CN1728976A - Minimally invasive joint implant with 3-dimensional geometry matching the articular surfaces - Google Patents

Abstract

This invention is directed to orthopedic implants and systems. The invention also relates to methods of implant design, manufacture, modeling and implantation as well as to surgical tools and kits used therewith. The implants are designed by analyzing the articular surface to be corrected and creating a device with an anatomic or near anatomic fit; or selecting a pre-designed implant having characteristics that give the implant the best fit to the existing defect.

Description

Wicresoft's joint implant with the three-dimensional geometrical structure that is complementary with articular surface

Technical field

The present invention is directed to orthopaedic implant and system.Described implant can be joint implant and/or interpolation joint implant.The present invention also relates to design, manufacturing, molded and implant the method for implant and with the surgical technique and tools and the external member of its use.The present invention also relates to can be to the orthopaedic implant that can expand voluntarily that arthroscope inserts and the profile change is revised.At last; the present invention relates to rebuild the joint implant of normal or approaching normal three-dimensional (3D) joint geometry or arrangement and promotion joint motions through setting so that described implant; described promotion joint motions surpass joint motions normal range 60% to 99.9%, and between active stage, can bear up to apply the joint in 100% of normal shearing force.

Background technology

There is polytype cartilage, for example, hyaline cartilage and fibrous cartilage.Hyaline cartilage is present in the articular surface (for example, in the joint) of skeleton, is responsible for providing the active characteristics of the smooth smoothness of movable joint.Consider to depend on the variation in joint and particular words in IA position, articular cartilage is connected to the skeleton under it firmly, and the thickness that records in the human joint is generally less than 5mm.In addition, articular cartilage is impassivity, no blood vessel and does not have lymph fluid (alymphatic).In the adult, cartilage is carried nutrition by the double diffusion system via the chondrocyte of dense intercellular substance in being present in the cartilage connective tissue of synovial membrane and cartilage.

Adult's repair of cartilage is limited in one's ability, therefore, by as the disease of rheumatic arthritis and/or osteoarthritis or wound generation can cause serious physical disabilities and weak to the cartilage injury.In addition, along with people's articular cartilage ageing, its tensile property changes.Therefore, along with the past of time, because constantly aging, the stretching rigidity and the strength of adult's cartilage have obviously reduced.

For example, up to the thirty year of life, the surf zone of knee cartilage presents stretching strength and increases, and after year, when at articular surface discernable damages of II Collagen Type VI matter taking place, stretching strength is along with aging minimizing significantly in the thirty of life.Although reducing does not appear in collagen content, along with the increase at age is distinguished cartilage deeply and stretching strength occurred and reduce gradually.Described observation indication along with aging cartilage machinery and thus structure organization change, if fully develop, trauma injuries can appear in cartilage.

Usually, by using repair materials, for example, as be used to the improve looks silicones repaired or the proper metal alloy replacing joint severe injury for the treatment of cartilage or damaged.See that for example No. the 6th, 383,228, the U.S. patent application case of the Schmotzer that issued on May 7th, 2002; No. the 6th, 203,576, the people's such as Afriat that issue March 20 calendar year 2001 U.S. patent application case; No. the 6th, 126,690, the people's such as Ateshian that on October 3rd, 2000 issued U.S. patent application case.The implantation of described prosthetic device is usually directed to undertissue and femur defect, and do not comprise the repertoire that recovers original cartilage, and use some device, can comprise the loosening of infection, osteolysis and implant with a large amount of damaged relevant serious long-term complications of tissue and skeleton.

Should be appreciated that the one or more skeleton that the arthroplasty wound is big and need to comprise in the surgical resection reparation articular surface integral body or great majority.Usually needing to strike off quite large-area marrow crack in described program is assemblied in the skeleton with the bar with prosthese.Strike off the damaged of the bone storage that causes the patient, and along with past of time, osteolysis will cause prosthetic loosening continually.In addition, along with degenerating in the past implant of time and the zone at skeleton coupling place, finally need use prosthetic replacement.Because patient's bone storage is limited, the quantity of possible replacement also is subject to arthroplasty.In brief, 15 to 20 years more than the course of disease, in some cases even shorter period, the patient can use up the treatment option, finally causes arthralgia, no function.

Also the substrate that will implant with cell (for example, chondrocyte, chondrocyte CFU-GM, stromal cell, mesenchymal cell stem cell etc.), the purposes of organizing skeleton or other carrier are described as being used for the potential treatment of repair of cartilage.See the open case WO 99/51719 in the world of the Fofonoff that on October 14th, 1999 issued again; The calendar year 2001 people's such as Simon that issued in 6th of December WO 01/91672; WO 01/17463 with the Mansmann that issues March 15 calendar year 2001; With the calendar year 2001 people's such as Vibe-Hansen that issued in 4th of JIUYUE U.S. patent application case the 6th, 283,980B1 number; The people's such as Naughton that December in 1998 was issued on the 1st 5,842,477; The Schwartz on June 23rd, 1998 issue 5,769,899; The people's such as Caplan that JIUYUE in 1986 was issued on the 2nd 4,609,551; The people's such as Vacanti that on August 20th, 1991 issued 5,041,138; The people's such as Caplan that on March 30th, 1993 issued 5,197,985; The people's such as Caplan that on July 13rd, 1993 issued 5,226,914; The calendar year 2001 people's such as Hardwick that issued in 11st of December 6,328,765; The people's such as Rueger that issue August 28 calendar year 2001 6,281,195; With 4,846,835 of the Grande that issued on July 11st, 1989.Yet, because most of biological substitution materials can not be realized and similar or identical morphologic arrangement or the structure of the metathetical normal anosis tissue of desire, so as heteroplastic transplantation of the same race and autotransplantation system and organize the clinical effectiveness of biological replacement material such as skeleton to determine as yet.Yet the mechanical endurance of described biological substitution material is not determined yet.

The people's such as Fell that No. the 6th, 206,927, the people's such as Fell that issue March 21 calendar year 2001 U.S. patent application case and on May 6th, 2003 issue U.S. patent application case has disclosed for the 6th, 558, No. 421 does not need the implantable knee prostheses of the surgical operation of resected bone.Described prosthese is the cardinal principle ellipse with one or more straight edge shape.Correspondingly, described device is not designed to that the true form (profile) with intravital remaining cartilage and/or sending down the fishbone is consistent substantially.Therefore, because patient's cartilage on every side and/or thickness and the curvature between following subchondral bone and the prosthese there are differences, the integraty of implant is difficulty quite.

Therefore, the one or more implant that still needs a kind of use to implant with being used for the instrument of described reparation and implantation with less invasive techniques is partly duplicated the system and method for the natural geometry structure in joint, and the method for the three-dimensional geometry relation of nature between two articular surfaces in reconstruction joint or approaching nature.

Summary of the invention

The invention provides the method and composition that is used to repair the joint, be provided for repairing articular cartilage especially and be used to promote various cartilages and bone repair material and curee's all-in-one-piece device and implant.Wherein, technology described herein take into account with the profile of specific curee's following cartilage and/or skeleton and/or other articulation structure substantially or the production of on all four device.In addition, device also preferably with the shape (size) of cartilage substantially or in full accord.When the shape of articular cartilage surface (for example, size, thickness and/or curvature) is dissected or when approximate original cartilage that is fit to unmarred cartilage, curee anatomically and/or sending down the fishbone, the successful property raising of reparation.

Can before implanting, repair materials be formalized, and described setting can provide the electronic image of information based on (for example), described information is about the curvature or the thickness of any " normally " cartilage around in damaged or ill cartilage zone, and/or about the curvature of following or on every side the skeleton in described ill cartilage defect or zone, and the skeleton and/or the cartilage that comprise the relative match surface in joint.

Wherein, the invention provides a kind of invasive methods that is used for local joint replacement.Described method can cause a small amount of damaged or N/D of the bone storage that causes because of program.In addition, method described herein is by dissecting in implant or the approaching integrity that is adapted at anatomically on every side or helps to recover articular surface between adjacent cartilage and/or the subchondral bone.

In most of the cases, the joint mobility scope in the joint through repairing will be 60% to 99.9% of normal motility.Range of activity is improved to 85% to 99.9%, and is better 90% to 99.9%, best between 95% to 99.9% and ideal between 98% to 99.9%.

In addition, generally to implant the otch of current available implant than needs little by 50% for otch that need to implant apparatus of the present invention.For example, whole knee joint substitutes the otch that generally needs 6-12 inch (15-30cm), and single lacuna knee replacement needs the otch of 3 inches (7cm).Design according to the present invention repair the tibia surface the implant otch of needs 3cm (about 1.5 inches) only, and the implant that is used to repair tibia surface and condyle of femur makes up the otch of needs 3 inches (7cm).In another example, traditional hip replacement needs the single otch between 6 to 12 inches (15-30cm), or in less invasive techniques, needs two otch of 1.5-4 inch (3-9.5cm).Rectification still two surfaces in optionally single surface are corrected and are decided, and the single otch of the implant needs 1.5 inches (3cm) to 6 inches (30cm) of acetabular bone is repaired in design according to the present invention.

Advantage of the present invention can include, but is not limited to: (i) for individual patient customization joint repair (for example, patient's particular design or solution), strengthen effect and mitigation degree according to repair procedure whereby; (ii) eliminate at the operation Chinese and foreign department doctor measuring of some embodiment damaged needs to be repaired; (iii) eliminate during implant procedure, the formalize needs of material of surgeon; (iv) provide according to skeleton, cartilage or tissue image or according to the curvature of exploration technology assessment repair materials or the method for shape in the operation; (v) provide the minimum damaged or damaged method of (in some instances) no bone storage of bone storage has only been arranged when repairing the joint; (vi) improve postoperative joint smooth (congruity).

Therefore, this paper describes the design and use of joint repair material meet damaged (for example, the position of implantation) more accurately and therefore the joint repair of improvement is provided.

Should be appreciated that as one of ordinary skill in the art, implant can be described as an interpolation joint implant, cartilage defect shaping implant, cartilage projection implant and/or subchondral bone shaping implant.Described implant has upper surface and lower surface.First articular surface in the relative joint of upper surface and the second joint surface in the described relatively joint of lower surface, and further, at least one in wherein said lower surface or the lower surface have with described first and second articular surfaces in one the shape 3D shape of fully mating.Described implant is fit to be placed in any intraarticular, and described joint comprises knee joint, hip, shoulder, elbow, wrist, refers to, toe and ankle.The upper surface of implant and lower surface generally have the 3D shape that at least one the shape in the articular surface lower surface with the articular surface of the upper surface abut of implant and implant adjacency is fully mated.Described implant is designed to have the thickness of the great cartilage defect of patient or its mark generally between 65% to 99.9%.

Can be by various suitable material manufacture implants, described material comprises biocompatible material, metal, metal alloy, bioactive materials, polymer and its analog.In addition, can make implant by a plurality of materials (comprising coating).

Implant can further have the mechanism that is attached to the joint.Suitable attachment mechanism comprises ridge, pin, contact pin, cross member, tooth and projection.Can provide the additional mechanism of stablizing the joint (as ridge, edge), along all or the part thickening of outer surface.

Also can design implant makes it have two or more assemblies.According to desired functional, but described assembly monolithic molding, indivisible shaping, interconnection shaping and the shaping that interdepends.Under a plurality of assembly situations, the joint contact component design can be become with the joint slidably or rotatably or its combination engagement.Perhaps, any or two of joint contact assembly can be fixed to the joint.Any extra assembly can be shaped or the shaping that interdepends with its any other assembly monolithic molding that is meshed, indivisible shaping, interconnection.

That each assembly of implant or implant itself can have is round, oval, avette along periphery, the periphery or the formed shape of girth of kidney shape, circle substantially, ellipse substantially, avette, kidney shape substantially substantially.In addition, each assembly of implant itself can have the shape of cross section of sphere, hemispherical, aspheric surface, convex surface, concave surface, convex surface substantially and concave surface substantially.

Implant design makes and helps to use 10cm or otch still less to implant.In addition, implant being designed to recover range of motion is natural joint active 80% to 99.9%.

Implant or its any assembly can have different shape makes that the thickness of middle body of the comparable implant of periphery of implant is bigger.Perhaps, can design implant or its any assembly and make that the middle body of implant is bigger than the thickness of periphery.See implant from a plurality of directions such as previous section, aft section, lateral parts and mid portion, implant or its any assembly can have along the thickness of the aft section of device, and it is equal to or greater than at least one the thickness in side, centre and the previous section of implant.Perhaps, implant or its any assembly can have along the thickness of the aft section of device, and it is equal to or less than at least one the thickness in side, centre and the previous section of implant.In another alternative method, implant or its any assembly can have along the thickness of the mid portion of device, and it is equal to or less than at least one the thickness in previous section, aft section and the lateral parts.In another alternative method, implant can have along the thickness of the mid portion of device, and it is equal to or greater than at least one the thickness in previous section, aft section and the lateral parts.

