Patent Application
20210000484
The present disclosure relates to instruments and methods to improve femoral and tibial alignment during knee arthroplasty. More specifically, the present disclosure relates to multi-pin guides and multi-cut guides.
The success of knee arthroplasty is largely dependent upon the accuracy of the distal femoral and proximal tibial bone cuts or resections. When the resections are well aligned to the mechanical axis of the leg and patient knee geometry and orientation, the reconstructed knee functions better and lasts longer. The problem to be solved is to devise instruments and methods which provide exceptional accuracy in combination with simplicity, speed, and value.
The various systems and methods of the present technology have been developed in response to the present state of the art, and in particular, in response to the problems and needs in the art that have not yet been fully solved by currently available knee arthroplasty instrument systems and methods. The systems and methods of the present technology may provide improved anatomical referencing, sizing, and alignment comparable to computerized navigation systems, at a fraction of the cost.
To achieve the foregoing, and in accordance with the technology as embodied and broadly described herein, in an aspect of the technology, an instrument system for knee arthroplasty of a femur and a tibia of a knee joint, the system including: a femoral apparatus that includes medial and lateral holes, anterior and posterior holes, and a femur-contacting feature, wherein the medial and lateral holes are parallel, extend along an anterior-posterior direction, and are adapted to receive bone pins for insertion into a distal anterior side of the femur, wherein the anterior and posterior holes are parallel, extend along a proximal-distal direction, and are adapted to receive bone pins for insertion into a distal side of the femur, wherein the femur-contacting feature is adapted to contact a distal surface of a femoral condyle; and a tibial apparatus that is slidingly connected to the femoral apparatus and includes a pin hole and a tibia-contacting feature, wherein the pin hole extends along the proximal-distal direction and is adapted to receive a bone pin for insertion into a proximal anterior side of the tibia, wherein the tibia-contacting feature is adapted to contact a proximal surface of a tibial plateau, wherein the tibial apparatus slides relative to the femoral apparatus along the anterior-posterior direction.
Embodiments of this aspect of the technology may include one or more of the following attributes. The instrument system, including: a femoral alignment rod that extends between proximal and distal ends and is adapted to align with a mechanical axis of the femur in an anterior view of the femur; a handle that extends between proximal and distal ends, wherein the proximal end of the handle is connected to the distal end of the femoral alignment rod; and a base that extends between proximal and distal ends and includes a bone-facing side, wherein the distal end of the base is connected to the distal end of the handle, wherein the bone-facing side is adapted to contact a central distal anterior surface of the femur; wherein the femoral apparatus is connected to the distal end of the base. The femoral apparatus includes a distal femoral saw slot and an anterior femoral saw slot, wherein the distal femoral saw slot is elongated along a medial-lateral direction, extends along the anterior-posterior direction, and is adapted to receive a saw blade to make a distal femoral resection, wherein the anterior femoral saw slot is elongated along the medial-lateral direction, extends along the proximal-distal direction, and is adapted to receive a saw blade to make an anterior femoral resection. The tibial apparatus includes a posterior femoral saw slot and a proximal tibial saw slot, wherein the posterior femoral saw slot is elongated along the medial-lateral direction, extends along the proximal-distal direction, and is adapted to receive a saw blade to make a posterior femoral resection, wherein the proximal tibial saw slot is elongated along the medial-lateral direction, extends along the proximal-distal direction, and is adapted to receive a saw blade to make a proximal tibial resection. The tibial apparatus includes a first portion and a second portion, wherein the first portion is slidingly connected to the femoral apparatus and includes the posterior femoral saw slot, wherein the second portion is slidingly connected to the first portion and includes the proximal tibial saw slot, wherein the first and second portions slide along the anterior-posterior direction. The pin hole of the tibial apparatus is a medial hole, wherein the tibial apparatus includes a lateral hole beside the medial hole, wherein the medial and lateral holes of the tibial apparatus are parallel, extend along the proximal-distal direction, and are adapted to receive bone pins for insertion into a proximal anterior side of the tibia. The instrument system, including: a tibial alignment rod connected to the tibial apparatus and adapted to align with a mechanical axis of the tibia in an anterior view of the tibia.
In another aspect of the technology, an instrument system for knee arthroplasty of a femur and a tibia of a knee joint, the system including: a femoral apparatus that includes a distal femoral saw slot, an anterior femoral saw slot, and a femur-contacting feature, wherein the distal femoral saw slot is elongated along a medial-lateral direction, extends along an anterior-posterior direction, and is adapted to receive a saw blade to make a distal femoral resection, wherein the anterior femoral saw slot is elongated along the medial-lateral direction, extends along a proximal-distal direction, and is adapted to receive a saw blade to make an anterior femoral resection, wherein the femur-contacting feature is adapted to contact a distal surface of a femoral condyle; and a tibial apparatus that is slidingly connected to the femoral apparatus and includes a posterior femoral saw slot, a proximal tibial saw slot, and a tibia-contacting feature, wherein the posterior femoral saw slot is elongated along the medial-lateral direction, extends along the proximal-distal direction, and is adapted to receive a saw blade to make a posterior femoral resection, wherein the proximal tibial saw slot is elongated along the medial-lateral direction, extends along the proximal-distal direction, and is adapted to receive a saw blade to make a proximal tibial resection, wherein the tibia-contacting feature is adapted to contact a proximal surface of a tibial plateau, wherein the tibial apparatus slides relative to the femoral apparatus along the anterior-posterior direction.
Embodiments of this aspect of the technology may include one or more of the following attributes. The instrument system, including: a femoral alignment rod that extends between proximal and distal ends and is adapted to align with a mechanical axis of the femur in an anterior view of the femur; a handle that extends between proximal and distal ends, wherein the proximal end of the handle is connected to the distal end of the femoral alignment rod; and a base that extends between proximal and distal ends and includes a bone-facing side, wherein the distal end of the base is connected to the distal end of the handle, wherein the bone-facing side is adapted to contact a central distal anterior surface of the femur; wherein the femoral apparatus is connected to the distal end of the base. The femoral apparatus includes medial and lateral holes and anterior and posterior holes, wherein the medial and lateral holes are parallel, extend along an anterior-posterior direction, and are adapted to receive bone pins for insertion into a distal anterior side of the femur, wherein the anterior and posterior holes are parallel, extend along a proximal-distal direction, and are adapted to receive bone pins for insertion into a distal side of the femur. The tibial apparatus includes a pin hole that extends along the proximal-distal direction and is adapted to receive a bone pin for insertion into a proximal anterior side of the tibia. The pin hole of the tibial apparatus is a medial hole, wherein the tibial apparatus includes a lateral hole beside the medial hole, wherein the medial and lateral holes of the tibial apparatus are parallel, extend along the proximal-distal direction, and are adapted to receive bone pins for insertion into a proximal anterior side of the tibia. The tibial apparatus includes a first portion and a second portion, wherein the first portion is slidingly connected to the femoral apparatus and includes the posterior femoral saw slot, wherein the second portion is slidingly connected to the first portion and includes the proximal tibial saw slot, wherein the first and second portions slide along the anterior-posterior direction. The instrument system, including: a tibial alignment rod connected to the tibial apparatus and adapted to align with a mechanical axis of the tibia in an anterior view of the tibia.
In yet another aspect of the technology, an instrument system for knee arthroplasty of a femur and a tibia of a knee joint, the system including: a femoral apparatus that includes a distal femoral saw slot, an anterior femoral saw slot, and a femur-contacting feature, wherein the distal femoral saw slot is elongated along a medial-lateral direction and extends along an anterior-posterior direction, wherein the anterior femoral saw slot is elongated along the medial-lateral direction and extends along a proximal-distal direction, wherein the distal femoral saw slot, anterior femoral saw slot, and femur-contacting feature are fixed relative to each other; and a tibial apparatus that is slidingly connected to the femoral apparatus and includes a posterior femoral saw slot, a proximal tibial saw slot, and a tibia-contacting feature, wherein the posterior femoral saw slot is elongated along the medial-lateral direction and extends along the proximal-distal direction, wherein the proximal tibial saw slot is elongated along the medial-lateral direction and extends along the proximal-distal direction, wherein the posterior femoral saw slot and tibia-contacting feature are fixed relative to each other, wherein the tibial apparatus slides relative to the femoral apparatus along the anterior-posterior direction.
