( 19 ) United States
`( 12 ) Patent Application Publication ( 10 ) Pub . No . : US 2018 / 0008350 A1
`Varadarajan et al .
`( 43 ) Pub . Date :
`Jan . 11 , 2018
`
`US 20180008350A1
`
`( 72 )
`
`( 54 ) REVERSE SHOULDER PRE - OPERATIVE
`PLANNING
`( 71 ) Applicant : Biomet Manufacturing , LLC , Warsaw ,
`IN ( US )
`Inventors : Ravikumar Varadarajan , Warsaw , IN
`( US ) ; Jeffrey E . Bischoff , Warsaw , IN
`( US ) ; Clinton E . Kehres , Warsaw , IN
`( US ) ; Bryce A . Isch , Warsaw , IN ( US )
`( 21 ) Appl . No . : 15 / 644 , 002
`( 22 ) Filed :
`Jul . 7 , 2017
`Related U . S . Application Data
`( 60 ) Provisional application No . 62 / 360 , 140 , filed on Jul .
`8 , 2016 , provisional application No . 62 / 476 , 112 , filed
`on Mar . 24 , 2017 .
`Publication Classification
`( 51 ) Int . Cl .
`( 2011 . 01 )
`G06F 19 / 00
`( 2006 . 01 )
`A61F 2 / 40
`
`( 52 ) U . S . CI .
`CPC . . . . . . . . . . A61B 34 / 10 ( 2016 . 02 ) ; G06F 19 / 3437
`( 2013 . 01 ) ; A61B 2034 / 101 ( 2016 . 02 ) ; A61F
`2 / 4014 ( 2013 . 01 )
`
`( 57 )
`ABSTRACT
`A method of pre - operatively developing a reverse shoulder
`arthroplasty plan can include receiving an image of a patient
`shoulder comprising a humerus and a glenoid . The image
`can be segmented to develop a 3D shoulder model . Virtual
`surgery can be performed on the 3D shoulder model to
`generate a modified shoulder model . The virtual surgery can
`include resecting and reaming a virtual humerus of the 3D
`shoulder model , and reaming a virtual glenoid of the 3D
`shoulder model . Selection of a humeral implant and selec
`tion of a glenoid implant can be received . A virtual repre
`sentation of the humeral implant can be implanted on the
`virtual humerus and a virtual representation of the glenoid
`implant on the virtual glenoid to virtually update the modi
`fied shoulder model . A range of motion of the patient
`shoulder can be determined and a reverse shoulder arthro
`plasty can be finalized based on the range of motion .
`
`moby og form
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`
`104 104
`
`100
`
`CATALYST, EX-1011
`PAGE 1
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`

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`Jan . 11 , 2018 Sheet 1 of 16
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`US 2018 / 0008350 A1
`
`OOT
`
`FIG . 1
`
`mwa 104
`
`110 - main
`
`106
`
`
`
`manninn 201
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`112
`
`CATALYST, EX-1011
`PAGE 2
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`Jan . 11 , 2018 Sheet 2 of 16
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`US 2018 / 0008350 A1
`
`100
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`CATALYST, EX-1011
`PAGE 3
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`Jan . 11 , 2018 Sheet 3 of 16
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`
`300
`
`_ 310
`
`
`
`Implant virtual humeral implant and virtual glenoid implant
`
`
`
`
`
`
`
`FIG . 3
`
`
`
`
`
`Ream virtual glenoid
`
`
`
`Model Performing Virtual Surgery on the Shoulder
`
`
`
`glenoid implant
`and Receive selection of humeral
`
`
`
`
`
`
`
`
`
`model Segmenting the image to create a 3D shoulder
`
`
`
`image of shoulder Receive
`
`302 - material
`
`
`
`
`
`312 momentinerente para
`
`314 -
`
`monnaire
`
`304 -
`
`306 mm
`
`
`
`Resect and
`
`ream virtual humerus
`
`
`
`308 www simonad
`
`CATALYST, EX-1011
`PAGE 4
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`Jan . 11 , 2018 Sheet 4 of 16
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`
`- 412
`
`410
`
`400
`
`
`
`
`
`
`
`
`
`glenoid implant Implant virtual humeral implant and virtual
`
`
`Receive
`
`
`
`implant selection of humeral implant and glenoid
`
`
`
`range of motion of shoulder model Determine
`
`402 402
`
`No
`
`
`
`range of motion ? Range of motion within desired
`
`
`
`FIG . 4
`
`406
`
`Yes
`
