Patent Application
20200060833
Reconstruction of the knee joint is treated with a total knee arthroplasty that is meant to replace the knee joint with metal and plastic components to replicate the kinematics of the knee joint. There exist numerous options for knee replacement devices, the choice of which to use is driven by patient anatomy, stability, deformity and intended functional use, but all systems include a femoral component, a tibial component, and an insert that acts as the bearing surface for the femoral component, along with other components as needed per the system used.
There are several major design options for knee replacement systems. Cruciate retaining systems leave the posterior cruciate ligament (PCL) in place, thereby naturally stabilizing the joint. Cruciate sacrificing systems require removal of the PCL but compensate with an implant that allows less free motion of the femoral component. One type of cruciate sacrificing system is a hinged knee system. Hinged knee systems are typically indicated for patients who have already had one or more total knee replacement surgeries, but, due to a wide range of possible factors, require a revision surgery with a new implant. Such factors may include bone necrosis, bi-condylar arthrosis caused by partly damaged collateral ligaments, previous implant wear, severe joint diseases with limitation of mobility due to degenerative, rheumatoid, or post traumatic arthrosis or arthritis, degradation of bone mass or inadequate amounts of bone mass, arthrosis of the patella flange, or varus/valgus deformities up to 30°. In addition to introducing a hinge mechanism to constrain knee motion and join the femur and tibia, hinged knee revision systems typically include longer intramedullary tibial and femoral stems and may include metal blocks (called “augments”) that can be attached to the femoral and tibial components to replace degraded or missing bone.
The benefits of using hinged knees for revision surgeries are numerous: improved immediate post-operative mobility, decreased pain, and restored leg alignment through replacement of degraded bone. However, many current hinged knee systems do not allow surgeons to quickly switch between a non-hinged and hinged option intraoperatively, resulting in increased surgical working time and decreased surgical flexibility during revision procedures. Furthermore, the customizability of metal augments used in situations where distal femoral resections are required is currently very limited. In many cases, surgeons do not have the correctly sized augments needed to revise missing or degraded bone and are forced to compromise in other areas of the revision procedure—either by using a larger, bulkier femoral implant, or by selecting a longer stem. In some cases, the patient is instead referred to a trauma surgeon for the distal femoral fracture to be treated with bone plates, which have longer recovery times for the patient. Furthermore, current hinge knee systems are often overly complicated in their surgical technique and component design and are extremely expensive to utilize.
U.S. Pat. No. 8,545,570
U.S. Pat. No. 7,572,292
An easy to use implant with intraoperative flexibility and many options for patient treatment of a joint replacement, including distal femoral fracture cases, is greatly desired. For example, a pre-assembled femoral component with the hinge components would decrease surgical room time from having to assemble them during the case. It also may make it easier for any surgeon familiar with primary and revision knee reconstruction surgeries to perform the hinge knee reconstruction since the hinged knee system would be very similar to a primary or revision surgical technique. It would also be desirable to have a hinge component of the assembly anteriorly accessible so as to reduce time in the surgical room by obviating the need to make additional resection(s) in order to access the lateral sides of the femur required by other hinge knee systems on the market. Additionally, it would be desirable to have various options for treating distal femoral fracture cases such that bone is completely replaced without the need for excessive resections or a switch to a total femur reconstruction system. Not necessarily all such aspects or advantages are achieved by any particular embodiment. Thus, various embodiments may be carried out in a manner that achieves or optimizes one advantage or group of advantages taught herein without necessarily achieving other aspects or advantages as may also be taught or suggested herein.
The present disclosure generally relates to knee replacement systems and more particularly relates to hinged knee systems and methods compatible with standard primary or revision surgical techniques and/or distal femoral replacement (DFR) procedures.
An aspect of the present disclosure provides a hinge knee system. The hinge knee system comprises a femoral component, an insert, a tibial tray, a hinge box, a hinge post, a hinge screw, a cross-pin, cross-pin bushings, tibial bushings, femoral augments, tibial augments, and stem extensions.
In some embodiments, the hinge knee system is a fixed hinge post design.
In some embodiments, the system can also treat DFR cases. The system may further comprise a DFR femoral augment and DFR augment screws. Alternatively, the femoral component may be a DFR femoral component. In some embodiments, the DFR femoral component may be pre-assembled to one or more hinge components (e.g., the hinge box, cross-pin, and cross-pin bushings) prior to surgical use. In some embodiments, the DFR system may further comprise a DFR stem. In some embodiments, one or more of the DFR system may allow for treatment of different distal femoral resection types. For example, the system may be configured to allow for intra-operative switching of components, such as switching from a resurfacing hinge to a DFR replacement.
In some embodiments, the system may comprise one or more components to limit hyperextension. For example, the femoral component may comprise a flat contour and the insert may comprise an anterior stop.
In some embodiments, the system may comprise one or more components configured to limit internal/external rotation. For example, the insert bearing surfaces may act as a primary rotation limiter and a tibial bushing may act as a secondary rotation limiter/stop.
In some embodiments, the femoral component may be pre-assembled to one or more hinge components (e.g., the hinge box, cross-pin, and cross-pin bushings) prior to surgical use.
In some embodiments, the hinge assembly may be an anterior hinge assembly. In some embodiments, the hinge assembly may comprise a hinge post, hinge box, and a hinge screw. The hinge post may be coupled to the hinge box with the hinge screw.
In some embodiments, the hinge post may be configured to lock to the femoral components to the tibial components. The hinge post may be configured to prevent excessive axial translation of the components. Alternatively, or in combination, the hinge post may be configured to reduce or prevent dislocation of the components.
In some embodiments, the hinge post may be configured to link the femoral components to the tibial components. The hinge post may, for example, be rotated from an unlocked position to a locked position in order to secure the femoral components to the tibial components.
In some embodiments, the hinge post assembly may be at least partially pre-assembled prior to surgery in order to facilitate surgical use.
Another aspect of the present disclosure provides a method for installing any of the hinge post knee systems described herein. The method may be substantially similar to other primary and revision systems on the market with the variation of a hinge post insertion and assembly step.
Another aspect of the present disclosure provides a hinged knee system with an anteriorly-assembled hinge that replicates the kinematics of the knee joint for indicated hinge knee or distal femoral replacement cases. A femoral component is pre-assembled with a hinge box, cross-pin, and bushings between its condylar surfaces. The femoral component comprises a femoral post configured to be coupled to a stem extension attachment(s) if needed. A tibial tray may comprise a post that can attach to stem extensions if needed. An aperture along the center of the tibial tray holds a bushing that acts as a bearing surface for the hinge post. The system further comprises an insert that connects to the tray and acts as a bearing surface for the femoral component. The hinge post may come in various lengths which correspond to different thicknesses of the insert available in the system. The hinge post assembly links the femoral components to the tibial components and is anteriorly secured in place in a hinge box. In an exemplary embodiment, the hinge pose assembly may be secured to the hinge box with a hinge screw. Additional femoral components may be included in the system to address distal femoral replacement cases.