Embodiments of this aspect of the technology may include one or more of the following attributes. The instrument system, including: a femoral alignment rod that extends between proximal and distal ends; a handle that extends between proximal and distal ends, wherein the proximal end of the handle is connected to the distal end of the femoral alignment rod; and a base that extends between proximal and distal ends and includes a bone-facing side, wherein the distal end of the base is connected to the distal end of the handle; wherein the femoral apparatus is connected to the distal end of the base. The femoral apparatus includes medial and lateral holes and anterior and posterior holes, wherein the medial and lateral holes are parallel and extend along an anterior-posterior direction, wherein the anterior and posterior holes are parallel and extend along a proximal-distal direction, wherein the medial, lateral, anterior, and posterior holes are fixed relative to each other and the distal femoral saw slot, anterior femoral saw slot, and femur-contacting feature. The tibial apparatus includes a pin hole that extends along the proximal-distal direction, wherein the proximal tibial saw slot and pin hole are fixed relative to each other. The pin hole of the tibial apparatus is a medial hole, wherein the tibial apparatus includes a lateral hole beside the medial hole, wherein the medial and lateral holes of the tibial apparatus are parallel and extend along the proximal-distal direction, wherein the medial and lateral holes of the tibial apparatus are fixed relative to each other. The tibial apparatus includes a first portion and a second portion, wherein the first portion is slidingly connected to the femoral apparatus and includes the posterior femoral saw slot, wherein the second portion is slidingly connected to the first portion and includes the proximal tibial saw slot, wherein the first and second portions slide along the anterior-posterior direction.
In yet another aspect of the technology, a system for inserting bone pins in a femur and a tibia of a knee joint, the system including: a femoral alignment rod that extends between proximal and distal ends and is adapted to align with a mechanical axis of the femur in an anterior view of the femur; a handle that extends between proximal and distal ends, the proximal end of the handle connected to the distal end of the femoral alignment rod; a base that extends between proximal and distal ends and includes a bone-facing side, the distal end of the base connected to the distal end of the handle, the bone-facing side adapted to contact a central distal anterior surface of the femur; a femoral apparatus including an arm, a protrusion, and a femur-contacting feature, the arm including a proximal end connected to the distal end of the base, a distal end connected to the protrusion, and medial and lateral holes that are parallel, extend along an anterior-posterior direction, and are adapted to receive bone pins for insertion into a distal anterior side of the femur, the protrusion including anterior and posterior holes that are parallel, extend along a proximal-distal direction, and are adapted to receive bone pins for insertion into a distal side of the femur, the femur-contacting feature connected to the protrusion and adapted to contact a distal surface of a femoral condyle, wherein the medial, lateral, anterior, and posterior holes and femur-contacting feature are fixed relative to each other; a tibial apparatus that is slidingly connected to the femoral apparatus and includes a pin hole and a tibia-contacting feature, the pin hole extending along the proximal-distal direction and adapted to receive a bone pin for insertion into a proximal anterior side of the tibia, the tibia-contacting feature adapted to contact a proximal surface of a tibial plateau, wherein the tibial apparatus slides relative to the femoral apparatus along the anterior-posterior direction; and a tibial alignment rod that extends between first and second ends and is adapted to align with a mechanical axis of the tibia in an anterior view of the tibia, the first end connected to the tibial apparatus, the second end extending away from the tibial apparatus.
In yet another aspect of the technology, a system for inserting bone pins in a femur and a tibia of a knee joint, the system including: a 6-in-1 pin guide including: a femoral body including an arm, a protrusion, and a femur-contacting feature, the arm including a proximal end and a distal end connected to the protrusion, the proximal end including medial and lateral holes that are parallel, extend along an anterior-posterior direction, and are adapted to receive bone pins for insertion into a distal anterior side of the femur, the protrusion including anterior and posterior holes that are parallel, extend along a proximal-distal direction, and are adapted to receive bone pins for insertion into a distal side of the femur, the femur-contacting feature connected to the protrusion and adapted to contact a distal surface of a femoral condyle, wherein the medial, lateral, anterior, and posterior holes and the femur-contacting feature of the femoral body are fixed relative to each other; a tibial body slidingly connected to the femoral body and including medial and lateral holes and a tibia-contacting feature, the medial and lateral holes of the tibial body extending in parallel along the proximal-distal direction and adapted to receive bone pins for insertion into a proximal anterior side of the tibia, the tibia-contacting feature adapted to contact a proximal surface of a tibial plateau, wherein the medial and lateral holes and the tibia-contacting feature of the tibial body are fixed relative to each other, wherein the tibial body slides relative to the femoral body along the anterior-posterior direction; and a tibial alignment rod extending between first and second ends and adapted to align with a mechanical axis of the tibia in an anterior view of the tibia, the first end connected to the tibial body, the second end extending away from the tibial body.
In yet another aspect of the technology, a system for resecting a femur and a tibia of a knee joint, the system including: a femoral alignment rod that extends between proximal and distal ends and is adapted to align with a mechanical axis of the femur in an anterior view of the femur; a handle that extends between proximal and distal ends, the proximal end of the handle connected to the distal end of the femoral alignment rod; a base that extends between proximal and distal ends and includes a bone-facing side, the distal end of the base connected to the distal end of the handle, the bone-facing side adapted to contact a central distal anterior surface of the femur; a first femoral body including an arm, a distal femoral saw slot, an anterior femoral saw slot, and a femur-contacting surface, the arm connected to the distal end of the base, the distal femoral saw slot elongated along a medial-lateral direction, extending along an anterior-posterior direction, and adapted to receive a saw blade to make a distal femoral resection, the anterior femoral saw slot elongated along the medial-lateral direction, extending along a proximal-distal direction, and adapted to receive a saw blade to make an anterior femoral resection, the femur-contacting surface adapted to contact a distal surface of a femoral condyle, wherein the distal and anterior femoral saw slots and the femur-contacting surface are fixed relative to each other; a second femoral body slidingly connected to the first femoral body and including a posterior femoral saw slot and a tibia-contacting feature, the posterior femoral saw slot elongated along the medial-lateral direction, extending along the proximal-distal direction, and adapted to receive a saw blade to make a posterior femoral resection, the tibia-contacting feature adapted to contact a proximal surface of a tibial plateau, wherein the posterior femoral saw slot and tibia-contacting feature are fixed relative to each other, wherein the second femoral body slides relative to the first femoral body along the anterior-posterior direction; a tibial cut guide slidingly connected to the second femoral body and including a proximal tibial saw slot elongated along the medial-lateral direction, extending along the proximal-distal direction, and adapted to receive a saw blade to make a proximal tibial resection, wherein the tibial cut guide slides relative to the second femoral body along the proximal-distal direction; and a tibial alignment rod connected to the tibial cut guide, extending away from the tibial pin guide, and adapted to align with a mechanical axis of the tibia in an anterior view of the tibia.
In yet another aspect of the technology, a system for resecting a femur and a tibia of a knee joint, the system including: a first femoral body including a distal femoral saw slot that is elongated along a medial-lateral direction, extends along an anterior-posterior direction, and is adapted to receive a saw blade to make a distal femoral resection; a second femoral body fixed to the first femoral body and including an anterior femoral saw slot and a femur-contacting surface, the anterior femoral saw slot elongated along the medial-lateral direction, extending along a proximal-distal direction, and adapted to receive a saw blade to make an anterior femoral resection, the femur-contacting surface adapted to contact a distal surface of a femoral condyle; a first post fixed to the second femoral body, protruding from the femur-contacting surface along the proximal-distal direction, and adapted to be inserted into a first hole extending into a distal surface of the femur along the proximal-distal direction; a second post fixed to the second femoral body posterior to the first post, protruding from the femur-contacting surface parallel to the first post along the proximal-distal direction, and adapted to be inserted into a second hole extending into the distal surface of the femur along the proximal-distal direction posterior to the first hole; a third femoral body slidingly connected to the second femoral body; a fourth femoral body fixed to the third femoral body and including a posterior femoral saw slot and a tibia-contacting feature, the posterior femoral saw slot elongated along the medial-lateral direction, extending along the proximal-distal direction, and adapted to receive a saw blade to make a posterior femoral resection, the tibia-contacting feature adapted to contact a proximal surface of a tibial plateau, wherein the third and fourth femoral bodies slide relative to the second femoral body along the anterior-posterior direction; a first tibial body slidingly connected to the fourth femoral body; a second tibial body fixed to the first tibial body and including a proximal tibial saw slot elongated along the medial-lateral direction, extending along the proximal-distal direction, and adapted to receive a saw blade to make a proximal tibial resection, wherein the first and second tibial bodies slide relative to the fourth femoral body along the anterior-posterior direction; and a tibial alignment rod connected to the second tibial body, extending away from the second tibial body, and adapted to align with a mechanical axis of the tibia in an anterior view of the tibia.
These and other features and advantages of the present technology will become more fully apparent from the following description and appended claims, or may be learned by the practice of the technology as set forth hereinafter.
