Adjustable devices for treating arthritis of the knee

Information

  • Patent Grant
  • 11213330
  • Patent Number
    11,213,330
  • Date Filed
    Friday, October 12, 2018
    6 years ago
  • Date Issued
    Tuesday, January 4, 2022
    2 years ago
Abstract
A method of changing a bone angle includes creating an osteotomy between a first portion and a second portion of a tibia of a patient; creating a cavity in the tibia by removing bone material along an axis extending in a substantially longitudinal direction from a first point at the tibial plateau to a second point; placing a non-invasively adjustable implant into the cavity, the non-invasively adjustable implant comprising an adjustable actuator having an outer housing and an inner shaft, telescopically disposed in the outer housing, and a driving element configured to be remotely operable to telescopically displace the inner shaft in relation to the outer housing; coupling one of the outer housing or the inner shaft to the first portion of the tibia; coupling the other of the outer housing or the inner shaft to the second portion of the tibia; and remotely operating the driving element to telescopically displace the inner shaft in relation to the outer housing, thus changing an angle between the first portion and second portion of the tibia.
Description
BACKGROUND OF THE INVENTION
Field of the Invention

The field of the invention generally relates to medical devices for treating knee osteoarthritis.


Description of the Related Art

Knee osteoarthritis is a degenerative disease of the knee joint that affects a large number of patients, particularly over the age of 40. The prevalence of this disease has increased significantly over the last several decades, attributed partially, but not completely, to the rising age of the population as well as the increase in obesity. The increase may also be due to the increase in highly active people within the population. Knee osteoarthritis is caused mainly by long term stresses on the knee that degrade the cartilage covering the articulating surfaces of the bones in the knee joint. Oftentimes, the problem becomes worse after a particular trauma event, but it can also be a hereditary process. Symptoms include pain, stiffness, reduced range of motion, swelling, deformity, muscle weakness, and several others. Osteoarthritis may include one or more of the three compartments of the knee: the medial compartment of the tibiofemoral joint, the lateral compartment of the tibiofemoral joint, and the patellofemoral joint. In severe cases, partial or total replacement of the knee is performed in order to replace the diseased portions with new weight bearing surfaces for the knee, typically made from implant grade plastics or metals. These operations involve significant post-operative pain and require substantial physical therapy. The recovery period may last weeks or months. Several potential complications of this surgery exist, including deep venous thrombosis, loss of motion, infection and bone fracture. After recovery, surgical patients who have received uni-compartmental or total knee replacement must significantly reduce their activity, removing running and high energy sports completely from their lifestyle.


For these reasons, surgeons are attempting to intervene early in order to delay or even preclude knee replacement surgery. Osteotomy surgeries may be performed on the femur or tibia, in order to change the angle between the femur and tibia, and thus adjust the stresses on the different portions of the knee joint. In closed wedge or closing wedge osteotomy, an angled wedge of bone is removed, and the remaining surfaces are fused together, creating a new improved bone angle. In open wedge osteotomy, a cut is made in the bone and the edges of the cut are opened, creating a new angle. Bone graft is often used to fill in the new opened wedge-shaped space, and often, a plate is attached to the bone with bone screws. Obtaining the correct angle during either of these types of osteotomy is almost always suboptimal, and even if the result is close to what was desired, there can be a subsequent loss of the correction angle. Some other complications experienced with this technique include nonunion and material failure.


SUMMARY OF THE INVENTION

In a first embodiment of the invention, a system for changing an angle of a bone of a subject includes an adjustable actuator having an outer housing and an inner shaft, telescopically disposed in the outer housing, a magnetic assembly configured to adjust the length of the adjustable actuator though axial movement of the inner shaft and outer housing in relation to one another, a first bracket configured for coupling to the outer housing, and a second bracket configured for coupling to the inner shaft, wherein application of a moving magnetic field externally to the subject moves the magnetic assembly such that the inner shaft and the outer housing move in relation to one another.


In another embodiment of the invention, a system for changing an angle of a bone of a subject includes a magnetic assembly having a radially-poled magnet coupled to a shaft having external threads, and a block having internal threads and coupled to the shaft, wherein rotational movement of the radially-poled magnet causes the shaft to turn and to move axially in relation to the block. The system further includes an upper bone interface and a lower bone interface having an adjustable distance, wherein axial movement of the shaft in a first direction causes the distance to increase.


In another embodiment of the invention, a system for changing an angle of a bone of a subject includes a scissors assembly having first and second scissor arms pivotably coupled via a hinge, the first and second scissor arms coupled, respectively, to upper and lower bone interfaces configured to move relative to one another. The system further includes a hollow magnetic assembly containing an axially moveable lead screw disposed therein, wherein the hollow magnetic assembly is configured to rotate in response to a moving magnetic field and wherein said rotation translations into axial movement of the lead screw. The system further includes a ratchet assembly coupled at one end to the lead screw and at another end to one of the first and second scissor arms, the ratchet assembly comprising a pawl configured to engage teeth disposed in one of the upper and lower bone interfaces, and wherein axial movement of the lead screw advances the pawl along the teeth and moves the upper and lower bone interfaces away from one another.


In another embodiment of the invention, a method of preparing a tibia for implantation of an offset implant includes making a first incision in the skin of a patient at a location adjacent the tibial plateau of the tibia of the patient, creating a first cavity in the tibia by removing bone material along a first axis extending in a substantially longitudinal direction from a first point at the tibial plateau to a second point, placing an excavation device within the first cavity, the excavation device including a main elongate body and configured to excavate the tibia asymmetrically in relation to the first axis, creating a second cavity in the tibia with the excavation device, wherein the second cavity communicates with the first cavity and extends substantially towards one side of the tibia, and removing the excavation device.


In another embodiment of the invention, a method of implanting a non-invasively adjustable system for changing an angle of the tibia of a patient includes creating an osteotomy between a first portion and a second portion of the tibia, making a first incision in the skin of a patient at a location adjacent the tibial plateau of the tibia of the patient, creating a first cavity in the tibia along a first axis extending in a substantially longitudinal direction from a first point at the tibial plateau to a second point, placing an excavation device within the first cavity, the excavation device configured to excavate the tibia asymmetrically in relation to the first axis, creating a second cavity in the tibia with the excavation device, wherein the second cavity extends substantially towards one side of the tibia, placing a non-invasively adjustable implant through the first cavity and at least partially into the second cavity, the non-invasively adjustable implant comprising an adjustable actuator having an outer housing and an inner shaft, telescopically disposed in the outer housing, coupling the outer housing to the first portion of the tibia, and coupling the inner shaft to the second portion of the tibia. In some embodiments, the implant could also be adjusted invasively, such as minimally invasively.


In another embodiment of the invention, a method of preparing a bone for implantation of an implant includes making a first incision in the skin of a patient, creating a first cavity in the bone by removing bone material along a first axis extending in a substantially longitudinal direction from a first point at the tibial plateau to a second point, placing an excavation device within the first cavity, the excavation device including a main elongate body and configured to excavate the bone asymmetrically in relation to the first axis, the excavation device further comprising an articulating arm having a first end and a second end, the arm including a compaction surface, creating a second cavity in the bone with the excavation device, wherein the second cavity communicates with the first cavity and extends substantially towards one side of the bone, and removing the excavation device.


In another embodiment of the invention, a method of preparing a bone for implantation of an implant includes making a first incision in the skin of a patient, creating a first cavity in the bone by removing bone material along a first axis extending in a substantially longitudinal direction from a first point at the tibial plateau to a second point, placing an excavation device within the first cavity, the excavation device including a main elongate body and configured to excavate the bone asymmetrically in relation to the first axis, the excavation device further comprising an articulating arm having a first end and a second end, the arm including an abrading surface, creating a second cavity in the bone with the excavation device, wherein the second cavity communicates with the first cavity and extends substantially towards one side of the bone, and removing the excavation device.


In another embodiment of the invention, a method of preparing a bone for implantation of an implant includes making a first incision in the skin of a patient, creating a first cavity in the bone by removing bone material along a first axis extending in a substantially longitudinal direction from a first point at the tibial plateau to a second point, placing an excavation device within the first cavity, the excavation device including a main elongate body and configured to excavate the bone asymmetrically in relation to the first axis, the excavation device further comprising a rotational cutting tool configured to be moved substantially towards one side of the bone while the rotational cutting tool is being rotated, creating a second cavity in the bone with the excavation device, wherein the second cavity communicates with the first cavity and extends substantially towards one side of the bone, and removing the excavation device.


In another embodiment of the invention, a system for changing an angle of a bone of a subject includes a non-invasively adjustable implant comprising an adjustable actuator having an outer housing and an inner shaft, telescopically disposed in the outer housing, the outer housing configured to couple to a first portion of the bone, and the inner shaft configured to couple to a second portion of the bone, a driving element configured to move the inner shaft in relation to the outer housing, and an excavation device including a main elongate body configured to insert within a first cavity of the bone along a first axis, the excavation device configured to excavate the bone asymmetrically in relation to the first axis to create a second cavity communicating with the first cavity, wherein the adjustable actuator is configured to be coupled to the bone at least partially within the second cavity.


In another embodiment of the invention, a method of changing a bone angle includes creating an osteotomy between a first portion and a second portion of a tibia of a patient; creating a cavity in the tibia by removing bone material along an axis extending in a substantially longitudinal direction from a first point at the tibial plateau to a second point; placing a non-invasively adjustable implant into the cavity, the non-invasively adjustable implant comprising an adjustable actuator having an outer housing and an inner shaft, telescopically disposed in the outer housing, and a driving element configured to be remotely operable to telescopically displace the inner shaft in relation to the outer housing; coupling one of the outer housing or the inner shaft to the first portion of the tibia; coupling the other of the outer housing or the inner shaft to the second portion of the tibia; and remotely operating the driving element to telescopically displace the inner shaft in relation to the outer housing, thus changing an angle between the first portion and second portion of the tibia.


In another embodiment of the invention, a system for changing an angle of a tibia of a subject having osteoarthritis of the knee includes a non-invasively adjustable implant comprising an adjustable actuator configured to be placed inside a longitudinal cavity within the tibia, and having an outer housing and an inner shaft, telescopically disposed in the outer housing, the outer housing configured to couple to a first portion of the tibia, and the inner shaft configured to couple to a second portion of the tibia, the second portion of the tibia separated at least partially from the first portion of the tibia by an osteotomy; and a driving element comprising a permanent magnet and configured to be remotely operable to telescopically displace the inner shaft in relation to the outer housing.


In another embodiment of the invention, a system for changing an angle of a bone of a subject includes a non-invasively adjustable implant comprising an adjustable actuator having an outer housing and an inner shaft, telescopically disposed in the outer housing, the outer housing associated with a first anchor hole, and the inner shaft associated with a second anchor hole, the first anchor hole configured to pass a first anchor for coupling the adjustable actuator to a first portion of the bone and the second anchor hole configured to pass a second anchor for coupling the adjustable actuator to a second portion of the bone, the second portion of the bone separated at least partially from the first portion of the bone by an osteotomy; a driving element configured to be remotely operable to telescopically displace the inner shaft in relation to the outer housing; and wherein the non-invasively adjustable implant is configured to be angularly unconstrained in relation to at least one of the first portion of the bone or the second portion of the bone when coupled to both the first portion and second portion of the bone.





BRIEF DESCRIPTION OF THE DRAWINGS


FIG. 1 illustrates the desired alignment of a knee joint in relation to a femur and tibia.



FIG. 2 illustrates a knee joint with misalignment and associated medial compartment osteoarthritis.



FIG. 3 illustrates an open wedge technique in a tibia.



FIG. 4 illustrates an open wedge technique with bone graft and a plate attached.



FIG. 5 illustrates a non-invasively adjustable wedge osteotomy device placed in a tibia according to a first embodiment of the present invention placed in a tibia.



FIG. 6 illustrates a view of the non-invasively adjustable wedge osteotomy device of FIG. 5.



FIG. 7 illustrates a detailed view of the lower clip of the non-invasively adjustable wedge osteotomy device of FIGS. 5 and 6.



FIG. 8 illustrates an embodiment of a magnetically adjustable implant.



FIG. 9 illustrates a non-invasively adjustable wedge osteotomy device based on a spring element according to a second embodiment of the present invention.



FIG. 10 illustrates a non-invasively adjustable wedge osteotomy device based on a linked lift according to a third embodiment of the present invention.



FIG. 11 illustrates the non-invasively adjustable wedge osteotomy device of FIG. 9 being inserted into a wedge opening in a tibia.



FIG. 12 illustrates a non-invasively adjustable wedge osteotomy device based on a scissor jack according to a fourth embodiment of the present invention.



FIG. 13 illustrates the non-invasively adjustable wedge osteotomy device of FIG. 12 with the upper bone interface removed to show the scissor jack mechanism.



FIG. 14 illustrates a sectional view of the non-invasively adjustable wedge osteotomy device of FIGS. 12 and 13.



FIG. 15 illustrates a perspective view of an external adjustment device.



FIG. 16 illustrates an exploded view of a magnetic handpiece of the external adjustment device of FIG. 15.



FIG. 17 illustrates a non-invasively adjustable wedge osteotomy device according to a fifth embodiment of the present invention.



FIG. 18 illustrates a sectional view of the non-invasively adjustable wedge osteotomy device of FIG. 17.



FIG. 19 illustrates an exploded view of the non-invasively adjustable wedge osteotomy device of FIG. 17.



FIGS. 20-27 illustrate a method of implanting and operating a non-invasively adjustable wedge osteotomy device for maintaining or adjusting an angle of an opening wedge osteotomy of the tibia of a patient.



FIG. 28 illustrates distraction axes in a tibia.



FIGS. 29-31 illustrate a method of implanting and operating a non-invasively adjustable wedge osteotomy device for maintaining or adjusting an angle of a closing wedge osteotomy of the tibia of a patient.



FIG. 32 illustrates a system for excavation of bone material according to a first embodiment of the present invention.



FIG. 33 illustrates a rotational cutting tool of the system of FIG. 32.



FIG. 34 illustrates a side view of the rotational cutting tool of FIG. 33.



FIG. 35 illustrates a section view of the rotational cutting tool of FIG. 34, taken along line 35-35.



FIG. 36 illustrates a drive unit of the system of FIG. 32 with covers removed.



FIG. 37 illustrates the system of FIG. 32 in place within a tibia.



FIG. 38 illustrates the system of FIG. 32 after removing bone material from the tibia.



FIG. 39 illustrates a system for excavation of bone material according to a second embodiment of the present invention in place within the tibia.



FIG. 40 illustrates the system of FIG. 39 in an expanded configuration within the tibia.



FIG. 41 illustrates an end view of an arm having an abrading surface as part of an excavation device of the system of FIG. 39.



FIG. 42 illustrates a system for excavation of bone material according to a third embodiment of the present invention in place within the tibia.



FIG. 43 illustrates the system of FIG. 42 in an expanded configuration within the tibia.



FIG. 44 illustrates an end view of an arm having a compaction surface as part of an excavation device of the system of FIG. 42.



FIG. 45A illustrates a non-invasively adjustable wedge osteotomy device according to a sixth embodiment of the present invention.



FIG. 45B illustrates the non-invasively adjustable wedge osteotomy device of FIG. 45A in a perspective view.



FIG. 46 illustrates a detailed view of the non-invasively adjustable wedge osteotomy device of FIG. 45B taken from within circle 46.



FIG. 47 illustrates the non-invasively adjustable wedge osteotomy device of FIG. 45A in a first distraction position.



FIG. 48 illustrates the non-invasively adjustable wedge osteotomy device of FIG. 45A in a second distraction position.



FIG. 49 illustrates a sectional view of the non-invasively adjustable wedge osteotomy device of FIG. 45A in a first distraction position.



FIG. 50 illustrates a sectional view of the non-invasively adjustable wedge osteotomy device of FIG. 45A in a second distraction position.



FIG. 51 illustrates a bushing of the non-invasively adjustable wedge osteotomy device of FIG. 45A.



FIGS. 52-55 illustrate a method of implanting and operating the non-invasively adjustable wedge osteotomy device of FIG. 45A for maintaining or adjusting an angle of an opening wedge osteotomy of the tibia of a patient.



FIGS. 56A-56D illustrate bone screw configurations for the non-invasively adjustable wedge osteotomy device of FIG. 45A.



FIG. 57 illustrates a non-invasively adjustable wedge osteotomy device according to a seventh embodiment of the present invention.



FIG. 58 illustrates a bone anchor for use with the non-invasively adjustable wedge osteotomy device of FIG. 57.



FIGS. 59-61 illustrate a method of implanting and operating the non-invasively adjustable wedge osteotomy device of FIG. 57 for maintaining or adjusting an angle of an opening wedge osteotomy of the tibia of a patient.



FIG. 62 illustrates a non-invasively adjustable wedge osteotomy device according to an eighth embodiment of the present invention in a first distraction position.



FIG. 63 illustrates the non-invasively adjustable wedge osteotomy device of FIG. 62 in a second distraction position.



FIG. 64A illustrates a magnetically adjustable actuator of a non-invasively adjustable wedge osteotomy device according to an embodiment of the present invention during removal of a magnetic assembly.



FIG. 64B illustrates the magnetically adjustable actuator of FIG. 64A after removal of a magnetic assembly.



FIG. 64C illustrates the magnetically adjustable actuator FIG. 64A after replacement of an actuator housing cap.



FIG. 65A illustrates a magnetically adjustable actuator of a non-invasively adjustable wedge osteotomy device according to an embodiment of the present invention prior to removal of a radially-poled permanent magnet.



FIG. 65B illustrates the magnetically adjustable actuator of FIG. 65A during removal of the radially-poled permanent magnet.



FIG. 65C illustrates the magnetically adjustable actuator of FIG. 64A after removal of the radially-poled permanent magnet and replacement of a magnetic housing cap.



FIG. 65D illustrates the magnetically adjustable actuator of FIG. 64A after replacement of an actuator housing cap.



FIGS. 66-69 schematically illustrate various embodiments of alternate sources of a driving element of a non-invasively adjustable wedge osteotomy device.





DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS


FIG. 1 illustrates a standard alignment of a femur 100, a tibia 102 and a knee joint 104, wherein a hip joint (at a femur head 108), a knee joint 104 and an ankle joint (at the midline of distal tibia 110) are oriented along a single line 112. A fibula 106 is shown alongside the tibia 102. The knee joint 104 of FIG. 2 is shown in an arthritic state, in which a medial compartment 114 has been compromised, causing the line 112 to pass medially off the center of the knee joint 104.



FIG. 3 illustrates an open wedge osteotomy 118 formed by making a cut along a cut line 120, and opening a wedge angle α. FIG. 4 illustrates the final setting of this open wedge by the placement of bone graft material 122 within the open wedge osteotomy 118, and then placement of a plate 124, which is then secured to the tibia 102 with tibial screws 126.



FIG. 5 illustrates a tibia 102 with a non-invasively adjustable wedge osteotomy device 128 implanted. The non-invasively adjustable wedge osteotomy device 128 is shown without the tibia 102 in FIG. 6. The non-invasively adjustable wedge osteotomy device 128 includes an actuator 142 comprising an outer housing 130 and an inner shaft 132 telescopically coupled within the outer housing 130 for non-invasive longitudinal adjustment. To implant the non-invasively adjustable wedge osteotomy device 128, a hole 138 is drilled in the tibia 102, and then a cut is made along cut line 120. The actuator 142 is then inserted, distal end 140 first, into the hole 138. A wedge opening 144 is opened enough to be able to insert a lower bracket 136 and an upper bracket 134. The lower bracket 136, as seen in FIG. 7, has an opening 146 and an internal diameter 148 which allow it to be snapped onto a circumferential groove 150 around the outer housing 130. The lower bracket 136 is then secured to the tibia 102 at the lower portion 152 of the wedge opening 144 by placing bone screws (not shown) through screw holes 154. Upper bracket 134 is then slid into place and secured to a proximal end 156 of the actuator 142 by tightening a tightening screw 158 which threads through a threaded hole in inner shaft 132 of the actuator 142. The upper bracket 134 is then secured to the tibia 102 at the upper portion 162 of the wedge opening 144 by placing bone screws (not shown) through screw holes 164.



FIG. 8 illustrates a magnetically adjustable actuator 142 which can be used in the embodiments of FIGS. 5-7, or other embodiments described herein. An inner shaft 132, having an end 160, is telescopically adjustable within an outer housing 130 by the use of a magnetic assembly 166 contained therein. The magnetic assembly 166 comprises a radially-poled, cylindrical magnet 168 which engages with one or more planetary gear stages 170. The planetary gear stages 170 output to a lead screw 172. In some embodiments, the final gear stage 170 may be pinned to the lead screw 172 with a high strength pin, for example, a pin constructed from 400 series stainless steel. The inner shaft 132 contains a cavity 174 into which is bonded a nut 176 having a female thread which interfaces with the male thread of the lead screw 172. A radial bearing 178 and a thrust bearing 180 allow the magnetic assembly 166 to operate with relatively low friction. An o-ring seal 182 is held within a circumferential groove on inside of the wall of the outer housing 130, and the inner diameter of the o-ring seal 182 dynamically seals the outer diameter of the inner shaft 132.


Returning to FIG. 5, the non-invasively adjustable wedge osteotomy device 128 is used to gradually open the wedge opening 144 over time. By applying a moving magnetic field from an external location relative to the patient, for example, after the patient has recovered from surgery, the actuator 142 of FIG. 6 can be gradually lengthened (for example about one (1) mm per day), allowing the wedge opening 144 to reach a desired angle, which can be tested by having the patient perform different motion studies (stepping, turning, etc.), until the most comfortable condition is reached. Gradual lengthening can allow for the possibility of Ilizarov osteogenesis, in which new bone material forms in the wedge opening as it is opened. In such manner, a bone graft may be unnecessary. After the desired wedge opening 144 angle is reached, the newly grown bone material can be allowed to consolidate. If, during the process, lengthening has been too rapid, or new bone has not consolidated sufficiently, a moving magnetic field may be applied in an opposite direction thereby shortening the actuator 142 to add compression and create a good dimension for callus formation. After confirming that sufficient callus formation has taken place, lengthening may be resumed at the same speed, or at a different speed. Once lengthening is sufficiently completed, and consolidated bone is stable, it may be desired to remove the entire non-invasively adjustable wedge osteotomy device 128, or simply the magnetic assembly 166.



FIG. 9 illustrates a non-invasively adjustable wedge osteotomy device 184 comprising magnetic assembly 192 including a magnet, e.g., a radially-poled cylindrical magnet 186 which is coupled to a drive screw 188. As radially-poled cylindrical magnet 186 is turned by an externally applied moving magnetic field, the drive screw 188 turns inside a block 190 having a female thread, causing the drive screw 188 and magnetic assembly 192 to be moved in a first axial direction (A). As the magnetic assembly 192 moves axially it pushes a curved shape memory (e.g., superelastic Nitinol®) plate spring 194 at connection point 196. A thrust bearing 198 at the connection point 196 allows for continued rotation of the radially-poled cylindrical magnet 186 as the force increases. As an inner curve 200 of the Nitinol plate spring 194 is pushed in the first axial direction (A), the width (W) of the Nitinol plate spring 194 increases. A cutout 202 in the Nitinol plate spring 194 provides space for the radially-poled cylindrical magnet 186 to turn and to move in the first axial direction (A).