Another aspect of the present disclosure provides a hinge knee system. The hinge knee system of this aspect comprises a femoral component; an insert; a tibial tray configured to be coupled to the insert; a tibial bushing configured to be disposed between the tibial tray and the insert; a poly locking screw configured to secure the tibial tray to the insert; a hinge box configured to be disposed between the femoral component and the insert; one or more cross-pin bushings configured to be disposed within the hinge box; a cross-pin configured to secure the hinge box to the femoral component; a hinge post configured to couple the hinge box to the tibial tray; and a hinge post set screw configured to secure the hinge box to the hinge post.
A further aspect of the present disclosures provides another hinge knee system. The hinge knee system of this aspect comprises a femoral component; a tibial component comprising an insert and a tibial tray; a hinge box coupled to the femoral component; and a hinge post configured to couple the hinge box to the tibial component.
Another aspect of the present disclosures provides an additional hinge knee system. The hinge knee system of this aspect comprises a femoral component; an insert; a tibial tray coupled to the insert with a poly locking screw; a tibial bushing disposed between the tibial tray and the insert; a hinge box disposed between the femoral component and the insert, wherein the hinge box comprises one or more cross-pin bushings disposed therein, wherein the hinge box is secured to the femoral component with a cross-pin; and a hinge post coupled to the hinge box and the tibial tray, wherein the hinge post is secured to the hinge box with a hinge post set screw.
Another aspect of the present disclosures provides a method of anteriorly assembling a hinge knee system. The method comprises resecting a tibia of a patient to correspond to a tibial component of a hinge knee system, the tibial component comprising a tibial tray and an insert. Additionally, the method comprises implanting the tibial component into the tibia of the patient. The method also comprises resecting a femur of the patient to correspond to a femoral component of the hinge knee system. Additionally, the method comprises implanting the femoral component into the femur of the patient. The method also comprises flexing the femoral component to expose a hinge box coupled to the femoral component. The method also comprises anteriorly assembling a hinge post through the hinge box into the insert. The method also comprises locking the hinge post to the tibial component. Additionally, the method comprises securing the hinge post to the hinge box.
A further aspect of the present disclosures provides a hinge instrument. The hinge instrument comprises a handle; a shaft body operably coupled to the handle; a turn-knob disposed on a proximal end of the handle; and an internal shaft rotatably disposed within the shaft body and operably coupled to the turn-knob, wherein a distal end of the shaft body is configured to install and lock a hinge post assembly to a femoral component and a tibial component of a hinge knee system, wherein a distal end of the internal shaft is configured to protrude past a distal end of the shaft body when the internal shaft is in a removal configuration, and wherein the distal end of the internal shaft is configured to correspond to a first aperture on a hinge post shaft of the hinge post assembly.
An additional aspect of the present disclosures provides a method of anteriorly removing a hinge knee system. The method comprises removing hinge post set screw from a hinge post and a hinge box of a hinge knee system. The method also comprises engaging a distal end of a shaft body of a hinge post instrument with a first aperture of a hinge post shaft of the hinge post. The method also comprises engaging a distal end of an internal shaft of the hinge post instrument with a second, threaded aperture of the hinge post shaft. The method also comprises rotating the hinge post shaft relative to a hinge post body of the hinge post with the hinge post instrument to unlock the hinge post shaft from a locked configuration. Additionally, the method comprises removing the hinge post from the hinge knee system.
All publications, patents, and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference.
The novel features of the invention are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the invention are utilized, and the accompanying drawings of which:
In the following detailed description, reference is made to the accompanying figures, which form a part hereof In the figures, similar symbols typically identify similar components, unless context dictates otherwise. The illustrative embodiments described in the detailed description, figures, and claims are not meant to be limiting. Other embodiments may be utilized, and other changes may be made, without departing from the scope of the subject matter presented herein. It will be readily understood that the aspects of the present disclosure, as generally described herein, and illustrated in the figures, can be arranged, substituted, combined, separated, and designed in a wide variety of different configurations, all of which are explicitly contemplated herein.
Although certain embodiments and examples are disclosed below, inventive subject matter extends beyond the specifically disclosed embodiments to other alternative embodiments and/or uses, and to modifications and equivalents thereof. Thus, the scope of the claims appended hereto is not limited by any of the particular embodiments described below. For example, in any method or process disclosed herein, the acts or operations of the method or process may be performed in any suitable sequence and are not necessarily limited to any particular disclosed sequence. Various operations may be described as multiple discrete operations in turn, in a manner that may be helpful in understanding certain embodiments, however, the order of description should not be construed to imply that these operations are order dependent. Additionally, the structures, systems, and/or devices described herein may be embodied as integrated components or as separate components.
For purposes of comparing various embodiments, certain aspects and advantages of these embodiments are described. Not necessarily all such aspects or advantages are achieved by any particular embodiment. Thus, for example, various embodiments may be carried out in a manner that achieves or optimizes one advantage or group of advantages as taught herein without necessarily achieving other aspects or advantages as may also be taught or suggested herein.
Described herein are hinge knee systems and methods. The hinge knee systems described may be configured to be implanted in a similar manner to currently available primary and revision surgical technique and, as such, may be easier to use than other hinge knee systems available in the market.
During primary and revision surgical procedures, the tibia of the patient is resected and prepared with instrumentation matching the tibial implants (such as a tibial tray and tibial insert). The patient's femur is then resected to match the shape of the femoral component to be implanted. The intramedullary canal is then reamed to the appropriate length and diameter if a stem extension is required. If there is bone loss or additional resection is needed on the femur or tibia, femoral and tibial augments are provided that attach to the femoral component or the tibial tray. Before final implantation of the implants, trial parts are fit into the joint space to ensure appropriate knee kinematics are achieved with the chosen implant sizes.
Other hinge knee systems differ from the procedure described above in that there is additional hinge assembly required. There are various hinge designs on the market, but most require lateral assembly. One such example requires additional resection to access the lateral side of the femur. A hole is drilled through the femur to provide lateral access for a component, such as a pin, to affix the femoral component to the hinge or to the tibial components. Other hinge designs also vary in how they link the femoral components to the tibial components. Some designs use a free hinge post design, where the hinge post is free to move axially and the femoral components are not fixed in place, or a fixed hinge post design, where the femoral components are fixed to the tibial components to prevent dislocation.
To keep the surgical procedure of the hinge knee system described herein similar to primary knee replacement systems, as well as to reduce assembly time compared to other hinge knee systems, the hinge components, with the exception of the hinge post itself, may come pre-assembled to the femoral component prior to surgery. Pre-assembly of the hinge components may allow for anterior hinge assembly, which may remove the need for additional patient resection to access the lateral side of the knee compared to other hinge knee systems, thereby reducing surgical time and complexity and improving patient recovery. The femur, tibia, and intramedullary canal can then be prepped and resected in a similar fashion to primary and revision knee systems.
Additional femoral components may be included in the system for cases that require a distal femoral replacement (DFR). One or more DFR augments may be attached to the femoral component. The surgical procedure for DFR may be substantially similar to that described herein with the difference being that the distal femur is resected with a different resection guide for DFR cases.
