In shoulder arthroplasty various guides and instruments are used to determine an alignment axis and guide an implant for anatomic or reverse shoulder arthroplasty. The present teachings provide various patient-specific and reusable guide instruments for use in shoulder arthroplasty.
The present teachings provide a glenoid device that includes a non-custom guide holder and a patient-specific glenoid guide for anatomic and/or reverse shoulder arthroplasty.
The present teachings provide a glenoid device for preparing a shoulder joint of a patient includes a reusable guide holder having a body between an upper surface and a lower surface and a bore passing through the body of the guide holder. The glenoid device also includes a patient-specific glenoid guide having a body with an upper and lower surface. The lower surface of the patient-specific glenoid guide is configured as a negative surface of a glenoid face based on preoperative image scans of the shoulder joint of the patient. The upper face of the patient-specific glenoid guide is configured to be coupled and contact the lower face of the guide holder, such that the bore of the guide holder is aligned along a patient-specific bore through the body of the patient-specific glenoid guide and along a corresponding alignment axis of the patient-specific glenoid guide.
The present teachings also provide a method of preparing a shoulder joint of a patient for arthroplasty. The method includes attaching a reusable non-custom guide holder to a patient-specific glenoid guide. The patient-specific glenoid guide has a patient-specific lower surface configured to nestingly mate and conform to a corresponding surface of a glenoid face of the patient based on a three-dimensional image of a shoulder joint of the patient reconstructed preoperatively from image scans of the shoulder joint of the patient. The patient-specific lower surface is mated to the glenoid face. A guiding pin is passed through a bore of the guide holder and through a bore of the patient-specific glenoid guide along a patient-specific alignment orientation of the shoulder joint of the patient. The guiding pin is inserted into the glenoid face. The guide holder and the patient-specific glenoid guide are removed without removing the guiding pin. The guiding pin can be used to prepare the shoulder joint for arthroplasty.
Further areas of applicability of the present teachings will become apparent from the description provided hereinafter. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present teachings.
The present teachings will become more fully understood from the detailed description and the accompanying drawings.
Corresponding reference numerals indicate corresponding parts throughout the several views of the drawings
The following description is merely exemplary in nature and is in no way intended to limit the present teachings, applications, or uses.
The present teachings generally provide a glenoid device that includes a reusable guide holder and a patient-specific alignment guide for use in shoulder joint replacement, shoulder resurfacing procedures and other procedures related to the shoulder joint or the various bones of the shoulder joint, including the glenoid face or cavity of the scapula, the humeral head and adjacent shoulder bones. The present teachings can be applied to anatomic shoulder replacement and reverse shoulder replacement. The reusable guide holder is not patient-specific. The patient-specific guide can be used either with conventional implant components or with patient-specific implant components and/or bone grafts that are prepared using computer-assisted image methods according to the present teachings. Computer modeling for obtaining three-dimensional images of the patient's anatomy using medical scans of the patient's anatomy (such as MRI, CT, ultrasound, X-rays, PET, etc.), any patient-specific prosthesis components and the patient-specific guides can be prepared using various commercially available CAD programs and/or software available, for example, by Object Research Systems or ORS, Montreal, Canada.
The patient-specific guide (and any associated patient-specific implants and bone grafts, when used) can be generally designed and manufactured based on computer modeling of the patient's 3-D anatomic image generated from medical image scans including, for example, X-rays, MRI, CT, PET, ultrasound or other medical scans. The patient-specific guide can have a three-dimensional engagement surface that is complementary and made to substantially mate and match in only one position (i.e., as a substantially negative or mirror or inverse surface) with a three-dimensional bone surface with or without associated soft tissues, which is reconstructed as a 3-D image via the aforementioned CAD or software. Very small irregularities need not be incorporated in the three-dimensional engagement surface. The patient-specific guide can include a custom-made guiding bore in an orientation selected to be aligned along the anatomic or reverse shoulder arthroplasty axis for the specific patient according to the preoperative surgical plan for the specific patient.
The three-dimensional geometry, shape and orientation of the various features of the patient-specific guide, as well as various patient-specific implants and bone grafts, if used, can be determined during the pre-operative planning stage of the procedure in connection with the computer-assisted modeling of the patient's anatomy. During the pre-operative planning stage, patient-specific instruments, custom, semi-custom or non-custom implants and other non-custom tools, can be selected and the patient-specific components can be manufactured for a specific-patient with input from a surgeon or other professional associated with the surgical procedure.
