CA2285768A1 - Methods and tools for tibial intermedullary revision surgery and associated tibial components - Google Patents
Methods and tools for tibial intermedullary revision surgery and associated tibial components Download PDFInfo
- Publication number
- CA2285768A1 CA2285768A1 CA002285768A CA2285768A CA2285768A1 CA 2285768 A1 CA2285768 A1 CA 2285768A1 CA 002285768 A CA002285768 A CA 002285768A CA 2285768 A CA2285768 A CA 2285768A CA 2285768 A1 CA2285768 A1 CA 2285768A1
- Authority
- CA
- Canada
- Prior art keywords
- offset
- template
- bushing
- tibial
- stem
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/38—Joints for elbows or knees
- A61F2/389—Tibial components
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1735—Guides or aligning means for drills, mills, pins or wires for rasps or chisels
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
- A61B17/1764—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the knee
Abstract
IM tibia revision tools include a trial stem extender having multiple notches which serve both as depth witness marks and holders for a stop clip, a collection of different sized tibial templates, each template adapted to receive an angular offset positioning guide, a collection of offset bushings, each bushing each bushing having a different offset distance and each being adapted to cooperate with the trial stem extender and the angular offset positioning guide, a neutral bushing for locating the position of the implant boss relative to the tibia and for reaming the tibia to accept the boss of the implant, a fin punch guide and fin punch for preparing the tibia to receive the keel of the tibial component, and a tool for translating the angular offset measurement to the tibial component.
Tibial components according to the invention have three parts: the baseplate portion, the offset portion, and the stem portion. Each portion is provided in a variety of sizes and the portions may be mixed and matched according to the measurements made with the tools described above.
Methods for using the tools and the tibial components are also disclosed.
Tibial components according to the invention have three parts: the baseplate portion, the offset portion, and the stem portion. Each portion is provided in a variety of sizes and the portions may be mixed and matched according to the measurements made with the tools described above.
Methods for using the tools and the tibial components are also disclosed.
Description
' CA 02285768 1999-10-12 IN THE UNITED STATES
PATENT AND TRADEMARK OFFICE
PATENT APPLICATION
METHODS AND TOOLS FOR TIBIAL INTERMEDULLARY
REVISION SURGERY AND ASSOCIATED TIBIAL COMPONENTS
This application is related to co-owned co-pending serial number 09/049,708, filed March 28, 1998, entitled Methods and Tools for Femor<<1 Imtermedullary Revision Surgery, the complete disclosure of which is hereby incorporated herein by reference.
BACKGROUND OF THE INVENTION
1. Field of the Invention The invention relates to methods and tools used in knee arthroplasty. More particularly, the invention relates to methods and tools used in revision surgery where an artificial tibial component is removed and replaced. The invention also relates to improved tibial components.
PATENT AND TRADEMARK OFFICE
PATENT APPLICATION
METHODS AND TOOLS FOR TIBIAL INTERMEDULLARY
REVISION SURGERY AND ASSOCIATED TIBIAL COMPONENTS
This application is related to co-owned co-pending serial number 09/049,708, filed March 28, 1998, entitled Methods and Tools for Femor<<1 Imtermedullary Revision Surgery, the complete disclosure of which is hereby incorporated herein by reference.
BACKGROUND OF THE INVENTION
1. Field of the Invention The invention relates to methods and tools used in knee arthroplasty. More particularly, the invention relates to methods and tools used in revision surgery where an artificial tibial component is removed and replaced. The invention also relates to improved tibial components.
2. Brief Description Of The Prior Art Total knee arthrop:Lasty involves the replacement of portions of the patellar, femur and tibia with artificial components. In particular, a proximal portion of the tibia and a distal portion of the femur are cut away (resected) t and replaced with artificial components. As used herein, when referring to bones or other body parts, the term "proximal" means closest to the heart and the term "distal"
means more distant from the heart. When referring to tools and instruments, the term "proximal" means closest to the practitioner and the term "distal" means more distant from the practitioner.
There are several types of knee prostheses known in the art. One type is sometimes referred to as a "resurfacing type". In the~.e prostheses, the articular surface of the distal femur and proximal tibia are "resurfaced" with respective metal and plastic condylar-type articular bearing components. These knee prostheses provide adequate rotational and translational freedom and require minimal bone resection to accommodate the components within the boundaries of the available joint space.
- The femoral component is a metallic alloy construction (cobalt-chrome alloy or 6A14V titanium alloy) and provides medial and lateral condylar bearing surfaces of multi-radius design of similar shape and geometry as the natural distal femur or femoral-side of the knee joint.
The tibial componE~nt usually includes a distal metal base component and a proximal interlocking plastic, e.g. UHMWPE (ultra high molecular weight polyethylene), component or insert. The plastic tibial plateau bearing surfaces are of concave multi-radius geometry to more or less match the articular geometry of the mating femoral condyles. Both the femoral and tibial components are usually provided with intermedullary (IM) stem options.
After preparing the distal surface of the femur-and the proximal surface of the tibia, an opening is made into the medullary canal of the femur, and an opening is made into the medullary canal of tibia. The interior surface and the IM stem of the femoral component are usually covered with a polymeric cement and the IM stem is inserted into the medullary canal of the femur until the interior surface of the femoral component meets the distal surface of the femur. The tibial component is similarly usually cemented to the proximal surface and medullary canal of the tibia.
Occasionally, the components are press fit without the use of cement. The use of cement has advantages and disadvantages. Press fit components rely on bone quality to obtain good fixation. Somei:imes it is impossible to obtain good fixation with a press fit component and sometimes a press fit component will fail early because of failure of successful biological ingrowth. Cement assures good fixation but puts strain along the component stem. In addition, as described below, cement complicates the removal of a failed component.
Often, due to normal wear over time, the prosthetic knee must be replaced via a procedure known as revision surgery. When the primary cemented prosthetic is removed, the proximal' surface of the tibia and the distal surface of the femur typically exhibit cavernous defects.
Absent the use of bone graft, the proximal surface of the tibia and the distal surface of the femur must be carefully l0 resected to remove cavernous defects before a replacement knee can be installed.
In addition, the intramedullary (IM) canals must be broached or reamed to remove any remaining cement or cavernous defects existing in the canals before a replacement knee can be installed.
According to the state of the art, after the primary prosthetic is removed, the proximal tibia is resected with a lateral template. The medullary canal is reamed and the reamer is tapped in place with a mallet. A
proximal resection guide is attached to the reamer and proximal resection is completed via slots in the guide.
Preparation of the distal femur is described in the above referenced related application.
means more distant from the heart. When referring to tools and instruments, the term "proximal" means closest to the practitioner and the term "distal" means more distant from the practitioner.
There are several types of knee prostheses known in the art. One type is sometimes referred to as a "resurfacing type". In the~.e prostheses, the articular surface of the distal femur and proximal tibia are "resurfaced" with respective metal and plastic condylar-type articular bearing components. These knee prostheses provide adequate rotational and translational freedom and require minimal bone resection to accommodate the components within the boundaries of the available joint space.
- The femoral component is a metallic alloy construction (cobalt-chrome alloy or 6A14V titanium alloy) and provides medial and lateral condylar bearing surfaces of multi-radius design of similar shape and geometry as the natural distal femur or femoral-side of the knee joint.
The tibial componE~nt usually includes a distal metal base component and a proximal interlocking plastic, e.g. UHMWPE (ultra high molecular weight polyethylene), component or insert. The plastic tibial plateau bearing surfaces are of concave multi-radius geometry to more or less match the articular geometry of the mating femoral condyles. Both the femoral and tibial components are usually provided with intermedullary (IM) stem options.
After preparing the distal surface of the femur-and the proximal surface of the tibia, an opening is made into the medullary canal of the femur, and an opening is made into the medullary canal of tibia. The interior surface and the IM stem of the femoral component are usually covered with a polymeric cement and the IM stem is inserted into the medullary canal of the femur until the interior surface of the femoral component meets the distal surface of the femur. The tibial component is similarly usually cemented to the proximal surface and medullary canal of the tibia.
Occasionally, the components are press fit without the use of cement. The use of cement has advantages and disadvantages. Press fit components rely on bone quality to obtain good fixation. Somei:imes it is impossible to obtain good fixation with a press fit component and sometimes a press fit component will fail early because of failure of successful biological ingrowth. Cement assures good fixation but puts strain along the component stem. In addition, as described below, cement complicates the removal of a failed component.
Often, due to normal wear over time, the prosthetic knee must be replaced via a procedure known as revision surgery. When the primary cemented prosthetic is removed, the proximal' surface of the tibia and the distal surface of the femur typically exhibit cavernous defects.
Absent the use of bone graft, the proximal surface of the tibia and the distal surface of the femur must be carefully l0 resected to remove cavernous defects before a replacement knee can be installed.
In addition, the intramedullary (IM) canals must be broached or reamed to remove any remaining cement or cavernous defects existing in the canals before a replacement knee can be installed.
According to the state of the art, after the primary prosthetic is removed, the proximal tibia is resected with a lateral template. The medullary canal is reamed and the reamer is tapped in place with a mallet. A
proximal resection guide is attached to the reamer and proximal resection is completed via slots in the guide.
Preparation of the distal femur is described in the above referenced related application.
The defects in the tibia are measured and the cutting guide is moved down 6 to lOmm. A flat cut from anterior to posterior is made. A tibial template is attached to the reamer and reference marks are typically in pen. A flat cut and sagittal cut are made relative to the reference marks. Another template is attached to the reamer and anterior and posterior holes are drilled for securing a wedge resection guide. A wedge cut is then made. The template is replaced and aligned with the marks. A revision mask punch guide is attached to the template and a revision box chisel is used to prepare for a stem.
Those skilled in the art will appreciate that revision surgery is difficult because (1) the type and location of cavernous defects make it difficult to match the exterior surfaces of the tibia and femur to the interior surfaces of the prosthetic, (2) the femur and tibia must be resected with reference to the IM canal, and (3) the use of multiple templates and guides during the course of the procedure makes it very diff=Lcult to keep all the cuts in proper alignment relative to the IM canal.
In particular, with respect to the tibia, resection of the proximal tibia results in the creation of a tibial plateau in which the IM canal is no longer centrally located. If a normal tibial component is installed, portions of the tibial component will overhang the resected tibial plateau.
In order to compensate for this problem, it is known in the art to provide tibial components with offset IM
stems. However, the relative location of the IM canal relative to the perimeter of the tibial plateau may be offset in any direction, anterior, posterior, medial, or lateral, depending on the individual bone. It is impossible or at least impractical to provide an offset stem tibial component for every possible variation in the relative location of the IM canal.
Moreover, it is difficult to estimate the offset of the IM canal in order to choose an appropriate offset tibial component.
According to the state of the art, offset tibial components are selected by trial and error, a tedious procedure which prolongs surgery. For example, as shown in FIG. 1, a relatively symmetrical tibial plateau 10 exhibits the IM canal 12 in a central location. After resection of the tibial plateau, the location of the IM canal may be located off center as shown in FIGS. 2 and 3 where canals 12' and 12" are seen to be located off center relative to the plateaus 10' and-10" respectively.
Those skilled in the art will appreciate that revision surgery is difficult because (1) the type and location of cavernous defects make it difficult to match the exterior surfaces of the tibia and femur to the interior surfaces of the prosthetic, (2) the femur and tibia must be resected with reference to the IM canal, and (3) the use of multiple templates and guides during the course of the procedure makes it very diff=Lcult to keep all the cuts in proper alignment relative to the IM canal.
In particular, with respect to the tibia, resection of the proximal tibia results in the creation of a tibial plateau in which the IM canal is no longer centrally located. If a normal tibial component is installed, portions of the tibial component will overhang the resected tibial plateau.
