Patent Grant
10835382
The present subject matter relates to orthopedic prostheses and, more particularly, to prostheses, systems and methods used in knee arthroplasties.
Orthopedic procedures and prostheses are commonly utilized to repair and/or replace damaged bone and tissue in the human body. For example, a knee arthroplasty can be used to restore natural knee function by repairing damaged or diseased articular surfaces of the femur and/or tibia. An incision is made into the knee joint to expose the bones comprising the joint. Cut guides are used to guide the removal of the articular surfaces that are to be replaced. Prostheses are used to replicate the articular surfaces. Knee prostheses can include a femoral component implanted on the distal end of the femur, which articulates with a tibial bearing component and a tibial component implanted on the proximal end of a tibia to replicate the function of a healthy natural knee. Various types of arthroplasties are known including a total knee arthroplasty, where all of the articulating compartments of the joint are repaired with prosthetic components.
This disclosure pertains generally to tibial prostheses, systems, and methods for a knee arthroplasty and/or as part of a knee revision surgery. The present inventors have recognized, among other things, that a patient may possess bone deficits or undesirable bone on all or some of the patient's tibia. Accordingly, portions of the tibia may be insufficient for mounting a tibial prosthesis. In such cases, the patient's tibia may require deeper resection and may additionally require augments to connect to a resected tibial and the tibial tray to place the tibial tray in alignment with femoral condyles or artificial condyles. Whether the augments or tibial tray is to connect to the resected tibia, it is generally desirable to firmly secure the tibial prosthesis to the tibia. In some cases, spikes are used to aid securing the tibial prosthesis to the tibia, as removable and exchangeable spikes can provide additional surface area for the bone to engage and can provide additional transmission of forces to and from the tibia in different areas of the tibia where there may be more desirable bone for mounting. In prior cases, tibial prostheses having spikes include a tibial tray with integral spikes have been used. However with this solution, augments are placed on or over the spikes, effectively shortening a tibial penetrating depth of the spikes. In other cases, long spikes may be used to extend an optimal depth past the augments into the tibia. In these cases, the spikes used may be much longer than is necessary to engage the bone when no augments are used. Thus, dedicated tibial tray designs with integral spikes having various lengths of spikes were manufactured leading to high inventory. Some tibial tray designs with spikes of a certain length were never utilized. Thus, the present inventors propose a tibial tray and augment system that includes spikes configured to removably and interchangeably couple to either one or both of the tibial tray and the augments.
To further illustrate the apparatuses and systems disclosed herein, the following non-limiting examples are provided:
In Example 1, a tibial replacement assembly for a knee arthroplasty, the tibial replacement assembly configured to couple to a resected proximal surface of a tibia of a human knee, can include subject matter (such as a device or apparatus) tibial replacement assembly comprising: a tibial tray comprising a proximal surface and a distal surface opposing the proximal surface, the distal surface configured to be disposed on a resected proximal surface of a tibia; and a first spike removably secured to the tibial tray and extending generally distally away from the distal surface, the first spike configured to extend beneath the resected proximal surface of the tibia.
In Example 2, the tibial replacement assembly of Example 1 can optionally be configured such that the tibial tray further comprises: a first bore extending from the distal surface into the tibial tray.
In Example 3, the tibial replacement assembly of any one or any combination of Examples 1-2 can optionally be configured such that the first spike is removably received in and securable to the first bore.
In Example 4, the tibial replacement assembly of any one or any combination of Examples 1-3 can optionally be configured to further comprise: a first augment having a second bore therein, the augment configured to abut the distal surface of the tibial tray to align the second bore with the first bore.
In Example 5, the tibial replacement assembly of any one or any combination of Examples 1-4 can optionally be configured such that the first spike is removably securable to the second bore of the augment and the first bore of the tibial tray.
In Example 6, the tibial replacement assembly of any one or any combination of Examples 1-5 can optionally be configured to further comprise: a keel extending generally distally away from the distal surface of the tibial tray; and a second augment configured to abut a lateral side of the tibial tray, wherein the first augment is configured to abut a medial side of the tibial tray, and wherein the first and second augments are disposed around the keel.