FIG. 10 illustrates a non-invasively adjustable wedge osteotomy device 216 similar to the non-invasively adjustable wedge osteotomy device 184 of FIG. 9, except that the Nitinol plate spring 194 of FIG. 9 is replaced by a linked lift 204. Linked lift 204 comprises a lower plate 206 and an upper plate 208 which are attached to a block 190 by pins 210 which allow each plate 206 and 208 to increase in angulation along arrows (B). Plates 206 and 208 are attached to inner plates 212 and 214 by pins 210. The hinged structure of inner plates 212, 214 is pushed forward in a similar manner as Nitinol plate spring 194 is pushed in the first axial direction (A) in FIG. 9.



FIG. 11 illustrates the non-invasively adjustable wedge osteotomy device 184 being placed into a wedge opening 144 in a tibia 102. The non-invasively adjustable wedge osteotomy device 216 of FIG. 10 can be inserted in the same manner.



FIGS. 12-14 illustrate a non-invasively adjustable wedge osteotomy device 218 based on a scissor jack. Non-invasively adjustable wedge osteotomy device 218 comprises a main housing 220 having a lower bone interface 222 and an upper bone interface 224, the upper bone interface 224 which can be adjusted with respect to the main housing 220 and the lower bone interface 222. FIG. 13 shows the non-invasively adjustable wedge osteotomy device 218 with the upper bone interface 224 removed to better appreciate the inner components. A scissors assembly 225 comprises a first scissor 226 and a second scissor 228 that can be coupled by a center pin 230 in a hinged manner. Distal arms 234 and 238 of scissors 226 and 228 can be coupled to the distal ends of the lower bone interface 222 and the upper bone interface 224 by pins 240. An arm 232 of the second scissor 228 is coupled to an interconnect 242 of a magnetic assembly 244 with a pin 240. A hollow magnetic assembly 246 has internal threads 247 which engage external threads 249 of a lead screw 248 which is bonded to the interconnect 242. The hollow magnetic assembly 246 may comprise a hollow radially-poled magnet. The interconnect 242 includes a pawl 251, which is able to engage teeth 253 of a ratchet plate 255. As an externally applied moving magnetic field causes the magnet 246 to rotate, the lead screw 248 and the interconnect 242 are moved in a first axial direction (A), causing scissors assembly 225 to open up, and thus increase the distance (D) between the lower bone interface 222 and the upper bone interface 224. An arm 236 of the first scissor 226 is able to slide within a channel 257 in the upper bone interface 224. The pawl 251 and the teeth 253 of the ratchet plate 255 form a one way ratchet, allowing the distance (D) to be increased but not decreased.



FIG. 15 illustrates an external adjustment device 1180 which is used to non-invasively adjust the devices and systems described herein. The external adjustment device 1180 comprises a magnetic handpiece 1178, a control box 1176 and a power supply 1174. The control box 1176 includes a control panel 1182 having one or more controls (buttons, switches or tactile, motion, audio or light sensors) and a display 1184. The display 1184 may be visual, auditory, tactile, the like or some combination of the aforementioned features. The external adjustment device 1180 may contain software which allows programming by the physician.



FIG. 16 shows the detail of the magnetic handpiece 1178 of the external adjustment device 1180. As seen in FIG. 16, there are a plurality of, e.g., two (2), magnets 1186 that have a cylindrical shape (also, other shapes are possible). The magnets 1186 can be made from rare earth magnets, and can in some embodiments be radially poled. The magnets 1186 are bonded or otherwise secured within magnetic cups 1187. The magnetic cups 1187 include a shaft 1198 which is attached to a first magnet gear 1212 and a second magnet gear 1214, respectively. The orientation of the poles of each the two magnets 1186 are maintained in relation to each other by means of the gearing system (by use of center gear 1210, which meshes with both first magnet gear 1212 and second magnet gear 1214). In one embodiment, the north pole of one of the magnets 1186 turns synchronously with the south pole of the other magnet 1186, at matching clock positions throughout a complete rotation. The configuration has been known to provide an improved delivery of torque, for example to cylindrical magnet 168 or magnet 246. Examples of methods and embodiments of external adjustment devices that may be used to adjust the non-invasively adjustable wedge osteotomy device 218, or other embodiments of the present invention, are described in U.S. Pat. No. 8,382,756, the disclosure of which is hereby incorporated by reference in its entirety, and U.S. patent application Ser. No. 13/172,598 which was published with publication number 2012-0004494 A1, the disclosure of which is hereby incorporated by reference in its entirety.


The components of the magnetic handpiece 1178 are held together between a magnet plate 1190 and a front plate 1192. Most of the components are protected by a cover 1216. The magnets 1186 rotate within a static magnet cover 188, so that the magnetic handpiece 1178 may be rested directly on the patient, while not imparting any motion to the external surfaces of the patient. Prior to distracting the intramedullary lengthening device 1110, the operator places the magnetic handpiece 1178 over the patient near the location of the cylindrical magnet 1134. A magnet standoff 1194 that is interposed between the two magnets 1186 contains a viewing window 1196, to aid in the placement. For instance, a mark made on the patient's skin at the appropriate location with an indelible marker may be viewed through the viewing window 1196. To perform a distraction, the operator holds the magnetic handpiece 1178 by its handles 1200 and depresses a distract switch 1228, causing motor 1202 to drive in a first direction. The motor 1202 has a gear box 1206 which causes the rotational speed of an output gear 1204 to be different from the rotational speed of the motor 1202 (for example, a slower speed). The output gear 1204 then turns a reduction gear 1208 which meshes with center gear 1210, causing it to turn at a different rotational speed than the reduction gear 1208. The center gear 1210 meshes with both the first magnet gear 1212 and the second magnet gear 1214 turning them at a rate which is identical to each other. Depending on the portion of the body where the magnets 1186 of the external adjustment device 1180 are located, it is desired that this rate be controlled, to minimize the resulting induced current density imparted by magnet 1186 and cylindrical magnet 1134 though the tissues and fluids of the body. For example a magnet rotational speed of 60 RPM or less is contemplated although other speeds may be used such as 35 RPM or less. At any time, the distraction may be lessened by depressing the retract switch 1230, which can be desirable if the patient feels significant pain, or numbness in the area holding the device.



FIGS. 17-19 illustrate a non-invasively adjustable wedge osteotomy device 300 comprising a magnetically adjustable actuator 342 having a first end 326 and a second end 328. An inner shaft 332 having a cavity 374 is telescopically coupled within an outer housing 330, which comprises a distraction housing 312 and a gear housing 306. At least one transverse hole 305 passes through an end cap 302 located at the first end 326 of the magnetically adjustable actuator 342. The end cap 302 may be sealably secured to the gear housing 306 by a circumferential weld joint 390. A second weld joint 392 sealably secures the distraction housing 312 to the gear housing 306. One or more transverse holes 364 pass through the inner shaft 332. The one or more transverse holes 364 and the at least one transverse hole 305 allow passage of at least one locking screw. Some embodiments use only one transverse hole 364 and one transverse hole 305 in order to better allow rotational play between the magnetically adjustable actuator 342 and the locking screws as the magnetically adjustable actuator 342 is adjusted. One or more longitudinal grooves 372 in the outer surface of the inner shaft 332 engage in a keyed manner with protrusions 375 in an anti-rotation ring 373 which engages undercuts within end of the distraction housing 312 at a flat edge 384 of the anti-rotation ring 373. One or more guide fins 383 in the anti-rotation ring 373 can keep the anti-rotation ring 373 rotationally static within cuts 391 in the distraction housing 312.


The contents of the magnetically adjustable actuator 342 are protected from body fluids by one or more o-rings 334 which reside within circumferential grooves 382 in the inner shaft 332, dynamically sealing along the inner surface of the distraction housing 312. The inner shaft 332 is driven axially with respect to the outer housing 330 by a lead screw 348 which is turned by a cylindrical radially poled magnet 368. The cylindrical radially poled magnet 368 is bonded within a first magnet housing 308 and a second magnet housing 310 and is rotatably held at a pin 336 on one end by a radial bearing 378, which directly engages the counterbore 304 of the end cap 302. The second magnet housing 310 outputs into a first stage 367 of three planetary gear stages 370. The planet gears 387 of the three planetary gear stages 370 turn within inner teeth 321 within the gear housing 306. The first stage 367 outputs to a second stage 369, and the second stage 369 outputs to a third stage 371. The third stage 371 is coupled to the lead screw 348 by a locking pin 385, which passes through holes 352 in both the output of the third stage 371 and in the lead screw 348. A lead screw coupler 339 is also held to the lead screw 348 by the pin 385, which passes through a hole 359. The lead screw 348 threadingly engages with a nut 376 which is bonded within the cavity 374 of the inner shaft 332. Each planetary gear stage 370 incorporates a 4:1 gear ratio, producing an overall gear ratio of 64:1, so that 64 turns of the cylindrical radially poled magnet 368 cause a single turn of the lead screw 348. A thrust bearing 380, is held loosely in the axial direction between ledges in the gear housing 306. The lead screw coupler 339 includes a ledge 355, which is similar to an opposing ledge (not shown) at the base of the lead screw 348. If the inner shaft 332 is retracted to the minimum length, the ledge at the base of the lead screw 348 abuts the ledge 355 of the lead screw coupler, assuring that the lead screw 348 cannot be jammed against the nut with too high of a torque. The thrust bearing 380 is held between a ledge 393 in the gear housing 306 and an insert 395 at the end of the gear housing 306. The thrust bearing 380 serves to protect the cylindrical radially poled magnet 368, the planetary gear stages 370, the magnet housings 308 and 310, and the radial bearing 378 from damage due to compression. A maintenance member 346 comprising a thin arc of magnetic material, such as ‘400 series’ stainless steel, is bonded within the gear housing 306, adjacent to the cylindrical radially poled magnet 368, and can attract a pole of the cylindrical radially poled magnet 368, in order to minimize the chance of the cylindrical radially poled magnet 368 turning when not being adjusted by the external adjustment device 1180, for example during patient movement.


The non-invasively adjustable wedge osteotomy device 300 has the capability to increase or decrease its length at least about three millimeters in each direction in one embodiment, and about nine millimeters in each direction in another embodiment. The non-invasively adjustable wedge osteotomy device 300 can achieve a distraction force of 240 pounds when the magnetic handpiece 1178 of the external adjustment device 1180 is placed so that the magnets 1186 are about one-half inch from the cylindrical radially poled magnet 368. The majority of the components of the non-invasively adjustable wedge osteotomy device may be made from Titanium or Titanium alloys such as Titanium-6Al-4V, Cobalt Chromium, Stainless Steel or other alloys. When implanted, the non-invasively adjustable wedge osteotomy device 300 may be inserted by hand or may be attached to an insertion tool (for example a drill guide). An interface 366 comprising an internal thread 397 is located in the end cap 302 for reversible engagement with the male threads of an insertion tool. Alternatively, these features may be located on the end 360 of the inner shaft 332. Additionally a detachable tether may be attached to either end of the non-invasively adjustable wedge osteotomy device 300, so that it may be easily removed if placed incorrectly.



FIGS. 20 through 27 illustrate a method of implanting and operating a non-invasively adjustable wedge osteotomy device 125 for changing an angle of the tibia of a patient. In FIG. 20, a front view of the right knee joint 104 of a patient with osteoarthritis of the knee is shown, including the femur 100, tibia 102 and fibula 106. The non-invasively adjustable wedge osteotomy device 125 can be placed towards the medial side of the tibia 102 (away from the fibula 106). The bone of the tibia 102 is thus prepared to allow a non-central placement of the non-invasively adjustable wedge osteotomy device. An incision is made in the skin at a medial side of the tibia 102 and an open wedge osteotomy 118 is made in relation to a hinge point 107, by creating a first cut 103, for example with an oscillating saw, and opening the open wedge osteotomy 118, as seen in FIG. 21. A typical location for the hinge point 107 may be described by the distances X and Y in FIG. 20. In some embodiments, X=10 mm and Y=15 mm. At the hinge point, it is common to make a small drill hole and place an apex pin, for example an apex pin with a diameter of about 3 mm to about 4 mm. The open wedge osteotomy 118 now separates a first portion 119 and second portion 121 of the tibia 102.


As seen in FIG. 22, an incision is made in the skin, a drill 111 is placed at the central tibial plateau 101 and a first cavity 109 having a first axis 117 is drilled from the tibial plateau 101 down the medullary canal of the tibia 102. It may be desired during this drilling step to place a temporary wedge 123 in the open wedge osteotomy 118, in order to maintain stability. A drill diameter of about 12 mm or less, or more preferably about 10 mm or less is used to create the first cavity 109. FIGS. 23 and 24 illustrate generalized steps for creating a second cavity 115. Several embodiments are represented here by an excavation device 113, which is inserted into the first cavity 109 through the opening at the tibial plateau 101. The second cavity 115 is then formed to one side of the first cavity 109, in this case the medial side. As shown in FIG. 25, after the excavation device 113 has been removed, a non-invasively adjustable wedge osteotomy device 125 having an outer housing 129 and an inner shaft 127 is inserted into the first cavity 109. In FIG. 25, the non-invasively adjustable wedge osteotomy device 125 is shown with the inner shaft 127 facing superiorly (up) on the patient, but it may desired in some situations to implant the non-invasively adjustable wedge osteotomy device 125 with the inner shaft 127 facing inferiorly (down). First transverse hole 135 and second transverse hole 137 in the non-invasively adjustable wedge osteotomy device 125 are configured for placement of bone anchors, for example locking screws.


In FIG. 26, the non-invasively adjustable wedge osteotomy device 125 is then placed into the second cavity 115 and secured with a first anchor 131 through first transverse hole 135 and a second anchor 133 through second transverse hole 137. Based on calculations made from pre-surgery and/or surgery x-rays or other images, a wedge angle α1 is set between the first portion 119 and second portion 121 of the tibia. After post-surgical recovery, the patient may return for a dynamic imaging session (for example x-ray) during which the patient stands, and even moves the knee joint 104, in order to best confirm whether the wedge angle α1 is allows for the optimal conformation of the knee joint 104. If, for example, at this time it is desired to increase the wedge angle α1, the magnetic handpiece 1178 of the external adjustment device 1180 of FIG. 15 is then placed over the knee joint 104 of the patient and operated so that the inner shaft 127 is distracted from the outer housing 129, to increase to a larger wedge angle α2 (FIG. 27). It may be desired for at least one of the anchors (for example second anchor 133) to have enough clearance in the transverse hole (for example the second transverse hole 137) so that any angulation that occurs while the non-invasively adjustable wedge osteotomy device 125 is distracted, will not put an additional bending moment on the non-invasively adjustable wedge osteotomy device 125. The dynamic imaging session may be done at a time following surgery when swelling has decreased, but before bone consolidation is significant. This period may be approximately one to two weeks following surgery. If an adjustment is made (increase or decrease), an additional dynamic imaging session may be performed, for example, a week later. The non-invasively adjustable wedge osteotomy device 125 is supplied so that it can be either lengthened or shortened, in other words, so that the angle of the open wedge osteotomy 118 may be subsequently increased or decreased, depending on the determination of the desired correction.


An alternative manner of quantifying the amount of opening of the open wedge osteotomy 118, is to measure, for example via radiography, the gap G1, G2 at the medial edge 181 of the open wedge osteotomy 118. At the typical range of angles of open wedge osteotomies 118, and the typical range of patient tibia 102 sizes, the gap G1, G2, in millimeters tends to approximate the wedge angle α1, α2 in degrees. For example, G1 (mm)≈α1(°); G2 (mm)≈α2 (°). It is expected that, assuming correction is required, productive lengthening will be done at a rate in the range of about 2 mm gap (G) increase per day or less. Gap increase rate (GIR) may be defined as the change in gap in millimeters per day. One consideration in determining the gap increase rate (GIR) to use is the pain tolerance of the patient. Some patients may tolerate a larger amount of pain, for example the pain caused by stretching of soft tissue, and thus a higher gap increase rate (GIR). Another consideration is the amount of bone growth that is occurring. One method of assessing the amount of bone growth is via radiography. The preferred gap increase rate (GIR) is that at which bone growth is occurring within the open wedge osteotomy 118, but early consolidation of the bone is not occurring (consolidation that would “freeze” the mobility of the open wedge osteotomy 118, making it unable to be opened more). It may be desired to purposely implant the non-invasively adjustable wedge osteotomy device 125 with an undersized initial gap (G0), so that an ideal gap (G1) may be gradually achieved via non-invasive adjustments. It is contemplated that over the adjustment period, a total of one to twenty or more adjustment procedures may be performed, for a total amount of about 1 mm to about 20 mm of gap (G) increase, such as during an adjustment period of one month or less. Typically, the adjustment period may span approximately ten days, involve approximately ten adjustment procedures and involve a total amount of about 5 mm to about 12 mm gap increase.


By locating the non-invasively adjustable wedge osteotomy device 125 medially in the tibia, instead of near the centerline, a larger moment may be placed on the first portion 119 and second portion 121 to open the open wedge osteotomy 118 in relation to the hinge point 107. Additionally, for any particular distraction force applied by the non-invasively adjustable wedge osteotomy device 125, a larger amount of distraction may be achieved. In FIG. 28, three different distraction axes (A, B, C) are shown, representing three possible positions of the non-invasively adjustable wedge osteotomy device 125. Distraction axis A is approximately midline in the tibia 102, while distraction axis B is approximately 110 angled from the midline, and distraction axis C is approximately 22° angled from the midline. The length DB from the hinge point 107 to distraction axis B can be approximately 32% greater than the length DA from the hinge point 107 to distraction axis A. More significantly, the length DC from the hinge point 107 to distraction axis C can be approximately 60% greater than the length DA from the hinge point 107 to distraction axis A. The distraction force of the non-invasively adjustable wedge osteotomy device 125 is needed to overcome a series of resistances arrayed along the tibia due to the tethering effect of soft tissue. A placement of the non-invasively adjustable wedge osteotomy device 125 along axis C, and thus in second cavity 115 (FIG. 27), can allow for a more effective distraction of the open wedge osteotomy 118.



FIGS. 29 through 31 illustrate a method of implanting and operating a non-invasively adjustable wedge osteotomy device 125 for changing an angle of the tibia of a patient, but unlike the open wedge osteotomy 118 shown in FIGS. 20-27, a closing wedge osteotomy 141 is shown. In FIG. 29, the first cut 103 is made, but in FIG. 30 a second cut 105 is made and a wedge of bone is removed. The second cut 105 purposely removes slightly more bone than is needed to optimize the correction angle, and as shown in FIG. 31, the closing wedge osteotomy 141 is left with a slight gap, allowing it to be subsequently adjusted in either direction (to increase or decrease then angle). The implantation method continues by following the remaining steps described in FIGS. 22-26, and the angle of the closing wedge osteotomy 141 may be increased or decreased as described in FIG. 27.



FIGS. 32 through 36 illustrate a first system for excavation of bone material 400. The system for excavation of bone material 400 is configured for creating a second cavity 115 as generally described in FIGS. 22 through 24. A drive unit 404 is coupled to a rotational cutting tool 402 by means of a flexible drive train 408. The rotational cutting tool 402 is an embodiment of the excavation device 113 as introduced in FIG. 23, but may also serve as the drill 111 of FIG. 22. The rotational cutting tool 402, as depicted in FIGS. 32 through 35, extends between a first end 444 and second end 446 (as shown in FIG. 34), and comprises a distal reamer 412 which is coupled to a proximal reamer 410. As shown in FIG. 35, the distal reamer 412 includes a small diameter portion 440 which inserts inside the proximal reamer 410. A circumferential engagement member 434 is held axially between the distal reamer 412 and the proximal reamer 410, and includes several cutouts 435 (FIG. 34) arrayed around its circumference, forming a pulley. The distal reamer 412, proximal reamer 410 and circumferential engagement member 434 are held together with pins 437, which are passed through holes 436, and which assure that all components rotate in unison. A cap screw 438 is secured within a female threaded internal surface of the proximal reamer 410. The distal reamer 412 further includes a taper 442 and a blunt tip 414. The outer diameter of the rotational cutting tool 402 may be about 12 mm or less, and more specifically about 10 mm or less. The outer diameter of the proximal reamer 410 may be about 9 mm and the outer diameter of the distal reamer may taper from about 9 mm to about 6.35 mm at the blunt tip 414. The drive unit 404, as best seen in FIGS. 32 and 36, comprises a drive housing 416 covered by a pulley cover plate 418 and a drive cover plate 420. Several screws 421 hold the drive cover plate 420 to the drive housing 416, and four screws 426 hold the pulley cover plate 418 to the drive housing 416. The drive housing 416 is not depicted in FIG. 36 in order to reveal more detail of the internal components. In FIG. 32, a handle 406 is coupled by screws 424 to a handle mounting plate 422 which in turn is removably attached to the drive housing 416 (for example by screws or a clip).


A shaft 428 (FIG. 36) having a keyed end 430, is configured for removeably coupling to an electric drill unit 468 (FIGS. 37 and 38). A large pulley 450 is attached to the shaft 428 with a set screw 451 so that rotation of the shaft 428 by the electric drill unit 468 causes rotation of the large pulley 450. The shaft 428 and large pulley 450 are held between two ball bearings 448 (lower ball bearing not visible), and a shim washer 464 and wave washer 466 are located on either side of the large pulley 450 in order to control the amount of axial play. A roller wheel 452 is rotatably attached to the end of a roller wheel slide 456 with a pin 454. The roller wheel slide 456 is able to slide axially within the drive housing 416 and drive cover plate 420 with the loosening of a thumb screw 432, whose threaded shaft engages with internal threads 462 on the roller wheel slide 456. The roller wheel slide 456 may be secured by tightening the thumb screw 432 so that it will not slide during use. A longitudinal slit 460 in the roller wheel slide 456 controls the total amount of axial sliding by providing a first end 461 and a second end 463 which abut a stop 458.


The flexible drive train 408 comprises a small timing belt, for example an about 3 mm wide Kevlar® or fiberglass reinforced polyurethane belt having a slippage torque of greater than 10 inch-ounces when used with the large pulley 450 or the circumferential engagement member 434. One potential example slippage torque for is 13 inch-ounces. The teeth of the flexible drive train may be located at a pitch of two millimeters. FIG. 37 shows the drive unit 404 of the System for excavation of bone material 400 coupled to the electric drill unit 468. The electric drill unit 468 includes a motor housing 476, a handle 470 and a battery pack 472. The handle may include any number of interfaces known in the art for turning the electric drill unit 468 on or off, or controlling the speed. In some embodiments, the electric drill unit 468 may plug directly into a standard power source instead of having the battery pack 472. The keyed end 430 of the shaft 428 is coupled to a shaft coupler 474 of the electric drill unit 468.


