Abstract: A method of preoperative planning and provision of patient-specific surgical aids includes creating a virtual model of a native patient tissue. A virtual device is placed into a predetermined device orientation relative to the virtual model of the native patient tissue. At least one predetermined landmark orientation is specified for placement of at least one virtual landmark relative to the native patient tissue. A virtual patient-specific template containing the predetermined landmark orientation and having a landmark guiding feature is generated. At least one virtual patient-specific placement guide configured to interact simultaneously with at least one previously placed virtual landmark and the virtual device when the virtual device is in the predetermined device orientation is generated. A physical patient-specific template is created as a tangible representation of the virtual patient-specific template.

Abstract: A patient tissue includes a primary patient tissue area and an anatomically differentiated bordering secondary patient tissue area. An apparatus is at least partially customized responsive to preoperative imaging of the patient tissue. Means are provided for mating with the primary patient tissue area in a preselected relative orientation. Means are provided for fixing a first landmark to the primary patient tissue area in at least one of a predetermined marking location and a predetermined marking trajectory. Means are provided for fixing a second landmark to the secondary patient tissue area in at least one of a predetermined marking location and a predetermined marking trajectory. A method of associating a plurality of landmarks with a patient tissue is also provided.

Abstract: A patient tissue includes a primary patient tissue area and an anatomically differentiated bordering secondary patient tissue area. An apparatus is at least partially customized responsive to preoperative imaging of the patient tissue. Means are provided for mating with the primary patient tissue area in a preselected relative orientation. Means are provided for fixing a first landmark to the primary patient tissue area in at least one of a predetermined marking location and a predetermined marking trajectory. Means are provided for fixing a second landmark to the secondary patient tissue area in at least one of a predetermined marking location and a predetermined marking trajectory. A method of associating a plurality of landmarks with a patient tissue is also provided.

Abstract: A guide and a stock instrument in combination. The stock instrument includes a guide interacting feature, a lower instrument surface to abut the patient tissue and an upper instrument surface for contacting the guide. The guide includes a guide body including a lower guide surface and an upper guide surface. The lower guide surface mates with the upper instrument surface of the stock instrument when the lower instrument surface is in contact with the patient tissue. The lower guide surface includes an instrument guiding feature to mate with the guide interacting feature. An orienting feature including an arm extends away from the upper guide surface. The arm has a landmark engaging portion to enter a predetermined relationship with a fixed landmark on the patient tissue. The predetermined relationship indicates that the stock instrument has achieved a predetermined instrument relationship with the patient tissue.

Abstract: An apparatus for providing a reference indication to a patient tissue includes a primary locating block having a patient-specific primary mating surface contoured for mating contact with a portion of the patient tissue in a predetermined primary mating orientation custom-configured responsive to preoperative imaging of the patient tissue. At least one mounting feature is provided to the primary locating block. At least one secondary item is configured for selective engagement with the primary locating block. The secondary item is at least one of a noncustomized secondary item and a patient-specific secondary item. The secondary item provides a reference indication to at least a portion of the patient tissue. The mounting feature of the primary locating block is configured for engagement with at least one secondary item in a predetermined secondary mounting relationship. The secondary mounting relationship is custom-configured for the patient tissue responsive to preoperative imaging of the patient tissue.

Abstract: An apparatus for providing a reference indication to a patient tissue includes a primary locating block having a patient-specific primary mating surface contoured for mating contact with a portion of the patient tissue in a predetermined primary mating orientation custom-configured responsive to preoperative imaging of the patient tissue. At least one mounting feature is provided to the primary locating block. At least one secondary item is configured for selective engagement with the primary locating block. The secondary item is at least one of a noncustomized secondary item and a patient-specific secondary item. The secondary item provides a reference indication to at least a portion of the patient tissue. The mounting feature of the primary locating block is configured for engagement with at least one secondary item in a predetermined secondary mounting relationship. The secondary mounting relationship is custom-configured for the patient tissue responsive to preoperative imaging of the patient tissue.

Abstract: A stock instrument includes at least one guide interacting feature. A lower instrument surface of the stock instrument is placed into contact with the patient tissue. A guide has a lower guide surface contoured to substantially mate with at least a portion of an upper instrument surface of the stock instrument. A predetermined instrument orientation upon the patient tissue is defined, which is preselected responsive to preoperative imaging of the patient tissue. The guide and instrument are mated in a predetermined relative guide/instrument orientation wherein at least one guide interacting feature of the instrument is placed into engagement with at least one instrument guiding feature of the guide. The guide is moved into a predetermined guide orientation with respect to the patient tissue and concurrently the instrument is moved into a predetermined instrument orientation with respect to the patient tissue.