In order to compensate for this problem, it is known in the art to provide tibial components with offset IM
stems. However, the relative location of the IM canal relative to the perimeter of the tibial plateau may be offset in any direction, anterior, posterior, medial, or lateral, depending on the individual bone. It is impossible or at least impractical to provide an offset stem tibial component for every possible variation in the relative location of the IM canal.
Moreover, it is difficult to estimate the offset of the IM canal in order to choose an appropriate offset tibial component.
According to the state of the art, offset tibial components are selected by trial and error, a tedious procedure which prolongs surgery. For example, as shown in FIG. 1, a relatively symmetrical tibial plateau 10 exhibits the IM canal 12 in a central location. After resection of the tibial plateau, the location of the IM canal may be located off center as shown in FIGS. 2 and 3 where canals 12' and 12" are seen to be located off center relative to the plateaus 10' and-10" respectively.
CA 02285768~1999-10-12 SUMMARY OF THE INVENTION
It is therefore an object of the invention to provide methods and tools for performing IM revision surgery.
It is also an object of the invention to provide-tools for IM revision surgery which maintain proper alignment with the IM canal while multiple resection cuts are made, tools for determining the offset location~of the IM canal relative to the tibial plateau, tools which enhance the accuracy of IM revision surgery and enhance the stability of the revision implant.
It is another object of the invention to provide methods for performing IM revision surgery in which a minimum number of tools are used.
The methods and tools of the invention provide accurate location of bone cuts so that the revision prosthetic is correctly oriented relative the IM canal and the bone cuts. Moreover, the tools and methods provide accurate measurements for u::e in selecting the appropriate tibial component and for adjusting the angular offset of the tibial component according to the measurements. Additional objects and advantages of the invention will become apparent to those skilled in the art upon reference to the detailed description taken in conjunction with the provided figures.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a schematic plan view of a relatively symmetrical tibial plateau;
FIG. 2 is a view similar to Fig. 1 showing a slightly offset IM canal;
FIG. 3 is a view similar to Fig. 1 showing a more dramatically offset IM canal;
FIG. 4 is a perspective view of the resection guide tower attached to the tool stem;
FIG. 5 is a perspective view of the impactor/extractor;
FIG. 6 is a broken perspective transparent view of the guide tower installed in the IM canal of the tibia;
FIG. 7 is a view similar to Fig. 6 with the optional collar attached to the tool stem:
FIG. 8 is a broken perspective view of the cutting block attached to the tool seem;
It is therefore an object of the invention to provide methods and tools for performing IM revision surgery.
It is also an object of the invention to provide-tools for IM revision surgery which maintain proper alignment with the IM canal while multiple resection cuts are made, tools for determining the offset location~of the IM canal relative to the tibial plateau, tools which enhance the accuracy of IM revision surgery and enhance the stability of the revision implant.
It is another object of the invention to provide methods for performing IM revision surgery in which a minimum number of tools are used.
The methods and tools of the invention provide accurate location of bone cuts so that the revision prosthetic is correctly oriented relative the IM canal and the bone cuts. Moreover, the tools and methods provide accurate measurements for u::e in selecting the appropriate tibial component and for adjusting the angular offset of the tibial component according to the measurements. Additional objects and advantages of the invention will become apparent to those skilled in the art upon reference to the detailed description taken in conjunction with the provided figures.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a schematic plan view of a relatively symmetrical tibial plateau;
FIG. 2 is a view similar to Fig. 1 showing a slightly offset IM canal;
FIG. 3 is a view similar to Fig. 1 showing a more dramatically offset IM canal;
FIG. 4 is a perspective view of the resection guide tower attached to the tool stem;
FIG. 5 is a perspective view of the impactor/extractor;
FIG. 6 is a broken perspective transparent view of the guide tower installed in the IM canal of the tibia;
FIG. 7 is a view similar to Fig. 6 with the optional collar attached to the tool stem:
FIG. 8 is a broken perspective view of the cutting block attached to the tool seem;
FIG. 9 is a view similar to Fig. 8 showing the optional extra medullary referencing tool attached to the cutting block:
FIG. 10 is a broken perspective transparent view of a trial stem extender and trial stem inserted into the IM
canal of the tibia;
FIG. 11 is a broken perspective view showing the tibial template and offset positioning guide placed over the trial stem on the tibial plateau;
FIG. 12 is a view similar to Fig. 11 showing the 4mm offset bushing installed in the angular offset positioning guide;
FIG. 13 is a persp~active view of the 4mm, 6mm. and 8mm offset bushings;
FIG. 14 is view similar to Fig. 12 showing the optional stop clip attached to the trial stem extender;
FIG. 15 is an enlarged broken perspective view of the 4mm offset bushing installed in the angular offset positioning guide indicating an angular offset of 320 degrees and showing the template pinned to the tibia;
FIG. 10 is a broken perspective transparent view of a trial stem extender and trial stem inserted into the IM
canal of the tibia;
FIG. 11 is a broken perspective view showing the tibial template and offset positioning guide placed over the trial stem on the tibial plateau;
FIG. 12 is a view similar to Fig. 11 showing the 4mm offset bushing installed in the angular offset positioning guide;
FIG. 13 is a persp~active view of the 4mm, 6mm. and 8mm offset bushings;
FIG. 14 is view similar to Fig. 12 showing the optional stop clip attached to the trial stem extender;
FIG. 15 is an enlarged broken perspective view of the 4mm offset bushing installed in the angular offset positioning guide indicating an angular offset of 320 degrees and showing the template pinned to the tibia;
FIG. 16 is a view similar to Fig. 15 showing the 4mm offset bushing removed and the boss reamer bushing in its place:
FIG. 17 is a view similar to Fig. 16 showing the boss reamer (or optionally an offset boss reamer) in the reamer bushing:
FIG. 18 is a view similar to Fig. 17 with the reamer, bushing, and angular offset guide removed from the template and with the fin punch guide and fin punch in their place:
FIG. 19 is an exploded perspective view of a tibial component according to the invention:
FIG. 20 is an exploded perspective view of the component stem and wrench;
FIG. 21 is an exploded perspective view of the tibial component and the toil for translating the angular offset to it; and FIG. 22 is a sectional view of the component and tool of Fig. 21.
' , CA 02285768 1999-10-12 DETAILED DESCRIPTION
An illustrative embodiment of the invention is set forth hereinafter. The illustrative embodiment makes reference to specific,measurements for tool diameters, cut depths, etc., which are intended only to give those skilled in the art an appreciation for the operating principals of .
the invention without any intent of limiting the spirt or scope thereof. It is applicants' intention that the invention only be limited by the appended claims and not any of the exemplary measurements set forth in the illustrative embodiment of the invention.
According to the methods of the invention, the previous tibial component is removed from the tibia and the IM canal of the tibia is reamed as described in the parent application hereto.
Referring now to FIG. 4, after the tibial IM canal is prepared, based on the diameter and reaming depth of the last IM reamer used, an appropriate tool stem 20 is chosen for attachment to the resection guide tower 22. The tower 22 has a boss 24 with a pair of surface grooves 26, a stem 28 with a pair of surface grooves 30, and an upstanding shaft 32 therebetween. The boss 24 has interior threads (not shown) and the stem 20 is provided with engaging exterior threads (not shown). According to one embodiment CA 02285768~1999-10-12 of the invention, the boss 24 has a diameter of l5mm and several stems 20 of different diameter are provided for attachment to the tower 22.
Turning now to FIGS. 5 and 6, the resection guide tower 22 with the attached tool stem 20 is installed in the IM canal 34 of the tibia 3'6 with the aid of the , impactor/extractor 40. The tool 4o has a nrnY;ma~ ha~~~e 42, a distal coupling 44, and a sliding mass 46. The coupling 44 has a slot 44a which is dimensioned to receive the stem 28 of the tower 22, and a pair of distal shoulders 44b which are dimensioned to fit into the slots 30 of the stem 28. A spring loaded latch 44c is located adjacent to the slot 44a.
The tool 40 is removably attached to the tower 22.
The stem 20 of the tower is then inserted into the IM canal 34 and the sliding mass 46 of the tool 40 is slid distally.
The force of the accelerated mass 46 impacts the coupling 44 and drives the stem 20 of the tower 22 into the IM canal 34.
If necessary, the mass is slid several times until the stem 22 is fully inserted into the IM canal 34. After the tower is installed, as shown in FIG. 6 the impactor/extractor tool is uncoupled from the tower.
In situations where the IM canal opening is enlarged and does not provide adequate support or a good reference point to seat the tower, a tibial collar 48, shown in FIG. 7, is attached to the boss 24 by engaging the grooves 26. The tibial collar 48 is shaped and dimensioned to cover the tibial plateau 37. In addition to stabilizing the tower 22, the collar 48 aids in preliminary sizing of -the tibial plateau 37.
Once the tower 22 is properly installed, a tibial cutting block 50 (which is provided in separate left and right versions) is attached to the upstanding shaft 32 of tower 22 as shown in FIGS. 8 and 9 by means of a cam lock 52 and the two 1/8" drill bits 54, 56 inserted into holes 58, 60. If desired, as shown in FIG. 9, a handle 70 and rod 72 are attached to the cutting block 50 so that an optional visual EM alignment inspection can be made.
With the cutting block 50 so secured, a typical 2mm clean-up cut can be made using the proximal surface 62 of the cutting block as a guide. According to a preferred embodiment of the invention, three degrees of posterior slope is built into the cutting block and this is why separate left and right cutting blocks are provided. Slots 64, 66 are provided for optional wedge cuts. After the clean-up cut and wedge cuts (if desired) are made, the cutting block 50 and the tower 22 are removed from the tibia - . CA 02285768 1999-10-12 36. The removal of the cutting block and tower is effected with the aid of the i~mpactor extractor 40.
Turning now to FIG. 10, after the cutting block and tower are removed from the tibia, a trial stem extender 74 is attached to the trial stem 20 (or another trial stem of the same size). The trial stem extender has a proximal coupling 76 for coupling to the impactor/extractor, and three pairs of circumferential grooves 78, 80, 82 which serve as witness marks and receivers for a stop clip' (described below with reference to FIG. 14). The witness marks are useful in determining the length of the stem portion of the tibial component implant.
With reference to FIG. 11, with the trial stem and extender 74 in place, an appropriately sized tibial template 84 is selected. The templates 84 are provided in a variety of sizes to correspond to different sized tibial plateaus 37. The size of the template 84 chosen may be based on the size of the collar 48 chosen above. According to the invention, therefore, several different sized templates 84 are provided. Each template 84 has a central circular opening 86 of standard size for receiving the offset positioning guide 88. The offset positioning guide 88 is a generally cylindrical member with a plurality of circumferential markings 90 which indicate angles between 0 degrees and 360 degrees. For clarity, the angle values are " " . CA 02285768 1999-10-12 not shown in the drawing, except for FIG. 15 which only shows one angle value.
In the presently preferred embodiment, the angle markings 90 are spaced 5 degrees apart (i.e. there are seventy-two markings about the perimeter of the offset positioning guide 88). As suggested by FIG.I 15, in the preferred embodiment, the angle values are provided for every other angle marking 90. The tibial template 84 is also provided with a plurality of pin receiving holes 92 (described below with reference to FIG. 15), and a coupling 94 for an optional EM alignment guide (like the guide 70, 72 shown in FIG. 9).
Turning now to FIGS. 12 and 13, the tools of the illustrative embodiment of invention include three offset bushings 96, 98, 100. Each bushing is a substantially cylindrical member which is dimensioned to fit within the cylindrical offset positioning guide 88,as shown in FIG. 12.