In FIG. 37, the first cavity 109 having been created, the flexible drive train 408 is inserted through the medial incision and into the open wedge osteotomy 118, between first portion 119 and second portion 121 of the tibia. The rotational cutting tool 402 is then placed down the first cavity 109 of the tibia 102 so that the flexible drive train 408 wraps around the circumferential engagement member 434 of the rotational cutting tool 402. With the thumb screw 432 loose, the desired amount of tension in the flexible drive train 408 is adjusted and then the thumb screw 432 is tightened. At this desired tension, the teeth of the flexible drive train 408 should engage well within the cutouts 435 (FIG. 34) of the circumferential engagement member 434 and the roller wheel 452 should rotatably contact the outer surface of the circumferential engagement member 434, stabilizing it. The electric drill unit 468 is operated, causing the large pulley 450 of FIG. 36 to rotate the flexible drive train 408, and thus rotate the rotational cutting tool 402 via engagement with the circumferential engagement member 434 (FIG. 34). The large pulley 450 can be twice the diameter of the circumferential engagement member 434, therefore causing the rotational cutting tool 402 to spin at one-half the speed of the output of the electric drill unit 468. Other ratios are also within the scope of this invention. It may be desired to control the rotational speed of the rotational cutting tool 402 in order to minimize heating of the bone surrounding the bone material being cut, and thus limit damage to the bone that may impede normal growth during the healing process. While the rotational cutting tool 402 is rotated by the drive unit 404, The handle 406 is pulled causing the rotational cutting tool 402 to cut a second cavity 115 following path 477 (FIG. 38). The proximal reamer 410 cuts within first portion 119 of the tibia 102 and the distal reamer 412 cuts within the second portion 121 of the tibia 102. After the second cavity 115 is created, the thumb screw 432 is loosened and tension on the flexible drive train 408 is at least partially reduced. The rotational cutting tool 402 is then removed and the flexible drive train 408 is pulled out of the open wedge osteotomy 118. A tether line may be attached to the rotational cutting tool 402, for example via the cap screw 438, to apply tension and thus aid removal. A swivel joint may further be included between the tether line and the rotational cutting tool 408 in order to keep the tether line from being twisted.



FIG. 39-41 illustrate a second system for excavation of bone material 500. The system for excavation of bone material comprises an excavation device 502 having a hollow outer shaft 508. The hollow outer shaft 508 has a distal end 507 and a proximal end 509 and is attached to an outer shaft handle 510 which is configured to be held with a single hand to stabilize or to move the excavation device 502. An adjustment member 512 having a threaded end 516 is attached to an adjustment handle 514. The threaded end 516 threadingly engages internal threads (not shown) within the hollow outer shaft 508, and turning the adjustment member 512 by manipulation of the adjustment handle 514 moves the adjustment member 512 axially in relation to the hollow outer shaft 508. The hollow outer shaft 508 has a cut away section 511 adjacent to an articulatable arm 504. The threaded end 516 is coupled to the arm 504 via a link 520. The link 520 connects to the arm 504 at a first pivot point 518, and the link 520 connects to the threaded end 516 of the adjustment member 512 at a second pivot point 521 (as seen in FIG. 40). Rotating the adjustment handle 514 in a rotational direction R in relation to the hollow outer shaft 508 and outer shaft handle 510 causes adjustment member 512 to move in direction D in relation to the hollow outer shaft 508, and causes the arm 504 to expand in path E in relation to the hollow outer shaft 508.


The arm 504 comprises an abrading surface 506 for removing bone material. As seen in FIG. 41, the arm 504 may be an elongate member having a semi-cylindrical cross-section, and the abrading surface 506 may comprise a rasp, covered with several sharp projections 513. FIG. 39 shows the excavation device 502 placed within a first cavity 109 made within a tibia 102. In order to create a second cavity 115 to one side of the first cavity 109, the operator grips the outer shaft handle 510 with one hand and the adjustment handle 514 with the other hand, and begins moving the system for excavation of bone material 500 in a back and forth motion 522, while slowly turning the adjustment handle 514 in rotational direction R. As bone material is removed, the arm 504 is able to be expanded more and more along path E (FIG. 40) as the adjustment handle 514 is turned in rotational direction R and the system for excavation of bone material 500 is moved in a back and forth motion 522. The culmination of this step is seen in FIG. 40, with the second cavity 115 created in the first portion 119 and the second portion 121 of the tibia 102. At the completion of this step, the adjustment handle is turned in an opposite rotational direction than rotational direction R, thus allowing the arm 504 to collapse, and the excavation device 502 to be removed from the tibia 102.



FIG. 42-44 illustrate a third system for excavation of bone material 600. The system for excavation of bone material 600 comprises an excavation device 602 having a hollow outer shaft 608. The hollow outer shaft 608 has a distal end 607 and a proximal end 609 and is attached to an outer shaft handle 610 which is configured to be held with a single hand to stabilize or to move the excavation device 602. An adjustment member 612 having a threaded end 616 is attached to an adjustment handle 614. The threaded end 616 threadingly engages internal threads (not shown) within the hollow outer shaft 608, and turning the adjustment member 612 by manipulation of the adjustment handle 614 moves the adjustment member 612 axially in relation to the hollow outer shaft 608. The hollow outer shaft 608 has a cut away section 611 adjacent to an articulatable arm 604. The threaded end 616 is coupled to the arm 604 via a link 620. The link 620 connects to the arm 604 at a first pivot point 618, and the link 620 connects to the threaded end 616 of the adjustment member 612 at a second pivot point 621. Rotating the adjustment handle 614 in a rotational direction R in relation to the hollow outer shaft 608 and outer shaft handle 610 causes adjustment member 612 to move in direction D in relation to the hollow outer shaft 608, and causes the arm 604 to expand in path E in relation to the hollow outer shaft 608, as seen in FIG. 43.


As seen in FIG. 44, the arm 604 comprises a compaction surface 606 for compacting cancellous bone. The arm 604 may be an elongate member having a tubular or partially tubular cross-section, and the compaction surface 606 may include a leading edge 690 for cutting a path through the cancellous bone and a first angled surface 692 extending from the leading edge 690. The first angled surface 692 serves to compact the cancellous bone, but also allows some sliding past cancellous bone as the cancellous bone moves out of the way. Similarly, a second angled surface 694 having an angle different from that of the first angled surface 692 may be configured as part of the compaction surface 606. FIG. 42 shows the excavation device 602 placed within a first cavity 109 made within a tibia 102. In order to create a second cavity 115 to one side of the first cavity 109, the operator grips the outer shaft handle 610 with one hand and the adjustment handle 614 with the other hand, and begins slowly turning the adjustment handle 614 in rotational direction R. Cancellous bone is compacted as the arm 604 is expanded more and more along path E by turning the adjustment handle 614 in rotational direction R. The culmination of this step is seen in FIG. 43, with the second cavity 115 created in the second portion 121 of the tibia 102. The excavation device 602 may be moved superiorly in the tibia 102 and the compaction may be completed within the first portion 119 of the tibia 102. At the completion of the compaction step, the adjustment handle is turned in an opposite rotational direction than rotational direction R, thus allowing the arm 604 to collapse, and the excavation device 602 to be removed from the tibia 102.



FIGS. 45A through 50 illustrate a non-invasively adjustable wedge osteotomy device 700. The non-invasively adjustable wedge osteotomy device 700 has a first end 726 and a second end 728, as shown in FIG. 45A, and is similar in construction to the non-invasively adjustable wedge osteotomy device 300 of FIGS. 17 through 19. However, the first end 726 of the non-invasively adjustable wedge osteotomy device 700 comprises a Herzog bend 780, in which the first end 726 projects at an angle θ. In some embodiments, the angle θ may range between about 5° and about 20°, or more specifically between about 8° to 12°, or about 10°, in relation to the central axis 782 of the non-invasively adjustable wedge osteotomy device 700. A magnetically adjustable actuator 742 comprises an inner shaft 732, telescopically disposed within an outer housing 730, the outer housing 730 further comprising a distraction housing 712 and a gear housing 706. First transverse hole 735, second transverse hole 743, third transverse hole 737 and fourth transverse hole 739 are sized for the passage of bone anchors, for example locking screws having diameters of about 3.0 mm to about 5.5 mm, and more specifically about 4.0 mm to about 5.0 mm. In some embodiments, the diameter of the outer housing 730 is between about 7.0 mm and about 9.5 mm, and more specifically about 8.5 mm. The diameter of the inner shaft 732 may also taper up to about 8.5 mm at the portion of the inner shaft 732 containing the second transverse hole 743 and third transverse hole 737. This is larger than the small-diameter portion 784 of the inner shaft 732, which telescopes within the outer housing 730, and thus this increase diameter allows the second transverse hole 743 and third transverse hole 737 to in turn be constructed with larger diameters, allowing the use of stronger, larger diameter bone screws. Likewise, the diameter of the first end 726 may taper up to about 10.7 mm in order to allow for even larger bone screws to be used. In a non-invasively adjustable wedge osteotomy device 700 having an outer housing 730 diameter of about 8.5 mm, tapering up to about 10.7 mm at the first end 726, and with an inner shaft 732 that tapers up to about 8.5 mm, it is contemplated that bone screws having diameter of about 4.0 mm will be placed through the second transverse hole 743 and the third transverse hole 737, while bone screws having a diameter of about 5.0 mm will be placed through the first transverse hole 735 and the fourth transverse hole 739. An exemplary length of the non-invasively adjustable wedge osteotomy device 700 from the extents of the first end 726 to the second end 728 is about 150 mm.


As seen in more detail in FIG. 46, an interface 766 at the first end 726 of the non-invasively adjustable wedge osteotomy device 700 includes internal thread 797 for reversible engagement with the male threads of an insertion tool. Examples of methods and embodiments of instruments that may be used to implant the non-invasively adjustable wedge osteotomy device 700, or other embodiments of the present invention, are described in U.S. Pat. No. 8,449,543, the disclosure of which is hereby incorporated by reference in its entirety. The fourth transverse hole 739 comprises a dynamic construction that allows some motion between a bone anchor and the non-invasively adjustable wedge osteotomy device 700 when the non-invasively adjustable wedge osteotomy device 700 is implanted and being non-invasively adjusted. A bushing 751, having substantially cylindrical outer and inner diameters resides within the fourth transverse hole 739 and has an inner diameter 753 configured to smoothly pass the shaft of a locking screw, for example a locking screw having a diameter of about 5.0 mm. In some embodiments, the bushing 751 may be constructed of metallic materials such as Titanium-6Al-4V. In other embodiments the bushing 751 may be constructed of PEEK. The bushing 751 can be angularly unconstrained, thus being able to rock or pivot within the fourth transverse hole 739.



FIG. 47 shows the non-invasively adjustable wedge osteotomy device 700 in a first, non-distracted state. The inner shaft 732 is substantially retracted within the outer housing 730. FIG. 48 shows the non-invasively adjustable wedge osteotomy device 700 in a partially distracted state, with a portion of the inner shaft 732 extending from the outer housing 730 (for example, after having been magnetically distracted). In addition, FIGS. 47 and 48 show two different possible positions for a bone screw 755, having a head 757, a shaft 759 and a threaded portion 761 for engaging cortical bone. The bone screw 755 is depicted rocking or pivoting along a general arcuate pathway 763. The bushing 751 may generally rock within the fourth transverse hole 739, or the bushing 751 may actually pivot upon an axis. For example, pins may extend transversely from the outer diameter of the bushing 751 at approximately the center point of its length, and attach into holes or recesses formed transversely within the fourth transverse hole 739. The words “rock” and “rocking”, as used herein, are generally intended to denote a motion that does not have a central pivot point. “Angularly unconstrained,” as used herein, is intended to denote any freedom of motion of the bushing 751 that allows angulation, not necessarily in a single plane, of the bone screw 755 in relation to the non-invasively adjustable wedge osteotomy device 700. “Angularly unconstrained,” as used herein, is intended to include both rocking and pivoting.



FIGS. 49 and 50 illustrate sectional views of the bushing 751 moving in an angularly constrained manner within the fourth transverse hole 739. As seen in FIG. 51, bushing 751 comprises two large diameter extensions 765, 770 and two small diameter extensions 767, 768, separated by a transition area 769. In some embodiments, a longitudinal slit 771 along one side of the bushing 751 may be present, to allow bone screws 755 having a certain amount of outer diameter variance to fit within the inner diameter 753. In FIG. 49, the bushing 751 has not reached its extents against the fourth transverse hole 739. In contrast, FIG. 50 shows one large diameter extension 765 abutting a first point 773 within the fourth transverse hole 739, and the other large diameter extension 770 abutting a second point 775 within the fourth transverse hole 739. In addition, this longitudinal slit 771, or alternatively, external contours on the bushing 751, may fit within matching contours the fourth transverse hole 739, so that the bushing 751 cannot rotate around its cylindrical axis (in relation to the fourth transverse hole 739), but is still able to rock or pivot. The sizing of the two large diameter extensions 765, 770 and two small diameter extensions 767, 768 may be controlled, for example, so that the bushing 751 is able to rock or pivot about 15° in one direction, but about 0° in the other direction. These about 15°, for example, may be chosen to correspond to the total amount of opening of the open wedge osteotomy 118 in a particular patient. The extent of this angulation may be controlled in different models of the bushing 751. For example about 15° in one direction, about 00 in the other direction; about 10° in one direction, about 5° in the other direction; about 20° in one direction, about 00 in the other direction; and about 10° in one direction, about 10° in the other direction.



FIGS. 52-55 illustrate a method of implanting and operating the non-invasively adjustable wedge osteotomy device 700 of FIGS. 45A-51 for maintaining or adjusting an angle of an opening wedge osteotomy of the tibia of a patient. In FIG. 52, a first cavity 109, extending from a first point on the tibia 102 at the tibial plateau 101, is made. In some embodiments, the first cavity 109 can be made as shown in FIGS. 20-22. In FIG. 53, the non-invasively adjustable wedge osteotomy device 700 is inserted into the first cavity 109, the inner shaft 732 first, followed by the outer housing 730. In FIG. 54, the non-invasively adjustable wedge osteotomy device 700 is secured to the first portion 119 of the tibia 102 with a first bone screw 755 which is passed through the fourth transverse hole 739 of FIG. 45B, and a second bone screw 777 which is passed through the first transverse hole 735, of FIG. 45B. In this embodiment, only the fourth transverse hole 739 has the bushing 751 incorporated therein. A third bone screw 779 and a fourth bone screw 781 are passed through the second transverse hole 743, in FIG. 45B, and the third transverse hole 737, in FIG. 45B, respectively, and secured to the second portion 121 of the tibia 102. The non-invasively adjustable wedge osteotomy device 700 is secured within the tibia 102 so that the Herzog bend 780, of FIG. 45A, points anteriorly (e.g. towards the patellar tendon). FIG. 55 illustrates the non-invasively adjustable wedge osteotomy device 700 after having been distracted over one or more non-invasive distractions, over a period of one or more days. The angle of the open wedge osteotomy 118 has been increased as the inner shaft 732 was displaced out of the outer housing 730. The bone screw 755 has been able to change its angle in relation to the non-invasively adjustable wedge osteotomy device 700, for example, by rocking or pivoting of the bushing 751 of FIG. 49 within the fourth transverse hole 739.



FIGS. 56A through 56D illustrate four possible bone screw configurations for securing the first end 726 of the non-invasively adjustable wedge osteotomy device 700 to the first portion 119 of the tibia 102 with the first bone screw 755 and the second bone screw 777. The medial 800, lateral 802, anterior 804 and posterior 806 portions of the tibia 102 are denoted. The medial 800 to lateral 802 orientation in FIGS. 56A through 56D is left to right respectively in each figure, while in FIGS. 52 through 55, medial was on the right and lateral was on the left. In the configuration of FIG. 56A, the first bone screw 755 is secured unicortically (through the cortex of the tibia 102 on one side only) and is at an angle of B≈10° with the medial-lateral axis 810. The second bone screw 777 is secured bicortically (through the cortex of the tibia 102 on both sides) and is at an angle of A≈20° with the anterior-posterior axis 808. In the configuration of FIG. 56B, the first bone screw 755 is secured unicortically and is at an angle of B≈10° (in the opposite direction than in FIG. 56A) with the medial-lateral axis 810. The second bone screw 777 is secured bicortically and is at an angle of A≈20° with the anterior-posterior axis 808. In the configuration of FIG. 56C, the first bone screw 755 and the second bone screw 777 are both secured bicortically. First bone screw 755 is secured at an angle of D≈45° with the anterior-posterior axis 808, and second bone screw 777 is secured at an angle of A≈20° with the anterior-posterior axis 808. In the configuration of FIG. 56D, the first bone screw 755 and the second bone screw 777 are both secured bicortically. First bone screw 755 is secured at an angle of D≈45° with the anterior-posterior axis 808, and second bone screw 777 is secured at an angle of E≈45° with the anterior-posterior axis 808.


Though not shown in FIGS. 56A through 56D, the third bone screw 779 and the fourth bone screw 781 may be secured in a number of orientations. Though shown in FIGS. 54 and 55 oriented slightly angled from the anterior-posterior plane, they may also be placed in other orientations, for example angled approximately 35° from the medial-lateral plane.



FIG. 57 illustrates a non-invasively adjustable wedge osteotomy device 900. The non-invasively adjustable wedge osteotomy device 900 comprises a magnetically adjustable actuator 942 having a first end 926 and a second end 928, and is similar in construction to the non-invasively adjustable wedge osteotomy device 300 of FIGS. 17 through 19. The second end 928 includes an inner shaft 932 having a small-diameter portion 984 which is telescopically disposed and axially distractable within an outer housing 930. The outer housing 930 comprises a distraction housing 912 and a gear housing 906. A first plate 950 extends from the outer housing 930 and is configured to be placed in proximity to an external surface of a bone, for example, the second portion 121 of a tibia 102 shown in FIG. 59. One or more anchor holes 952 are arrayed on the first plate 950, and configured for interface with corresponding bone screws. A bone screw 954 is shown in FIG. 58, and includes a threaded, tapered head 956 and a threaded shaft 958. A keyed cavity 960 couples with a driving instrument (not shown). The first plate 950 features a bone interface side 962 and a non-bone interface side 964. A second plate 966, having a bone interface side 968 and a non-bone interface side 970, extends from the inner shaft 932. The second plate 966 is coupled to the inner shaft 932 by a cap 972, and secured with a set screw 974. One or more anchor holes 976 are arrayed on the second plate 966, and configured for interface with corresponding bone screws, for example bone screw 954. Anchor hole 978 is shown having a threaded taper 980, for interfacing with the tapered head 956 of the bone screw 954.



FIGS. 59-61 illustrate a method of implanting and operating the non-invasively adjustable wedge osteotomy device of FIG. 57 for maintaining or adjusting an angle of an opening wedge osteotomy of the tibia of a patient. In FIG. 59, an open wedge osteotomy 118 is made in the tibia 102. In FIG. 60, the non-invasively adjustable wedge osteotomy device 900 is placed through an incision and is secured to the tibia 102 by coupling the first plate 950 to the second portion 121 of the tibia 102 and coupling the second plate 966 to the first portion 119 of the tibia, for example with bone screws 954. FIG. 61 illustrates the tibia 102 after the non-invasively adjustable wedge osteotomy device 900 has been non-invasively distracted, for example with the external adjustment device 1180.



FIGS. 62 and 63 illustrate a non-invasively adjustable wedge osteotomy device 1000. The non-invasively adjustable wedge osteotomy device 1000 comprises a magnetically adjustable actuator 1042 having a first end 1026 and a second end 1028, and is similar in construction to the non-invasively adjustable wedge osteotomy device 300 of FIGS. 17 through 19, and the non-invasively adjustable wedge osteotomy device 900 of FIG. 57. The magnetically adjustable actuator 1042 comprises an outer housing 1030 and an inner shaft 1032 telescopically disposed within the outer housing 1030. Like the non-invasively adjustable wedge osteotomy device 900 of FIG. 57, non-invasively adjustable wedge osteotomy device 1000 has a first plate 1050 extending from the outer housing 1030. A second plate 1066 is secured to the inner shaft 1032 by a cap 1072. The second plate 1066 is rotatably coupled to the cap 1072 at pivot point 1091, thus allowing the second plate 1066 to rotate from the position in FIG. 62 to the position in FIG. 63 along arrow 1081, for example as the inner shaft 1032 is distracted from the position in FIG. 62 to the position in FIG. 63. This allows the first portion 119 of the tibia 102 to be moved apart from the second portion 121 of the tibia 102, and thus opening the open wedge osteotomy 118, but without creating too large of a bending moment (and related frictional force increases) on the movement of the inner shaft 1032 within the outer housing 1030. In this manner, the torque supplied by the magnetic coupling of the external adjustment device 1180 of FIG. 15 will be sufficient to distract the magnetically adjustable actuator 1042. The rotatability of the second plate 1066 with relation to the rest of the non-invasively adjustable wedge osteotomy device 900 is analogous to the angularly unconstrained motion of the bushing 751 and the bone screw 755 in relation to the non-invasively adjustable wedge osteotomy device 700 of FIGS. 45A through 50.


The use of the non-invasively adjustable wedge osteotomy device 900 or the non-invasively adjustable wedge osteotomy device 1000, which do not require any removal of bone at the tibial plateau 101, may be preferred in certain patients in whom it is desired to maintain the knee joint 104 in as original a condition as possible. This may include younger patients, patients who may be able to avoid later partial or total knee replacement, or patients with deformities at the knee joint 104. It may also include small patients who have small medullary canal dimensions, in whom intramedullary devices will not fit well.



FIGS. 64A through 64C illustrate a magnetically adjustable actuator 1504 which may be used with any of the embodiments of the present invention, and which allows for temporary or permanent removal of a rotatable magnetic assembly 1542. Subjects undergoing magnetic resonance imaging (MRI) may require that the radially-poled permanent magnet 1502 be removed prior to MRI in order to avoid an imaging artifact which may be caused by the radially-poled permanent magnet 1502. Additionally, there is a risk that an implanted radially-poled permanent magnet 1502 may be demagnetized upon entering an MRI scanner. In some embodiments, an actuator housing cap 1588 has a male thread 1599 which engages with a female thread 1597 of the outer housing 1505 of the magnetically adjustable actuator 1504. In other embodiments, a snap/unsnap interface may be used. A smooth diameter portion 1595 of the actuator housing cap 1588 is sealed within an o-ring 1593, which is held within a circumferential groove in the outer housing 1505. If at a time subsequent to the implantation of the magnetically adjustable actuator 1504 it desired to remove the rotatable magnetic assembly 1542 while leaving the rest of the implant intact, a small incision may be made in the skin of the subject in proximity to the actuator housing cap 1588, and the actuator housing cap 1588 may be unscrewed. The rotatable magnetic assembly 1542 may then be removed, as shown in FIG. 64A. FIGS. 64B and 64C show the subsequent steps of replacing the actuator housing cap 1588 onto the magnetically adjustable actuator 1504, once again sealing it with the o-ring 1593. The incision may then be closed, and the subject can undergo typical MRI scanning. If desired, after the MRI scanning, the magnetic assembly 1542 may be replaced by following a reverse method.