In some embodiments, the system may have two separate configurations: a regular hinge knee configuration or a hinged distal femoral replacement knee configuration. The hinge knee system may be provided for use as a cemented configuration.
Also disclosed herein is a hinge knee system configured to treat DFR cases. The system comprises a DFR femoral component which may be substantially similar to other femoral components described herein and may be pre-assembled with all of the hinge components described herein except the hinge post. The hinge post may be assembled anterior during surgical implantation as described herein. The surgical procedure for DFR may be substantially similar to that described herein with the difference being that the distal femur is resected with a different resection guide for DFR cases
The DFR embodiments described herein may allow for a quick and straightforward surgical implantation that not all systems in the market provide. A unique advantage of the systems described herein is that they allow distal femoral replacements to be treated with a hinge knee system, allowing non-trauma surgeons who are already familiar with primary and revision knees, to treat DFR cases.
In some embodiments, the femoral component 1 may be provided to the user pre-assembled with the hinge box 5, including the cross-pin 7 and bushings 6. Pre-assembly of the femoral component 1 with hinge box 5, cross-pin 7, and bushings 6 may facilitate anterior assembly of the hinge knee system as described herein. Alternatively, or in combination, pre-assembly of the femoral component 1 with hinge box 5, cross-pin 7, and bushings 6 may enhance the ease and/or speed of the surgical procedure, particularly compared to other hinge knee systems.
In other instances, intraoperative assembly by the user may be desired and the femoral component 1 may not be provided to the user pre-assembled with the hinge box 5, cross-pin 7, and bushings 6.
The system may be configured to allow for flexion and hyperextension similar to other systems on the market.
In some embodiments, the system may be configured to allow for about 0 degrees, about 1 degree, about 2 degrees, about 3 degrees, about 4 degrees, about 5 degrees, about 6 degrees, about 7 degrees, about 8 degrees, about 9 degrees, or about 10 degrees of hyperextension. The system may be configured to about for hyperextension within a range of about 0 degrees to about 10 degrees, about 2 degrees to about 8 degrees, about 3 degrees to about 7 degrees, or about 4 degrees to about 7 degrees. In a preferred embodiment, the system may be configured to allow for about 5 degrees of hyperextension.
In some embodiments, the system may be configured to allow for about 90 degrees, about 100 degrees, about 110 degrees, about 120 degrees, about 130 degrees, about 140 degrees, about 150 degrees, about 160 degrees, about 170 degrees, or about 180 degrees of flexion. The system may be configured to about for flexion of at least 90 degrees, about 100 degrees, about 110 degrees, about 120 degrees, about 130 degrees, about 140 degrees, about 150 degrees, about 160 degrees, about 170 degrees, or about 180 degrees. In a preferred embodiment, the system may be configured to allow for a minimum of about 120 degrees of flexion.
The system may be configured to allow for internal/external rotation similar to other systems in the art. For example, a bearing surface 11 of the insert 3 may be configured to dictate internal/external rotation as described herein. The system may, for example, be configured to allow for a minimum of about 15 degrees of rotation in each direction to allow for key knee kinematics. The system may be configured to allow for at least about 10 degrees, about 15 degrees, about 20 degrees, about 25 degrees, about 30 degrees, about 35 degrees, about 40 degrees, about 45 degrees, about 50 degrees, about 55 degrees, about 60 degrees, about 65 degrees, about 70 degrees, about 75 degrees, about 80 degrees, about 85 degrees, or about 90 degrees of internal/external rotation in each direction.
One or more components of the system may comprise more than one size option, thus enabling the surgeon to select the correctly sized component prior to or during surgery to suit the needs of the patient.
In some embodiments, the femoral component 1 may be a one-piece construction. In some embodiments, the femoral component 1 may comprise a multi-part construction.
The femoral component 1 may come in different sizes to accommodate varying patient anatomy. For example, the system may be configured to provide five differently-sized femoral components 1 similar to the size ranges and options of other systems in the market.
In some embodiments, the medial-lateral dimension of the femoral component 1 may be within a range of about 51 mm to about 80 mm. In some embodiments, the anterior-posterior dimension of the femoral component 1 may be within a range of about 50 mm to about 74 mm. It will be understood by one of ordinary skill in the art that the dimensions and size of the femoral component 1 may be selected on a patient by patient basis in order to most closely match the previously-existing patient anatomy.
The inter-condylar box 15 width may be configured for each femoral component 1 size offered in the system. For example, the inter-condylar box 15 may comprise a width within a range of about 14 mm to about 22 mm.
The femoral component 1 may comprise any appropriate biocompatible metal similar to other systems in the art. For example, the femoral component 1 may comprise cobalt chromium, titanium, titanium-based alloys, stainless steel, or the like, or any combination thereof.
The bushings 6 may comprise an appropriate biocompatible material similar to other systems in the art. The bushings 6 may comprise an appropriate biocompatible plastic. For example, the bushings 6 may comprise ultra high molecular weight polyethylene (UHMWPE), ultra high cross-linked polyethylene (UHXLPE), vitamin E-doped UHMWPE, polytetrafluoroethylene (PTFE), low density polyethylene (LDPE), high density polyethylene (PEHD), polysulfone, polyetheretherketone (PEEK), polypropylene (PP), or the like, or any combination thereof.
In some embodiments, the bushings 6 are identical. In some embodiments, the bushings 6 have the same shape. In some embodiments, the bushings 6 are made of the same material(s).
In some embodiments, the bushings 6 are different. In some embodiments, one or more bushing 6 may have a different shape that one or more other bushing 6. In some embodiments, one or more of the bushings 6 may be made of a different material(s).
The overall shape of the hinge box 5 may be optimized to (a) fit within the inter-condylar box 15 of the femoral component 1 and/or (b) to have enough space therewithin to house the bushings 6 and hinge post assembly 8 as described herein.
The shape of the hinge box 5 may be configured to accommodate the fixed dimensions of the bushings 6 and the hinge post assembly 8. The hinge post assembly 8 and cross-pin 7 diameter dimension may be defined such that they are no smaller than similar features in other systems in the art. The hinge post assembly 8 and cross-pin 7 diameter dimension may be defined such that they can withstand physiologic loading conditions a patient may experience during use.
The center of the hinge post through hole 24 may be aligned with the center of a tibial post (e.g., tibial post 45 shown in
The posterior through hole 21 may be configured to align on a posterior location on the femoral component 1 that allows for the best knee kinematics for the system. Due to the nature of the single radius design of the condylar bearing surfaces 12 of the hinged knee system described herein, the posterior through hole 21 may be placed at the center of the arc that defines the single radius condylar bearing surfaces 12. The posterior through hole 21 may not be placed too anteriorly in order to avoid it impinging with the hinge post through hole 24.
The size of the hinge box 5 may be configured to correspond to the size of the inter-condylar box 15. The system may be configured such that there exists a hinge box 5 size that corresponds to each sized femoral component 1. The width of the hinge boxes 5 may be within a range of about 14 mm to about 21 mm such that they fit within the inter-condylar box 15 of each corresponding femoral component 1 as described herein.