Each bushing 96, 98, 100 is provided with a circumferential indicator 9cia, 98a, 100a and a throughbore 96b, 98b, 100b which is designed to receive the trial stem extender 74. According to the invention, the throughbores are not centrally located relative to the center of the cylindrical bushings. Each bushing 96, 98, 100 has a throughbore 96b, 98b, 100b crhich is offset a different amount from the center of the cylindrical bushing.
According to the presently preferred embodiment, bushing 96 has a 4mm offset, bushing 98 has a 6mm offset, and bushing 100 has an 8mm offset. The circumterenziai indicators 96a, 98a, 100a are preferably located on the same radius along which the throughbores 96b, 98b, 100b are offset.
As shown in FIGS. 12 and 14, an appropriate offset bushing, e.g. 96, is chosen and fitted into the cylindrical offset positioning guide 88 with the trial stem extender 74 extending through the throughbore, e.g. 96b. The appropriate bushing is chosen by visual assessment or by trial and error. Optionally, if the trial stem and extender 74 are unstable in the IM canal, a stop clip 102 may be attached to one of the grooves in the extender 74 as shown in FIG. 14.
With the extender 74, template 84, cylindrical offset positioning guide 88, and bushing 96 assembled as shown, the bushing is rotated relative to the cylindrical offset positioning guide 88 until the template 84 assumes a position relative to the tibial plateau 37 where there is minimum or no overhang. When the optimal (best) position is obtained, the template 84 i~ pinned to the tibia 36, for example with 1/8" drill pins (or headed nails) 104 through the pin receiving holes 92. The angle indicated by the indicia 96a and 90 is noted before the bushing 96~and stem with extender 74 are removed.
According to the invention, a neutral (boss reaming) bushing 106 is provided. The neutral bushing 106 is substantially the same~size and shape as the offset bushings 96, 98, 100, but has a centrally located throughbore 107 and no radial indicia. The purpose of the neutral bushing is to act as a guide for reaming a hole in the center of the tibial plateau 37 for receipt of the boss portion of the tibial implant. Those skilled in the art will appreciate from the foregoing that the location of the center of the "boss hole" will be offset from the tibial IM
in the angular direction indicated by the indicators 90, 96a at the step shown in FIG. 15 by an amount equal to the offset amount of the bushing 96 (e. g. 4mm).
Turning now to FIG. 17, with the template 84 pinned to the tibia 36 by drill pins 104 and with the neutral bushing 106 inserted, in the offset positioning guide 88, a boss reamer 110 (or optionaly an offset boss reamer) is inserted into the throughbore 107 of the neutral bushing 106. The illustrative boss reamer 110 shown in FIG. 17 is l5mm in diameter and has twc; depth markings shown, 112 and 114. All of the tibial baseplates according to the illustrative embodiment of the invention have a l5mm ' CA 02285768 1999-10-12 diameter boss, but different baseplates have bosses with different lengths.
Having chosen the appropriately sized template 84, the practitioner will know which tibial baseplate will be used in the implant and will know how deep to ream the hole for the boss of the baseplate. Thus, at this stage of the, method of the invention, the practitioner uses the reamer 110 to ream to the appropriate depth indicated by the appropriate depth mark 112 or 114.
After reaming for the baseplate boss, the tibia is punched to make space for the baseplate fins or "keel". The boss reamer 110, the neutral bushing 106, and the offset positioning guide 88 are removed and the template 84 is left pinned to the tibia. The fin punch guide 120, shown in FIG. 18, is attached to the template 84. The guide 120 has left and right fin guides 122, 124 and a central boss guide 126. The fin punch 130 has left and right fins 132, 134 and a central boss 136.
The punch 130 is inserted into the punch guide 120 as shown in FIG. 18 with the central boss 136 entering the central boss guide 126 and the left and right fins 132, 134 entering the left and right. fin guides 122, 124. With the punch 130 in place, it is struck with a mallet (or attached to the impactor/extractor), driven into the tibial plateau, and then removed. Optionally, if a wedge cut had not been performed at the start (i.e. during the steps described with reference to FIGS. 8 and 9), a wedge cutting guide (not shown) may be attached to the coupling 94 of the template 84 and a wedge cut performed at this stage of the procedure.
All of the apparatus are now removed from the tibia and the tibial component is prepared for implant into the tibia. As mentioned above and as shown in FIG. 19, the tibial component 140 includes the baseplate portion 142, the offset portion 144, and the stem portion 146. It will be appreciated that the tibial component 140 is shown inverted and exploded in FIG. 19 to illustrate the manner in which it is assembled rather than tr.e manner in which it is implanted.
The baseplate 142 can be seen to have a central boss 148 and a pair of fins 150, 152. The offset portion 144 has a male coupling 154 which engages the boss 148, and a female coupling 15G which mates with the stem portion 146.
The axes of the couplings 154 and 156 are offset by a certain amount, e.g. 4mm, 6mm, or 8mm, corresponding to the offset bushings 96, 98, l0U shown in FIG. 13 and described above. Between the male coupling 154 and the female coupling 156 is a tightening nut 155 which is used to lock the angular position of the two couplings relative to each other as described in detail below with reference to FIGS.
21 and 22.
According to the presently preferred embodiment, the stem 146 has a male coupling 158 at its proximal end and a trifurcated distal end 160. The fluted stem 146 is preferably coupled to the offset component 144 with the air of a trifluted wrench 162 which is shown in FIG. 20.
Turning now to FIG. 21, the offset portion 144 is fixedly attached to the stem portion 146 and loosely coupled to the baseplate portion 142. The baseplate portion 142 is placed in the base 164 of an angular adjustment tool 166. A
turntable portion 168 of the tool 166 is placed over the stem portion 146, the offset portion 144 and tightening nut 155, engaging both the base 164 and baseplate portion 142.
The turntable 168 has a locking knob 170 and an angle indicator/wrench key 172.
With the tool 166 assembled about the tibial component 140 as shown in FIG. 22, the angle indicator/wrench key 172 is turned until it indicates the angle previously noted at the step described with reference to FIG. 15. When the angle has been so "dialed in", the offset portion 144 is tightened to the baseplate 142 using the wrench 174 (FIG. 21) on the tightening nut 155. The tibial component is now assembled and ready for implantation. Optionally, if wedge cuts had been made, one or more wedges may be added to the bottom of the baseplate 142 either before or after the assembly of the baseplate, stem, and offset portion.
There have been described and illustrated herein methods and tools for IM revision surgery involving tibial components. While particular embodiments of the invention have been described, it is not intended that the invention be limited thereto, as it is intended that the invention be as broad in scope as the art will allow and that the specification be read likewise. It will therefore be appreciated by those skilled in the art that yet other modifications could be made to the provided invention without deviating from its spirit and scope as so claimed.
FIG. 17 is a view similar to Fig. 16 showing the boss reamer (or optionally an offset boss reamer) in the reamer bushing:
FIG. 18 is a view similar to Fig. 17 with the reamer, bushing, and angular offset guide removed from the template and with the fin punch guide and fin punch in their place:
FIG. 19 is an exploded perspective view of a tibial component according to the invention:
FIG. 20 is an exploded perspective view of the component stem and wrench;
FIG. 21 is an exploded perspective view of the tibial component and the toil for translating the angular offset to it; and FIG. 22 is a sectional view of the component and tool of Fig. 21.
' , CA 02285768 1999-10-12 DETAILED DESCRIPTION
An illustrative embodiment of the invention is set forth hereinafter. The illustrative embodiment makes reference to specific,measurements for tool diameters, cut depths, etc., which are intended only to give those skilled in the art an appreciation for the operating principals of .
the invention without any intent of limiting the spirt or scope thereof. It is applicants' intention that the invention only be limited by the appended claims and not any of the exemplary measurements set forth in the illustrative embodiment of the invention.
According to the methods of the invention, the previous tibial component is removed from the tibia and the IM canal of the tibia is reamed as described in the parent application hereto.
Referring now to FIG. 4, after the tibial IM canal is prepared, based on the diameter and reaming depth of the last IM reamer used, an appropriate tool stem 20 is chosen for attachment to the resection guide tower 22. The tower 22 has a boss 24 with a pair of surface grooves 26, a stem 28 with a pair of surface grooves 30, and an upstanding shaft 32 therebetween. The boss 24 has interior threads (not shown) and the stem 20 is provided with engaging exterior threads (not shown). According to one embodiment CA 02285768~1999-10-12 of the invention, the boss 24 has a diameter of l5mm and several stems 20 of different diameter are provided for attachment to the tower 22.
Turning now to FIGS. 5 and 6, the resection guide tower 22 with the attached tool stem 20 is installed in the IM canal 34 of the tibia 3'6 with the aid of the , impactor/extractor 40. The tool 4o has a nrnY;ma~ ha~~~e 42, a distal coupling 44, and a sliding mass 46. The coupling 44 has a slot 44a which is dimensioned to receive the stem 28 of the tower 22, and a pair of distal shoulders 44b which are dimensioned to fit into the slots 30 of the stem 28. A spring loaded latch 44c is located adjacent to the slot 44a.
The tool 40 is removably attached to the tower 22.
The stem 20 of the tower is then inserted into the IM canal 34 and the sliding mass 46 of the tool 40 is slid distally.
The force of the accelerated mass 46 impacts the coupling 44 and drives the stem 20 of the tower 22 into the IM canal 34.
If necessary, the mass is slid several times until the stem 22 is fully inserted into the IM canal 34. After the tower is installed, as shown in FIG. 6 the impactor/extractor tool is uncoupled from the tower.
In situations where the IM canal opening is enlarged and does not provide adequate support or a good reference point to seat the tower, a tibial collar 48, shown in FIG. 7, is attached to the boss 24 by engaging the grooves 26. The tibial collar 48 is shaped and dimensioned to cover the tibial plateau 37. In addition to stabilizing the tower 22, the collar 48 aids in preliminary sizing of -the tibial plateau 37.
Once the tower 22 is properly installed, a tibial cutting block 50 (which is provided in separate left and right versions) is attached to the upstanding shaft 32 of tower 22 as shown in FIGS. 8 and 9 by means of a cam lock 52 and the two 1/8" drill bits 54, 56 inserted into holes 58, 60. If desired, as shown in FIG. 9, a handle 70 and rod 72 are attached to the cutting block 50 so that an optional visual EM alignment inspection can be made.
With the cutting block 50 so secured, a typical 2mm clean-up cut can be made using the proximal surface 62 of the cutting block as a guide. According to a preferred embodiment of the invention, three degrees of posterior slope is built into the cutting block and this is why separate left and right cutting blocks are provided. Slots 64, 66 are provided for optional wedge cuts. After the clean-up cut and wedge cuts (if desired) are made, the cutting block 50 and the tower 22 are removed from the tibia - . CA 02285768 1999-10-12 36. The removal of the cutting block and tower is effected with the aid of the i~mpactor extractor 40.
Turning now to FIG. 10, after the cutting block and tower are removed from the tibia, a trial stem extender 74 is attached to the trial stem 20 (or another trial stem of the same size). The trial stem extender has a proximal coupling 76 for coupling to the impactor/extractor, and three pairs of circumferential grooves 78, 80, 82 which serve as witness marks and receivers for a stop clip' (described below with reference to FIG. 14). The witness marks are useful in determining the length of the stem portion of the tibial component implant.
With reference to FIG. 11, with the trial stem and extender 74 in place, an appropriately sized tibial template 84 is selected. The templates 84 are provided in a variety of sizes to correspond to different sized tibial plateaus 37. The size of the template 84 chosen may be based on the size of the collar 48 chosen above. According to the invention, therefore, several different sized templates 84 are provided. Each template 84 has a central circular opening 86 of standard size for receiving the offset positioning guide 88. The offset positioning guide 88 is a generally cylindrical member with a plurality of circumferential markings 90 which indicate angles between 0 degrees and 360 degrees. For clarity, the angle values are " " . CA 02285768 1999-10-12 not shown in the drawing, except for FIG. 15 which only shows one angle value.
