Lateral entry insert for cup trial

Information

  • Patent Grant
  • 8858641
  • Patent Number
    8,858,641
  • Date Filed
    Wednesday, November 28, 2012
    12 years ago
  • Date Issued
    Tuesday, October 14, 2014
    10 years ago
Abstract
Trials for a reverse shoulder system are described. The trials generally include an insert housed within a humeral cup. The insert has a proximal end and a distal end, the proximal end having a concave recess therein adapted to receive a glenosphere prosthesis. The distal end of the insert includes a shaft, the shaft is substantially housed within the confines of the humeral cup. A distal end of the humeral cup is inserted in a humeral stem.
Description
FIELD OF THE INVENTION

The present invention relates to a shoulder trial for reverse shoulder arthroplasty (RSA), and in particular it relates to such a trial including an insert and humeral cup that are configured to engage one another by sliding the insert from a transverse or lateral direction into engagement with the humeral cup.


BACKGROUND OF THE INVENTION

The successful outcome of RSA depends greatly on proper soft tissue tension in the shoulder joint. The stability of the shoulder joint is generally maintained from significant deltoid tension holding this ball and socket joint together. Some RSA systems require the surgeon to use a trial and error approach in establishing proper soft tissue tension. Such approaches often take several attempts before adequate stability is achieved.


When performing a trialing step in a reverse shoulder procedure, one important aspect is to determine the correct height of the humeral insert implant that will ultimately be chosen for the patient. A series of humeral insert trials with varying heights is normally utilized to determine the correct height for the implant. By using thicker or thinner insert trials the soft tissue tension and joint range of motion can be optimized for the patient.


Such trialing procedures generally include selecting a first trial insert, installing it into other parts of the shoulder system, reducing the joint, and then checking the joint for soft tissue tension and range of motion. The joint is then dislocated, and if the correct humeral insert implant height has been determined the reverse shoulder implantation proceeds. When the correct trial is determined, the soft tissue tension is significant, requiring the surgeon to apply extreme force to the humerus and surrounding soft tissues to reduce the joint. If no additional damage is done during this reduction process, the joint must then be dislocated to allow the surgeon to implant a joint replacement prosthesis.


If the correct humeral insert height has not yet been determined, then a second trial insert with a different thickness than the first trial is selected. The second trial insert is installed and the joint is assessed. As a result of the trialing procedure, the reverse shoulder joint can be reduced and dislocated multiple times.


Traditionally, each time the reverse shoulder joint is reduced and dislocated, the soft tissue has to be stretched in order for the glenosphere to be placed in or removed from the humeral insert. This stretching of the soft tissue can lead to joint instability and increased recovery time for the patient.


BRIEF SUMMARY OF THE INVENTION

The trial assembly of the present invention includes at least a trial cup and a trial insert. In one embodiment of the present invention, a recess or guide track of an insert trial is slid over a centering member or positive stop pin on a cup trial. Flanges on the cup trial are received within a groove of the insert trial as the guide track is slid over the centering member. After the centering member is located adjacent the deepest part of the guide track, the insert trial is preferably rotated in either a clockwise or counterclockwise direction substantially locking the lateral and vertical movement of the insert trial with respect to the cup trial. The rotational movement of the insert trial with respect to the cup trial can still occur.


The lateral engagement and disengagement of the insert trial and insert cup allows any size insert trial and cup to be used during the trialing process in contrast to having to reduce and distract the trials from each other prior to and after use.


In the past, there have been issues with achieving appropriate tensioning during RSA due to difficulties in inserting and removing the trials from between the humeral components and the glenosphere component on the glenoid. The trial assembly of the present invention provides a way of reducing and dislocating the joint without any temporary increase in joint tension that is usually experienced when reducing the ball up, over, and into the insert trial socket.


In accordance with a first aspect of the present invention is a trial assembly comprising a trial cup and a trial insert. The trial cup has a distal end surface and a proximal end surface, the proximal end surface including first and second flanges and a centering member protruding outwardly therefrom. The trial insert includes a proximal end portion and a shaft portion having a distal end, the shaft portion having a groove around an outer circumference thereof and a recess in the distal end thereof. The trial insert is operatively coupled to the trial cup when the centering member is received in the recess of the trial insert and an engagement member on each of the first and second flanges is received within the groove of the trial insert.


In one embodiment of this first aspect, the trial assembly further includes an elongate shaft having proximal and distal ends, the distal end surface of the trial cup adapted to lie adjacent to the proximal end of the elongate shaft when the trial cup is coupled to the elongate shaft.


In another embodiment of this first aspect, the first and second flanges of the trial cup extend outwardly from at least a portion of an outer circumference of the proximal end surface of the trial cup.


In yet another embodiment of this first aspect, the recess of the trial insert begins at the outer circumference of the shaft portion and terminates adjacent a central axis of the trial insert. When a longitudinal axis of the centering member is collinear with the central axis of the trial insert, the trial insert may be rotated in a radial direction about the central axis thereof. Further, rotating the trial insert 90° in either a first or second radial direction about a central axis thereof results in lateral locking of the trial insert and trial cup such that the trial insert and trial cup cannot be uncoupled by offsetting the longitudinal axis of the centering member of the trial cup and central axis of the trial insert. Further still, rotating the trial insert another 90° in either a first or second radial direction about the central axis thereof results in lateral unlocking of the trial insert and trial cup such that the trial insert and trial cup can be uncoupled by offsetting the longitudinal axis of the centering member of the trial cup and central axis of the trial insert.


In still yet another embodiment of this first aspect, the proximal end portion of the trial insert has a concave recess therein.