Exemplary embodiments of the technology will become more fully apparent from the following description and appended claims, taken in conjunction with the accompanying drawings. Understanding that these drawings depict only exemplary embodiments and are, therefore, not to be considered limiting of the scope of the technology, the exemplary embodiments will be described with additional specificity and detail through use of the accompanying drawings in which:
Exemplary embodiments of the technology will be best understood by reference to the drawings, wherein like parts are designated by like numerals throughout. It will be readily understood that the components of the technology, as generally described and illustrated in the figures herein, could be arranged and designed in a wide variety of different configurations. Thus, the following more detailed description of the embodiments of the apparatus, system, and method is not intended to limit the scope of the invention, as claimed, but is merely representative of exemplary embodiments of the technology.
The phrases “connected to,” “coupled to” and “in communication with” refer to any form of interaction between two or more entities, including mechanical, electrical, magnetic, electromagnetic, fluid, and thermal interaction. Two components may be functionally coupled to each other even though they are not in direct contact with each other. The term “abutting” refers to items that are in direct physical contact with each other, although the items may not necessarily be attached together. The phrase “fluid communication” refers to two features that are connected such that a fluid within one feature is able to pass into the other feature.
The word “exemplary” is used herein to mean “serving as an example, instance, or illustration.” Any embodiment described herein as “exemplary” is not necessarily to be construed as preferred or advantageous over other embodiments. While the various aspects of the embodiments are presented in drawings, the drawings are not necessarily drawn to scale unless specifically indicated.
Standard medical planes of reference and descriptive terminology are employed in this specification. While these terms are commonly used to refer to the human body, certain terms are applicable to physical objects in general.
A standard system of three mutually perpendicular reference planes is employed. A sagittal plane divides a body into right and left portions. A coronal plane divides a body into anterior and posterior portions. A transverse plane divides a body into superior and inferior portions. A mid-sagittal, mid-coronal, or mid-transverse plane divides a body into equal portions, which may be bilaterally symmetric. The intersection of the sagittal and coronal planes defines a superior-inferior or cephalad-caudal axis. The intersection of the sagittal and transverse planes defines an anterior-posterior axis. The intersection of the coronal and transverse planes defines a medial-lateral axis. The superior-inferior or cephalad-caudal axis, the anterior-posterior axis, and the medial-lateral axis are mutually perpendicular.
Anterior means toward the front of a body. Posterior means toward the back of a body. Superior or cephalad means toward the head. Inferior or caudal means toward the feet or tail. Medial means toward the midline of a body, particularly toward a plane of bilateral symmetry of the body. Lateral means away from the midline of a body or away from a plane of bilateral symmetry of the body. Axial means toward a central axis of a body. Abaxial means away from a central axis of a body. Ipsilateral means on the same side of the body. Contralateral means on the opposite side of the body. Proximal means toward the trunk of the body. Proximal may also mean toward a user or operator. Distal means away from the trunk. Distal may also mean away from a user or operator. Dorsal means toward the top of the foot. Plantar means toward the sole of the foot.
Standard terminology related to knee arthroplasty is employed in this specification with the ordinary and customary meanings. Varus means deviation of the distal part of the leg below the knee inward, resulting in a bowlegged appearance. Valgus means deviation of the distal part of the leg below the knee outward, resulting in a knock-kneed appearance.
Referring to
The femoral multi-pin guide 4302 may include an arm 4314 that extends superiorly and anteriorly, terminating in a free end 4316 which may engage a complementary socket of a handle, base, or other component, similar to socket 3624 of femoral pin guide assembly 3500. The arm 4314 may include a pair of tubes 4318, 4320 located on medial and lateral sides of the arm. The tubes 4318, 4320 include holes 4322, 4324 which extend parallel to each other along an anterior-posterior direction. The tubes 4318 may include longitudinal slots 4326, 4328 through the superior side walls of the tubes. The holes 4322, 4324 may receive pin sleeves, such as pin sleeve 3510 discussed above or pin sleeves 1515, 2515 disclosed in U.S. patent application Ser. No. 15/630,555, which is incorporated herein in its entirety. The holes 4322, 4324 preferably correspond to holes in a distal cut guide, as discussed below. The femoral multi-pin guide 4302 may include a femoral condyle paddle 4330 or plate at the inferior posterior end of the arm 4314. In use, the condyle paddle 4330 is placed in direct contact with a femoral condyle, thus it may be referred to as a femur-contacting feature. The condyle paddle 4330 may be a flat plate which extends along medial-lateral and anterior-posterior directions. Therefore, the condyle paddle 4330 may establish a plane that is parallel to the plane established by the holes 4322, 4324. The condyle paddle 4330 shown is for a medial femoral condyle, so it extends medially from the arm 4314. When the illustrated condyle paddle 4330 contacts the medial femoral condyle, the holes 4322, 4324 are positioned so that the distal cut guide will make an 8 mm cut. The same portion of the arm 4314 may include a protrusion 4332 which extends inferiorly from the junction with the condyle paddle 4330. The protrusion 4332 may include anterior and posterior holes 4334, 4336 which extend parallel to each other along a superior-inferior direction which may be parallel with a bone contacting surface of a base when viewed in a lateral view, or which may have a defined orientation relative to the bone contacting surface of the base, for example an acute angle in a lateral view. The direction of the holes 4334, 4336 may be parallel to the mechanical axis 202 of the leg in an anterior view. The anterior hole 4334 may be larger in diameter than the posterior hole. In the example shown, the anterior hole 4334 has a 5 mm diameter and the posterior hole 4336 has a 3.2 mm hole. The holes 4334, 4336, taken together, establish the rotational orientation of the four-in-one cut guide for the anterior, anterior chamfer, posterior chamfer, and posterior resections of the distal femur 100, as well as the depth and orientation of the anterior resection relative to the distal anterior femoral cortex immediately superior to the trochlear groove. An inferior portion of the protrusion 4332 may include a T-slot 4338 or dovetail slot which extends along an anterior-posterior direction along one medial or lateral side of the protrusion 4332.
The tibial pin guide 4304 may include a T-rail 4340 or dovetail rail which is complementary to the T-slot 4338 of the femoral multi-pin guide 4302. The T-rail may extend along an anterior-posterior direction relative to the femur 100. A transverse through hole 4342 may extend across the anterior end of the T-rail 4340 to receive the pin 4310. The tibial pin guide 4304 may include a tibial condyle paddle 4344 or plate which protrudes superiorly (relative to the femur 100) from a posterior portion of the tibial pin guide. In use, the condyle paddle 4344 is placed in direct contact with a tibial condyle or intercondylar area of the tibial plateau, thus it may be referred to as a tibia-contacting feature. The condyle paddle 4344 may be a flat plate which extends along medial-lateral and superior-inferior directions. Therefore, the condyle paddle 4344 may establish a plane that is perpendicular to the planes established by the holes 4322, 4324 and the femoral condyle paddle 4330. Alternatively, the condyle paddle 4344 may be at an acute angle relative to the planes established by the holes 4322, 4324 and the femoral condyle paddle 4330 in a lateral view. The tibial pin guide 4304 may include a hole 4346 which extends along a superior-inferior direction, parallel to the condyle paddle 4344 in a lateral view and parallel to the mechanical axis 202 of the leg in an anterior view. The hole 4346 is preferably spaced apart from the bone-contacting surface of the condyle paddle 4344 so that when the condyle paddle 4344 contacts the tibial plateau, the hole 4346 is positioned so that a tibial cut guide will make a proximal tibial resection at the desired distance from the posterior femoral resection, to accommodate the planned implant thickness, and in the same rotational alignment as the femoral cut guide. The tibial pin guide 4304 may include anterior and posterior brackets 4348, 4350 which couple to the tube 4306.
The tube 4306 includes a longitudinal through hole 4352. The tube 4306 may include a window 4354 which extends through one side wall in a central portion of the tube. The tube 4306 may include a hole 4356 which extends through one side wall of the tube near the posterior end to receive the pin 4312.
The tibial alignment rod 4308 is shown foreshortened in
The multi-pin guide assembly 4300 may be assembled by performing some or all of the following steps in any order.
Orienting the tibial pin guide 4304 relative to the femoral multi-pin guide 4302 as shown in
Orienting the tube 4306 relative to the tibial pin guide 4304 as shown in
Orienting the tibial alignment rod 4308 relative to the tube 4306 as shown in
When the multi-pin guide assembly 4300 is fully assembled, the tibial pin guide 4304 is movable relative to the femoral multi-pin guide 4302 along an anterior-posterior direction (relative to the femur 100) established by the T-rail 4340 in the T-slot 4338. Unintentional disassembly is prevented by the pin 4310 extending across the T-rail 4340. Indicia 4364, 4366 on the femoral multi-pin guide 4302 and the tibial pin guide 4304 indicate to the user the femoral component size for a particular patient. The tibial alignment rod 4308 is movable relative to the tibial pin guide 4304 along an anterior-posterior direction (relative to the femur 100) established by the rod in the hole 4352.