The program of using following described implant to repair the joint may further comprise the steps: arthroscopy is implanted down has the implant of upper surface and lower surface, and at least one in wherein said upper surface and the lower surface has the 3D shape of fully mating with the shape of articular surface.Analysis image before implanting.Described image is generally MRI, CT, X-ray or its combination.

The method of implant constructed in accordance comprises: the 3D shape of judging the one or more articular surface in joint; Has the implant of upper surface and lower surface with generation, first and second articular surfaces in wherein said upper surface and the relative described joint of lower surface, and further, at least one in wherein said upper surface and the lower surface and the 3D shape of described articular surface are fully mated.

In addition; the invention provides a kind of use implant material and (for example substitute the joint; cartilage and/or skeleton) a part (for example; affected areas and/or less times greater than the zone of affected areas) novel apparatus and method; wherein implant dissect or near the suitable surrounding structure of dissecting and at least one surface of tissue, and make joint mobility return to 60% to 99.9% of joint normal activity scope.In addition, the joint motion implant can bear the shearing force that puts on the joint (up to) 100%.Comprise under the situation of the element that is associated with the hypozygal skeleton that at device and/or method the present invention also provides with skeleton and is associated that element is dissected with subchondral bone or aliging near dissection.The present invention also can carry out pretreatment to the implantation position with single otch.Described device is unimodule, two assembly not, or has plurality of element.

Method of the present invention comprises step: (a) measure the size (for example, thickness and/or curvature and/or size) of desiring implantation position or the size of desiring the implantation position peripheral region; (b) provide with step (a) in consistent cartilage substitute or the material of measurement result that obtained.In some aspects, step (a) comprises that measuring the thickness and the measurement of cartilage on every side of desire implantation position desires the implantation position curvature of cartilage on every side.Perhaps, step (a) can comprise the size of measurement desire implantation position and measure the curvature of desiring implantation position cartilage on every side; Or measure at the thickness of desiring cartilage around the implantation position, measure the size of desiring implantation position, and measure the curvature of desiring cartilage around the implantation position; Or desiring the cartilage surface that the implantation position place rebuilds health; Or measure to desire the size of implantation position and/or desiring the implantation position place or desiring to measure around the implantation position curvature or the geometry of subchondral bone.In addition, can desire thickness, curvature or the surface geometry that the measurement of implantation position place remains cartilage, and it can compared with thickness, curvature or surface geometry around the cartilage.This relatively can be used for obtaining more accurately the shape of cartilage substitute or material.

The size that substitution material is selected in the back is measured in operation, and described measurement is for example used as ultrasound wave, MRI, CT scan, the measurement carried out with imaging techniques such as the X-ray imaging of X-ray color matching acquisition and fluoroscopy imagings.Mechanical detector (have or do not have imaging function) also can be used for selected size, for example ultrasonic detector, laser, optical detector, coining detector and deformable material.

One or more implantable device comprises three-dimensional body.In a knee joint, implant can be used for one (single lacuna) or a plurality of (multi-cavity crack) lacunas (compartment).In described knee joint, the non-ellipse of implant, but meet the 3D geometry of articular cartilage, subchondral bone and/or intraarticular structure.Implant has a pair of relative face.The profile of a face of implant and following cartilage and/or bone contours is complementary or mate substantially; And being the coupling articular surface that joins, the profile of the opposite face of implant creates a surface.For example, working modelization comes the surface of projection opposite face to be used for the surface of mating with the joint with optimization.In addition, can use the interface of a circle to connect relative face.The interface also can be extended outside articular surface.Arthroscopy is inserted, and implant of the present invention also can be that can expand voluntarily and amendable.

Each face of device needn't be unified dimensionally.Can be variable via the length D on the axis of getting in arbitrary set point place along described axis.Similarly, equally also can be variable via second axis (being orthogonal to described first axle) length 2D along described axis.One of ordinary skill in the art will understand along any D length of first axle and be fit to wait to correct any ratio that health is dissected in having along the ratio between any D length of second axis.

Those skilled in the art will understand as described, not deviate under the situation of category of the present invention, and any of implantable articular prosthesis described herein can comprise can be (for example, slidably) and/or a plurality of (for example, two or multi-disc) object assembly of separable engagement.For example, can in each assembly, provide two block assemblies with the consistent face of its profile and following cartilage and/or skeleton (partly or substantially).In certain embodiments, the apparent surface of engageable assembly is crooked.Can select to be similar to or reflect the curvature of curvature of at least one articular surface in joint.In other embodiments, the apparent surface of engageable assembly is flat.In other embodiments, the apparent surface of engageable assembly is flat and combination bending.The apparent surface of engageable assembly is irregular for also can be.Under this kind situation, described surface is preferably designed at least one or more than one position and matches each other.

In any method described herein, can select substitution material (for example, being selected from existing repair system storehouse).Therefore, can be before operation, in the operation or operation back production substitution material.In addition, in any method described herein, also can make in this technology known suitable technology or operation before, in the operation or operation afterwards substitution material was formalized.Described technology comprises: manual, automatically or pass through machine; Use comprises the abrasion of polishing, laser ablation, radio frequency ablation, extruding, injection, modelling, compact modelization and/or Machining Technology or its analog.At last, implant can comprise such as one or more bioactive materials such as medicine, cell, non-cellular material, pharmacological agents, biological reagent and its analog.

The present invention includes the method for the cartilage among a kind of curee of reparation, described method comprises the step of implantation according to the repair of cartilage material of any method preparation described herein.Implant general under arthroscope and can finish via relatively little otch.

The present invention also provides a kind of method of judging the curvature of articular surface, and described method comprises the curvature of using mechanical detector (mechanical probe) or surgical operation machinery navigation system (surgical mechanical navigation system) to measure articular surface in the operation.Articular surface can comprise cartilage and/or subchondral bone.Mechanical detector (have or do not have imaging function) can comprise: (for example) ultrasonic detector, laser, mechanical hand (as titanium FARO hands (Titanium FARO arm)), optical detector and/or deformable material or device.

Various tool can be used for being convenient to the implantation of device.Instrument is the guider of auxiliary phase for the device of articular surface best located.The Design of device that is suitable for particular joint is taken from the instrument that uses in the device mode and the design of guider.Instrument can comprise and implantation position or articular cavity part or trial implants or operation tool unanimous on the whole.

Any repair system described herein or prosthese (for example, outer surface) can comprise polymer material or fluent material.Polymer material can be connected to metal or metal alloy.When polymer material is exposed to chemicals, energy beam, light source, ultrasound wave and other thing, can inject polymer material and (for example) but its self-hardening or sclerosis.In addition, any system described herein or prosthese can be suitable for (for example) by the reception of the opening (for example, the opening in the outer surface causes the plurality of openings on the bone surface) in the outer surface of cartilage substitution material injection.Can inject bone engagement agent, therapeutic agent and/or other bioactive substance by described opening.In certain embodiments, can make a bet into the skeleton cement to finish the part of bone engagement agent infiltration implantation position in the situation of compressing articular surface or subchondral bone or bone marrow.In addition, can make any repair system described herein or prosthese be fixed in the bone marrow or in the subchondral bone.One or more reinforcing extension (for example, contact pin etc.) can be extended by skeleton and/or bone marrow.

In certain embodiments, can be under the situation of not destroying subchondral bone or only use a small amount of contact pin or the anchor that extend to subchondral bone or pass subchondral bone to implant cartilage substitute system.This technology has avoids in the future implant " sinkings " and osteolysis to cause joint incongruity or implant to be become flexible or the advantage of other complication.

To understand as one of ordinary skill in the art, suitable joint can comprise (saying several names) knee joint, shoulder, hip, vertebra, intervertebral disc, elbow, ankle, wrist, refers to, carpometacarpus, mesopodium and preceding joints of foot.Described technology is not limited to the mankind's that found joint equally, and can expand to any mammiferous joint.

According to the announcement of this paper, of the present invention these are incited somebody to action apparent with other embodiment for one of ordinary skill in the art.

Description of drawings

Figure 1A is the block chart that is used for assessing according to the present invention the method for the needs of repairing the joint, and wherein existing articular surface is constant or constant substantially before receiving selected implant.Figure 1B is the block chart that is used for assessing according to the present invention the method for the needs of repairing the joint, and wherein existing articular surface is constant or constant substantially before design is suitable for finishing the implant of reparation.

Fig. 2 is the reproduction of three-dimensional thickness chart picture of the articular cartilage of distal femur.Can (for example) produce three-dimensional thickness chart picture by ultrasound wave, CT or MRI data.The zone of the cartilage defect of the black hole indication full depth in the cartilage material.

Fig. 3 A is the example of Po Laxiduo (Placido) dish of the aperture of altogether middle heart arrangement.Fig. 3 B is at the fixing example of the lip-deep projection Po Laxi polydisc of curvature.

Fig. 4 mirror image that the projection of the concentrical aperture (Po Laxi polydisc) on each condyle of femur produces of serving as reasons.

Fig. 5 is the example of the 2D colour code topological diagram picture of regular curved surface.

Fig. 6 is the example of the 3D colour code topological diagram picture of regular curved surface.

Fig. 7 A-B is the block chart that is used for assessing according to the present invention the method for the needs of repairing the joint, and wherein the articular surface that existed before the reception implant is changed.

Fig. 8 A is for being suitable for the perspective view of the joint implant of the present invention locating to implant at kneed tibial plateau (tibial plateau).Fig. 8 B is the vertical view of the implant of Fig. 8 A.Fig. 8 C by along among Fig. 8 B the cross-sectional view of implant of Fig. 8 B of displaying line C-C.Fig. 8 D is the cross-sectional view along the line D-D that is showed among Fig. 8 B.Fig. 8 E is the cross-sectional view along the line E-E that is showed among Fig. 8 B.Fig. 8 F is the side view of the implant of Fig. 8 A.Fig. 8 G is the cross-sectional view of the implant of showing Fig. 8 A that implants along the planar interception that is parallel to the sagittal plane.Fig. 8 H is the cross-sectional view of the implant of showing Fig. 8 A that implants along the planar interception that is parallel to coronal plane.Fig. 8 I is the cross-sectional view of the implant of showing Fig. 8 A that implants along the planar interception that is parallel to axial plane.Fig. 8 J for (towards the edge of tibial plateau) medially and anteriorly and ground, the back bigger a little implant of extending near skeleton.Fig. 8 K is the side view of the alternate embodiment of the joint implant of Fig. 8 A of displaying anchor.Fig. 8 L is the upward view of the alternate embodiment of the joint implant of Fig. 8 A of displaying anchor.Fig. 8 M and 8N are the alternate embodiment of two implants being seen by the front and seen by the side.

Fig. 9 A and 9B are perspective view infra respectively and the joint implant that is suitable for using on condyle of femur top point of observation.Fig. 9 C is the side view of the implant of Fig. 9 A.Fig. 9 D is the following figure of implant.Fig. 9 E is that top figure and Fig. 9 F of implant is the cross section of implant.Fig. 9 G is the figure above the joint implant that is suitable for using on two joints of tibia.Fig. 9 H is the side perspective view of the implant of Fig. 9 G.

Figure 10 A is the side view of acetabular bone.Figure 10 B is the rotation diagram of immediate femur.Figure 10 C is the cross-sectional view of implant that is used to show the hip joint of constant radius substantially.

Figure 10 D is similar to the cross-sectional view that implant seen in Figure 10 C has the implant of the edge of a circle and an asymmetric radius.

Figure 11 A is the cross-sectional view with the implant that extends to the member in the capital recessed head.Figure 11 B with implant be shown as hemisphere, Figure 11 C is that part hemisphere and Figure 11 D are fence, it all shows extra and alternate plane graph.Figure 11 is the figure with alternate embodiment of the implant that spoke arranges.

Figure 12 A is the cross-sectional view with the implant that extends to the member in the acetabular fossa.Figure 12 B-E is various perspective views, and wherein implant is hemispherical, part hemispherical, a fence and a spoke.

Figure 13 A is the cross-sectional view of a pair of assembly " it the is movable to bear a heavy burden " implant of displaying two block structures and smooth match surface.Also show plane graph, its displaying have two hemisphere two assemblies, (meaning promptly to have the external module of a fence or class fence, hemispherical in one dimension, but not in its codimension) single hemisphere, have the fence internal structure single hemisphere, have the single hemisphere of spoke intraware and have the single hemisphere of spoke external module.

Figure 13 B-J is the alternate embodiment of two assembly implants, wherein the internal table mask of external module have one with the outer surface of intraware on the tuberosity of zigzag engagement.Also show extra variation.