FIGS. 65A through 65D illustrate a magnetically adjustable actuator 1604 which may be used with any of the embodiments of the present invention, and which advantageously allows for temporary or permanent removal of the radially-poled permanent magnet 1602. An actuator housing cap 1688 attaches to and detaches from the magnetically adjustable actuator 1604 in the same manner as in the magnetically adjustable actuator 1504 of FIGS. 64A through 64C. The radially-poled permanent magnet 1602 has two radial portions 1687 and two flat portions 1685. The two flat portions 1685 fit within flat walls 1683 of a magnetic housing 1640, which allows rotation of the radially-poled permanent magnet 1602 to directly impart a torque upon the magnetic housing 1640 without the need for any adhesive or epoxy. A magnetic housing cap 1681 having an o-ring 1679 is attachable to and removable from the magnetic housing 1640. If an MRI of the subject is desired and it has been determined that the radially-poled permanent magnet 1602 should be removed, an small incision is made in the skin of the subject in proximity to the actuator housing cap 1688, and the actuator housing cap 1688 is removed. Then magnetic housing cap 1681 is removed from the magnetic housing 1640. A pull rod 1677 extends through a longitudinal hole (not shown) in the radially-poled permanent magnet 1602, extending at one end such that it may be gripped, for example by forceps or hemostats. The pull rod 1677 may have a flat base 1675 at the opposite end so that when it is pulled, it can drag the radially-poled permanent magnet 1602 with it. The radially-poled permanent magnet 1602 can be permanently or temporarily removed (FIG. 65B) (note removal path 1691) and the magnetic housing cap 1681 replaced (FIG. 65C). The actuator housing cap 1688 can then be replaced (FIG. 65D). The incision is then closed, and the subject may undergo typical MRI scanning. If desired, after the MRI scanning, the radially-poled permanent magnet 1602 may be replaced by following a reverse method. Alternatively, the magnetic housing cap 1681 or the actuator housing cap 1688 may be replaced by an alternatively shaped cap which will guide into a keyed structure within the magnet actuator 1604, thus keeping the internal mechanisms from turning, and keeping the subject's particular amount of adjustment from changing as he subject walks, runs or stretches.


Throughout the embodiments presented, a radially-poled permanent magnet (e.g. 168 of FIG. 8), as part of a magnetic assembly (e.g. 166), is used a driving element to remotely create movement in a non-invasively adjustable wedge osteotomy device. FIGS. 66-69 schematically show four alternate embodiments, wherein other types of energy transfer are used in place of permanent magnets.



FIG. 66 illustrates a non-invasively adjustable wedge osteotomy device 1300 comprising an implant 1306 having a first implant portion 1302 and a second implant portion 1304, the second implant portion 1304 non-invasively displaceable with relation to the first implant portion 1302. The first implant portion 1302 is secured to a first bone portion 197 and the second implant portion 1304 is secured to a second bone portion 199 within a patient 191. A motor 1308 is operable to cause the first implant portion 1302 and the second implant portion 1304 to displace relative to one another. An external adjustment device 1310 has a control panel 1312 for input by an operator, a display 1314 and a transmitter 1316. The transmitter 1316 sends a control signal 1318 through the skin 195 of the patient 191 to an implanted receiver 1320. Implanted receiver 1320 communicates with the motor 1308 via a conductor 1322. The motor 1308 may be powered by an implantable battery, or may be powered or charged by inductive coupling.



FIG. 67 illustrates a non-invasively adjustable wedge osteotomy device 1400 comprising an implant 1406 having a first implant portion 1402 and a second implant portion 1404, the second implant portion 1404 non-invasively displaceable with relation to the first implant portion 1402. The first implant portion 1402 is secured to a first bone portion 197 and the second implant portion 1404 is secured to a second bone portion 199 within a patient 191. An ultrasonic motor 1408 is operable to cause the first implant portion 1402 and the second implant portion 1404 to displace relative to one another. An external adjustment device 1410 has a control panel 1412 for input by an operator, a display 1414 and an ultrasonic transducer 1416, which is coupled to the skin 195 of the patient 191. The ultrasonic transducer 1416 produces ultrasonic waves 1418 which pass through the skin 195 of the patient 191 and operate the ultrasonic motor 1408.



FIG. 68 illustrates a non-invasively adjustable wedge osteotomy device 1700 comprising an implant 1706 having a first implant portion 1702 and a second implant portion 1704, the second implant portion 1704 non-invasively displaceable with relation to the first implant portion 1702. The first implant portion 1702 is secured to a first bone portion 197 and the second implant portion 1704 is secured to a second bone portion 199 within a patient 191. A shape memory actuator 1708 is operable to cause the first implant portion 1702 and the second implant portion 1704 to displace relative to one another. An external adjustment device 1710 has a control panel 1712 for input by an operator, a display 1714 and a transmitter 1716. The transmitter 1716 sends a control signal 1718 through the skin 195 of the patient 191 to an implanted receiver 1720. Implanted receiver 1720 communicates with the shape memory actuator 1708 via a conductor 1722. The shape memory actuator 1708 may be powered by an implantable battery, or may be powered or charged by inductive coupling.



FIG. 69 illustrates a non-invasively adjustable wedge osteotomy device 1800 comprising an implant 1806 having a first implant portion 1802 and a second implant portion 1804, the second implant portion 1804 non-invasively displaceable with relation to the first implant portion 1802. The first implant portion 1802 is secured to a first bone portion 197 and the second implant portion 1804 is secured to a second bone portion 199 within a patient 191. A hydraulic pump 1808 is operable to cause the first implant portion 1802 and the second implant portion 1804 to displace relative to one another. An external adjustment device 1810 has a control panel 1812 for input by an operator, a display 1814 and a transmitter 1816. The transmitter 1816 sends a control signal 1818 through the skin 195 of the patient 191 to an implanted receiver 1820. Implanted receiver 1820 communicates with the hydraulic pump 1808 via a conductor 1822. The hydraulic pump 1808 may be powered by an implantable battery, or may be powered or charged by inductive coupling. The hydraulic pump 1808 may alternatively be replaced by a pneumatic pump.


In one embodiment a system for changing an angle of a bone of a subject includes an adjustable actuator having an outer housing and an inner shaft, telescopically disposed in the outer housing; a magnetic assembly configured to adjust the length of the adjustable actuator though axial movement of the inner shaft and outer housing in relation to one another; a first bracket configured for coupling to the outer housing; a second bracket configured for coupling to the inner shaft; and wherein application of a moving magnetic field externally to the subject moves the magnetic assembly such that the inner shaft and the outer housing move in relation to one another.


In another embodiment, a system for changing an angle of a bone of a subject includes a magnetic assembly comprising a radially-poled magnet coupled to a shaft having external threads; a block having internal threads and coupled to the shaft, wherein rotational movement of the radially-poled magnet causes the shaft to turn and to move axially in relation to the block; an upper bone interface and a lower bone interface having an adjustable distance; and wherein axial movement of the shaft in a first direction causes the distance to increase. The upper and lower bone interfaces may be formed as part of a plate spring. The upper and lower bone interfaces may be formed as part of a plurality of interlinked plates.


In another embodiment, a system for changing an angle of a bone of a subject includes a scissors assembly comprising first and second scissor arms pivotably coupled via a hinge, the first and second scissor arms coupled, respectively, to upper and lower bone interfaces configured to move relative to one another; a hollow magnetic assembly containing an axially moveable lead screw disposed therein, wherein the hollow magnetic assembly is configured to rotate in response to a moving magnetic field and wherein said rotation translations into axial movement of the lead screw; a ratchet assembly coupled at one end to the lead screw and at another end to one of the first and second scissor arms, the ratchet assembly comprising a pawl configured to engage teeth disposed in one of the upper and lower bone interfaces; and wherein axial movement of the lead screw advances the pawl along the teeth and moves the upper and lower bone interfaces away from one another


In another embodiment, a method of preparing a tibia for implantation of an offset implant includes making a first incision in the skin of a patient at a location adjacent the tibial plateau of the tibia of the patient; creating a first cavity in the tibia by removing bone material along a first axis extending in a substantially longitudinal direction from a first point at the tibial plateau to a second point; placing an excavation device within the first cavity, the excavation device including a main elongate body and configured to excavate the tibia asymmetrically in relation to the first axis; creating a second cavity in the tibia with the excavation device, wherein the second cavity communicates with the first cavity and extends substantially towards one side of the tibia; and removing the excavation device. The second cavity may extend substantially laterally in the patient. The second cavity may extend substantially medially in the patient. The method may further include compacting a portion of the cancellous bone of the tibia in the creating a second cavity step. The excavation device may comprise an articulating arm having a first end and a second end, the arm including a compaction surface. The compaction surface may include a leading edge and at least one angled surface. The arm may be adjustable in relation to the main elongate body. The first end of the arm may be pivotally coupled to the main elongate body and the second end of the arm may be adjustable to a plurality of distances from the main elongate body. The excavation device may be coupled to an adjustment member configured to move the second end of the arm into at least one of the plurality of distances from the main elongate body. The creating a second cavity step may further comprise adjusting the adjustment member to move the second end of the arm along at least several of the plurality of distances from the main elongate body such that the compaction surface compacts cancellous bone against cortical bone. The creating a second cavity step may comprise removing bone material from the tibia. The excavation device may comprise an articulating arm having a first end and a second end, the arm including an abrading surface. The abrading surface may comprise a rasp. The arm may be adjustable in relation to the main elongate body. The first end of the arm may be pivotally coupled to the main elongate body and the second end of the arm may be adjustable to a plurality of distances from the main elongate body. The excavation device may be coupled to an adjustment member configured to move the second end of the arm into at least one of the plurality of distances from the main elongate body. The creating a second cavity step may further comprise moving the excavation device longitudinally along a bidirectional path approximating the first axis and adjusting the adjustment member to move the second end of the arm to at least one of the plurality of distances from the main elongate body such that the abrading surface removes bone material. The main elongate body may comprise a rotational cutting tool having a first end, a second end, a cutting region extending at least partially between the first end and second end, and a circumferential engagement member and the excavation device may further comprise a flexible drive train configured to engage the circumferential engagement member. The placing an excavation device step may further comprise creating a pathway through cortical bone on at least one side of the tibia, inserting the flexible drive train through a the pathway, and coupling the flexible drive train to the rotational cutting tool so that movement of the flexible drive train causes rotation of the rotational cutting tool. The creating a second cavity step may further comprise moving the circumferential engagement member of the rotational cutting tool substantially towards one side of the tibia while the rotational cutting tool is being rotated by the flexible drive train. The flexible drive train may be moved by drive unit. The rotational cutting tool may be used to create the first cavity. The rotational cutting tool may comprise a reamer. The first end of the rotational cutting tool may comprise a blunt tip. The second end of the rotational cutting tool may be coupled to a retrieval tether extending from the first incision. The retrieval tether may be coupled to the rotational cutting tool by a swivel joint. The removing step may comprise removing the rotational cutting tool by applying tension to the retrieval tether from a location external to the patient. The method may further comprise the step of creating an osteotomy between a first portion and a second portion of the tibia, wherein the flexible drive train extends through the osteotomy.


In another embodiment, a method of implanting a non-invasively adjustable system for changing an angle of the tibia of a patient includes creating an osteotomy between a first portion and a second portion of the tibia; making a first incision in the skin of the patient at a location adjacent the tibial plateau of the tibia of the patient; creating a first cavity in the tibia along a first axis extending in a substantially longitudinal direction from a first point at the tibial plateau to a second point; placing an excavation device within the first cavity, the excavation device configured to excavate the tibia asymmetrically in relation to the first axis; creating a second cavity in the tibia with the excavation device, wherein the second cavity extends substantially towards one side of the tibia; placing a non-invasively adjustable implant through the first cavity and at least partially into the second cavity, the non-invasively adjustable implant comprising an adjustable actuator having an outer housing and an inner shaft, telescopically disposed in the outer housing; coupling the outer housing to the first portion of the tibia; and coupling the inner shaft to the second portion of the tibia. The first portion may be above the osteotomy and the second portion may be below the osteotomy. The first portion may be below the osteotomy and the second portion may be above the osteotomy. The second cavity may communicate with the first cavity. The method may further comprise the step of non-invasively causing the inner shaft to move in relation to the outer housing. The non-invasively adjustable implant may comprise a driving element configured to move the inner shaft in relation to the outer housing. The driving element may be selected from the group comprising: a permanent magnet, an inductively coupled motor, an ultrasonically actuated motor, a subcutaneous hydraulic pump, a subcutaneous pneumatic pump, and a shape-memory driven actuator.


In another embodiment, a method of preparing a bone for implantation of an implant includes making a first incision in the skin of a patient; creating a first cavity in the bone by removing bone material along a first axis extending in a substantially longitudinal direction from a first point at the to a second point; placing an excavation device within the first cavity, the excavation device including a main elongate body and configured to excavate the bone asymmetrically in relation to the first axis, the excavation device further comprising an articulating arm having a first end and a second end, the arm including a compaction surface; creating a second cavity in the bone with the excavation device, wherein the second cavity communicates with the first cavity and extends substantially towards one side of the bone; and removing the excavation device.


In another embodiment, a method of preparing a bone for implantation of an implant includes making a first incision in the skin of a patient; creating a first cavity in the bone by removing bone material along a first axis extending in a substantially longitudinal direction from a first point at the to a second point; placing an excavation device within the first cavity, the excavation device including a main elongate body and configured to excavate the bone asymmetrically in relation to the first axis, the excavation device further comprising an articulating arm having a first end and a second end, the arm including an abrading surface; creating a second cavity in the bone with the excavation device, wherein the second cavity communicates with the first cavity and extends substantially towards one side of the bone; and removing the excavation device.


In another embodiment, a method of preparing a bone for implantation of an implant includes making a first incision in the skin of a patient; creating a first cavity in the bone by removing bone material along a first axis extending in a substantially longitudinal direction from a first point at the to a second point; placing an excavation device within the first cavity, the excavation device including a main elongate body and configured to excavate the bone asymmetrically in relation to the first axis, the excavation device further comprising a rotational cutting tool configured to be moved substantially towards one side of the bone while the rotational cutting tool is being rotated; creating a second cavity in the bone with the excavation device, wherein the second cavity communicates with the first cavity and extends substantially towards one side of the bone; and removing the excavation device.


In another embodiment, a system for changing an angle of a bone of a subject includes a non-invasively adjustable implant comprising an adjustable actuator having an outer housing and an inner shaft, telescopically disposed in the outer housing, the outer housing configured to couple to a first portion of the bone, and the inner shaft configured to couple to a second portion of the bone; a driving element configured to move the inner shaft in relation to the outer housing; and an excavation device including a main elongate body configured to insert within a first cavity of the bone along a first axis, the excavation device configured to excavate the bone asymmetrically in relation to the first axis to create a second cavity communicating with the first cavity, wherein the adjustable actuator is configured to be coupled to the bone at least partially within the second cavity. The driving element may be selected from the group comprising: a permanent magnet, an inductively coupled motor, an ultrasonically actuated motor, a subcutaneous hydraulic pump, a subcutaneous pneumatic pump, and a shape-memory driven actuator. The excavation device may be configured to compact cancellous bone. The excavation device may comprise an articulating arm having a first end and a second end, the arm including an abrading surface. The abrading surface may comprise a rasp. The excavation device may comprise a rotational cutting tool having a first end, a second end, a cutting region extending at least partially between the first end and second end, and a circumferential engagement member, and the excavation device may further comprise a flexible drive train configured to engage the circumferential engagement member.


In another embodiment, a system for changing an angle of a bone of a subject includes a non-invasively adjustable implant comprising an adjustable actuator having an outer housing and an inner shaft, telescopically disposed in the outer housing, the outer housing configured to couple to a first portion of the bone, and the inner shaft configured to couple to a second portion of the bone; and a driving element configured to move the inner shaft in relation to the outer housing, wherein the driving element is selected from the group comprising: a permanent magnet, an inductively coupled motor, an ultrasonically actuated motor, a subcutaneous hydraulic pump, a subcutaneous pneumatic pump, and a shape-memory driven actuator. The driving element may comprise a permanent magnet.


In another embodiment, a system for changing an angle of a tibia of a subject having osteoarthritis of the knee includes a non-invasively adjustable implant comprising an adjustable actuator having an outer housing and an inner shaft, telescopically disposed in the outer housing, the outer housing having a first transverse hole, and the inner shaft having a second transverse hole; a driving element configured to move the inner shaft in relation to the outer housing, wherein the driving element is selected from the group comprising: a permanent magnet, an inductively coupled motor, an ultrasonically actuated motor, a subcutaneous hydraulic pump, a subcutaneous pneumatic pump, and a shape-memory driven actuator; a first anchor configured to place through the first transverse hole and to couple to a first portion of the tibia; and a second anchor configured to place through the second transverse hole and to couple to a second portion of the tibia, wherein at least one of the first anchor and second anchor is configured to be pivotable in relation to the non-invasively adjustable implant when coupled to either the first portion or second portion of the tibia. The driving element may comprise a permanent magnet.


In another embodiment, a method of changing a bone angle includes creating an osteotomy between a first portion and a second portion of a tibia of a patient; creating a cavity in the tibia by removing bone material along an axis extending in a substantially longitudinal direction from a first point at the tibial plateau to a second point; placing a non-invasively adjustable implant into the cavity, the non-invasively adjustable implant comprising an adjustable actuator having an outer housing and an inner shaft, telescopically disposed in the outer housing, and a driving element configured to be remotely operable to telescopically displace the inner shaft in relation to the outer housing; coupling one of the outer housing or the inner shaft to the first portion of the tibia; coupling the other of the outer housing or the inner shaft to the second portion of the tibia; and remotely operating the driving element to telescopically displace the inner shaft in relation to the outer housing, thus changing an angle between the first portion and second portion of the tibia.


While embodiments of the present invention have been shown and described, various modifications may be made without departing from the scope of the present invention. Any of the embodiments of the non-invasively adjustable wedge osteotomy device may be used for gradual distraction (Ilizarov osteogenesis) or for acute correction of an incorrect angle. The implant itself may be used as any one of the elements of the excavation device, for example, the external portion of the implant may have features that allow it to be used as a reamer, rasp or bone compactor. As an alternative, remote adjustment described above may be replaced by manual control of any implanted part, for example manual pressure by the patient or caregiver on a button placed under the skin. The invention, therefore, should not be limited, except to the following claims, and their equivalents.


It is contemplated that various combinations or subcombinations of the specific features and aspects of the embodiments disclosed above may be made and still fall within one or more of the inventions. Further, the disclosure herein of any particular feature, aspect, method, property, characteristic, quality, attribute, element, or the like in connection with an embodiment can be used in all other embodiments set forth herein. Accordingly, it should be understood that various features and aspects of the disclosed embodiments can be combined with or substituted for one another in order to form varying modes of the disclosed inventions. Thus, it is intended that the scope of the present inventions herein disclosed should not be limited by the particular disclosed embodiments described above. Moreover, while the invention is susceptible to various modifications, and alternative forms, specific examples thereof have been shown in the drawings and are herein described in detail. It should be understood, however, that the invention is not to be limited to the particular forms or methods disclosed, but to the contrary, the invention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the various embodiments described and the appended claims. Any methods disclosed herein need not be performed in the order recited. The methods disclosed herein include certain actions taken by a practitioner; however, they can also include any third-party instruction of those actions, either expressly or by implication. For example, actions such as “inserting a bone reamer into the first portion” include “instructing the inserting of a bone reamer into the first portion.” The ranges disclosed herein also encompass any and all overlap, sub-ranges, and combinations thereof. Language such as “up to,” “at least,” “greater than,” “less than,” “between,” and the like includes the number recited. Numbers preceded by a term such as “approximately”, “about”, and “substantially” as used herein include the recited numbers, and also represent an amount close to the stated amount that still performs a desired function or achieves a desired result. For example, the terms “approximately”, “about”, and “substantially” may refer to an amount that is within less than 10% of, within less than 5% of, within less than 1% of, within less than 0.1% of, and within less than 0.01% of the stated amount.

Claims
  • 1. A method of changing a bone angle, the method comprising: creating an open wedge osteotomy between a first portion and a second portion of a tibia of a patient, wherein the first portion of the tibia remains hingedly attached to the second portion of the tibia;creating an intramedullary cavity in the tibia by removing bone material along an axis extending in a substantially longitudinal direction from a first point at a tibial plateau to a second point;placing a non-invasively adjustable implant into the intramedullary cavity, the non-invasively adjustable implant comprising: an outer housing;an inner shaft telescopically disposed within the outer housing; anda driving element configured to be remotely operable to telescopically displace the inner shaft in relation to the outer housing;coupling one of the outer housing and the inner shaft to the first portion of the tibia;coupling the other of the outer housing and the inner shaft to the second portion of the tibia; andremotely operating the driving element, to telescopically displace the inner shaft in relation to the outer housing, thus changing an angle between the first portion and second portion of the tibia.
  • 2. The method of claim 1, wherein the remotely operating step increases the angle between the first portion and second portion of the tibia.
  • 3. The method of claim 1, wherein the remotely operating step decreases the angle between the first portion and second portion of the tibia.
  • 4. The method of claim 1, wherein the remotely operating step is performed a plurality of times.
  • 5. The method of claim 4, wherein the remotely operating step is performed a plurality of times over of period of between one day and one month.
  • 6. The method of claim 4, wherein a gap (G) measured at a medial edge of the open wedge osteotomy is increased a total of between 1 mm and 20 mm during the plurality of times.
  • 7. The method of claim 6, wherein the gap (G) is increased at an average gap increase rate (GIR) of less than or equal to two millimeters per day during the plurality of times.
  • 8. The method of claim 1, wherein a gap (G) measured at a medial edge of the osteotomy is increased at a positive distance less than or equal to two millimeters during a twenty-four hour period.
  • 9. The method of claim 1, further comprising monitoring the growth of bone within the open wedge.
  • 10. The method of claim 9, wherein the step of monitoring is performed via radiography.
  • 11. The method of claim 1, further comprising allowing bone material to consolidate between the first portion and the second portion of the tibia.
  • 12. The method of claim 1, further comprising surgically removing the non-invasively adjustable implant from the tibia.
  • 13. The method of claim 1, further comprising removing the driving element from the patient.
  • 14. The method of claim 1, wherein the remotely operating step is performed with the patient awake.
  • 15. The method of claim 14, wherein an amount chosen to telescopically displace the inner shaft is at least partially determined by interpreting feedback from the awake patient.
  • 16. The method of claim 1, wherein the driving element is selected from the group comprising: a permanent magnet, an inductively coupled motor, an ultrasonically actuated motor, a subcutaneous hydraulic pump, a subcutaneous pneumatic pump, and a shape-memory driven actuator.
  • 17. The method of claim 16, wherein the driving element comprises a permanent magnet.
  • 18. The method of claim 17, wherein the permanent magnet is a radially poled rare earth magnet.
  • 19. The method of claim 17, wherein the remotely operating step further comprises placing an external adjustment device capable of causing a moving magnetic field in the proximity of the patient and causing the permanent magnet to rotate.
  • 20. The method of claim 17, wherein the outer housing comprises a bend projecting a first end at an angle in relation to a central axis of the non-invasively adjustable implant.
CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No. 14/379,742 filed on Aug. 19, 2014, a National Stage Entry of International Application No. PCT/US/2013/067142 filed on Oct. 28, 2013 which claims priority under 35 U.S.C. § 119(c) to the U.S. Provisional Application Ser. No. 61/868,535 filed on Aug. 21, 2013, entitled “Adjustable Devices For Treating Arthritis Of The Knee,” and to U.S. Provisional Application Ser. No. 61/719,887 filed on Oct. 29, 2012, entitled “Adjustable Devices For Treating Arthritis Or The Knee,” the contents of all of which are incorporated herein by reference in their entireties.