In Example 7, the tibial replacement assembly of any one or any combination of Examples 1-6 can optionally be configured such that the tibial tray further comprises a plurality of bores including the first bore, each of the plurality of bores extending from the distal surface into the tibial tray.
In Example 8, the tibial replacement assembly of any one or any combination of Examples 1-7 can optionally be configured to further comprise: a plurality of a spikes including the first spike, each of the plurality of spikes configured to secure to any of the plurality of the bores.
In Example 9, the tibial replacement assembly of any one or any combination of Examples 1-8 can optionally be configured such that the plurality of spikes includes a quantity of spikes that is lower than a quantity of the plurality of bores, and wherein the plurality of spikes are each configured to secure into any of the plurality of bores in a pattern as desired.
In example 10, a tibial replacement system for a revision knee arthroplasty, the tibial replacement system couplable to a resected proximal surface of a tibia of a human knee, can include subject matter (system), the tibial replacement system comprising: a tibial tray comprising a proximal surface and a distal surface opposing the proximal surface; and an augment comprising: an augment proximal surface configured to couple to the distal surface of the tibial tray; an augment distal surface opposite the augment proximal surface, wherein at least one or both of the distal surface of the tibial tray and the augment distal surface are configured to be disposed on the resected proximal surface of the tibia; and a first spike removably securable to one or both of the augment and the tibial tray, the first spike extending generally distally away from the augment distal surface, the first spike configured to extend beneath the resected proximal surface of the tibia.
In Example 11, the tibial replacement system of Example 10 can optionally be configured such that the tibial tray further comprises: a first bore extending from the distal surface into the tibial tray; and wherein the augment further comprises a first augment having a second bore therein, wherein the first augment is configured to abut the distal surface of the tibial tray to align the second bore with the first bore.
In Example 12, the tibial replacement system of any one or any combination of Examples 10-11 can optionally be configured to further comprise: a keel extending generally distally away from the distal surface of the tibial tray; and wherein the augment further comprises a second augment configured to abut a lateral side of the tibial tray, wherein the first augment is configured to abut a medial side of the tibial tray, and wherein the first and second augments are disposed around the keel.
In Example 13, the tibial replacement system of any one or any combination of Examples 10-12 can optionally be configured such that the tibial tray further comprises: a plurality of bores including the first bore, each extending from the distal surface into the tibial tray; and a plurality of spikes including the first spike, each spike configured to secure to any of the plurality of the bores.
In Example 14, the tibial replacement system of any one or any combination of Examples 10-13 can optionally be configured such that the plurality of spikes includes a quantity of spikes that is lower than a quantity of the plurality of bores, and wherein the plurality of spikes are each configured to secure into any of the plurality of bores in a pattern as desired.
In Example 15, the tibial replacement system of any one or any combination of Examples 10-14 can optionally be configured such that the augment includes a second plurality of bores, and wherein the plurality of spikes are each configured to secure into any of the plurality of bores and any of the second plurality of bores.
In example 16, a tibial replacement system for a revision knee arthroplasty, the tibial replacement system couplable to a resected proximal surface of a tibia of a human knee, can include subject matter (such as a system), the tibial replacement system comprising: a tibial tray comprising a proximal surface and a distal surface opposing the proximal surface; and an augment comprising: an augment proximal surface couplable to the distal surface of the tibial tray; and an augment distal surface opposite the augment proximal surface, wherein the distal surface of the tibial tray and the augment distal surface are both configured to be disposed on a resected proximal surface of a tibia; and a plurality of spikes configured to be removably secured to one or more of the augment and the tibial tray, each of the plurality of spikes configured to extend past the augment distal surface to beneath the resected proximal surface of the tibia.
In Example 17, the tibial replacement system of Example 16 can optionally be configured such that the tibial tray further comprises: a first bore extending from the distal surface into the tibial tray; and wherein the augment further comprises a first augment having a second bore therein, the first augment configured to abut the distal surface of the tibial tray to align the second bore with the first bore.
In Example 18, the tibial replacement system of any one or any combination of Examples 16-17 can optionally be configured to further comprise: a keel extending generally distally away from the distal surface of the tibial tray; wherein the augment further comprises a second augment configured to abut a lateral side of the tibial tray, wherein the first augment is configured to abut a medial side of the tibial tray, and wherein the first and second augments are disposed around the keel.