`range of motion on user interface
`Display
`
`
`Finalize
`
`reverse shoulder arthroplasty plan
`
`404 -
`
`408
`
`CATALYST, EX-1011
`PAGE 5
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`Jan . 11 , 2018 Sheet 5 of 16
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`
`508
`
`510
`
`512
`
`
`
`Central Device
`
`506
`
`- 501
`
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`Central Device Database
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`
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`
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`
`500
`
`502
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`504
`
`CATALYST, EX-1011
`PAGE 6
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`Jan . 11 , 2018 Sheet 6 of 16
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`
`5600
`
`614
`
`- - - 612
`
`
`
`Receive
`
`selection of humeral implant and glenoid implant
`
`
`
`glenoid implant implant virtual humeral implant and virtual
`
`
`
`
`
`
`
`
`
`Determine range of motion of shoulder model
`
`
`Select daily activities having ranges of motion
`
`
`
`
`Range of motion within daily
`
`activity range of motion ?
`
`602 - www
`
`Yes
`
`
`Finalize
`
`reverse shoulder arthroplasty plan
`
`
`Display range of motion and
`
`
`
`daily activity range of motion on user interface
`
`ammorning
`
`606 m
`
`FIG . 6
`
`608
`
`610
`
`CATALYST, EX-1011
`PAGE 7
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`
`700
`
`714 714
`
`
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`
`
`glenoid implant Implant virtual humeral implant and virtual
`
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`
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`
`Receive
`
`implant selection of humeral implant and glenoid
`
`I
`
`
`
`Identify collisions
`
`Determine range of motion
`
`based on collisions
`
`FIG . 7
`
`range of motion ? Range of motion within desired
`
`
`
`
`702 mm
`
`704 .
`
`708 mm
`
`Yes
`
`
`
`Display collisions
`
`and / or range of motion on user interface
`
`
`
`706 manna
`
`
`Finalize
`
`reverse shoulder arthroplasty plan
`
`CATALYST, EX-1011
`PAGE 8
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`

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`Patent Application Publication
`
`Jan . 11 , 2018 Sheet 8 of 16
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`
`whihihihihihihihihihihihihihihihihihihihihihihihihihihihihihihihihihihihihihihihihi
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`Coliding Samples
`
`Non - Colliding Samples
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`CATALYST, EX-1011
`PAGE 9
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`

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`Patent Application Publication
`
`Jan . 11 , 2018 Sheet 9 of 16
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`US 2018 / 0008350 A1
`
`Glenosphere Eccentricity
`
`904
`
`
`
`Select Glenoid Implant
`
`
`
`Select Humeral Implant
`
`
`
`range of motion Determine
`
`emancing
`
`906 . m
`
`902
`
`range of motion ? Range of motion within desired
`
`
`
`
`908 mm
`
`FIG . 9
`
`Yes
`
`fanananananana Yesu
`
`
`base glenoid implant
`
`Select base humeral implant and
`
`
`910 mm
`
`Position
`
`Offset
`
`Thickness
`
`Position
`
`Offset
`
`Articulation Surface
`Radius
`
`Thickness
`
`Implant Version
`
`
`
`pininininingning ingenting tingin ninyinyinyire
`
`
`
`
`
`CATALYST, EX-1011
`PAGE 10
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`

`

`Patent Application Publication
`
`Jan . 11 , 2018 Sheet 10 of 16
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`US 2018 / 0008350 A1
`
`1000
`
`51000
`
`mm 1012
`
`
`
`Method 900
`
`
`
`
`
`Adjust virtual surgery
`
`Saman No
`
`
`base glenoid implant
`Select base humeral implant and
`
`
`
`
`Determining a probability of joint operations
`
`Probability of joint operations within desired range ?