US Referenced Citations (1279)
Number Name Date Kind
1599538 Ludger Sep 1926 A
3111945 Von Nov 1963 A
3372476 Richard et al. Mar 1968 A
3377576 Edwin et al. Apr 1968 A
3397928 Galle Aug 1968 A
3512901 Law May 1970 A
3527220 Summers Sep 1970 A
3597781 Eibes et al. Aug 1971 A
3726279 Barefoot et al. Apr 1973 A
3749098 De Bennetot Jul 1973 A
3750194 Summers Aug 1973 A
3810259 Summers May 1974 A
3840018 Heifetz Oct 1974 A
3866510 Eibes et al. Feb 1975 A
3900025 Barnes, Jr. Aug 1975 A
3915151 Kraus Oct 1975 A
RE28907 Eibes et al. Jul 1976 E
3976060 Hildebrandt et al. Aug 1976 A
4010758 Rockland et al. Mar 1977 A
4056743 Clifford et al. Nov 1977 A
4068821 Morrison Jan 1978 A
4078559 Nissinen Mar 1978 A
4118805 Reimels Oct 1978 A
4204541 Kapitanov May 1980 A
4222374 Sampson et al. Sep 1980 A
4235246 Weiss Nov 1980 A
4256094 Kapp et al. Mar 1981 A
4286584 Sampson et al. Sep 1981 A
4300223 Make Nov 1981 A
4357946 Dutcher et al. Nov 1982 A
4386603 Mayfield Jun 1983 A
4395259 Prestele et al. Jul 1983 A
4448191 Rodnyansky et al. May 1984 A
4486176 Tardieu et al. Dec 1984 A
4501266 McDaniel Feb 1985 A
4522501 Shannon Jun 1985 A
4537520 Ochiai et al. Aug 1985 A
4550279 Klein Oct 1985 A
4561798 Elcrin et al. Dec 1985 A
4573454 Hoffman Mar 1986 A
4592339 Kuzmak et al. Jun 1986 A
4592355 Antebi Jun 1986 A
4595007 Mericle Jun 1986 A
4642257 Chase Feb 1987 A
4658809 Ulrich et al. Apr 1987 A
4696288 Kuzmak et al. Sep 1987 A
4700091 Wuthrich Oct 1987 A
4747832 Buffet May 1988 A
4760837 Petit Aug 1988 A
4854304 Zielke Aug 1989 A
4872515 Lundell Oct 1989 A
4904861 Epstein et al. Feb 1990 A
4931055 Bumpus et al. Jun 1990 A
4940467 Tronzo Jul 1990 A
4957495 Kluger Sep 1990 A
4973331 Pursley et al. Nov 1990 A
4978323 Freedman Dec 1990 A
4998013 Epstein et al. Mar 1991 A
5010879 Moriya et al. Apr 1991 A
5025183 Fuschetto Jun 1991 A
5030235 Campbell, Jr. Jul 1991 A
5041112 Mingozzi et al. Aug 1991 A
5053047 Yoon Oct 1991 A
5064004 Lundell Nov 1991 A
5074868 Kuzmak Dec 1991 A
5074882 Grammont et al. Dec 1991 A
5092889 Campbell, Jr. Mar 1992 A
5133716 Plaza Jul 1992 A
5142407 Varaprasad et al. Aug 1992 A
5152770 Bengmark et al. Oct 1992 A
5156605 Pursley et al. Oct 1992 A
5176618 Freedman Jan 1993 A
5180380 Pursley et al. Jan 1993 A
5222976 Yoon Jun 1993 A
5226429 Kuzmak Jul 1993 A
5261908 Campbell, Jr. Nov 1993 A
5263955 Baumgart et al. Nov 1993 A
5290289 Sanders et al. Mar 1994 A
5306275 Bryan Apr 1994 A
5330503 Yoon Jul 1994 A
5334202 Carter Aug 1994 A
5336223 Rogers Aug 1994 A
5356411 Spievack Oct 1994 A
5356424 Buzerak et al. Oct 1994 A
5360407 Leonard et al. Nov 1994 A
5364396 Robinson et al. Nov 1994 A
5381943 Allen et al. Jan 1995 A
5399168 Wadsworth, Jr. et al. Mar 1995 A
5403322 Herzenberg et al. Apr 1995 A
5429638 Muschler et al. Jul 1995 A
5433721 Hooven et al. Jul 1995 A
5437266 McPherson et al. Aug 1995 A
5449368 Kuzmak Sep 1995 A
5466261 Richelsoph Nov 1995 A
5468030 Walling Nov 1995 A
5480437 Draenert Jan 1996 A
5498262 Bryan Mar 1996 A
5509888 Miller Apr 1996 A
5516335 Kummer et al. May 1996 A
5527309 Shelton Jun 1996 A
5536269 Spievack Jul 1996 A
5536296 Ten Eyck et al. Jul 1996 A
5549610 Russell et al. Aug 1996 A
5573496 McPherson et al. Nov 1996 A
5575790 Chen et al. Nov 1996 A
5582616 Bolduc et al. Dec 1996 A
5601224 Bishop et al. Feb 1997 A
5620445 Brosnahan et al. Apr 1997 A
5620449 Faccioli et al. Apr 1997 A
5626579 Muschler et al. May 1997 A
5626613 Schmieding May 1997 A
5628888 Bakhir et al. May 1997 A
5632744 Campbell, Jr. May 1997 A
5659217 Petersen Aug 1997 A
5662683 Kay Sep 1997 A
5672175 Martin Sep 1997 A
5672177 Seldin Sep 1997 A
5676162 Larson, Jr. et al. Oct 1997 A
5693091 Larson, Jr. et al. Dec 1997 A
5700263 Schendel Dec 1997 A
5702430 Larson, Jr. et al. Dec 1997 A
5704893 Timm Jan 1998 A
5704938 Staehlin et al. Jan 1998 A
5704939 Justin Jan 1998 A
5720746 Soubeiran Feb 1998 A
5722429 Larson, Jr. et al. Mar 1998 A
5722930 Larson, Jr. et al. Mar 1998 A
5743910 Bays et al. Apr 1998 A
5758666 Larson, Jr. et al. Jun 1998 A
5762599 Sohn Jun 1998 A
5766208 McEwan Jun 1998 A
5771903 Jakobsson Jun 1998 A
5800434 Campbell, Jr. Sep 1998 A
5810815 Morales Sep 1998 A
5824008 Bolduc et al. Oct 1998 A
5827286 Incavo Oct 1998 A
5829662 Allen et al. Nov 1998 A
5830221 Stein et al. Nov 1998 A
5843129 Larson, Jr. et al. Dec 1998 A
5874796 Petersen Feb 1999 A
5879375 Larson, Jr. et al. Mar 1999 A
5902304 Walker et al. May 1999 A
5935127 Border Aug 1999 A
5938669 Klaiber et al. Aug 1999 A
5945762 Chen et al. Aug 1999 A
5954915 Voorhees et al. Sep 1999 A
5961553 Coty et al. Oct 1999 A
5964763 Incavo et al. Oct 1999 A
5976138 Baumgart et al. Nov 1999 A
5979456 Magovern Nov 1999 A
5985110 Bakhir et al. Nov 1999 A
5997490 McLeod et al. Dec 1999 A
6009837 McClasky Jan 2000 A
6022349 McLeod et al. Feb 2000 A
6033412 Losken et al. Mar 2000 A
6034296 Elvin et al. Mar 2000 A
6067991 Forsell May 2000 A
6074341 Anderson et al. Jun 2000 A
6074882 Eckardt Jun 2000 A
6092531 Chen et al. Jul 2000 A
6102922 Jakobsson et al. Aug 2000 A
6106525 Sachse Aug 2000 A
6126660 Dietz Oct 2000 A
6126661 Faccioli et al. Oct 2000 A
6138681 Chen et al. Oct 2000 A
6139316 Sachdeva et al. Oct 2000 A
6162223 Orsak et al. Dec 2000 A
6183476 Gerhardt et al. Feb 2001 B1
6200317 Aalsma et al. Mar 2001 B1
6210347 Forsell Apr 2001 B1
6217847 Contag et al. Apr 2001 B1
6221074 Cole et al. Apr 2001 B1
6234299 Voorhees et al. May 2001 B1
6234956 He et al. May 2001 B1
6241730 Alby Jun 2001 B1
6245075 Betz et al. Jun 2001 B1
6283156 Motley Sep 2001 B1
6296643 Hopf et al. Oct 2001 B1
6296656 Bolduc et al. Oct 2001 B1
6299613 Ogilvie et al. Oct 2001 B1
6315784 Djurovic Nov 2001 B1
6319255 Grundei et al. Nov 2001 B1
6321106 Lemelson Nov 2001 B1
6325805 Ogilvie et al. Dec 2001 B1
6327492 Lemelson Dec 2001 B1
6331744 Chen et al. Dec 2001 B1
6336929 Justin Jan 2002 B1
6343568 McClasky Feb 2002 B1
6358283 Hogfors et al. Mar 2002 B1
6375682 Fleischmann et al. Apr 2002 B1
6386083 Hwang May 2002 B1
6389187 Greenaway et al. May 2002 B1
6400980 Lemelson Jun 2002 B1
6402753 Cole et al. Jun 2002 B1
6409175 Evans et al. Jun 2002 B1
6416516 Stauch et al. Jul 2002 B1
6417750 Sohn Jul 2002 B1
6423061 Bryant Jul 2002 B1
6432040 Meah Aug 2002 B1
6450173 Forsell Sep 2002 B1
6450946 Forsell Sep 2002 B1
6453907 Forsell Sep 2002 B1
6454698 Forsell Sep 2002 B1
6454699 Forsell Sep 2002 B1
6454700 Forsell Sep 2002 B1
6454701 Forsell Sep 2002 B1
6460543 Forsell Oct 2002 B1
6461292 Forsell Oct 2002 B1
6461293 Forsell Oct 2002 B1
6463935 Forsell Oct 2002 B1
6464628 Forsell Oct 2002 B1
6470892 Forsell Oct 2002 B1
6471635 Forsell Oct 2002 B1
6475136 Forsell Nov 2002 B1
6482145 Forsell Nov 2002 B1
6494879 Lennox et al. Dec 2002 B2
6499907 Baur Dec 2002 B1
6500110 Davey et al. Dec 2002 B1
6503189 Forsell Jan 2003 B1
6508820 Bales Jan 2003 B2
6510345 Van Bentem Jan 2003 B1
6511490 Robert Jan 2003 B2
6527701 Sayet et al. Mar 2003 B1
6527702 Whalen et al. Mar 2003 B2
6536499 Voorhees et al. Mar 2003 B2
6537196 Creighton, IV et al. Mar 2003 B1
6547801 Dargent et al. Apr 2003 B1
6554831 Rivard et al. Apr 2003 B1
6558400 Deem et al. May 2003 B2
6562051 Bolduc et al. May 2003 B1
6565573 Ferrante et al. May 2003 B1
6565576 Stauch et al. May 2003 B1
6573706 Mendes et al. Jun 2003 B2
6582313 Perrow Jun 2003 B2
6583630 Mendes et al. Jun 2003 B2
6587719 Barrett et al. Jul 2003 B1
6595912 Lau et al. Jul 2003 B2
6602184 Lau et al. Aug 2003 B2
6604529 Kim Aug 2003 B2
6607363 Domroese Aug 2003 B1
6609025 Barrett et al. Aug 2003 B2
6612978 Lau et al. Sep 2003 B2
6612979 Lau et al. Sep 2003 B2
6616669 Ogilvie et al. Sep 2003 B2
6621956 Greenaway et al. Sep 2003 B2
6626899 Houser et al. Sep 2003 B2
6626917 Craig Sep 2003 B1
6627206 Lloyd Sep 2003 B2
6649143 Contag et al. Nov 2003 B1
6656135 Zogbi et al. Dec 2003 B2
6656194 Gannoe et al. Dec 2003 B1
6657351 Chen et al. Dec 2003 B2
6667725 Simons et al. Dec 2003 B1
6669687 Saadat Dec 2003 B1
6673079 Kane Jan 2004 B1
6676674 Dudai Jan 2004 B1
6682474 Lau et al. Jan 2004 B2
6689046 Sayet et al. Feb 2004 B2
6702732 Lau et al. Mar 2004 B1
6702816 Buhler Mar 2004 B2
6706042 Taylor Mar 2004 B2
6709293 Mori et al. Mar 2004 B2
6709385 Forsell Mar 2004 B2
6730087 Butsch May 2004 B1
6749556 Banik Jun 2004 B2
6752754 Feng et al. Jun 2004 B1
6761503 Breese Jul 2004 B2
6765330 Baur Jul 2004 B2
6769499 Cargill et al. Aug 2004 B2
6773437 Ogilvie et al. Aug 2004 B2
6774624 Anderson et al. Aug 2004 B2
6789442 Forch Sep 2004 B2
6796984 Soubeiran Sep 2004 B2
6802844 Ferree Oct 2004 B2
6802847 Carson et al. Oct 2004 B1
6809434 Duncan et al. Oct 2004 B1
6835183 Lennox et al. Dec 2004 B2
6835207 Zacouto et al. Dec 2004 B2
6849076 Blunn et al. Feb 2005 B2
6852113 Nathanson et al. Feb 2005 B2
6864647 Duncan et al. Mar 2005 B2
6884248 Bolduc et al. Apr 2005 B2
6890515 Contag et al. May 2005 B2
6908605 Contag et al. Jun 2005 B2
6915165 Forsell Jul 2005 B2
6916462 Contag et al. Jul 2005 B2
6918838 Schwarzler et al. Jul 2005 B2
6918910 Smith et al. Jul 2005 B2
6921360 Banik Jul 2005 B2
6921400 Sohngen Jul 2005 B2
6923951 Contag et al. Aug 2005 B2
6926719 Sohngen et al. Aug 2005 B2
6939533 Contag et al. Sep 2005 B2
6953429 Forsell Oct 2005 B2
6961553 Zhao et al. Nov 2005 B2
6971143 Domroese Dec 2005 B2
6980921 Anderson et al. Dec 2005 B2
6997952 Furukawa et al. Feb 2006 B2
7001327 Whalen et al. Feb 2006 B2
7001346 White Feb 2006 B2
7008425 Phillips Mar 2006 B2
7011621 Sayet et al. Mar 2006 B2
7011658 Young Mar 2006 B2
7011682 Lashinski et al. Mar 2006 B2
7018380 Cole Mar 2006 B2
7029475 Panjabi Apr 2006 B2
7041105 Michelson May 2006 B2
7060075 Govari et al. Jun 2006 B2
7060080 Bachmann Jun 2006 B2
7063706 Wittenstein Jun 2006 B2
7077802 Lau et al. Jul 2006 B2
7081086 Lau et al. Jul 2006 B2
7083629 Weller et al. Aug 2006 B2
7096148 Anderson et al. Aug 2006 B2
7097611 Lau et al. Aug 2006 B2
7105029 Doubler et al. Sep 2006 B2
7105968 Nissen Sep 2006 B2
7114501 Johnson et al. Oct 2006 B2
7115129 Heggeness Oct 2006 B2
7115130 Michelson Oct 2006 B2
7124493 Lau et al. Oct 2006 B2
7128707 Banik Oct 2006 B2
7135022 Kosashvili et al. Nov 2006 B2
7160312 Saadat Jan 2007 B2
7163538 Altarac et al. Jan 2007 B2
7172607 Hofle et al. Feb 2007 B2
7175589 Deem et al. Feb 2007 B2
7175660 Cartledge et al. Feb 2007 B2
7186262 Saadat Mar 2007 B2
7188627 Nelson et al. Mar 2007 B2
7189005 Ward Mar 2007 B2
7189202 Lau et al. Mar 2007 B2
7189251 Kay Mar 2007 B2
7191007 Desai et al. Mar 2007 B2
7194297 Talpade et al. Mar 2007 B2
7195608 Burnett Mar 2007 B2
7198774 Contag et al. Apr 2007 B2
7211094 Gannoe et al. May 2007 B2
7216648 Nelson et al. May 2007 B2
7217284 Houser et al. May 2007 B2
7218232 DiSilvestro et al. May 2007 B2
7232449 Sharkawy et al. Jun 2007 B2
7234468 Johnson et al. Jun 2007 B2
7234544 Kent Jun 2007 B2
7238152 Lau et al. Jul 2007 B2
7238191 Bachmann Jul 2007 B2
7241300 Sharkawy et al. Jul 2007 B2
7243719 Baron et al. Jul 2007 B2
7255682 Bartol, Jr. et al. Aug 2007 B1
7255714 Malek Aug 2007 B2
7255851 Contag et al. Aug 2007 B2
7276022 Lau et al. Oct 2007 B2
7282023 Frering Oct 2007 B2
7285087 Moaddeb et al. Oct 2007 B2
7288064 Boustani et al. Oct 2007 B2
7288099 Deem et al. Oct 2007 B2
7288101 Deem et al. Oct 2007 B2
7296577 Lashinski et al. Nov 2007 B2
7297150 Cartledge et al. Nov 2007 B2
7299091 Barrett et al. Nov 2007 B2
7302858 Walsh et al. Dec 2007 B2
7306614 Weller et al. Dec 2007 B2
7311690 Burnett Dec 2007 B2
7314372 Belfor et al. Jan 2008 B2
7314443 Jordan et al. Jan 2008 B2
7320706 Al-Najjar Jan 2008 B2
7331995 Eisermann et al. Feb 2008 B2
7333013 Berger Feb 2008 B2
7338433 Coe Mar 2008 B2
7340306 Barrett et al. Mar 2008 B2
7351198 Byrum et al. Apr 2008 B2
7351240 Hassler, Jr. et al. Apr 2008 B2
7353747 Swayze et al. Apr 2008 B2
7357037 Hnat et al. Apr 2008 B2
7357635 Belfor et al. Apr 2008 B2
7360542 Nelson et al. Apr 2008 B2
7361192 Doty Apr 2008 B2
7364542 Jambor et al. Apr 2008 B2
7364589 Eisermann Apr 2008 B2
7367340 Nelson et al. May 2008 B2
7367937 Jambor et al. May 2008 B2
7367938 Forsell May 2008 B2
7371244 Chatlynne et al. May 2008 B2
7374557 Conlon et al. May 2008 B2
7390007 Helms et al. Jun 2008 B2
7390294 Hassler, Jr. Jun 2008 B2
7400926 Forsell Jul 2008 B2
7402134 Moaddeb et al. Jul 2008 B2
7402176 Malek Jul 2008 B2
7410461 Lau et al. Aug 2008 B2
7416528 Crawford et al. Aug 2008 B2
7422566 Miethke Sep 2008 B2
7429259 Cadeddu et al. Sep 2008 B2
7431692 Zollinger et al. Oct 2008 B2
7441559 Nelson et al. Oct 2008 B2
7442196 Fisher et al. Oct 2008 B2
7445010 Kugler et al. Nov 2008 B2
7455690 Cartledge et al. Nov 2008 B2
7458981 Fielding et al. Dec 2008 B2
7468060 Utley et al. Dec 2008 B2
7476195 Sayet et al. Jan 2009 B2
7476238 Panjabi Jan 2009 B2
7481224 Nelson et al. Jan 2009 B2
7481763 Hassler, Jr. et al. Jan 2009 B2
7481841 Hazebrouck et al. Jan 2009 B2
7485149 White Feb 2009 B1
7489495 Stevenson Feb 2009 B2
7494459 Anstadt et al. Feb 2009 B2
7500484 Nelson et al. Mar 2009 B2
7503922 Deem et al. Mar 2009 B2
7503934 Eisermann et al. Mar 2009 B2
7507252 Lashinski et al. Mar 2009 B2
7510559 Deem et al. Mar 2009 B2
7530981 Kutsenko May 2009 B2
7531002 Sutton et al. May 2009 B2
7547291 Lennox et al. Jun 2009 B2
7553298 Hunt et al. Jun 2009 B2
7559951 DiSilvestro et al. Jul 2009 B2
7561916 Hunt et al. Jul 2009 B2
7562660 Saadat Jul 2009 B2
7566297 Banik Jul 2009 B2
7569057 Liu et al. Aug 2009 B2
7578821 Fisher et al. Aug 2009 B2
7584788 Baron et al. Sep 2009 B2
7594887 Moaddeb et al. Sep 2009 B2
7601156 Robinson Oct 2009 B2
7601162 Hassler, Jr. et al. Oct 2009 B2
7601171 Ainsworth et al. Oct 2009 B2
7611526 Carl et al. Nov 2009 B2
7615001 Jambor et al. Nov 2009 B2
7615068 Timm et al. Nov 2009 B2
7618435 Opolski Nov 2009 B2
7621886 Burnett Nov 2009 B2
7635379 Callahan et al. Dec 2009 B2
7651483 Byrum et al. Jan 2010 B2
7658753 Carl et al. Feb 2010 B2
7666132 Forsell Feb 2010 B2
7666184 Stauch Feb 2010 B2
7666210 Franck et al. Feb 2010 B2
7678136 Doubler et al. Mar 2010 B2
7678139 Garamszegi et al. Mar 2010 B2
7691144 Chang et al. Apr 2010 B2
7695512 Lashinski et al. Apr 2010 B2
7704279 Moskowitz et al. Apr 2010 B2
7704282 Disilvestro et al. Apr 2010 B2
7708737 Kraft et al. May 2010 B2
7708762 McCarthy et al. May 2010 B2
7708765 Carl et al. May 2010 B2
7708779 Edie et al. May 2010 B2
7713287 Timm et al. May 2010 B2
7717959 William et al. May 2010 B2
7727141 Hassler, Jr. et al. Jun 2010 B2
7727143 Birk et al. Jun 2010 B2
7749224 Cresina et al. Jul 2010 B2
7753913 Szakelyhidi, Jr. et al. Jul 2010 B2
7753915 Eksler et al. Jul 2010 B1
7757552 Bogath et al. Jul 2010 B2
7762998 Birk et al. Jul 2010 B2
7763053 Gordon Jul 2010 B2
7763080 Southworth Jul 2010 B2
7766815 Ortiz Aug 2010 B2
7775099 Bogath et al. Aug 2010 B2
7775215 Hassler, Jr. et al. Aug 2010 B2
7776061 Garner et al. Aug 2010 B2
7776068 Ainsworth et al. Aug 2010 B2
7776075 Bruneau et al. Aug 2010 B2
7776091 Mastrorio et al. Aug 2010 B2
7780590 Birk et al. Aug 2010 B2
7787958 Stevenson Aug 2010 B2
7789912 Manzi et al. Sep 2010 B2
7793583 Radinger et al. Sep 2010 B2
7794447 Dann et al. Sep 2010 B2
7794476 Wisnewski Sep 2010 B2
7798954 Birk et al. Sep 2010 B2
7799080 Doty Sep 2010 B2
7803106 Whalen et al. Sep 2010 B2
7803157 Michelson Sep 2010 B2
7811275 Birk et al. Oct 2010 B2
7811298 Birk Oct 2010 B2
7811328 Molz, IV et al. Oct 2010 B2
7815643 Johnson et al. Oct 2010 B2
7828714 Feng et al. Nov 2010 B2
7828813 Mouton Nov 2010 B2
7833228 Hershberger Nov 2010 B1
7835779 Anderson et al. Nov 2010 B2
7837669 Dann et al. Nov 2010 B2
7837691 Cordes et al. Nov 2010 B2
7842036 Phillips Nov 2010 B2
7845356 Paraschac et al. Dec 2010 B2
7846188 Moskowitz et al. Dec 2010 B2
7850660 Uth et al. Dec 2010 B2
7850735 Eisermann et al. Dec 2010 B2
7854769 Hershberger Dec 2010 B2
7862546 Conlon et al. Jan 2011 B2
7862574 Deem et al. Jan 2011 B2
7862586 Malek Jan 2011 B2
7867235 Fell et al. Jan 2011 B2
7871368 Zollinger et al. Jan 2011 B2
7875033 Richter et al. Jan 2011 B2
7887566 Hynes Feb 2011 B2
7901381 Birk et al. Mar 2011 B2
7901419 Bachmann et al. Mar 2011 B2
7909790 Burnett Mar 2011 B2
7909838 Deem et al. Mar 2011 B2
7909839 Fields Mar 2011 B2
7909852 Boomer et al. Mar 2011 B2
7918844 Byrum et al. Apr 2011 B2
7921850 Nelson et al. Apr 2011 B2
7922765 Reiley Apr 2011 B2
7927354 Edidin et al. Apr 2011 B2
7927357 Sacher et al. Apr 2011 B2
7931679 Heggeness Apr 2011 B2
7932825 Berger Apr 2011 B2
7938836 Ainsworth et al. May 2011 B2
7938841 Sharkawy et al. May 2011 B2
7942903 Moskowitz et al. May 2011 B2
7942908 Sacher et al. May 2011 B2
7947011 Birk et al. May 2011 B2
7951067 Byrum et al. May 2011 B2
7951180 Moskowitz et al. May 2011 B2
7958895 Nelson et al. Jun 2011 B2
7958896 Nelson et al. Jun 2011 B2