In still yet another embodiment of this first aspect, the proximal end portion of the insert includes an outer face having a plurality of calibration marks arranged thereon. The calibration marks are preferably located at 90° increments.


In still yet another embodiment of this first aspect, an outer face of the insert includes a plurality of attachment locations adapted to be engaged by an adjustment tool for rotating the trial insert about the central axis thereof.


In still yet another embodiment of this first aspect, the proximal end surface of the cup has a marker thereon.


In still yet another embodiment of this first aspect, a size or height of the trial assembly is measured by the axial distance between a proximal end surface of the trial insert and the distal end surface of the trial cup.


In accordance with a second aspect of the present invention is a trial assembly comprising a trial cup and a trial insert. The trial cup has a distal end surface and a proximal end surface, the proximal end surface including first and second flanges about a circumference thereof and a centering member protruding outwardly along a central longitudinal axis thereof. The trial insert includes a proximal end portion and a shaft portion having a distal end, the shaft portion having a groove around an outer circumference thereof and a recess in the distal end thereof, the recess begins about a circumference of the shaft and terminates adjacent a central longitudinal axis of the trial insert. The trial insert is operatively coupled to the trial cup when the centering member is received in the recess of the trial insert such that the central longitudinal axes of the centering member and trial insert are collinear and a portion of each of the first and second flanges is received at least partially within the groove of the trial insert.


In one embodiment of this second aspect, when the central longitudinal axes of the centering member and trial insert are collinear, the trial insert may be rotated in a radial direction about the central longitudinal axis of the centering member. Further, rotating the trial insert 90° in either a first or second radial direction about a central axis thereof results in lateral locking of the trial insert and trial cup such that the trial insert and trial cup cannot be uncoupled by offsetting the longitudinal axis of the centering member of the trial cup and central axis of the trial insert. Further still, rotating the trial insert another 90° in either a first or second radial direction about the central axis thereof results in lateral unlocking of the trial insert and trial cup such that the trial insert and trial cup can be uncoupled by offsetting the longitudinal axis of the centering member of the trial cup and central axis of the trial insert.


In another embodiment of this second aspect, a size or height of the trial assembly is measured by the axial distance between a proximal end surface of the trial insert and the distal end surface of the trial cup.





BRIEF DESCRIPTION OF THE DRAWINGS

A more complete appreciation of the subject matter of the present invention and the various advantages thereof can be realized by reference to the following detailed description in which reference is made to the accompanying drawings in which:



FIG. 1 is an exploded perspective view of one embodiment of a trial assembly of the present invention including a trial cup and a trial insert.



FIG. 2 is an assembled perspective view of one embodiment of a trial assembly of the present invention including the trial cup and the trial insert of FIG. 1.



FIG. 3 is a side view of the trial assembly shown in FIG. 2.



FIG. 4A is a perspective view of one embodiment of a trial cup of the present invention.



FIG. 4B is a side view of the trial cup shown in FIG. 4A.



FIG. 4C is a top view of the trial cup shown in FIG. 4A.



FIG. 4D is a bottom view of the trial cup shown in FIG. 4A.



FIG. 5A is a perspective view of one embodiment of a trial insert of the present invention.



FIG. 5B is a side view of the trial insert shown in FIG. 5A.



FIG. 5C is a top view of the trial insert shown in FIG. 5A.



FIG. 5D is a bottom view of the trial insert shown in FIG. 5A.



FIG. 6A is an exploded view of an implant cup and trial insert.



FIG. 6B is an assembled view of the implant cup and trial insert shown in FIG. 6A.



FIG. 7A is an exploded view of a broach, trial cup and trial insert.



FIG. 7B is an assembled view of the broach, cup and trial insert shown in FIG. 7A.



FIG. 8A is an exploded view of an implant stem, implant cup and trial insert.



FIG. 8B is an assembled view of the implant stem, implant cup and trial insert shown in FIG. 8A.



FIG. 9A is an exploded view of an implant stem, trial cup and trial insert.



FIG. 9B is an assembled view of the implant stem, trial cup and trial insert shown in FIG. 9A.





DETAILED DESCRIPTION

Referring to FIGS. 1-3, there is shown an embodiment of a trial assembly of the present invention designated generally by reference numeral 100. As shown in those figures, trial assembly 100 includes a trial cup 120 and a trial insert 160.



FIGS. 4A-D show an embodiment of trial cup 120. As shown in these figures, trial cup 120 includes a distal end surface 122 and a base surface 124. Base surface 124 includes first and second flanges 126, 128 and a centering member 130 protruding outwardly therefrom. Base surface 124 preferably includes a marker 144 thereon as shown in FIG. 4D.


First and second flanges 126, 128 preferably extend outwardly from at least a portion of an outer circumference 136 of base surface 124 of trial cup 120. First and second flanges 126, 128 include an engagement member 132, 134 respectively. Engagement members 132, 134 preferably extend outwardly from inner surfaces of first and second flanges 126, 128. Engagement members 132, 134 preferably include a top surface 133, 135, respectively, which define a proximal end surface of trial cup 120. As seen in FIGS. 4A and 4B, axis A1 is a central longitudinal axis through centering member 130 and is also is a central longitudinal axis for trial cup 120.


Protruding outwardly from distal end surface 122 of trial cup are preferably first and second coupling members 140, 142. Coupling members 140, 142 are configured to engage first and second recesses in a stem or elongate shaft (not shown) in order to couple the stem and trial cup 120.