The hinge box 5 may comprise an appropriate biocompatible metal similar to other systems in the art. For example, the hinge box 5 may comprise cobalt chromium, titanium , titanium-based alloys, stainless steel, or the like, or any combination thereof.
The hinge post through hole 24 may be sized and shaped to correspond to an outer dimension of the hinge post assembly 8. For example, in a preferred embodiment, the hinge post through hole 24 and the hinge post assembly 8 may each comprise a circular cross-section in order to allow for axial rotation of the components. In some embodiments, the hinge post through hole 24 and the hinge post assembly 8 may each comprise a cross-sectional shape configured to allow for about 15 degrees of axial rotation in each direction as described herein.
The cross-pin 7 may comprise be a singular part construction. Alternatively, the cross-pin 7 may be a multi-part construction.
The cross-pin 7 may comprise an appropriate biocompatible metal. For example, the cross-pin 7 may comprise cobalt chromium, titanium, titanium-based alloys, stainless steel, or the like, or any combination thereof.
There are various ways the cross-pin 7 can be fixed in place. For example, the cross-pin 7 and the aperture 16 may be correspondingly threaded to enable the cross-pin 7 to be screwed into the aperture 16. Alternatively, or in combination, the cross-pin 7 may comprise one or more features configured to engage with the aperture 16 with a snap-fit such that the cross-pin 7 snaps into the aperture 16 to secure it in place.
In a preferred embodiment, the cross-pin 7 may comprise threads on its distal end 28 and a screw head on the proximal end 29 configured to correspond to a hex or torx driver or the like. The aperture 16 on the medial wall of the inter-condylar box 15 may be correspondingly threaded 30. The cross-pin 7 can then be screwed into place with the appropriate driver.
Because the inter-condylar box 15 size may differ for each differently-sized femoral component 1 as described herein, the hinge box 5 and cross-pin 7 may be similarly sized to correspond to each differently-side femoral component 1. The cross-pin 7 may, for example, comprise a length which matches the width of the inter-condylar box 15. In some embodiments, the cross-pin 7 may comprise a length within a range of about 14 mm to about 22 mm.
In many embodiments, the femoral component 1 and the hinge components may be pre-assembled prior to surgical use. This may be beneficial in that it may enable a surgeon, or anyone in the surgical room, to select the correct femoral component 1 without worrying about choosing the correct sizing of the various other hinge components, as the assembly described could be completed during manufacturing and thus be ready for use during surgery.
The distal surface of the insert 3 may comprise one or more features configured to interact with a tibial tray (e.g., tibial tray 2 as shown in
The flat, cleared space 33 may be configured to constrain internal/external rotational motion to a pre-determined extent. The hinge knee system may vary from having no rotational stop to allowing for any degree of rotation desired, similar to other hinge knee systems. When the system comprises a rotational stop as described herein, the system may provide for internal/external rotation within a range of about 0 degrees to about 15 degrees or more. In a preferred embodiments, the system may be configured to allow for a minimum of 15 degrees of internal/external rotation.
The insert 3 may comprise a symmetric component. The proximal surface 11 of the insert 3 may comprise at least one axis of symmetry. Alternatively, or in combination, the distal surface of the insert 3 may comprise at least one axis of symmetry.
The insert 3 may comprise varying thicknesses. The insert 3 may comprise a thickness within a range of about 9 mm to about 20 mm.
The insert 3 may come in varying sizes configured to match a size of the tibial tray (e.g., tibial tray 2). Each tibial tray size described herein may have a correspondingly shaped and sized insert 3. For example, if five tibial tray sizes are provided, then five insert 3 sizes may also be provided. The outside profile of the insert 3 may be shaped to match the profile of the tibial tray base (e.g., tibial tray base 44 shown in
The insert 3 may comprise an appropriate biocompatible material similar to other systems in the art. The insert 3 may comprise an appropriate biocompatible plastic. For example, the insert 3 may comprise UHMWPE or UHXLPE.
The poly lock screw 10 may be retained within the insert 3 in various ways as described herein. In a preferred embodiment, the poly lock screw 10 may be retained in the insert 3 via threads in the anterior aperture 36. After the poly lock screw 10 is threaded into the anterior aperture 36, the poly lock screw 10 may be held in place by interference between the diameter of the threaded aperture 36 and the slightly larger diameter of the poly lock screw 10. The assembly of the poly lock screw 10 to the insert 3 may be done during the manufacturing and assembly processes such that the two components can be packaged together and ready for use during surgery. In the example embodiment described for locking between the tibial tray 2 and the insert 3, the insert 3 may be slid onto the tibial tray 2 during surgery. It will be understood by one of ordinary skill in the art that other coupling methods may be used as desired and may be guided by at least in part the choice of locking mechanism. After the insert 3 is placed onto the tibial tray 2 during the case, it may then be impacted so it is fully seated in the tibial tray 2 as shown in
The poly lock screw 10 may be coupled and/or locked onto the tibial tray 2 in various ways. For example, in a preferred embodiment, the poly lock screw 10 may comprise threads on a proximal end thereof (as shown in
In some embodiments, the shaft 40 of the poly lock screw 10 may comprise two different diameters. In some embodiments, the shaft 40 of the poly lock screw 10 may comprise the same diameter. In some embodiments, the shaft 40 of the poly lock screw 10 may comprise more than two different diameters.
In some embodiments, the shaft 40 of the poly lock screw 10 may comprise a first diameter and a second diameter. A first diameter may be large enough for an interference fit with the threaded aperture 36 in the insert 3 and the second diameter may be small enough for a clearance fit through threaded aperture 36. The diameter dimensions of the shaft 40 may depend on the threads chosen for this connection and may be configured such that there is enough thread space for the shaft 40 to fit into the insert 3 and the tibial tray 2.
The poly lock screw 10 is made of an appropriate biocompatible material. For example, the poly lock screw 10 may be made of an appropriate biocompatible metal. For example, the poly lock screw 10 may comprise cobalt chromium, titanium, titanium-based alloys, stainless steel, or the like, or any combination thereof.
In some embodiments, the insert 3 may be configured such that it limits hyperextension of the system to a pre-determined amount. In some embodiments, as described herein, hyperextension may range from about 0 degrees to about 7 degrees. In a preferred embodiment, the system may be configured to allow for about 5 degrees of hyperextension.
In some embodiments, the anterior buildup 41 may be part of a single-part construction insert 3. In some embodiments, the anterior buildup 41 may comprise a separate component from the insert 3 that can be fixed to the insert 3 onto the same location shown in
In some embodiments, a second (or alternative) feature may be provided. For example, a relatively flat portion 42 may be disposed along the condyle profile of the femoral component 1. The flat portion 42 may be configured such that the femoral component 1 bottoms out on the insert 3 when it reaches the desired angle of hyperextension. The degree of hyperextension allowed in the system may be similar to others in the art, which may range from about 0 degrees to about 7 degrees. The length of the flat portion 42 may vary for each femoral component 1 size provided in the system. The length of the flat portion 42 may be configured to fit between the features for the anterior trochlear groove 119 of the femoral component 1 and the posterior condyle profile 118. In a preferred embodiment, the system may allow for about 5 degrees of hyperextension. In this way, the flat 42 on the femoral component 1 may act as a hyperextension stop.
