U.S. patent application number 16/786522 was filed with the patent office on 2020-06-04 for robotized system for femoroacetabular impingement resurfacing.
The applicant listed for this patent is MedTech S.A.. Invention is credited to Louis-Philippe Amiot, Seth Anderson Nash, John R. White.
Application Number | 20200170721 16/786522 |
Document ID | / |
Family ID | 59254037 |
Filed Date | 2020-06-04 |
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United States Patent
Application |
20200170721 |
Kind Code |
A1 |
Amiot; Louis-Philippe ; et
al. |
June 4, 2020 |
ROBOTIZED SYSTEM FOR FEMOROACETABULAR IMPINGEMENT RESURFACING
Abstract
Systems and methods are described herein for resurfacing bones,
and in particular, for detecting and resurfacing one or more
femoroacetabular impingements (FAIs). A FAI resurfacing controller
may be used to perform this detecting and resurfacing of FAIs. The
FAI resurfacing controller may include a bone model generator to
receive bone imaging and to generate a model of at least one
osteophyte and of a surface of a native bone surrounding the at
least one osteophyte. The FAI resurfacing controller may include an
osteophyte identifier to set a virtual 3D boundary surface between
native bone surface and the at least one osteophyte. The FAI
resurfacing controller may include a resurfacing navigator to
generate and output a navigation file. The navigation file may
include the model with the 3D boundary surface between native bone
surface and the at least one osteophyte.
Inventors: |
Amiot; Louis-Philippe;
(Montreal, CA) ; Nash; Seth Anderson; (Fort Wayne,
IN) ; White; John R.; (Winona Lake, IN) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
MedTech S.A. |
Montpellier |
|
FR |
|
|
Family ID: |
59254037 |
Appl. No.: |
16/786522 |
Filed: |
February 10, 2020 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
15625555 |
Jun 16, 2017 |
10582971 |
|
|
16786522 |
|
|
|
|
62350891 |
Jun 16, 2016 |
|
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 2034/2057 20160201;
A61B 17/00234 20130101; A61B 2034/2065 20160201; A61B 17/175
20130101; A61B 2090/3983 20160201; A61B 34/20 20160201; A61B 34/10
20160201; A61B 34/30 20160201; A61B 17/1764 20130101; A61B
2034/2046 20160201; A61B 17/1746 20130101; A61B 2034/105
20160201 |
International
Class: |
A61B 34/20 20060101
A61B034/20; A61B 34/10 20060101 A61B034/10; A61B 34/30 20060101
A61B034/30; A61B 17/00 20060101 A61B017/00; A61B 17/17 20060101
A61B017/17 |
Claims
1. A femoroacetabular impingement resurfacing system comprising: a
bone model generator to receive a bone imaging data set and
generate a resurfacing model based on the bone imaging data set,
the resurfacing model including at least one osteophyte and a
native bone surface connected to the at least one osteophyte; an
osteophyte identifier to map a virtual 3D boundary surface based on
the resurfacing model, the virtual 3D boundary surface identifying
an osteophyte virtual boundary located between the native bone
surface and the at least one osteophyte; a resurfacing navigator to
generate a navigation file, the navigation file including the
resurfacing model and the virtual 3D boundary surface, the
navigation file to provide control instructions to resurface the
native bone surface to remove the at least one osteophyte; and an
osteophyte removal device to automatically resurface the native
bone surface based on the navigation file.
Description
CLAIM OF PRIORITY
[0001] This application is a divisional of U.S. patent application
Ser. No. 15/625,555, filed on Jun. 16, 2017, which claims the
benefit of U.S. Provisional Patent Application Ser. No. 62/350,891,
filed on Jun. 16, 2016, the benefit of priority of each of which is
claimed hereby, and each of which is incorporated by reference
herein in its entirety.
FIELD
[0002] The present application relates to computer-assisted
orthopedic surgery involving robotized apparatuses.
BACKGROUND
[0003] Computer-assisted surgery has been developed to help an
operator in altering bones, and in positioning and orienting
implants to a desired orientation. Among the various tracking
technologies used in computer-assisted surgery, optical navigation,
C-arm validation, and manual reference guides have been used. The
optical navigation typically requires the use of a navigation
system, which adds operative time. Moreover, the optical navigation
is bound to line-of-sight constraints that hamper the normal
surgical flow. C-arm validation requires the use of bulky
equipment, and the C-arm validation is not cost-effective.
[0004] Such tracking technologies often assist manual work
performed by an operator or surgeon. While surgeons may have
developed an expertise in manipulations performed during surgery,
some practitioners prefer the precision and accuracy of robotized
surgery.
BRIEF DESCRIPTION OF THE DRAWINGS
[0005] FIG. 1 is a schematic view of a robotized surgery system, in
accordance with some embodiments.
[0006] FIG. 2 is an exemplary perspective view of a foot support of
the robotized surgery system of FIG. 1, in accordance with some
embodiments.
[0007] FIG. 3A is a perspective schematic view of femoroacetabular
impingement (FAI) conditions on the pelvis, in accordance with some
embodiments.
[0008] FIG. 3B is a perspective schematic view of FAI conditions on
the femoral head and neck, in accordance with some embodiments.
[0009] FIG. 4 is a block diagram of a FAI resurfacing controller
used with the robotized surgery system of FIG. 1, in accordance
with some embodiments.
[0010] FIG. 5 illustrates a flow chart showing a robotized surgery
system technique for FAI resurfacing, in accordance with some
embodiments.
[0011] FIG. 6 illustrates generally an example of a block diagram
of a machine upon which any one or more of the techniques (e.g.,
methodologies) discussed herein may perform in accordance with some
embodiments.