FIGS. 5A-D show an embodiment of trial insert 160. As shown in these figures, trial insert 160 includes a proximal end portion 162 and a shaft portion 164 having a distal end 166. Shaft portion 164 has a groove 168 around an outer circumference 170 thereof and a recess 172 in the distal end 166 thereof. Recess 172 of trial insert 160 preferably begins at outer circumference 170 of shaft portion 164 and preferably terminates adjacent a central axis A2 of the trial insert 160.


As shown in FIG. 5C, proximal end portion 162 of trial insert 160 has a concave recess 180 therein. Concave recess 180 is adapted to contact and house a portion of a glenosphere (not shown). Proximal end portion 162 of trial insert 160 includes an outer face 182 preferably having a plurality of attachment locations 184 and calibration marks 186 arranged thereon. The attachment locations 184 are preferably located at 30° increments about outer face 182, but may be located from one another at increments greater or less than 30°. The calibration marks 186 are preferably located at 90° increments about outer face 182, but may be located from one another at increments greater or less than 90°. Attachment locations 184 are adapted to be engaged by an adjustment tool (not shown) for rotating the trial insert 160 about central axis A2 thereof.


A reverse shoulder implant typically consists of five components: a humeral stem, a humeral cup, a humeral insert, a glenosphere baseplate, and a glenosphere. The embodiment of trial assembly 100 shown in FIGS. 1-3 includes two distinct components, namely trial cup 120 and trial insert 160, which are designed to allow a surgeon to determine which size humeral cup and humeral insert are needed to provide a shoulder joint with optimal deltoid tension in a RSA procedure. Both trial cup 120 and trial insert 160 are designed to work with other components or parts of a reverse shoulder implant and instrumentation thereof as part of a complete system in order to give a surgeon intraoperative flexibility and to accommodate surgeon preference. In addition, the design of trial cup 120 and trial insert 160 allows trial insert 160 to slide into trial cup 120 from a direction substantially transverse to the direction of trial cup axis A1, which minimizes soft tissue stretching when reducing or dislocating a reverse shoulder during a trialing process, and gives a surgeon the ability to perform a trialing procedure using instruments only or some combination of instruments and implants.


The design of trial assembly 100 overcomes the challenge of soft tissue stretching when reducing or dislocating a joint by allowing the trial humeral insert to slide into the trial humeral cup at an angle substantially transverse to the axis of the cup. Since the trial insert 160 can enter the trial cup 120 at a transverse angle to trial cup axis A1, reduction or dislocation of the joint can be achieved without the need to pull the glenosphere over the rim of trial insert 160. Soft tissue stretching is therefore minimized.


In one method of the present invention, trial insert 160 is operatively coupled to trial cup 120 when centering member 130 of trial cup 120 is received in recess 172 of trial insert 160 and an engagement member 132, 134 on each of first and second flanges 126, 128 of trial cup 120 is received within groove 168 of trial insert 160. When centering member 130 is located within recess 172 of trial insert 160 and longitudinal axis A1 of centering member 130 is collinear with central axis A2 of trial insert 160, trial insert 160 may be rotated in a radial direction about central axis A2 thereof. The trial insert 160 can be reversibly locked into the trial cup 120 simply by turning the trial insert 160 approximately 15 degrees to approximately 165 degrees after initially engaging the trial insert 160 and trial cup 120. For example, after axes A1, A2 become collinearly oriented, rotating the trial insert 160 approximately 90° in either a first or second radial direction about central axis A2 thereof results in lateral locking of trial insert 160 and trial cup 120 such that trial insert 160 and trial cup 120 cannot be uncoupled by offsetting longitudinal axis A1 of the centering member 130 of trial cup 120 and central axis A2 of trial insert 160. Rotating trial insert 160 approximately another 90° in either a first or second radial direction about central axis A2 thereof results in lateral unlocking of trial insert 160 and trial cup 120 such that trial insert 160 and trial cup 120 can be uncoupled by offsetting longitudinal axis A1 of centering member 130 of trial cup 120 and central axis A2 of trial insert 160.


When operatively coupled, trial insert 160 can be rotated with respect to trial cup 120 by using an attachment tool having an end that can be received in attachment locations 184. A surgeon can estimate the amount of degrees that trial insert 160 has been rotated with respect to trial cup 120 by visualizing the movement of calibration marks 186 located on outer face 182 or by visualizing the movement of calibration marks 186 with respect to marker 144 located on base surface 124 of trial cup 120.


As shown in FIGS. 3 and 5B, a first height H1 is defined by the planar distance between a proximal end surface 161 and distal surface 163 of proximal end portion 162 of trial insert 160. As shown in FIGS. 3 and 4B, a second height H2 is defined by the planar distance between a top surface 133, 135 of engagement members 132, 134 and distal end surface 122 of trial cup 120. A size or height H of trial assembly 100 is measured by the axial or planar distance between proximal surface 161 of trial insert 160 and distal end surface 122 of trial cup 120 as shown in FIG. 3.


During the trial process, a surgeon may use one or more of a plurality of different sized trial cups and inserts. Each insert 160 preferably has a first height H1 between 4 mm and 12 mm in increments of 2 mm as shown in the chart below. A surgeon may then use one or more of a plurality of different sized trial cups 120. Each cup 120 preferably has a second height H2 that is either 4 mm or 10 mm as shown in the chart below. The following chart is a non-limiting example of the different sized trial inserts 160, trial cups 120 and the resultant total height H (8 mm, 10 mm, 12 mm, 14 mm, 16 mm, 18 mm, 20 mm and 22 mm) that can be achieved when trial inserts 160 and trial cups 120 are assembled and used during the trialing process:





















4 mm
6 mm
8 mm
10 mm
12 mm




Insert
Insert
Insert
Insert
Insert























 4 mm Cup
8
10
12
14
16



10 mm Cup
14
16
18
20
22










The design of trial assembly 100 overcomes the challenge of having one system allowing multiple intraoperative options with regard to trialing by allowing the trial cup 120 to be connected to either a broach 200 as shown in FIGS. 7A-B or humeral stem implant 220 as shown in FIGS. 9A-B, and also by allowing the trial insert 160 to be able to be connected to either trial cup 120 or implant cup 190 as shown in FIGS. 6A-6B and 8A-8B.