Figure 14 A is the alternate embodiment with the implant that extends to the member in the capital recessed head.Figure 14 B and Figure 14 C are cross section embodiment, and wherein one of assembly forms a hemisphere and second assembly does not form hemisphere.

Figure 15 A is the cross-sectional view of two assemblies " it is movable to bear a heavy burden " implant with the member that extends to acetabular fossa.Figure 15 B and Figure 15 C are cross section embodiment, and wherein one of assembly forms a hemisphere and second assembly does not form hemisphere.

Figure 16 A is the cross-sectional view of three assemblies " it is movable to bear a heavy burden " implant.Figure 16 B-D is the cross-sectional view of three assemblies " it is movable to bear a heavy burden " implant with assembly of one or more formation hemisphere, and at least one other assembly does not form hemisphere.

Figure 17 A is the cross-sectional view of two assemblies " it is movable to bear a heavy burden " implant with the member that extends to acetabular fossa.Figure 17 B and Figure 17 C are cross section embodiment, and wherein one of assembly forms a hemisphere and second assembly does not form hemisphere.

Figure 18 A is the cross-sectional view of two assemblies " it is movable to bear a heavy burden " implant with the member that extends to acetabular fossa.Figure 18 B is four fins on the top of the member showed among Figure 18 A in the acetabular fossa that extends on the top of acetabular bone assembly.

Figure 19 A has the cross-sectional view that extends to two members " it the is movable to bear a heavy burden " implant in the capital recessed head.Figure 19 B is the cross-sectional view of two assembly fixation implants.

Figure 20 A is the cross-sectional view that is used for the implant of the radius with variation of hip joint and thickness.Figure 20 B is the cross-sectional view that is used for the implant of the radius with variation of hip joint and thickness.Figure 20 C is used for the cross-sectional view of the implant of the radius with variation of hip joint and thickness.Figure 20 D be used for hip joint have infra ground and at the cross-sectional view of the implant at the edge that extends lastly.

Figure 21 A is at the front elevation such as the bony structures in the shoulder joint such as clavicle, scapula, shoulder mortar (glenoid), acromion, processus coracoideus and humerus.Figure 21 B is the arthroplasty installation drawing that is positioned between upper arm head and the shoulder mortar.Figure 21 C be have with the shape of upper arm head humeral surface unanimous on the whole and with the front cross sectional view of the inclination of the arthroplasty device on the shape of shoulder mortar shoulder mortar surface unanimous on the whole.Figure 21 D be have with the shape of upper arm head humeral surface unanimous on the whole and with the axial cross-sectional view of the arthroplasty device on the shape of shoulder mortar shoulder mortar surface unanimous on the whole.Figure 21 E is for showing articular cartilage and at the front elevation of the inclination of last and shoulder following labium glenoidale.Figure 21 F is for the demonstration articular cartilage with in last and axial view shoulder following labium glenoidale.Figure 21 G be have with the shape of upper arm head humeral surface unanimous on the whole and with the front cross sectional view of the inclination of the arthroplasty device on the shape of shoulder mortar and labium glenoidale shoulder mortar surface unanimous on the whole.Figure 21 H be have with the shape of upper arm head humeral surface unanimous on the whole and with the arthroplastic axial cross-sectional view on the shape of shoulder mortar and labium glenoidale shoulder mortar surface unanimous on the whole.Figure 21 I be have with the shape of upper arm head humeral surface unanimous on the whole and with the front cross sectional view of the inclination of the arthroplasty device on the shape of shoulder mortar shoulder mortar surface unanimous on the whole.Show an edge above and/or under extend, it provides the stability of shoulder on the mortar.Figure 21 J be have with the shape of upper arm head humeral surface unanimous on the whole and with the axial cross-sectional view of the arthroplasty device on the shape of shoulder mortar shoulder mortar surface unanimous on the whole.Show the extension of front, an edge and/or back, it provides the stability on the shoulder mortar.Figure 21 K be have with the shape of upper arm head humerus unanimous on the whole form the surface and with the front cross sectional view of the inclination of two assemblies " it is movable to bear a heavy burden " arthroplasty device on the shape of shoulder mortar shoulder mortar surface unanimous on the whole.

Figure 21 L has with the shape of upper arm head humerus unanimous on the whole to form the surface and form the axial cross-sectional view of two assemblies " it is movable to bear a heavy burden " arthroplasty device on surface with the shape of shoulder mortar shoulder mortar unanimous on the whole.

Figure 21 M has with the shape of upper arm head humerus unanimous on the whole to form the surface and form the alternate figures of two assemblies " it is movable to bear a heavy burden " arthroplasty device on surface with the shape of shoulder mortar shoulder mortar unanimous on the whole.Described device has a tuberosity on the surface of first assembly, the lip-deep zigzag coupling of itself and second assembly is to strengthen joint motions.

Figure 21 N is the front cross sectional view of the inclination of two assembly " it is movable to bear a heavy burden " arthroplasty devices.Figure 21 O is the front cross sectional view of the inclination of two assembly " it is movable to bear a heavy burden " arthroplasty devices.The cross-sectional view of the alternate embodiment that Figure 21 P and Q install for two assemblies " it is movable to bear a heavy burden " of being showed among Figure 21 O.

Figure 22 is for showing distal humerus, olecranon and vertical figure of the inclination of passing through elbow joint of head radially.Also show cartilage surface.

Figure 23 A in position passes through carpal vertical figure with the arthroplasty system for showing distal radius, ulna and some carpal bones.Figure 23 B is for showing distal radius, ulna and some carpal bones, by carpal vertical figure.Figure 23 C is the carpal vertical figure that passes through that in position shows distal radius, ulna and some carpal bones with the arthroplasty system.Figure 23 D is vertical figure of two assemblies " it is movable to bear a heavy burden " arthroplasty device of being suitable for wrist.Figure 23 E is vertical figure of another pair assembly arthroplasty devices, does not have the edge under this kind situation.Figure 23 F is vertical figure of two assembly " it is movable to bear a heavy burden " arthroplasty devices.

Figure 24 is the radially figure (sagittal view) by a finger.Displaying is inserted the arthroplasty device between the bottom of head of metacarpal bone and immediate phalanges.

Figure 25 A is in position locating to show with the arthroplasty system the radially figure that passes through ankle joint of distal tibia, astragalus and calcaneus and other skeleton.Figure 25 B is for showing the coronal section figure that passes through ankle joint (coronal view) of distal tibia, distal fibula and astragalus.Displaying is inserted the arthroplasty device between distal tibia and the tibial astragaloid joint face.Figure 25 C is for showing the radially figure that passes through ankle joint of distal tibia, astragalus and calcaneus and other skeleton.。Also show cartilage surface.Displaying is inserted the arthroplasty device between distal tibia and the tibial astragaloid joint face.Figure 25 D is for showing the coronal section figure that passes through ankle joint of distal tibia, distal fibula and astragalus.Displaying is inserted the arthroplasty device between distal tibia and the tibial astragaloid joint face.

Figure 26 is the radially figure by toe.Displaying is inserted the arthroplasty device between the bottom of head of metatarsal bone and immediate phalanx.

Figure 27 A-D is the block chart of employed method step when implanting device of the present invention in the target joint.

Figure 28 is the plane graph that is suitable for being used for implanting the implant steering tool of the device of being showed among Fig. 8 L.

Figure 29 A and B are the plane graph that is suitable for being used for implanting the implant steering tool of the device of being showed among Fig. 9 B.

The specific embodiment

Providing following description makes any technical staff in affiliated field can make and use the present invention.Various corrections to embodiment will become apparent to those of ordinary skill in the art, and under not breaking away from by the situation of adhering to spirit that claim defines and category, during the General Principle that this paper defined can be applicable to other embodiment and uses.Thereby the present invention does not wish to be confined to shown embodiment, but meets and principle disclosed herein and the corresponding to broad range of feature.In order to reach the of the present invention necessary degree that understanding is fully disclosed, the detailed description of all patents of giving of in this piece application case, being quoted, patent disclosure case and patent application case and graphicly all be incorporated herein by reference.

As be understood by those skilled in the art that enforcement of the present invention uses x radial imaging conventional in (unless indication is arranged in addition) affiliated art and processing, x ray tomography to synthesize, comprise the method for ultrasound wave, computer tomography (CT scan), NMR (Nuclear Magnetic Resonance)-imaging (MRI), optical coherence tomography, single photon emission tomography (SPECT) and the positron radial pattern tomography (PET) of A sweep, B scanning and C scanning.These technology have explained in detail in the literature and unnecessaryly are described in this article.Consult, for example, X-RAY Structure Determination:A Practical Guide, the 2nd edition, editor Stout andJensen, 1989, John Wiley ﹠amp; Sons, publishing house; Body CT:A Practical Approach, editor Slone, 1999, McGraw-Hill publishing house; X-ray Diagnosis:A Physician ' sApproach, editor Lam, 1998Springer-Verlag, publishing house; With Dental Radiology:Understanding the X-Ray Image, editor Laetitia Brocklebank 1997, Press publishing house of Harvard University.

1, the two-sided or multiaspect in joint assessment

Wherein, the present invention allows the practitioner to estimate and to treat the joint damaged, and described joint is damaged to be derived from (for example) joint disease, cartilage decline, osteoarthritis, seroreaction is positive and seroreaction is negative arthritis, bone injury, cartilage injury, wound and/or owing to overuse or age former thereby the decline that causes.The size in the zone of being paid close attention to, volume and shape can only comprise having damaged cartilage zone, but also can be preferably included in the cartilage portion around the described cartilage defect.In addition, the size in the zone of being paid close attention to, volume and shape can comprise subchondral bone, bone marrow and other articulation structure, for example meniscus, ligament and tendon.

Figure 1A is a flow chart of being assessed the step that adopts in a joint by the practitioner.At first, the practitioner obtains the measurement result in target joint 10.Can finish the step that obtains measurement result by the image that obtains the joint.A plurality of images further improve the joint evaluation process thereby this step can repeat 11 acquisitions where necessary.In case the practitioner obtains necessary measurement result, just use this information to generate the model representation 30 in target joint to be assessed.This model representation can adopt the form of configuration figure or image.The model representation in joint can be one dimension, two dimension or three-dimensional.It can comprise a physical model.Can produce a plurality of models 31 when needing.No matter be that archetype or the model or its both that produce subsequently can use.After the model representation 30 that generates the joint, the practitioner can generate the projection model in target joint according to circumstances and represent 40 under correct condition.This process is necessary or still can repeat 41 when needing.Difference between the configuration condition in selection course 50 use joints and the projection image in joint repeats to realize required result in the strategic point as required.

As be understood by those skilled in the art that as shown in arrow 32, the practitioner can be directly be directly to the step of selecting suitable joint replacement implant 50 from the step of the model representation 30 that generates the target joint.In addition, selected after the suitable joint replacement implant 50, shown in flow process 24,25,26, the step that obtains the measurement result 10 in target joint, the model representation 30 that generates the target joint and generation projection model 40 can repeat continuously or concurrently.

Figure 1B shows the alternative flow of being assessed step that adopt in the joint by the practitioner.At first, the practitioner obtains the measurement result 10 in target joint.Can finish the step that obtains measurement result by the image that obtains the joint.Thereby this step can repeat 11 where necessary to be obtained a plurality of images and further improves the joint evaluation process.In case the practitioner obtains necessary measurement result, just use this information to generate the model representation 30 in target joint to be assessed.This model representation can adopt the form of configuration figure or image.The model representation in joint can be one dimension, two dimension or three-dimensional.Necessary or can repeat this process 31 when needing.Can comprise a physical model.After the model representation 30 of having assessed the joint, the practitioner can generate the shielded model representation 40 in target joint according to circumstances under correct condition.This process is necessary or can repeat 41 when needing.The practitioner uses the difference between the projection image in the configuration condition in joint and joint can then design suitable joint implant 52 and realizes that correct joint dissects, and realizes required implant design with regard to design iterations process 53 in case of necessity.The practitioner can also assess provides additional features (for example edge, pin or anchor) whether can improve the implant performance in the target joint.

As be understood by those skilled in the art that as shown in arrow 38, the practitioner can be directly proceeds to the step of the suitable joint replacement implant 52 of design from the step of the model representation 30 that generates the target joint.Flow process shown in being similar to above, designed after the suitable joint replacement implant 52, shown in flow process 42,43,44, the step that obtains the measurement result 10 in target joint, the model representation 30 that generates the target joint and generation projection model 40 can repeat continuously or concurrently.

Joint implant selected or design is realized dissection or the proximate anatomic construction suitable mutually with the existing surface in joint, and the surface that represents a coupling simultaneously is used to duplicate the relative articular surface of natural joint anatomic construction.In this case, can assess the articular surface of existing surface, joint and required gained.This technology is particularly useful for the implant that does not anchor in the skeleton.