DETAILED DESCRIPTION
[0012] The present disclosure describes a robotic system for
resurfacing bones, and in particular, for detecting and resurfacing
one or more femoroacetabular impingements (FAIs). A FAI resurfacing
controller may be used to perform this detecting and resurfacing of
FAIs. The FAI resurfacing controller may include a bone model
generator to receive bone imaging and to generate a model of at
least one osteophyte and of a surface of a native bone surrounding
the at least one osteophyte. The FAI resurfacing controller may
include an osteophyte identifier to set a virtual 3D boundary
surface between native bone surface and the at least one
osteophyte. The FAI resurfacing controller may include a
resurfacing navigator to generate and output a navigation file. The
navigation file may include the model with the 3D boundary surface
between native bone surface and the at least one osteophyte. The
navigation file may also include patient-specific numerical control
data for resurfacing the bone to remove the at least one
osteophyte.
[0013] 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.
[0014] FIG. 1 is a schematic view of a robotized surgery system 10,
in accordance with some embodiments. Robotized surgery system 10
may be used to perform orthopedic surgery maneuvers on a patient,
such as FAI resurfacing, arthroscopy, or other surgical procedures.
The robotized surgery system 10 is shown relative to a patient's
leg in a supine decubitus, though the patient may be in lateral
decubitus (e.g., to expose the hip joint) or in another
position.
[0015] The robotized surgery system 10 may include a robot arm 20,
a foot support 30, a thigh support 40, a robotized surgery
controller 50, a FAI resurfacing controller 60, and a supplementary
tracking apparatus 70. The robot arm 20 is the working end of the
system 10, and is used to perform bone alterations as planned by an
operator and as controlled by the robotized surgery controller 50.
The robot arm 20 is positioned to access the hip joint of the
patient for performing FAI resurfacing. The foot support 30
supports the foot and lower leg of the patient, in such a way that
it is only selectively movable for adjustment to the patient's
position and morphology. The thigh support 40 supports the thigh
and upper leg of the patient, again in such a way that it is only
optionally movable. The thigh support 40 may assist in keeping the
hip joint fixed during FAI resurfacing, and should hence be
positioned so as not to impede the movements of the robot arm 20.
The robotized surgery controller 50 controls the robot arm 20. The
FAI resurfacing controller 60 output data used to drive the robot
arm 20 in performing the FAI resurfacing. The tracking apparatus 70
may optionally be used to track the robot arm 20 and the patient
limbs.
[0016] The robot arm 20 may stand from a base 21, for instance in a
fixed relation relative to the operating room (OR) table supporting
the patient. Indeed, the relative positioning of the robot arm 20
relative to the patient is a determinative factor in the precision
of the surgical procedure, whereby the foot support 30 and thigh
support 40 may assist in keeping the operated limb fixed in the
illustrated {X Y Z} coordinate system. The robot arm 20 has a
plurality of joints 22 and links 23, of any appropriate form, to
support a tool head 24 that interfaces with the patient. The arm 20
is shown being a serial mechanism, arranged for the tool head 24 to
be displaceable in sufficient degrees of freedom (DOF). For
example, the robot arm 20 controls 6-DOF movements to the tool head
24, {X Y Z} in the coordinate system, and pitch, roll, and yaw.
Fewer or additional DOFs may be present. For simplicity, only a
generic illustration of the joints 22 and links 23 is provided, but
more joints of different types may be present to move the tool head
24 in the manner described above. The joints 22 are powered for the
robot arm 20 to move as controlled by the controller 50 in the six
DOFs. Therefore, the powering of the joints 22 is such that the
tool head 24 of the robot arm 20 may execute precise movements,
such as moving along a single direction in one translation DOF, or
being restricted to moving along a plane, among possibilities.
Various types of robot arms 20 may be used, such as those described
in U.S. patent application Ser. No. 11/610,728, incorporated herein
by reference.
[0017] The tool head 24 may also comprise a chuck or like tool
interface, typically actuatable in rotation. In FIG. 1, the tool
head 24 supports a burr 26A, such as may be used during FAI
resurfacing. The tool head 24 may support other surgical tools,
such as a registration pointer, a reamer, a cannula, a
reciprocating saw, or another surgical tool. The various tools may
be interchanged, whether with human assistance, or as an automated
process. The installation of a tool in the tool head 24 may then
require some calibration to position the installed tool in the {X Y
Z} coordinate system of the robot arm 20. Various surgical
procedures may be performed when tool head 24 is used with a
cannula. In an example, the robot arm 20 may be used to perform a
robotically assisted arthroscopy procedure. A shaver, burr, suture
applicator, or another surgical instrument may be operated through
the cannula. The controller 50 may target the cannula using sensors
within the robot arm 20, such as sensors used to detect position or
rotation of various components of the robot arm 20. The controller
50 may target the cannula using one or more cameras mounted on the
tracking apparatus 70.
[0018] Tracking apparatus 70 may include various types of tracking
systems depending on the particular surgical application. For
example, the tracking apparatus 70 may be used to track the robot
arm 20 or other components of the surgery system 10 using one or
more image capture devices (e.g., cameras). The tracking apparatus
70 may include an arthroscopic camera for viewing the surgical site
in a minimally invasive manner. The tracking apparatus 70 may also
be used to provide video recognition and tracking-guided surgery
procedures. For example, the controller 50 may use the tracking
apparatus 70 to detect an unhealthy acetabular labrum, place the
cannula in a predetermined location, and stitch the acetabular
labrum. The tracking apparatus 70 can also include an associated
controller or computing system to processing data received from
various sensors (e.g., cameras, etc.) to provide guidance to other
components of the system. For example, in an optical tracking
scenario, the tracking apparatus 70 can include at least two
cameras coupled to a computing system that utilizes images captured
from the cameras to triangulate positions of tracked objects. In
another example, the tracking apparatus 70 can include an
arthroscopic camera and a computing device that receives image data
and performs image processing operations to segment information out
of the image data related to osteophyte removal.