`
`FIG . 10
`
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`
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`
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`interface Display range of motion on user
`online
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`
`reverse shoulder arthroplasty plan
`
`1010 mm
`
`CATALYST, EX-1011
`PAGE 11
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`

`

`Patent Application Publication
`
`Jan . 11 , 2018 Sheet 11 of 16
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`US 2018 / 0008350 A1
`
`1100
`
`Y
`
`
`
`image of shoulder Receive
`
`
`
`model Segmenting the image to create a 3D shoulder
`
`
`
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`
`1102 - - women
`
`1104 mm
`
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`
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`
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`
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`
`1106
`
`
`
`Position implants
`
`imanowa
`1108 -
`
`
`
`Adjust model
`
`1110 -
`
`FIG . 11
`
`
`Perform Analysis
`
`Perform Analysis
`
`2 1112
`
`1
`
`1
`
`CATALYST, EX-1011
`PAGE 12
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`

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`Jan . 11 , 2018 Sheet 12 of 16
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`US 2018 / 0008350 A1
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`1200
`
`1216
`
`1214
`
`w 1212
`
`
`
`Update model
`
`
`
`Perform Analysis
`
`1202 mm
`
`implant placement
`Update
`
`wwwwwwwwwww
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`
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`
`Update implant selection
`
`
`
`Determine condition
`
`1204
`
`model and condition
`Display
`
`mm
`
`1206
`
`FIG . 12
`
`No
`
`Condition Acceptable ?
`
`1208
`
`Yes am
`
`
`Finalize
`
`reverse shoulder arthroplasty plan
`
`CATALYST, EX-1011
`PAGE 13
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`

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`Jan . 11 , 2018 Sheet 13 of 16
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`1318
`
`Range of Motion
`
`1310 1312 1314
`1310
`1314
`
`mamman 1312
`
`
`
`ramenim 1316
`
`Tisue 7 Humeral Implant 7
`
`
`Humeral Implant
`
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`Scapula / Glenoid
`
`Soft Tissue
`
`
`
`Glenoid Implant
`
`
`
`menanam 1308
`
`I
`
`Humerus
`Humerus
`
`ANA
`
`H
`
`Force
`Force
`
`1302
`
`Stress
`
`1304
`
`Strain
`Strain
`
`1306 1306 -
`
`FIG . 13
`
`Condition
`Condition
`
`CATALYST, EX-1011
`PAGE 14
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`

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`Jan . 11 , 2018 Sheet 14 of 16
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`US 2018 / 0008350 A1
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`1400
`
`1422
`
`FIG . 14
`
`- 1420
`
`1408
`
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`
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`1414
`
`maritime 1410
`
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`
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`
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`Humerus T Scapulassembled
`Humerus
`wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww
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`Force Max Force Max
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`
`Max Stress
`
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`
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`
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`
`
`Humeral Implant
`
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`
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`
`]
`
`Strain Max Strain Max
`
`
`
`
`
`
`Perform Analysis
`
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`
`
`
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`
`NO
`- - - No
`
`Condition Acceptable ?
`
`trinnene
`
`1401 -
`
`Condition
`Condition
`
`smpetention
`
`1300 -
`
`1402 - - -
`
`1402
`
`1404 — 1906 -
`1404 mm
`1406
`
`CATALYST, EX-1011
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`Jan . 11 , 2018 Sheet 15 of 16
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`1500
`por
`
`~ 1504
`
`
`
`Select Glenoid Implant
`
`
`
`Select Humeral Implant
`
`
`
`Determine condition
`
`
`
`1506 mamman
`
`1502 -
`
`Position
`
`Offset
`
`Thickness
`
`Position
`
`Offset
`
`Thickness
`
`o
`
`Summenmuseum . N
`
`Condition Acceptable ?
`
`FIG . 15
`
`Yes
`reforma
`glenoid implant
`
`Output humeral implant
`and
`
`marrament
`1510
`
`CATALYST, EX-1011
`PAGE 16
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`

`

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`
`Jan . 11 , 2018 Sheet 16 of 16
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`US 2018 / 0008350 A1
`
`s 2000
`
`mm 1614
`
`implant placement
`Update
`
`interaction condition
`and glenoid
`Select humeral
`
`
`. . . . . . . . . . . . . . . . . .
