-readable medium of claim 14, wherein the processor
is further to use a preoperative plan to determine the fixed
distance.
17. The machine-readable medium of claim 16, wherein the processor
is further to adjust the preoperative plan based on the maximum
pressure.
18. The machine-readable medium of claim 14, wherein the processor
is further to determine an implant based on the maximum
pressure.
19. The machine-readable medium of claim 14, wherein the processor
is to receive the pressure measurements from an iAssist device.
Description
CLAIM OF PRIORITY
[0001] This application claims the benefit of priority to U.S.
Provisional Application Nos. 62/625,706, filed Feb. 2, 2018, titled
"SOFT TISSUE BALANCING IN ROBOTIC KNEE SURGERY"; 62/697,227, filed
Jul. 12, 2018, titled "SOFT TISSUE BALANCING IN ROBOTIC KNEE
SURGERY"; and 62/697,220, filed Jul. 12, 2018, titled "RANGE OF
MOTION EVALUATION IN ORTHOPEDIC SURGERY" each of which is hereby
incorporated herein by reference in its entirety.
BACKGROUND
[0002] Computer-assisted surgery has been developed in order to
help a surgeon in altering bones, and in positioning and orienting
implants to a desired location. Computer-assisted surgery may
encompass a wide range of devices, including surgical navigation,
pre-operative planning, and various robotic devices. One area where
computer-assisted surgery has potential is in orthopedic joint
repair or replacement surgeries. For example, post-operative range
of motion is an important consideration for a surgeon during
orthopedic procedures. However, when performing orthopedic surgery
on joints, range of motion evaluations are conventionally done by
eye, with the surgeon qualitatively assessing the limits of
patient's range of motion. The conventional technique may result in
errors or lack precision.
BRIEF DESCRIPTION OF THE DRAWINGS
[0003] In the drawings, which are not necessarily drawn to scale,
like numerals may describe similar components in different views.
Like numerals having different letter suffixes may represent
different instances of similar components. The drawings illustrate
generally, by way of example, but not by way of limitation, various
embodiments discussed in the present document.
[0004] FIG. 1 illustrates an adjustable spacer used in a surgical
procedure in accordance with some embodiments.
[0005] FIG. 2 illustrates a surgical technique in accordance with
some embodiments.
[0006] FIG. 3 illustrates an adjustable spacer and graphs showing
effects of the adjustable spacer in accordance with some
embodiments.
[0007] FIG. 4 illustrates a system for using an adjustable spacer
with a robotic surgical device in accordance with some
embodiments.
[0008] FIG. 5 illustrates a flowchart showing a technique for using
an adjustable spacer in a surgical knee procedure in accordance
with some embodiments.
[0009] FIG. 6 illustrates a system for performing techniques
described herein, in accordance with some embodiments.
[0010] FIG. 7 illustrates a block diagram of an example of a
machine upon which any one or more of the techniques discussed
herein may perform in accordance with some embodiments.
DETAILED DESCRIPTION
[0011] Systems and methods for using an adjustable spacer in a
surgical procedure are provided herein. The systems described
herein may include using an adjustable spacer for use during a
range of motion test. In an example, the adjustable spacer may be
controlled by fixing pressure or fixing distance (e.g., of a neck
of a trial for use in an orthopedic procedure, such as on a
shoulder or hip) during an evaluation. The adjustable spacer
systems and methods described herein may be used with a robotic
surgical device.
[0012] Robotics offer a useful tool for assisting the surgeon in
the surgical field. A robotic device may assist in the surgical
field performing tasks such as biopsies, electrode implantation for
functional procedures (e.g., stimulation of the cerebral cortex,
deep brain stimulation), open skull surgical procedures, endoscopic
interventions, other "key-hole" procedures, arthroplasty
procedures, such as total or partial knee replacement, hip
replacement, shoulder implant procedures, or the like. In an
example, a surgical procedure may use a surgical robot. The
surgical robot may include a robotic arm for performing operations.
A tracking system may be used to determine a relative location of
the surgical robot or robotic arm within a coordinate system or a
surgical field. The surgical robot may have a different coordinate
system or tracking system (e.g., using known movements of the
surgical robot). The robotic arm may include an end effector of the
robotic arm of the surgical robot, which may use sensors, such as a
gyroscope, magnetoscope, accelerometer, etc. In an example, a
processor may be used to process information, such as tracking
information, operation parameters, applied force, location, or the
like.