In the following discussion, the terms “patient-specific”, “custom-made” or “customized” are defined to apply to components, including tools such as alignment or drilling guides, implants, portions or combinations thereof, which include certain geometric features, including surfaces, curves, or other lines, and which are made to closely or nestingly conform and mate substantially as mirror-images or negatives or complementary surfaces of corresponding geometric features or anatomic landmarks of a patient's anatomy obtained or gathered during a pre-operative planning stage based on 3-D computer images of the corresponding anatomy reconstructed from image scans of the patient by computer imaging methods. Further, patient-specific guiding features, such as, guiding bores or other holes or openings that are included in patient-specific guides are defined as features that are made to have positions, orientations, dimensions, and axes specific to the particular patient's anatomy including various anatomic or reverse alignment axes based on the computer-assisted pre-operative plan associated with the patient.
The patient-specific guides can be configured to mate in alignment with natural anatomic landmarks by orienting and placing the corresponding alignment guide intra-operatively on top of the bone (with or without associated soft tissue at the discretion of the surgeon) to mate with corresponding landmarks. The anatomic landmarks function as passive fiducial identifiers or fiducial markers for positioning of the various alignment guides, drill guides or other patient-specific instruments.
The patient-specific guides can be made of any biocompatible material, including, polymer, ceramic, metal or combinations thereof. The patient-specific alignment guides can be disposable and can be combined or used with reusable and non patient-specific drilling, cutting, reaming and guiding components. The reusable guide holder can be made of metallic or polymeric materials that provide adequate rigidity for holding the patient-specific guide and guiding a drill. The reusable guide holder can be removable attached to an upper surface of the patient-specific guide such that an alignment pin or a drilling bit can be inserted through the guide holder and through the patient-specific guide along a patient-specific trajectory that corresponds to an anatomic or reverse alignment axis for the specific patient, as discussed below.
More specifically, the present teachings provide a reusable guide holder and a patient-specific glenoid guide that are used co-operatively for anatomic and reverse arthroplasty. The patient-specific glenoid guide of the present teachings can have a patient-specific engagement surface that references various portions of the shoulder joint and includes a patient-specific bore. The glenoid guide has a three-dimensional shape configured to align the guide holder to accurately position a guide wire or pin for later glenoid preparation and implantation procedures and for alignment purposes, including implant position control, implant version control, and implant inclination control for both anatomic and reverse arthroplasty.
In the following, when a portion of a glenoid guide is described as “referencing” a portion of the anatomy, it will be understood that the referencing portion of the glenoid guide is a patient-specific portion that mirrors or is a negative of the corresponding referenced anatomic portion.
In some embodiments, the glenoid guide can reference (substantially as a negative of) the face of the glenoid or glenoid cavity, avoiding the glenoid rim and any portion of the labrum. In other embodiments, the glenoid guide can reference (substantially as a negative of) the face of the glenoid and a portion of the glenoid rim. The glenoid guide can be designed to only remove a portion of the labrum (from 2-5 o'clock, for example) or the entire labrum. When the glenoid guide is designed to sit directly on bone rather than soft tissue, then the labrum is removed. In other embodiments, the glenoid guide can reference the labrum itself, such as when MRI scans are used to reconstruct details of the geometry of the soft tissue and the glenoid guide is designed references off soft tissue. In other embodiments, the glenoid guide can reference the glenoid face and a portion of the coracoid process or coracoid attachment or other bone surface that extends off the upper aspect of the glenoid.
A glenoid device 101 according to the present teachings is illustrated in use for anatomic shoulder arthroplasty of the glenoid of a scapula of a patient in
Referring to
The patient-specific glenoid guide 200 is configured to guide a guiding pin (such as the guiding pin 150 shown in
For the same patient, the reverse alignment axis R can have an inferior tilt a relative to the anatomic alignment axis A, such as, for example, a ten-degree inferior tilt a. The patient-specific bore 210 of
Referring to
In other embodiments, the handle shaft 102 and the guide element 104 can be removably coupled to the body 106 for compact and easy packaging during transportation. The removable coupling can be a snap-fit, screw in or other removable attachment. It is noted that whether removably or fixedly attached to the body 106, the handle shaft 102 and the tubular guiding element 104 have fixed, non-custom orientations relative to the upper surface 110 of the body 106 of the guide holder 100.