`
`
`
`Perform Analysis
`
`
`
`1602 venninnen
`
`1604
`
`
`
`Determine condition
`
`ammamuntament
`
`1606 m
`
`1608 mm
`
`
`
`
`
`Display model and condition
`
`No
`
`FIG . 16
`
`
`
`Update implant selection
`
`No
`
`-
`
`Condition Acceptable ?
`
`1618
`
`-
`
`1610
`
`Yes
`
`1616
`
`-
`
`
`
`Final iteration in range of motion ?
`
`
`reverse shoulder arthroplasty
`Finalize
`
`plan
`
`Yes
`
`CATALYST, EX-1011
`PAGE 17
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`

`

`US 2018 / 0008350 A1
`
`Jan . 11 , 2018
`
`REVERSE SHOULDER PRE - OPERATIVE
`PLANNING
`CLAIM OF PRIORITY
`This application claims the benefit of U . S . Provi
`[ 0001 ]
`sional Patent Application Ser . No . 62 / 360 , 140 , filed on Jul .
`8 , 2016 , and U . S . Provisional Patent Application Ser . No .
`62 / 476 , 112 , filed on Mar . 24 , 2017 , the benefit of priority of
`each are claimed hereby , and which are incorporated by
`reference herein in its entirety .
`FIELD
`[ 0002 ] The present subject matter relates to orthopedic
`procedures and , more particularly , to systems and methods
`that can aid in performing reverse shoulder arthroplasties .
`BACKGROUND
`[ 0003 ] The shoulder joint is a complex joint with the
`scapula , clavicle and the humerus all coming together to
`enable a wide range of movement , at least in a properly
`functioning joint . In a properly functioning shoulder joint
`the head of the humerus fits into a shallow socket in the
`scapula , typically referred to as the glenoid . Articulation of
`the shoulder joint involves movement of the humeral head in
`the glenoid , with the structure of the mating surfaces and
`surrounding tissues providing a wide range of motion .
`[ 0004 ] The shoulder joint can undergo degenerative
`changes caused by various issues , such as rheumatoid arthri
`tis , osteoarthritis , rotator cuff arthroplasty , vascular necrosis ,
`or bone fracture . When severe joint damage occurs and no
`other means of treatment is found to be effective , a total ,
`partial , or reverse shoulder replacement or reconstruction
`may be necessary . Reverse shoulder replacements can
`include a cup shaped articular surface attached to a stem
`implanted into the humerus , while a spherical glenoid com
`ponent is used to provide an articular surface to engage the
`humeral cup .
`
`OVERVIEW
`[ 0005 ] During shoulder arthroplasty surgery , the compo
`nents of the prosthesis are matched with the biology of the
`patient in an effort to maintain or restore a natural range of
`motion of a healthy shoulder joint . Patient specific instru
`mentation can assist a surgeon in planning and implement
`ing a shoulder arthroplasty to restore natural movement .
`However , even with the multitude of advances in prosthetic
`components and patient specific instrumentation , restoring a
`full range of motion can remain difficult , especially for a
`surgeon who does not regularly perform shoulder replace
`ments . In some cases , range of motion of a patient following
`a successful procedure is limited more than is desirable to
`some patients .
`SO
`[ 0006 ]
`The systems , devices , methods , and instruments
`discussed herein can provide virtual calculations and mea
`surements to assist surgeons in determining whether virtual
`prosthetic devices may provide a patient with desirable
`outcomes . By determining range of motion , conditions of
`operation , and probability of joint functions , a pre - operative
`plan can be developed to provide standards of care that more
`routinely result in successful outcomes . Well - formed pre
`operative plans can also result in more successful outcomes
`over intra - operative selection of prostheses and installation
`provisions , such as resection and reaming .
`
`[ 0007 ] While the above discusses issues and procedures
`specific to shoulder replacement procedures , discussion of
`the following systems , devices , methods , and instruments is
`also applicable for use in other joint replacement procedures ,
`such as anatomic total shoulder arthroplasty ( aTSA ) , total
`hip arthroplasty ( THA ) or total knee arthroplasty ( TKA ) .