[0013] The systems and methods described herein provide an
expandable or adjustable component for use within an orthopedic
surgical procedure. For example, a shoulder or hip procedure may
include using an adjustable spacer during a range of motion test.
The adjustable spacer may include a component inflatable by a pump.
The pump may maintain a fixed distance or fixed pressure in the
component, for example throughout the range of motion test. Using a
fixed distance, a maximum pressure or force may be determined (or
various pressures or forces throughout the range of motion). Using
a fixed pressure, various distances or a maximum distance may be
determined during the range of motion test. The adjustable spacer
may be a part of a trial or insert for use in a surgical procedure,
for example, a femoral stem or humeral stem may include the
adjustable spacer. In another example, a femoral head, humeral
head, or glenosphere may include the adjustable spacer. A
determined pressure or distance (e.g., maximum throughout a range
of motion) may be used to adjust a preoperative plan. For example,
a planned implant may be modified to be larger or smaller.
[0014] FIG. 1 illustrates an adjustable spacer 102 within a neck
component used in a surgical procedure in accordance with some
embodiments. The diagram 100 illustrated in FIG. 1 shows the
adjustable spacer 102 as part of a hip trial or hip implant, but
may also be used with a shoulder trial or a shoulder implant, or
for use with other orthopedic surgical trials or implants (e.g.,
knee). The adjustable spacer 102 may be within a neck component,
which may be connected to a shaft 104 and a head 106. The neck
therefore may be inflated to change the distance between a proximal
end of the shaft 104 and a distal end of the head 106 (defining the
distal end of the head 106 to be opposite a proximal end configured
to fit into an acetabular component 108, such as a trial). A distal
end of the shaft 104 may be embedded into a femur, an acetabulum,
or a humerus of a patient (or in the glenoid of the patient in a
reverse shoulder arthroplasty procedure).
[0015] The neck may experience pressure (e.g., a compression force)
from between the head 106 (imparted, for example by the acetabular
component 108 onto the head 106) and the shaft 104. In an example,
the distance of the neck is controlled to remain equal throughout a
range of motion test, while allowing pressure to change. In another
example, the pressure in the neck is controlled and held equal
throughout a range of motion test while the distance is allowed to
change.
[0016] The adjustable spacer 102 may be inflated or adjusted using
a pump (e.g., which may be controlled by a robotic surgical system
in an example). An inflated component of the adjustable spacer 102
may be used during a range of motion test, such as for a hip or
shoulder procedure. In an example, a fixed distance or a fixed
pressure for the adjustable spacer 102 (e.g., as identified in a
surgical plan, which may be a preoperative plan or a plan generated
or modified intraoperatively) may be used during the range of
motion test. An extrema may be determined, such as a maximum or
minimum pressure (for a fixed distance) or maximum or minimum
distance (for a fixed pressure) during the range of motion test.
The extrema may be output, such as for display on a user interface
or for use in automatically adjusting a parameter of a surgical
plan. The surgical plan may be modified based on soft tissue
tension, a change in implant sizing, or the like, such as based on
the extrema.
[0017] In an example, an adjustable spacer similar to that
described above (102) may be used with a patella. For example, an
inflatable trial may be used to replace a patella before a range of
motion test is conducted. The inflatable trial may be used at a
fixed distance or fixed pressure, and a maximum pressure or maximum
distance (respectively) may be determined for the inflatable trial
throughout the range of motion. In an example, the inflatable trial
may replace the patella and be used after the patella is cut. The
range of motion test may be conducted to check stability in the
patella with the inflatable trial. In another example, the
inflatable trial may be used to place the patella at a new height
or distance away from the knee joint, and the range of motion test
may use the inflatable trial and the patella together to check
stability.
[0018] The inflatable trial may be used to check different fixed
distances (e.g., away from the knee joint) to determine an optimal
fixed distance for range of motion, for example to minimize
pressure on the trial. In another example, a fixed pressure may be
used in the inflatable trial to determine a range of distances
throughout the range of motion (e.g., to determine a maximum
distance needed for a fixed pressure). A preoperative plan may be
used for any initial testing, and the plan may be automatically
adjusted based on results (e.g., changing an initial distance,
pressure, or volume).