In Example 19, the tibial replacement system of any one or any combination of Examples 16-18 can optionally be configured such that the tibial tray further comprises a plurality of bores, including the first bore, each bore extending from the distal surface into the tibial tray, wherein the plurality of spikes includes a quantity of spikes that is lower than a quantity of the plurality of bores, and wherein the plurality of spikes are each configured to secure into any of the plurality of bores in a pattern as desired.
In Example 20, the tibial replacement system of any one or any combination of Examples 16-19 can optionally be configured such that the augment includes a second plurality of bores, including the second bore, and wherein the plurality of spikes are each configured to secure into any of the plurality of bores or the second plurality of bores.
In the drawings, which are not necessarily drawn to scale, like numerals can describe similar components in different views. Like numerals having different letter suffixes can represent different instances of similar components. The drawings illustrate generally, by way of example, but not by way of limitation, various examples discussed in the present document.
The present application relates tibial prostheses, systems, and methods. The systems, for example, can include a tibial bearing component, and a femoral component.
The present application relates to devices and methods for a tibial tray and augment system that can be used in or with a knee prosthesis, such as during a knee arthroplasty and/or as part of a later knee revision surgery. As described herein, a tibial plate can be part of a knee prosthesis and the fixation structure can promote securement and/or stabilization of the tibial baseplate to a patient's proximal tibia. An augment system can include two or more augments configured to attach to a tibial baseplate and can be located between the tibial baseplate and a resected surface of a tibia. The augment system can include plates of variable thickness and plates formed of different materials. The augment system can facilitate restoration of the anatomic joint line and address bone deficits on all or some of a proximal surface of a patient's tibia. In an example, the augment system can be used in combination with an implant structure configured to replace damaged bone within a medullary region of the patient's tibia.
As used herein, the terms “proximal” and “distal” should be given their generally understood anatomical interpretation. The term “proximal” refers to a direction generally toward the torso of a patient, and “distal” refers to the opposite direction of proximal, i.e., away from the torso of a patient. It should be understood that the use of the terms “proximal” and “distal” should be interpreted as though the patient were standing with the knee joint in extension despite the apparatuses described herein generally being used with the knee joint in flexion. The intent is to differentiate the terms “proximal” and “distal” from the terms “anterior” and “posterior”. As used herein, the terms “anterior” and “posterior” should be given their generally understood anatomical interpretation. Thus, “posterior” refers to a rear of the patient, e.g., a back of the knee. Similarly, “anterior” refers to a front of the patient, e.g., a front of the knee. Thus, “posterior” refers to the opposite direction of “anterior”.
Tibial replacement system 102 can include tibial tray 104, augments 106A and 106B, bearing 108, keel assembly 110, and spikes 112A and 112B. Keel assembly 110 can include a keel stem (not shown in
As part of a knee arthroplasty, tibial replacement system 102 can be configured to interface with and articulate with a femoral replacement implant (not shown), in some examples. In some examples, a distal portion of tibial replacement system 102 can connect to tibia 12, as discussed further below.
In some examples, tibial tray 104 can include proximal side 104p, which can be configured to couple to and interface with bearing 108. Tibial tray 104 can also include distal side 104d, which can be coupled to augments 106A and 106B according to some examples. According to other examples, distal side 104d can be configured to interface with and rest upon resected proximal surface 14. Proximal side 104p can be opposed to distal side 104d. Augments 106A and 106B can also include proximal and distal sides 106p and 106d, respectively. Augment 106A can be coupled at proximate side 106p to distal side 104d at a lateral side of tibial tray 104. Similarly, augment 106B can be coupled at proximate side 106p to distal side 104d at a medial side of tibial tray 104. Proximal side 106p can be opposed to distal side 106d. Distal sides 106d of augments 106A and 106B can be coupled to tibia 12 at resected proximal surface 14.
Keel assembly 110 can be coupled to distal side 104d of tibial tray 104 in some examples. More specifically, keel 114 can be coupled to a keel stem (not shown) and can extend distally away from distal side 104d of tibial tray into a recess in tibia 12. Tibial keel stem 116 can be coupled to keel 114 or keel stem (not shown) and can also extend distally away from distal side 104d of tibial tray 104 into the recess in tibia 12. For example, the recess can comprise a cavity created along a tibial medullary space of the tibia 12. Keel 114 and tibial keel stem 116 can extend into and engage this tibial medullary cavity of tibia 12, securing tibial replacement system 102 to tibia 12.