The body 4400, base 4402, and handle 4404 may be comparable to portions of the femoral pin guide assembly 3500 or the trunnion 12, base 10, handle 26; base 302, handle 304; femoral riser 504, base 502; base 1502, handle 1516; and base 2502, handle 2516 disclosed in U.S. patent application Ser. No. 15/630,555. The body 4400, base 4402, and handle 4404 may be exchanged with these alternative apparatus.
The femoral extension rod 4406 may be similar to or identical to or exchanged with femoral extension rod 3524, or alignment rod 156 or femoral extension rods 306, 506, 1506, 2506 disclosed in U.S. patent application Ser. No. 15/630,555.
The femoral target assembly 4408 may be similar to or identical to or exchanged with target assemblies 818, 1818, 2818 disclosed in U.S. patent application Ser. No. 15/630,555.
The femoral support arm assembly 4410 may be similar to or identical to or exchanged with femoral support arm assemblies 786, 1786, 2786 disclosed in U.S. patent application Ser. No. 15/630,555. However, the assembly 4410 includes a bar having various openings and features conducive to organizing and storing surgical items.
The foot holder assembly 4100 may be similar to or identical to or exchanged with the foot holder assembly 3950 or foot holder assemblies 870, 1870, 2870 disclosed in U.S. patent application Ser. No. 15/630,555.
Referring to
Coupling the femoral multi-pin guide 4302 to a base and a femoral extension rod. This step may include inserting the free end 4316 of the femoral multi-pin guide arm 4314 into a socket like socket 3624 of femoral pin guide assembly 3500 and tightening a thumbscrew.
Aligning the femoral extension rod over the center of the femoral head and over the medial-lateral center of the distal femur 100. This step may include coupling the femoral extension rod to a femoral target which was previously centered relative to the femoral head.
Coupling the finial 4362 to a tibial target which was previously centered relative to the distal tibia 104 or medial-lateral center of the ankle. The knee may be in 90 degrees of flexion for this step and the following steps.
Centering the proximal tibia 104 relative to the hole 4346 of the tibial pin guide 4304 along a medial-lateral direction.
Contacting a distal femoral condyle with the condyle paddle 4330, contacting the tibial plateau with the condyle paddle 4344, and reading the femoral component size from the indicia 4364, 4366.
While maintaining the alignments of the preceding steps, driving pins 4420, 4422 through holes 4322, 4324 of the femoral multi-pin guide 4302; driving pins 4424, 4426 through holes 4334, 4336 of the femoral multi-pin guide 4302; and driving a pin 4428 through hole 4346 of the tibial pin guide 4304. This step may be preceded by a step of inserting pin sleeves in holes 4322, 4324 before driving pins 4420, 4422 through the holes. Pins 4424 and 4426 are parallel to each other, parallel to the femoral mechanical axis in an anterior view of the femur 100, parallel to (or in a defined orientation relative to) the bone-facing side of the base 4402 in a lateral view of the femur 100, and positioned along Whiteside's line on the distal end of the femur 100. Pins 4420, 4422 are parallel to each other, perpendicular to pins 4424, 4426, and positioned along a line that is perpendicular to the femoral mechanical axis in an anterior view of the femur. Pin 4428 is parallel to pins 4424, 4426 and positioned along the tibial mechanical axis in an anterior view of the tibia 104.
Optionally removing the pin sleeves from holes 4322, 4324, if used. Optionally disengaging the femoral extension rod from the femoral target, if used. Disengaging the tibial alignment rod 4308 from the tibial target. Disengaging the femoral alignment rod, base, and multi-pin guide assembly 4300 from the operative site by pulling the apparatus along the direction established by the pins 4424, 4426, 4428. Preferably, the pins 4424, 4426, 4428 and their corresponding holes 4334, 4336, 4346 are mutually parallel. The pins 4420, 4422 exit holes 4322, 4324 via slots 4326, 4328.
Removing pins 4424, 4426 and coupling a distal femoral cut guide 4412 to the anterior distal femur 100 using pins 4420, 4422. Holes 4425, 4427 remain in the femur 100 after pins 4424, 4426 are removed.
Making a distal femoral resection through the distal femoral cut guide 4412, removing pins 4420, 4422, coupling a femoral four-in-one cut guide 4414 to the distal femoral resection, coupling a tibial cut guide 4416 to the proximal anterior tibia 104 using pin 4428, and coupling the finial of a tibial extension rod to a tibial target which was previously centered relative to the distal tibia 104 or medial-lateral center of the ankle. Holes 4421, 4423 remain in the femur 100 after pins 4420, 4422 are removed. Coupling the femoral four-in-one cut guide 4414 to the distal femoral resection may include inserting two posts (not shown) on the bone-facing side of the cut guide 4414 into the holes 4425, 4427. This arrangement sets the rotation of the femoral four-in-one cut guide 4414 relative to Whiteside's line.
Additional steps may be performed, such as making the anterior, anterior chamfer, posterior, and posterior chamfer cuts and the proximal tibial cut, and removing the cut guides 4414, 4416 and pin 4428. At least the anterior femoral, posterior femoral, and proximal tibial cuts are made perpendicular to Whiteside's line due to the orientation established by pins 4424, 4426 and holes 4425, 4427.
A target 4506 is coupled to a bridge 4508 of the foot holder assembly 4500 and is positioned over a medial-lateral center of an ankle joint of the patient. Optionally, the target 4506 may be positioned over a medial-lateral center of another anatomical structure, such as the Achilles tendon, anterior tibial spine or crest, distal tibia 104, second toe, and the like. However, for brevity, the target 4506 will be referred to as an ankle center target 4506 in this application. The ankle center target 4506 may be the target 882, 1882, or 2882 of U.S. Pat. No. 10,568,650, or the target 3962 or 4162 of U.S. patent application Ser. No. 16/287,976.
Referring to
A femoral pin guide 4512 is positioned against a central distal anterior cortical portion of the femur 100. The femoral pin guide 4512 includes a base 4514 and an arm 4516. The arm 4516 includes at least one barrel 4518 or guide tube to guide a first bone pin 4538 from distal to proximal into a distal aspect of the femur 100. An optional additional barrel 4520 is shown, which is parallel to barrel 4518 and spaced apart from barrel 4518 along an anterior-posterior direction relative to the femur 100. A second bone pin 4540 is shown extending through barrel 4520. The femoral pin guide 4512 may be related to the pin guide assembly 1501 or 2501 of U.S. Pat. No. 10,568,650, or pin guide assembly 3500 or pin guide 4302, body 4400, base 4402, and handle 4404 of pin guide assembly 4300 of U.S. patent application Ser. No. 16/287,976. The first bone pin 4538 may be a drill bit (
A distal end of a femoral extension rod 4550 is hinged to the femoral pin guide 4512 and a proximal end of the femoral extension rod 4550 is received in the femoral head center target 4510. The femoral extension rod 4550 may be considered as part of the femoral pin guide 4512, or as a separate apparatus connected to the femoral pin guide. The femoral extension rod may be related to the extension rods or alignment rods 156, 306, 313, 506, 511, 1506, 1511, 2506, 2511 of U.S. Pat. No. 10,568,650, or extension rods or alignment rods 3524, 4308, 4406 of U.S. patent application Ser. No. 16/287,976.
In an anterior view of the femur 100, and when positioned as described, the femoral extension rod 4550 lies along the mechanical axis 202 of the femur 100 (
In an optional step that may occur between
If the optional second bone pin 4540 is not present, the 6-in-1 pin guide 4552 and tibial alignment rod 4558 may pivot about the first bone pin 4538 as the distal end of the tibial alignment rod 4558 is placed in the ankle center target 4506. In an anterior view of the tibia 104, and when positioned as described, at least the distal portion of the tibial alignment rod 4558 lies along the mechanical axis 202 of the tibia 104. Alternatively, when the 6-in-1 pin guide 4552 is coupled to the first and second bone pins 4538, 4540, the 6-in-1 pin guide 4552 and tibial alignment rod 4558 may be prevented from pivoting about the bone pins. Instead, the proximal and/or distal ends of the tibia 104 may be oriented and positioned relative to the 6-in-1 pin guide 4552 and tibial alignment rod 4558 in order to engage the distal end of the tibial alignment rod 4558 in the ankle center target 4506.
Referring to
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The cut guide 4620 may be coupled to the third and fourth bone pins 4542, 4544 so that a distal femoral resection 206 may be made through the saw slot 4634, optionally with the first and second bone pins 4538, 4540 temporarily removed; and moved to the fifth and sixth 4546, 4548 so that a proximal tibial resection 210 may be made through the saw slot 4634.