[0019] The surgeon may adjust any planned resections, test, and
record the forces (e.g., pressure) captured by a force or pressure
sensor throughout a range of motion. This procedure may be repeated
as necessary until the plan results in the desired expected tension
values. The surgeon may remove bone according to the final plan.
Once sufficient bone is removed according to the plan, range of
motion may be confirmed with the adjustable spacer 102, or a trial
implant.
[0020] FIG. 2 illustrates a surgical technique 200 in accordance
with some embodiments. The technique 200 uses an adjustable spacer
to perform a range of motion test. The technique 200 includes
initiating or generating a plan (e.g., preoperatively) at 201, such
as using a user interface 202. The plan may be for an orthopedic
procedure, such as for a hip or shoulder.
[0021] The user interface 202 may include a visual depiction of a
range of motion test. For example, the user interface 202 includes
a range of motion visualization component 208. In an example, the
range of motion visualization component 208 may be an actual range
of motion of a patient, a potential range of motion, an ideal range
of motion, a possible range of motion, or a planned range of motion
(e.g., after orthopedic surgery). The range of motion may be for a
shoulder or hip, in an example. The range of motion visualization
component 208 may include one or more zones, such as a green zone
210 representing a pressure or distance for an adjustable spacer
within a first tolerance. A yellow zone 212 may represent a
pressure or distance between the first tolerance and a second
tolerance (e.g., with a potentially problematic pressure or
distance). A red zone 214 may represent a pressure or distance
beyond the second tolerance (e.g., traversing a planned pressure or
distance maximum or minimum). The tolerances or zones may be
selected such as preoperatively, in a plan, by a surgeon, etc.
[0022] The zones 210-214 may be generated based on the range of
motion test (or potential, possible, or ideal range of motion) with
a given neck length of an adjustable spacer between a shaft (e.g.,
femoral shaft) and a cup or head (for a hip procedure). In an
example, the range of motion visualization component 208
illustrates a pressure map for three different fixed neck lengths,
210, 212, and 214. The pressure maps may show different pressures
at different points around the range of motion for the respective
neck lengths.
[0023] In another example, a pressure in the adjustable spacer may
be fixed and the neck length allowed to change. In this example,
the range of motion visualization component 208 illustrates a neck
length map for three different fixed pressures, 210, 212, and 214.
In this example, the neck lengths change throughout the range of
motion for each fixed pressure.
[0024] In either of the two above examples (fixed neck length or
fixed pressure), a single range of motion test may be run or
multiple range of motion tests may be run, such as at different
fixed pressures or neck lengths (the three examples are shown for
illustration purposes). The resulting map (a pressure map when the
neck length is fixed or a neck length map when the pressure is
fixed) may be used to change a preoperative plan. For example, a
maximum pressure or maximum neck length may be used from the range
of motion visualization component 208 to change a planned neck
length, implant size, trial size, or the like.
[0025] The technique 200 includes an operation 204 to capture
balance during a range of motion test, for example using an
adjustable spacer. The adjustable spacer is described in more
detail below. The technique 200 may include using feedback from the
range of motion test to adjust the plan (e.g., automatically change
a parameter of the preoperative plan based on the range of motion
test, such as balance information, a maximum or minimum distance,
range of motion, or implant or trial angle), for example by fine
tuning the plan at operation 206. The technique 200 may include
performing a resection, burr action, or otherwise reduce bone. The
technique 200 may include evaluating balance in soft tissue or for
range of motion using the adjustable spacer.
[0026] In an example, the technique 200 may include using an
optical tracker to track components of a surgery. For example,
tracked components may include a leg, an arm, a bone, a tool, or
the like. The technique 200 may include performing a range of
motion test to evaluate pressure or distance in a shoulder or hip
joint over a range. Optical trackers may be used to determine
various attributes of bones or soft tissue during the range of
motion test. For example, distance traveled by the leg or arm
throughout the range of motion test, angle of bone during the range
of motion test (e.g., a maximum angle), distance at various points
or throughout the range of motion test, or the like.