[0019] The tracking apparatus 70 may also be used to verify removal
of one or more osteophytes. A primary source of error during
surgical procedures involving removal of osteophytes is the failure
to completely remove the osteophyte, which may be due to the
difficulty in determining how much of an osteophyte has been
removed. The controller 50 may use the tracking apparatus 70 and
robot arm 20 to determine how much of the osteophyte has been
removed and whether the osteophyte removal process is complete. In
an example, a feedback mechanism may be used to indicate when the
osteophyte has been removed. The feedback may include a green
light, an audible feedback, a tactile feedback, or other feedback.
The determination of whether the osteophyte has been removed may be
based on an image from the tracking apparatus 70, based on
comparing the burr 26A location against a 3D model, based on manual
leg manipulation and tracking range of movement through the
tracking apparatus 70, or based on another osteophyte removal
confirmation.
[0020] The controller 50 may drive the robot arm 20 in performing
the surgical procedure based on the planning achieved
pre-operatively. The robotized surgery controller 50 runs various
modules, in the form of algorithms, code, non-transient executable
instructions, etc., to operate the system 10 in the manner
described herein. For example, the controller 50 may include a
robot driver module, where the robot driver module is tasked with
powering or controlling the various joints of the robot arm 20.
Force feedback may be provided by the robot arm 20 to avoid
damaging the soft tissue or surrounding environment. The robotized
surgery controller 50 may have a processor unit to control movement
of the robot arm 20. System 10 may include an interface 90 to
provide information to the operator. The interface 90 may include a
display, a wireless portable electronic device (e.g., phone,
tablet), a speaker for audio guidance, an LED display, or other
type of interface.
[0021] The controller 50 may be used to drive the robot arm 20 to
avoid various predetermined soft tissues. In an embodiment, the
controller 50 may use the tracking apparatus 70 to detect a
particular soft tissue and drive the robot arm 20 to avoid that
soft tissue. In an embodiment, the controller 50 may identify a
safety zone, and may guide the robot arm 20 to enforce a safety
zone by avoiding performing surgical procedures within the safety
zone during a surgical procedure. In various examples, the safety
zone may include surrounding soft tissue, a native bone surface of
a patient, or a critical blood vessel (e.g., femoral artery, neck
artery).
[0022] To preserve the fixed relation between the leg and the
coordinate system, a generic embodiment of a foot support 30 is
shown in FIG. 1, while one possible implementation of the foot
support 30 is shown in greater detail in FIG. 2. The foot support
30 may be displaceable relative to the OR table, to adjust to the
patient, with the joints then lockable once a suitable position is
reached. The mechanism of the foot support 30 may have a slider 31,
moving along the OR table in the X-axis direction. Joints 32 and
links 33 may also be part of the mechanism of the foot support 30,
to support a foot interface 34 receiving the patient's foot.
[0023] The thigh support 40 may be displaceable relative to the OR
table, to be better positioned as a function of the patient's
location on the table, so as not to impede action of the robot arm
20. Accordingly, the thigh support 40 is shown as including a
passive mechanism, with various lockable joints to lock the thigh
support 40 in a desired position and orientation. The mechanism of
the thigh support 40 may have a slider 41, moving along the OR
table in the X-axis direction. Joints 42 and links 43 may also be
part of the mechanism of the thigh support 40, to support a thigh
bracket 44. A strap 45 can immobilize the thigh/femur in the thigh
support 40. The thigh support 40 may not be necessary in some
instances.
[0024] The foot support 30 or the thigh support 40 may assist in
keeping the bones fixed relative to the {X Y Z} coordinate system.
For instance, the fixed relation may be required in instances in
which no additional tracking is present to assist the actions of
the robot arm 20. However, the tracking apparatus 70 may provide
intraoperative tracking information for the robot arm 20 and for
the patient bones, in such a way that some movement of the patient
is permissible intraoperatively as the movement is calculable and
thus known in the {X Y Z} coordinate system.
[0025] The operation of the tracking apparatus 70 may depend on the
information within the navigation file C. For example, the tracking
apparatus 70 may assist in performing the calibration of the
patient bone with respect to the robot arm 20, for subsequent
navigation in the {X Y Z} coordinate system. The tracking apparatus
70 may include two cameras to provide stereoscopic (e.g., 3D) image
data to optically identify and locate retro-reflective references
71A, 71B, and 71B to triangulate positions of objects associated
with the references, in an embodiment, the reference 71A is on the
tool head 24 of the robot arm 20 such that its tracking allows the
controller 50 to calculate the position and/or orientation of the
tool head 24 and tool 26A thereon. In an example, reference 71A may
be etched on a stable portion of a burr tool 26A. The controller 50
may use information about the position of the tool head 24 and the
camera on the tracking apparatus 70 to adjust the camera to
optimize the collected images, such as adjusting camera position,
camera angle, camera distance from tool head 24, focal length, or
other dynamic camera adjustments. The tracking apparatus 70 may
also include a robot tracking arm, and the controller 50 may
control the robot tracking arm to adjust the camera position or
perform other dynamic camera adjustments. The robot tracking arm
may be controlled independently or in conjunction with controlling
the robot arm 20.