In the presently preferred embodiment, the angle markings 90 are spaced 5 degrees apart (i.e. there are seventy-two markings about the perimeter of the offset positioning guide 88). As suggested by FIG.I 15, in the preferred embodiment, the angle values are provided for every other angle marking 90. The tibial template 84 is also provided with a plurality of pin receiving holes 92 (described below with reference to FIG. 15), and a coupling 94 for an optional EM alignment guide (like the guide 70, 72 shown in FIG. 9).
Turning now to FIGS. 12 and 13, the tools of the illustrative embodiment of invention include three offset bushings 96, 98, 100. Each bushing is a substantially cylindrical member which is dimensioned to fit within the cylindrical offset positioning guide 88,as shown in FIG. 12.
Each bushing 96, 98, 100 is provided with a circumferential indicator 9cia, 98a, 100a and a throughbore 96b, 98b, 100b which is designed to receive the trial stem extender 74. According to the invention, the throughbores are not centrally located relative to the center of the cylindrical bushings. Each bushing 96, 98, 100 has a throughbore 96b, 98b, 100b crhich is offset a different amount from the center of the cylindrical bushing.
According to the presently preferred embodiment, bushing 96 has a 4mm offset, bushing 98 has a 6mm offset, and bushing 100 has an 8mm offset. The circumterenziai indicators 96a, 98a, 100a are preferably located on the same radius along which the throughbores 96b, 98b, 100b are offset.
As shown in FIGS. 12 and 14, an appropriate offset bushing, e.g. 96, is chosen and fitted into the cylindrical offset positioning guide 88 with the trial stem extender 74 extending through the throughbore, e.g. 96b. The appropriate bushing is chosen by visual assessment or by trial and error. Optionally, if the trial stem and extender 74 are unstable in the IM canal, a stop clip 102 may be attached to one of the grooves in the extender 74 as shown in FIG. 14.
With the extender 74, template 84, cylindrical offset positioning guide 88, and bushing 96 assembled as shown, the bushing is rotated relative to the cylindrical offset positioning guide 88 until the template 84 assumes a position relative to the tibial plateau 37 where there is minimum or no overhang. When the optimal (best) position is obtained, the template 84 i~ pinned to the tibia 36, for example with 1/8" drill pins (or headed nails) 104 through the pin receiving holes 92. The angle indicated by the indicia 96a and 90 is noted before the bushing 96~and stem with extender 74 are removed.
According to the invention, a neutral (boss reaming) bushing 106 is provided. The neutral bushing 106 is substantially the same~size and shape as the offset bushings 96, 98, 100, but has a centrally located throughbore 107 and no radial indicia. The purpose of the neutral bushing is to act as a guide for reaming a hole in the center of the tibial plateau 37 for receipt of the boss portion of the tibial implant. Those skilled in the art will appreciate from the foregoing that the location of the center of the "boss hole" will be offset from the tibial IM
in the angular direction indicated by the indicators 90, 96a at the step shown in FIG. 15 by an amount equal to the offset amount of the bushing 96 (e. g. 4mm).
Turning now to FIG. 17, with the template 84 pinned to the tibia 36 by drill pins 104 and with the neutral bushing 106 inserted, in the offset positioning guide 88, a boss reamer 110 (or optionaly an offset boss reamer) is inserted into the throughbore 107 of the neutral bushing 106. The illustrative boss reamer 110 shown in FIG. 17 is l5mm in diameter and has twc; depth markings shown, 112 and 114. All of the tibial baseplates according to the illustrative embodiment of the invention have a l5mm ' CA 02285768 1999-10-12 diameter boss, but different baseplates have bosses with different lengths.
Having chosen the appropriately sized template 84, the practitioner will know which tibial baseplate will be used in the implant and will know how deep to ream the hole for the boss of the baseplate. Thus, at this stage of the, method of the invention, the practitioner uses the reamer 110 to ream to the appropriate depth indicated by the appropriate depth mark 112 or 114.
After reaming for the baseplate boss, the tibia is punched to make space for the baseplate fins or "keel". The boss reamer 110, the neutral bushing 106, and the offset positioning guide 88 are removed and the template 84 is left pinned to the tibia. The fin punch guide 120, shown in FIG. 18, is attached to the template 84. The guide 120 has left and right fin guides 122, 124 and a central boss guide 126. The fin punch 130 has left and right fins 132, 134 and a central boss 136.
The punch 130 is inserted into the punch guide 120 as shown in FIG. 18 with the central boss 136 entering the central boss guide 126 and the left and right fins 132, 134 entering the left and right. fin guides 122, 124. With the punch 130 in place, it is struck with a mallet (or attached to the impactor/extractor), driven into the tibial plateau, and then removed. Optionally, if a wedge cut had not been performed at the start (i.e. during the steps described with reference to FIGS. 8 and 9), a wedge cutting guide (not shown) may be attached to the coupling 94 of the template 84 and a wedge cut performed at this stage of the procedure.
All of the apparatus are now removed from the tibia and the tibial component is prepared for implant into the tibia. As mentioned above and as shown in FIG. 19, the tibial component 140 includes the baseplate portion 142, the offset portion 144, and the stem portion 146. It will be appreciated that the tibial component 140 is shown inverted and exploded in FIG. 19 to illustrate the manner in which it is assembled rather than tr.e manner in which it is implanted.
The baseplate 142 can be seen to have a central boss 148 and a pair of fins 150, 152. The offset portion 144 has a male coupling 154 which engages the boss 148, and a female coupling 15G which mates with the stem portion 146.
The axes of the couplings 154 and 156 are offset by a certain amount, e.g. 4mm, 6mm, or 8mm, corresponding to the offset bushings 96, 98, l0U shown in FIG. 13 and described above. Between the male coupling 154 and the female coupling 156 is a tightening nut 155 which is used to lock the angular position of the two couplings relative to each other as described in detail below with reference to FIGS.
21 and 22.
According to the presently preferred embodiment, the stem 146 has a male coupling 158 at its proximal end and a trifurcated distal end 160. The fluted stem 146 is preferably coupled to the offset component 144 with the air of a trifluted wrench 162 which is shown in FIG. 20.
Turning now to FIG. 21, the offset portion 144 is fixedly attached to the stem portion 146 and loosely coupled to the baseplate portion 142. The baseplate portion 142 is placed in the base 164 of an angular adjustment tool 166. A
turntable portion 168 of the tool 166 is placed over the stem portion 146, the offset portion 144 and tightening nut 155, engaging both the base 164 and baseplate portion 142.
The turntable 168 has a locking knob 170 and an angle indicator/wrench key 172.
With the tool 166 assembled about the tibial component 140 as shown in FIG. 22, the angle indicator/wrench key 172 is turned until it indicates the angle previously noted at the step described with reference to FIG. 15. When the angle has been so "dialed in", the offset portion 144 is tightened to the baseplate 142 using the wrench 174 (FIG. 21) on the tightening nut 155. The tibial component is now assembled and ready for implantation. Optionally, if wedge cuts had been made, one or more wedges may be added to the bottom of the baseplate 142 either before or after the assembly of the baseplate, stem, and offset portion.
There have been described and illustrated herein methods and tools for IM revision surgery involving tibial components. While particular embodiments of the invention have been described, it is not intended that the invention be limited thereto, as it is intended that the invention be as broad in scope as the art will allow and that the specification be read likewise. It will therefore be appreciated by those skilled in the art that yet other modifications could be made to the provided invention without deviating from its spirit and scope as so claimed.
Claims (39)
1. A positioning template system for determining the relative location of the IM canal relative to the perimeter of the tibial plateau with the aid of a trial stem inserted in the IM canal, said system comprising:
(a) a template approximating the size and shape of a tibial plateau;
(b) angular indication means coupled to said template for indicating an angle about the center of said template;
(c) offset bushing means rotatably coupled to said angular indication means, said offset bushing means having positional indicia and a throughbore dimensioned to fit over the trial stem, said throughbore being offset from the center of said bushing means; wherein rotation of said bushing relative to said angular indication means causes movement of said template relative to said tibial plateau and said positional indicia with said angular indication means indicating the approximate angular position of the center of said template relative to the IM canal.
(a) a template approximating the size and shape of a tibial plateau;
(b) angular indication means coupled to said template for indicating an angle about the center of said template;
(c) offset bushing means rotatably coupled to said angular indication means, said offset bushing means having positional indicia and a throughbore dimensioned to fit over the trial stem, said throughbore being offset from the center of said bushing means; wherein rotation of said bushing relative to said angular indication means causes movement of said template relative to said tibial plateau and said positional indicia with said angular indication means indicating the approximate angular position of the center of said template relative to the IM canal.
2. A system according to claim 1 wherein said template comprises a plurality of different sized templates.
3. A system according to claim 2 wherein said angular indication means is adapted to be removably coupled to each of said plurality of different sized templates.
4. A system according to claim 3 wherein said offset bushing means includes a plurality of offset bushing means, each offset bushing means have a throughbore which is offset by a different amount from the center of the offset bushing means, and each offset bushing means adapted to be removably rotationally coupled to said angular indication means.
5. A system according to claim 1 wherein said template includes means for fixing said template to the tibia.
6. A system according to claim 5 further comprising neutral bushing means adapted to be removably coupled to said template, said neutral bushing means having a throughbore located at the center of said. template.
7. A system according to claim 6 wherein said offset bushing means is adapted to be removably rotationally coupled to said angular indication means and said neutral bushing means is adapted to be removably rotationally coupled to said angular indication means.
8. A system according to claim 1 further comprising a fin punch guide coupled to said template and adapted to receive a fin punch.
9. A system according to claim 9 wherein said angular indication means is adapted to be removably-coupled to said template and said fin punch guide is adapted to be removably coupled to said template.
10. A tibial component system for a prosthetic knee, said system comprising:
(a) a baseplate portion having a first coupling means:
(b) an offset portion having a second coupling means matable with said first coupling means and a third coupling means:
(c) a stem portion having a fourth coupling means matable with said third coupling means wherein when said first coupling means is coupled to said second coupling means and said third coupling means is coupled too said fourth coupling means, said stem is located relative to said baseplate such that a longitudinal axis of said stem does not pass through the center of said baseplate.
(a) a baseplate portion having a first coupling means:
(b) an offset portion having a second coupling means matable with said first coupling means and a third coupling means:
(c) a stem portion having a fourth coupling means matable with said third coupling means wherein when said first coupling means is coupled to said second coupling means and said third coupling means is coupled too said fourth coupling means, said stem is located relative to said baseplate such that a longitudinal axis of said stem does not pass through the center of said baseplate.
11. A system according to claim 10, wherein at least one of said coupling means is adjustable so that the angular orientation of the longitudinal axis of said stem is adjustable.
12. A system according to claim 10, wherein said baseplate.
portion includes a plurality of baseplate portions of different sizes: said offset portion includes a plurality of offset portions each having a different offset amount: and said stem portion includes a plurality of stem portions of different sizes.
portion includes a plurality of baseplate portions of different sizes: said offset portion includes a plurality of offset portions each having a different offset amount: and said stem portion includes a plurality of stem portions of different sizes.
13. A tool for adjusting a tibial component having a baseplate and a stem where the stem is offset from the center of the baseplate, said tool comprising:
(a) a base portion adapted to be coupled to the baseplate of the tibial component; and (b) a turntable portion adapted to be coupled to the stem of the tibial component, said turntable having angular indication means for indicating the angular offset position of the stem relative to the baseplate.