Fig. 2 illustrates the color rendering of three-dimensional thickness chart of the articular cartilage of distal femur.Can generate 3 dimension thickness charts from (for example) ultrasound wave, CT or MRI data.The zone of whole thickness cartilage disappearance is indicated in black hole in the cartilage material.Can be from 3 dimension thickness charts to cartilage injury's size and judging of shape.

As be understood by those skilled in the art that, can use any suitable technique to obtain size, curvature and/or thickness measure result.For example, can use suitable mechanical component, laser aid, electromagnetism or optical tracking system, mold, the material of articular surface that is applied to hardening and " memory surface profile " and/or affiliated field known one or more plant imaging techniques and obtain one dimension, two dimension and/or three-dimensional measuring result.Can need not interpolation and/or surgical operation (for example, using probe or other operation device) and obtain measurement result.As being understood by those skilled in the art that the thickness of prosthetic device can change at any given time, this depends on the cartilage that will repair and/or the lesion depths of skeleton on any ad-hoc location of articular surface.

A. imaging technique

As be understood by those skilled in the art that, the imaging technique that is applicable to the thickness of measuring morbidity cartilage zone or cartilage disappearance and/or curvature (for example cartilage and/or skeleton) or size comprises and uses x ray, NMR (Nuclear Magnetic Resonance)-imaging (MRI), computer tomography scanning (CT is also referred to as axial tomoscan of computer or CAT), optical coherence tomography, SPECT, PET, ultrasound imaging techniques and optical image technology.(consult people's such as disclosed Alexander on the 21st March in 2002 the open case WO02/22014 of international monopoly; Gave people's such as Tsoref No. the 6th, 373,250, United States Patent (USP) on April 16th, 2002; (2002) actinology (Radiology) 222:430-436 with people such as Vandeberg).Use any dispensing path (for example, by vein, intraarticular etc.) can use contrast medium or other to strengthen reagent.

In certain embodiments, use CT or MRI assessment tissue, skeleton with wherein any damaged (for example cartilage infringement or morbidity cartilage zone) thus the acquisition information relevant and providing about on the form of damage field or the information on upward biochemical or the biomechanics with subchondral bone or cartilage decline.Particularly, use one or more these methods to may detect the change of crack for example, segment thickness or through thickness cartilage disappearance and remain endochondral signal change.For the discussion of basic NMR principle and technology, can consult MRI ultimate principle and application (MRI Basic Principles and Applications), second edition, MarkA.Brown and RichardC.Semelka, Wiley-Liss company limited (1999).(comprise conventional T1 and T2 weighting spin-echo imaging, gtadient echo (GRE) imaging, magnetic conversion contrast (MTC) imaging, fast spin echo (FSE) imaging, strengthen the contrast imaging, obtain lax the enhancing under (RARE) imaging, the steady statue fast and obtain gtadient echo (GRASS) and driven equilibrium fourier transform (DEFT) imaging) be used to obtain the discussion of the information relevant for MRI, consult people's such as Alexander WO 02/22014 with cartilage.Thereby, in a preferred embodiment, the measurement result that is obtained be based on obtained as the 3-dimensional image in the joint described in people's such as Alexander the WO 02/22014 or finally form many groups bidimensional image of 3D information.Can obtain cartilage two dimension, 3-D view or figure independent or that combine with the Move Mode (for example, bending to stretching, extension, translation and/or soft commentaries on classics) in joint.3-D view can comprise with Move Mode, contact point, two or more relative to the contact zones of articular surface and during move in the joint the mobile relevant information of contact point or band.Two dimension or 3-D view can comprise the information relevant with the biochemical component of articular cartilage.In addition, imaging technique can compare (for example) in time, and the up-to-date information relevant with type with the shape of required repair materials is provided.

Any imaging device described herein can also use (consulting hereinafter) in operation, for example use hand-held ultrasound and/or optical probe to make the articular surface imaging in surgical operation.

B. surgical operation is measured

In addition, or except above-mentioned non-interpolation imaging technique, can in operation, obtain measurement result, cartilage thickness and/or the cartilage of size in morbidity cartilage zone or cartilage disappearance zone or the measurement result of skeleton curvature at arthroscopy or disclosed arthrotomy intra-operative.Measurement result in the surgical operation can relate to or not relate to the actual contact with one or more articular surface zones.

The device that is applicable to the measurement result in the surgical operation that obtains cartilage or skeleton or other cartilage joint structure and generates the configuration figure on surface includes, but is not limited to Po Laxi polydisc and laser interferometer, and/or deformable material or device.(consult, for example gave people's such as Wooh No. the 6th, 382,028, United States Patent (USP) on May 17th, 2002; Gave people's such as Levesque 6,057,927 on May 2nd, 2000; Gave people's such as Yamane 5,523,843 on June 4th, 1996; Give 4,5,847,804 and 1997 on the November that December in 1998 was given people such as Sarver on the 8th Fujeda 5,684,562).

The Po Laxi polydisc of arranging the ring of light is concentrated in Fig. 3 A explanation.The ring of light with varied radius that the concentrated array projection of Po Laxi polydisc is well defined, these rings of light can be generated by laser or the white light through fiber-optic transfer.The Po Laxi polydisc can make and the ring of light can be projected on the cartilage surface attached to the end of endoscope apparatus (or attached on any probe, for example hand-held probe).Fig. 3 B explanation is through projecting to the fixedly example of the lip-deep Po Laxi polydisc of curvature.Can use one or more cameras (for example attached on the device) to catch the reflection of the ring of light.Use mathematical analysis to determine surperficial curvature.This curvature can (for example) be apparent on the watch-dog as the configuration figure of the colour code of cartilage surface then.In addition, can use the mathematical model of configuration figure to determine ideal surfac topography, replace any cartilage defect in institute's analyzed area.Also this ideal surfaced as calculated can be apparent in (for example dimension of 3 shown in Fig. 2 thickness chart) on the watch-dog, and can be used for selecting the surperficial curvature of substitution material or regrown material.

Fig. 4 shows the map that is produced by the ring of light in the set of projections on each condyle of femur (Po Laxi polydisc), has confirmed the variation effect in the surface profile on the tore of reflection.

Similarly, laser interferometer also can be attached to the end of endoscope apparatus.In addition, a little pick off is duplicated on the device determines cartilage surface or skeleton curvature to use phase shift interference to measure, thereby the striped pattern that produces cartilage surface is analyzed phase place vision figure (leading wave).The configuration figure of curvature as the colour code of cartilage surface can be revealed on the watch-dog then.In addition, can use the mathematical model of configuration figure to determine that ideal surfac topography is damaged with any cartilage or the skeleton that substitutes in institute's analyzed area.Also can be apparent in this ideal surfaced as calculated on the watch-dog and can be used for selecting substituting the curvature of cartilage.

The those skilled in the art will recognize easily, can use other technology that is used for optical measurement cartilage surface curvature under the situation that does not break away from category of the present invention.For example, can generate dimension of 2 shown in (for example) Fig. 5 and Fig. 6 or 3 dimension figure.

Mechanism also can be used for surgical operation measures, for example deformable material (example gel body, mold, any hardening material (for example non deformable material of ability when heating, cooling off or carrying out other operation)).Consult people's such as Dickson disclosed WO 02/34310 in 2 days Mays in 2002.For example, can use the deformable gelinite to condyle of femur.The gel side of pointing to joint can generate the former of the surface profile of joint.Then this former can be used for determining damaged size, the damaged degree of depth and damaged in or the curvature of articular surface on every side.This information can be used for selecting a kind of therapy, for example, and a kind of articular surface repair system.In another example, can use the hardening material to articular surface (for example condyle of femur or tibial plateau).Described hardening material can be stayed on the articular surface up to hardening.The hardening material can be removed from articular surface then.The hardening material side of pointing to articular surface can generate the former of articular surface.Then this former can be used for determining damaged size, the damaged degree of depth and damaged in or the curvature of articular surface on every side.This information can be used for selecting a kind of therapy, for example, and a kind of articular surface repair system.In some instances, hardening system can keep in place and form the articular surface repair system of reality.

In certain embodiments, deformable material comprises a plurality of mechanical organs that can move individually.When paying close attention to the surface when pushing down, the degree that can promote each element and its promotion (distortion) on relative direction can be corresponding to the curvature on pay close attention to surface.This device can comprise an arrestment mechanism, makes described element to be fixed on the position that conforms to the surface of cartilage and/or skeleton.Can and carry out the curvature analysis from removal device on one's body the patient then.Perhaps, each element that can move individually can comprise that indication is deformed to the labelling of the quantity and/or the degree of a given degree.Camera can be used in and device imaging and described image can be preserved and be used to analyze curvature information.Suitable labelling comprises the linear measurement (metric system or English system) that (but being not limited to) is actual, corresponding to the different darkness of not commensurability distortion and/or same hue and the different color of tone.Also can use electronic component to measure the displacement of displaceable element.

Other device of measuring cartilage and subchondral bone in the surgical operation comprises (for example) ultrasonic probe.(preferably hand-held) ultrasonic probe can be used to cartilage and the curvature of cartilage and/or subchondral bone can be measured.In addition, can assess the size of cartilage defect and can determine the thickness of articular cartilage.Can in A pattern, B pattern or C pattern, obtain this ultrasonic measurement.If obtain the measurement of A pattern, the operator can some different stylus orientation (for example, lateral oblique position and anteroposterior position) repeat these measurements usually so, to obtain the three-dimensional assessment of size, curvature and thickness.

The those skilled in the art will recognize easily, use optics, laser interferometer, machinery can make different probe design become possibility with ultrasonic probe.Probe is preferably in the formula of holding.In certain embodiments, probe or at least a portion probe generally are to be sterile with organizing contacted probe.Use sterile lid can realize aseptic, for example be similar to and 25 days February in 1999 of Lang disclosed among the disclosed WO 99/08598A1.

The analysis relevant with articular cartilage or subchondral bone of using imaging test and/or surgical operation measurement to carry out can be used for determining the size in morbidity cartilage or cartilage disappearance zone.For example, curvature can change suddenly in the zone of cartilage disappearance.This unexpected or unexpected boundary line that can be used for surveying morbidity cartilage or cartilage defect that changes of curvature.

II. the assessment on the single surface in joint

Forward Fig. 7 A now to, a structure chart is provided, shown the step of the assessment on the single surface that is used to carry out the joint.As Figure 1A and Figure 1B, it obtains the image or the measurement result 60 in target joint.Take a measuring method assisted Selection proper device correct damaged 70 thereafter.But repeated measure or image-forming step promote to discern most of proper device with repair deficiency 80 when needing.In case taked measuring method, just selected device is used to correct damaged 90.In this case, only duplicate a surface in joint.This technology is for comprising that the implant that the mechanism of skeleton is gone in the implant grappling is particularly useful.Thereby described implant has at least one surface, and it uses at least one second surface to duplicate articular surface, and the articular surface or the skeleton in described second surface and some or all damage joint to be repaired are related.

As be understood by those skilled in the art that as by shown in the arrow 38, the practitioner can be directly to the step of selecting suitable device to come repair deficiency 80 from the step of measuring joint damaged 70.In addition, obtain the target joint measurement result 60, measure the joint is damaged 70, identification is fit to device and come repair deficiency 80, selecting arrangement to come any or all steps in the repair deficiency 90 can repeat once when needed or once above 61,71,81,91.

Be similar to above-mentioned flow process, after selecting arrangement comes repair deficiency 90, as by shown in the arrow 65,66,67, obtain the target joint measurement 60, measure that the joint is damaged 70, the suitable device of identification comes the step of repair deficiency 80 to repeat serially or concurrently.

Fig. 7 B has shown a kind of alternate method.A structure chart is provided, has shown the step of the assessment on the single surface of carrying out the joint.As Figure 1A and Figure 1B, it obtains the image or the measurement result 60 in target joint.Take a measuring method assisted Selection proper device to correct damaged 70 thereafter.But repeated measure or image-forming step promote to discern most of proper device with repair deficiency 80 when needing.In case taked measuring method, just made a device and be used to correct damaged 92.

As be understood by those skilled in the art that as by shown in the arrow 39, the practitioner can be directly to the step of selecting manufacturing installation to come repair deficiency 92 from the step of measuring joint damaged 70.In addition, obtain the target joint measurement result 60, measure the joint is damaged 70, identification is fit to device and come repair deficiency 80, manufacturing installation to come any or all steps in the repair deficiency 92 can repeat once when needed or once above 61,71,81,93.