Surgeon preferences result in implants and instruments being used in different combinations. For example, some surgeons prefer to perform the trialing procedure off of a broach including cutting portions 210 such as teeth, for example, as shown in FIGS. 7A-7B used to create a cavity into which a humeral stem implant will eventually be placed. Some surgeons instead prefer to trial off of the humeral stem itself as shown in FIGS. 8A-8B and 9A-9B. As a result, it is advantageous for any trial humeral cup to be able to be connected to both the broach and humeral stem implant. Likewise, some surgeons prefer to perform the trialing procedure off of a trial humeral cup and some surgeons prefer to trial off of the humeral cup implant. Therefore it is advantageous for the humeral insert trial to be able to be connected to both the trial humeral cup and the humeral cup implant.


The same trial insert 160 that can be slid into engagement with trial cup 120 at an angle transverse to trial cup axis A1 can also be dropped into a humeral cup implant along an axis coincident with both the humeral cup implant and trial insert 160. The attachment mechanisms that permit a connection between an implant component and a trial do not compromise the integrity of the attachment mechanisms used to connect two implant components. Such a design allows a surgeon to trial off of an implant with confidence that the trialing procedure is not damaging the implant attachment mechanisms which could possibly compromise the performance of the implant after final assembly.


In other embodiments, trial insert 160 may be able to engage trial cup 120 by sliding in a lateral direction into engagement with the trial cup 120, with trialing occurring as the trial insert 160 expands away from and collapses toward trial cup 120. For example, groove 168 of trial insert 160 may be in the form of a helical groove about shaft portion 164. The motion of trial insert along axis A1 of trial cup 120 may be guided by the interaction between the helical groove and an engagement member 133 or 125, for example. In such an embodiment, centering member 130 of trial cup 120 will have a larger height and recess 172 of trial insert 160 will have a greater depth such that the centering member 130 will remain at least partially within recess 172 as trial insert 160 expands and collapses with respect to trial cup 120.


The interaction of the helical groove and engagement member occurs much like that shown in U.S. Pat. Pub. No. 2009/0099662 titled “Expandable Reverse Shoulder Trial,” the disclosure of which is hereby incorporated by reference in its entirety. When trial insert 160 first becomes operatively engaged to trial cup 120, trial insert 160 may then be rotated into a fully collapsed or neutral position. Such a device may allow a surgeon to easily reduce the shoulder joint.


Preferably, trial insert 160 may then be advanced to a position where optimal deltoid tension is achieved. At this position, the trial insert 160 and trial cup 120 are preferably calibrated such that the surgeon may determine a liner thickness corresponding to a dialed position of the insert with respect to the cup.


Preferably, the surgeon may then easily collapse the trial back to the neutral position and simply dislocate the joint. Further, the trial may also be preferably expanded prior to joint reduction and collapsed prior to joint dislocation repeatedly, depending on surgeon preference. Once the trial has been optimized, a surgeon preferably records the dialed position of the expanded trial. This measurement should preferably be the liner thickness. If this measurement does not correspond to the size of a particular liner in the system, the surgeon may select a next larger sized liner. At this time, the surgeon may remove the trial and then implant a prosthesis including a humeral cup and the selected liner.


The embodiments described herein have applications in RSA as well as any other ball and socket joints that require dislocation and reduction, such as hip joints for example.


Although the invention herein has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the present invention. It is therefore to be understood that numerous modifications may be made to the illustrative embodiments and that other arrangements may be devised without departing from the spirit and scope of the present invention as defined by the appended claims.