Abstract: An apparatus for aiding visualization of a prosthetic implant and concurrently landmarking a patient tissue includes a center post having proximal and distal post ends longitudinally separated by a post body. The post body defines a post axis coaxially therewith. An implant emulator embodies a reference feature of a prosthetic implant. The implant emulator is carried on an outer surface of the center post at a predetermined longitudinal spacing from the distal post end. A guiding device is removably attached to the implant emulator. The guiding device includes an attachment structure attached to the implant emulator. A spacing arm is connected to the attachment structure and extends laterally outward from the post axis. A landmark guiding structure is connected to the spacing arm, spaced apart from the center post, and embodies at least one of a location and a trajectory for placement of a landmark.

Abstract: A stock instrument includes at least one guide interacting feature. A lower instrument surface of the stock instrument is placed into contact with the patient tissue. A guide has a lower guide surface contoured to substantially mate with at least a portion of an upper instrument surface of the stock instrument. A predetermined instrument orientation upon the patient tissue is defined, which is preselected responsive to preoperative imaging of the patient tissue. The guide and instrument are mated in a predetermined relative guide/instrument orientation wherein at least one guide interacting feature of the instrument is placed into engagement with at least one instrument guiding feature of the guide. The guide is moved into a predetermined guide orientation with respect to the patient tissue and concurrently the instrument is moved into a predetermined instrument orientation with respect to the patient tissue.

Abstract: An apparatus for transferring location and/or trajectory information from a reference surface to a patient tissue surface for guiding placement of a landmark includes a landmark guiding structure. At least two locating feet are provided, each being laterally spaced from, and indirectly connected to, the landmark guiding structure. A holdaway structure is connected to each locating foot and to the landmark guiding structure. The landmark guiding structure is placed in desired location and/or a desired trajectory with respect to the reference surface. Each locating foot is adjusted into guiding contact with a particular portion of the reference surface. Each locating foot is maintained in the guiding contact position, and the apparatus is placed with each locating foot in guiding contact with a particular portion of the patient tissue surface. A method of transferring location and/or trajectory information from a reference surface to a patient tissue surface is also disclosed.

Abstract: An apparatus for providing a reference indication to a patient tissue includes a primary locating block having a patient-specific primary mating surface contoured for mating contact with a portion of the patient tissue in a predetermined primary mating orientation custom-configured responsive to preoperative imaging of the patient tissue. At least one mounting feature is provided to the primary locating block. At least one secondary item is configured for selective engagement with the primary locating block. The secondary item is at least one of a noncustomized secondary item and a patient-specific secondary item. The secondary item provides a reference indication to at least a portion of the patient tissue. The mounting feature of the primary locating block is configured for engagement with at least one secondary item in a predetermined secondary mounting relationship. The secondary mounting relationship is custom-configured for the patient tissue responsive to preoperative imaging of the patient tissue.

Abstract: A directed structure placement guide assists with positioning at least one directed structure in at least one of a predetermined insertion trajectory and a predetermined insertion location with respect to a patient tissue surface during preparation of the patient tissue surface to receive an implant. The implant has a tissue-contacting surface. A guide base has a distal base surface mimicking the structure of at least a portion of a tissue-contacting surface of the implant. The guide base also has a proximal base surface longitudinally spaced from the proximal base surface. At least one insertion guiding structure is movably supported by the guide base and is adjustable into a guiding configuration in which at least one of the predetermined insertion trajectory and the predetermined insertion location is selectively imparted to the directed structure.

Abstract: A positioning apparatus for guiding resection of a patient tissue and guiding placement of a prosthetic implant component in a desired implant position with respect to the resected patient tissue and method of use are described. A locating block includes a mating surface contoured for mating contact with the patient tissue. A cutting plane indicator provides a physical indication of a desired cutting plane for the resection. A placement indicator is spaced apart from the locating block and includes a component-contacting feature. An elongate spacing arm is operative to space the placement indicator apart from the locating block. The spacing arm is configured to place the component-contacting feature of the placement indicator at a predetermined placement position in three-dimensional space relative to the patient tissue. The placement position predetermination is at least partially based upon pre-operative imaging of the patient tissue.