Be similar to above-mentioned flow process, after manufacturing installation comes repair deficiency 92, as by shown in the arrow 76,77,78, obtain the target joint measurement result 60, measure that the joint is damaged 70, the suitable device of identification comes the step of repair deficiency 80 to repeat serially or concurrently.

The whole bag of tricks promotes the joint modeling during being used in the assessment on single surface.For example, use the information relevant with curvature with the thickness of cartilage, the surface model that can produce articular cartilage and/or sending down the fishbone is used for any joint.The model representation in joint can be one dimension, two dimension or three-dimensional.Can comprise a physical model.On behalf of IA finite region, this physical model can maybe can contain whole joint.

More specifically, in knee joint, physical model only can be contained intermediary or lateral condyle of femur, condyle of femur and incision tract, intermediary tibial plateau, lateral tibial plateau, whole tibial plateau, intermediary Patella, lateral Patella, whole Patella or whole joint.The position of joint diseased region be can determine, the conversion of 3D Euclidean distance or Laplce's conversion described in people's such as 3D coordinate system or Alexander the WO02/22014 for example used.

By this way, can accurately determine damaged size to be repaired.As will be apparent, some, but be not whole damaged comprising less than whole cartilage.The positive regular incidence of measurement around one or more cartilage defects or only be the cartilage thickness of slight morbidity.Can on a single point or plurality of points, obtain this thickness measure result.Take many more measuring processs, it is accurate more and accurate that measurement result just becomes.Thereby, can be at (for example) the 2nd point, 4-6 point, 7-10 point, greater than 10 or whole residue cartilage place measuring.Can obtain the two and three dimensions measurement result.In addition, in case determine damaged size, can select relevant suitable therapy (for example, substitute equal or slightly greater than the implantation or the implant of the morbidity cartilage that covers one or more articular surfaces), make the surrounding tissue that can protect the health as much as possible.

Perhaps, the curvature that can measure articular surface or the sending down the fishbone repair materials that designs and/or formalize.In this case, the curvature that can measure residue thickness of cartilage and the articular surface repair materials that designs and/or formalize.Perhaps, can measure the curvature of subchondral bone, and the measurement result of the gained cartilage substitution material that can be used for designing, produce, select and/or formalizing.

III. joint arrangement

Current device is a prosthese.Outline projection by will having cartilage and/or skeleton now is determined the shape of prosthese or device on the effectively imitated form of natural joint structure.Device restores normal joint arrangement substantially and/or the surface that will be fit to or be fit to substantially is provided to the initial or natural articular surface of close-fitting relative articular surface.In addition, it can eliminate other decline in fact, because the conformable surface of device provides anatomical structure or approximate anatomical structure with the existing articular surface coupling in joint.Via the insertion of little (for example, 3cm is to 5cm) otch finishing device and do not need to excise skeleton or device is carried out mechanical fixation.Yet, be understood by those skilled in the art that, extra structure can be provided, for example transverse arm, fin, pin, tusk (for example taper, leg-of-mutton, spheric or conical projection) or contact pin, these structures can intensifiers more effectively be fixed on the ability on the articular surface.Can easily remove hyperosteogeny or other structure that countermeasure set is placed.By occupying the joint space in anatomical structure or the approximate anatomical structure, described device has improved the stability in joint and has restored the normal or approximate normal mechanical arrangement in joint.

By obtaining and analyze the device that the image of special object and design and patient's joint anatomical structure (cartilage and/or skeleton) conform to substantially, by considering above-mentioned existing articular surface anatomical structure, can determine the accurate dimension of device as herein described simultaneously.Thereby, can be the true form that individuality is made this device to measure.

Prosthetic appliance of the present invention can be to be fit to not that needs excise the Wicresoft of skeleton, the device that surgery is implanted.Described device can be attached on the skeleton (but not necessarily needing).For example, in knee, device can be undivided, that is to say, is located in a compartment, is normally placing the meniscus of nature in this compartment.The meniscus of nature can keep going up in position maybe can be with its all or part of removing, and this depends on its state.Under general situation, remove the first quarter moon plate of the nature that has been pulled off, and can repair the zone of damaged in case of necessity.Perhaps, removable all remaining meniscuss.This can finish by the cutting step that is used to insert device.For many implants, can also finish with the arthroscope method, produce the long otch of 1-15cm, but it is long to be preferably 1-8cm, and 1-4cm more preferably.

Implant as herein described can be in identical plane (before and after for example or the interior outside or downside or plane inclined) or is had the curvature and the radius of variation in a plurality of plane.By this way, thus the articular surface repair system that can formalize is realized the arrangement of anatomical structure between implant and implantation place or approximate anatomical structure.This design not only allows convex surface or concave surface in various degree, and allows the recessed portion in the main body convex or vice versa.Can have indefinite layout with the surface of the close-fitting implant in joint in repairing, it can be the physically impaired function to the articular surface in repairing.However, the those skilled in the art will recognize, can make implant based on common damage style.Can also make implant based on the normal coordination of the expectation that the preceding articulation structure of damage takes place.

In addition, make the change that shape took place that implant can solve apparent surface during move in the joint.Thereby implant can solve the change in the shape of bending, stretching, extension, abduction, rotation, translation, slip and the one or more articular surface of its Assemble Duration.

Device described herein preferably edge is transferable and self centering.Thereby, during connecting the joint naturally, allow device to do slight moving, or change its position in due course and be used for coordinating moving naturally of joint.Yet device is not free-floating in the joint.In addition, by move to the second position from primary importance during linear joint, when reverse linear joint and when arriving previous position, device is tending towards turning back to its original substantially position.As a result, device is not tending towards progressively " climbing " side to the compartment that it was positioned at.The self-centering performance of the indefinite layout on surface and the irregularly shaped a little promotion implant of implant.

Device also can be maintained fixed on an articular surface.For example, in knee joint, when condyle of femur moved freely on device, device can keep the middle position on tibia.With hypozygal surface closely the irregular a little shape of the implant of coupling help to realize this stability on the articular surface.

The IA motion of device described herein can be limited by the mill auxiliaries member according to circumstances when needed.These mechanical components can (for example) allow the device rotation, but do not allow its translation.It also can allow device translation in one direction, and anti-simultaneously locking apparatus moves to another direction and gets on.Described mechanical component can further be fixed on device in the joint, allows device to tilt simultaneously.Suitable mill auxiliaries member comprises ridge, pin, contact pin, cross member, tusk and projection.The configuration of these mechanical components can be parallel to each other, or non-parallel orientation.Described mechanical component can be taper, leg-of-mutton, spheric, the conical Any shape that maybe can realize effect.One or more mill auxiliaries members can be provided.Wherein, when an above mechanical component is provided, the whole surface that described mechanical component can cladding system, or part surface.Can provide other stable mechanical component, for example ridge, edge and along all or a part of outer surface thickening.

The implant shape also can combine with the shape in joint of (for example muscles and bones spine part) on its position location.Increase with tibia spine (for example, the base portion of tibia spine) concordance and can help the stable implant relative with tibial plateau.

Can select the height of selected implant or profile to change bearing capacity with respect to the joint.In addition, the height that can regulate implant solves skeleton or the topological structure of articulation structure on dissecting is undesired.In addition, for any implant that this paper explained, when running into laxity of ligament,, the height of scalable implant, profile or other size improve function thereby allowing to strain tough belting.Above behavior does not preferably interfere with the pivot awl of skeleton substantially and arranges.Usually, the joint can sustain the shearing force that is applied to 100% on the movable joint.

Implant of the present invention generally the motility in joint is returned to the special object joint natural motility 99%.For example, under the situation in the total joint of knee, scope is 0 to 140 ° usually.The current effective solution returns to the joint substantially the scope less than 99.9% usually.And implant of the present invention generally returns to range of movement between the 95-99.9% of patient's normal range.

The hands of the healthy male that National Institute of Standards and Tech (National Institute of Standards and Technology) (http://ovrt.nist.gov) obtains and the range of motion of arm have been described in the table 1.

Table 1

The range of activity of hands and shoulder joint

Joint motion	Average range (degree)	Scope (degree)
			Wrist flex	90	12
Wrist stretches	99	13
			Receive in the wrist	27	9
Wrist is launched	47	7
			Forearm is faced upward commentaries on classics	113	22
The forearm commentaries on classics of bowing	77	24
			The elbow bending	142	10
Shoulder is crooked	188	12
			Shoulder stretches	61	14
Receive in the shoulder	48	9
			Shoulder launches	134	17

The foot of the healthy male that National Institute of Standards and Tech (http://ovrt.nist.gov) obtains and the range of motion of lower limb have been described in the table 2.

Table 2

The range of activity of foot and leg joint

Joint motion	Average range (degree)	Scope (degree) S.D
			The ankle bending	35	7
Ankle stretches	38	12
			Receive in the ankle	24	9
Ankle launches	23	7
			Gonycampsis-stand	113	13
Gonycampsis-go down on one's kness	159	9

Gonycampsis tilts	125	10
			Knee joint rotation-centre	35	12
Knee joint rotation-side	43	12
			The hip bending	113	13
Receive in the hip	31	12
			Hip launches	53	12
Hip rotates-sits down (centre)	31	9
			Hip rotates-sits down (side)	30	9
Hip rotation-inclination (centre)	39	10
			Hip rotation-inclination (side)	34	10

Implant of the present invention generally should return to the range of movement of the one or more measurement of any joint in table 1 and table 2 between the 60-99.9% of patient's regular event scope, and is preferably between the 95-99.9% of patient's regular event scope.

As hereinafter more detailed discussion, any device that this paper explained can be made in various manners, makes device (for example) expand after insertion.Expansion can be automatically, and is automanual or regulated by user.

It then is illustrative example according to the joint implant of category of the present invention and explanation content.

A. knee

Fig. 8 A shows the perspective view of the joint implant of the present invention 100 that is adapted at the implantation of kneed tibial plateau place.Shown in Fig. 8 A, describe about Figure 1A and Figure 1B as mentioned, use the assessment of two surfaces to produce implant figure.

Implant 100 has a upper surface 102 and a lower surface 104 and a periphery 106.Forming upper surface 102 makes its formation hold the mating face of relative articular surface; Part is recessed to hold femur in this example.Concave surface can be variable concave surface, makes it present a surface to the relative articular surface similar in appearance to its corrigent joint mating face.Lower surface 104 has a convex surface, and the tibial plateau coupling or the approximate match in itself and joint make it produce an anatomical structure or an approximate anatomical structure of mating with the muscles and bones platform.According to the shape of tibial plateau, lower surface can the part epirelief.Thereby the tibial plateau that 104 pairs of lower surfaces are suitable in the existing surface presents a surface.As be understood by those skilled in the art that the convex surface of lower surface 104 does not need complete epirelief.And lower surface more than 104 is made up of to be suitable for the existing surface of tibial plateau convex and concave member.Thereby described surface comes down to variable convex and spill.

The vertical view of the implant of Fig. 8 B displayed map 8A.Shown in Fig. 8 B, the interior shape 108 of implant can extend.The form of elongation can adopt different shape, comprises ellipse, accurate ellipse, runway shape or the like.Yet as will be understood, inside dimension is normally irregular, thereby is not to form how much real ellipses.As be understood by those skilled in the art that the interior shape of the reality of implant is visual to be treated that corrigent joint is damaged and change.Thereby length L can change to 1.5 from (for example) 0.5 to the ratio of width W, and can change to 2.0 from 0.25 in particular.As Fig. 8 B further shown in, when getting along the width of implant, change across the length of the axle of implant 100.For example, shown in Fig. 8 B, L ₁≠ L ₂≠ L ₃

Turn to Fig. 8 C to Fig. 8 E now, its describe along shown in line C-C, D-D and the cross section of the implant shown in Fig. 8 B of E-E intercepting.Implant has thickness t 1, t2 and t3 respectively.As illustrated by cross section, the thickness of implant changes along its length L.The actual (real) thickness of the specific location of implant 100 is functions for the treatment of alternate cartilage and/or skeleton and joint mating face's to be duplicated thickness.In addition, the profile along the implant 100 of any position of implant 100 length and width is a function for the treatment of alternate cartilage and/or skeleton.

Fig. 8 F is the side view of the implant 100 of Fig. 8 A.In this example, the height h of the first end implant 100 ₁The height h that is different from the second end implant ₂In addition, top edge 108 can have an integral inclination on downward direction.Yet as described, the inclination of the reality of top edge 108 varies along its length and can be anacline in some instances.In addition, line edge 110 can have an integral inclination on downward direction, yet as described, the inclination of the reality of lower limb 110 varies along its length and can be anacline in some instances.