7959552 Jordan et al. Jun 2011 B2
7972315 Birk et al. Jul 2011 B2
7972346 Bachmann et al. Jul 2011 B2
7972363 Moskowitz et al. Jul 2011 B2
7976545 Hershberger et al. Jul 2011 B2
7983763 Stevenson et al. Jul 2011 B2
7985256 Grotz et al. Jul 2011 B2
7987241 St Jacques, Jr. et al. Jul 2011 B2
7988707 Panjabi Aug 2011 B2
7988709 Clark et al. Aug 2011 B2
7993342 Malandain et al. Aug 2011 B2
7993397 Lashinski et al. Aug 2011 B2
7998174 Malandain et al. Aug 2011 B2
7998208 Kohm et al. Aug 2011 B2
8002801 Carl et al. Aug 2011 B2
8002809 Baynham Aug 2011 B2
8007458 Lennox et al. Aug 2011 B2
8007474 Uth et al. Aug 2011 B2
8007479 Birk et al. Aug 2011 B2
8011308 Picchio Sep 2011 B2
8012162 Bachmann Sep 2011 B2
8016745 Hassler, Jr. et al. Sep 2011 B2
8016837 Giger et al. Sep 2011 B2
8016860 Carl et al. Sep 2011 B2
8026729 Kroh et al. Sep 2011 B2
8029477 Byrum et al. Oct 2011 B2
8029507 Green et al. Oct 2011 B2
8029567 Edidin et al. Oct 2011 B2
8034080 Malandain et al. Oct 2011 B2
8037871 McClendon Oct 2011 B2
8038680 Ainsworth et al. Oct 2011 B2
8038698 Edidin et al. Oct 2011 B2
8043206 Birk Oct 2011 B2
8043290 Harrison et al. Oct 2011 B2
8043299 Conway Oct 2011 B2
8043338 Dant Oct 2011 B2
8043345 Carl et al. Oct 2011 B2
8048169 Burnett et al. Nov 2011 B2
8057473 Orsak et al. Nov 2011 B2
8057513 Kohm et al. Nov 2011 B2
8066650 Lee et al. Nov 2011 B2
8070670 Deem et al. Dec 2011 B2
8070671 Deem et al. Dec 2011 B2
8070695 Gupta et al. Dec 2011 B2
8070813 Grotz et al. Dec 2011 B2
8074654 Paraschac et al. Dec 2011 B2
8075577 Deem et al. Dec 2011 B2
8079974 Stergiopulos Dec 2011 B2
8079989 Birk et al. Dec 2011 B2
8080022 Deem et al. Dec 2011 B2
8080025 Deem et al. Dec 2011 B2
8088166 Makower et al. Jan 2012 B2
8092459 Malandain Jan 2012 B2
8092499 Roth Jan 2012 B1
8095317 Ekseth et al. Jan 2012 B2
8096302 Nelson et al. Jan 2012 B2
8096938 Forsell Jan 2012 B2
8096995 Kohm et al. Jan 2012 B2
8097018 Malandain et al. Jan 2012 B2
8097038 Malek Jan 2012 B2
8100819 Banik Jan 2012 B2
8100943 Malandain et al. Jan 2012 B2
8100967 Makower et al. Jan 2012 B2
8105360 Connor Jan 2012 B1
8105363 Fielding et al. Jan 2012 B2
8105364 McCarthy et al. Jan 2012 B2
8109974 Boomer et al. Feb 2012 B2
8114158 Carl et al. Feb 2012 B2
8123765 Deem et al. Feb 2012 B2
8123805 Makower et al. Feb 2012 B2
8128628 Freid et al. Mar 2012 B2
8133280 Voellmicke et al. Mar 2012 B2
8137349 Soubeiran Mar 2012 B2
8137366 Deem et al. Mar 2012 B2
8137367 Deem et al. Mar 2012 B2
8142454 Harrison et al. Mar 2012 B2
8142494 Randert et al. Mar 2012 B2
8147517 Trieu et al. Apr 2012 B2
8147549 Metcalf, Jr. et al. Apr 2012 B2
8157841 Malandain et al. Apr 2012 B2
8162897 Byrum Apr 2012 B2
8162979 Sachs et al. Apr 2012 B2
8163013 Machold et al. Apr 2012 B2
8177789 Magill et al. May 2012 B2
8182411 Dlugos May 2012 B2
8187324 Webler et al. May 2012 B2
8197544 Manzi et al. Jun 2012 B1
8202305 Reiley Jun 2012 B2
8211127 Uth et al. Jul 2012 B2
8211149 Justis Jul 2012 B2
8211151 Schwab et al. Jul 2012 B2
8211179 Molz, IV et al. Jul 2012 B2
8216275 Fielding et al. Jul 2012 B2
8221420 Keller Jul 2012 B2
8226690 Altarac et al. Jul 2012 B2
8236002 Fortin et al. Aug 2012 B2
8241292 Collazo Aug 2012 B2
8241293 Stone et al. Aug 2012 B2
8241331 Arnin Aug 2012 B2
8246630 Manzi et al. Aug 2012 B2
8251888 Roslin et al. Aug 2012 B2
8252063 Stauch Aug 2012 B2
8257370 Moskowitz et al. Sep 2012 B2
8257442 Edie et al. Sep 2012 B2
8263024 Wan et al. Sep 2012 B2
8267969 Altarac et al. Sep 2012 B2
8273112 Garamszegi et al. Sep 2012 B2
8278941 Kroh et al. Oct 2012 B2
8282671 Connor Oct 2012 B2
8287540 LeCronier et al. Oct 2012 B2
8298133 Wiley et al. Oct 2012 B2
8298240 Giger et al. Oct 2012 B2
8308779 Reiley Nov 2012 B2
8313423 Forsell Nov 2012 B2
8316856 Nelson et al. Nov 2012 B2
8317761 Birk et al. Nov 2012 B2
8317802 Manzi et al. Nov 2012 B1
8323290 Metzger et al. Dec 2012 B2
8326435 Stevenson Dec 2012 B2
8328807 Brigido Dec 2012 B2
8328854 Baynham et al. Dec 2012 B2
8333204 Saadat Dec 2012 B2
8333790 Timm et al. Dec 2012 B2
8353913 Moskowitz et al. Jan 2013 B2
8357169 Henniges et al. Jan 2013 B2
8357182 Seme Jan 2013 B2
8357183 Seme et al. Jan 2013 B2
8360955 Sayet et al. Jan 2013 B2
8366628 Denker et al. Feb 2013 B2
8372078 Collazo Feb 2013 B2
8382652 Sayet et al. Feb 2013 B2
8382756 Pool et al. Feb 2013 B2
8386018 Stauch et al. Feb 2013 B2
8388667 Reiley et al. Mar 2013 B2
8394124 Biyani Mar 2013 B2
8394143 Grotz et al. Mar 2013 B2
8403958 Schwab Mar 2013 B2
8409203 Birk et al. Apr 2013 B2
8409281 Makower et al. Apr 2013 B2
8414584 Brigido Apr 2013 B2
8414648 Reiley Apr 2013 B2
8419755 Deem et al. Apr 2013 B2
8419801 DiSilvestro et al. Apr 2013 B2
8425570 Reiley Apr 2013 B2
8425608 Dewey et al. Apr 2013 B2
8433519 Ekseth et al. Apr 2013 B2
8435268 Thompson et al. May 2013 B2
8439915 Harrison et al. May 2013 B2
8439926 Bojarski et al. May 2013 B2
8444693 Reiley May 2013 B2
8449543 Pool et al. May 2013 B2
8449553 Kam et al. May 2013 B2
8449580 Voellmicke et al. May 2013 B2
8454695 Grotz et al. Jun 2013 B2
8469908 Asfora Jun 2013 B2
8469978 Fobi et al. Jun 2013 B2
8470003 Voellmicke et al. Jun 2013 B2
8470004 Reiley Jun 2013 B2
8475354 Phillips et al. Jul 2013 B2
8475356 Feng et al. Jul 2013 B2
8475499 Cournoyer et al. Jul 2013 B2
8480554 Phillips et al. Jul 2013 B2
8480668 Fernandez et al. Jul 2013 B2
8480741 Grotz et al. Jul 2013 B2
8486070 Morgan et al. Jul 2013 B2
8486076 Chavarria et al. Jul 2013 B2
8486110 Fielding et al. Jul 2013 B2
8486113 Malek Jul 2013 B2
8486147 de Villiers et al. Jul 2013 B2
8491589 Fisher et al. Jul 2013 B2
8494805 Roche et al. Jul 2013 B2
8496662 Novak et al. Jul 2013 B2
8500810 Mastrorio et al. Aug 2013 B2
8506517 Stergiopulos Aug 2013 B2
8506569 Keefer et al. Aug 2013 B2
8517973 Burnett Aug 2013 B2
8518062 Cole et al. Aug 2013 B2
8518086 Seme et al. Aug 2013 B2
8522790 Nelson et al. Sep 2013 B2
8523865 Reglos et al. Sep 2013 B2
8523866 Sidebotham et al. Sep 2013 B2
8523883 Saadat Sep 2013 B2
8529474 Gupta et al. Sep 2013 B2
8529606 Alamin et al. Sep 2013 B2
8529607 Alamin et al. Sep 2013 B2
8529630 Bojarski et al. Sep 2013 B2
8545384 Forsell Oct 2013 B2
8545508 Collazo Oct 2013 B2
8545814 Contag et al. Oct 2013 B2
8551092 Morgan et al. Oct 2013 B2
8551142 Altarac et al. Oct 2013 B2
8551422 Wan et al. Oct 2013 B2
8556901 Anthony et al. Oct 2013 B2
8556911 Mehta et al. Oct 2013 B2
8556975 Ciupik et al. Oct 2013 B2
8562653 Alamin et al. Oct 2013 B2
8568416 Schmitz et al. Oct 2013 B2
8568457 Hunziker Oct 2013 B2
8574267 Linares Nov 2013 B2
8579919 Bolduc et al. Nov 2013 B2
8579979 Edie et al. Nov 2013 B2
8585595 Heilman Nov 2013 B2
8585702 Orsak et al. Nov 2013 B2
8585738 Linares Nov 2013 B2
8585740 Ross et al. Nov 2013 B1
8591549 Lange Nov 2013 B2
8597362 Shenoy et al. Dec 2013 B2
8613749 Deem et al. Dec 2013 B2
8613758 Linares Dec 2013 B2
8617212 Linares Dec 2013 B2
8617220 Skaggs Dec 2013 B2
8617243 Eisermann et al. Dec 2013 B2
8622936 Schenberger et al. Jan 2014 B2
8623036 Harrison et al. Jan 2014 B2
8623042 Roslin et al. Jan 2014 B2
8623056 Linares Jan 2014 B2
8632544 Haaja et al. Jan 2014 B2
8632547 Maxson et al. Jan 2014 B2
8632548 Soubeiran Jan 2014 B2
8632563 Nagase et al. Jan 2014 B2
8632594 Williams et al. Jan 2014 B2
8636770 Hestad et al. Jan 2014 B2
8636771 Butler et al. Jan 2014 B2
8636802 Serhan et al. Jan 2014 B2
8641719 Gephart et al. Feb 2014 B2
8641723 Connor Feb 2014 B2
8652175 Timm et al. Feb 2014 B2
8657765 Asfora Feb 2014 B2
8657856 Gephart et al. Feb 2014 B2
8657885 Burnett et al. Feb 2014 B2
8663139 Asfora Mar 2014 B2
8663140 Asfora Mar 2014 B2
8663285 Dall et al. Mar 2014 B2
8663287 Butler et al. Mar 2014 B2
8663338 Burnett et al. Mar 2014 B2
8668719 Alamin et al. Mar 2014 B2
8673001 Cartledge et al. Mar 2014 B2
8679161 Malandain et al. Mar 2014 B2
8690858 Machold et al. Apr 2014 B2
8707959 Paraschac et al. Apr 2014 B2
8709090 Makower et al. Apr 2014 B2
8715243 Uth et al. May 2014 B2
8715290 Fisher et al. May 2014 B2
8721570 Gupta et al. May 2014 B2
8721643 Morgan et al. May 2014 B2
8728125 Bruneau et al. May 2014 B2
8734318 Forsell May 2014 B2
8734516 Moskowitz et al. May 2014 B2
8734519 de Villiers et al. May 2014 B2
8747444 Moskowitz et al. Jun 2014 B2
8752552 Nelson et al. Jun 2014 B2
8758303 Uth et al. Jun 2014 B2
8758347 Weiner et al. Jun 2014 B2
8758355 Fisher et al. Jun 2014 B2
8758372 Cartledge et al. Jun 2014 B2
8762308 Najarian et al. Jun 2014 B2
8764713 Uth et al. Jul 2014 B2
8771272 LeCronier et al. Jul 2014 B2
8777947 Zahrly et al. Jul 2014 B2
8777995 McClintock et al. Jul 2014 B2
8781744 Ekseth et al. Jul 2014 B2
8784482 Randert et al. Jul 2014 B2
8790343 McClellan et al. Jul 2014 B2
8790380 Buttermann Jul 2014 B2
8790409 Van den Heuvel et al. Jul 2014 B2
8794243 Deem et al. Aug 2014 B2
8795339 Boomer et al. Aug 2014 B2
8801795 Makower et al. Aug 2014 B2
8808206 Asfora Aug 2014 B2
8813727 McClendon Aug 2014 B2
8814869 Freid et al. Aug 2014 B2
8828058 Elsebaie et al. Sep 2014 B2
8828087 Stone et al. Sep 2014 B2
8840623 Reiley Sep 2014 B2
8840651 Reiley Sep 2014 B2
8845692 Wisnewski Sep 2014 B2
8845724 Shenoy et al. Sep 2014 B2
8864717 Conlon et al. Oct 2014 B2
8864823 Cartledge et al. Oct 2014 B2
8870881 Rezach et al. Oct 2014 B2
8870918 Boomer et al. Oct 2014 B2
8870959 Arnin Oct 2014 B2
8882699 Burnett Nov 2014 B2
8882830 Cartledge et al. Nov 2014 B2
8888672 Phillips et al. Nov 2014 B2
8888673 Phillips et al. Nov 2014 B2
8894663 Giger et al. Nov 2014 B2
8915915 Harrison et al. Dec 2014 B2
8915917 Doherty et al. Dec 2014 B2
8920422 Homeier et al. Dec 2014 B2
8932247 Stergiopulos Jan 2015 B2
8945188 Rezach et al. Feb 2015 B2
8945210 Cartledge et al. Feb 2015 B2
8956407 Macoviak et al. Feb 2015 B2
8961386 Phillips et al. Feb 2015 B2
8961521 Keefer et al. Feb 2015 B2
8961567 Hunziker Feb 2015 B2
8968402 Myers et al. Mar 2015 B2
8968406 Arnin Mar 2015 B2
8986348 Reiley Mar 2015 B2
8992527 Guichet Mar 2015 B2
9005251 Heggeness Apr 2015 B2
9005293 Moskowitz et al. Apr 2015 B2
9005298 Makower et al. Apr 2015 B2
9011491 Carl et al. Apr 2015 B2
9015057 Phillips et al. Apr 2015 B2
9022917 Kasic et al. May 2015 B2
9028550 Shulock et al. May 2015 B2
9033957 Cadeddu et al. May 2015 B2
9033988 Gephart et al. May 2015 B2
9034016 Panjabi May 2015 B2
9044218 Young Jun 2015 B2
9060810 Kercher et al. Jun 2015 B2
9060844 Kagan et al. Jun 2015 B2
9072530 Mehta et al. Jul 2015 B2
9072606 Lucas et al. Jul 2015 B2
9078703 Arnin Jul 2015 B2
9084632 Orsak et al. Jul 2015 B2
9089348 Chavarria et al. Jul 2015 B2
9095436 Boyden et al. Aug 2015 B2
9095437 Boyden et al. Aug 2015 B2
9101422 Freid et al. Aug 2015 B2
9101427 Globerman et al. Aug 2015 B2
9107706 Alamin et al. Aug 2015 B2
9113967 Soubeiran Aug 2015 B2
9114016 Shenoy et al. Aug 2015 B2
9125746 Clifford et al. Sep 2015 B2
9138266 Stauch Sep 2015 B2
9144482 Sayet Sep 2015 B2
9155565 Boomer et al. Oct 2015 B2
9161856 Nelson et al. Oct 2015 B2
9168071 Seme et al. Oct 2015 B2
9168076 Patty et al. Oct 2015 B2
9173681 Seme Nov 2015 B2
9173715 Baumgartner Nov 2015 B2
9186158 Anthony et al. Nov 2015 B2
9186185 Hestad et al. Nov 2015 B2
9198771 Ciupik Dec 2015 B2
9204899 Buttermann Dec 2015 B2
9204908 Buttermann Dec 2015 B2
9220536 Skaggs Dec 2015 B2
9226783 Brigido Jan 2016 B2
9242070 Tieu Jan 2016 B2
9259243 Giger et al. Feb 2016 B2
9272159 Phillips et al. Mar 2016 B2
9278004 Shenoy et al. Mar 2016 B2
9278046 Asfora Mar 2016 B2
9282997 Hunziker Mar 2016 B2
9301792 Henniges et al. Apr 2016 B2
9301854 Moskowitz et al. Apr 2016 B2
9308089 Vicatos et al. Apr 2016 B2
9308387 Phillips et al. Apr 2016 B2
9320618 Schmitz et al. Apr 2016 B2
9326728 Demir et al. May 2016 B2
9333009 Kroll et al. May 2016 B2
9339197 Griswold et al. May 2016 B2
9339300 Kantelhardt May 2016 B2
9339307 McClintock et al. May 2016 B2
9339312 Doherty et al. May 2016 B2
9358044 Seme et al. Jun 2016 B2
9364267 Northcutt et al. Jun 2016 B2
9370388 Globerman et al. Jun 2016 B2
9393123 Lucas et al. Jul 2016 B2
9408644 Zahrly et al. Aug 2016 B2
9421347 Burnett Aug 2016 B2
9427267 Homeier et al. Aug 2016 B2
9439744 Forsell Sep 2016 B2
9439797 Baym et al. Sep 2016 B2
9445848 Anderson et al. Sep 2016 B2
9451997 Carl et al. Sep 2016 B2
9456953 Asfora Oct 2016 B2
9474612 Haaja et al. Oct 2016 B2
9492199 Orsak et al. Nov 2016 B2
9492276 Lee et al. Nov 2016 B2
9498258 Boomer et al. Nov 2016 B2
9498366 Burnett et al. Nov 2016 B2
9510834 Burnett et al. Dec 2016 B2
9532804 Clifford et al. Jan 2017 B2
9561062 Hayes et al. Feb 2017 B2
9561063 Reiley Feb 2017 B2
9572588 Fisher et al. Feb 2017 B2
9572746 Asfora Feb 2017 B2
9572910 Messersmith et al. Feb 2017 B2
9579110 Bojarski et al. Feb 2017 B2
9579203 Soubeiran Feb 2017 B2
9603605 Collazo Mar 2017 B2
9603713 Moskowitz et al. Mar 2017 B2
9610161 Macoviak et al. Apr 2017 B2
9622875 Moskowitz et al. Apr 2017 B2
9642735 Burnett May 2017 B2
9655651 Panjabi May 2017 B2
9668868 Shenoy et al. Jun 2017 B2
9687243 Burnett et al. Jun 2017 B2
9687414 Asfora Jun 2017 B2
9693867 Lucas et al. Jul 2017 B2
9700419 Clifford et al. Jul 2017 B2
9700450 Burnett Jul 2017 B2
9717537 Gordon Aug 2017 B2
9724135 Koch et al. Aug 2017 B2
9724265 Asfora Aug 2017 B2
9730738 Gephart et al. Aug 2017 B2
9743969 Reiley Aug 2017 B2
9782206 Mueckter et al. Oct 2017 B2
9795410 Shenoy et al. Oct 2017 B2
9814600 Shulock et al. Nov 2017 B2
9820789 Reiley Nov 2017 B2
9826987 Keefer et al. Nov 2017 B2
9833291 Baumgartner Dec 2017 B2
9848894 Burley et al. Dec 2017 B2
9848993 Moskowitz et al. Dec 2017 B2
9861376 Chavarria et al. Jan 2018 B2
9861390 Hunziker Jan 2018 B2
9861404 Reiley Jan 2018 B2
9867719 Moskowitz et al. Jan 2018 B2
20010011543 Forsell Aug 2001 A1
20020019580 Lau et al. Feb 2002 A1
20020050112 Koch et al. May 2002 A1
20020072758 Reo et al. Jun 2002 A1
20020164905 Bryant Nov 2002 A1
20020188296 Michelson Dec 2002 A1
20030019498 Forsell Jan 2003 A1
20030040671 Somogyi et al. Feb 2003 A1
20030066536 Forsell Apr 2003 A1
20030114731 Cadeddu et al. Jun 2003 A1
20030114856 Nathanson Jun 2003 A1
20030187447 Ferrante et al. Oct 2003 A1
20030208212 Cigaina Nov 2003 A1
20030220643 Ferree Nov 2003 A1
20030220644 Thelen et al. Nov 2003 A1
20040006342 Altarac et al. Jan 2004 A1
20040011137 Hnat et al. Jan 2004 A1
20040011365 Govari et al. Jan 2004 A1
20040019353 Freid et al. Jan 2004 A1
20040023623 Stauch et al. Feb 2004 A1
20040055610 Forsell Mar 2004 A1
20040064030 Forsell Apr 2004 A1
20040068205 Zogbi et al. Apr 2004 A1
20040092939 Freid et al. May 2004 A1
20040098121 Opolski May 2004 A1
20040116773 Furness et al. Jun 2004 A1
20040133219 Forsell Jul 2004 A1
20040138725 Forsell Jul 2004 A1
20040153106 Dudai Aug 2004 A1
20040158254 Eisermann Aug 2004 A1
20040172040 Heggeness Sep 2004 A1
20040173222 Kim Sep 2004 A1
20040193266 Meyer Sep 2004 A1
20040220567 Eisermann et al. Nov 2004 A1
20040220668 Eisermann et al. Nov 2004 A1
20040230307 Eisermann Nov 2004 A1
20040250820 Forsell Dec 2004 A1
20040260287 Ferree Dec 2004 A1
20040260319 Egle Dec 2004 A1
20050002984 Byrum et al. Jan 2005 A1
20050043802 Eisermann et al. Feb 2005 A1
20050055025 Zacouto et al. Mar 2005 A1
20050070937 Jambor et al. Mar 2005 A1
20050080427 Govari et al. Apr 2005 A1
20050080439 Carson et al. Apr 2005 A1
20050090823 Bartimus Apr 2005 A1
20050096750 Kagan et al. May 2005 A1
20050131352 Conlon et al. Jun 2005 A1
20050159754 Odrich Jul 2005 A1
20050159755 Odrich Jul 2005 A1
20050165440 Cancel et al. Jul 2005 A1
20050171543 Timm et al. Aug 2005 A1
20050177164 Walters et al. Aug 2005 A1
20050182400 White Aug 2005 A1
20050182401 Timm et al. Aug 2005 A1
20050182412 Johnson et al. Aug 2005 A1
20050192629 Saadat et al. Sep 2005 A1
20050222489 Rahdert et al. Oct 2005 A1
20050234289 Anstadt et al. Oct 2005 A1
20050234448 McCarthy Oct 2005 A1
20050234462 Hershberger Oct 2005 A1
20050246034 Soubeiran Nov 2005 A1
20050251109 Soubeiran Nov 2005 A1
20050251147 Novak Nov 2005 A1
20050261779 Meyer Nov 2005 A1
20050272976 Tanaka et al. Dec 2005 A1
20050288672 Ferree Dec 2005 A1
20060004459 Hazebrouck Jan 2006 A1
20060009767 Kiester Jan 2006 A1
20060020278 Burnett et al. Jan 2006 A1
20060036251 Reiley Feb 2006 A1
20060036259 Carl et al. Feb 2006 A1
20060036323 Carl et al. Feb 2006 A1
20060036324 Sachs et al. Feb 2006 A1
20060069447 Disilvestro Mar 2006 A1
20060079897 Harrison et al. Apr 2006 A1
20060116757 Lashinski et al. Jun 2006 A1
20060124140 Forsell Jun 2006 A1
20060136062 DiNello et al. Jun 2006 A1
20060142634 Anstadt et al. Jun 2006 A1
20060142767 Green et al. Jun 2006 A1
20060155279 Ogilvie Jul 2006 A1
20060155347 Forsell Jul 2006 A1
20060184240 Jimenez et al. Aug 2006 A1
20060184248 Edidin et al. Aug 2006 A1
20060195102 Malandain Aug 2006 A1