[0027] In an example, the distance or pressure may be shown on a
user interface during the range of motion test. The distance may be
shown based on a planned bone removal (or a resection). The planned
bone removal may be shown on the user interface, along with
distance or pressure throughout the range of motion test to display
differences or issues that may arise based on the planned bone
removal and the evaluated pressure or distance.
[0028] The technique 200 may include establishing the preoperative
plan and showing the hip or shoulder with the planned resections on
the user interface. Then as distance or pressure are determined
throughout the range of motion test, the distance or pressure are
displayed on the user interface with the planned bone removal. This
combination of preplanned bone removal visualization with actual
measured distance or pressure information allows for evaluation of
the planned bone removal with real feedback. This combination also
allows for evaluating the ultimate distance or pressure with the
planned bone removal rather than distance or pressure pre-bone
removal, which may not ultimately be accurate. The combination
further allows for accurate planning of what the soft tissue
balancing (e.g., rotation of the leg or arm relative to the hip or
shoulder joint, respectively) will be after the planned bone
removal without needing to actually perform the bone removal. This
allows for accurate planning, and modification to the bone removal
may be made.
[0029] In an example the technique 200 may include displaying the
measured and actual neck distance or pressure with the planned bone
removal by reference to a hip or shoulder, and an axis or a plane
of a bone (e.g., a femoral axis). The distance or pressure may be
measured using a sensor on an adjustable spacer as described
throughout this disclosure.
[0030] In an example, the range of motion test may include
registering the femur with reference to a bone model (e.g., a
preoperative plan), and registering a tracker for the femur (the
humerus or glenoid may be registered and tracked for a shoulder
procedure). The range of motion test is then performed. The femur,
the glenoid, or the humerus is tracked throughout the range of
motion test. The distance or pressure at a point or throughout a
range (e.g., a maximum distance or pressure, an animation of
distance or pressure throughout the range of motion, or a distance
or pressure at a selectable angle of range of motion) may be
displayed on the user interface.
[0031] FIG. 3 illustrates an adjustable spacer and graphs 300 and
301 showing effects of the adjustable spacer in accordance with
some embodiments. The adjustable spacer may be used within a hip or
shoulder, such as for a surgical procedure. The adjustable spacer
may be used to measure, determine, or change a distance or pressure
difference within a neck 308 of a trial or implant for use with a
femur, an acetabulum, a glenoid, or a humerus of a patient. For
example, the adjustable spacer may be placed into the neck 308
between a head 306 and a shaft 308 to be inserted into the femur,
the acetabulum, the glenoid, or the humerus. The adjustable spacer
may be inflated to measure distance or pressure, for example
throughout a range of motion test. The head 306 may fit into an
acetabular component 310 (e.g., trial), as adjusted by the neck
308.
[0032] In the illustrated femoral stem/head prosthesis, the
adjustable spacer operates to shift the position of the femoral
head portion 306 to extend or contract the neck 308 of the femoral
stem. Adjusting the neck length (e.g., by extending or shortening
the neck 308) may be an adjustment to a preoperative plan, for
example based on a maximum pressure or distance determined during a
range of motion test. In another example, the adjustable spacer may
be located within the femoral head portion 306, and be used to
determine an adjustment to the head size of the femoral head (e.g.,
from a preoperative plan).
[0033] The adjustable spacer is shown in a first controlled
configuration corresponding to graph 300 and a second controlled
configuration corresponding to graph 301. The first configuration
includes controlling the adjustable spacer such that the pressure
within the adjustable spacer is fixed. A fixed pressure means that
the pressure output from a pump or pumps is maintained within the
adjustable spacer while distance (e.g., length or volume of the
spacer) is allowed to fluctuate (e.g., during a range of motion
test).
[0034] Graph 300 illustrates changes in distance for the fixed
pressure adjustable spacer throughout a range of motion test. Graph
300 has an x-axis illustrating degrees of the range of motion test.
The y-axis of graph 300 illustrates a distance (e.g., in the
example shown in FIG. 3, fluctuating between 0 and 30 mm). The
graph 300 may be output to a user interface on a display (e.g., a
display of a robotic surgical system) for evaluation by a surgeon.