In some embodiments, the hyperextension block 43 may be configured such that it limits hyperextension of the system to a pre-determined amount. The degree of hyperextension by the hyperextension block 43 may be within a range from about 0 degrees to about 7 degrees as described herein. In a preferred embodiment, the hyperextension block 43 may allow for about 5 degrees of hyperextension.
The hyperextension block 43 may comprise an appropriate biocompatible material. The hyperextension block 43 may comprise an appropriate biocompatible plastic. For example, the hyperextension block 43 may comprise a biocompatible polyethylene (e.g., UHMWPE), polyether ether ketone (PEEK), or the like, or any combination thereof.
In some embodiments, the tibial tray 2 may comprise a one-piece construction. In some embodiments, the tibial tray 2 may comprise a multi-piece construction.
The tibial tray 2 may comprise an appropriate biocompatible material. The tibial tray 2 may comprise an appropriate biocompatible metal. For example, the tibial tray 2 may comprise cobalt chromium, titanium, titanium-based alloys, stainless steel, or the like, or any combination thereof.
The tibial tray 2 may come in various sizes in the system. There may be as many sizes of tibial tray 2 as there are sizes of femoral component 1. The tibial tray 2 may be sized to be compatible with the femoral component 1 sizing. Compatibility in the system is defined as the femoral component 1 fitting and working with the correct range of motion described for each tibial tray 2 it can be implanted with. The tibial tray 2 sizes may be configured to fit a wide range of patient anatomy. The sizing, similar to the sizing of the femoral component 1, may be configured to fit a patient's previously-existing anatomy. In a preferred embodiment, the system may be configured with at least one femoral component 1 size which corresponds to at least one tibial tray 2 size (e.g., size 1 femoral component 1 corresponds to size 1 tibial tray 2, size 2 femoral component 1 corresponds to size 2 tibial tray 2, etc.) and optionally one size above and/or below (e.g., size 3 femoral component 1 corresponds to size 4 and/or size 2 tibial trays 2).
The tibial tray 2 dimensions may vary depending on the size of the components of the system. The tibial tray 2 dimensions may include the medial/lateral and anterior/posterior dimensions of the tibial base 44, the length and diameter of the tibial post 45, and the width and length of the wings 46.
An outside diameter of the tibial bushing 4 may be configured to be press-fit into the aperture 48 of the tibial tray 2. The tibial bushing 4 may be long enough to fully cover the hinge post assembly 8 when assembled in place as shown in
The tibial bushing 4 may comprise an appropriate biocompatible material. The tibial bushing 4 may comprise an appropriate biocompatible plastic. For example, the tibial bushing 4 may comprise UHMWPE or a similar polyethylene.
The hinge post assembly 8 may comprise a hinge post body 54, a hinge post shaft 55, a hinge post tab 56, and a spring 57.
The hinge post assembly 8 may comprise a biocompatible metal. For example, the hinge post assembly 8 components may comprise cobalt chromium, titanium, titanium-based alloys, stainless steel, or the like, or any combination thereof.
The hinge post body 54 may comprise a biocompatible metal. For example, the hinge post body 54 may comprise cobalt chromium, titanium, titanium-based alloys, stainless steel, or the like, or any combination thereof.
The hinge post shaft 55 may comprise a biocompatible metal. For example, the hinge post shaft 55 may comprise cobalt chromium, titanium, titanium-based alloys, stainless steel, or the like, or any combination thereof.
The hinge post tab 56 may comprise a biocompatible metal. For example, the hinge post tab 56 may comprise cobalt chromium, titanium, titanium-based alloys, stainless steel, or the like, or any combination thereof.
The spring 57 may comprise a biocompatible metal. For example, the spring 57 may comprise cobalt chromium, titanium, titanium-based alloys, stainless steel, or the like, or any combination thereof.
An aperture 61 on the distal end of the hinge post body 54 may goes through the entire component. The aperture 61 may be large enough to hold the hinge post tab 56 for a clearance fit. The aperture 61 may be configured to hold the hinge post tab 56. There may also be a channel or lumen 65 that runs axially down the center of the hinge post body 54 from the head 59 to the distal aperture 61. The hinge post body 54 may be closed on the distal end. The hinge post body 54 may be open on the distal end as long as the hinge post tab 56 is held in place and can still function as described herein. The channel or lumen 65 may be configured to fit a hinge post shaft (e.g., hinge post shaft 55 shown in
In a preferred embodiment, the distal feature 69 may comprise a small pin with a circular cross-section that is no longer than that hinge post tab 56. An aperture 70 may be disposed on the anterior side of the proximal shaft 67 to match the location of the aperture 60 on the hinge post body 54 when correctly rotationally aligned. The head 66 of the hinge post shaft 55 may follow the same profile as the head 59 of the hinge post body 54 when their anterior apertures 60, 70 are aligned. A notch cut 71 may be disposed on the anterior, proximal end of the head 66 and may be configured to match the lip feature 63 on the hinge post body 54. This cut 71 may not only guide the orientation the hinge post shaft 55 for assembly into the hinge post body 54, but also act as a visual guide to let the surgeons know when the hinge post shaft 55 is in its final, assembled position because it is then aligned to the anterior feature 64 on the hinge post body 54. The head 66 may be configured such that, after the hinge post shaft 55 is placed and rotated within the hinge post body 54, it cannot be pulled out because the lip 63 on the hinge post body 54 keeps it in place. A track 72 on the proximal head 66 may be configured to guide the allowed rotation of the hinge post shaft 55 within the hinge post body 54. The track 72 may be configured to allow for 90 degrees of rotation between the hinge post shaft 55 and the hinge post body 54 once they are assembled. One or more indents 73 may be disposed on the track 72 where the lip 63 of the hinge post body 54 fits in. In a preferred embodiment, these indents 73 may be located in pre-determined places that allow for quarter-turn rotations of the hinge post shaft 55 (e.g., as shown in
In some embodiments, the hinge post shaft 55 may comprise a unitary body. In some embodiments, the hinge post shaft 55 may comprise a multi-part construction.
In some embodiments, the hinge post tab 56 may comprise a unitary body. In some embodiments, the hinge post tab 56 may comprise a multi-part construction.
The hinge post assembly 8 may be configured with the same diameter regardless of the size of the remaining components. For example, the hinge post assembly 8 may comprise a diameter of at least about 9.5 mm. The hinge post assembly 8 may be configured with different lengths that correspond to the different thicknesses of the insert 3 sizes provided in the system as described herein. For ease of use, the hinge post assembly 8 may be labeled with lasermarks and/or on the label of the packaging to match with the corresponding insert 3 and the hinge post assembly may be packaged with the hinge post set screw 9.
