An instrument for treating tissue during a medical procedure includes a hand-held portion and a working portion. The hand-held portion is manually supported and moved by a user and the working portion is movably coupled to the hand-held portion. A tracking device is attached to the hand-held portion for tracking the instrument. The tracking device is in communication with a control system, which is used to keep the working portion within or outside of a boundary. A plurality of actuators are operatively coupled to the working portion. The control system instructs the actuators to move the working portion relative to the hand-held portion during the medical procedure in order to maintain a desired relationship between the working portion and the boundary.

Surgical instrument including housing, a cutting accessory that extends from the housing and actuators that establish the position of the cutting accessory relative to the housing

Disclosed herein are methods, compositions and tools for repairing articular surfaces repair materials and for repairing an articular surface. The articular surface repairs are customizable or highly selectable by patient and geared toward providing optimal fit and function. The surgical tools are designed to be customizable or highly selectable by patient to increase the speed, accuracy and simplicity of performing total or partial arthroplasty.

Patient selectable joint arthroplasty devices and surgical tools

Patient selectable joint arthroplasty devices and surgical tools facilitating increased accuracy, speed and simplicity in performing total and partial joint arthroplasty

Methods and devices are disclosed relating improved articular models, implant components, and related guide tools and procedures. In addition, methods and devices are disclosed relating articular models, implant components, and/or related guide tools and procedures that include one or more features derived from patient-data, for example, images of the patient's joint. The data can be used to create a model for analyzing a patient's joint and to devise and evaluate a course of corrective action. The data also can be used to create patient-adapted implant components and related tools and procedures.

Patient-adapted and improved articular implants, designs and related guide tools

Disclosed herein are methods and compositions for producing articular repair materials and for repairing an articular surface. In particular, methods for providing articular repair systems. Also provided are articular surface repair systems designed to replace a selected area cartilage, for example, and surgical tools for repairing articular surfaces.

Methods and Compositions for Articular Repair

Recent developments in computer assisted surgery offer promising solutions for the translation of the high accuracy of the preoperative imaging and planning into precise intraoperative surgery. Broad clinical application is hindered by high costs, additional time during intervention, problems of intraoperative man and machine interaction, and the spatially constrained arrangement of additional equipment within the operating theater. An alternative technique for computerized tomographic image based preoperative three-dimensional planning and precise surgery on bone structures using individual templates has been developed. For the preoperative customization of these mechanical tool guides, a desktop computer controlled milling device is used as a three-dimensional printer to mold the shape of small reference areas of the bone surface automatically into the body of the template. Thus, the planned position and orientation of the tool guide in spatial relation to bone is stored in a structural way and can be reproduced intraoperatively by adjusting the position of the customized contact faces of the template until the location of exact fit to the bone is found. No additional computerized equipment or time is needed during surgery. The feasibility of this approach has been shown in spine, hip, and knee surgery, and it has been applied clinically for pelvic repositioning osteotomies in acetabular dysplasia therapy.

Computer assisted orthopaedic surgery with image based individual templates.

Computer assisted orthopaedic surgery with image based individual templates : Computer assisted orthopaedic surgery: Medical robotics and image guided surgery

The CRIGOS (compact robot for image-guided orthopedic surgery) project was set up for the development of a compact surgical robot system for image-guided orthopedic surgery based on user requirements. The modular system comprises a compact parallel robot and a software system for planning of surgical interventions and for supervision of the robotic device. Because it is not sufficient to consider only technical aspects in order to improve clinical routines the therapeutic outcome of conventional interventions, a user-centered and task-oriented design process has been developed which also takes human factors into account. The design process for the CRIGOS system was started from requirement analysis of various orthopedic interventions using information gathered from literature, questionnaires, and workshops with domain experts. This resulted in identification of conventional interventions for which the robotic system would improve the medical and procedural quality. A system design concept has been elaborated which includes definitions of components, functionalities, and interfaces, Approaches to the acquisition of calibrated X-rays will be presented in the paper together with design and evaluation of a first human-computer interface. Finally, the first lab-type parallel robot based on low-cost standard components is presented together with the first evaluation results concerning positioning accuracy.

CRIGOS: a compact robot for image-guided orthopedic surgery

Individual templates for Orthopedic Surgery provide a precise intraoperative reproduction of the geometries of work on bone planned preoperatively on the base of CT-image data. The general feasibility concerning the adaptation to different surgical applications has already been demonstrated in various in-vitro studies as well as within clinical application1,2,3,4,5. Within the framework of the European IGOS-project a demonstrator for image guided pelvis surgery as an exemplary clinical application will be developed. In contrast to initial feasibility studies with our first labtyp systems, the introduction into clinical routine induces additional constraints. To provide an adequate level of reliability and usability additional efforts are necessary especially concerning quality assurance, ergonomic design and standardisation of the related chain of image acquisition and surgical planning, manufacturing of individual templates and finally the intraoperative execution. Aspects of the integration into clinical routine as well as laboratory investigations concerning accuracy and integrated manufacturing are discussed.

Image-guided orthopedic surgery using individual templated - experimental results and aspects of the development of a demonstrator for pelvis surgery

Bei der Planung von Eingriffen in der orthopadischen Chirurgie kann der Orthopade auf eine Vielzahl von bildgebenden Verfahren zuruckgreifen, wie z.B. CT, MR, Ultraschall und Rontgenaufnahmen. Die jungsten Entwicklungen im Bereich der computerunterstutzten Chirurgie bieten verschiedene Losungsansatze, um die hohe geometrische Genauigkeit der praoperativen Bildgebung und Planung fur eine ebenso prazise intraoperative Ausfuhrung zu nutzen. Am Helmholtz-Institut wurde dafur das Prinzip der Individualschablonen entwickelt. Hierbei werden individuell angepaste Schablonen auf Basis von CT-Daten praoperativ gefertigt, die intraoperativ eine prazise Werkzeugfuhrung fur die geplanten Knochenbearbeitung darstellen. Die Realisierbarkeit des Konzeptes fur verschiedene chirurgische Anwendungen wurde bereits in Laboruntersuchungen sowie in klinischen Applikationen demonstriert. Im folgenden werden Aspekte der Entwicklung eines integrierten klinischen Demonstrators zur chirurgischen Planung und Fertigung von Individualschablonen fur periacetabulare Umstellungsosteotomien dargestellt.

A. Zimolong

Papers

Computer assisted orthopaedic surgery with image based individual templates.

Computer assisted orthopaedic surgery with image based individual templates : Computer assisted orthopaedic surgery: Medical robotics and image guided surgery

CRIGOS: a compact robot for image-guided orthopedic surgery

Image-guided orthopedic surgery using individual templated - experimental results and aspects of the development of a demonstrator for pelvis surgery

Entwicklung eines klinischen Demonstrators für die computerunterstützte Orthopädische Chirurgie mit CT-Bildbasierten Individualschablonen