In an example, a maximum or minimum distance for the adjustable
spacer may be determined from the range of motion test. The maximum
or minimum distance may be used to adjust a surgical plan (e.g., a
preoperative plan), such as by changing a parameter for a planned
bone removal, changing an implant size, or adjusting soft tissue
(e.g., releases). The changes to the preoperative plan may be made
automatically, for example changing a parameter of a planned bone
removal by a robotic arm. In an example, a change may include
determining a longer or shorter neck length for a trial or implant
or changing a cup size or cup position (of a trial or implant
acetabular cup). For example, a user interface may be used to
provide a length needed of implant neck to achieve the tested
pressure (e.g., a maximum pressure).
[0035] The second configuration includes controlling the adjustable
spacer such that the distance is fixed. A fixed distance means that
the pressure output from a pump or pumps varies throughout a range
of motion test for the adjustable spacer. The adjustable spacer is
thus fixed to a certain distance, which may be determined as part
of a preoperative plan or interoperative change to a preoperative
plan. The change in pressure may be adjusted during a range of
motion test to retain the fixed distance. The change in pressure
may correspond to a change in force (e.g., 35 N for 7 psi and 52 N
for 12 psi).
[0036] Graph 301 illustrates changes in pressure for the fixed
distance in the adjustable spacer throughout a range of motion
test. Graph 301 has an x-axis illustrating degrees of the range of
motion test. The y-axis of graph 301 may illustrate a pressure
(e.g., applied from a pump) or a force applied by the or within the
adjustable spacer (e.g., in the example shown in FIG. 3, a force is
illustrated). The graph 301 may be output to a user interface on a
display (e.g., a display of a robotic surgical system) for
evaluation by a surgeon. In an example, a maximum or minimum
pressure for the adjustable spacer may be determined from the range
of motion test. The maximum or minimum pressure may be used to
adjust a surgical plan (e.g., a preoperative plan), such as by
changing a parameter for a planned bone removal of the femur, the
acetabulum, the glenoid, or the humerus, changing an implant size,
or adjusting soft tissue (e.g., releases). The changes to the
preoperative plan may be made automatically, for example changing a
parameter of a planned resection by a robotic arm. In an example, a
change may include determining a longer or shorter neck length for
a trial or implant. For example, a user interface may be used to
provide a length needed of implant neck to achieve the tested
pressure (e.g., a maximum pressure).
[0037] FIG. 4 illustrates a system 400 for using an adjustable
spacer with a robotic surgical device in accordance with some
embodiments. The system 400 may include a robotic surgical system
or device (e.g., a Rosa), which may include a user interface and a
robotic arm. The robotic surgical system or device may include a
pump, be configured to hold or support a pump, interface with a
pump, or the like. In another example, the system 400 may include a
pump separate from the robotic surgical system or device. The pump
(which may include more than one pump) may be used to control an
adjustable spacer. In the example where the pump is controlled by
the robotic system or device, a processor of the robotic system or
device may control pressure output to one or more components of the
adjustable spacer. The robotic surgical system or device may be
used to control the pump during a range of motion test, such as to
evaluate distance or pressure in the adjustable spacer (e.g.,
during a hip or shoulder procedure).
[0038] FIG. 5 illustrates a flowchart showing a technique 500 for
using an adjustable spacer in a surgical procedure, such as a
shoulder or hip procedure, in accordance with some embodiments. The
technique 500 includes an operation 502 to inflate (e.g., using a
pump) an adjustable component of an adjustable spacer (e.g., of an
implant or a trial). The technique 500 includes a decision
operation 504 to determine whether a fixed pressure or a fixed
distance (or volume) is to be used for a range of motion test.
[0039] The technique 500 includes an operation 506 to, during a
range of motion test, maintain a fixed pressure in the component by
allowing a distance (e.g., of a neck in a trial for a hip or
shoulder implant) to change. The technique 500 includes an
operation 508 to determine a maximum distance during the range of
motion test. The technique 500 includes an operation 510 to, during
a range of motion test, maintain a fixed distance in the component
by increasing or decreasing pressure (e.g., using a pump). The
technique 500 includes an operation 512 to determine a maximum
pressure during the range of motion test.