(a) a base portion adapted to be coupled to the baseplate of the tibial component; and (b) a turntable portion adapted to be coupled to the stem of the tibial component, said turntable having angular indication means for indicating the angular offset position of the stem relative to the baseplate.
14. A system for determining the relative location of the IM canal relative to the perimeter of the tibial plateau with the aid of a trial stem inserted in the IM canal and for preparing a tibial component having a baseplate and an offset stem, said system comprising:
(a) a template approximating the size and shape of a tibial plateau;
(b) angular indication means coupled to said template for indicating an angle about the center of said template;
(c) offset bushing means rotatably coupled to said angular indication means, said offset bushing means having positional indicia and a throughbore dimensioned to fit over the trial stem, said throughbore being offset from the center of said bushing means;
(d) a tibial component adjustment tool having (d1) a base portion adapted to be coupled to the baseplate of the tibial component: and (d2) a turntable portion adapted to be coupled to the stem of the tibial component, said turntable having angular indication means for indicating the angular offset position of the stem relative to the baseplate wherein rotation of said bushing relative to said angular indication means causes movement of said template relative to said tibial plateau and said positional indicia with said angular indication means indicate the approximate angular position of the center of said template relative to the IM canal and said turntable portion of said adjustment tool is rotatable so said angular indication means indicate the same angle indicated by said positional indicia with said angular indication means.
(a) a template approximating the size and shape of a tibial plateau;
(b) angular indication means coupled to said template for indicating an angle about the center of said template;
(c) offset bushing means rotatably coupled to said angular indication means, said offset bushing means having positional indicia and a throughbore dimensioned to fit over the trial stem, said throughbore being offset from the center of said bushing means;
(d) a tibial component adjustment tool having (d1) a base portion adapted to be coupled to the baseplate of the tibial component: and (d2) a turntable portion adapted to be coupled to the stem of the tibial component, said turntable having angular indication means for indicating the angular offset position of the stem relative to the baseplate wherein rotation of said bushing relative to said angular indication means causes movement of said template relative to said tibial plateau and said positional indicia with said angular indication means indicate the approximate angular position of the center of said template relative to the IM canal and said turntable portion of said adjustment tool is rotatable so said angular indication means indicate the same angle indicated by said positional indicia with said angular indication means.
15. A system according to claim 14 wherein said template comprises a plurality of different sized templates.
16. A system according to claim 15 wherein said angular indication means is adapted to be removably coupled to each of said plurality of different sized templates.
17. A system according to claim 16 wherein said offset bushing means includes a plurality of offset bushing means, each offset bushing means have a throughbore which is offset by a different amount from the center of the offset bushing means, and each offset bushing means adapted to be removably rotationally coupled to said angular indication means.
18. A system according to claim 14 wherein said template includes means for fixing said template to the tibia.
19. A system according to claim 18 further comprising neutral bushing means adapted to be removably coupled to said template, said neutral bushing means having a throughbore located at the center of said template.
20. A system according to claim 19 wherein said offset bushing means is adapted to be removably rotationally coupled to said angular indication means: and said neutral bushing means is adapted to be removably rotationally coupled to said angular indication means.
21. A system according to claim 14 further comprising a fin punch guide coupled to said template and adapted to receive a fin punch.
22. A system according to claim 21 wherein said angular indication means is adapted to be removably coupled to said template; and said fin punch guide is adapted to be removably coupled to said template.
23. A method for determining the relative location of the IM canal relative to the perimeter of the tibial plateau with the aid of a trial stem inserted in the IM canal, said method comprising the steps of:
(a) placing a template approximating the size and shape of a tibial plateau on the tibial plateau;
(b) coupling angular indication means to the template for indicating an angle about the center of said template;
(c) placing offset bushing means having positional indicia and an offset throughbore over the trial stem and into the angular indication means;
(d) rotating the bushing relative to the angular indication means causing movement of the template relative to said tibial plateau;
(e) stopping rotation when the position of the template is located over the tibial plateau with little or no overhang:
(f) noting the location of the positional indicia relative to the angular indication means.
(a) placing a template approximating the size and shape of a tibial plateau on the tibial plateau;
(b) coupling angular indication means to the template for indicating an angle about the center of said template;
(c) placing offset bushing means having positional indicia and an offset throughbore over the trial stem and into the angular indication means;
(d) rotating the bushing relative to the angular indication means causing movement of the template relative to said tibial plateau;
(e) stopping rotation when the position of the template is located over the tibial plateau with little or no overhang:
(f) noting the location of the positional indicia relative to the angular indication means.
24. A method according to claim 23 wherein said step of placing a template includes selecting one of a plurality of different sized templates.
25. A method according to claim 24 wherein said step of placing offset bushing means includes selecting one of a plurality of offset bushing means, each offset bushing means having a throughbore which is offset by a different amount from the center of the offset bushing means.
26. A method according to claim 23 further comprising the step of removably fixing the template to the tibia after noting the location.
27. A method according to claim 26 further comprising the steps of:
(a) removing the offset bushing means from the angular indication means:
(b) removing the trial stem from the tibial IM canal:
(c) inserting neutral bushing means having a central throughbore into the angular indication means: and (d) reaming a hole for an implant boss using the neutral bushing means as a guide.
(a) removing the offset bushing means from the angular indication means:
(b) removing the trial stem from the tibial IM canal:
(c) inserting neutral bushing means having a central throughbore into the angular indication means: and (d) reaming a hole for an implant boss using the neutral bushing means as a guide.
28. A method according to claim 26 further comprising the steps of:
(a) removing the offset bushing means from the angular indication means:
(b) removing the trial stem from the tibial IM canal;
(c) attaching a fin punch guide to the template;
(d) inserting a fin punch into the guide; and (e) driving the fin punch into the tibia.
(a) removing the offset bushing means from the angular indication means:
(b) removing the trial stem from the tibial IM canal;
(c) attaching a fin punch guide to the template;
(d) inserting a fin punch into the guide; and (e) driving the fin punch into the tibia.
29. A method according to claim 28 further comprising the step of removing the angular indication means prior to attaching a fin punch guide to the template.
30. A method according to claim 23 and for translating the determined location to a tibial component having a baseplate and a stem where the stem is offset from the center of the baseplate, said method further comprising the steps of:
(a) attaching the baseplate of the tibial component to a base portion of an adjustment tool:
(b) attaching a turntable portion of the adjustment tool to the stem of the tibial component and to the base portion of the tool:
(c) rotating the turntable until angular indication means on the tool indicate substantially the same noted location of the positional indicia relative to the angular indication means.
(a) attaching the baseplate of the tibial component to a base portion of an adjustment tool:
(b) attaching a turntable portion of the adjustment tool to the stem of the tibial component and to the base portion of the tool:
(c) rotating the turntable until angular indication means on the tool indicate substantially the same noted location of the positional indicia relative to the angular indication means.
31. A set of IM tibia revision tools, comprising:
(a) a trial stem extender having at least one notch which serves as a depth witness mark:
(c) a plurality of different sized tibial templates each template adapted to receive an angular offset positioning guide;
(d) an angular offset positioning guide;
(a) a trial stem extender having at least one notch which serves as a depth witness mark:
(c) a plurality of different sized tibial templates each template adapted to receive an angular offset positioning guide;
(d) an angular offset positioning guide;
32 (e) a plurality of offset bushings, each bushing having a different offset distance and each being adapted to cooperate with said trial stem extender and said angular offset positioning guide to indicate the approximate angular offset position measurement of the center of said given template relative to the IM canal:
(f) a neutral bushing for locating the position of the implant boss relative to the tibia and for reaming the tibia to accept the boss of the implant:
(g) a fin punch guide and fin punch for preparing the tibia to receive the keel of the tibial component':
and (h) means for translating said angular offset position measurement to the tibial component.
32. A set of instruments as set forth in claim 31 further comprising an instrument stabilizing stop clip and further wherein said at least one notch on said trial stem extender serves as a holder for said stop clip.
(f) a neutral bushing for locating the position of the implant boss relative to the tibia and for reaming the tibia to accept the boss of the implant:
(g) a fin punch guide and fin punch for preparing the tibia to receive the keel of the tibial component':
and (h) means for translating said angular offset position measurement to the tibial component.
32. A set of instruments as set forth in claim 31 further comprising an instrument stabilizing stop clip and further wherein said at least one notch on said trial stem extender serves as a holder for said stop clip.
33 33. A set of instruments for use in revision knee surgery to determine the offset location of the tibial IM canal relative to the perimeter of the tibial plateau and translate the determined offset location to the stem portion of a tibial component, comprising:
(a) an impactor-extractor with a distal coupling for attaching to other tools which are inserted into and removed from the IM canal:
(b) a resection guide tower to which a cutting block may be attached, said guide tower including a notch which serves as both a witness mark and a holder for a tibial collar;
(c) a plurality of different sized trial stems attachable to said guide tower;
(d) a plurality of different sized tibial collars;
(e) right and left cutting blocks, each attachable to said guide tower, for resecting the proximal tibia;
(f) a trial stem extender having at least one notch which serve as a depth witness mark and holder for an instrument stabilizing stop clip:
(a) an impactor-extractor with a distal coupling for attaching to other tools which are inserted into and removed from the IM canal:
(b) a resection guide tower to which a cutting block may be attached, said guide tower including a notch which serves as both a witness mark and a holder for a tibial collar;
(c) a plurality of different sized trial stems attachable to said guide tower;
(d) a plurality of different sized tibial collars;
(e) right and left cutting blocks, each attachable to said guide tower, for resecting the proximal tibia;
(f) a trial stem extender having at least one notch which serve as a depth witness mark and holder for an instrument stabilizing stop clip:
34 (g) an instrument stabilizing stop clip:' op (h) a plurality of different sized tibial templates, each template adapted to receive an angular offset positioning guide:
(i) an angular offset positioning guide:
(j) a plurality of offset bushings, each bushing having a different offset distance and each being adapted to cooperate with said trial stem extender and said angular offset positioning guide to indicate the approximate angular offset position measurement of the center of a given template relative to the IM canal:
(k) a neutral bushing for locating the position of an implant boss relative to the tibia and for reaming the tibia to accept the boss of the implant:
(l) a fin punch guide and fin punch for preparing the tibia to receive the keel of a tibial component;
and (k) means for translating said angular offset position measurement to the tibial component.
(i) an angular offset positioning guide:
(j) a plurality of offset bushings, each bushing having a different offset distance and each being adapted to cooperate with said trial stem extender and said angular offset positioning guide to indicate the approximate angular offset position measurement of the center of a given template relative to the IM canal:
(k) a neutral bushing for locating the position of an implant boss relative to the tibia and for reaming the tibia to accept the boss of the implant:
(l) a fin punch guide and fin punch for preparing the tibia to receive the keel of a tibial component;
and (k) means for translating said angular offset position measurement to the tibial component.
35 34. Apparatus as set forth in claim 33 wherein each of said right and left cutting blocks further comprise a clamp from removably attaching a given cutting block to said guide tower.
35. A method for performing tibial IM revision surgery, comprising the steps of:
(a) removing the primary tibial component;
(b) reaming the tibial IM canal to the extent necessary to receive a trial stem:
(c) selecting a trial stem for insertion into the IM canal;
(d) attaching a trial stem extender to said trial stem, said trial stem extender having at least one depth marking thereon;
(e) inserting said trial stem into the tibial IM canal noting the depth markings on the attached trial stem extender:
(f) selecting a tibial template;
35. A method for performing tibial IM revision surgery, comprising the steps of:
(a) removing the primary tibial component;
(b) reaming the tibial IM canal to the extent necessary to receive a trial stem:
(c) selecting a trial stem for insertion into the IM canal;
(d) attaching a trial stem extender to said trial stem, said trial stem extender having at least one depth marking thereon;
(e) inserting said trial stem into the tibial IM canal noting the depth markings on the attached trial stem extender:
(f) selecting a tibial template;
36 (g) attaching an angular offset positioning guide to the selected template, and (h) selecting an offset bushing and placing the selected offset bushing onto said trial stem extender, engaging said positioning guide with said bushing and rotating said bushing until the selected tibial template is located in a position relative to the tibial plateau where there is a minimum of overhang.