Claims
  • 1. A reverse shoulder system comprising: at least one stem member having a shaft portion adapted to be received in a canal of a humeral bone of a patient;a trial cup and a prosthesis cup each adapted to be coupled at a distal end thereof to the at least one stem member, the trial cup and prosthesis cup each having a distal end surface, a base surface and a proximal end surface, the trial cup including first and second flanges and a centering member protruding outwardly from the base surface;a trial insert and a prosthesis insert each including a proximal end portion having a proximal end surface and a shaft portion having a distal end surface,wherein a linear trial distance is defined by a linear distance between the distal end surface of the trial cup and the proximal end surface of the trial insert when the trial insert is operatively coupled to the trial cup such that the distal end surface of the shaft portion of the trial insert lies adjacent to the base surface of the trial cup, andwherein a linear prosthesis distance is defined by a linear distance between the distal end surface of the prosthesis cup and the proximal end surface of the prosthesis insert when the prosthesis insert is operatively coupled to the prosthesis cup such that the distal end surface of the shaft portion of the prosthesis insert lies adjacent to the base surface of the prosthesis cup, andwherein the linear trial distance is substantially the same as the linear prosthesis distance.
  • 2. The reverse shoulder system of claim 1, wherein the at least one stem member is a broach.
  • 3. The reverse shoulder system of claim 1, wherein the at least one stem member is a humeral implant.
  • 4. The reverse shoulder system of claim 1, wherein the at least one stem member is a broach and a humeral implant.
  • 5. The reverse shoulder system of claim 1, wherein the at least one stem member has a proximal end including an engagement member and the distal end portion of both the trial cup and prosthesis cup include an engagement member configured to engage to the engagement member of the at least one stem member in order to couple either the at least one stem member and trial cup or at least one stem member and prosthesis cup.
  • 6. The reverse shoulder system of claim 1, wherein the shaft portion of the trial insert includes a groove around an outer circumference thereof and a recess in the distal end thereof, and wherein the trial insert is operatively coupled to the trial cup when the centering member is received in the recess of the trial insert and an engagement member on each of the first and second flanges is received within the groove of the trial insert.
  • 7. The reverse shoulder system of claim 6, wherein the first and second flanges of the trial cup extend outwardly from at least a portion of an outer circumference of the base surface of the trial cup.
  • 8. The reverse shoulder system of claim 6, wherein the recess of the trial insert begins at the outer circumference of the shaft portion and terminates adjacent a central axis of the trial insert.
  • 9. The reverse shoulder system of claim 8, wherein when a longitudinal axis of the centering member is collinear with the central axis of the trial insert, the trial insert may be rotated in a radial direction about the central axis thereof.
  • 10. The reverse shoulder system of 9, wherein rotating the trial insert 90° in either a first or second radial direction about a central axis thereof results in lateral locking of the trial insert and trial cup such that the trial insert and trial cup cannot be uncoupled by offsetting the longitudinal axis of the centering member of the trial cup and central axis of the trial insert.
  • 11. The reverse shoulder system of 10, wherein rotating the trial insert another 90° in either a first or second radial direction about the central axis thereof results in lateral unlocking of the trial insert and trial cup such that the trial insert and trial cup can be uncoupled by offsetting the longitudinal axis of the centering member of the trial cup and central axis of the trial insert.
  • 12. The reverse shoulder system of claim 1, wherein the proximal end surface of both the trial insert and prosthesis insert have a concave recess portion.
  • 13. The reverse shoulder system of claim 1, wherein an outer face of the trial insert adjacent the proximal end surface thereof includes a plurality of attachment locations adapted to be engaged by an adjustment tool.
  • 14. The reverse shoulder system of claim 1, wherein an outer face of the proximal end portion of the trial insert has a plurality of calibration marks arranged thereon.
  • 15. The reverse shoulder system of claim 14, wherein the calibration marks are located at 90° increments.
  • 16. The reverse shoulder system of claim 1, wherein an outer face of the proximal end portion of the trial insert includes a plurality of attachment locations adapted to be engaged by an adjustment tool for rotating the trial insert about the central axis thereof.
  • 17. The reverse shoulder system of claim 1, wherein the proximal end surface of the cup has at least one marker thereon.
  • 18. A reverse shoulder system comprising: at least one stem member having a shaft portion adapted to be received in a canal of a humeral bone of a patient;a trial cup and a prosthesis cup each adapted to be coupled at a distal end thereof to the at least one stem member, the trial cup and prosthesis cup each having a distal end surface, a base surface and a proximal end surface, the trial cup including first and second flanges and a centering member protruding outwardly from the base surface;a trial insert and a prosthesis insert each including a proximal end portion having distal and proximal end surfaces and a shaft portion having a distal end surface,wherein a linear trial distance is defined by a linear distance between the proximal end surface of the trial cup and the proximal end surface of the trial insert when the trial insert is operatively coupled to the trial cup such that the distal end surface of the proximal end portion of the trial insert lies adjacent to the proximal end surface of the trial cup,wherein a linear prosthesis distance is defined by a linear distance between the proximal end surface of the prosthesis cup and the proximal end surface of the prosthesis insert when the prosthesis insert is operatively coupled to the prosthesis cup such that the distal end surface of the proximal end portion of the prosthesis insert lies adjacent to the proximal end surface of the prosthesis cup, andwherein the linear trial distance is substantially the same as the linear prosthesis distance.
  • 19. A method of using trial inserts of a reverse shoulder system to determine a height of a prosthesis cup to achieve proper deltoid tension comprising: inserting a shaft portion of a stem member in a canal of a humeral bone of a patient;coupling a cup member at a distal end thereof to the stem member, the cup member having a base surface and a proximal end surface, the base surface including first and second flanges and a centering member protruding outwardly therefrom;selecting trial inserts having a proximal end portion including proximal and distal end surfaces and a shaft portion having a distal end surface, a height of each of the trial inserts defined by a planar distance between the proximal and distal end surfaces of the proximal end portion of the trial inserts;coupling the trial inserts one at a time to the cup member, each of the trial inserts being operatively coupled to the cup member when the distal end surface of the shaft portion of each of the trial inserts lies adjacent to the base surface of the cup member;determining which of the trial inserts when operatively coupled to the cup member achieves proper deltoid tension and noting the height thereof;uncoupling the trial insert that achieves proper deltoid tension and the cup member; andcoupling a prosthesis insert to the cup member such that a distal end surface of a shaft portion of the prosthesis insert lies adjacent to the base surface of the cup member, a height of the prosthesis insert defined by a planar distance between proximal and distal end surfaces of a proximal end portion of the prosthesis insert,wherein the height of the prosthesis insert is substantially the same as the height of the trial insert.
CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a continuation of U.S. patent application Ser. No. 13/484,557, filed May 31, 2012, the disclosure of which is incorporated herein by reference.