[0040] In an example, the fixed distance or the fixed pressure may
be determined using a preoperative plan. The preoperative plan may
be adjusted based on the maximum distance or the maximum pressure
determined during the range of motion test. In an example, an
implant or a trial may be determined using the maximum distance or
the maximum pressure. The maximum pressure or the maximum distance
may be determined using a sensor (e.g., an iAssist device) or an
optical tracker. In an example, a change to a preoperative plan may
include determining a longer or shorter neck length for a trial or
implant. For example, a user interface may be used to provide a
length needed of implant neck to achieve the tested pressure (e.g.,
a maximum pressure).
[0041] The technique 500 includes an operation 514 to output
results for display on a user interface, such as the maximum
distance or the maximum pressure determined during the range of
motion test. In an example, operations 506-508 may be done
independently from operations 510-512, such as only doing one set
of operations, or doing each set sequentially (e.g., fixed pressure
range of motion test then fixed distance range of motion test, or
vice versa). In an example, the fixed distance or the fixed
pressure may be increased or decreased during a repeated range of
motion test.
[0042] In an example, a surgical device used to operate the pump is
a robotic surgical device, and a processor may operate a robotic
controller. In this example, the pump is controlled by the
processor, and the robotic surgical device includes a display, the
display configured to present the user interface including the
maximum pressure or the maximum distance.
[0043] In an example, the pressure and the gap distance may be
allowed to change during the range of motion test. In this example,
a 3D plan (e.g., a preoperative plan) may be used to set limits or
targets for gap distance or pressure. For example, a maximum
pressure may be set for different angles (e.g., from extension to
flexion) or a maximum distance may be set. The technique 500 may
then proceed to, during a range of motion test, maintain a neck
distance or pressure based on the 3D plan. At some portions of the
range of motion test, the neck distance may be held constant while
at other portions of the range of motion test, the pressure may be
held constant, according to the 3D plan. The technique 500 may
include an operation to determine a maximum pressure or maximum
neck distance during the range of motion test (e.g., at different
portions of the test, based on when the neck distance or the
pressure is held constant, respectively).
[0044] FIG. 6 illustrates a system 600 for performing techniques
described herein, in accordance with some embodiments. The system
600 includes a robotic surgical device 602, which may be coupled to
a pump 604 (in an example not shown, pump 604 is a stand-alone
pump, not coupled to a robotic device), which may be used to
control a spacer device 606 (e.g., an implant or a trial). The
spacer device 606 includes an adjustable component 608. The system
600 may include a display device 614, which may be used to display
a user interface 616. The system 600 may include a control system
618 (e.g., a robotic controller), including a processor 620 and
memory 622. In an example, the display device 614 may be coupled to
one or more of the robotic surgical device 602, the spacer device
606, or the control system 618.
[0045] In an example, the display device 614 may be used to display
results of a range of motion procedure on the user interface 616.
The results may include distance or pressure information, such as
over different angles during a range of motion test. The distance
or pressure information may be derived from a sensor, such as a
sensor 610, which may be on the adjustable component 608 or
elsewhere on or within the spacer device 606. The sensor 610 may be
a Hall effect sensor. The distance or pressure information may be
related to a shoulder or hip joint.
[0046] FIG. 7 illustrates a block diagram of an example machine 700
upon which any one or more of the techniques discussed herein may
perform in accordance with some embodiments. In alternative
embodiments, the machine 700 may operate as a standalone device or
may be connected (e.g., networked) to other machines. In a
networked deployment, the machine 700 may operate in the capacity
of a server machine, a client machine, or both in server-client
network environments. In an example, the machine 700 may act as a
peer machine in peer-to-peer (P2P) (or other distributed) network
environment. The machine 700 may be a personal computer (PC), a
tablet PC, a set-top box (STB), a personal digital assistant (PDA),
a mobile telephone, a web appliance, a network router, switch or
bridge, or any machine capable of executing instructions
(sequential or otherwise) that specify actions to be taken by that
machine. Further, while only a single machine is illustrated, the
term "machine" shall also be taken to include any collection of
machines that individually or jointly execute a set (or multiple
sets) of instructions to perform any one or more of the
methodologies discussed herein, such as cloud computing, software
as a service (SaaS), other computer cluster configurations.