36. A method as set forth in claim 35 further comprising the steps of:
(a) attaching a guide tower to the trial stem;
(b) inserting the trial stem with attached guide tower into the tibial IM canal:
(c) attaching an impactor/extractor to the proximal end of said guide tower;
(d) impacting said tibial stem and said guide tower combination into the IM canal:
(e) optionally attaching an instrument stabilizing stop to the trial stem;
36. A method as set forth in claim 35 further comprising the steps of:
(a) attaching a guide tower to the trial stem;
(b) inserting the trial stem with attached guide tower into the tibial IM canal:
(c) attaching an impactor/extractor to the proximal end of said guide tower;
(d) impacting said tibial stem and said guide tower combination into the IM canal:
(e) optionally attaching an instrument stabilizing stop to the trial stem;
37 (f) attaching a cutting block to said guide towers (g) resecting the proximal tibia;
(h) removing said cutting block from said guide tower;
and (i) removing said guide tower and said trial stem utilizing said impactor/extractor;
37. A method as set forth in claim 35 further comprising the steps of:
(a) pinning said selected template to the tibia;
(b) recording the angle indicated by the bushing on the positioning guide: and (c) removing the offset bushing and the trial stem.
(h) removing said cutting block from said guide tower;
and (i) removing said guide tower and said trial stem utilizing said impactor/extractor;
37. A method as set forth in claim 35 further comprising the steps of:
(a) pinning said selected template to the tibia;
(b) recording the angle indicated by the bushing on the positioning guide: and (c) removing the offset bushing and the trial stem.
38. A method as set forth in claim 37 further comprising the steps of:
(a) placing a boss reaming bushing in said positioning guide:
(b) reaming the tibia to receive the implant boss: and (c) removing the positioning guide from the template.
(a) placing a boss reaming bushing in said positioning guide:
(b) reaming the tibia to receive the implant boss: and (c) removing the positioning guide from the template.
39. A method as set forth in claim 38 further comprising the steps of:
(a) attaching the fin punch guide to the template:
(b) punching the tibia with the fin punch;
(c) choosing a baseplate, offset and stem for the implant;
(d) assembling the implant:
(e) translating said angular offset position measurement to the assembled implant; and (f) installing the implant.
(a) attaching the fin punch guide to the template:
(b) punching the tibia with the fin punch;
(c) choosing a baseplate, offset and stem for the implant;
(d) assembling the implant:
(e) translating said angular offset position measurement to the assembled implant; and (f) installing the implant.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US09/170,572 | 1998-10-13 | ||
| US09/170,572 US6063091A (en) | 1998-10-13 | 1998-10-13 | Methods and tools for tibial intermedullary revision surgery and associated tibial components |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA2285768A1 true CA2285768A1 (en) | 2000-04-13 |
Family
ID=22620414
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA002285768A Abandoned CA2285768A1 (en) | 1998-10-13 | 1999-10-12 | Methods and tools for tibial intermedullary revision surgery and associated tibial components |
Country Status (6)
| Country | Link |
|---|---|
| US (3) | US6063091A (en) |
| EP (1) | EP0993807B1 (en) |
| JP (1) | JP2000116683A (en) |
| AU (1) | AU757125B2 (en) |
| CA (1) | CA2285768A1 (en) |
| DE (1) | DE69924574T2 (en) |
Families Citing this family (167)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US8083745B2 (en) | 2001-05-25 | 2011-12-27 | Conformis, Inc. | Surgical tools for arthroplasty |
| US7468075B2 (en) | 2001-05-25 | 2008-12-23 | Conformis, Inc. | Methods and compositions for articular repair |
| US7534263B2 (en) | 2001-05-25 | 2009-05-19 | Conformis, Inc. | Surgical tools facilitating increased accuracy, speed and simplicity in performing joint arthroplasty |
| US7239908B1 (en) | 1998-09-14 | 2007-07-03 | The Board Of Trustees Of The Leland Stanford Junior University | Assessing the condition of a joint and devising treatment |
| ATE439806T1 (en) | 1998-09-14 | 2009-09-15 | Univ Leland Stanford Junior | DETERMINING THE CONDITION OF A JOINT AND PREVENTING DAMAGE |
| US7184814B2 (en) | 1998-09-14 | 2007-02-27 | The Board Of Trustees Of The Leland Stanford Junior University | Assessing the condition of a joint and assessing cartilage loss |
| US6063091A (en) * | 1998-10-13 | 2000-05-16 | Stryker Technologies Corporation | Methods and tools for tibial intermedullary revision surgery and associated tibial components |
| US6974481B1 (en) * | 1999-10-20 | 2005-12-13 | Smith & Nephew, Inc. | Tibial trial system |
| US7635390B1 (en) | 2000-01-14 | 2009-12-22 | Marctec, Llc | Joint replacement component having a modular articulating surface |
| US6702821B2 (en) | 2000-01-14 | 2004-03-09 | The Bonutti 2003 Trust A | Instrumentation for minimally invasive joint replacement and methods for using same |
| US7485119B2 (en) * | 2000-03-07 | 2009-02-03 | Zimmer Technology, Inc. | Method and apparatus for reducing femoral fractures |
| US20030220644A1 (en) * | 2002-05-23 | 2003-11-27 | Thelen Sarah L. | Method and apparatus for reducing femoral fractures |
| US7258692B2 (en) * | 2000-03-07 | 2007-08-21 | Zimmer, Inc. | Method and apparatus for reducing femoral fractures |
| US7488329B2 (en) * | 2000-03-07 | 2009-02-10 | Zimmer Technology, Inc. | Method and apparatus for reducing femoral fractures |
| US20030220646A1 (en) * | 2002-05-23 | 2003-11-27 | Thelen Sarah L. | Method and apparatus for reducing femoral fractures |
| US7678151B2 (en) * | 2000-05-01 | 2010-03-16 | Ek Steven W | System and method for joint resurface repair |
| WO2001082843A2 (en) | 2000-05-03 | 2001-11-08 | Smith & Nephew, Inc. | Multi modular trialing system and instrumentation |
| ATE426357T1 (en) | 2000-09-14 | 2009-04-15 | Univ Leland Stanford Junior | ASSESSING THE CONDITION OF A JOINT AND PLANNING TREATMENT |
| GB0028445D0 (en) * | 2000-11-22 | 2001-01-10 | Depuy Int Ltd | A tamp assembly |
| US6942670B2 (en) * | 2000-12-27 | 2005-09-13 | Depuy Orthopaedics, Inc. | Prosthesis evaluation assembly and associated method |
| US6355045B1 (en) * | 2000-12-28 | 2002-03-12 | Depuy Orthopaedics, Inc. | Method and apparatus for surgically preparing a tibia for implantation of a prosthetic implant component which has an offset stem |
| US20020120340A1 (en) * | 2001-02-23 | 2002-08-29 | Metzger Robert G. | Knee joint prosthesis |
| US6629978B2 (en) | 2001-04-23 | 2003-10-07 | Howmedica Osteonics Corp. | Valgus adapter |
| JP2005504563A (en) | 2001-05-25 | 2005-02-17 | イメージング セラピューティクス，インコーポレーテッド | Methods and compositions for resurfacing joints |
| US8439926B2 (en) | 2001-05-25 | 2013-05-14 | Conformis, Inc. | Patient selectable joint arthroplasty devices and surgical tools |
| US8951260B2 (en) | 2001-05-25 | 2015-02-10 | Conformis, Inc. | Surgical cutting guide |
| US6723102B2 (en) | 2001-06-14 | 2004-04-20 | Alexandria Research Technologies, Llc | Apparatus and method for minimally invasive total joint replacement |
| US6482209B1 (en) * | 2001-06-14 | 2002-11-19 | Gerard A. Engh | Apparatus and method for sculpting the surface of a joint |
| US6953479B2 (en) * | 2001-07-16 | 2005-10-11 | Smith & Nephew, Inc. | Orthopedic implant extension |
| US7708741B1 (en) | 2001-08-28 | 2010-05-04 | Marctec, Llc | Method of preparing bones for knee replacement surgery |
| US7618421B2 (en) * | 2001-10-10 | 2009-11-17 | Howmedica Osteonics Corp. | Tools for femoral resection in knee surgery |
| GB0127658D0 (en) * | 2001-11-19 | 2002-01-09 | Acrobot Company The Ltd | Apparatus for surgical instrument location |
| AU2003217389B2 (en) * | 2002-02-11 | 2008-10-30 | Smith & Nephew, Inc. | Image-guided fracture reduction |
| WO2003094802A1 (en) * | 2002-05-09 | 2003-11-20 | Hayes Medical, Inc. | System for establishing the orientation of a modular implant |
| US6645215B1 (en) * | 2002-08-07 | 2003-11-11 | Howmedica Osteonics Corp. | Tibial rotation guide |
| AU2003287190A1 (en) | 2002-10-23 | 2004-05-13 | Alastair J. T. Clemow | Modular femoral component for a total knee joint replacement for minimally invasive implantation |
| US8821581B2 (en) * | 2002-10-24 | 2014-09-02 | Biomet Manufacturing, Llc | Method and apparatus for wrist arthroplasty |
| US8105390B2 (en) * | 2002-10-24 | 2012-01-31 | Biomet Manufacturing Corp. | Method and apparatus for wrist arthroplasty |
| US6746486B1 (en) * | 2002-10-24 | 2004-06-08 | Biomet, Inc. | Method and apparatus for total wrist angled back carpal plate |
| US8066777B2 (en) * | 2002-10-24 | 2011-11-29 | Biomet Manufacturing Corp. | Method and apparatus for wrist arthroplasty |
| US8105388B2 (en) * | 2002-10-24 | 2012-01-31 | Biomet Manufacturing Corp. | Method and apparatus for wrist arthroplasty |
| US8372154B2 (en) * | 2002-10-24 | 2013-02-12 | Biomet Manufacturing Corp. | Method and apparatus for wrist arthroplasty |
| US8940055B2 (en) | 2002-10-24 | 2015-01-27 | Biomet Manufacturing, Llc | Method and apparatus for wrist arthroplasty |
| US8052756B2 (en) * | 2002-10-24 | 2011-11-08 | Biomet Manufacturing Corp. | Method and apparatus for wrist arthroplasty |
| US8105389B2 (en) * | 2002-10-24 | 2012-01-31 | Biomet Manufacturing Corp. | Method and apparatus for wrist arthroplasty |
| US20060052788A1 (en) * | 2003-02-04 | 2006-03-09 | Thelen Sarah L | Expandable fixation devices for minimally invasive surgery |
| US20040153091A1 (en) * | 2003-02-04 | 2004-08-05 | Marvin Figueroa | Sizing plate and sizing plate extraction |
| US8105386B2 (en) * | 2003-02-04 | 2012-01-31 | Zimmer, Inc. | Rotating/non-rotating tibia base plate/insert system |