US Referenced Citations (310)
Number Name Date Kind
3102536 Rose Sep 1963 A
3806957 Shersher et al. Apr 1974 A
3842442 Kolbel Oct 1974 A
3978528 Crep Sep 1976 A
4030143 Elloy et al. Jun 1977 A
4040131 Gristina Aug 1977 A
4279041 Buchholz et al. Jul 1981 A
4524467 DeCarlo, Jr. Jun 1985 A
D285968 Kinnett Sep 1986 S
4693723 Gabard Sep 1987 A
4711639 Grundei Dec 1987 A
4795468 Hodorek et al. Jan 1989 A
4936853 Fabian et al. Jun 1990 A
4944757 Martinez et al. Jul 1990 A
5080673 Burkhead et al. Jan 1992 A
5358526 Tornier Oct 1994 A
5413604 Hodge May 1995 A
5462563 Shearer et al. Oct 1995 A
5489309 Lackey et al. Feb 1996 A
5569263 Hein Oct 1996 A
5609639 Walker et al. Mar 1997 A
5609644 Ashby et al. Mar 1997 A
5658340 Muller et al. Aug 1997 A
5702447 Walch et al. Dec 1997 A
5702457 Walch et al. Dec 1997 A
5702470 Menon Dec 1997 A
5702486 Craig et al. Dec 1997 A
5723018 Cyprien et al. Mar 1998 A
5728161 Camino et al. Mar 1998 A
5741335 Gerber et al. Apr 1998 A
5755801 Walker et al. May 1998 A
5824106 Fournol Oct 1998 A
5871545 Goodfellow et al. Feb 1999 A
5879401 Besemer et al. Mar 1999 A
5910171 Kummer et al. Jun 1999 A
5961555 Huebner Oct 1999 A
5964808 Blaha et al. Oct 1999 A
6015437 Stossel Jan 2000 A
6033439 Camino et al. Mar 2000 A
6045582 Prybyla Apr 2000 A
6102953 Huebner Aug 2000 A
6120542 Camino et al. Sep 2000 A
6123728 Brosnahan et al. Sep 2000 A
6129764 Servidio Oct 2000 A
6168627 Huebner Jan 2001 B1
6168628 Huebner Jan 2001 B1
6193758 Huebner Feb 2001 B1
6197062 Fenlin Mar 2001 B1
6197063 Dews Mar 2001 B1
6206925 Tornier Mar 2001 B1
6210444 Webster et al. Apr 2001 B1
6217618 Hileman Apr 2001 B1
6228119 Ondrla et al. May 2001 B1
6228120 Leonard et al. May 2001 B1
6283999 Rockwood, Jr. Sep 2001 B1
6368352 Camino et al. Apr 2002 B1
6379388 Ensign et al. Apr 2002 B1
6485520 Hubach et al. Nov 2002 B1
6494913 Huebner Dec 2002 B1
6500208 Metzger et al. Dec 2002 B1
6508840 Rockwood et al. Jan 2003 B1
6508841 Martin et al. Jan 2003 B2
6514287 Ondrla et al. Feb 2003 B2
6520994 Nogarin Feb 2003 B2
6524342 Muhlhausler et al. Feb 2003 B1
6530957 Jack Mar 2003 B1
6569202 Whiteside May 2003 B2
6589282 Pearl Jul 2003 B2
6602292 Burkinshaw Aug 2003 B2
6673114 Hartdegen et al. Jan 2004 B2
6679916 Frankle et al. Jan 2004 B1
6719799 Kropf Apr 2004 B1
6736852 Callaway et al. May 2004 B2
6749637 Bahler Jun 2004 B1
6761740 Tornier Jul 2004 B2
6790234 Frankle Sep 2004 B1
6800094 Burkinshaw Oct 2004 B2
6818019 Horber Nov 2004 B2
6887276 Gerbec et al. May 2005 B2
6887277 Rauscher et al. May 2005 B2
6890358 Ball et al. May 2005 B2
6899736 Rauscher et al. May 2005 B1
6942699 Stone et al. Sep 2005 B2
6953478 Bouttens et al. Oct 2005 B2
6969406 Tornier Nov 2005 B2
6969407 Klotz et al. Nov 2005 B2
6986790 Ball et al. Jan 2006 B2
6986791 Metzger Jan 2006 B1
7011686 Ball et al. Mar 2006 B2
7033396 Tornier Apr 2006 B2
7044973 Rockwood et al. May 2006 B2
7097663 Nicol et al. Aug 2006 B1
7108405 Matts et al. Sep 2006 B2
7108719 Horber Sep 2006 B2
7166132 Callaway et al. Jan 2007 B2
7169184 Dalla Pria Jan 2007 B2
7175663 Stone Feb 2007 B1
7175664 Lakin Feb 2007 B1
7186269 Cyprien et al. Mar 2007 B2
7204854 Guederian et al. Apr 2007 B2
7238207 Blatter et al. Jul 2007 B2
7238208 Camino et al. Jul 2007 B2
7241314 Winslow Jul 2007 B1
7297163 Huebner Nov 2007 B2
7303585 Horber Dec 2007 B2
7309360 Tornier et al. Dec 2007 B2
7329284 Maroney et al. Feb 2008 B2
7338528 Stone et al. Mar 2008 B2
7357817 D'Alessio, II Apr 2008 B2
7425214 McCarthy et al. Sep 2008 B1
7445638 Beguin et al. Nov 2008 B2
7462197 Tornier et al. Dec 2008 B2
7465319 Tornier Dec 2008 B2
7470287 Tornier et al. Dec 2008 B2
7531003 Reindel May 2009 B2
7537618 Collazo May 2009 B2
7544211 Rochetin Jun 2009 B2
7608109 Dalla Pria Oct 2009 B2
7611539 Bouttens et al. Nov 2009 B2
7621961 Stone Nov 2009 B2
7648530 Habermeyer et al. Jan 2010 B2
7678150 Tornier et al. Mar 2010 B2
7753959 Berelsman et al. Jul 2010 B2