Spikes 112A and 112B can comprise attachable and removable features such as fasteners (e.g., nails, pins, screw thread, and the like). According to some examples spikes 112A and 112B can be removably coupled to augments 106A and 106B. According to further examples, spikes 112A and 112B can be removably coupled to tibial tray 104, as described below in
In some surgical procedures, tibia 12 can be resected at resected proximal surface 14, creating an attachment surface for tibial tray 104 to secure to tibia 12. Bearing 108 can then be secured to tibial tray 104 to provide femoral condyles of a femoral implant (not shown) a smooth articulating surface. In some of these examples, spikes 112A and 112B can be secured to tibial tray 104 to engage tibia 12. Then, spikes 112A and 112B can transmit rotational forces between tibia 12 and tibial tray 104.
In some examples, tibia 12 may need to be resected to provide installation and operating clearance for tibial tray 104 and bearing 108 due to the condition of tibia 12. In other examples, tibia 12 may need to be resected to a further depth to provide a solid engagement surface for tibial tray 104 due to the condition of tibia 12 In these other examples, augments 106A and 106B can be secured to resected proximal surface 14 and attached to tibial tray 104, as described above, to make up for absence of bone, and to position bearing 108 and tibial tray 104 in approximately the position of an ideal location of a patient's meniscus and proximal tibia termination. In these examples, spikes 112A and 112B can be secured to augments 106A and 106B to engage tibia 12.
In some examples, spikes 112A and 112B can be configured to transmit kinematic forces created by a patient articulating the knee joint. The forces can be transmitted from augments 106A and 106B to tibia 12 through spikes 112A and 112B, and can be transmitted from tibia 12 to augments 106A and 106B through spikes 112A and 112B. In these examples, augments 106A and 106B can be configured to transmit the forces to and from tibial tray 104.
Because spikes 112A and 112B can be secured to either tibial tray 104 and/or augments 106A and 106B, tibial replacement system 102 provides the benefit of a single system that can be used for procedures having a relatively large variety of tibial resection depths.
Tibial replacement system 202 can include tibial tray 204, augment 206A, keel assembly 210, and fasteners 218. Tibial tray 204 can include proximal side 204p and distal side 204d. Tibial tray 204 can also include tray bores 220 and 222. Augment 206A can include proximal side 206p and distal side 206d. Augment 206A can also include augment bores 224 and 226, and recessed portion 228. Keel assembly 210 can include keel 214, and keel stem 230. Keel 214 can include keel fins 232 and 234. Also shown are orientation indications Proximal, Distal, Anterior, Posterior, Medial, and Lateral. The components of tibial replacement system 202 can be connected and operate consistently with tibial replacement system 102 of
Tray bores 220 and 222 can be threaded bores extending from distal side 204d into tibial tray 204 toward proximal side 204p and terminating prior to reaching proximal side 204p. Tray bores 220 and 222 are only shown in
Tray bores 220 and 222 can be positioned at various locations about keel assembly 210. In some examples, tray bores 220 and 222 can be positioned toward a periphery of tibial tray 204, as shown in the example of
In some examples, fasteners 218 can be inserts removably fitted (through a threaded engagement or other means), into tray bores 220 and 222. In these examples, spikes can be used to engage the inserts and/or tray bores 220 and 222 to secure augment 206A to tibial tray 204.
In some examples, fasteners 218 may not be used and spikes, such as spikes 112A and 112B of
Augment bores 224 and 226 can be threaded bores extending from proximal side 206p into augment 206A toward distal side 206d and extending entirely through augment 206A. Though only augment 206A is shown in
Fasteners 218 and/or spikes can be used to affix augment 206A to tibial tray 204. In the example shown in
Recessed portion 228 of augment 206A can define a portion of the periphery of augment 206A near the center of tibial tray 204. Recessed portion 228 can be configured to provide clearance for keel 214, and especially fin 232, allowing keel 214 to pass through augment 206A without making contact.