| US8388624B2 (en) | 2003-02-24 | 2013-03-05 | Arthrosurface Incorporated | Trochlear resurfacing system and method |
| FR2852223B1 (en) * | 2003-03-11 | 2005-06-10 | Perception Raisonnement Action En Medecine | INSTRUMENT FOR TRACKING THE POSITION OF A CUTTING PLAN |
| US7153326B1 (en) | 2003-06-19 | 2006-12-26 | Biomet Manufacturing Corp. | Method and apparatus for use of an offset stem connection |
| US7481814B1 (en) | 2003-07-28 | 2009-01-27 | Biomet Manufacturing Corporation | Method and apparatus for use of a mill or reamer |
| US7547327B2 (en) * | 2003-10-03 | 2009-06-16 | Howmedica Osteonics Corp. | Expandable augment trial |
| US7390327B2 (en) * | 2003-10-03 | 2008-06-24 | Howmedica Osteonics Corp. | Punch apparatus and method for surgery |
| US7862570B2 (en) | 2003-10-03 | 2011-01-04 | Smith & Nephew, Inc. | Surgical positioners |
| US7867234B2 (en) * | 2003-10-06 | 2011-01-11 | Howmedica Osteonics Corp. | Reamer bushing |
| US7764985B2 (en) | 2003-10-20 | 2010-07-27 | Smith & Nephew, Inc. | Surgical navigation system component fault interfaces and related processes |
| US7794467B2 (en) * | 2003-11-14 | 2010-09-14 | Smith & Nephew, Inc. | Adjustable surgical cutting systems |
| GB0329870D0 (en) * | 2003-12-24 | 2004-01-28 | Depuy Int Ltd | Reamer guide and method |
| US7819878B2 (en) * | 2003-12-30 | 2010-10-26 | Zimmer, Inc. | Tibial condylar hemiplasty tissue preparation instruments and methods |
| US7867236B2 (en) * | 2003-12-30 | 2011-01-11 | Zimmer, Inc. | Instruments and methods for preparing a joint articulation surface for an implant |
| JP2007523696A (en) * | 2004-01-16 | 2007-08-23 | スミス アンド ネフュー インコーポレーテッド | Computer-aided ligament balancing in total knee arthroplasty |
| US7172599B2 (en) * | 2004-03-03 | 2007-02-06 | Zimmer Technology, Inc. | Tibial sizer |
| US7608079B1 (en) | 2004-03-05 | 2009-10-27 | Biomet Manufacturing Corp. | Unicondylar knee apparatus and system |
| US20060089621A1 (en) * | 2004-03-18 | 2006-04-27 | Mike Fard | Bone mill and template |
| WO2005104978A1 (en) | 2004-04-21 | 2005-11-10 | Smith & Nephew, Inc. | Computer-aided methods, systems, and apparatuses for shoulder arthroplasty |
| US20050240197A1 (en) * | 2004-04-23 | 2005-10-27 | Kmiec Stanley J Jr | Device and method for inserting, positioning and removing an implant |
| EP1765201A4 (en) | 2004-06-28 | 2013-01-23 | Arthrosurface Inc | System for articular surface replacement |
| US7632284B2 (en) * | 2004-07-06 | 2009-12-15 | Tyco Healthcare Group Lp | Instrument kit and method for performing meniscal repair |
| US8852195B2 (en) * | 2004-07-09 | 2014-10-07 | Zimmer, Inc. | Guide templates for surgical implants and related methods |
| US7806898B2 (en) * | 2004-07-09 | 2010-10-05 | Zimmer, Inc. | Modular guide systems and related rasps and methods for resecting a joint articulation surface |
| KR100562518B1 (en) | 2004-08-16 | 2006-03-21 | 서재곤 | Cutter for tibial |
| US20060064108A1 (en) * | 2004-09-09 | 2006-03-23 | Blaylock Jeffrey C | Tibial sizing apparatus and method |
| US20060064104A1 (en) * | 2004-09-09 | 2006-03-23 | Kana Richard J | Translating surgical mount |
| US7998217B1 (en) | 2005-02-02 | 2011-08-16 | Biomet Manufacturing Corp. | Modular offset stem implants |
| US8317797B2 (en) | 2005-02-08 | 2012-11-27 | Rasmussen G Lynn | Arthroplasty systems and methods for optimally aligning and tensioning a knee prosthesis |
| US7927336B2 (en) * | 2005-02-08 | 2011-04-19 | Rasmussen G Lynn | Guide assembly for guiding cuts to a femur and tibia during a knee arthroplasty |
| US8303597B2 (en) | 2005-02-08 | 2012-11-06 | Rasmussen G Lynn | Systems and methods for guiding cuts to a femur and tibia during a knee arthroplasty |
| US20060184176A1 (en) * | 2005-02-17 | 2006-08-17 | Zimmer Technology, Inc. | Tibial trialing assembly and method of trialing a tibial implant |
| JP2008531091A (en) | 2005-02-22 | 2008-08-14 | スミス アンド ネフュー インコーポレーテッド | In-line milling system |
| KR101274641B1 (en) * | 2005-03-29 | 2013-06-17 | 마틴 로슈 | Biometric sensor for detecting biometric parameters |
| US20110213221A1 (en) * | 2005-03-29 | 2011-09-01 | Roche Martin W | Method for Detecting Body Parameters |
| US11457813B2 (en) | 2005-03-29 | 2022-10-04 | Martin W. Roche | Method for detecting body parameters |
| US8147547B2 (en) * | 2005-04-29 | 2012-04-03 | Warsaw Orthopedic, Inc. | Spinal implant |
| US7695477B2 (en) * | 2005-05-26 | 2010-04-13 | Zimmer, Inc. | Milling system and methods for resecting a joint articulation surface |
| US7727239B2 (en) * | 2005-06-10 | 2010-06-01 | Zimmer Technology, Inc. | Milling system with guide paths and related methods for resecting a joint articulation surface |
| JP5175030B2 (en) * | 2005-12-19 | 2013-04-03 | ルネサスエレクトロニクス株式会社 | Solid-state imaging device |
| US9241800B2 (en) * | 2005-12-21 | 2016-01-26 | Orthopaedic International Inc. | Tibial component with a conversion module for a knee implant |
| WO2007092841A2 (en) | 2006-02-06 | 2007-08-16 | Conformis, Inc. | Patient selectable joint arthroplasty devices and surgical tools |
| US8623026B2 (en) | 2006-02-06 | 2014-01-07 | Conformis, Inc. | Patient selectable joint arthroplasty devices and surgical tools incorporating anatomical relief |
| CA2648444C (en) * | 2006-04-04 | 2014-03-18 | Smith & Nephew, Inc. | Trial coupler systems and methods |
| US7842093B2 (en) * | 2006-07-18 | 2010-11-30 | Biomet Manufacturing Corp. | Method and apparatus for a knee implant |
| US7959639B1 (en) | 2006-08-21 | 2011-06-14 | Howmedica Osteonics Corp. | Trialing system and method utilizing offset |
| KR100822471B1 (en) * | 2006-11-22 | 2008-04-16 | 서재곤 | Tibia impacter |
| AU2007332787A1 (en) | 2006-12-11 | 2008-06-19 | Arthrosurface Incorporated | Retrograde resection apparatus and method |
| US8491587B2 (en) * | 2006-12-21 | 2013-07-23 | Howmedica Osteonics Corp. | Adjustable offset bushing |
| US8187280B2 (en) | 2007-10-10 | 2012-05-29 | Biomet Manufacturing Corp. | Knee joint prosthesis system and method for implantation |
| US8163028B2 (en) | 2007-01-10 | 2012-04-24 | Biomet Manufacturing Corp. | Knee joint prosthesis system and method for implantation |
| US8157869B2 (en) | 2007-01-10 | 2012-04-17 | Biomet Manufacturing Corp. | Knee joint prosthesis system and method for implantation |
| US8562616B2 (en) | 2007-10-10 | 2013-10-22 | Biomet Manufacturing, Llc | Knee joint prosthesis system and method for implantation |
| US8328873B2 (en) | 2007-01-10 | 2012-12-11 | Biomet Manufacturing Corp. | Knee joint prosthesis system and method for implantation |
| IL181211A0 (en) * | 2007-02-07 | 2007-07-04 | Nmb Medical Applic Ltd | Device and methods for strengthening long bones |
| US8403940B2 (en) * | 2007-02-19 | 2013-03-26 | Lanx, Inc. | Tool to dissect or compress and measure a vertebral body segment |
| DE102007028087B4 (en) | 2007-06-11 | 2014-05-15 | Aesculap Ag | Modular implant part and knee joint prosthesis |
| DE102008014837A1 (en) | 2008-03-07 | 2009-09-10 | Aesculap Ag | Medical implant and knee joint endoprosthesis |
| US8287547B2 (en) * | 2008-06-23 | 2012-10-16 | Depuy Products, Inc. | Adjustable drill guide |
| US8562608B2 (en) | 2008-09-19 | 2013-10-22 | Zimmer, Inc. | Patello-femoral milling system |
| US20100168752A1 (en) * | 2008-12-29 | 2010-07-01 | Edwards Jon M | Orthopaedic cutting tool having a chemically etched metal insert and method of manufacturing |
| US9375221B2 (en) * | 2008-12-29 | 2016-06-28 | Depuy (Ireland) | Orthopaedic cutting block having a chemically etched metal insert |
| US8808303B2 (en) | 2009-02-24 | 2014-08-19 | Microport Orthopedics Holdings Inc. | Orthopedic surgical guide |
| US8808297B2 (en) | 2009-02-24 | 2014-08-19 | Microport Orthopedics Holdings Inc. | Orthopedic surgical guide |
| US9017334B2 (en) | 2009-02-24 | 2015-04-28 | Microport Orthopedics Holdings Inc. | Patient specific surgical guide locator and mount |
| SG175229A1 (en) | 2009-04-16 | 2011-11-28 | Conformis Inc | Patient-specific joint arthroplasty devices for ligament repair |
| US9662126B2 (en) | 2009-04-17 | 2017-05-30 | Arthrosurface Incorporated | Glenoid resurfacing system and method |
| US10945743B2 (en) | 2009-04-17 | 2021-03-16 | Arthrosurface Incorporated | Glenoid repair system and methods of use thereof |
| US8998997B2 (en) | 2009-08-11 | 2015-04-07 | Michael D. Ries | Implantable mobile bearing prosthetics |
| US9095453B2 (en) * | 2009-08-11 | 2015-08-04 | Michael D. Ries | Position adjustable trial systems for prosthetic implants |
| US8828013B2 (en) * | 2009-11-02 | 2014-09-09 | Synvasive Technology, Inc. | Bone positioning device and method |
| WO2011053332A1 (en) * | 2009-11-02 | 2011-05-05 | Synvasive Technology, Inc. | Knee arthroplasty apparatus and method |
| US9095352B2 (en) | 2009-11-02 | 2015-08-04 | Synvasive Technology, Inc. | Bone positioning device and method |
| BR112012022482A2 (en) | 2010-03-05 | 2016-07-19 | Arthrosurface Inc | tibial surface recomposition system and method. |
| US9301846B2 (en) | 2010-08-13 | 2016-04-05 | Smith & Nephew, Inc. | Instruments for knee placement |
| US8979847B2 (en) | 2011-06-06 | 2015-03-17 | Biomet Manufacturing, Llc | Method and apparatus for implanting a knee prosthesis |
| AU2012295374B2 (en) * | 2011-08-12 | 2016-11-17 | Zimmer, Inc. | Prosthesis resection guide |
| EP2564792A1 (en) * | 2011-09-02 | 2013-03-06 | Episurf Medical AB | Modular surgical kit for cartilage repair |
| US11000387B2 (en) | 2011-09-02 | 2021-05-11 | Episurf Ip-Management Ab | Implant for cartilage repair |
| US10603049B2 (en) | 2011-09-02 | 2020-03-31 | Episurf Ip-Management Ab | Implant specific drill bit in surgical kit for cartilage repair |
| US9808356B2 (en) | 2011-10-24 | 2017-11-07 | Synvasive Technology, Inc. | Knee balancing devices, systems and methods |