[0026] In addition to reference 71A on the tool head 24, references
71B and 71C may be fixed to the patient bones, such as the tibia
for reference 71B and the femur for reference 71C. In an example,
references 71B and 71C are applied to the patent bones using a
brief procedure to provide rapid reference tracking. In another
example, references 71B and 71C may include application of a
virtual marker (e.g., "painted on") to an image of the bone, such
as using interface 90. In FAI resurfacing, it may only be necessary
to have the reference 71C, although it may be desired to have
another reference on the pelvis as well, depending on the location
of the osteophytes. As shown, the references 71 attached to the
patient need not be invasively anchored to the bone, as straps or
like attachment means may provide sufficient grasping to prevent
movement between the references 71 and the bones, in spite of being
attached to soft tissue. For example, the references 71 may include
a fabric removably and non-invasively attachable to a bone, where
references 71 each include a plurality of reference markers
distributed on the surface of the fabric. The controller 50
continuously updates the position or orientation of the robot arm
20 and patient bones in the {X Y Z} coordinate system using the
data from the tracking apparatus 70. Tracking system 70 may include
one or more of optical tracking sensors, inertial tracking sensors,
or other motion or location sensors. For example, tracking system
70 may include inertial sensors (e.g., accelerometers, gyroscopes,
etc.) that produce tracking data to be used by the controller 50 to
update the position or orientation of the robot arm 20
continuously. Other types of tracking technology may also be
used.
[0027] The calibration may be achieved in the manner described
above, with the robot arm 20 using a registration pointer on the
robot arm 20, and with the assistance of the tracking apparatus 70
if present in the robotized surgery system 10. Another calibration
approach is to perform radiography of the bones with the references
71 thereon, at the start of the surgical procedure. For example, a
C-arm may be used for providing suitable radiographic images. The
images are then used for the surface matching with the bone model B
of the patient. Because of the presence of the references 71 as
fixed to the bones, the intraoperative registration may then not be
necessary, as the tracking apparatus 70 tracks the position or
orientation of the bones in the {X Y Z} coordinate system after the
surface matching between X-ray and bone model is completed.
[0028] FIG. 2 is an exemplary perspective view of a robotized
surgery system foot support 30, in accordance with some
embodiments. The foot interface 34 may have an L-shaped body
ergonomically shaped to receive the patient's foot To fix the foot
in the foot support 33, different mechanisms may be used, one of
which features an ankle clamp 35. The ankle clamp 35 surrounds the
rear of the foot interface 34, and laterally supports a pair of
malleolus pads 36. The malleolus pads 36 are positioned to be
opposite the respective malleoli of the patient, and are
displaceable via joints 37, to be brought together and hence clamp
onto the malleoli. A strap 38 may also be present to secure the leg
in the foot support 30 further, for example by attaching to the
patient's shin. As an alternative to the arrangement of FIG. 2, a
cast-like boot may be used, or a plurality of straps 38, provided
the foot is fixed in the foot support 33.
[0029] FIG. 3A is a perspective schematic view of FAI conditions on
the pelvis D, in accordance with some embodiments. FIG. 3B is a
perspective schematic view of FAI conditions on the femoral head F1
and neck F2, in accordance with some embodiments. The system 10 is
used to resurface the femoral head F1 or neck F2, or to resurface
the periphery of the acetabulum A1 in a FAI condition. The FAI
condition may be caused by one or more osteophytes on the rim of
the acetabulum A1 or femoral head F1 or neck F2. In FIG. 3A,
osteophyte O1 is shown built up on the periphery of the acetabulum
A1, part of the pelvis D. This acetabular bone growth may be known
as a pincer deformity, and may cause a pincer impingement. In FIG.
3B, osteophyte O2 is shown built up at the junction of the femoral
head F1 and femoral neck F2, part of the pelvis D. This femoral
bone growth may be known as a cam deformity, and may cause a
femoral cam impingement. One or both of the pincer deformity and
cam deformity may occur, and both may be corrected using the FAI
resurfacing techniques described herein. FIGS. 3A and 3B are
examples of possible osteophyte locations, but other osteophytes
can build up at other locations.
[0030] FIG. 4 is a block diagram of a FAI resurfacing controller
used with the robotized surgery system of FIG. 1, in accordance
with some embodiments. To drive the robot arm 20 in resurfacing the
hip joint, in either or both conditions of FIGS. 3A and 3B, a
navigation file C may be created. Referring to FIG. 4, a FAI
resurfacing controller is generally shown at 60. The controller 60
may be part of the system 10, for example as part of a set of
modules that are in the robotized surgery controller 50. The FAI
resurfacing controller 60 may also be a stand-alone processing
unit, used in pre-operative planning to prepare a navigation file
C.
[0031] The FAI resurfacing controller 60 may receive bone imagery
131. The bone imagery B1 may include a computed tomography (CT)
scan image, magnetic resonance imaging (MRI) image, or any other
radiography imagery. A bone model generator module 61 receives the
bone imagery B1 to generate a bone model therefrom. The model may
be a 3D representation of at least a portion of the surface having
osteophytes thereon. For example, the 3D representation may be that
of a portion of the acetabulum A1 or of a portion of the femoral
head F1 and neck F2. The 3D representation may include a portion of
the bone surface surrounding the osteophytes, and the
osteophytes.
[0032] An osteophyte identifier module 62 receives the bone model,
and segments the osteophyte from the native bone surface. Various
approaches may be used for the segmentation by the osteophyte
identifier module 62. According to an embodiment, the osteophyte
identifier module 62 consults a bone atlas database 132. The bone
atlas database 132 includes a compilation of different femur or
pelvis geometries, for instance also as 3D bone models. The
osteophyte identifier module 62 compares the bone model,
particularly the native bone surface surrounding the osteophyte,
with bone geometries of the database B2 to find closest matches.