20060204156 Takehara et al. Sep 2006 A1
20060211909 Anstadt et al. Sep 2006 A1
20060235299 Martinelli Oct 2006 A1
20060235424 Vitale et al. Oct 2006 A1
20060241636 Novak Oct 2006 A1
20060241746 Shaoulian et al. Oct 2006 A1
20060249914 Dulin Nov 2006 A1
20060252983 Lembo et al. Nov 2006 A1
20060271107 Harrison et al. Nov 2006 A1
20060276812 Hill et al. Dec 2006 A1
20060282073 Simanovsky Dec 2006 A1
20060289014 Purdy et al. Dec 2006 A1
20060293671 Heggeness Dec 2006 A1
20060293683 Stauch Dec 2006 A1
20070010814 Stauch Jan 2007 A1
20070015955 Tsonton Jan 2007 A1
20070021644 Woolson et al. Jan 2007 A1
20070031131 Griffitts Feb 2007 A1
20070043376 Leatherbury et al. Feb 2007 A1
20070050030 Kim Mar 2007 A1
20070055237 Edidin et al. Mar 2007 A1
20070055368 Rhee et al. Mar 2007 A1
20070118215 Moaddeb May 2007 A1
20070135913 Moaddeb et al. Jun 2007 A1
20070162032 Johnson et al. Jul 2007 A1
20070173837 Chan et al. Jul 2007 A1
20070173869 Gannoe et al. Jul 2007 A1
20070179493 Kim Aug 2007 A1
20070213751 Scirica et al. Sep 2007 A1
20070239159 Altarac et al. Oct 2007 A1
20070250084 Sharkawy et al. Oct 2007 A1
20070255088 Jacobson et al. Nov 2007 A1
20070256693 Paraschac et al. Nov 2007 A1
20070260270 Assell et al. Nov 2007 A1
20070264605 Belfor et al. Nov 2007 A1
20070270631 Nelson et al. Nov 2007 A1
20070276369 Allard et al. Nov 2007 A1
20070276372 Malandain et al. Nov 2007 A1
20070276373 Malandain Nov 2007 A1
20070276493 Malandain et al. Nov 2007 A1
20070288024 Gollogly Dec 2007 A1
20070288183 Bulkes et al. Dec 2007 A1
20080015577 Loeb Jan 2008 A1
20080015604 Collazo Jan 2008 A1
20080021454 Chao et al. Jan 2008 A1
20080021455 Chao et al. Jan 2008 A1
20080021456 Gupta et al. Jan 2008 A1
20080033431 Jung et al. Feb 2008 A1
20080051784 Gollogly Feb 2008 A1
20080051895 Malandain et al. Feb 2008 A1
20080058936 Malandain et al. Mar 2008 A1
20080058937 Malandain et al. Mar 2008 A1
20080065077 Ferree Mar 2008 A1
20080065215 Reiley Mar 2008 A1
20080066764 Paraschac et al. Mar 2008 A1
20080071275 Ferree Mar 2008 A1
20080071276 Ferree Mar 2008 A1
20080082118 Edidin et al. Apr 2008 A1
20080082167 Edidin et al. Apr 2008 A1
20080083413 Forsell Apr 2008 A1
20080086128 Lewis Apr 2008 A1
20080091059 Machold et al. Apr 2008 A1
20080097523 Bolduc et al. Apr 2008 A1
20080108995 Conway et al. May 2008 A1
20080140188 Randert et al. Jun 2008 A1
20080147139 Barrett et al. Jun 2008 A1
20080147192 Edidin et al. Jun 2008 A1
20080161933 Grotz et al. Jul 2008 A1
20080167685 Allard et al. Jul 2008 A1
20080172063 Taylor Jul 2008 A1
20080177319 Schwab Jul 2008 A1
20080177326 Thompson Jul 2008 A1
20080195104 Sidebotham Aug 2008 A1
20080195156 Ainsworth et al. Aug 2008 A1
20080226563 Contag et al. Sep 2008 A1
20080228186 Gall et al. Sep 2008 A1
20080255615 Vittur et al. Oct 2008 A1
20080272928 Shuster Nov 2008 A1
20080275552 Makower et al. Nov 2008 A1
20080275555 Makower et al. Nov 2008 A1
20080275557 Makower et al. Nov 2008 A1
20080275567 Makower et al. Nov 2008 A1
20080293995 Moaddeb et al. Nov 2008 A1
20090076597 Dahlgren et al. Mar 2009 A1
20090082815 Zylber et al. Mar 2009 A1
20090088803 Justis et al. Apr 2009 A1
20090093820 Trieu et al. Apr 2009 A1
20090093890 Gelbart Apr 2009 A1
20090112207 Walker et al. Apr 2009 A1
20090112262 Pool Apr 2009 A1
20090118699 Utley et al. May 2009 A1
20090171356 Klett Jul 2009 A1
20090177203 Reiley Jul 2009 A1
20090182356 Coe Jul 2009 A1
20090192514 Feinberg et al. Jul 2009 A1
20090198144 Phillips et al. Aug 2009 A1
20090204055 Lennox et al. Aug 2009 A1
20090216113 Meier et al. Aug 2009 A1
20090216262 Burnett et al. Aug 2009 A1
20090222014 Bojarski Sep 2009 A1
20090240173 Hsia et al. Sep 2009 A1
20090259236 Burnett et al. Oct 2009 A2
20090270871 Liu et al. Oct 2009 A1
20090275984 Kim et al. Nov 2009 A1
20090318919 Robinson Dec 2009 A1
20100004654 Schmitz et al. Jan 2010 A1
20100030281 Gollogly Feb 2010 A1
20100057127 McGuire et al. Mar 2010 A1
20100081868 Moaddeb et al. Apr 2010 A1
20100087821 Trip Apr 2010 A1
20100094293 Mcclellan Apr 2010 A1
20100094306 Chang Apr 2010 A1
20100094925 Jacques, Jr. Apr 2010 A1
20100100185 Trieu et al. Apr 2010 A1
20100106192 Barry Apr 2010 A1
20100106193 Barry Apr 2010 A1
20100106247 Makower Apr 2010 A1
20100106248 Makower Apr 2010 A1
20100114103 Harrison et al. May 2010 A1
20100114322 Clifford May 2010 A1
20100121323 Pool et al. May 2010 A1
20100121457 Clifford et al. May 2010 A1
20100130941 Conlon et al. May 2010 A1
20100137872 Kam et al. Jun 2010 A1
20100145449 Makower et al. Jun 2010 A1
20100145462 Ainsworth et al. Jun 2010 A1
20100168751 Anderson et al. Jul 2010 A1
20100179601 Jung et al. Jul 2010 A1
20100198261 Trieu et al. Aug 2010 A1
20100228167 Ilovich et al. Sep 2010 A1
20100241168 Franck et al. Sep 2010 A1
20100249782 Durham Sep 2010 A1
20100249837 Seme Sep 2010 A1
20100249839 Alamin et al. Sep 2010 A1
20100249847 Jung et al. Sep 2010 A1
20100256626 Muller et al. Oct 2010 A1
20100256686 Fisher Oct 2010 A1
20100274290 Jung et al. Oct 2010 A1
20100286730 Gordon Nov 2010 A1
20100286791 Goldsmith Nov 2010 A1
20100318129 Seme et al. Dec 2010 A1
20100324684 Eisermann et al. Dec 2010 A1
20100331883 Schmitz et al. Dec 2010 A1
20110004076 Janna et al. Jan 2011 A1
20110057756 Marinescu et al. Mar 2011 A1
20110060336 Pool et al. Mar 2011 A1
20110060422 Makower et al. Mar 2011 A1
20110098748 Jangra Apr 2011 A1
20110130702 Stergiopulos Jun 2011 A1
20110137415 Clifford Jun 2011 A1
20110184505 Sharkawy et al. Jul 2011 A1
20110196371 Forsell Aug 2011 A1
20110196435 Forsell Aug 2011 A1
20110202138 Shenoy et al. Aug 2011 A1
20110213371 Anthony Sep 2011 A1
20110257655 Copf, Jr. Oct 2011 A1
20110275879 Nelson et al. Nov 2011 A1
20110284014 Cadeddu et al. Nov 2011 A1
20120004494 Payne et al. Jan 2012 A1
20120019341 Gabay et al. Jan 2012 A1
20120019342 Gabay et al. Jan 2012 A1
20120053633 Stauch Mar 2012 A1
20120088953 King Apr 2012 A1
20120089186 Carl et al. Apr 2012 A1
20120089191 Altarac et al. Apr 2012 A1
20120109207 Trieu May 2012 A1
20120116522 Makower et al. May 2012 A1
20120116535 Ratron et al. May 2012 A1
20120130426 Thompson May 2012 A1
20120136449 Makower et al. May 2012 A1
20120157996 Walker Jun 2012 A1
20120172883 Sayago Jul 2012 A1
20120179273 Clifford et al. Jul 2012 A1
20120185040 Rahdert et al. Jul 2012 A1
20120197258 Chavarria Aug 2012 A1
20120203282 Sachs et al. Aug 2012 A1
20120209265 Pool Aug 2012 A1
20120209269 Pool Aug 2012 A1
20120221101 Moaddeb et al. Aug 2012 A1
20120221106 Makower et al. Aug 2012 A1
20120271353 Barry Oct 2012 A1
20120277747 Keller Nov 2012 A1
20120283781 Arnin Nov 2012 A1
20120296234 Wilhelm et al. Nov 2012 A1
20120312307 Paraschac et al. Dec 2012 A1
20120316568 Manzi Dec 2012 A1
20130013066 Landry et al. Jan 2013 A1
20130018468 Moskowitz et al. Jan 2013 A1
20130018469 Moskowitz et al. Jan 2013 A1
20130023991 Moskowitz et al. Jan 2013 A1
20130072931 Homeier Mar 2013 A1
20130072932 Stauch Mar 2013 A1
20130079830 Garamszegi et al. Mar 2013 A1
20130138017 Jundt et al. May 2013 A1
20130138112 Young May 2013 A1
20130138154 Reiley May 2013 A1
20130150889 Fening et al. Jun 2013 A1
20130178903 Abdou Jul 2013 A1
20130184764 Stone Jul 2013 A1
20130197639 Clifford et al. Aug 2013 A1
20130204266 Heilman Aug 2013 A1
20130204376 DiSilvestro et al. Aug 2013 A1
20130211521 Shenoy Aug 2013 A1
20130238094 Voellmicke et al. Sep 2013 A1
20130253344 Griswold et al. Sep 2013 A1
20130253587 Carls et al. Sep 2013 A1
20130261623 Voellmicke et al. Oct 2013 A1
20130261672 Horvath Oct 2013 A1
20130296863 Globerman et al. Nov 2013 A1
20130296870 Keefer Nov 2013 A1
20130296940 Northcutt et al. Nov 2013 A1
20130325006 Michelinie et al. Dec 2013 A1
20130325071 Niemiec et al. Dec 2013 A1
20130331889 Alamin et al. Dec 2013 A1
20130345802 Cartledge et al. Dec 2013 A1
20140005788 Haaja et al. Jan 2014 A1
20140018913 Cartledge et al. Jan 2014 A1
20140025172 Lucas et al. Jan 2014 A1
20140031826 Bojarski et al. Jan 2014 A1
20140031929 Cartledge et al. Jan 2014 A1
20140039558 Alamin et al. Feb 2014 A1
20140051914 Fobi et al. Feb 2014 A1
20140052134 Orisek Feb 2014 A1
20140058392 Mueckter et al. Feb 2014 A1
20140058450 Arlet Feb 2014 A1
20140067075 Makower et al. Mar 2014 A1
20140080203 Wan et al. Mar 2014 A1
20140107704 Serhan et al. Apr 2014 A1
20140128920 Kantelhardt May 2014 A1
20140135838 Alamin et al. May 2014 A1
20140142631 Hunziker May 2014 A1
20140142698 Landry et al. May 2014 A1
20140155946 Skinlo et al. Jun 2014 A1
20140156004 Shenoy Jun 2014 A1
20140156005 Shenoy Jun 2014 A1
20140163664 Goldsmith Jun 2014 A1
20140172097 Clifford et al. Jun 2014 A1
20140194932 Bruneau et al. Jul 2014 A1
20140222138 Machold et al. Aug 2014 A1
20140296918 Fening et al. Oct 2014 A1
20140303538 Baym et al. Oct 2014 A1
20140303539 Baym et al. Oct 2014 A1
20140303540 Baym et al. Oct 2014 A1
20140324047 Zahrly et al. Oct 2014 A1
20140336756 Lee et al. Nov 2014 A1
20140358150 Kaufman et al. Dec 2014 A1
20150013687 Paraschac et al. Jan 2015 A1
20150057490 Forsell Feb 2015 A1
20150073565 Nelson et al. Mar 2015 A1
20150105782 D'Lima et al. Apr 2015 A1
20150105824 Moskowitz et al. Apr 2015 A1
20150132174 Marinescu et al. May 2015 A1
20150134007 Alamin et al. May 2015 A1
20150142110 Myers et al. May 2015 A1
20150150561 Burnett et al. Jun 2015 A1
20150272600 Mehta et al. Oct 2015 A1
20150313649 Alamin et al. Nov 2015 A1
Foreign Referenced Citations (104)
Number Date Country
20068468 Mar 2001 AU
101040807 Sep 2007 CN
1541262 Jun 1969 DE
8515687 Dec 1985 DE
68515687.6 Dec 1985 DE
19626230 Jan 1998 DE
19751733 Dec 1998 DE
19745654 Apr 1999 DE
102005045070 Apr 2007 DE
102007053362 May 2009 DE
102007053362 Jun 2014 DE
0663184 Jul 1995 EP
1547549 Jun 2005 EP
1745765 Jan 2007 EP
1905388 Apr 2008 EP
2802406 Jun 2001 FR
2823663 Oct 2002 FR
2827756 Jan 2003 FR
2892617 May 2007 FR
2900563 Nov 2007 FR
2901991 Dec 2007 FR
2916622 Dec 2008 FR
2961386 Dec 2011 FR
1174814 Dec 1969 GB
223454 Apr 2002 HU
05-104022 Apr 1993 JP
09-056736 Mar 1997 JP
2001-507608 Jun 2001 JP
2003-172372 Jun 2003 JP
2003-530195 Oct 2003 JP
2007-050339 Mar 2007 JP
WO8604498 Aug 1986 WO
WO8707134 Dec 1987 WO
WO8906940 Aug 1989 WO
WO9601597 Jan 1996 WO
WO9808454 Mar 1998 WO
WO9830163 Jul 1998 WO
WO1998044858 Oct 1998 WO
WO9850309 Nov 1998 WO
WO9903348 Jan 1999 WO
WO9923744 May 1999 WO
WO9951160 Oct 1999 WO
WO1999051160 Oct 1999 WO
WO9963907 Dec 1999 WO
WO0000108 Jan 2000 WO
2000061018 Oct 2000 WO
WO0072768 Dec 2000 WO
WO0105463 Jan 2001 WO
WO0112108 Feb 2001 WO
WO0124742 Apr 2001 WO
WO2001024697 Apr 2001 WO
WO0141671 Jun 2001 WO
WO0145485 Jun 2001 WO
WO0145487 Jun 2001 WO
WO0145597 Jun 2001 WO
WO0158390 Aug 2001 WO
2001067973 Sep 2001 WO
WO0167973 Sep 2001 WO
2001078614 Oct 2001 WO
WO0178614 Oct 2001 WO
WO0236975 May 2002 WO
WO03059215 Jul 2003 WO
WO2004014245 Feb 2004 WO
WO2004019796 Mar 2004 WO
WO2004021870 Mar 2004 WO
WO2004043280 May 2004 WO
WO2005023090 Mar 2005 WO
WO2005072195 Aug 2005 WO
WO2005072664 Aug 2005 WO
2005092219 Oct 2005 WO
WO2005105001 Nov 2005 WO
WO2006019520 Feb 2006 WO
WO2006019521 Feb 2006 WO
WO2006089085 Aug 2006 WO
WO2006090380 Aug 2006 WO
WO2006103071 Oct 2006 WO
WO2006103074 Oct 2006 WO
WO2006105084 Oct 2006 WO
WO2007013059 Feb 2007 WO
WO2007015239 Feb 2007 WO
WO2007025191 Mar 2007 WO
WO2007048012 Apr 2007 WO
WO2007081304 Jul 2007 WO
WO2007118179 Oct 2007 WO
WO2007140180 Dec 2007 WO
WO2007149555 Dec 2007 WO
WO20071144489 Dec 2007 WO
WO2008003952 Jan 2008 WO
WO2008013623 Jan 2008 WO
WO2008015679 Feb 2008 WO
WO2008040880 Apr 2008 WO
WO2008140756 Nov 2008 WO
2010017649 Feb 2010 WO
WO2010017649 Feb 2010 WO
2010050891 May 2010 WO
WO2010050891 May 2010 WO
WO2010056650 May 2010 WO
2011018778 Feb 2011 WO
WO2011018778 Feb 2011 WO
WO2011116158 Sep 2011 WO
WO2013119528 Aug 2013 WO
WO2013181329 Dec 2013 WO
WO2014040013 Mar 2014 WO
WO2011041398 Apr 2015 WO
Non-Patent Literature Citations (103)
Entry
US 9,161,784 B2, 10/2015, Buttermann (withdrawn)
Abe, Jun, Kensei Nagata, Mamoru Ariyoshi, and Akio Inoue. “Experimental external fixation combined with percutaneous discectomy in the management of scoliosis.” Spine 24, No. 7 (1999): 646-653.
Amer, A. R. A. L., and Ashraf A. Khanfour. “Evaluation of treatment of late-onset tibia vara using gradual angulationtranslation high tibial osteotomy.” Acta orthopaedica Belgica 76, No. 3 (2010): 360.
Baumgart, Rainer, Stefan Hinterwimmer, Michael Krammer, Oliver Muensterer, and Wolf Mutschler. “The bioexpandable prosthesis: a new perspective after resection of malignant bone tumors in children.” Journal of pediatric hematology/oncology 27, No. 8 (2005): 452-455.
Baumgart, R., P. Thaller, S. Hinterwimmer, M. Krammer, T. Hierl, and W. Mutschler. “A fully implantable, programmable distraction nail (Fitbone)—new perspectives for corrective and reconstructive limb surgery.” In Practice of Intramedullary Locked Nails, pp. 189-198. Springer Berlin Heidelberg, 2006.
Bodó, László, László Hangody, Balázs Borsitzky, György Béres, Gabriella Arató{acute over (,)}, Péter Nagy, and Gábor K. Ráthonyi. “Development of a tension-adjustable implant for anterior cruciate ligament reconstruction.” Eklem Hast Cerrahisi 19, No. 1 (2008): 27-32.
Boudjemline, Younes, Emmanuelle Pineau, Caroline Bonnet, Alix Mollet, Sylvia Abadir, Damien Bonnet, Daniel Sidi, and Gabriella Agnoletti. “Off-label use of an adjustable gatric banding system for pulmonary artery banding.” The Journal of thoracic and cardiovascular surgery 131, No. 5 (2006): 1130-1135.
Brown, S. “Single Port Surgery and the Dundee Endocone.” SAGES Annual Scientific Sessions, Poster Abstracts (2007): 323-324.
Buchowski, Jacob M., Rishi Bhatnagar, David L. Skaggs, and Paul D. Sponseller. “Temporary internal distraction as an aid to correction of severe scoliosis.” The Journal of Bone & Joint Surgery 88, No. 9 (2006): 2035-2041.
Burghardt, R. D., J. E. Herzenberg, S. C. Specht, and D. Paley. “Mechanical failure of the Intramedullary Skeletal Kinetic Distractor in limb lengthening.” Journal of Bone & Joint Surgery, British vol. 93, No. 5 (2011): 639-643.
Burke, John Gerard. “Design of a minimally invasive non fusion device for the surgical management of scoliosis in the skeletally immature.” Studies in health technology and informatics 123 (2005): 378-384.
Carter, D. R., and W. E. Caler. “A cumulative damage model for bone fracture.” Journal of Orthopaedic Research 3, No. 1 (1985): 84-90.
Chapman, Andrew E., George Kiroff, Philip Game, Bruce Foster, Paul O'Brien, John Ham, and Guy J. Maddern. “Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review.” Surgery 135, No. 3 (2004): 326-351.
Cole, J. Dean, Daniel Justin, Tagus Kasparis, Derk DeVlught, and Carl Knobloch. “The intramedullary skeletal distractor (ISKD): first clinical results of a new intramedullary nail for lengthening of the femur and tibia.” Injury 32 (2001):129-139.
Cole, J., D. Paley, and M. Dahl. “Operative Technique. ISKD. Intramedullary Skeletal Kinetic Distractor. Tibial Surgical Technique.” IS-0508 (A)-OPT-US© Orthofix Inc 28 (2005).
Dailey, Hannah L., Charles J. Daly, John G. Galbraith, Michael Cronin, and James A. Harty. “A novel intramedullary nail for micromotion stimulation of tibial fractures.” Clinical Biomechanics 27, No. 2 (2012): 182-188.
Daniels, A. U., Patrick Gemperline, Allen R. Grahn, and Harold K. Dunn. “A new method for continuous intraoperative measurement of Harrington rod loading patterns.” Annals of biomedical engineering 12, No. 3 (1984): 233-246.
De Giorgi, G., G. Stella, S. Becchetti, G. Martucci, and D. Miscioscia. “Cotrel-Dubousset instrumentation for the treatment of severe scoliosis.” European Spine Journal 8, No. 1 (1999): 8-15.
Dorsey, W. O., Bruce S. Miller, Jared P. Tadje, and Cari R. Bryant. “The stability of three commercially available implants used in medial opening wedge high tibial osteotomy.” The journal of knee surgery 19, No. 2 (2006): 95-98.
Edeland, H. G., G. Eriksson, and E. Dahlberg. “Instrumentation for distraction by limited surgery in scoliosis treatment.” Journal of biomedical engineering 3, No. 2 (1981): 143-146.
Ember, T., and H. Noordeen. “Distraction forces required during growth rod lengthening.” Journal of Bone & Joint Surgery, British vol. 88, No. SUPP II (2006): 229-229.
Fabry, Hans, Robrecht Van Hee, Leo Hendrickx, and Eric Totté. “A technique for prevention of port adjustable silicone gastric banding.” Obesity surgery 12, No. 2 (2002): 285-288.
Fried, M., W. Lechner, and K. Kormanova. “In vivo measurements of different gastric band pressures towards the gastric wall at the stoma region.” In Obesity Surgery, vol. 14, No. 7, pp. 914-914. 3100 Bayview Ave, Unit 4, Toronto, Ontario M2N 5L3, Canada: F D-Communications Inc, 2004.