Fig. 8 G is the cross section that sagittal plane intercepted in the human body, and it shows that implant 100 is implanted in the knee joint 120, makes implant be on the tibial plateau 122 and femur 124 is positioned on the upper surface 102 of implant 100.Fig. 8 H is the cross section that coronal plane intercepted in the human body, and it shows that implant 100 is implanted in the knee joint 120.As from then on view is scrutable, implant 100 makes it be fit to higher articular surface 124 through the location.As be understood by those skilled in the art that articular surface can be intermediary or lateral when needing.

Fig. 8 I is the cross section that axial plane intercepted along human body, and it shows that implant 100 is implanted in the knee joint 120, shows from view aerial or that the top is seen.Fig. 8 J is the cross section of an alternate embodiment, and wherein, implant is a bit big a little, makes it extend near skeleton from middle (that is, towards the edge of tibial plateau, and previous and extension thereafter).

Fig. 8 K is the cross section according to the implant of the present invention 100 of alternate embodiment.In this embodiment, lower surface 104 further comprises joint anchor 112.Shown in embodiment like this, joint anchor 112 forms a projection, Os Draconis or the vertical element that extends from the lower surface 104 of implant 100, and is projected in the skeleton in (for example) joint.In addition, shown in Fig. 8 L, joint anchor 112 can have a cross member 114, makes joint anchor 112 see from the bottom and can present one forked or one " X ".As be understood by those skilled in the art that joint anchor 112 can be taked various other forms, still can be implemented in the same target of the stability that the implant increase is provided in the joint simultaneously.These forms include, but is not limited to contact pin, sphere, tusk, ball etc.One or more anchor 112 can be provided when needing in addition.

Device can have two or more assemblies, and one another is connected with distal femoral component substantially with the tight coupling in tibia surface in fact.Described two assemblies can have a smooth apparent surface.Perhaps, the apparent surface can be crooked.Curvature can be the map of tibia shape, and femur shape comprises shape and meniscal-like shape and its combination during the joint motions.Fig. 8 M and Fig. 8 N explanation is seen and from the side from the cross section of the alternate embodiment of two assembly implants of seeing previously.

Turn to Fig. 9 A to Fig. 9 F now, the implant that its demonstration is suitably for Fig. 8 A provides the implant of relative articular surface.This implant is corrected damaged (that is, (for example) and the tight paired femoral component of tibial plateau) on the inner surface of femur and can be used separately, that is, can be used on the femur, or be used in combination with another joint repair device.Fig. 9 A shows the perspective view of implant 150, and described implant 150 has the mating face 152 and the buttknuckle abutment surface 154 of a bending.Considering provides anchor 156 to promote being connected of implant and femur, and joint abutment surface 154 does not need to form an anatomical structure or an approximate anatomical structure with the femur coupling.In this example, anchor 156 is shown as the pin with recessed head.Recess promotes the grappling process in the femur.Yet, do not have the pin of recess to can be used as the pin that helps the grappling process with other configuration yet.The pin of implant and other parts can be that porous applies.Can cement skeleton or use skeleton binding agent and insert implant.Implant can be designed in abutting connection with subchondral bone, that is, it can be substantially after the profile of subchondral bone.This has advantage, need not to remove skeleton except substituting pin hole, thereby significantly protects the bone storage.As be understood by those skilled in the art that the multicompartment solution that hip joint is repaired in illustrated in fig. 9 being used to also can be applicable to intravital other joint of people.

Fig. 9 G and Fig. 9 H illustrate that the implant that is suitably for Fig. 8 A provides apparent surface's implant 151, and wherein said implant can cover condyle of femur and can face toward the implant of one or more Fig. 8 A according to circumstances.

Can design the appearance that the arthroplasty system reflects tibia shape and/or femur shape.Tibia shape and femur shape can comprise cartilage and skeleton.In addition, the shape of implant also can comprise some or all assemblies of other articulation structure (for example meniscus).Described meniscus is compressible, particularly during walking or load.For this reason, the implant appearance that can be designed to merge the meniscus shape solves meniscal compression problem during load or the body movement.For example, the lower surface of implant can be designed to mate the shape of tibial plateau (comprise cartilage or skeleton or its both).The high surfaces of implant can be the combination of tibia (especially in the zone that is not covered by meniscus) and meniscal articular surface.Thereby the profile of device can be a reflection of meniscus height.Compression can account for unpressed meniscus height (for example) 20%, 40%, 60% or 80%.

In certain embodiments, the profile of the device of reflection meniscus shape can be made by another kind of (preferably compression material) material.If the selection compressible material is preferably designed to so and mates meniscal compressibility and biomechanical property substantially.Whole device can be made by this class material or nonmetallic materials usually.

Can directly measure meniscal height and shape by an imaging test.As fruit part or all meniscuss all gone bad, so can be by measuring the offside joint or using the measurement of other articulation structure of the estimation that can provide relevant to obtain meniscal height and shape with the meniscus size.

In another embodiment, can be according to higher the setting of femur with implant.Preferably obtain shape, and then solve the problem of the variation in the femur shape and tibia femur contact area when condyle of femur bending on tibia and meniscus, stretching, extension, rotation, translation and slip from activity pattern with respect to the femur of tibial plateau.

Known current or following method of testing (for example, fluoroscopy, MRI, walking analysis and its combination) measurement activity pattern in the field under can using.

B. hip joint

Figure 10 A is the side view of the acetabular bone 200 of hip joint.Cartilage overlay area 202 has an inverse U-shaped.Triangle radiation cartilage zone or supraacetabular groove 204 are positioned at the cartilage overlay area.Figure 10 B is the rotation diagram of proximal femurs 210.Cartilage overlay area 202 and fovea of femoral head 206 have also been shown.

Turn to the implant that is fit to hip joint now, Figure 10 C is the cross section that is used for the implant of hip joint 220.In the time of any on the intercepting implant length, the radius r of this implant is fixed substantially.Can select the radius of implant to be approximately the inner surface radius that implant will be carried out corrigent capital radius and can be measured the capital implant 220 of engagement.Perhaps, can select the radius of implant to be approximately the radius of acetabular bone or its combination.The edge grain of the inner surface 222 of implant facing to femur and can with the radius of femur coupling or with the similar radius of acetabular bone; Facing to the radius of the implant surface of acetabular bone also can with the radius coupling of acetabular bone 224 or with the similar radius of femur;

Be understood by those skilled in the art that the natural geometry shape of acetabular bone generally is an aspheric surface, somewhat different than real sphere.Thereby the change radius that the radius of implant can be adjusted into acetabular bone in case of necessity provides better matching.Thereby the high surfaces of implant and/or inner surface can be sphere or aspheric on radius.

Figure 10 D is the cross section that is suitable for the implant of the similar hip joint of the hip joint seen with Figure 10 C, is characterised in that the edge 226 with a circle.Circular edge 226 is favourable, because it can be tending towards avoiding in use pinning implant, and minimizes any pain relevant with implant.

Figure 11 A is the cross section that is suitable for the implant 220 of the similar hip joint of the hip joint shown in Figure 10 C, this implant has a protrusion 230, and this protrusion 230 extends in the fovea of femoral head of femoral head 240 on the inner surface 222 of the fovea of femoral head of femoral head 240.Element 230 can be with making with implant 220 identical materials or the material that is different from the remainder of implant.Advantage with implant of a protrusion 230 that meshes fovea of femoral head is that described protrusion 230 can retrain implant 220 with respect to capital move (shown in Figure 10 B).As be understood by those skilled in the art that protrusion 230 can have various configurations, the same effect in the time of still can realizing by implantation engagement fovea of femoral head simultaneously.The various plane graphs that shown implant, have hemispheric, part is hemispheric or adopt the form of fence.Other shape will become apparent to those of ordinary skill in the art.In addition, the edge of implant can be circular, virtually any size bevel or that promote the implant operation.Figure 11 B is to the alternate embodiment of the implant shown in Figure 11 E key diagram 11A, implant wherein be hemispheric, part is hemispheric, the fence shape with spoke-like.

Figure 12 A is the cross section that is suitable for the implant 220 of hip joint, and this implant 220 has a flange 232, and this flange 232 extends in the supraacetabular groove 204 on the outer surface 224 of supraacetabular groove 204.Described flange 232 can be by making with implant 220 remainder identical materials or different materials.Described flange 232 can be used for retraining implant 220 moving with respect to supraacetabular groove.As be understood by those skilled in the art that flange 232 can have various configurations, the same effect in the time of still can realizing meshing supraacetabular groove simultaneously.The various plane graphs that shown implant, have hemispheric, part is hemispheric or adopt fence or the forms of four fork coronas.Other shape will become apparent to those of ordinary skill in the art.In addition, the edge of implant can be circular, virtually any size bevel or that promote the implant operation.Figure 12 B is to the alternate embodiment of the implant shown in Figure 12 E key diagram 12A, implant wherein be hemispheric, part is hemispheric, the fence shape with spoke-like.

Figure 13 A is the cross section of two assemblies " it is movable to bear a heavy burden " implant 221 with various plane graphs.Described implant has one first assembly 230 and one second assembly 231.First assembly and second assembly coupling and have two smooth surfaces.Second assembly is engaged in the outer surface of first assembly and also has two smooth surfaces.Under the situation that does not break away from category of the present invention, calculated various configurations all are fine.For example, each assembly can be hemispheric.An assembly can be hemispheric, and another assembly adopts the shapes of hemispherical, short hemispherical, fence of part or four fork domes.Figure 13 B is to the alternate embodiment of the implant shown in Figure 13 F key diagram 13A, implant wherein have at least one be hemispheric, part is hemispheric, the assembly fence shape or spoke-like.

Figure 13 G is the cross section of two assembly " it is movable to bear a heavy burden " implants to Figure 13 J.Described implant has one first assembly and one second assembly.First assembly and second assembly coupling.Second assembly is engaged in the outer surface of first assembly.As shown here, a protrusion is provided on second assembly, it is engaged in the breach on first assembly, as be understood by those skilled in the art that, although do not illustrate, under the situation that does not break away from category of the present invention, described protrusion can be positioned on first assembly and with the wellhole on second assembly and mate.As shown in the figure, also may on first assembly, provide other grappling mechanical component on second assembly or on both.Under the situation that does not break away from category of the present invention, calculated various configurations all are fine, and just illustrate.For example, each assembly can be hemispheric.An assembly can be hemispheric, and another assembly adopts the shapes of hemispherical, short slightly hemispherical, fence of part or four fork domes.

Figure 14 A is the cross section of two assembly " it is movable to bear a heavy burden " implants 240, and this implant 240 has a protrusion 246, and described protrusion extends in the capital fovea of femoral head 206.Two assembly implants 240 have one first assembly 242 and one second assembly 244.A protrusion 246 is provided on second assembly 244.It is described to be relevant to Figure 11 C as mentioned, and second assembly 244 that described protrusion 246 can be used for retraining implant 240 moves with respect to capital.First assembly 242 facing to acetabular bone can be with respect to moving freely facing to capital second assembly 244.As be understood by those skilled in the art that, can be configured two assembly implants and make the surface of first assembly 243 on surface of engagement second assembly 245 have identical length or identical substantially length.Thereby produce the pairing assembly that matches each other substantially.Perhaps, can be configured described assembly and make an assembly can be shorter than another assembly as shown in Figure 14 B and Figure 14 C.Figure 15 A is the cross section of another pair assembly " it is movable to bear a heavy burden " implant 240, and it has a flange 248 that extends in the supraacetabular groove.Two assembly implants 240 have one first assembly 242 and one second assembly 244.A flange 248 is provided on first assembly 242.Described flange 248 can be used for retraining first assembly 242 the moving with respect to acetabular bone of implant 240.Can move freely with respect to first assembly 242 facing to capital second assembly 244 facing to acetabular bone.It is described to be relevant to Figure 13 A as mentioned, also can be disposed the implant shown in Figure 15 A to make an assembly can be shorter than another assembly as shown in Figure 15 B and Figure 15 C.

Figure 16 A is the cross section of three assemblies " it is movable to bear a heavy burden " implant 250.First assembly 252 facing to hipbone has a protrusion 253 that extends in the acetabular bone 204.As indicated above, described protrusion 253 can be used for retraining implant 250 moving with respect to hipbone.Has a flange 255 that extends in the fovea of femoral head 206 facing to capital second assembly 254.Be relevant to unit piece as mentioned and the dual-element implant is described, second assembly 254 that described flange 255 can be used for retraining implant 250 moves with respect to capital.But the 3rd assembly 256 between other two assemblies and between move freely.As be understood by those skilled in the art that, the 3rd assembly 256 can be between first assembly 252 and second assembly 254, and the length that makes its length can be shorter than first assembly 252 and second assembly 254 (as shown in Figure 16 B) can be longer than the length (shown in Figure 16 C and Figure 16 D) of first assembly 252 and second assembly 254 again.Similarly, the length of the 3rd assembly also can be longer than the length of first assembly 252 and second assembly 254.