`Further , the systems , devices , methods , and instruments may
`also be applicable to aspects of partial knee replacements
`and other orthopedic procedures to repair of joints .
`[ 0008 ] To further illustrate the apparatuses and systems
`disclosed herein , the following non - limiting examples are
`provided :
`[ 0009 ] Example 1 is a method of pre - operatively devel
`oping a reverse shoulder arthroplasty plan , the method can
`include : receiving an image of a patient shoulder comprising
`a humerus and a glenoid ; segmenting the image to develop
`a 3D shoulder model ; performing virtual surgery on the 3D
`shoulder model to generate a modified shoulder model , the
`virtual surgery comprising : resecting and reaming a virtual
`humerus of the 3D shoulder model ; reaming a virtual
`glenoid of the 3D shoulder model ; receiving selection of a
`humeral implant ; receiving selection of a glenoid implant ;
`implanting , virtually to update the modified shoulder model ,
`a virtual representation of the humeral implant on the virtual
`humerus and a virtual representation of the glenoid implant
`on the virtual glenoid ; determining a range of motion of the
`patient shoulder based on analysis of the updated modified
`shoulder model including determining an expected interac
`tion between the virtual representation of the humerus
`implant and the virtual representation of the glenoid implant
`after the selected virtual humeral implant and the selected
`virtual glenoid implant are virtually implanted , and finaliz
`ing a reverse shoulder arthroplasty plan when the range of
`motion is within a desired range and receiving selection of
`at least one of a second humeral implant and a second
`glenoid implant when the range of motion is not within the
`desired range .
`[ 0010 ]
`In Example 2 , the subject matter of Example 1
`optionally includes displaying on a user interface a graphic
`representation of the range of motion .
`[ 0011 ]
`In Example 3 , the subject matter of Example 2
`optionally includes displaying on the graphic representation
`of the range of motion and a range of motion required to
`perform a common daily activity .
`[ 0012 ]
`In Example 4 , the subject matter of any one or
`more of Examples 2 - 3 optionally include determining
`whether the updated modified shoulder model can perform
`the common daily activity as a function of the range of
`motion .
`[ 0013 ]
`In Example 5 , the subject matter of any one or
`more of Examples 2 - 4 optionally include displaying on the
`graphic representation of the range of motion and a range of
`motion required to perform a second common daily activity ;
`and determining whether the updated modified shoulder
`model can perform the second common daily activity as a
`function of the range of motion .
`[ 0014 ]
`In Example 6 , the subject matter of any one or
`more of Examples 2 - 5 optionally include identifying colli
`sions between components of the updated modified shoulder
`model ; and developing the range of motion as a function of
`the identified collisions .
`[ 0015 ]
`In Example 7 , the subject matter of Example 6
`optionally includes identifying areas of collision as a func
`
`CATALYST, EX-1011
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`US 2018 / 0008350 A1
`
`Jan . 11 , 2018
`
`tion of the identified collisions ; and displaying on the
`graphic representation of the range of motion , the identified
`areas of collision .
`[ 0016 ]
`In Example 8 , the subject matter of any one or
`more of Examples 1 - 7 optionally include wherein : the
`virtual representation of the humeral implant includes a
`humeral implant thickness , offset , articulation surface
`radius , implant version , and position on the virtual humerus ;
`and the virtual representation of the glenoid implant includes
`a glenoid implant thickness , offset , eccentricity , and position
`on the virtual glenoid .
`[ 0017 ]
`In Example 9 , the subject matter of Example 8
`optionally includes wherein receiving selection of the
`humeral implant includes selecting the humeral implant
`from a library of humeral implants as a function of the
`humeral implant thickness , offset , articulation surface
`radius , implant version , and position on the virtual humerus ;
`and wherein receiving selection of the glenoid implant
`includes selecting the glenoid implant from a library of
`glenoid implants as a function of the glenoid implant thick
`ness , offset , eccentricity , and position on the virtual glenoid .