Once a closest match is identified, the bone models may be overlaid
to define a surface of the patient bone covered by osteophytes.
[0033] Various geometric features may be used by the osteophyte
identifier module 62 to identify an osteophyte. In an example, the
received bone model may be used to identify geometric features of
the bone, and the osteophytes may be identified by identifying
differences between bone model geometric features and a bone atlas
databases match. In another example, one or more femoral or
acetabular geometric measurements may be used to identify geometric
features of the bone. The geometric measurements may include an
alpha angle, a lateral center edge angle, a femoral head coverage,
a sourcil angle, an acetabular angle, or other femoral or
acetabular geometric measurements. In an example, the alpha angle
may be used to characterize the concavity of the anterior femoral
head-neck junction, or how big the bump is on the femoral neck. The
alpha angle is defined as the acute angle between the femoral neck
axis and a line between the femoral head center with the point
where the head-neck junction cortical surface first meets with a
circle superimposed upon an ideally spherical femoral head. The
alpha angle may be particularly useful in detecting an osteophyte
that causes or contributes to a femoral cam impingement. In another
example, the lateral center edge angle may be used to characterize
the angular coverage of the femoral head by the weight-bearing zone
of the acetabulum. The lateral center edge angle is defined as the
angle formed by intersection of a vertical line extending through
the femoral head center and a line extending through the femoral
head center to the lateral sourcil. The lateral center edge angle
may be particularly useful in detecting an osteophyte that
contributes to acetabular dysplasia, acetabular instability, or
femoral impingement. In another example, the femoral head coverage
may be used to characterize weight-bearing femoral head coverage,
where the femoral head coverage is defined as the percentage
coverage of the femoral head by the weight-bearing zone of the
acetabulum. The femoral head coverage may be particularly useful in
detecting an osteophyte that contributes to acetabular dysplasia or
pincer impingement, and may also be used when resurfacing the
acetabular rim due to pincer impingement. In another example, the
sourcil angle may be used to characterize the angle-dependent
coverage of the femoral head by the acetabulum. The sourcil angle
(e.g., Tonnis angle) is defined as the angle formed between a
horizontal line and a line extending from the medial edge of the
sourcil to the lateral edge of the sourcil. The sourcil angle may
be particularly useful in detecting an osteophyte that contributes
to acetabular dysplasia, acetabular instability, or femoral
impingement. In another example, the acetabular angle may be used
to characterize the acetabular inclination or opening. The
acetabular angle may include the acetabular angle of Sharp, defined
as the angle formed between a horizontal line and a line from the
teardrop to lateral acetabulum. The acetabular angle may include
the acetabular roof angle of Tonnis, defined as the angle formed by
a horizontal line connecting both triradiate cartilages (e.g., the
Hilgenreiner line) and a second line connecting the acetabular
roofs. The acetabular angle may be particularly useful in detecting
an osteophyte that contributes to pincer impingement. Once the
osteophyte identifier module 62 analyzes the bone geometry to
identify the osteophyte, the geometric features may be used by the
resurfacing navigator 63 to achieve a desired geometric goal or to
correspond with a preoperatively planned geometric goal. For
example, the osteophyte identifier module 62 may identify the alpha
angle, which may be used by the resurfacing navigator 63 to achieve
a desired alpha angle or to correspond with a preoperatively
planned alpha angle.
[0034] In an embodiment, the osteophyte identifier module 62 may
analyze the bone model directly, such as by generating a 3D model
based on the bone model and determining an impingement-free range
of motion. For example, the osteophyte identifier module 62 may
perform 3D reconstruction along the neck of the femur, identify the
center of the sphere of the femoral head, and identify the
non-spherical portions to determine impingement-free range of
motion. Accordingly, the osteophyte identifier module 62 virtually
segments the native bone surface from the osteophyte, by defining a
3D boundary surface between the native bone and the osteophyte.
[0035] In the model generated by the osteophyte identifier module
62, the 3D boundary surface is affixed and surrounded by the 3D
bone model of the bone model generator module 61. The osteophyte
identifier module 62 may alternatively or supplementally require
the assistance of an operator. For instance, the 3D boundary
surface based on the bone atlas data B2 may be a starting point for
an operator to perform adjustments to the virtual segments or other
virtual boundaries. As another example, the osteophyte identifier
module 62 may provide the bone model to the bone model generator
module 61, along with interactive virtual tools, for an operator to
define a 3D boundary surface between the osteophyte and the native
bone surface. The interactive virtual tool may include a suggested
3D boundary surface based on extensions of the native bone
surrounding the osteophytes.
[0036] A resurfacing navigator 63 uses the bone model with 3D
boundary surface to generate the navigation file C. The navigation
file C may include the bone model with 3D boundary surface, with a
high enough surface resolution of native bone surface surrounding
the 3D boundary surface for an intraoperative registration to be
executed by the robot arm 20, in a calibration. The calibration may
include the bone model B of the patient, for surface matching to be
performed by a registration pointer of the robot arm 20. The robot
arm 20 would obtain a cloud of bone landmarks of the exposed bones,
to reproduce a 3D surface of the bone. The 3D surface would then be
matched to the bone model B of the patient, to set the 3D model in
the {X Y Z} coordinate system. If a bone model is not available, a
bone model may be generated intraoperatively. For example, a
surgical registration pointer may be used to contact a bone surface
to register a point, and multiple points may be synthesized to
generate a cloud of small surfaces representing an approximate bone
model.