The hinge post screw 9 may comprise a biocompatible metal. For example, this hinge post screw 9 may comprise cobalt chromium, titanium, titanium-based alloys, stainless steel, or the like, or any combination thereof.
Although a preferred embodiment of the attachment between the hinge post assembly 8 and the hinge box 5 has been described with reference to a screw 9, it will be understood by one of ordinary skill in the art that there may be alternate anterior assembly embodiments that may also be used to affix the two components. One such embodiment may require the hinge post assembly 8 to be placed in the hinge box 5 and a set screw, pin, or clip may then be inserted anteriorly into the hinge box 5 such that it sits above the proximal end of the hinge post assembly 8 and keeps it in place. In another embodiment, there could be a latch mechanism in the hinge box 5 that locks into a notch in the hinge post assembly 8. The latch may be pressed so the hinge post assembly 8 is placed into a countersink of the hinge box 5 and it keeps the hinge post 8 in place when released. Another embodiment could include a bal seal around the aperture 24 in the hinge box 5 configured to engage with a circumferential groove on the hinge post body 54. In another embodiment, the hinge post assembly 8 could be impacted into place so a tapered proximal end engages with a female taper on the aperture 24 of the hinge box 5. Those are only some example embodiments, as there are other possible ways the hinge post assembly 8 could be affixed to the hinge box 5 which may be understood by one of ordinary skill in the art based on the description herein.
The shaft body 82 may comprise a distal end 88 configured to correspond to the aperture 74 on the hinge post shaft 55. The shaft body 82 may be made of an appropriate material such as stainless steel or a similar metal. In a preferred embodiment, the distal end 88 may comprise a symmetric profile for ease of use, such as preferably a circle or more preferably a square a profile. The distal end 88 may comprise a profile which corresponds to the shape of aperture 74. The shaft body 82 may be hollow and the internal shaft 85 may be configured to fit within and rotate within the shaft body 82.
The internal shaft 85 may comprise a uniform component made of a metal similar to the shaft body 82 described herein. The proximal end of the internal shaft 85 may be configured to engage with and fit into the turn-knob 84 such that rotation of the turn-knob 84 relative to the handle 83 causes rotation of the internal shaft 85. The internal shaft 85 may be configured to fit within at least a portion the handle 83 and at least a portion of the hollow shaft body 82. The internal shaft 85 may comprising a length sufficient to engage with the turn-knob 84 and extend a few millimeters past the distal end 88 of the shaft body 82 when exposed. The internal shaft 85 may be configured to engage with features such as a spring and/or an internal feature on the handle 83, for example, to allow it to protrude past the distal end 88 of the shaft body 82 or sit within it such that it is not exposed. The instrument 76 may be configured so that when fully-assembled (e.g., when the internal shaft 85, connected to the turn-knob 84, is placed through the handle 83 and then the shaft body 82 is slide over the internal shaft 85 and connected to the handle 83), the distal end 88 of the internal shaft 85 does not come out past the shaft body 82. A spring, lever, latch, or the like may be used to keep the internal shaft 85 in place until the turn-knob 84 is pressed in towards the handle 83 and only then is the distal end 89 of the internal shaft 85 exposed.
The distal tip 89 of the internal shaft 85 may be threaded to engage and lock into the aperture 75 of the hinge post shaft 55. The distal tip 89 may be about the same length as the aperture 75. The distal end 88 of the shaft body 82 may be configured to install and lock the hinge post assembly 8 with just a press-fit between the two components whereas the distal tip 89 of the internal shaft 85 may be configured to remove or unlock the hinge post assembly 8 from the femoral and tibial components.
Should removal or replacement of the system be needed, the femoral component 1, tibial tray 2, and insert 3 can be removed with available instruments in a similar manner as a primary or revision system. The hinge components could also be replaced or removed if needed. If the hinge post assembly 8 needs to be replaced, the same instrument used to insert the hinge set screw 9 may be used to first remove the hinge set screw 9. In a preferred embodiment, the hinge post instrument 76 can then be used to remove the hinge post assembly 8 by first engaging (e.g., with a press-fit) the distal end 88 of the shaft body 82 to the aperture 74 hinge post shaft 55. The distal threads 89 on the inner shaft 85 should then be pushed out by pressing the turn-knob 84 and then threading them into the threaded aperture 75 of the hinge post shaft 55 using the knob 84. Once the hinge post instrument 76 is fixed onto the hinge post shaft 55, the hinge post assembly 8 can be disengaged from the tibial bushing 4 and pulled out. In the example embodiment of the hinge post assembly 8 described here, this may be done by having the surgeon turn the hinge post shaft 55 counter-clockwise. This action may translate the hinge post tab 56 anteriorly such that it now sits flush within the hinge post body 54, as seen in
The femoral augments 90 may be provided in a number of different heights to accommodate varying bone loss in the patient. The femoral augments 90 may comprise a height greater than 5 mm. In some embodiments, the femoral augments 90 may comprise multiple different heights in increments. For example, the femoral augments 90 may be provided in heights of 5 mm and 10 mm.
The tibial augments 91 may be provided in a number of different heights to accommodate varying bone loss in the patient. The tibial augments 91 may comprise a height greater than 5 mm. In some embodiments, the tibial augments 91 may comprise multiple different heights in increments. For example, the tibial augments 91 may be provided in heights of 5 mm and 10 mm.
The augments 90, 91 can be attached to the femur or tibia, respectively, in a number of ways, such as with cement, screws, or a snap fit, or the like, or any combination thereof, as will be understood by one of ordinary skill in the art based on the teachings herein. In a preferred embodiment, augments may be affixed with either (or both) of (a) a bone cement similar to ones in the art, in which case the augments may comprise one or more cement pockets 92 on the edges that will be in contact with the femoral component 1, the tibial tray 2, or bone; or (b) one or more augment screws 92 of an appropriate length to engage into the threaded augment screw apertures on the tibial tray 2 and femoral component 1 as shown in
Additional femoral components may be included in the system to treat DFR cases. For DFR cases, additional resection is required of the distal femur that is not done in primary or revision surgery. An additional DFR cutting guide may be provided in the system to guide the additional resection on the femur. The DFR cutting guide may be used during a case where the distal femur has been previously resurfaced in a primary or revision knee surgery or in a case where the hinge knee DFR system will be the first surgery and the femoral condyles of the patient are still present. After the distal femur is resected to the appropriate length, the bone may be replaced with augments. Depending on the length of resected distal femur, the surgeon may decide to treat the case using the combination of a DFR augment (such as DFR augment 93 shown in
In some embodiments, the DFR augment 93 may comprise a uniform part in order to decrease the number of components a surgeon needs to handle and/or to enhance ease of use.
In some embodiments, the DFR augment 93 may be made of a biocompatible metal. For example, the DFR augment 93 may comprise cobalt chromium, titanium, titanium-based alloys, stainless steel, or the like, or any combination thereof.
