Patient specific 3-d interactive total joint model and surgical planning system

Abstract

Methods, systems and devices for pre-operatively planned total or partial joint surgery including, for example, anatomic and reverse shoulder surgery guides and implants. There are also methods for pre-operative planning methods for designing glenoid implants and prostheses, particularly with patient-specific augmentation, based on considerations of multiple factors affecting the outcome of a selected reverse or anatomic shoulder surgery. There are also described methods of performing total or partial joint surgery, including anatomic or reverse shoulder surgery, using surgery guides and implants in patients undergoing joint surgery.

1 . (canceled) 
     
     
         2 . A pre-operative planning method for a computer implemented interactive patient specific surgical planning system, the method comprising:
 conducting pre-operative planning of a partial or a total joint surgery;   determining a best fit size of a joint implant;   conducting range of motion analysis including virtually positioning a joint implant under evaluation in a patient specific kinematic model of the joint and simulating motion of the virtually implanted joint through extreme ranges of motion to measure impact locations and compensate for necessary functional range of motion;   assessing and adjusting characteristics of the joint implant withing the patient specific kinematic model; and   selecting patient specific instruments for use with the selected joint implant based on the pre-operative analysis of the conducting steps.   
     
     
         3 . The method of  claim 2  the step of conducting pre-operative planning including one or more of analyzing a joint line, comprising comparing an original joint line and a new joint line, wherein the new joint line is substantially similar to the original joint line. 
     
     
         4 . The method of  claim 2  the step of determining a best fit size of a joint implant including selecting a humeral implant from a range of sizes, wherein the range of sizes is selected from the group consisting of length of stem, size of humeral stem, diameter of stem, size diameter of head, height of head, and offset of the center spherical head compared to the center of the face of the humeral stem. 
     
     
         5 . The method of  claim 2  the step of assessing and adjusting the characteristics of the joint implant comprising: assessing and adjusting the thickness/height of the glenoid implant; assessing and adjusting the depth of the glenoid fossa; and assessing and adjusting the thickness of a graft. 
     
     
         6 . The method of  claim 2  the step of selecting patient specific instruments including selecting a humeral implant and a glenoid implant based on the pre-operative analysis, or assessing and adjusting a humeral head, a glenoid thickness, a glenoid fossa depth, and a graft thickness based on the pre-operative analysis. 
     
     
         7 . The method of  claim 2  further comprising instructions for a comprehensive pre-operative total joint planning method for comparison of anatomic or reverse shoulder surgery implants or guides. 
     
     
         8 . The method of  claim 2  further comprising conducting range of motion analysis, including virtually positioning implants through extreme ranges of motion to measure impact locations and compensate for necessary functional range of motion and assessment of motion within anatomical ranges in order to substantially achieve most common activities of daily living. 
     
     
         9 . The method of  claim 2  further comprising assessing and adjusting as needed the thickness/height of the glenoid implant. 
     
     
         10 . The method of  claim 2  further comprising assessing and adjusting as needed the depth of the glenoid fossa. 
     
     
         11 . The method of  claim 2  wherein the pre-operative planning is done virtually based on images taken from a subject prior to surgery. 
     
     
         12 . The method of  claim 2  further comprising optimizing the dimensions of fixation elements of the glenoid implant using correspondence matrix between a three dimensional (3D) bony structure of the patient and a statistical shape based atlas according to the following steps: developing a registration between patient bone and statistical shape model of the bone of interest; extracting the principle modes representing the patient bone; defining the fixation configuration, position or dimensions according to the corresponding modes; and applying collision detection to confirm the configuration of the bone fixation. 
     
     
         13 . The method of  claim 2  further comprising identifying and comparing procedural risks between selected reverse or anatomic shoulder procedures by determining: whether a glenoid face coverage is maximized; whether an overhang of the glenoid face is minimized; whether bone removal on the glenoid face is minimized; whether the glenoid retroversion is less than about 5 to about 10 degrees; whether seating of the glenoid implant is greater than about 80% of the implant coverage area; whether there is minimized penetration of the glenoid cortical wall anteriorily; whether there is greater than about 3 mm bone thickness behind glenoid; whether the orientation offset between the native glenoid and implant superior/inferior axis is less than about 5 degrees; whether the superior or inferior tilt versus native glenoid is less than 5 degrees; whether there is an absence of a humeral head overhang compared to the cut, or prepared surface of the humeral bone; whether there is less than about 3 mm difference in humeral head diameter between anatomic and implant; whether there is less than about 1 mm difference in humeral head height between anatomic and implant; and whether there is less than about 2 mm greater tuberosity to medial head edge in comparison to anatomic; whereby procedural risks are identified; and the selection of prosthetic implants for the selected shoulder surgery are based at least in part on the identified procedural risks. 
     
     
         14 . The method of  claim 5  wherein the glenoid implant is augmented to fit a patient for which pre-operative planning of an anatomic or reverse shoulder procedure was performed. 
     
     
         15 . The method of  claim 14  wherein the depth of augmentation, the size of augmentation, and/or the radial position of augmentation varies depending on the pre-operative planning of a selected reverse or anatomic shoulder procedure. 
     
     
         16 . The method of  claim 15  wherein the augmentation can comprise a depth ranging from about 2 mm to about 4 mm or wherein the augmentation covers about 5%, 10%, 15%, 20%, 30%, 40% or 50% of the back side of the glenoid implant or wherein the augmentation covers about 50%, 60%, 70%, 80%, 90%, 95% or greater of the back side of the glenoid implant. 
     
     
         17 . The method of  claim 15  wherein the radial location of the augmentation on the backside of the glenoid implant is selected from the group consisting of a posterior location, an anterior location, a superior location, an inferior location, and combinations thereof. 
     
     
         18 . The method of  claim 7  further comprising for a selected anatomic or reverse shoulder procedure recommending prosthetic shoulder implants and placement positions, selected from the group consisting of adjustments in glenoid implant size, augmentation depth, augment position, positioning in six degrees of freedom, fixation type, fixation size, reaming depth, reaming diameter, reaming angle(s) and/or a combination thereof. 
     
     
         19 . The method of  claim 18  further comprising a computer readable medium having stored thereon executable instructions that when executed by the processor of a computer control the computer to perform one or more of the planning method steps or a selected reverse or anatomic shoulder procedure.