[0037] The resurfacing navigator 63 may also include a resurfacing
path for the robot arm 10 based on a model of the osteophyte, and
an identification of the tool that may be used, such as the burr
26A shown in FIG. 1. The resurfacing path may consider the
surrounding soft tissue to be minimally invasive, such as by
defining a safety zone to avoid specific soft tissues. The
resultant navigation file C defines the maneuvers to be performed
by the robot arm 20 as directed by the controller 50 of the system
10. The resultant navigation file C may include a patient-specific
numerical control data, such as anatomical information specific to
the patient to aid in navigating the robot arm 20. The maneuvers
may be performed by the robot arm 20 without surgeon
intervention.
[0038] FIG. 5 illustrates a flow chart showing a robotized surgery
system technique 80 for FAI resurfacing, in accordance with some
embodiments. In an embodiment, technique 80 is performed
autonomously by a robotized system for femoroacetabular impingement
resurfacing. The robotized system may include one or more of the
components of the robotized surgery system 10 described above, such
as robotized surgery controller 50, robotic arm 20, tracking system
70, or other component. In particular, the robotized surgery
controller 50 may include an FAI resurfacing controller 60, which
may include a bone model generator 61, an osteophyte identifier 62,
and a resurfacing navigator 63. Technique 80 may include receiving
81 a bone imaging data set at a bone model generator 61. The bone
imaging data set may include an x-ray image, a computed tomography
(CT) scan image, MRI imaging, or any other radiography imagery that
can provide sufficient detail to allow identification of
osteophytes. The bone model generator 61 may generate 82 a
resurfacing model. The resurfacing model may include at least one
osteophyte and a native bone surface surrounding the at least one
osteophyte. As discussed above, generating 82 the resurfacing model
can optionally include manual intervention through a graphical user
interface provided to a surgeon or technician. The osteophyte
identifier 62 may map 83 a virtual 3D boundary surface based on the
resurfacing model. The virtual 3D boundary surface may identify an
osteophyte virtual boundary located between the native bone surface
and the at least one osteophyte. The resurfacing navigator 63 may
generate 84 a navigation file. The navigation file may include the
resurfacing model, the virtual 3D boundary surface, and a plurality
of patient-specific numerical control data. The navigation file can
include control vectors used by the surgery controller 50 to direct
a cutting tool attached to the robotic arm 20 to remove the
identified osteophytes. The surgery controller 50 may execute the
navigation file to direct the robotic arm in automatically removing
85 the at least one osteophyte from the native bone surface based
on the navigation file. Removing 85 the at least one osteophyte may
include the surgery controller 50 receiving 86 tracking data from a
tracking system 70. The surgery controller 50 may further direct
the cutting tool attached to the robotic arm 20 based on tracking
data received from the tracking system 70. Regardless of whether a
tracking device is used, the robotic arm may remove 85 the at least
one osteophyte without surgeon intervention. In an embodiment, the
surgery controller 50 may generate or update a 3D model based on
tracking data received 86 from the tracking system 70 to verify
osteophyte removal. For example, the surgery controller 50 may
update the 3D model to confirm the current state of the resurfaced
bone provides impingement-free range of motion. In addition to the
surgery controller 50 verifying osteophyte removal, a surgeon may
manipulate a joint intraoperatively and provide osteophyte removal
confirmation or other feedback to the surgery controller 50.
[0039] FIG. 6 illustrates generally an example of a block diagram
of a machine 100 upon which any one or more of the techniques
(e.g., methodologies) discussed herein may perform in accordance
with some embodiments. In alternative embodiments, the machine 100
may operate as a standalone device or may be connected (e.g.,
networked) to other machines. In a networked deployment, the
machine 100 may operate in the capacity of a server machine, a
client machine, or both in server-client network environments. The
machine 100 may be a personal computer (PC), a tablet PC, 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.
[0040] Examples, as described herein, may include, or may operate
on, logic or a number of components, modules, or like mechanisms.
Such mechanisms are tangible entities (e.g., hardware) capable of
performing specified operations when operating. In an example, the
hardware may be specifically configured to carry out a specific
operation (e.g., hardwired). In an example, the hardware may
include configurable execution units (e.g., transistors, circuits,
etc.) and a computer readable medium containing instructions, where
the instructions configure the execution units to carry out a
specific operation when in operation. The configuring may occur
under the direction of the executions units or a loading mechanism.
Accordingly, the execution units are communicatively coupled to the
computer readable medium when the device is operating. For example,
under operation, the execution units may be configured by a first
set of instructions to implement a first set of features at one
point in time and reconfigured by a second set of instructions to
implement a second set of features.
[0041] Machine (e.g., computer system) 100 may include a hardware
processor 102 (e.g., a central processing unit (CPU), a graphics
processing unit (GPU), a hardware processor core, or any
combination thereof), a main memory 104 and a static memory 106,
some or all of which may communicate with each other via an
interlink (e.g., bus) 108. The machine 100 may further include a
display unit 110, an alphanumeric input device 112 (e.g., a
keyboard), and a user interface (UI) navigation device 114 (e.g., a
mouse). In an example, the display unit 110, alphanumeric input
device 112 and UI navigation device 114 may be a touch screen
display. The display unit 110 may include goggles, glasses, an
augmented reality (AR) display, a virtual reality (VR) display, or
another display component. For example, the display unit may be
worn on a head of a user and may provide a heads-up-display to the
user. The alphanumeric input device 112 may include a virtual
keyboard (e.g., a keyboard displayed virtually in a VR or AR
setting.