`[ 0018 ]
`In Example 10 , the subject matter of Example 9
`optionally includes receiving a thickness adjustment of at
`least one of the humeral implant and the glenoid implant
`when the range of motion is not within the desired range ;
`receiving an offset adjustment of at least one of the humeral
`implant relative to the humerus and the glenoid implant
`relative to the glenoid when the range of motion is not within
`the desired range ; and receiving a position adjustment of at
`least one of the humeral implant on the virtual humerus and
`the glenoid implant on the virtual glenoid when the range of
`motion is not within the desired range .
`[ 0019 ]
`In Example 11 , the subject matter of any one or
`more of Examples 9 - 10 optionally include selecting a base
`virtual representation of the humeral implant and a base
`virtual representation of the glenoid implant as a function of
`adjusting at least one of thickness , offset , and position of the
`virtual representation of the humeral implant and the virtual
`representation of the glenoid implant .
`[ 0020 ]
`In Example 12 , the subject matter of Example 11
`optionally includes displaying a graphic representation on a
`user interface of a range of motion of the updated modified
`shoulder model including the base virtual representation of
`the humeral implant and the base virtual representation of
`the glenoid implant ; and adjusting at least one of the base
`virtual representation of the humeral implant and the base
`virtual representation of the glenoid implant using the user
`interface .
`10021 ]
`In Example 13 , the subject matter of any one or
`more of Examples 11 - 12 optionally include adjusting the
`virtual surgery as a function of at least one of the base virtual
`humeral implant and a base virtual glenoid implant .
`[ 0022 ]
`In Example 14 , the subject matter of any one or
`more of Examples 1 - 13 optionally include determining a
`probability of one or more of joint loosening , dislocation ,
`laxity , and muscle activation ; and adjusting at least one of
`the base virtual representation of the humeral implant and
`the base virtual representation of the glenoid implant as a
`function of the probability of one or more of joint loosening ,
`dislocation , laxity , and muscle activation .
`[ 0023 ] Example 15 is a method of pre - operatively devel
`oping a shoulder arthroplasty plan , the method comprising :
`receiving an image of a patient shoulder comprising a
`humerus and a glenoid ; segmenting the image to develop a
`
`3D shoulder model ; selecting , based at least in part on the
`3D shoulder model , a humeral implant ; selecting , base at
`least in part on the 3D shoulder model , a glenoid implant ;
`positioning within the 3D shoulder model a virtual repre
`sentation of the humeral implant on the virtual humerus and
`a virtual representation of the glenoid implant on the virtual
`glenoid ; analyzing the 3D shoulder model with the virtual
`representation of the humeral implant and the virtual repre
`sentation of the glenoid to determine a condition of the
`patient shoulder including determining an expected interac
`tion between the humerus implant and the glenoid implant ;
`and generating a shoulder arthroplasty plan based at least in
`part on the condition .
`[ 0024 ]
`In Example 16 , the subject matter of Example 15
`optionally includes wherein the condition is
`a range of
`motion of the patient shoulder .
`f0025 ] . In Example 17 , the subject matter of any one or
`more of Examples 15 - 16 optionally include wherein the
`analysis includes finite element analysis .
`[ 0026 ]
`In Example 18 , the subject matter of Example 17
`optionally includes wherein in the condition includes one or
`more of a humeral force , a humeral stress , a humeral strain ,
`a glenoid force , a glenoid stress , a glenoid strain , a humeral
`implant force , a humeral implant stress , a humeral implant
`strain , a glenoid implant force , a glenoid implant stress , a
`glenoid implant strain , a soft tissue force , a soft tissue stress ,
`and a soft tissue strain .
`[ 0027 ]
`In Example 19 , the subject matter of Example 18
`optionally includes displaying a graphic representation on a
`user interface of the condition of the updated modified
`shoulder model including the virtual representation of the
`humeral implant and the virtual representation of the glenoid
`implant ; and adjusting at least one of the base virtual
`representation of the humeral implant and the base virtual
`representation of the glenoid implant using the user inter
`face .