Referring to
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In
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The foot holder assembly 4802 may be the foot holder assembly 870, 1870, or 2870 of U.S. Pat. No. 10,568,650, or the foot holder assembly 3950 or 4100 of U.S. patent application Ser. No. 16/287,976, or foot holder 4500. The foot holder assembly 4802 is shown including an Achilles tendon alignment guide 4868 which may be the Achilles tendon alignment guide 4108 of U.S. patent application Ser. No. 16/287,976.
The femoral target 4816 may be mounted on a femoral support arm assembly (not shown), such as femoral support arm assemblies 786, 1786, or 2786 of U.S. Pat. No. 10,568,650, or the femoral support arm assembly 4410 of U.S. patent application Ser. No. 16/287,976, or the support apparatus 4504. The femoral target 4816 may be positioned over the femoral head center 120.
The femoral alignment assembly 4818 may be related to the base 10 and alignment rod 156, base 302 and femoral extension rod 306, base 502 and femoral extension rod 506, base 1502 and femoral extension rod assembly 1506, base 2502 and femoral extension rod assembly 2506 of U.S. Pat. No. 10,568,650; base 3502 and femoral extension rod assembly 3524, base 4402 and femoral extension rod 4406 of U.S. patent application Ser. No. 16/287,976; or base 4514 and femoral extension rod 4550. In this paragraph, reference to a base and corresponding rod includes all intervening structure between the base and rod, as well as component parts of the base and rod. The femoral alignment assembly 4818 may include a body 4820, a handle 4822, a base 4824, a femoral extension rod 4826, a thumbscrew 4828, a screw 4864, and a pin 4866. The body 4820, handle 4822, and base 4824 may be fixed together, and may optionally be fabricated as a single unitary part. The femoral extension rod 4826 may be considered a separate apparatus from the femoral alignment assembly 4818. A distal end of the femoral extension rod 4826 is hinged to a proximal end of the handle 4822, and a proximal end of the femoral extension rod is shown coupled to the femoral target 4816.
The cut guide assembly 4830 may be related to the cut guide assembly 30; cut guide assembly 1321, tibial extension rod assembly 1511, and/or cut guide 1240; or cut guide assembly 3010, tibial extension rod assembly 2511, and/or cut guide 2964 of U.S. Pat. No. 10,568,650; cut guide assembly 3840; or pin guide assembly 4300 and corresponding cut guides 4412, 4414, 4416 of U.S. patent application Ser. No. 16/287,976; or pin guide 4552 and corresponding cut guides 4620, 4638. These references include intervening structure and subcomponent parts. The cut guide assembly 4830 may include a first femoral body 4832 or femoral apparatus, a pin lock button 4834, a pin lock spring 4836, a pin lock screw 4838, a second femoral body 4840, a size lock button 4842, a size lock spring 4844, a tibial retaining pin 4846, first and second rod retaining pins 4848, 4850, a tibial cut guide 4852, and an offset tibial alignment rod assembly 4854. The second femoral body 4840 and the tibial cut guide 4852 together may be referred to as a tibial apparatus. The tibial alignment rod assembly 4854 may be considered a separate apparatus from the cut guide assembly 4830. The tibial alignment rod assembly 4854 may include a rod 4856, an offset bar 4858, and a spherical target-engaging part 4860.
A telescoping tibial alignment rod assembly 4862 is shown in
Referring to
The handle 4822 includes a distal slot 4888 which receives the tab 4878 of the body 4820. A hole 4890 extends transversely through the handle 4822 and across the slot 4888. When the tab 4878 is in the slot 4888, the holes 4880, 4890 are coaxial. The holes 4880, 4890 receive the screw 4864. At least a portion of hole 4880 or hole 4890 is internally threaded to match the screw 4864. The handle 4822 includes a proximal slot 4892 which receives the distal end of the femoral extension rod 4826 (see
The base 4824 includes three oblong holes 4896, 4898, 4900. Each hole includes a unilateral shelf 4902. The hole 4896 receives the post 4882 of the body 4820. The hole 4898 or 4900 receives the post 4884 for a right or left configuration as labeled. The feet 4886 engage the shelves 4902. The base 4824 may include one or more frictional elements, such as spikes 4904 protruding from the posterior bone-facing surface. The base 4824 may include a cam 4906 like cam 512 associated with base 502 of U.S. Pat. No. 10,568,650. The cam 4906 locks and unlocks the base 4824 and body 4820. An oblique hole 5030 extends through the base 4824 along an anterior-inferior to posterior-superior trajectory. The hole 5030 may be non-circular, and may be thought of as the projection, superposition, or intersection of holes 5026, 5028 of the body 4820 when the body and base are coupled together in the right or left configuration. The holes 5026, 5028, 5030 may enable visualization of the central anterior distal femoral cortex, optionally by use of a scope through the holes.
Referring to
The distal cut guide portion 4910 includes a saw slot 4916, an oval hole 4918, holes 4920, 4922, and indicia 4924. The saw slot 4916 is for making a distal femoral resection 206. The saw slot 4916 and the oval hole 4918 are elongated along a medial-lateral direction and centered medial-lateral relative to the boss 4908. The oval hole 4918 is proximal to the saw slot 4916, with reference to the femur 100 (
The anterior cut guide portion 4912 includes a saw slot 4926, elbow 4928 or stalk, boss 4930, oval holes 4932, 4934, and boss 4936. The saw slot 4926 is for making an anterior femoral resection 214. The saw slot 4926 is elongated along a medial-lateral direction and centered medial-lateral relative to the boss 4908 and elbow 4914. The elbow 4928 originates posterior to a medial end of the saw slot 4926 and extends distally and medially to terminate in a free end 4938 with an undercut channel 4940, a slot 4942, and a blind hole 4944 (not visible in
The pin lock button 4834 of the cut guide assembly 4830 includes a pair of longitudinal ribs 4962, 4964, which together with the overall shape of the pin lock button 4834 are complementary to the undercut channel 4952 of the anterior cut guide portion 4912 so that the pin lock button 4834 is received in the undercut channel 4952. A longitudinal groove 4966 extends part way along a medial side of the pin lock button 4834. An oval hole 4968 extends through the pin lock button 4834 and is elongated parallel to the groove 4966 and ribs 4962, 4964. A pin-contacting area 4970 is provided on the medial side of the pin lock button 4834 to press against a bone pin in hole 4946 to retain the first femoral body 4832 to the bone pin. The pin lock spring 4836 of the cut guide assembly 4830 is received in the hole 4954 of the first femoral body 4832 and the groove 4966 of the pin lock button 4834 and biases the pin lock button toward an anterior position. The pin lock screw 4838 of the cut guide assembly 4830 extends through the oval hole 4968 and threads into the hole 4956 to retain the pin lock button 4834 to the first femoral body 4832 and to limit the anterior-posterior travel of the pin lock button.
Referring to
The size lock button 4842 includes a bridge 5006 extending between opposite end bodies 5008, 5010. A medial side of the bridge 5006 has a V-shape for engaging one of the grooves 4980 of the second femoral body 4840. A medial side of at least one of the end bodies 5008, 5010 includes a notch 5012 of about the same size as the holes 4996 of the second femoral body 4840. The size lock spring 4844 is received in the hole 4944 of the first femoral body 4832 and the bridge 5006 of the size lock button 4842 is received in the slot 4942 so that the size lock spring 4844 presses against the bridge 5006. The undercut rail 4978 of the second femoral body 4840 is received in the undercut channel 4940 of the first femoral body 4832 so that the end bodies 5008, 5010 of the size lock button 4842 are on proximal and distal sides of the undercut rail 4978, respectively, with the notch 5012 on the distal side with the indicia 4994. The tibial retaining pin 4846 is received in the hole 4982 to retain the second femoral body 4840 to the first femoral body 4832. As the second femoral body 4840 slides relative to the first femoral body 4832, the V-shape of the bridge 5006 engages each groove 4980 in turn and the notch 5012 aligns with each hole 4996 or indicia 4994 to indicate a corresponding femoral implant size matching the anterior-posterior distance between the saw slots 4926, 4972. If indexing pins are present in holes 4996, they may positively engage the notch 5012 to supplement the resistance provided by the V-shape of the bridge 5006 engaging the groove 4980.
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Providing the femoral support arm assembly 4410 or 4504. Fixing the support arm assembly to an operating table with a cross bar of the femoral support arm assembly 4804 over the patient's hips and a femoral head center target mounted to the cross bar and aligned over the center of the patient's femoral head.
Creating an incision over the patient's knee joint.
Inserting a base 4824 of a femoral alignment assembly 4818 between a central distal anterior cortical surface of the femur 100 and the overlying soft tissues so that the base is against the central distal anterior cortical surface of the femur 100 and generally aligned with the femoral shaft axis.