[0042] The machine 100 may additionally include a storage device
(e.g., drive unit) 116, a signal generation device 118 (e.g., a
speaker), a network interface device 120, and one or more sensors
121, such as a global positioning system (GPS) sensor, compass,
accelerometer, or other sensor. The machine 100 may include an
output controller 128, 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.
[0043] The storage device 116 may include a machine readable medium
122 that is non-transitory on which is stored one or more sets of
data structures or instructions 124 (e.g., software) embodying or
utilized by any one or more of the techniques or functions
described herein. The instructions 124 may also reside, completely
or at least partially, within the main memory 104, within static
memory 106, or within the hardware processor 102 during execution
thereof by the machine 100. In an example, one or any combination
of the hardware processor 102, the main memory 104, the static
memory 106, or the storage device 116 may constitute machine
readable media.
[0044] While the machine readable medium 122 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, or associated caches and servers) configured to store the
one or more instructions 124.
[0045] The term "machine readable medium" may include any medium
that is capable of storing, encoding, or carrying instructions for
execution by the machine 100 and that cause the machine 100 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. Specific
examples of machine readable media may include: non-volatile
memory, such as semiconductor memory devices (e.g., Electrically
Programmable Read-Only Memory (EPROM), Electrically Erasable
Programmable Read-Only Memory (EEPROM)) and flash memory devices;
magnetic disks, such as internal hard disks and removable disks;
magneto-optical disks; and CD-ROM and DVD-ROM disks.
[0046] The instructions 124 may further be transmitted or received
over a communications network 126 using a transmission medium via
the network interface device 120 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., as the personal area network family
of standards known as Bluetooth.RTM. that are promulgated by the
Bluetooth Special Interest Group, peer-to-peer (P2P) networks,
among others. In an example, the network interface device 120 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 126. In an example, the network interface
device 120 may include a plurality of antennas to wirelessly
communicate using at least one of single-input multiple-output
(SEM), 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 100, and includes digital or analog communications signals
or other intangible medium to facilitate communication of such
software.
VARIOUS NOTES & EXAMPLES
[0047] 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.
[0048] Example 1 is a femoroacetabular impingement resurfacing
system comprising: a bone model generator to receive a bone imaging
data set and generate a resurfacing model based on the bone imaging
data set, the resurfacing model including at least one osteophyte
and a native bone surface connected to the at least one osteophyte;
an osteophyte identifier to map a virtual 3D boundary surface based
on the resurfacing model, the virtual 3D boundary surface
identifying an osteophyte virtual boundary located between the
native bone surface and the at least one osteophyte; a resurfacing
navigator to generate a navigation file, the navigation file
including the resurfacing model and the virtual 3D boundary
surface, the navigation file to provide control instructions to
resurface the native bone surface to remove the at least one
osteophyte; and an osteophyte removal device to automatically
resurface the native bone surface based on the navigation file.
[0049] In Example 2, the subject matter of Example 1 optionally
includes wherein the osteophyte removal device includes an
osteophyte removal tool, a robotic arm, and a robotic controller;
and wherein the robotic controller executes the navigation file to
cause the robotic arm to maneuver the osteophyte removal tool to
automatically resurface the native bone surface to remove the at
least one osteophyte.
[0050] In Example 3, the subject matter of Example 2 optionally
includes wherein the navigation file includes a safety zone, the
safety zone representing a plurality of virtual boundaries that
prevent movement of the osteophyte removal device into a plurality
of surrounding soft tissues; and wherein the robotic controller
uses the navigation tile to cause the osteophyte removal device to
avoid the safety zone when resurfacing the native bone surface.
[0051] In Example 4, the subject matter of any one or more of
Examples 1-3 optionally include a tracking apparatus to generate
tracking data, wherein the robotic controller processes the
tracking data to determine a location of at least one of the
osteophyte removal device and the native bone surface.
[0052] In Example 5, the subject matter of Example 4 optionally
includes wherein the tracking apparatus includes an image capture
device to generate image data; and wherein the robotic controller
processes the image data to identify and determine the location of
at least one of the osteophyte removal device and the native bone
surface.
[0053] In Example 6, the subject matter of any one or more of
Examples 4-5 optionally include wherein the tracking apparatus
includes a robotic tracking arm to position the image capture
device; and wherein the robotic controller executes the navigation
file to control the robotic tracking arm to improve an image
quality of the generated image data.
[0054] In Example 7, the subject matter of any one or more of
Examples 1-6 optionally include a bone atlas database, wherein the
osteophyte identifier is further operable to: compare the bone
imaging data set against the bone atlas database to find a closest
bone atlas entry; and use the closest bone atlas as a model for the
native bone surface and to identify the at least one
osteophyte.
[0055] In Example 8, the subject matter of Example 7 optionally
includes wherein the osteophyte identifier identifying the at least
one osteophyte includes identifying geometric features based on the
bone imaging data set.
[0056] In Example 9, the subject matter of any one or more of
Examples 1-8 optionally include wherein the osteophyte identifier
is further to: generate a 3D bone model based on the bone imaging
data set; and determine an impingement-free range of motion based
on the 3D bone model.
[0057] In Example 10, the subject matter of Example 9 optionally
includes D bone model includes: performing a 3D reconstruction
along a femoral neck; and identifying a femoral head spherical
center.
[0058] In Example 11, the subject matter of Example 10 optionally
includes D bone model.