Abstract: An apparatus for providing a reference indication to a patient tissue includes a primary locating block having a patient-specific primary mating surface contoured for mating contact with a portion of the patient tissue in a predetermined primary mating orientation custom-configured responsive to preoperative imaging of the patient tissue. At least one mounting feature is provided to the primary locating block. At least one secondary item is configured for selective engagement with the primary locating block. The secondary item is at least one of a noncustomized secondary item and a patient-specific secondary item. The secondary item provides a reference indication to at least a portion of the patient tissue. The mounting feature of the primary locating block is configured for engagement with at least one secondary item in a predetermined secondary mounting relationship. The secondary mounting relationship is custom-configured for the patient tissue responsive to preoperative imaging of the patient tissue.

Abstract: An apparatus transfers predetermined spatial positioning information to an adjustable tool. Means are provided for temporarily holding at least a carrier portion of the adjustable tool stationary relative to a manipulable reference surface. Means are provided for imparting predetermined spatial positioning information to the reference surface in a first degree of freedom. Means are provided for imparting predetermined spatial positioning information to the reference surface in a second degree of freedom. The predetermined spatial positioning information is imparted to the reference surface in the first and second degrees of freedom to generate a pre-set reference surface. At least a portion of the adjustable tool is held stationary relative to the pre-set reference surface. At least a functional portion of the adjustable tool is manipulated into a predetermined setting position relative to the reference surface. The predetermined setting position reflects a position of the pre-set reference surface.

Abstract: A positioning apparatus for guiding resection of a patient tissue and guiding placement of a prosthetic implant component in a desired implant position with respect to the resected patient tissue and method of use are described. A locating block includes a mating surface contoured for mating contact with the patient tissue. A cutting plane indicator provides a physical indication of a desired cutting plane for the resection. A placement indicator is spaced apart from the locating block and includes a component-contacting feature. An elongate spacing arm is operative to space the placement indicator apart from the locating block. The spacing arm is configured to place the component-contacting feature of the placement indicator at a predetermined placement position in three-dimensional space relative to the patient tissue. The placement position predetermination is at least partially based upon pre-operative imaging of the patient tissue.

Abstract: A positioning apparatus for guiding resection of a patient tissue and guiding placement of a prosthetic implant component in a desired implant position with respect to the resected patient tissue and method of use are described. A locating block includes a mating surface contoured for mating contact with the patient tissue. A cutting plane indicator provides a physical indication of a desired cutting plane for the resection. A placement indicator is spaced apart from the locating block and includes a component-contacting feature. An elongate spacing arm is operative to space the placement indicator apart from the locating block. The spacing arm is configured to place the component-contacting feature of the placement indicator at a predetermined placement position in three-dimensional space relative to the patient tissue. The placement position predetermination is at least partially based upon pre-operative imaging of the patient tissue.

Abstract: An apparatus for aiding visualization of a prosthetic implant and concurrently landmarking a patient tissue includes a center post having proximal and distal post ends longitudinally separated by a post body. The post body defines a post axis coaxially therewith. An implant emulator embodies a reference feature of a prosthetic implant. The implant emulator is carried on an outer surface of the center post at a predetermined longitudinal spacing from the distal post end. A guiding device is removably attached to the implant emulator. The guiding device includes an attachment structure attached to the implant emulator. A spacing arm is connected to the attachment structure and extends laterally outward from the post axis. A landmark guiding structure is connected to the spacing arm, spaced apart from the center post, and embodies at least one of a location and a trajectory for placement of a landmark.

Abstract: A distance indicator for indicating the distance that a device has traveled includes an elongate housing with a guidewire connector configured for operative connection to a guidewire to hold the housing stationary with respect thereto. A plunger is operatively connected to the housing for longitudinal motion with respect to the housing. A first plunger end is configured to operatively contact the device. As the guidewire connector is holding the housing stationary with respect to the guidewire, the first plunger end is placed into operative contact with the device with the plunger and housing in a first relative plunger/housing position. The device moves longitudinally. The plunger moves into a second relative plunger/housing position assisted by the operative connection between the first plunger end and the device. The longitudinal difference between the first and second relative plunger/housing positions indicates a distance that the device has moved longitudinally with respect to the guidewire.

Abstract: A patient-specific instrument is placed into a predetermined setting position with respect to a patient tissue. A navigation aid is associated in a predetermined origin position with respect to the patient tissue. The navigation aid is zeroed while in the predetermined origin position to record the location and orientation of the navigation aid relative to the patient tissue. An instantaneous position of the zeroed navigation aid is determined with respect to the patient tissue. Feedback is provided to a user on a physical motion needed to bring the instantaneous position of the navigation aid closer to a predetermined desired target position. An indication is made when the instantaneous position of the navigation aid is sufficiently similar to the predetermined desired target position.