While the base is so positioned against the femur 100, placing a proximal end of the femoral extension rod 4826 in the femoral head center target 4816 so that the central longitudinal axis of the femoral extension rod lies along the mechanical axis 202 of the femur 100 in an anterior view of the femur 100. In other words, the femoral extension rod 4826 passes over the center 120 of the femoral head and the medial-lateral center of the distal femoral epicondyles.
Providing a cut guide assembly 4830, operatively assembled. Coupling the cut guide assembly 4830 to the femoral alignment assembly 4818. This step may be done before or after the femoral alignment assembly 4818 is positioned against the femur 100 and along the mechanical axis 202 of the femur 100. When the cut guide assembly 4830 is coupled to the femoral alignment assembly 4818, the first femoral body 4832 preferably abuts the distal aspect of at least one distal femoral condyle.
While the femoral alignment assembly 4818 is positioned against the distal anterior femur 100 and along the femoral mechanical axis 202, and while the cut guide assembly 4830 is coupled to the femoral alignment assembly, placing the spherical target-engaging part 4860 of the tibial alignment rod assembly 4854 in the distal tibial target of the foot holder assembly 4802.
Referring to
After the bone pin 5050 has been inserted through hole 4946 into the distal femur 100 and while the spherical target-engaging part 4860 of the tibial alignment rod assembly 4854 is in the distal tibial target, there may be an optional sequence of steps including inserting a bone pin through hole 4918 in line with the “0°” indicia 4924, removing the tibial alignment rod assembly 4854 from the distal tibial target, and rotating the cut guide assembly 4830 about the bone pin 5050 in hole 4946, as limited by the bone pin in hole 4918, to further adjust external rotation.
Inserting bone pins through holes 4920, 4922, 4948, 4950, 4958, and/or 4960 to secure the first femoral body 4832 to the femur 100. Bone pins 5052, 5054, 5056 are shown in holes 4948, 4920, and 4922, respectively. This step may occur after the bone pin 5050 has been inserted through hole 4946, or at the same time. Preferably, pins 5050, 5052 are parallel to each other, parallel to the femoral mechanical axis in an anterior view of the femur 100, parallel to (or in a defined orientation relative to) the bone-facing side of the base 4824 in a lateral view of the femur 100, and positioned along Whiteside's line on the distal end of the femur 100; pins 5054, 5056 are parallel to each other, perpendicular to pins 5050, 5052, and positioned along a line that is perpendicular to the femoral mechanical axis in an anterior view of the femur 100; and pins 5058, 5060 are parallel to each other and to pins 5050, 5052 (or at a defined slope), and positioned along a line that is perpendicular to the tibial mechanical axis in an anterior view of the tibia 104.
While the first femoral body 4832 is secured to the femur 100, moving the second femoral body 4840 anteriorly or posteriorly relative to the femur 100 and the first femoral body 4832 until the tibia-contacting feature 5000 contacts the tibial plateau. Moving the second femoral body 4840 anteriorly or posteriorly to the closest femoral implant size setting, as per the size lock button 4842 versus the indicia 4994, grooves 4980, and/or holes 4996.
Sliding the tibial cut guide 4852 proximally or distally relative to the femur 100, the first femoral body 4832, and the second femoral body 4840 until the tibial cut guide 4852 abuts the proximal anterior tibia. While the second femoral body 4840 and the tibial cut guide 4852 are so positioned, inserting bone pins through one or more holes 5020 and/or 5022 to secure the tibial cut guide 4852 to the proximal tibia. Bone pins 5058, 5060 are shown in holes 5020.
Referring to
Making a proximal tibial resection 210 by actuating a saw through the saw slot 5014. Making a distal femoral resection 206 through the saw slot 4916.
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Optionally, bone pins 5054, 5056 may be removed from holes 4920, 4922 while the anterior and posterior femoral resections 214, 220 are being made, and bone pins 5050, 5052, 5064 may be removed from holes 4946, 4948, 4950, 4958, and/or 4960 while the distal femoral resection 206 is being made. Therefore, preferably the sequence of bone pin insertion into and removal from holes 4920, 4922, 4946, 4948, 4950, 4958, and/or 4960 is coordinated with the sequence of making the resections 206, 214, 220, 210, which may be made in any order.
The illustrated apparatus provides saw slots 4916, 4926, 4972, 5014 for at least the distal femoral resection 206, anterior femoral resection 214, posterior femoral resection 220, and proximal tibial resection 210, respectively. The anterior and posterior chamfer cuts 216, 218 may be made by removing the cut guide assembly 4830, leaving bone pins 5050, 5052 in the distal aspect of the femur 100, placing a separate chamfer cut guide (not shown) on the bone pins, and making the chamfer cuts 216, 218. The chamfer cut guide may be a generally triangular part with one side for contacting the distal femoral resection 206, with the saw guided along the remaining two planar exterior surfaces versus operating within saw slots. Optionally, one of skill in the art will appreciate that the illustrated cut guide assembly 4830 may be modified to include saw slots or planar guide surfaces for the chamfer cuts 216, 218, wherein each chamfer saw slot or guide surface is movable relative to the anterior and/or posterior saw slots 4926, 4972 in accordance with the design rationale for the femoral implant size range.
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The first femoral body 5110 is analogous to the distal cut guide portion 4910. The first femoral body 5110 includes saw slots 5170, 5172, an oval hole 5174, holes 5176, 5178, and an interconnection feature 5180. The saw slots 5170, 5172 are for making a distal femoral resection 206 while avoiding sawing the first and second posts 5114, 5116. The saw slots 5170, 5172 and the oval hole 5174 are elongated along a medial-lateral direction. The oval hole 5174 is proximal to the saw slots 5170, 5172, in use, relative to the femur 100. The holes 5176, 5178 are medial and lateral to the oval hole 5174. The holes 5176, 5178 receive bone pins to secure the first femoral body 5110 to the femur 100. The holes 5176, 5178 are parallel. The saw slots 5170, 5172, oval hole 5174, and holes 4920, 4922 extend through the first femoral body 5110 along an anterior-posterior direction relative to the femur 100. The interconnection feature 5180 is shown as a short rectangular boss that is centrally located on a distal side of the first femoral body 5110. A groove 5182 extends across the boss along an anterior-posterior direction relative to the femur 100, resulting in a pair of walls 5184, 5186 along either side of the groove 5182.
Referring to
The second femoral body 5112 is analogous to the anterior cut guide portion 4912 of the first femoral body 4832 of the cut guide assembly 4830. The second femoral body 5112 includes saw slots 5190, 5192, a boss 5194, oval holes 5196, 5198, bosses 5200, 5202, a boss 5204, and an interconnection feature 5206. The saw slots 5190, 5192 are for making an anterior femoral resection 214. The saw slots 5190, 5192 are elongated along a medial-lateral direction and located on either side of the boss 5194. The boss 5194 extends anteriorly from an anterior side of the second femoral body 5112, and has a substantially rectangular exterior shape. An undercut channel 5208 extends along a distal side of the boss 5194, resulting in a pair of walls 5210, 5212 along the medial and lateral sides of the channel 5208. The channel 5208 and walls 5210, 5212 continue across the entire anterior-posterior dimension of the second femoral body 5112. The anterior end of the channel 5208 includes an enlarged semicircular alcove 5214. A hole 5216 extends through the walls 5210, 5212 and across the channel 5208 at the level of the alcove 5214. The hole 5216 receives the bolt pin 5120. The oval holes 5196, 5198 are medial and lateral to the boss 5194, respectively. The oval holes 5196, 5198 are elongated along an anterior-posterior direction relative to the femur 100. The oval holes 5196, 5198 may enable visualization of the femur 100, may reduce component weight, and/or may improve part cooling after autoclaving (if made of an autoclavable material). The saw slots 5190, 5192 and the oval holes 5196, 5198 extend through the second femoral body 5112 along a proximal-distal direction relative to the femur 100. The bosses 5200, 5202 are analogous to the boss 4936, and are located medial and lateral to the oval holes 5196, 5198. The boss 5200 originates posterior to a medial end of the saw slot 5190 and extends obliquely along an antero-medial direction. The boss 5200 includes two holes 5218, 5220 located from anterior to posterior in the boss and extending through the second femoral body 5112 along the same oblique antero-medial direction as the boss 5200. The boss 5202 originates posterior to a lateral end of the saw slot 5192 and extends obliquely along an antero-lateral direction. The boss 5202 includes two holes 5222, 5224 located from anterior to posterior in the boss and extending through the second femoral body 5112 along the same oblique antero-lateral direction as the boss 5202. The holes 5218, 5220, 5222, 5224 receive bone pins to secure the second femoral body 5112 to the femur 100. The boss 5204 extends laterally from the lateral posterior portion of the wall 5212. The boss 5204 includes an internally threaded hole 5226 which extends through the boss and wall 5212 to communicate with the channel 5208. The hole 5226 receives the screw 5122. Indicia 5228 may be present along the distal side of at least one of the walls 5210, 5212, such as the pair of arrowheads shown. The interconnection feature 5206 is shown as a short rectangular boss that is located on a proximal or superior side of the boss 5194. Holes 5230, 5232 extend through the second femoral body 5112 in parallel along a proximal-distal direction through the bottom of the channel 5208. The holes 5230, 5232 receive the first and second posts 5114, 5116, respectively. The proximal side 5233 of the second femoral body 5112 directly abuts a distal surface of a medial distal condyle of the femur 100 in use, thus it may be referred to as a femur-contacting feature.