Gao, Xiaochong, Derek Gordon, Dongping Zhang, Richard Browne, Cynthia Helms, Joseph Gillum, Samuel Weber et al. “CHD7 gene polymorphisms are associated with susceptibility to idiopathic scoliosis.” The American Journal of Human Genetics 80, No. 5 (2007): 957-965.
Gebhart, M., M. Neel, A. Soubeiran, and J. Dubousset. “Early clinical experience with a custom made growing endoprosthesis in children with malignant bone tumors of the lower extremity actioned by an external permanent magnet: the Phenix M system.” In International Society of Limb Salvage 14th International Symposium on Limb Salvage.2007.
Gillespie, R., and J. Obrien. “Harrington instrumentation without fusion.” In Journal of Bone and Joint Surgerybritish Volume, vol. 63, No. 3, pp. 461-461. 22 Buckingham Street, London, England WC2N 6ET: British Editorial Soc Bone Joint Surgery, 1981.
Goodship, Allen E., James L. Cunningham, and John Kenwright. “Strain rate and timing of stimulation in mechanical modulation of fracture healing.” Clinical orthopaedics and related research 355 (1998): S105-S115.
Grass, P. Jose, A. Valentin Soto, and H. Paula Araya. “Intermittent distracting rod for correction of high neurologic risk congenital scoliosis.” Spine 22, No. 16 (1997): 1922-1927.
Gray's Anatomy, http://education.yahoo.com/reference/gray/subjects/subject/128, published Jul. 1, 2007.
Grimer, R., S. Carter, R. Tillman, A. Abudu, and L. Jeys. “Non-Invasive Extendable Endoprostheses for Children—Expensive but Worth It!.” Journal of Bone & Joint Surgery, British vol. 93, No. SUPP I (2011): 5-5.
Grünert, R. D. “[The development of a totally implantable electronic sphincter].” Langenbecks Archiv fur Chirurgie 325 (1968): 1170-1174.
Guichet, Jean-Marc, Barbara Deromedis, Leo T. Donnan, Giovanni Peretti, Pierre Lascombes, and Flavio Bado. “Gradual femoral lengthening with the Albizzia intramedullary nail.” The Journal of Bone & Joint Surgery 85, No. 5 (2003): 838-848.
Gupta, A., J. Meswania, R. Pollock, S. R. Cannon, T. W. R. Briggs, S. Taylor, and G. Blunn. “Noninvasive distal femoral expandable endoprosthesis for limb-salvage surgery in paediatric tumours.” Journal of Bone & Joint Surgery, British vol. 88, No. 5 (2006): 649-654.
Hankemeier S, Gösling T, Pape HC, et al. Limb lengthening with the Intramedullary Skeletal Kinetic Distractor (ISKD) Oper Orthop Traumatol. 2005;17:79-101.
Harrington PR (1962) Treatment of scoliosis. Correction and internal fixation by spine instrumentation. J Bone Joint Surg Am 44-A:591-610.
Hazem Elsebaie, M. D. “Single Growing Rods.” Changing the Foundations: Does it affect the Results., J Child Orthop. (2007) 1:258.
Hennig, Alex C.; Incavo, Stephen J.; Beynnon, Bruce D.; Abate, Joseph A.; Urse, John S.; Kelly, Stephen / The safety and efficacy of a new adjustable plate used for proximal tibial opening wedge osteotomy in the treatment of unicompartmental knee osteoarthrosis. In: The journal of knee surgery, vol. 20, No. 1, Jan. 1, 2007, p. 6-14.
Hofmeister, M., C. Hierholzer, and V. Bühren. “Callus Distraction with the Albizzia Nail.” In Practice of Intramedullary Locked Nails, pp. 211-215. Springer Berlin Heidelberg, 2006.
Horbach, T., D. Herzog, and I. Knerr. “First experiences with the routine use of the Rapid Port (TM) system with the Lap-Band (R).” In Obesity Surgery, vol. 16, No. 4, pp. 418-418. 3100 Bayview Ave, Unit 4, Toronto, Ontario M2N 5L3, Canada: F D-Communications Inc, 2006.
Hyodo, Akira, Helmuth Kotschi, Helen Kambic, and George Muschler. “Bone transport using intramedullary fixation and a single flexible traction cable.” Clinical orthopaedics and related research 325 (1996): 256-268.
Ahlbom, A., U. Bergqvist, J. H. Bernhardt, J. P. Cesarini, M. Grandolfo, M. Hietanen, A. F. Mckinlay et al. “Guidelines for limiting exposure to time-varying electric, magnetic, and electromagnetic fields (up to 300 GHz). International Commission on Non-Ionizing Radiation Protection.” Health Phys 74, No. 4 (1998): 494-522.
International Commission on Non-Ionizing Radiation Protection. “Guidelines on limits of exposure to static magnetic fields.” Health Physics 96, No. 4 (2009): 504-514.
INVIS®/Lamello Catalog, 2006, Article No. 68906A001 GB.
Kasliwal, Manish K., Justin S. Smith, Adam Kanter, Ching-Jen Chen, Praveen V. Mummaneni, Robert A. Hart, and Christopher I. Shaffrey. “Management of high-grade spondylolisthesis.” Neurosurgery Clinics of North America 24, No. 2 (2013): 275-291.
Kenawey, Mohamed, Christian Krettek, Emmanouil Liodakis, Ulrich Wiebking, and Stefan Hankemeier. “Leg lengthening using intramedullay skeletal kinetic distractor: results of 57 consecutive applications.” Injury 42, No. 2 (2011): 150-155.
Kent, Matthew E., Arvind Arora, P. Julian Owen, and Vikas Khanduja. “Assessment and correction of femoral malrotation following intramedullary nailing of the femur.” Acta Orthop Belg 76, No. 5 (2010): 580-4.
Klemme, William R., Francis Denis, Robert B. Winter, John W. Lonstein, and Steven E. Koop. “Spinal instrumentation without fusion for progressive scoliosis in young children.” Journal of Pediatric Orthopaedics 17, No. 6 (1997): 734-742.
Korenkov, M., S. Sauerland, N. Yücel, L. Köhler, P. Goh, J. Schierholz, and H. Troidl. “Port function after laparoscopic adjustable gastric banding for morbid obesity.” Surgical Endoscopy and Other Interventional Techniques 17, No. 7 (2003): 1068-1071.
Krieg, Andreas H., Bernhard M. Speth, and Bruce K. Foster. “Leg lengthening with a motorized nail in adolescents.” Clinical orthopaedics and related research 466, No. 1 (2008): 189-197.
Kucukkaya, Metin, Raffi Armagan, and Unal Kuzgun. “The new intramedullary cable bone transport technique.” Journal of orthopaedic trauma 23, No. 7 (2009): 531-536.
Lechner, W. L., W. Kirchmayr, and G. Schwab. “In vivo band manometry: a new method in band adjustment.” In Obesity Surgery, vol. 15, No. 7, pp. 935-935. 3100 Bayview Ave, Unit 4, Toronto, Ontario M2N 5L3, Canada: F DCommunicationsInc, 2005.
Lechner, W., M. Gadenstatter, R. Ciovica, W. Kirchmayer, and G. Schwab. “Intra-band manometry for band adjustments: The basics.” In Obesity Surgery, vol. 16, No. 4, pp. 417-418. 3100 Bayview Ave, Unit 4, Toronto, Ontario M2N 5L3, Canada: F D-Communications Inc, 2006.
Li, G., S. Berven, N. A. Athanasou, and A. H. R. W. Simpson. “Bone transport over an intramedullary nail: A case report with histologic examination of the regenerated segment.” Injury 30, No. 8 (1999): 525-534.
Lonner, Baron S. “Emerging minimally invasive technologies for the management of scoliosis.” Orthopedic Clinics of North America 38, No. 3 (2007): 431-440.
Teli, Marco MD. “Measurement of Forces Generated During Distraction of Growing Rods, J.” Marco Teli. Journal of Child Orthop 1 (2007): 257-258.
Matthews, Michael Wayne, Harry Conrad Eggleston, Steven D. Pekarek, and Greg Eugene Hilmas. “Magnetically adjustable intraocular lens.” Journal of Cataract & Refractive Surgery 29, No. 11 (2003): 2211-2216.
Micromotion “Micro Drive Engineering⋅General catalogue” pp. 14⋅24; Jun. 2009.
Mineiro, Jorge, and Stuart L. Weinstein. “Subcutaneous rodding for progressive spinal curvatures: early results.” Journal of Pediatric Orthopaedics 22, No. 3 (2002): 290-295.
Moe, John H., Khalil Kharrat, Robert B. Winter, and John L. Cummine. “Harrington instrumentation without fusion plus external orthotic support for the treatment of difficult curvature problems in young children.” Clinical orthopaedics and related research 185 (1984): 35-45.
Montague, R. G., C. M. Bingham, and K. Atallah. “Magnetic gear dynamics for servo control.” In Melecon 2010-2010 15th IEEE Mediterranean Electrotechnical Conference, pp. 1192-1197. IEEE, 2010.
Montague, Ryan, Chris Bingham, and Kais Atallah. “Servo control of magnetic gears.” Mechatronics, IEEE/ASME Transactions on 17, No. 2 (2012): 269-278.
Nachemson, Alf, and Gösta Elfström. “Intravital wireless telemetry of axial forces in Harrington distraction rods in patients with idiopathic scoliosis.” The Journal of Bone & Joint Surgery 53, No. 3 (1971): 445-465.
Nachlas, I. William, and Jesse N. Borden. “The cure of experimental scoliosis by directed growth control.” The Journal of Bone & Joint Surgery 33, No. 1 (1951): 24-34.
Newton, P. “Fusionless Scoliosis Correction by Anterolateral Tethering . . . Can it Work?.” In 39th Annual Scoliosis Research Society Meeting. 2004.
Observations by a third party under Article 115 EPC issued by the European Patent Office dated Feb. 15, 2010 in European Patent Application No. 08805612.2, Applicant: Soubeiran, Arnaud (7 pages).
Oh, Chang-Wug, Hae-Ryong Song, Jae-Young Roh, Jong-Keon Oh, Woo-Kie Min, Hee-Soo Kyung, Joon-Woo Kim, Poong-Taek Kim, and Joo-Chul Ihn. “Bone transport over an intramedullary nail for reconstruction of long bone defects in tibia.” Archives of orthopaedic and trauma surgery 128, No. 8 (2008): 801-808.
Ozcivici, Engin, Yen Kim Luu, Ben Adler, Yi-Xian Qin, Janet Rubin, Stefan Judex, and Clinton T. Rubin. “Mechanical signals as anabolic agents in bone.” Nature Reviews Rheumatology 6, No. 1 (2010): 50-59.
Patient Guide, VEPTR Vertical Expandable Prosthetic Titanium Rib, Synthes Spine (2005) (23pages).
Piorkowski, James R., Scott J. Ellner, Arun A. Mavanur, and Carlos A. Barba. “Preventing port site inversion in laparoscopic adjustable gastric banding.” Surgery for Obesity and Related Diseases 3, No. 2 (2007): 159-161.
Prontes, Isabel, http://wwwehow.com/about_4795793_longest-bone-body.html, published Jun. 12, 2012.
Rathjen, Karl, Megan Wood, Anna McClung, and Zachary Vest. “Clinical and radiographic results after implant removal in idiopathic scoliosis.” Spine 32, No. 20 (2007): 2184-2188.
Ren, Christine J., and George A. Fielding. “Laparoscopic adjustable gastric banding: surgical technique.” Journal of Laparoendoscopic & Advanced Surgical Techniques 13, No. 4 (2003): 257-263.
Reyes-Sánchez, Alejandro, Luis Miguel Rosales, and Victor Miramontes. “External fixation for dynamic correction of severe scoliosis.” The Spine Journal 5, No. 4 (2005): 418-426.
Rinsky, Lawrence A., James G. Gamble, and Eugene E. Bleck. “Segmental Instrumentation Without Fusion in Children With Progressive Scoliosis.” Journal of Pediatric Orthopedics 5, No. 6 (1985): 687-690.
Rode, V., F. Gay, A. J. Baraza, and J. Dargent. “A simple way to adjust bands under radiologic control.” In Obesity Surgery, vol. 16, No. 4, pp. 418-418. 3100 Bayview Ave, Unit 4, Toronto, Ontario M2N 5L3, Canada: F DCommunications Inc, 2006.
Schmerling, M. A., M. A. Wilkov, A. E. Sanders, and J. E. Woosley. “Using the shape recovery of nitinol in the Harrington rod treatment of scoliosis.” Journal of biomedical materials research 10, No. 6 (1976): 879-892.
Scott, D. J., S. J. Tang, R. Fernandez, R. Bergs, and J. A. Cadeddu. “Transgastric, transcolonic, and transvaginal cholecystectomy using magnetically anchored instruments.” In SAGES Meeting, p. P511. 2007.
Sharke, Paul. “The machinery of life.” Mechanical Engineering 126, No. 2 (2004): 30.
Shiha, Anis, Mohamed Alam El-Deen, Abdel Rahman Khalifa, and Mohamed Kenawey. “Ilizarov gradual correction of genu varum deformity in adults.” Acta Orthop Belg 75 (2009): 784-91.
Simpson, A. H. W. R., H. Shalaby, and G. Keenan. “Femoral lengthening with the intramedullary skeletal kinetic distractor.” Journal of Bone & Joint Surgery, British vol. 91, No. 7 (2009): 955-961.
Smith, John T. “The use of growth-sparing instrumentation in pediatric spinal deformity.” Orthopedic Clinics of North America 38, No. 4 (2007): 547-552.
Soubeiran, A., M. Gebhart, L. Miladi, J. Griffet, M. Neel, and J. Dubousset. “The Phenix M System. A Mechanical Fully Implanted Lengthening Device Externally Controllable Through the Skin with a Palm Size Permanent Magnet; Applications to Pediatric Orthopaedics.” In 6th European Research Conference in Pediatric Orthopaedics. 2006.
Sun, Zongyang, Katherine L. Rafferty, Mark A. Egbert, and Susan W. Herring. “Masticatory mechanics of a mandibular distraction osteogenesis site: interfragmentary micromovement.” Bone 41, No. 2 (2007): 188-196.
Takaso, Masashi, Hideshige Moriya, Hiroshi Kitahara, Shohei Minami, Kazuhisa Takahashi, Keijiro Isobe, Masatsune Yamagata, Yoshinori Otsuka, Yoshinori Nakata, and Masatoshi Inoue. “New remote-controlled growing-rod spinal instrumentation possibly applicable for scoliosis in young children.” Journal of orthopaedic science 3, No. 6 (1998): 336-340.
Tello, Carlos A. “Harrington instrumentation without arthrodesis and consecutive distraction program for young children with severe spinal deformities. Experience and technical details.” The Orthopedic clinics of North America 25, No. 2 (1994): 333-351.
Thaller, Peter Helmut, Julian Hirmetz, Florian Wolf, Thorsten Eilers, and Wolf Mutschler. “Limb lengthening with fully implantable magnetically actuated mechanical nails (PHENIX®)—Preliminary results.” Injury 45 (2014): S60-S65.
Thompson, George H., Lawrence G. Lenke, Behrooz A. Akbarnia, Richard E. McCarthy, and Robert M. Campbell. “Early onset scoliosis: future directions.” The Journal of Bone & Joint Surgery 89, No. suppl 1 (2007): 163-166.
Thonse, Raghuram, John E. Herzenberg, Shawn C. Standard, and Dror Paley. “Limb lengthening with a fully implantable, telescopic, intramedullary nail.” Operative Techniques in Orthopedics 15, No. 4 (2005): 355-362.
Trias, A., P. Bourassa, and M. Massoud. “Dynamic loads experienced in correction of idiopathic scoliosis using two types of Harrington rods.” Spine 4, No. 3 (1978): 228-235.
VEPTR II. Vertical Expandable Prosthetic Titanium Rib II, Technique Guide, Systhes Spine (2008) (40 pages).
Verkerke, G. J., Koops H. Schraffordt, R. P. Veth, H. J. Grootenboer, L. J. De Boer, J. Oldhoff, and A. Postma. “Development and test of an extendable endoprosthesis for bone reconstruction in the leg.” The International journal of artificial organs 17, No. 3 (1994): 155-162.
Verkerke, G. J., H. Schraffordt Koops, R. P. H. Veth, J. Oldhoff, H. K. L. Nielsen, H. H. Van den Kroonenberg, H. J. Grootenboer, and F. M. Van Krieken. “Design of a lengthening element for a modular femur endoprosthetic system.” Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 203, No. 2 (1989): 97-102.
Verkerke, G. J., H. Schraffordt Koops, R. P. H. Veth, H. H. van den Kroonenberg, H. J. Grootenboer, H. K. L. Nielsen, J. Oldhoff, and A. Postma. “An extendable modular endoprosthetic system for bone tumour management in the leg.” Journal of biomedical engineering 12, No. 2 (1990): 91-96.
Weiner, Rudolph A., Michael Korenkov, Esther Matzig, Sylvia Weiner, and Woiteck K. Karcz. “Initial clinical experience with telemetrically adjustable gastric banding.” Surgical technology international 15 (2005): 63-69.
Wenger, H. L. “Spine Jack Operation in the Correction of Scoliotic Deformity: A Direct Intrathoracic Attack to Straighten the Laterally Bent Spine: Preliminary Report.” Archives of Surgery 83, No. 6 (1961): 901-910.
White III, Augustus A., and Manohar M. Panjabi. “The clinical biomechanics of scoliosis.” Clinical orthopaedics and related research 118 (1976): 100-112.
Yonnet, Jean-Paul. “Passive magnetic bearings with permanent magnets.” Magnetics, IEEE Transactions on 14, No. 5 (1978): 803-805.
Yonnet, Jean-Paul. “A new type of permanent magnet coupling.” Magnetics, IEEE Transactions on 17, No. 6 (1981): 2991-2993.
Zheng, Pan, Yousef Haik, Mohammad Kilani, and Ching-Jen Chen. “Force and torque characteristics for magnetically driven blood pump.” Journal of Magnetism and Magnetic Materials 241, No. 2 (2002): 292-302.
International Search Report, Written Opinion and International Preliminary Report on Patentability for International Application No. PCT/U2013/067142, 11 pages.
VEPTR Vertical Expandable Prosthetic Titanium Rib, Patient Guide, Synthes Spine (2005) (23pages).
L. Angrisani et al., Abstract, “27 Lap-Band(R) Rapid Port(TM) System: Preliminary Results in 21 Patients,” Obesity Surgery, 15:936, 2005 (1 page).
Stokes et al., Abstract, “23. Reducing Radiation Exposure in Early-Onset Scoliosis Patients: Novel use of Ultrasonography to Measure Lengthening in Magnetically-Controlled Growing Rods Prospective Validation Study and Assessment of Clinical Algorithm,” Final Program, 20th International Meeting on Advanced Spine Techniques, pp. 80-81, Jul. 10-13, 2013 (4 pages).
Related Publications (1)
Number Date Country
20190046252 A1 Feb 2019 US
Provisional Applications (2)
Number Date Country
61868535 Aug 2013 US
61719887 Oct 2012 US
Continuations (1)
Number Date Country
Parent 14379742 US
Child 16159061 US