The guide holder 100 also includes a plurality of short extensions, pegs or pins 120 that extend from the lower surface 108 of the guide holder 100 and can be received in corresponding mating bores or holes 212 preoperatively prepared through the upper surface 202 of the patient-specific glenoid guide 200 by a snap-fit or taper-to-taper or other type of quick connection. Three pins 120 and three corresponding holes 212 are shown in
The guide holder 100 and the patient-specific glenoid guide 200 can include corresponding markings indicating whether the patient-specific glenoid guide 200 is prepared for anatomic or reverse shoulder arthroplasty, facilitating easy identification and to avoid confusion. The markings can provide visual and keyed identification through the guide holder 100. The guide holder 100 can include two windows, anatomic window 130 and reverse window 132, correspondingly marked as A or anatomic and R or reverse, as illustrated in
Referring to
Generally, the patient-specific glenoid guide 200 of the present teachings references landmarks on the glenoid to orient the glenoid guide 200 in a predetermined orientation according to a preoperative plan for the specific patient. Landmarks can include, for example, the glenoid face 80 with or without any portion of the labrum, the coracoid process (or portions thereof or coracoid attachment), the glenoid rim and/or other landmarks of the scapula. The patient-specific glenoid guide 200 can be used to correctly orient a guide wire or guiding pin 150 along a patient-specific orientation that will be used in later glenoid preparation procedures in combination with a non-custom reusable guide holder 100, as discussed above. The patient-specific orientation can be designed and configured into the patient-specific glenoid guide 200 during the preoperative planning stage for the patient for implant positioning, implant version control, and implant inclination control.
As described above, the patient-specific glenoid guide 200 can fit around or on the exposed glenoid rim and surface substantially as a negative of the corresponding anatomy of the patient. Additionally, the glenoid guide 200 can match or correct defects and imperfections in the specific patient's glenoid. The overall, three-dimensional shape and size of the patient-specific guide 200 and the orientation of the upper surface 202 relative to the patient-specific anatomic alignment axis A or reverse alignment axis R are preoperatively designed such that the patient-specific guide 200 can be coupled to the reusable guide holder 100 and orient the tubular element 104 of the guide holder 100 along the corresponding anatomic alignment axis A or reverse alignment axis R.
The guide holder 100 and the patient-specific glenoid guide 200 can be included in any anatomic or reverse arthroplasty kit with corresponding implants and other instruments.
The foregoing description of the embodiments has been provided for purposes of illustration and description. It is not intended to be exhaustive or to limit the disclosure. Individual elements or features of a particular embodiment are generally not limited to that particular embodiment, but, where applicable, are interchangeable and can be used in a selected embodiment, even if not specifically shown or described. The same may also be varied in many ways. Such variations are not to be regarded as a departure from the disclosure, and all such modifications are intended to be included within the scope of the disclosure.
Example embodiments are provided so that this disclosure will be thorough, and will fully convey the scope to those who are skilled in the art. Numerous specific details are set forth such as examples of specific components, devices, and methods, to provide a thorough understanding of embodiments of the present disclosure. It will be apparent to those skilled in the art that specific details need not be employed, that example embodiments may be embodied in many different forms and that neither should be construed to limit the scope of the disclosure. In some example embodiments, well-known processes, well-known device structures, and well-known technologies are not described in detail.
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WO-2012058349 | May 2012 | WO |
WO-2012058353 | May 2012 | WO |
WO-2012058355 | May 2012 | WO |
WO-2012061042 | May 2012 | WO |
WO-2012116206 | Aug 2012 | WO |
WO-2012158917 | Nov 2012 | WO |
WO-2012173929 | Dec 2012 | WO |
WO-2012174008 | Dec 2012 | WO |
WO-2013170872 | Nov 2013 | WO |
WO-2014019712 | Feb 2014 | WO |
WO-2014164346 | Oct 2014 | WO |
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Number | Date | Country | |
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20180028204 A1 | Feb 2018 | US |
Number | Date | Country | |
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61776607 | Mar 2013 | US |
Number | Date | Country | |
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Parent | 13889869 | May 2013 | US |
Child | 15728126 | US |