Keel stem 230 and can extend distally away from the center of distal side 204d of tibial tray 204. Keel 214 can be configured to secure to keel stem 230 and can extend distally away from the center of distal side 204d of tibial tray 204 below resected proximal surface 14 to engage tibia 12 (of
Augment 306B can include recessed portion 329, which can provide clearance for a keel, such as keel 114 of
Though spike 312B is shown coupled to augment bore 327 in the example of
In operation of some examples, spikes 312A and 312B can transmit forces from tibia 12 (of
In some examples, portions of resected tibial surface 14 and/or tibia 12 may be insufficient for mounting tibial tray 12. In these examples, spikes 312A and 312B can be selectively inserted to engage good portions of tibia 12 and/or resected tibial surface 14. In operation of some examples, there can be two spikes, such as spikes 312A and 312B can be secured to any of augment bores 324, 325, 326, and 327 in a pattern that optimizes transmission of forces from the tibial tray (such as tibial tray 104 of
In some examples, such as the example of
Tibial tray 404 can include tray bores 420-423, which can be configured to receive fasteners (not shown) and spikes, such as spikes 412A and 412B as shown in
Though spike 412B is shown as being coupled to tray bore 422, spike 412B can also be secured to tray bores 420, 421, and 423 in other examples. Similarly, though spike 412A is shown as being coupled to tray bore 421, spike 412A can also be secured to tray bores 420, 422, and 423. In some examples, spikes 412A and 412B can be configured to secure to of any of tray bores 420-423. In these examples, there can be more bores than spikes, allowing for several configurations of spikes 412A and 412B coupled to tibial tray 404. These examples can allow a physician to select a location of the spikes based upon knee joint kinematics or suitability of tibia 12.
In operation of some examples, spikes 412A and 412B can transmit forces from tibia 12 to tibial tray 404 and from tibial tray 404 to tibia 12, helping to prevent rotation of tibial tray 404 relative to tibia 12. This increases the effectiveness and longevity of tibial replacement system 402. In operation of some examples, spikes 412A and 412B can be secured to any of tray bores 420-423 in a pattern that optimizes transmission of forces from tibial tray 404 to tibia 12, as a function of the condition of tibia 12.
In some examples, two spikes, such as spikes 412A and 412B, can be required to adequately transfer forces from tibial tray 404 to tibia 12 to prevent rotation of tibial tray 404 relative to tibia 12. In other examples, more spikes may be required to adequately transfer forces. In one example, two additional spikes may be secured to tray bores 420 and 423 for a total of four spikes (including spikes 412A and 412B). This configuration can further aid the distribution of forces from the tibial tray to tibia 12.
The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention can be practiced. These embodiments are also referred to herein as “examples.” Such examples can include elements in addition to those shown or described. However, the present inventors also contemplate examples in which only those elements shown or described are provided. Moreover, the present inventors also contemplate examples using any combination or permutation of those elements shown or described (or one or more aspects thereof), either with respect to a particular example (or one or more aspects thereof), or with respect to other examples (or one or more aspects thereof) shown or described herein.
In this document, the terms “a” or “an” are used, as is common in patent documents, to include one or more than one, independent of any other instances or usages of“at least one” or “one or more.” In this document, the term “or” is used to refer to a nonexclusive or, such that “A or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated. In this document, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Also, in the following claims, the terms “including” and “comprising” are open-ended, that is, a system, device, article, composition, formulation, or process that includes elements in addition to those listed after such a term in a claim are still deemed to fall within the scope of that claim. Moreover, in the following claims, the terms “first,” “second,” and “third,” etc. are used merely as labels, and are not intended to impose numerical requirements on their objects.
The above description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more aspects thereof) can be used in combination with each other. Other examples can be used, such as by one of ordinary skill in the art upon reviewing the above description. The Abstract is provided to comply with 37 C.F.R. § 1.72(b), to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above detailed description, various features can be grouped together to streamline the disclosure. This should not be interpreted as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter can lie in less than all features of a particular disclosed example. Thus, the following claims are hereby incorporated into the detailed description as examples or embodiments, with each claim standing on its own as a separate example, and it is contemplated that such examples can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.
This application claims the benefit of priority to U.S. Provisional Application Ser. No. 62/448,492, filed on Jan. 20, 2017, which is incorporated herein by reference in its entirety.
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