[0059] Example 12 is a femoroacetabular impingement resurfacing
method comprising: performing the following operations on a
computing device including a processor and memory, the operations
including: receiving a bone imaging data set; generating a
resurfacing model based on the bone imaging data set, the
resurfacing model including at least one osteophyte and a native
bone surface connected to the at least one osteophyte; mapping a
virtual 3D boundary surface based on the resurfacing model, the
virtual 3D boundary surface identifying an osteophyte virtual
boundary located between the native bone surface and the at least
one osteophyte; generating a navigation file, the navigation file
including the resurfacing model and the virtual 3D boundary
surface, the navigation file to provide control instructions to
resurface the native bone surface to remove the at least one
osteophyte; and outputting the navigation file for use by an
osteophyte removal device to automatically resurface the native
bone surface based on the navigation file.
[0060] In Example 13, the subject matter of Example 12 optionally
includes wherein the osteophyte removal device includes an
osteophyte removal tool, a robotic arm, and a robotic controller;
and the method further comprises executing the navigation file on
the robotic controller to cause the robotic arm to maneuver the
osteophyte removal tool to automatically resurface the native bone
surface to remove the at least one osteophyte.
[0061] In Example 14, the subject matter of Example 13 optionally
includes the operations further including generating a safety zone,
the safety zone representing a plurality of virtual boundaries that
prevent movement of the osteophyte removal device into a plurality
of surrounding soft tissues; wherein the navigation file includes
instructions to cause the osteophyte removal device to avoid the
safety zone when resurfacing the native bone surface.
[0062] In Example 15, the subject matter of any one or more of
Examples 12-14 optionally include the operations further including
determining a location of at least one of the osteophyte removal
device and the native bone surface using a tracking system.
[0063] In Example 16, the subject matter of Example 15 optionally
includes wherein receiving tracking data includes receiving image
data from an image capture device; and wherein the operations
include processing the image data to identify and determine the
location of at least one of the osteophyte removal device and the
native bone surface.
[0064] In Example 17, the subject matter of Example 16 optionally
includes wherein the tracking system includes a robotic tracking
arm to position the image capture device; and the method further
comprises executing the navigation file to control the robotic
tracking arm to improve an image quality of the received image
data.
[0065] In Example 18, the subject matter of any one or more of
Examples 12-17 optionally include the operations further including:
comparing the bone imaging data set against a bone atlas database
to find a closest bone atlas entry; and use the closest bone atlas
as a model for the native bone surface and to identify the at least
one osteophyte.
[0066] In Example 19, the subject matter of Example 18 optionally
includes wherein identifying the at least one osteophyte includes
identifying geometric features based on the bone imaging data
set.
[0067] In Example 20, the subject matter of any one or more of
Examples 12-19 optionally include D boundary surface further
includes: generating a 3D bone model based on the bone imaging data
set; and determining an impingement-free range of motion based on
the 3D bone model.
[0068] In Example 21, the subject matter of Example 20 optionally
includes D bone model includes: performing a 3D reconstruction
along a femoral neck; and identifying a femoral head spherical
center.
[0069] In Example 22, the subject matter of Example 21 optionally
includes D bone model.
[0070] Example 23 is at least one machine-readable storage medium,
comprising a plurality of instructions that, responsive to being
executed with processor circuitry of a computer-controlled
femoroacetabular impingement resurfacing device, cause the device
to: receive a bone imaging data set; generate a resurfacing model
based on the bone imaging data set, the resurfacing model including
at least one osteophyte and a native bone surface connected to the
at least one osteophyte; map a virtual 3D boundary surface based on
the resurfacing model, the virtual 3D boundary surface identifying
an osteophyte virtual boundary located between the native bone
surface and the at least one osteophyte; generate a navigation
tile, the navigation file including the resurfacing model and the
virtual 31) boundary surface, the navigation file to provide
control instructions to resurface the native bone surface to remove
the at least one osteophyte; and output the navigation file for use
by an osteophyte removal device to automatically resurface the
native bone surface based on the navigation file.
[0071] In Example 24, the subject matter of Example 23 optionally
includes wherein the osteophyte removal device includes an
osteophyte removal tool, a robotic arm, and a robotic controller;
and the instructions further causing the device to execute the
navigation tile on the robotic controller to cause the robotic arm
to maneuver the osteophyte removal tool to automatically resurface
the native bone surface to remove the at least one osteophyte.
[0072] In Example 25, the subject flatter of Example 24 optionally
includes the instructions further causing the device to generate a
safety zone, the safety zone representing a plurality of virtual
boundaries that prevent movement of the osteophyte removal device
into a plurality of surrounding soft tissues; wherein the
navigation file includes instructions to cause the osteophyte
removal device to avoid the safety zone when resurfacing the native
bone surface.
[0073] In Example 26, the subject matter of any one or more of
Examples 23-25 optionally include the instructions further causing
the device to determine a location of at least one of the
osteophyte removal device and the native bone surface using a
tracking system.
[0074] In Example 27, the subject matter of Example 26 optionally
includes wherein determining the location using a tracking system
includes receiving image data from an image capture device within
the tracking system; and wherein the determining the location
includes processing the image data to identify and determine the
location of at least one of the osteophyte removal device and the
native bone surface.
[0075] In Example 28, the subject matter of Example 27 optionally
includes wherein the tracking system includes a robotic tracking
arm to position the image capture device; and the method further
comprises executing the navigation file to control the robotic
tracking arm to improve an image quality of the received image
data.
[0076] Example 134 is at least one non-transitory machine-readable
medium including instructions for operation of a robotic arm, which
when executed by at least one processor, cause the at least one
processor to perform operations of any of the methods of Examples
1-28.
[0077] Example 135 is a method for performing any one of examples
1-28.
[0078] 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.
* * * * *