The first post 5114 is analogous to the bone pin 4538 or 5050. The second post 5116 is analogous to the bone pin 4540 or 5052. Each may be a substantially cylindrical part, with the first post 5114 optionally having a larger outer diameter as shown. The posts 5114, 5116 may include circumferential flanges 5234, 5236, respectively, near one end. The opposite ends may be blunt.
The bolt 5118 may include a head 5238 and an externally threaded shaft 5240 extending from the head. The head 5238 may include a circumferential exterior groove 5242 and a torque input feature 5244, such as the hex socket shown. The groove 5242 receives the bolt pin 5120. The torque input feature 5244 connects to a driver, hex key, or the like to turn the bolt 5118.
The screw 5122 may include a head 5246 and an externally threaded shaft 5248 extending from the head. The head 5246 may include a torque input feature 5250, such as the hex socket shown. The torque input feature 5250 connects to a driver, hex key, or the like to turn the screw 5122.
The first femoral group 5102 may be assembled by performing some or all of the following steps in any order: orienting the first femoral body 5110 and second femoral body 5112 as shown in
When the first femoral group 5102 is operatively assembled, the first femoral body 5110, second femoral body 5112, first post 5114, and second post 5116 may all be fixed together so that they function as a single unitary part. Optionally, these parts 5110, 5112, 5114, and 5116 may be fabricated as a single unitary part. The bolt 5118 is retained within the channel 5208 due to the bolt pin 5120 in the hole 5216 and groove 5242, and is free to rotate within the channel 5208. However, the bolt 5118 is prevented from translating along the channel 5208 by the bolt pin 5120 in the hole 5216 and groove 5242, and the head 5238 in the alcove 5214.
Referring to
The third femoral body 5124 is analogous to the elbow 4974 or stalk. The third femoral body 5124 includes an undercut rail 5252 for interconnection with the undercut channel 5208 of the second femoral body 5112 of the first femoral group 5102, and an undercut channel 5254 like channel 5208. The rail 5252 and the channel 5254 both extend along an anterior-posterior direction relative to the femur 100. The rail 5252 is proximal to the channel 5254. Indicia 5256 may be present on the distal side of the rail 5252, such as the numerals and lines shown. The proximal side of the rail 5252 may include a longitudinal groove 5258 of semicircular cross-section. An internally threaded portion 5260 may be included in the groove 5258 near the anterior end for engagement with the externally threaded shaft 5240 of the bolt 5118 of the first femoral group 5102; the remaining smooth portions of the groove 5258 may receive the shaft 5240 with clearance. The channel 5254 extends along the posterior distal portion of the rail 5252, and has a pair of walls 5262, 5264 along the medial and lateral sides of the channel. The anterior end of the channel 5254 includes an enlarged semicircular alcove 5266. A hole 5268 extends through the walls 5262, 5264 and across the channel 5254 at the level of the alcove 5214. The hole receives the bolt pin 5130. Indicia 5270 may be present along the distal side of at least one of the walls 5262, 5264, such as the pair of arrowheads shown. A boss 5272 extends laterally from the lateral middle portion of the wall 5264. The boss 5272 includes an internally threaded hole 5274 which extends through the boss and wall 5264 to communicate with the channel 5254. The hole 5274 receives the screw 5132.
The fourth femoral body 5126 is analogous to the portion of the second femoral body 4840 that includes the saw slot 4972. The fourth femoral body 5126 includes saw slots 5276, 5278 for making a posterior femoral resection 220. The saw slots 5276, 5278 are elongated along a medial-lateral direction and extend through the fourth femoral body 5126 along a superior-inferior direction relative to the femur 100. An undercut channel 5280 extends across a distal side of the fourth femoral body 5126 between the anterior and posterior sides. The channel 5280 is located between the saw slots 5276, 5278, and is shaped and sized to receive the posterior end of the undercut rail 5252 of the third femoral body 5124. A tibia-contacting feature 5282 extends from a superior posterior middle portion of the fourth femoral body 5126; a rectangular boss is shown. A posterior side 5284 of the tibia-contacting feature 5282 (relative to the femur 100) is adapted to contact a proximal surface of the tibia 104 in use, preferably a central anterior portion of the tibial plateau in the vicinity of the base of the tibial eminence, or a provisional tibial resection in this area.
The bolt 5128 may include a head 5286 and an externally threaded shaft 5288 extending from the head. The head 5286 may include a circumferential exterior groove 5290 and a torque input feature 5292, such as the hex socket shown. The groove 5290 receives the bolt pin 5130. The torque input feature 5292 connects to a driver, hex key, or the like to turn the bolt 5128.
The screw 5132 may include a head 5294 and an externally threaded shaft 5296 extending from the head. The head 5294 may include a torque input feature 5298, such as the hex socket shown. The torque input feature 5298 connects to a driver, hex key, or the like to turn the screw 5132.
The second femoral group 5104 may be assembled by performing some or all of the following steps in any order: orienting the third femoral body 5124 and fourth femoral body 5126 as shown in
When the second femoral group 5104 is operatively assembled, the third and fourth femoral bodies 5124, 5126 may be fixed together so that they function as a single unitary part. Optionally, these parts 5124, 5126 may be fabricated as a single unitary part. The bolt 5128 is retained within the channel 5254 due to the bolt pin 5130 in the hole 5268 and groove 5242. The bolt 5128 is free to rotate within the channel 5208, but is prevented from translating along the channel by the bolt pin 5120 in the hole 5216 and groove 5242, and the head 5286 in the alcove 5266.
Referring to
The first tibial body 5134 includes an undercut rail 5300 for interconnection with the undercut channel 5254 of the third femoral body 5124 of the second femoral group 5104, and an interconnection feature 5302. The rail 5300 extends along an anterior-posterior direction relative to the femur 100. Indicia 5304 may be present on the distal side of the rail 5300, such as the numerals and lines shown. The proximal side of the rail 5300 may include a longitudinal groove 5306 of semicircular cross-section. An internally threaded portion 5308 may be included in the groove 5306 near the anterior end for engagement with the externally threaded shaft 5288 of the bolt 5128 of the second femoral group 5104; the remaining smooth portions of the groove 5306 may receive the shaft 5288 with clearance. The interconnection feature 5302 is shown as a rectangular boss that extends distally from a posterior end of the rail 5300. A groove 5310 extends across the boss along a proximal-distal direction relative to the femur 100, resulting in a pair of walls 5312, 5314 along either side of the groove 5310.
The second tibial body 5136 is analogous to the portion of the tibial cut guide 4852 that includes the saw slot 5014. The second tibial body 5136 includes a saw slot 5316 for making a proximal tibial resection 210. The saw slot 5316 is elongated along a medial-lateral direction and extends through the second tibial body 5136 along a proximal-distal direction relative to the femur 100. An interconnection feature 5318 extends anteriorly relative to the femur 100; a rectangular boss is shown. A pattern of holes 5320 may extend through the second tibial body 5136 along a proximal-distal direction. A pair of holes 5322 may extend through the second tibial body 5136 along an oblique medial-posterior direction. The holes 5320, 5322 may receive bone pins to secure the second tibial body 5136 to the tibia 104. The second tibial body 5136 is shown with a bifurcated distal arm 5324 for optional snap fit connection to the tibial alignment rod assembly 5108.
The tibial group 5106 may be assembled by orienting the first tibial body 5134 and second tibial body 5136 as shown in
When the tibial group 5106 is operatively assembled, the first and second tibial bodies 5134, 5136 may be fixed together so that they function as a single unitary part. Optionally, these parts 5134, 5136 may be fabricated as a single unitary part.