`In Example 20 , the subject matter of any one or
`[ 0028 ]
`more of Examples 17 - 19 optionally include wherein : the
`virtual representation of the humeral implant includes a
`humeral implant thickness , offset , and position on the virtual
`humerus ; the virtual representation of the glenoid implant
`includes a glenoid implant thickness , offset , and position on
`the virtual glenoid ; and the selection of one or more of the
`humeral implant and the glenoid implant can be updated by
`updating a selection of one or more of the thickness , offset ,
`and position of the virtual representation of the humeral
`implant and virtual representation of the glenoid implant .
`[ 0029 ]
`In Example 21 , the subject matter of any one or
`more of Examples 17 - 20 optionally include aborting an
`iteration of the finite element analysis of the updated modi
`fied shoulder model when one of a maximum humeral force ,
`a maximum humeral stress , a maximum humeral strain , a
`glenoid maximum force , a glenoid maximum stress , a gle
`noid maximum strain , a soft tissue maximum force , and a
`soft tissue force minimum force can be determined during
`the finite element analysis .
`[ 0030 ]
`In Example 22 , the subject matter of any one or
`more of Examples 17 - 21 optionally include wherein the
`finite element analysis of the updated modified shoulder
`model can be performed on a static model of the updated
`modified shoulder model .
`[ 0031 ]
`In Example 23 , the subject matter of any one or
`more of Examples 17 - 22 optionally include wherein the
`finite element analysis of the updated modified shoulder
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`model can be performed on a dynamic model of the updated
`modified shoulder including finite element analysis of the
`updated modified shoulder model throughout a range of
`motion of the updated modified shoulder model .
`[ 0032 ] Example 24 is a method of pre - operatively devel
`oping a reverse shoulder arthroplasty plan , the method
`comprising : receiving an image of a patient shoulder com
`prising a humerus and a glenoid ; segmenting the image to
`develop a 3D shoulder model ; performing virtual surgery on
`the 3D shoulder model to generate a modified shoulder
`model , the virtual surgery comprising : resecting and ream
`ing a virtual humerus of the 3D shoulder model ; reaming a
`virtual glenoid of the 3D shoulder model ; receiving selection
`of a humeral implant ; receiving selection of a glenoid
`implant ; implanting , virtually to update the modified shoul
`der model , a virtual representation of the humeral implant on
`the virtual humerus and a virtual representation of the
`glenoid implant on the virtual glenoid ; determining a range
`of motion of the patient shoulder based on analysis of the
`updated modified shoulder model including determining an
`expected interaction between the virtual representation of
`the humerus implant and the virtual representation of the
`glenoid implant after the selected virtual humeral implant
`and the selected virtual glenoid implant are virtually
`implanted ; and finalizing a reverse shoulder arthroplasty
`plan when the range of motion is within a desired range and
`receiving selection of at least one of a second humeral
`implant and a second glenoid implant when the range of
`motion is not within the desired range .
`[ 0033 ]
`In Example 25 , the subject matter of Example 24
`optionally includes displaying on a user interface a graphic
`representation of the range of motion .
`[ 0034 ] In Example 26 , the subject matter of any one or
`more of Examples 24 - 25 optionally include displaying on
`the graphic representation of the range of motion and a range
`of motion required to perform a common daily activity .
`[ 0035 ]
`In Example 27 , the subject matter of any one or
`more of Examples 24 - 26 optionally include determining
`whether the updated modified shoulder model can perform
`the common daily activity as a function of the range of
`motion .
`[ 0036 ]
`In Example 28 , the subject matter of any one or
`more of Examples 24 - 27 optionally include displaying on
`the graphic representation of the range of motion and a range
`of motion required to perform a second common daily
`activity ; and determining whether the updated modified
`shoulder model can perform the second common daily
`activity as a function of the range of motion .
`[ 0037 ]
`In Example 29 , the subject matter of any one or
`more of Examples 24 - 28 optionally include identifying
`collisions between components of the updated modified
`shoulder model ; and developing the range of motion as a
`function of the identified collisions .
`[ 0038 ]
`In Example 30 , the subject matter of any one or
`more of Examples 24 - 29 optionally include identifying areas
`of collision as a function of the identified collisions ; and
`displaying on the graphic representation of the range of
`motion , the identified areas of collision .