7758650 Dews et al. Jul 2010 B2
7785370 Collazo Aug 2010 B2
7819923 Stone et al. Oct 2010 B2
7854768 Wiley et al. Dec 2010 B2
7918892 Huebner Apr 2011 B2
7922769 Deffenbaugh et al. Apr 2011 B2
7951204 Chambat et al. May 2011 B2
7959680 Stone et al. Jun 2011 B2
8002838 Klotz Aug 2011 B2
8002841 Hasselman Aug 2011 B2
8062376 Shultz et al. Nov 2011 B2
8070820 Winslow et al. Dec 2011 B2
8092466 Splieth et al. Jan 2012 B2
8105385 Maroney et al. Jan 2012 B2
8118875 Rollet Feb 2012 B2
8118876 Gupta et al. Feb 2012 B2
8137407 Todd et al. Mar 2012 B2
8142510 Lee et al. Mar 2012 B2
8147557 Lee et al. Apr 2012 B2
8147558 Lee et al. Apr 2012 B2
8157866 Winslow et al. Apr 2012 B2
8182542 Ferko May 2012 B2
8192497 Ondrla Jun 2012 B2
8206453 Cooney, III et al. Jun 2012 B2
8231682 Lafosse et al. Jul 2012 B2
8231683 Lappin et al. Jul 2012 B2
8236059 Stone et al. Aug 2012 B2
8241366 Roche et al. Aug 2012 B2
8246687 Katrana et al. Aug 2012 B2
8257363 Splieth et al. Sep 2012 B2
8273130 Gradl Sep 2012 B2
8277511 Tornier et al. Oct 2012 B2
8303665 Tornier et al. Nov 2012 B2
8323347 Guederian et al. Dec 2012 B2
8328874 Lee Dec 2012 B2
8337563 Roche et al. Dec 2012 B2
8343226 Nogarin et al. Jan 2013 B2
8361157 Bouttens et al. Jan 2013 B2
8366780 Klawitter et al. Feb 2013 B2
8377142 Trail et al. Feb 2013 B2
8419798 Ondrla et al. Apr 2013 B2
8444698 Klotz et al. May 2013 B2
8454702 Smits et al. Jun 2013 B2
8460390 Biss et al. Jun 2013 B2
8545504 Durand-Allen et al. Oct 2013 B2
8545511 Splieth et al. Oct 2013 B2
8562686 Klotz et al. Oct 2013 B2
8591591 Winslow et al. Nov 2013 B2
8608805 Forrer et al. Dec 2013 B2
8617249 Emami Dec 2013 B2
8623092 Bickley et al. Jan 2014 B2
8623093 Dickerson Jan 2014 B2
8632603 Hodorek et al. Jan 2014 B2
8647387 Winslow Feb 2014 B2
8663334 Viscardi et al. Mar 2014 B2
20010007957 Martin et al. Jul 2001 A1
20010011192 Ondrla et al. Aug 2001 A1
20010011193 Nogarin Aug 2001 A1
20010049561 Dews et al. Dec 2001 A1
20010053935 Hartdegen et al. Dec 2001 A1
20020016634 Maroney et al. Feb 2002 A1
20020099445 Maroney et al. Jul 2002 A1
20020120339 Callaway et al. Aug 2002 A1
20020128719 Burkinshaw Sep 2002 A1
20030014119 Capon et al. Jan 2003 A1
20030028253 Stone et al. Feb 2003 A1
20030099519 Robinson et al. May 2003 A1
20030114933 Bouttens et al. Jun 2003 A1
20030149486 Huebner Aug 2003 A1
20030158605 Tornier Aug 2003 A1
20040030394 Horber Feb 2004 A1
20040030396 Horber Feb 2004 A1
20040039449 Tornier Feb 2004 A1
20040059424 Guederian et al. Mar 2004 A1
20040064187 Ball et al. Apr 2004 A1
20040064188 Ball et al. Apr 2004 A1
20040064190 Ball et al. Apr 2004 A1
20040143336 Burkinshaw Jul 2004 A1
20040143337 Burkinshaw Jul 2004 A1
20040186579 Callaway et al. Sep 2004 A1
20040210317 Maroney et al. Oct 2004 A1
20040220673 Pria Nov 2004 A1
20040220674 Pria Nov 2004 A1
20040236428 Burkinshaw et al. Nov 2004 A1
20040267370 Ondrla Dec 2004 A1
20050033443 Blatter et al. Feb 2005 A1
20050085921 Gupta et al. Apr 2005 A1
20050113931 Horber May 2005 A1
20050128755 Matts et al. Jun 2005 A1
20050137709 Klotz et al. Jun 2005 A1
20050143829 Ondrla et al. Jun 2005 A1
20050256583 Bouttens et al. Nov 2005 A1
20050278030 Tornier et al. Dec 2005 A1
20050278032 Tornier et al. Dec 2005 A1
20050288681 Klotz et al. Dec 2005 A1
20050288791 Tornier et al. Dec 2005 A1
20060004462 Gupta Jan 2006 A1
20060020344 Shultz et al. Jan 2006 A1
20060030946 Ball et al. Feb 2006 A1
20060036329 Webster et al. Feb 2006 A1
20060052875 Bernero et al. Mar 2006 A1
20060069445 Ondrla et al. Mar 2006 A1
20060079963 Hansen Apr 2006 A1
20060129247 Brown et al. Jun 2006 A1
20060142872 Klotz et al. Jun 2006 A1
20060161260 Thomas et al. Jul 2006 A1
20060200247 Charrois Sep 2006 A1
20060200248 Beguin et al. Sep 2006 A1
20060229730 Railey et al. Oct 2006 A1
20070050040 Guederian et al. Mar 2007 A1
20070078519 Klotz Apr 2007 A1
20070100458 Dalla Pria May 2007 A1
20070112430 Simmen et al. May 2007 A1