| US20130165982A1 (en) | 2011-12-22 | 2013-06-27 | Arthrosurface Incorporated | System and Method for Bone Fixation |
| US9486226B2 (en) | 2012-04-18 | 2016-11-08 | Conformis, Inc. | Tibial guides, tools, and techniques for resecting the tibial plateau |
| US9675471B2 (en) | 2012-06-11 | 2017-06-13 | Conformis, Inc. | Devices, techniques and methods for assessing joint spacing, balancing soft tissues and obtaining desired kinematics for joint implant components |
| DE112013003358T5 (en) | 2012-07-03 | 2015-03-19 | Arthrosurface, Inc. | System and procedure for joint surface replacement and repair |
| US9480571B2 (en) | 2012-12-27 | 2016-11-01 | Wright Medical Technology, Inc. | Ankle replacement system and method |
| US10080573B2 (en) | 2012-12-27 | 2018-09-25 | Wright Medical Technology, Inc. | Ankle replacement system and method |
| US9974588B2 (en) | 2012-12-27 | 2018-05-22 | Wright Medical Technology, Inc. | Ankle replacement system and method |
| CA2836651C (en) | 2012-12-27 | 2016-03-22 | Wright Medical Technology, Inc. | Ankle replacement system and method |
| US9918724B2 (en) | 2012-12-27 | 2018-03-20 | Wright Medical Technology, Inc. | Ankle replacement system and method |
| WO2014126913A2 (en) * | 2013-02-13 | 2014-08-21 | Smith & Nephew, Inc. | Pressure alleviating instruments and methods |
| US9949837B2 (en) | 2013-03-07 | 2018-04-24 | Howmedica Osteonics Corp. | Partially porous bone implant keel |
| US9107757B2 (en) | 2013-03-13 | 2015-08-18 | Depuy (Ireland) | Tibial trial instruments for setting offset |
| US9386999B2 (en) * | 2013-03-13 | 2016-07-12 | Depuy (Ireland) | Tibial orthopaedic surgical instruments for setting offset |
| US9216089B2 (en) | 2013-03-13 | 2015-12-22 | Depuy (Ireland) | Method of surgically preparing a patient's tibia |
| CN105228541A (en) | 2013-03-14 | 2016-01-06 | 瑞特医疗技术公司 | Ankle replacement system and method |
| US9554810B2 (en) | 2013-03-15 | 2017-01-31 | Depuy Ireland Unlimited Company | Femoral system handle surgical instrument and method of assembling same |
| US9492200B2 (en) | 2013-04-16 | 2016-11-15 | Arthrosurface Incorporated | Suture system and method |
| KR101553311B1 (en) | 2013-12-24 | 2015-09-15 | 주식회사 코렌텍 | Patient specific surgical instrument for tibia |
| US10624748B2 (en) | 2014-03-07 | 2020-04-21 | Arthrosurface Incorporated | System and method for repairing articular surfaces |
| US11607319B2 (en) | 2014-03-07 | 2023-03-21 | Arthrosurface Incorporated | System and method for repairing articular surfaces |
| US9861492B2 (en) | 2014-03-07 | 2018-01-09 | Arthrosurface Incorporated | Anchor for an implant assembly |
| WO2015160852A1 (en) * | 2014-04-14 | 2015-10-22 | Mahfouz Mohamed R | Kinematic alignment and novel femoral and tibial prosthetics |
| EP3166540B1 (en) | 2014-07-09 | 2019-06-19 | Episurf IP-Management AB | A surgical joint implant |
| WO2016004991A1 (en) | 2014-07-09 | 2016-01-14 | Episurf Ip-Management Ab | Customized implant for cartilage repair and corresponding method of design |
| EP3195138A4 (en) | 2014-09-17 | 2019-03-06 | Canary Medical Inc. | Devices, systems and methods for using and monitoring medical devices |
| US9943413B2 (en) | 2015-01-30 | 2018-04-17 | Russell Nevins | Revision stepped tibial implant |
| US9668883B2 (en) * | 2015-08-19 | 2017-06-06 | Depuy Ireland Unlimited Company | Trial kit for knee prosthesis system |
| JP2019509132A (en) | 2016-03-23 | 2019-04-04 | ライト メディカル テクノロジー インコーポレイテッドＷｒｉｇｈｔ Ｍｅｄｉｃａｌ Ｔｅｃｈｎｏｌｏｇｙ， Ｉｎｃ． | Fixation device and method for total ankle replacement |
| AU2017237099B2 (en) | 2016-03-23 | 2022-05-26 | Canary Medical Inc. | Implantable reporting processor for an alert implant |
| WO2017201272A2 (en) | 2016-05-18 | 2017-11-23 | Depuy Ireland Unlimited Company | Orthopaedic surgical instrument system for surgically-preparing a patient's femur |
| US20180125667A1 (en) * | 2016-11-07 | 2018-05-10 | John Bodeker Savage | Prosthetic apparatus and systems for total knee arthroplasty |
| CA3108761A1 (en) | 2017-08-04 | 2019-02-07 | Arthrosurface Incorporated | Multicomponent articular surface implant |
| US10537446B2 (en) * | 2017-09-20 | 2020-01-21 | Depuy Ireland Unlimited Company | Method and instruments for assembling an orthopaedic prosthesis |
| US10537341B2 (en) | 2017-09-20 | 2020-01-21 | Depuy Ireland Unlimited Company | Orthopaedic system and method for assembling prosthetic components |
| US10543001B2 (en) | 2017-09-20 | 2020-01-28 | Depuy Ireland Unlimited Company | Method and instruments for assembling a femoral orthopaedic prosthesis |
| US11607323B2 (en) | 2018-10-15 | 2023-03-21 | Howmedica Osteonics Corp. | Patellofemoral trial extractor |
| WO2020186099A1 (en) | 2019-03-12 | 2020-09-17 | Arthrosurface Incorporated | Humeral and glenoid articular surface implant systems and methods |
| GB201913436D0 (en) | 2019-09-18 | 2019-10-30 | Depuy Ireland Ultd Co | Cutting block |
| US11872137B2 (en) | 2021-06-15 | 2024-01-16 | Wright Medical Technology, Inc. | Unicompartmental ankle prosthesis |
Family Cites Families (20)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US4678471A (en) | 1985-08-22 | 1987-07-07 | Noble Philip C | Method and apparatus for preventing rotational failure of orthopedic endoprostheses |
| US5047061A (en) | 1989-01-20 | 1991-09-10 | Brown Byron L | Prosthesis holder |
| US5192329A (en) | 1991-03-07 | 1993-03-09 | Joint Medical Products Corporation | Oblong acetabular cup |
| US5282866A (en) * | 1992-02-12 | 1994-02-01 | Osteonics Corp. | Prosthetic knee tibial component with axially ribbed keel and apparatus for effecting implant |
| US5275603A (en) * | 1992-02-20 | 1994-01-04 | Wright Medical Technology, Inc. | Rotationally and angularly adjustable tibial cutting guide and method of use |
| US5417695A (en) | 1992-07-27 | 1995-05-23 | Pfizer Hospital Products Group, Inc. | Instrumentation for preparing a distal femur |
| US5290313A (en) * | 1992-11-23 | 1994-03-01 | Zimmer, Inc. | Offset prosthetic stem extension |
| US5464406A (en) * | 1992-12-09 | 1995-11-07 | Ritter; Merrill A. | Instrumentation for revision surgery |
| US5908424A (en) * | 1994-05-16 | 1999-06-01 | Zimmer, Inc, By Said Stalcup, Dietz, Bays And Vanlaningham | Tibial milling guide system |
| US5578039A (en) * | 1995-02-15 | 1996-11-26 | Smith & Nephew Richards Inc. | Tibial resection instrumentation and surgical method |
| US5609642A (en) * | 1995-02-15 | 1997-03-11 | Smith & Nephew Richards Inc. | Tibial trial prosthesis and bone preparation system |
| US5613970A (en) * | 1995-07-06 | 1997-03-25 | Zimmer, Inc. | Orthopaedic instrumentation assembly having an offset bushing |
| US5634927A (en) * | 1995-07-06 | 1997-06-03 | Zimmer, Inc. | Sizing plate and drill guide assembly for orthopaedic knee instrumentation |
| CA2193451C (en) * | 1995-12-21 | 2005-11-01 | Diana F. Mccue | Instrument system for knee prosthesis implantation with universal handle or slap hammer |
| US5690636A (en) * | 1995-12-21 | 1997-11-25 | Johnson & Johnson Professional, Inc. | Punch system for tibial prosthesis |
| US5782921A (en) * | 1996-07-23 | 1998-07-21 | Johnson & Johnson Professional, Inc. | Modular knee prosthesis |
| US5681316A (en) * | 1996-08-22 | 1997-10-28 | Johnson & Johnson Professional, Inc. | Tibial resection guide |
| US5782920A (en) | 1996-11-14 | 1998-07-21 | Johnson & Johnson Professional, Inc. | Offset coupling for joint prosthesis |
| US5976147A (en) * | 1997-07-11 | 1999-11-02 | Johnson & Johnson Professional, Inc | Modular instrumentation for bone preparation and implant trial reduction of orthopedic implants |
| US6063091A (en) * | 1998-10-13 | 2000-05-16 | Stryker Technologies Corporation | Methods and tools for tibial intermedullary revision surgery and associated tibial components |
-
1998
- 1998-10-13 US US09/170,572 patent/US6063091A/en not_active Expired - Lifetime
-
1999
- 1999-10-11 EP EP99850146A patent/EP0993807B1/en not_active Expired - Lifetime
- 1999-10-11 DE DE69924574T patent/DE69924574T2/en not_active Expired - Lifetime
- 1999-10-12 JP JP11289219A patent/JP2000116683A/en active Pending
- 1999-10-12 CA CA002285768A patent/CA2285768A1/en not_active Abandoned
- 1999-10-12 AU AU53607/99A patent/AU757125B2/en not_active Ceased
- 1999-12-07 US US09/454,553 patent/US6228091B1/en not_active Expired - Lifetime
-
2000
- 2000-05-12 US US09/570,112 patent/US6620168B1/en not_active Expired - Lifetime
Also Published As
| Publication number | Publication date |
|---|---|
| US6063091A (en) | 2000-05-16 |
| US6228091B1 (en) | 2001-05-08 |
| JP2000116683A (en) | 2000-04-25 |
| AU757125B2 (en) | 2003-02-06 |
| AU5360799A (en) | 2000-04-20 |
| EP0993807A1 (en) | 2000-04-19 |
| DE69924574T2 (en) | 2006-02-09 |
| DE69924574D1 (en) | 2005-05-12 |
| US6620168B1 (en) | 2003-09-16 |
| EP0993807B1 (en) | 2005-04-06 |
Similar Documents
| Publication | Publication Date | Title |
|---|---|---|
| US6063091A (en) | Methods and tools for tibial intermedullary revision surgery and associated tibial components | |
| US11147691B2 (en) | Punch, implant and associated method | |
| US6740092B2 (en) | Methods and tools for femoral intermedullary revision surgery | |
| US10736747B2 (en) | Knee joint prosthesis system and method for implantation | |
| EP0474320B1 (en) | Femoral distractor | |
| US5250050A (en) | Apparatus for knee prosthesis | |
| US5116338A (en) | Apparatus for knee prosthesis | |
| EP1833387B1 (en) | Surgical tools facilitating increased accuracy, speed and simplicity in performing joint arthroplasty | |
| JP5466647B2 (en) | Artificial knee joint system and implant method | |
| US6033410A (en) | Orthopaedic instrumentation | |
| US5423822A (en) | Method and apparatus for preparing a bone for receiving a prosthetic device | |
| US6629978B2 (en) | Valgus adapter | |
| WO2001028467A1 (en) | Tibial trial system |
Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| FZDE | Dead |