[0047] Machine (e.g., computer system) 700 may include a hardware
processor 702 (e.g., a central processing unit (CPU), a graphics
processing unit (GPU), a hardware processor core, or any
combination thereof), a main memory 704 and a static memory 706,
some or all of which may communicate with each other via an
interlink (e.g., bus) 708. The machine 700 may further include a
display unit 710, an alphanumeric input device 712 (e.g., a
keyboard), and a user interface (UI) navigation device 714 (e.g., a
mouse). In an example, the display unit 710, input device 712 and
UI navigation device 714 may be a touch screen display. The machine
700 may additionally include a storage device (e.g., drive unit)
716, a signal generation device 718 (e.g., a speaker), a network
interface device 720, and one or more sensors 721, such as a global
positioning system (GPS) sensor, compass, accelerometer, or other
sensor. The machine 700 may include an output controller 728, such
as a serial (e.g., Universal Serial Bus (USB), parallel, or other
wired or wireless (e.g., infrared (IR), near field communication
(NFC), etc.) connection to communicate or control one or more
peripheral devices (e.g., a printer, card reader, etc.).
[0048] The storage device 716 may include a machine readable medium
722 on which is stored one or more sets of data structures or
instructions 724 (e.g., software) embodying or utilized by any one
or more of the techniques or functions described herein. The
instructions 724 may also reside, completely or at least partially,
within the main memory 704, within static memory 706, or within the
hardware processor 702 during execution thereof by the machine 700.
In an example, one or any combination of the hardware processor
702, the main memory 704, the static memory 706, or the storage
device 716 may constitute machine readable media.
[0049] While the machine readable medium 722 is illustrated as a
single medium, the term "machine readable medium" may include a
single medium or multiple media (e.g., a centralized or distributed
database, and/or associated caches and servers) configured to store
the one or more instructions 724. The term "machine readable
medium" may include any medium that is capable of storing,
encoding, or carrying instructions for execution by the machine 700
and that cause the machine 700 to perform any one or more of the
techniques of the present disclosure, or that is capable of
storing, encoding or carrying data structures used by or associated
with such instructions. Non-limiting machine readable medium
examples may include solid-state memories, and optical and magnetic
media.
[0050] The instructions 724 may further be transmitted or received
over a communications network 726 using a transmission medium via
the network interface device 720 utilizing any one of a number of
transfer protocols (e.g., frame relay, internet protocol (IP),
transmission control protocol (TCP), user datagram protocol (UDP),
hypertext transfer protocol (HTTP), etc.). Example communication
networks may include a local area network (LAN), a wide area
network (WAN), a packet data network (e.g., the Internet), mobile
telephone networks (e.g., cellular networks), Plain Old Telephone
(POTS) networks, and wireless data networks (e.g., Institute of
Electrical and Electronics Engineers (IEEE) 802.11 family of
standards known as Wi-Fi.RTM., IEEE 802.16 family of standards
known as WiMax.RTM.), IEEE 802.15.4 family of standards,
peer-to-peer (P2P) networks, among others. In an example, the
network interface device 720 may include one or more physical jacks
(e.g., Ethernet, coaxial, or phone jacks) or one or more antennas
to connect to the communications network 726. In an example, the
network interface device 720 may include a plurality of antennas to
wirelessly communicate using at least one of single-input
multiple-output (SIMO), multiple-input multiple-output (MIMO), or
multiple-input single-output (MISO) techniques. The term
"transmission medium" shall be taken to include any intangible
medium that is capable of storing, encoding or carrying
instructions for execution by the machine 700, and includes digital
or analog communications signals or other intangible medium to
facilitate communication of such software.
[0051] Each of these non-limiting examples may stand on its own, or
may be combined in various permutations or combinations with one or
more of the other examples.
[0052] Example 1 is a surgical device for evaluating soft tissue
during a surgical procedure comprising: a pump to: inflate an
adjustable spacer in a neck portion of a femoral trial for a hip
replacement procedure; and during a range of motion test, maintain
a fixed distance in the adjustable spacer by increasing or
decreasing pressure in the adjustable spacer; and a processor to:
determine a maximum pressure during the range of motion test; and
output the maximum pressure for display on a user interface.
[0053] In Example 2, the subject matter of Example 1 includes,
wherein the pump is further to decrease the fixed distance during a
repeated range of motion test.
[0054] In Example 3, the subject matter of Examples 1-2 includes,
wherein the processor is to use a preoperative plan to determine
the fixed distance.