In some embodiments, the DFR augment screws 98 may be packaged with the DFR augment 93. In some embodiments, the DFR augment screws 98 may be come pre-assembled onto the DFR augment 93. By packaging the screws 98 and augment 93 together, either pre-assembled or not, use and assembly of the system may be made substantially easier than other systems currently available.
The DFR augment screw 98 may be coupled to the augment 93 using any technique known to one of ordinary skill in the art, such as retaining threads similar to the ones described with respect to the insert 3.
The DFR augment screw 98 may be made of an appropriate biocompatible metal. For example, the DFR augment screw 98 may comprise cobalt chromium, titanium, titanium-based alloys, stainless steel, or the like, or any combination thereof.
The DFR femoral component 94 may come in right and left options and be nearly identical to the femoral component 1 described herein. For example, an anterior flange 105, the condylar bearing surface 12, the intercondylar box 15, and other features of the femoral component 1 may be incorporated into the DFR femoral component 94. The DFR femoral component 94 may also comprise an aperture 106 on the proximal end of the component that allows for a stem connection to be added as described herein. The stem connection aperture 106 may be positioned and oriented similar to other systems in the art. In this particular embodiment, the stem connection features 106 may be made at a 5 degree angle from a vertical plane. This angle may typically be about 5 degrees or about 6 degrees as in other systems known in the art. The main difference between the DFR femoral component 94 and the femoral component 1 may be the material buildup 107 on the distal plane configured to fill the space where the chamfer cuts typically are on primary and revision femoral components. The material buildup 107 may follow the general shape of other DFR femoral components in the art that imitate the anatomical shape of the femur and are no wider than the medial/lateral dimensions of the femoral component 1 described herein. The DFR femoral component 94, similar to the femoral component 1, may come pre-assembled with the hinge components (e.g., hinge box 5, bushings 6, and cross-pin 7) so the same surgical procedure outlined herein with respect to the femoral component 1 may be used when this DFR femoral component 94 is needed. The only difference may be the amount of distal femur resected and the size and/or shape of the optional stems that attach to the stem connection 106 on the DFR femoral component 94.
The DFR femoral component 94 may comprise a single component. The DFR femoral component 94 may comprise a multi-part construction.
The DFR femoral component 94 may comprise a biocompatible material. The DFR femoral component 94 may comprise a biocompatible metal. For example, the DFR femoral component 94 may comprise cobalt chromium, titanium, titanium-based alloys, stainless steel, or the like, or any combination thereof.
In some embodiments, a flange 111 may be disposed towards the distal end of the DFR stem extension 108. Ridges 113 may be disposed circumferentially on the flange 111 to help prevent rotation of the system once it is implanted. The flange 111 may be configured to sit on the resected distal femur when installed in the patient so that there is sufficient contact area between the resected distal femur of the patient and the implants. In at least some instances, it may be important to have the flange 111 in place due to the unique cross-sections that may be encountered at high resection lengths on a femur so that the DFR stem 108 does not fall through and into the medullary canal.
The DFR stem collar 114 may comprise a single uniform component. The DFR stem collar 114 may comprise a multi-part construction.
The DFR stem collar 114 may comprise a biocompatible material. The DFR stem collar 114 may comprise a biocompatible metal. For example, the stem collar 114 may comprise cobalt chromium, titanium, titanium-based alloys, stainless steel, or the like, or any combination thereof.
In the hinged knee TKA method shown on the left, Step 201 may comprise preparing, sizing, and reaming the femur.
Step 202 may comprise reaming the tibia and/or resecting the distal tibia.
Step 203 may comprise resecting the distal femur.
Step 204 may comprise cutting one or more femoral chamfer cuts.
Step 205 may comprise resecting and/or reaming space for a hinge box (e.g., hinge box 5 described herein).
Step 206 may comprise testing one or more trial implants for the correct joint space replacement and/or desired range of motion. Step 6 may optionally comprise testing one or more femoral components 1, one or more tibial trays 2, one or more inserts 3, one or more hinge post assemblies 8, one or more stems 112, one or more femoral augments 90, and/or one or more tibial augments 91.
Step 207 may comprise implanting the components of the hinged knee system. Step 7 may comprise one or more sub-steps. For example, Step 7 may comprise (a) attaching optional stem 112 and optional tibial augments 91 to tibial tray 2, (b) implanting the tibial tray 2 assembly, (c) attaching optional stem 112 and optional femoral augments 90 to the pre-assembled femoral component 1, (d) implanting the femoral component 1 assembly, (e) implanting insert 3, (f) locking insert 3 in place with screw 10, (g) flexing the femoral component 1 to at least 90 degrees and inserting the hinge post assembly 8 (e.g., as shown in
Step 208 may comprise conducting final motion and stability checks before closing the incision.
Although the steps above show a method of performing a hinged knee TKA using the system described herein, a person of ordinary skill in the art will recognize many variations based on the teaching described herein. The steps may be completed in a different order. Steps may be added or deleted. Some of the steps may comprise sub-steps. Many of the steps may be repeated as often as necessary ensure correct placement of one or more article component on the operator-side of the first platform.
For example, in many embodiments, augments 90, 91 are not utilized, stem 112 is attached only to the femur or tibia but not both, stem 112 is not necessary at all, and/or other mechanisms for securing components to one another may be utilized.
In the DFR hinged knee TKA with DFR augment method shown in the middle, Step 301 may comprise preparing, sizing, and reaming the femur.
Step 302 may comprise reaming the tibia and/or resecting the distal tibia.
Step 303 may comprise resecting the distal femur.
Step 304 may comprise cutting one or more femoral chamfer cuts.
Step 305 may comprise testing one or more trial implants for the correct joint space replacement and/or desired range of motion. Step 6 may optionally comprise testing one or more femoral components 1, one or more tibial trays 2, one or more inserts 3, one or more hinge post assemblies 8, one or more stems 112, one or more DFR augments 93, and/or one or more tibial augments 91.
Step 306 may comprise implanting the components of the DFR hinged knee system. Step 6 may comprise one or more sub-steps. For example, Step 6 may comprise (a) attaching optional stem 112 and optional tibial augments 91 to tibial tray 2, (b) implanting the tibial tray 2 assembly, (c) attaching optional stem 112 and DFR femoral augments 93 to the pre-assembled femoral component 1, (d) implanting the femoral component 1 assembly, (e) implanting insert 3, (f) locking insert 3 in place with screw 10, (g) flexing the femoral component 1 to at least 90 degrees and inserting the hinge post assembly 8 (e.g., as shown in
Step 307 may comprise conducting final motion and stability checks before closing the incision.
Although the steps above show a method of performing a DFR hinged knee TKA using the DFR augment system described herein, a person of ordinary skill in the art will recognize many variations based on the teaching described herein. The steps may be completed in a different order. Steps may be added or deleted. Some of the steps may comprise sub-steps. Many of the steps may be repeated as often as necessary ensure correct placement of one or more article component on the operator-side of the first platform.
For example, in many embodiments, augments 91 are not utilized, stem 112 is attached only to the femur or tibia but not both, stem 112 is not necessary at all, and/or other mechanisms for securing components to one another may be utilized.