Figure 17 A is the cross section of another pair assembly " it is movable to bear a heavy burden " implant 240 of the implant shown in being similar to above.In this embodiment, provide anchor to make first assembly, 242 grappling supraacetabular grooves 204.Shown anchor is the form with one or more contact pins 262.Use two parallel pins of cardinal principle to be fixed on the acetabular bone facing to the assembly of acetabular bone.Can on first assembly 242, move freely facing to capital second assembly 244 facing to acetabular bone.As previous embodiment, can change with respect to the length of first assembly 242 of second assembly 244.Figure 17 B and Figure 17 C show alternate cross-sectional view, and wherein first assembly is greater than second assembly, and vice versa.As previous embodiment, under the situation that does not break away from category of the present invention, calculated various configurations all are fine.For example, each assembly can be hemispheric.An assembly can be hemispheric, and another assembly adopts the shapes of hemispherical, short slightly hemispherical, fence of part or four fork domes.

Figure 18 A is the cross section of another pair assembly " it is movable to bear a heavy burden " implant 240, and this implant 240 has the anchor that extends in the supraacetabular groove 204.Adopt the form of projection facing to the anchor of acetabular bone, this projection has one or more fins 264.Can on first assembly 242, move freely facing to capital second assembly 244 facing to acetabular bone.Figure 18 B is the view of the implant of Figure 18 A of seeing from the top, four fins on its display element top (264,264 ', 264 ", 264 ) extend in the supraacetabular groove on the acetabular bone assembly top.Described fin can be point or the sharp substantially limit that maybe can have circle as shown in the figure.

Figure 19 A is the cross section of another pair assembly " it is movable to bear a heavy burden " implant 240, and this implant 240 has an anchor 266 that can extend in the capital fovea of femoral head 206.In the embodiment shown, use one or more parallel substantially pins (be shown as 268,268 ') to be fixed on the femoral head facing to capital second assembly 244.Shown in previous embodiment, first assembly 242 is facing to acetabular bone, and can move freely on facing to capital assembly.

Figure 19 B is the cross section of another pair assembly implant 240.In this embodiment, two assemblies 240 are fixed.As explanation herein, use 3 pins or other adhering member that distal femoral component is attached on the femoral head.The number of pin can be greater than or less than 3 when needing.Preferably, subchondral bone keeps this complete design except the inlet point of pin.Use fin 264 or the similar for example adhering member of pin (shown in Figure 17 A) that the acetabular bone assembly is attached on the acetabular bone.Adhering member can be molded in the supraacetabular groove, and element is extended in the femur.Except that entering the zone of adhering member, preferred subchondral bone also remains unchanged.

Figure 20 A is the radius (r with variation that is used for hip joint ₁, r ₂, r ₃) and thickness (t ₁, t ₂, t ₃) the cross section of implant 470; R wherein ₁≠ r ₂≠ r ₃And thickness t ₁≠ t ₂≠ t ₃As be understood by those skilled in the art that, adopt three measured values of radius and thickness to illustrate a little, but under the situation that does not break away from category of the present invention, can use more or measured value still less.In addition, can use other combination of radius and thickness, for example, r ₁=r ₂≠ r ₃, r ₁≠ r ₂=r ₃, t ₁=t ₂≠ t ₃And t ₁≠ t ₂=t ₃Other combination will become apparent to those of ordinary skill in the art.As the explanation among Figure 20 A, core c has than one or two outer peripheral portion p ₁, p ₂Relative thicker thickness t.

Figure 20 B is the cross section that is used for the alternative implant 470 of the radius with variation of hip joint and thickness.In this embodiment, core c has than one or more outer peripheral portions (p ₁, p ₂) relatively thin thickness t _c

Figure 20 C is the cross section that is used for the alternative implant 470 of the radius with variation of hip joint and thickness.In this embodiment, core c has than the terminal p of first periphery ₁Thickness t ₁Relatively thin thickness t _c, and than the terminal p of second periphery of outer peripheral portion ₂Thickness t ₂Thicker relatively.

Figure 20 D is the cross section that is used for the alternative implant 470 of hip joint, and this alternative implant 470 has the L of extending upward _iAnd/or the L that extends downwards _sOne or more edges or grappling extension.Edge designs one-tenth is extended beyond articular surface and enters (for example) non-cartilage zone.It can be consistent with anatomical structure on every side, periphery substantially.The edge can provide extra stability.This design can reach " it is movable to bear a heavy burden " design with two assemblies and three assemblies and combine.

As be understood by those skilled in the art that the spatial form of the implant shown in Figure 10 to 20 can be one dimension or the semicircle more than the one dimension (promptly 180 °), but this might not need.When implant was semicircle in all dimensions, described implant formed one hemispherical (that is to say, by half the spheroid that passes with a plane that its center cutting obtains).When implant at some, but be not when being semicircle in whole dimensions, its shape can not be hemispherical just.Face in the higher and lower side of this shape or two faces be can right and wrong spherical to be used to coordinate acetabular bone.In addition, when having more than one assembly, can use the combination of 3D shape.For example, first assembly can be hemispheric, and second lose and be not, or the like.

In addition, when these implants are shown as when having one to three assembly, should be appreciated that under the situation that does not break away from category of the present invention, each assembly can further be modified to intermeshing plurality of element.

The those skilled in the art should be further appreciated that the design that Figure 10 is explained in Figure 20 considers that item can be used for being other joint designs implant, for example knee, ankle, shoulder, elbow and wrist.For fear of making the present invention become ambiguous, all possible configuration of the implant that this paper explained does not all have diagram.

C. take on

Figure 21 A is the front view of the bone structure in the shoulder joint 300, and described shoulder joint is clavicle 302, scapula 304, shoulder mortar 306, acromion 308, processus coracoideus 310 and humerus 312 for example.By oblique line indication cartilage overlay area 314,316.

Figure 21 B is the view that places the arthroplasty device 320 between upper arm head 313 and the shoulder mortar 306.Arthroplasty device 320 can have to Fig. 4 A to the similar design feature of design feature shown in Fig. 4 R, for example plurality of element, the movable design of bearing a heavy burden, adhere to the design of non-cohesive design, thickness and curvature, with upper arm head 313 or shoulder mortar 306 or its both corresponding to designs, with articular cartilage and/or the corresponding to design of subchondral bone, have the edge or the circuit elements design that are used for stablizing purpose with variation.

Figure 21 C is the inclination cross-sectional view of arthroplasty device 320, and it has to the corresponding to humerus contact surface 322 of the shape of small part and upper arm head 313 with to the shape corresponding to shoulder mortar contact surface 324 of small part with shoulder mortar 306.

Figure 21 D is the axial cross-sectional view of arthroplasty device 520, its have with the corresponding to humerus contact surface 322 of the shape of upper arm head and with the shoulder mortar 306 the corresponding to shoulder mortar of shape contact surface 324.

Figure 21 E is the inclination front view of shoulder joint, its illustrate respectively articular cartilage 316 and last broad-mouthed receptacle for holding liquid lip 306 ' and following broad-mouthed receptacle for holding liquid lip 306 ".Figure 21 F is the axial view of shoulder joint, its illustrate respectively articular cartilage 316 and preceding broad-mouthed receptacle for holding liquid lip 307 ' and back broad-mouthed receptacle for holding liquid lip 307 ".

Figure 21 G is the inclination normal cross-section figure of arthroplasty device 320, its have with the corresponding to humerus contact surface 322 of the shape of upper arm head 313 and with shoulder mortar 306 and broad-mouthed receptacle for holding liquid lip (306 ', the corresponding to shoulder mortar of the shape of 306 ") contact surface 324.Figure 21 H is the axial cross-sectional view of the arthroplasty device 320 shown in Figure 21 G.As mentioned, a corresponding to humerus contact surface 322 of the shape with upper arm head 313 is provided and the corresponding to shoulder mortar of a shape contact surface 324 with shoulder mortar 306 and broad-mouthed receptacle for holding liquid lip is provided.

Figure 21 I is the inclination normal cross-section figure of the alternate embodiment of arthroplasty device 340, its have with the corresponding to humerus contact surface 342 of the shape of upper arm head 313 and with the shoulder mortar 306 the corresponding to substantially shoulder mortar of shape contact surface 344.Can be provided at the top and/or below the one or more flange that extends or edge 346,346 '.The stability that provides on the shoulder mortar can be provided at described edge.Figure 21 J is the axial cross-sectional view of the arthroplasty device 340 shown in Figure 21 I, its have with the corresponding to humerus contact surface 342 of the shape of upper arm head 313 and with the shoulder mortar 306 the corresponding to substantially shoulder mortar of shape contact surface 344.Can be provided at the top and/or below one or more edges 346 of extending ", 346 provide the stability on the shoulder mortar 306.

Figure 21 K is two assemblies, the inclination normal cross-section figure of " it is movable to bear a heavy burden " arthroplasty device 350, its have with the humerus contact surface 354 of corresponding to first assembly 351 of at least a portion upper arm head and with the shoulder mortar contact surface 354 of corresponding to second assembly 353 of shape of at least a portion shoulder mortar.As be understood by those skilled in the art that, the radius of two joint implant surfaces can through select with coupling mate humerus substantially or shoulder mortar or its both.In addition, implant can have with humerus or take on the consistent substantially or consistent as far as possible contact surface of mortar to realize required rectification and functional effect.In addition, the center of rotation of the center of rotation on two joint implant surfaces 356,358 and upper arm head mates substantially.As be understood by those skilled in the art that two joint implant surfaces 356,358 can have the Any shape that comprises the plane.

Figure 21 L is the two assemblies shown in Figure 21 K, the axial cross-sectional view of " it is movable to bear a heavy burden " arthroplasty device.Dispose humerus contact surface 352 in this embodiment as shown in the figure and make that the shape of itself and upper arm head 313 is unanimous on the whole, and configuration shoulder mortar contact surface 354 makes that its shape with shoulder mortar 306 is unanimous on the whole in this embodiment.The radius on two joint implant surfaces can be through selecting with coupling humerus, shoulder mortar or its both surface.In addition, the center of rotation on two joint implant surfaces can be through selecting to mate the center of rotation of upper arm head substantially.Figure 21 M is an alternate embodiment, and it shows that implant has one at the breach on first assembly and the spheroid on second assembly.The configuration that can reverse breach and spheroid makes that it is positioned at facing surfaces under the situation that does not break away from category of the present invention.As will be understood, shown spheroid and nest are arranged and will be promoted relative to each other mobile of implant assembly, but can help prevent assembly unnecessary movement in operation.

Figure 21 N is two assemblies, the inclination normal cross-section figure of another embodiment of " it is movable to bear a heavy burden " arthroplasty device 360.Implant 360 has one first assembly 362 and one second assembly 364.Shoulder acetabular component 364 is configured and has two surfaces.First surface 363 is configured and is relative with first assembly, 362 joints.Second surface 363 is configured to and takes on mortar 306 pairings.Use one or more anchors 365 with second or the shoulder acetabular component 364 be attached to the shoulder mortar on.Form or other suitable being configured to that anchor 365 can be pin or fin realize takeing on acetabular component 364 and the required result who takes on the mortar grappling.Can these pins or fin are bonding, porous applies or its both.Similarly, can the shoulder mortar contact surface 363 of assembly 362 is bonding, porous applies or its both.Preferably only anchor 365 extends in the subchondral bone.

Figure 21 O is two assemblies, the inclination normal cross-section figure of the alternate embodiment of " it is movable to bear a heavy burden " arthroplasty device 370.Use attachment mechanism (for example spike 373 shown in pin, fin or the embodiment like this) that humerus contact assembly 372 is attached on the upper arm head 312.These pins, fin, tooth (teeth) or spike can be carried out that bonding, porous applies or its both.Similarly, the lower surface of humeral component can be carried out bonding or porous applies or its both.Preferably only attachment mechanism self (that is, pin, fin or spike) may extend in the subchondral bone.Described pin, fin, tooth or spike can be the flange of taper, conical, leg-of-mutton, spheric, coronal or any kind and random arrangement or in an organized way be configured (for example, row) from the teeth outwards.As described herein, the shoulder mortar side in joint has an articular cartilage 374.Implant 370 can be designed to that both are consistent with articular cartilage 374 or subchondral bone or its.As shown in Figure 21 P and 21Q, fin and spike can have other length and can be configured makes fin parallel to each other.

In another embodiment, implant can be suitable for soft tissue injury.For example, in the incident that rotation flesh tendon is torn, implant can have the some or all top scopes that cover upper arm head.By this way, the senior transplanting of the upper arm head that carries out after soft commentaries on classics flesh tendon is torn does not cause the pathology joint in upper arm head and shoulder lock joint, produces pain and deformity.As an alternative, the top of upper arm head can be connected with the extending element of implant, and then avoided the eburnation in AC joint.