The cut guide assembly 5100 may be assembled by performing some or all of the following steps in any order: orienting the first and second femoral groups 5102, 5104 as shown in
When the cut guide assembly 5100 is operatively assembled, rotating the bolt 5118 clockwise and counterclockwise moves the second femoral group 5104 anteriorly and posteriorly (relative to the femur 100) relative to the first femoral group 5102 to adjust the anterior-posterior distance between the saw slots 5190, 5192 and the saw slots 5276, 5278. The indicia 5228, 5256 cooperate to indicate the femoral implant component size corresponding to the anterior-posterior distance between the saw slots 5190, 5192 and the saw slots 5276, 5278. Rotating the bolt 5118 also moves the tibial group 5106 relative to the first femoral group 5102. Rotating the bolt 5128 clockwise and counterclockwise moves the tibial group 5106 anteriorly and posteriorly relative to the second femoral group 5104 to adjust the anterior-posterior distance between the saw slots 5276, 5278 and the saw slot 5316. The indicia 5270, 5304 cooperate to indicate the tibial articular insert thickness corresponding to the anterior-posterior distance between the saw slots 5276, 5278 and the saw slot 5316. Rotating the bolt 5128 also moves the tibial group 5106 relative to the first femoral group 5102.
Returning to
Actuating or adjusting the cut guide assembly 5100 to position the posterior side 5284 of the tibia-contacting feature 5282 against the proximal side of the tibia 104, such as a central anterior portion of the tibial plateau in the vicinity of the base of the tibial eminence, or a provisional tibial resection in this area. Actuating or adjusting the cut guide assembly 5100 may include turning the bolt 5118 to move the second femoral group 5104 anteriorly relative to the femur 100 until the indicia 5228, 5256 indicate the smallest femoral implant component size; turning the bolt 5118 to move the second femoral group 5104 posteriorly relative to the femur 100 until the posterior side 5284 of the tibia-contacting feature 5282 contacts the tibial plateau, and reading the femoral implant component size indicated by the indicia 5228, 5256; optionally tightening the screw 5122 to lock the second femoral group 5104 in a fixed position relative to the first femoral group 5102; turning the bolt 5128 to move the tibial group 5106 anteriorly relative to the femur 100 until the indicia 5270, 5304 indicate the thinnest tibial articular insert; turning the bolt 5128 to move the tibial group 5106 posteriorly relative to the femur until the indicia 5270, 5304 indicate the desired tibial articular insert thickness; and/or optionally tightening the screw 5132 to lock the tibial group 5106 in a fixed position relative to the second femoral group 5104.
Inserting bone pins 5150, 5152, 5154, 5156 through holes 5176, 5178, 5320 of the cut guide assembly 5100 and into the femur 100 and tibia 104.
Referring to
Referring to
Referring to
The illustrated apparatus provides saw slots 5170, 5172, 5316, 5190, 5192, 5276, 5278 for at least the distal femoral resection 206, proximal tibial resection 210, anterior femoral resection 214, and posterior femoral resection 220, respectively. The anterior and posterior chamfer cuts 216, 218 may be made by removing the cut guide assembly 5100, coupling a separate chamfer cut guide (not shown) to the bone holes 4539, 4541, and making the chamfer cuts 216, 218. The chamfer cut guide may be a generally triangular part with one side for contacting the distal femoral resection 206, with the saw guided along the remaining two planar exterior surfaces versus operating within saw slots. Optionally, one of skill in the art will appreciate that the illustrated cut guide assembly 5100 may be modified to include additional bodies with saw slots or planar guide surfaces for the chamfer cuts 216, 218, wherein each chamfer body may be movable relative to the anterior and/or posterior saw slots 5190, 5192 and 5276, 5278 in accordance with the design rationale for the femoral implant size range.
The pin guide assembly 4300, 6-in-1 pin guide 4552, cut guide assembly 4830, and/or cut guide assembly 5100 may be modified to include a soft tissue tensioning apparatus (not shown) which is biased to apply tension to the collateral ligaments and/or other soft tissues of the knee as the pin or cut guide assembly is coupled to the femur 100 and tibia 104 for the purpose of balancing the soft tissues with respect to the femoral and tibial resections. The tensioning apparatus may include a spring or force actuator between the femoral multi-pin guide 4302 and tibial pin guide 4304 of the pin guide assembly 4300, between the femoral body 4554 and tibial body 4556 of the 6-in-1 pin guide 4552, between the first femoral body 4832 and second femoral body 4840 of the cut guide assembly 4830, and/or between the first femoral group 5102 and second femoral group 5104 of the cut guide assembly 5100. Multiple springs or actuators may be included, as well as multiple femur and/or tibia-contacting features. The tensioning apparatus may also include indicia or a display to show the actual or relative tension applied at one or more locations.
Any methods disclosed herein includes one or more steps or actions for performing the described method. The method steps and/or actions may be interchanged with one another. In other words, unless a specific order of steps or actions is required for proper operation of the embodiment, the order and/or use of specific steps and/or actions may be modified.
Reference throughout this specification to “an embodiment” or “the embodiment” means that a particular feature, structure or characteristic described in connection with that embodiment is included in at least one embodiment. Thus, the quoted phrases, or variations thereof, as recited throughout this specification are not necessarily all referring to the same embodiment.
Similarly, it should be appreciated that in the above description of embodiments, various features are sometimes grouped together in a single embodiment, Figure, or description thereof for the purpose of streamlining the disclosure. This method of disclosure, however, is not to be interpreted as reflecting an intention that any claim require more features than those expressly recited in that claim. Rather, as the following claims reflect, inventive aspects lie in a combination of fewer than all features of any single foregoing disclosed embodiment. Thus, the claims following this Detailed Description are hereby expressly incorporated into this Detailed Description, with each claim standing on its own as a separate embodiment. This disclosure includes all permutations of the independent claims with their dependent claims.
Recitation in the claims of the term “first” with respect to a feature or element does not necessarily imply the existence of a second or additional such feature or element. Elements recited in means-plus-function format are intended to be construed in accordance with 35 U.S.C. § 112 Para. 6. It will be apparent to those having skill in the art that changes may be made to the details of the above-described embodiments without departing from the underlying principles of the technology.
While specific embodiments and applications of the present technology have been illustrated and described, it is to be understood that the technology is not limited to the precise configuration and components disclosed herein. Various modifications, changes, and variations which will be apparent to those skilled in the art may be made in the arrangement, operation, and details of the methods and systems of the present technology disclosed herein without departing from the spirit and scope of the technology.
The present application claims the benefit of: U.S. Provisional Patent Application Ser. No. 62/902,892, filed Sep. 19, 2019, entitled KNEE INSTRUMENTS AND METHODS, Attorney's Docket No. EMG-8 PROV, which is pending; and U.S. Provisional Patent Application Ser. No. 62/987,153, filed Mar. 9, 2020, entitled KNEE INSTRUMENTS AND METHODS, Attorney's Docket No. EMG-9 PROV, which is pending. The present application is a continuation-in-part of: U.S. patent application Ser. No. 16/287,976, filed Feb. 27, 2019, entitled KNEE INSTRUMENTS AND METHODS, Attorney's Docket No. EMG-6, which is pending. U.S. patent application Ser. No. 16/287,976 claims the benefit of: U.S. Provisional Patent Application Ser. No. 62/640,006, filed Mar. 7, 2018, entitled KNEE INSTRUMENTS AND METHODS, Attorney's Docket No. EMG-6 PROV, which is expired. The present application is related to: U.S. patent application Ser. No. 15/630,555, filed Jun. 22, 2017, entitled KNEE INSTRUMENTS AND METHODS, Attorney's Docket No. EMG-1 CIP1, which issued as U.S. Pat. No. 10,568,650 on Feb. 25, 2020. U.S. patent application Ser. No. 15/630,555 claims the benefit of: U.S. Provisional Application Ser. No. 62/353,553, filed Jun. 22, 2016, entitled KNEE INSTRUMENTS AND METHODS, Attorney's Docket No. EMG-4 PROV, which is expired. U.S. patent application Ser. No. 15/630,555 is a continuation-in-part of: U.S. patent application Ser. No. 15/081,828, filed Mar. 25, 2016, entitled KNEE INSTRUMENTS AND METHODS, Attorney's Docket No. EMG-1, which issued as U.S. Pat. No. 10,426,565 on Oct. 1, 2019. U.S. patent application Ser. No. 15/081,828 claims the benefit of: U.S. Provisional Patent Application No. 62/138,307, filed Mar. 25, 2015, entitled KNEE INSTRUMENTS AND METHODS, Attorney's Docket No. EMG-1 PROV, which is expired; and U.S. Provisional Patent Application No. 62/302,787, filed Mar. 2, 2016, entitled KNEE INSTRUMENTS AND METHODS, Attorney's Docket No. EMG-1P, which is expired. The foregoing are incorporated by reference as though set forth herein in their entirety.
| Number | Date | Country | |
|---|---|---|---|
| 62902892 | Sep 2019 | US | |
| 62987153 | Mar 2020 | US | |
| 62640006 | Mar 2018 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 16287976 | Feb 2019 | US |
| Child | 17023988 | US |