`[ 0039 ]
`In Example 31 , the subject matter of any one or
`more of Examples 24 - 30 optionally include wherein : the
`the
`virtual representation of the humeral implant includes a
`humeral implant thickness , offset , articulation surface
`radius , implant version , and position on the virtual humerus ;
`
`and the virtual representation of the glenoid implant includes
`a glenoid implant thickness , offset , eccentricity , and position
`on the virtual glenoid .
`[ 0040 ]
`In Example 32 , the subject matter of any one or
`more of Examples 24 - 31 optionally include wherein receiv
`ing selection of the humeral implant includes selecting the
`humeral implant from a library of humeral implants as a
`function of the humeral implant thickness , offset , articula
`tion surface radius , implant version , and position on the
`virtual humerus ; and wherein receiving selection of the
`glenoid implant includes selecting the glenoid implant from
`a library of glenoid implants as a function of the glenoid
`implant thickness , offset , eccentricity , and position on the
`virtual glenoid .
`[ 0041 ]
`In Example 33 , the subject matter of any one or
`more of Examples 24 - 32 optionally include receiving a
`thickness adjustment of at least one of the humeral implant
`and the glenoid implant when the range of motion is not
`within the desired range ; receiving an offset adjustment of at
`least one of the humeral implant relative to the humerus and
`the glenoid implant relative to the glenoid when the range of
`motion is not within the desired range ; and receiving a
`position adjustment of at least one of the humeral implant on
`the virtual humerus and the glenoid implant on the virtual
`glenoid when the range of motion is not within the desired
`range .
`10042 ]
`In Example 34 , the subject matter of any one or
`more of Examples 24 - 33 optionally include selecting a base
`virtual representation of the humeral implant and a base
`virtual representation of the glenoid implant as a function of
`adjusting at least one of thickness , offset , and position of the
`virtual representation of the humeral implant and the virtual
`representation of the glenoid implant .
`[ 0043 ]
`In Example 35 , the subject matter of any one or
`more of Examples 24 - 34 optionally include displaying a
`graphic representation on a user interface of a range of
`motion of the updated modified shoulder model including
`the base virtual representation of the humeral implant and
`the base virtual representation of the glenoid implant ; and
`adjusting at least one of the base virtual representation of the
`humeral implant and the base virtual representation of the
`glenoid implant using the user interface .
`10044 ]
`In Example 36 , the subject matter of any one or
`more of Examples 24 - 35 optionally include adjusting the
`virtual surgery as a function of at least one of the base virtual
`humeral implant and a base virtual glenoid implant .
`[ 0045 ]
`In Example 37 , the subject matter of any one or
`more of Examples 24 - 36 optionally include determining a
`probability of one or more of joint loosening , dislocation ,
`laxity , and muscle activation ; and adjusting at least one of
`the base virtual representation of the humeral implant and
`the base virtual representation of the glenoid implant as a
`function of the probability of one or more of joint loosening ,
`dislocation , laxity , and muscle activation .
`[ 0046 ]
`In Example 38 , the subject matter of any one or
`more of Examples 24 - 37 optionally include aborting an
`iteration of the finite element analysis of the updated modi
`fied shoulder model when one of a maximum humeral force ,
`a maximum humeral stress , a maximum humeral strain , a
`glenoid maximum force , a glenoid maximum stress , a gle
`noid maximum strain , a soft tissue maximum force , and a
`soft tissue force minimum force can be determined during
`the finite element analysis , and wherein the analysis includes
`finite element analysis , and wherein in
`the condition
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`includes one or more of a humeral force , a humeral stress ,
`a humeral strain , a glenoid force , a glenoid stress , a glenoid
`strain , a humeral implant force , a humeral implant stress , a
`humeral implant strain , a glenoid implant force , a glenoid
`implant stress , a glenoid implant strain , a soft tissue force ,
`a soft tissue stress , and a soft tissue strain .
`[ 0047 ]
`In Example 39 , the system , assembly , or method of
`any one of or any combination of Examples 1 - 38 is option
`ally configured such that all elements or options recited are
`available to use or select from .
`[ 0048 ]
`These and other examples and features of the
`present apparatuses and systems will be set forth in part in
`the following D