In the DFR hinged knee TKA with DFR femoral component method shown on the right, Step 401 may comprise preparing, sizing, and reaming the femur.
Step 402 may comprise reaming the tibia and/or resecting the distal tibia.
Step 403 may comprise resecting the distal femur.
Step 404 may comprise testing one or more trial implants for the correct joint space replacement and/or desired range of motion. Step 6 may optionally comprise testing one or more DFR femoral components 94, one or more tibial trays 2, one or more inserts 3, one or more hinge post assemblies 8, one or more DFR stems 108, one or more stems 112, one or more DFR stem collars 114, and/or one or more tibial augments 91.
Step 405 may comprise implanting the components of the DFR hinged knee system with DFR femoral component 94. Step 5 may comprise one or more sub-steps. For example, Step 5 may comprise (a) attaching optional stem 112 and optional tibial augments 91 to tibial tray 2, (b) implanting the tibial tray 2 assembly, (c) attaching DFR stem 108 to the pre-assembled DFR femoral component 94, (d) attaching DFR stem 108 to the DFR stem collar 114 and attaching the DFR stem-DFR stem collar complex to the pre-assembled DFR femoral component 94, (e) implanting the DFR femoral component 94 assembly, (f) implanting insert 3, (g) locking insert 3 in place with screw 10, (h) flexing the DFR femoral component 94 to at least 90 degrees and inserting the hinge post assembly 8 (e.g., as shown in
Step 406 may comprise conducting final motion and stability checks before closing the incision.
Although the steps above show a method of performing a DFR hinged knee TKA using the DFR femoral component system described herein, a person of ordinary skill in the art will recognize many variations based on the teaching described herein. The steps may be completed in a different order. Steps may be added or deleted. Some of the steps may comprise sub-steps. Many of the steps may be repeated as often as necessary ensure correct placement of one or more article component on the operator-side of the first platform.
For example, in many embodiments, augments 91 are not utilized, stem 112 and/or stem 108 is not necessary at all, and/or other mechanisms for securing components to one another may be utilized.
The present disclosure describes both preferred embodiments as well as possible alternate embodiments, but it should not be limited to any of the particular forms shown. The disclosure is intended to cover any variations or adaptations of the invention that capture the idea behind what was described.
When a feature or element is herein referred to as being “on” another feature or element, it can be directly on the other feature or element or intervening features and/or elements may also be present. In contrast, when a feature or element is referred to as being “directly on” another feature or element, there are no intervening features or elements present. It will also be understood that, when a feature or element is referred to as being “connected”, “attached” or “coupled” to another feature or element, it can be directly connected, attached or coupled to the other feature or element or intervening features or elements may be present. In contrast, when a feature or element is referred to as being “directly connected”, “directly attached” or “directly coupled” to another feature or element, there are no intervening features or elements present. Although described or shown with respect to one embodiment, the features and elements so described or shown can apply to other embodiments. It will also be appreciated by those of skill in the art that references to a structure or feature that is disposed “adjacent” another feature may have portions that overlap or underlie the adjacent feature.
Terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. For example, as used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprises” and/or “comprising,” when used in this specification, specify the presence of stated features, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, and/or groups thereof. As used herein, the term “and/or” includes any and all combinations of one or more of the associated listed items and may be abbreviated as “/”.
Spatially relative terms, such as “under”, “below”, “lower”, “over”, “upper” and the like, may be used herein for ease of description to describe one element or feature's relationship to another element(s) or feature(s) as illustrated in the figures. It will be understood that the spatially relative terms are intended to encompass different orientations of the device in use or operation in addition to the orientation depicted in the figures. For example, if a device in the figures is inverted, elements described as “under” or “beneath” other elements or features would then be oriented “over” the other elements or features. Thus, the exemplary term “under” can encompass both an orientation of over and under. The device may be otherwise oriented (rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly. Similarly, the terms “upwardly”, “downwardly”, “vertical”, “horizontal” and the like are used herein for the purpose of explanation only unless specifically indicated otherwise.
Although the terms “first” and “second” may be used herein to describe various features/elements (including steps), these features/elements should not be limited by these terms, unless the context indicates otherwise. These terms may be used to distinguish one feature/element from another feature/element. Thus, a first feature/element discussed below could be termed a second feature/element, and similarly, a second feature/element discussed below could be termed a first feature/element without departing from the teachings of the present invention.
Throughout this specification and the claims which follow, unless the context requires otherwise, the word “comprise”, and variations such as “comprises” and “comprising” means various components can be co-jointly employed in the methods and articles (e.g., compositions and apparatuses including device and methods). For example, the term “comprising” will be understood to imply the inclusion of any stated elements or steps but not the exclusion of any other elements or steps.
As used herein in the specification and claims, including as used in the examples and unless otherwise expressly specified, all numbers may be read as if prefaced by the word “about” or “approximately,” even if the term does not expressly appear. The phrase “about” or “approximately” may be used when describing magnitude and/or position to indicate that the value and/or position described is within a reasonable expected range of values and/or positions. For example, a numeric value may have a value that is +/−0.1% of the stated value (or range of values), +/−1% of the stated value (or range of values), +/−2% of the stated value (or range of values), +/−5% of the stated value (or range of values), +/−10% of the stated value (or range of values), etc. Any numerical values given herein should also be understood to include about or approximately that value, unless the context indicates otherwise. For example, if the value “10” is disclosed, then “about 10” is also disclosed. Any numerical range recited herein is intended to include all sub-ranges subsumed therein. It is also understood that when a value is disclosed that “less than or equal to” the value, “greater than or equal to the value” and possible ranges between values are also disclosed, as appropriately understood by the skilled artisan. For example, if the value “X” is disclosed the “less than or equal to X” as well as “greater than or equal to X” (e.g., where X is a numerical value) is also disclosed. It is also understood that the throughout the application, data is provided in a number of different formats, and that this data, represents endpoints and starting points, and ranges for any combination of the data points. For example, if a particular data point “10” and a particular data point “15” are disclosed, it is understood that greater than, greater than or equal to, less than, less than or equal to, and equal to 10 and 15 are considered disclosed as well as between 10 and 15. It is also understood that each unit between two particular units are also disclosed. For example, if 10 and 15 are disclosed, then 11, 12, 13, and 14 are also disclosed.
While preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the invention. It should be understood that various alternatives to the embodiments of the invention described herein may be employed in practicing the invention. It is intended that the following claims define the scope of the invention and that methods and structures within the scope of these claims and their equivalents be covered thereby.
This application is a continuation application of International Application No. PCT/US19/29735, filed on Apr. 29, 2019, which claims the benefit of U.S. Provisional Application No. 62/663,940, filed Apr. 27, 2018, entitled “HINGE JOINT SYSTEM WITH DISTAL FEMORAL REPLACEMENT PROSTHETIC KNEE”, the entire contents of which are incorporated herein by reference.
| Number | Date | Country | |
|---|---|---|---|
| 62663940 | Apr 2018 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | PCT/US19/29735 | Apr 2019 | US |
| Child | 16399762 | US |