20070118230 Callaway et al. May 2007 A1
20070156246 Meswania et al. Jul 2007 A1
20070173945 Wiley et al. Jul 2007 A1
20070179624 Stone et al. Aug 2007 A1
20070198094 Berelsman et al. Aug 2007 A1
20070225820 Thomas et al. Sep 2007 A1
20070243045 Gaska Oct 2007 A1
20070244563 Roche et al. Oct 2007 A1
20080221622 Triplett et al. Sep 2008 A1
20080228281 Forrer et al. Sep 2008 A1
20080243261 Wyss et al. Oct 2008 A1
20080243262 Lee Oct 2008 A1
20080275507 Triplett et al. Nov 2008 A1
20080294268 Baum et al. Nov 2008 A1
20080306600 Huebner Dec 2008 A1
20090062923 Swanson Mar 2009 A1
20090099662 Splieth et al. Apr 2009 A1
20090149961 Dallmann Jun 2009 A1
20090164021 Dallmann Jun 2009 A1
20090171462 Poncet et al. Jul 2009 A1
20090192621 Winslow et al. Jul 2009 A1
20090210065 Nerot et al. Aug 2009 A1
20090216332 Splieth et al. Aug 2009 A1
20090270993 Maisonneuve et al. Oct 2009 A1
20090281630 Delince et al. Nov 2009 A1
20090287309 Walch et al. Nov 2009 A1
20100023068 Bouttens et al. Jan 2010 A1
20100049327 Isch et al. Feb 2010 A1
20100057210 Ondrla Mar 2010 A1
20100087927 Roche et al. Apr 2010 A1
20100125336 Johnson et al. May 2010 A1
20100161065 Williams, Jr. et al. Jun 2010 A1
20100161066 Iannotti et al. Jun 2010 A1
20100211178 Nogarin et al. Aug 2010 A1
20100222886 Wiley et al. Sep 2010 A1
20100228352 Courtney, Jr. et al. Sep 2010 A1
20100234959 Roche et al. Sep 2010 A1
20110054624 Iannotti Mar 2011 A1
20110060417 Simmen et al. Mar 2011 A1
20110082557 Mutchler et al. Apr 2011 A1
20110098822 Walch et al. Apr 2011 A1
20110106267 Grant May 2011 A1
20110118846 Katrana et al. May 2011 A1
20110153023 Deffenbaugh et al. Jun 2011 A1
20110178604 Porter Jul 2011 A1
20110196491 Huebner Aug 2011 A1
20110295376 Winslow Dec 2011 A1
20120029647 Winslow et al. Feb 2012 A1
20120179262 Metcalfe et al. Jul 2012 A1
20120191201 Smits et al. Jul 2012 A1
20120209392 Angibaud et al. Aug 2012 A1
20120221112 Lappin Aug 2012 A1
20120253467 Frankle Oct 2012 A1
20120265315 Kusogullari et al. Oct 2012 A1
20120271425 Maurer Oct 2012 A1
20120271426 Roche et al. Oct 2012 A1
20120277880 Winslow et al. Nov 2012 A1
20120303130 Winslow et al. Nov 2012 A1
20120330428 Splieth et al. Dec 2012 A1
20130006369 Wiley et al. Jan 2013 A1
20130197650 Smits et al. Aug 2013 A1
20130197651 McDaniel et al. Aug 2013 A1
20130197652 Ekelund et al. Aug 2013 A1
20130204375 Winslow et al. Aug 2013 A1
20130245775 Metcalfe Sep 2013 A1
20130261750 Lappin Oct 2013 A1
20130282129 Phipps Oct 2013 A1
20130325130 Viscardi et al. Dec 2013 A1
20130325131 Roche et al. Dec 2013 A1
20130325133 Viscardi et al. Dec 2013 A1
20130325134 Viscardi et al. Dec 2013 A1
20140018927 De Wilde et al. Jan 2014 A1
20140039633 Roche et al. Feb 2014 A1
20140039634 Klotz Feb 2014 A1
Foreign Referenced Citations (17)
Number Date Country
10335442 Feb 2005 DE
202008008565 Aug 2008 DE
1314407 May 2003 EP
1520560 Apr 2005 EP
1656910 May 2006 EP
2047827 Apr 2009 EP
2201912 Jun 2010 EP
2689756 Oct 1993 FR
2699400 Jun 1994 FR
2001247 Jan 1979 GB
2405346 Mar 2005 GB
0147442 Jul 2001 WO
2005032430 Apr 2005 WO
2007031575 Mar 2007 WO
2007039820 Apr 2007 WO
2007084939 Jul 2007 WO
2008000928 Jan 2008 WO
Non-Patent Literature Citations (8)
Entry
Delta Reverse Shoulder System, Surgical Technique, DePuy 2004.
European Search Report, EP 10156704, dated Jun. 14, 2010.
Mode Operatoire, Operative Technique, Arrow, date not known.
Reverse Shoulder Prosthesis, Surgical Technique, Encore, 2005.
Trabecular Metal Reverse Shoulder System, Zimmer, date not known.
Extended European Search Report for Application No. EP12195588 dated Mar. 1, 2013.
Extended European Search Report for Application No. EP13169019 dated Jul. 26, 2013.
Extended European Search Report for Application No. 12183703 dated Jan. 30, 2013.
Related Publications (1)
Number Date Country
20130325133 A1 Dec 2013 US
Continuations (1)
Number Date Country
Parent 13484557 May 2012 US
Child 13687302 US