[0055] In Example 4, the subject matter of Example 3 includes,
wherein the processor is further to adjust the preoperative plan
based on the maximum pressure.
[0056] In Example 5, the subject matter of Examples 1-4 includes,
wherein the processor is further to determine an implant based on
the maximum pressure.
[0057] In Example 6, the subject matter of Examples 1-5 includes,
wherein to determine the maximum pressure, the processor is to use
optical tracking of the neck portion of the femoral trial.
[0058] In Example 7, the subject matter of Examples 1-6 includes,
wherein the surgical device is a robotic surgical device, wherein
the processor operates a robotic controller, wherein the pump is
controlled by the processor, and wherein the robotic surgical
device includes a display, the display configured to present the
user interface including the maximum pressure.
[0059] Example 8 is a method comprising: inserting a trial for a
hip replacement procedure, the trial including an adjustable spacer
in a neck portion; inflating the adjustable spacer to a fixed
distance; using a pressure sensor device, measuring pressure on the
adjustable spacer throughout a range of motion test with the trial
in place and the adjustable spacer inflated at the fixed distance;
determining a maximum pressure during the range of motion test; and
outputting the maximum pressure for display on a user
interface.
[0060] In Example 9, the subject matter of Example 8 includes,
decreasing the fixed distance and performing the range of motion
test again.
[0061] In Example 10, the subject matter of Examples 8-9 includes,
using a preoperative plan to determine the fixed distance.
[0062] In Example 11, the subject matter of Example 10 includes,
adjusting the preoperative plan based on the maximum pressure.
[0063] In Example 12, the subject matter of Examples 8-11 includes,
determining an implant based on the maximum pressure.
[0064] In Example 13, the subject matter of Examples 8-12 includes,
determining the maximum pressure using an iAssist device.
[0065] Example 14 is a machine-readable medium including
instructions for controlling an adjustable spacer of a trial
inserted into a femur of a patient for a hip replacement procedure,
which when executed by a processor, cause the processor to: cause
the adjustable spacer to inflate to a fixed distance; receive
pressure measurements from a pressure sensor device, the pressure
measurements taken by the pressure sensor device on the adjustable
spacer throughout a range of motion test with the trial in place
and the adjustable spacer inflated at the fixed distance; determine
a maximum pressure during the range of motion test; and output the
maximum pressure for display on a user interface.
[0066] In Example 15, the subject matter of Example 14 includes,
wherein the instructions further cause the processor to cause the
fixed distance of the adjustable spacer to decrease, during a
repeat of the range of motion test.
[0067] In Example 16, the subject matter of Examples 14-15
includes, wherein the processor is further to use a preoperative
plan to determine the fixed distance.
[0068] In Example 17, the subject matter of Example 16 includes,
wherein the processor is further to adjust the preoperative plan
based on the maximum pressure.
[0069] In Example 18, the subject matter of Examples 14-17
includes, wherein the processor is further to determine an implant
based on the maximum pressure.
[0070] In Example 19, the subject matter of Examples 14-18
includes, wherein the processor is to receive the pressure
measurements from an iAssist device.
[0071] Example 20 is at least one machine-readable medium including
instructions that, when executed by processing circuitry, cause the
processing circuitry to perform operations to implement of any of
Examples 1-19.
[0072] Example 21 is an apparatus comprising means to implement of
any of Examples 1-19.
[0073] Example 22 is a system to implement of any of Examples
1-19.
[0074] Example 23 is a method to implement of any of Examples
1-19.
[0075] Method examples described herein may be machine or
computer-implemented at least in part. Some examples may include a
computer-readable medium or machine-readable medium encoded with
instructions operable to configure an electronic device to perform
methods as described in the above examples. An implementation of
such methods may include code, such as microcode, assembly language
code, a higher-level language code, or the like. Such code may
include computer readable instructions for performing various
methods. The code may form portions of computer program products.
Further, in an example, the code may be tangibly stored on one or
more volatile, non-transitory, or non-volatile tangible
computer-readable media, such as during execution or at other
times. Examples of these tangible computer-readable media may
include, but are not limited to, hard disks, removable magnetic
disks, removable optical disks (e.g., compact disks and digital
video disks), magnetic cassettes, memory cards or sticks, random
access memories (RAMs), read only memories (ROMs), and the
like.
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