D. elbow

Figure 22 is the vertical view of inclination that passes elbow joint 600, its distal humerus 602 of having demonstrated, olecranon 604 and head of radius 606.Respectively by 603,605,607 visible cartilage surfaces.Illustrated arthroplasty device 620 is being connected between the surface on distal humerus and ulna 608 and radius 610.Arthroplasty device 620 can have and be relevant to Figure 10 to the same design feature of design feature shown in the device shown in Figure 20, for example unimodule, two assembly, three assemblies; The movable design of bearing a heavy burden; Adhere to the design of non-cohesive design, thickness and curvature, make up corresponding to design with humerus or ulna or radius or its with variation, with articular cartilage and/or the corresponding to design of subchondral bone, have the edge or the circuit elements design that are used for stablizing purpose.Yet for fear of making the present invention ambiguous, the design of being explained in this application case considers that each possible change of item does not all have this joint is described.

E. carpal joint

Figure 23 A is the vertical view that passes carpal joint 700, its distal humerus 702 of having demonstrated, ulna 704 and form some carpal bones of carpal row 706 (for example nut bone, lunar, triquetrum, magnum and collude the shape bone).Illustrated arthroplasty device 720 be between distal humerus 702, ulna far-end 704 and carpal row near-end be connected surface 706 ', 706 ", between 706 .The shape of the shape of arthroplasty device 720 and distal radius 702, the shape of carpal row near-end 706 and the TFC 708 (dotted line) in this example is consistent.

As be understood by those skilled in the art that arthroplasty device 720 can have and be relevant to the same design feature of design feature that Figure 10 describes to the device shown in Figure 20, for example unimodule, two assembly, three assemblies; The movable design of bearing a heavy burden; Adhere to (for example, being attached on the distal radius) and non-cohesive design, thickness and curvature with variation design, with radius or ulna or carpal bone or its make up corresponding to design, with articular cartilage and/or subchondral bone and also with the corresponding to design of other articulation structure of for example TFC, have the edge or the circuit elements design that are used for stablizing purpose.

Figure 23 B is the vertical view by carpal joint 700, its explanation distal radius 702, ulna 704 and form some carpal bones of carpal row 706 (for example nut bone, lunar, triquetrum, magnum and collude the shape bone).Illustrated arthroplasty device 720 be between distal humerus 702, ulna far-end 704 and carpal row near-end 706 be connected surface 706 ', 706 ", between 706 .Arthroplasty device 720 is configured and makes that its shape with the shape of the shape of at least a portion distal radius 702, ulna far-end 704 and carpal row near-end 706 is consistent.

Figure 23 C still passes vertical view of carpal joint 700, its distal radius 702 of having demonstrated, ulna 704 and some carpal bones 706.Shown arthroplasty device 730 be between distal humerus 702, ulna far-end 704 and near-end carpal row (carpal row) 706 be connected surface 706 ', 706 ", between 706 .The shape of shown arthroplasty device 730 and distal radius 702, the shape of carpal row near-end 706 and comprise that the shape of ulna far-end 704 of processus styloideus ulnae 710 is unanimous on the whole.Being seen edge 732 is along the middle part of distal radius and comprise that the sidepiece of the ulna far-end 704 of processus styloideus ulnae 710 extends; The stability of implant with respect to these skeletons can be provided like this.One or more edges 732, or other flange that is fit to configuration can extend towards the back or the middle part of any ossa articularia.

Figure 23 D is two assemblies, vertical view of " it is movable to bear a heavy burden " arthroplasty device 740.Described device 740 has one first assembly 742 and one second assembly 744.Each assembly has the surface 743,745 that is connected with the surface of other assembly.Two radiuses that connect implant surface can be through selecting with coupling radius 702 or ulna 704 or carpal bone 706 or its combination.In addition, two center of rotation that connect implant surfaces can be through selecting with coupling or near the center of rotation in joint 700.As be understood by those skilled in the art that two connect the Any shape that implant surface 743,745 can have the promotion joint motion, comprise the plane.The edge 746,748 of noting the near-end assembly extends in centre and side.The edge also can extend towards back and middle part.

Figure 23 E is another pair assembly, and vertical view of " it is movable to bear a heavy burden " arthroplasty device 750 does not have the edge under this situation.Described device 750 has one first assembly 752 and one second assembly 754.Each assembly has the surface 753,755 that is connected with the surface of other assembly.Can see obviously that from cross-sectional view the length on the connection surface 753 of first assembly is longer than the length on the connection surface 755 of second assembly.

Figure 23 F is a two assembly, vertical view of " it is movable to bear a heavy burden " arthroplasty device 760.As described, use an attachment mechanism or anchor 766 to be attached on these skeletons facing to first assembly 762 of radius and ulna.Suitable anchor 766 comprises pin, and as shown in this embodiment, spike and/or fin are not enumerated.As be understood by those skilled in the art that the adhering to be limited to and only be attached to (for example, ulna or radius) on the skeleton of device 760.

F. point

Figure 24 is the radially figure that passes finger 800.Illustrated arthroplasty device 820 is between the base portion of head of metacarpal bone 802 and proximal extremity of phalanx of finger 804.The side 824 that one side 822 of described arthroplasty device 820 is consistent with the shape of head of metacarpal bone 802 and it is relative and the base portion unanimity of proximal extremity of phalanx of finger 804.Arthroplasty device 820 can have with Figure 10 to the same design feature of design feature seen in fig. 20, for example unimodule, two assembly, three assemblies; The movable design of bearing a heavy burden; Adhere to (for example, being attached on the base portion of head of metacarpal bone or phalanges) and non-cohesive design, thickness and curvature with variation design, with near-end or distal joint surface or its make up corresponding to design, with articular cartilage and/or subchondral bone and also with the corresponding to design of other articulation structure, have the edge or the circuit elements design that are used for stablizing purpose.Similar design can be applicable to metapedes, mesopodium and front foot, comprises toe.

G. ankle

Figure 25 A is the radially figure that passes ankle joint 900, and it shows distal tibial 902, astragalus 904 and calcaneus 906 and other skeleton.Also shown cartilage surface.Illustrated arthroplasty device 920 is between distal tibial 902 and talar dome904 '.In this embodiment, arthroplasty system 920 is consistent with the shape of astragalus 904.As be understood by those skilled in the art that, and be before to discuss, device can be consistent with cartilage or subchondral bone or its both shape.Arthroplasty device 920 can have design feature, for example unimodule, two assembly, three assemblies like the Design of device feature class illustrated in fig. 20 with Figure 10; The movable design of bearing a heavy burden; Adhere to the design of non-cohesive design, thickness and curvature, with tibia or astragalus or the corresponding to design of fibula, with articular cartilage and/or the corresponding to design of subchondral bone, have the edge or the circuit elements design that are used for stablizing purpose with variation.

Figure 25 B is the coronal section figure that passes ankle joint 900, and it illustrates distal tibial 902, distal fibular 908 and astragalus 904.Illustrated arthroplasty device 930 be between distal tibial 902 and tibial astragaloid joint face (talar dome) 904 ' between.In this example, shown arthroplasty system 930 is consistent with the shape of astragalus 904.

Figure 25 C is the radially figure that passes ankle joint 900, and it illustrates distal tibial 902, astragalus 904 and calcaneus 906 and other skeleton.Also shown cartilage surface.Described arthroplasty device 940 be between distal tibial 902 and tibial astragaloid joint face 904 ' between, in this example, the shape of the lower surface of arthroplasty system 942 and astragalus 904 is unanimous on the whole.Upper surface 944 is unanimous on the whole with the shape of distal tibial 902 and fibula (908, not shown).Shown edge 946 is on the upper surface 942 of engagement astragalus 904.

Figure 25 D is the coronal section figure that passes ankle joint 900, and it illustrates distal tibial 902, distal fibular 908 and astragalus 904.Shown arthroplasty device 950 be between distal tibial 902 and tibial astragaloid joint face 904 ' between.In this example, the lower surface 952 of arthroplasty system is consistent with the shape of astragalus 904.Upper surface 954 is consistent with the shape of distal tibial 902 and fibula 908.

H. toe

Figure 26 is the radially figure that passes toe 1000.Illustrated arthroplasty device 1020 is between the base portion of head of metacarpal bone 1002 with proximal phalanx 1004.The first surface 1022 of illustrated arthroplasty device 1020 is consistent with the shape of head of metacarpal bone and second surface 1024 is consistent with the base portion of proximal phalanx.As be understood by those skilled in the art that, arthroplasty device can have with Figure 10 to design feature similar design feature seen in fig. 20, for example unimodule, two assembly, three assemblies; The movable design of bearing a heavy burden; Adhere to (for example, being attached on the base portion of head of metacarpal bone or phalanges) and non-cohesive design, thickness and curvature with variation design, with near-end or distal joint surface or its make up corresponding to design, with articular cartilage and/or subchondral bone and also with the corresponding to design of other articulation structure, have the edge or the circuit elements design that are used for stablizing purpose.Similar design can be applicable to metapedes, mesopodium and front foot.

D. install manufacturing, combination and characteristic

Can be from affiliated field known various suitable material preparation devices mentioned above, or any device of making of explanation according to the present invention.The material that discovery is useful on the broad variety in the example of the present invention includes, but is not limited to plastics, metal, pottery, biomaterial (for example collagen or other cell epimatrix material), hydroxyapatite, cell (for example stem cell, chondrocyte etc.), or its combination.Based on damaged and/or articular surface and/or the relevant information of subchondral bone, can select a kind of suitable material.In addition, use one or more technology in these technology as herein described, can form the cartilage with sweep and replace part or regrown material, described sweep can mate specific cartilage defect, the profile and the shape of articular surface can be met, and the thickness of cartilage on every side can be mated.In addition, use one or more technology in these technology as herein described, the joint arrangement that can be shaped, it can mate and can meet the profile and the shape of articular surface or other articulation structure in joint space.Described material can comprise the combination of material, and preferably includes at least one non-substantially easy bent material.

In addition, material can have a hardness gradient.Thereby for example hardness gradient can reduce to outward flange from the center of device.Thereby produce a kind of device, it has comprehensively firm, but for along the surface of some or all outer surface, having a spot of flexibility.The ability that provides the outer surface of being made by the material with some flexibility can improve implant is come and the joint pairing.Perhaps, in some cases, the outer surface that can produce a kind of device has the device greater than the Shore hardnes figure of its inside.

The inside hardness of device can make implant be adapted at intraarticular and carry out.Suitable hardness will become apparent to those of ordinary skill in the art and can comprise a scope.Usually, weigh according to Shore hardness hardness is discussed, and its scope can be from common engineering level material plastics to strengthening steel and titanium, and preferably about typical rockwell hardness scale part, duroplasts and the ceramic material of steel.From required high rigidity device, the mode of clearly installing to be different from prior art fully operates.The purpose of device of the present invention be realize being similar to across effect come the damaged zone of bridge joint.Yet in compound variation, any unimodule (as bioactive materials assembly hereinafter described) can be softer than supporting material.

Current, articular repair system (comprising device) uses metal and/or polymeric material.Consult the United States Patent (USP) the 6th of giving people such as Afriat on (for example) March calendar year 2001 20,203, No. 576, give people's such as Fell United States Patent (USP) the 6th March 27 calendar year 2001,206, No. 927, give people's such as Ogle No. the 6th, 322,588, United States Patent (USP) and the reference of wherein quoting with November 27 calendar year 2001.Similarly, the metal of broad variety is found to can be used in the example of the present invention, and can select based on any standard, for example, provides required flintiness based on elasticity.Nonrestrictive suitable metal example comprises silver, gold, platinum, palladium, iridium, copper, stannum, lead, antimony, bismuth, zinc, titanium, cobalt, rustless steel, nickel, ferroalloy, cobalt alloy (for example dust Er Jiluoyi alloy (Elgiloy), cobalt chrome-nickel and MP35N, Ni, Co, Cr molybdenum alloy, and Nitinol ^TM, Nitinol, aluminum, manganese, ferrum, tantalum and can slowly form polyvalent metal ferrum and come (for example) to suppress or organize calcific other metal and its combination of contacted implantation substrate with patient's body fluid.

Suitable synthetic polymer is including but not limited to polyamide (for example nylon), polyester, polystyrene, polyacrylate, polyvinyl (for example, polyethylene, politef, polypropylene and polrvinyl chloride), Merlon, polyurethane, polydimethylsiloxane, cellulose acetate, polymethacrylates, polyether-ether-ketone, PEKK, ethylene ethylene acetate, polysulfones, nylon fiber element, similar copolymer and its mixture.Also can use biology to absorb synthetic polymer again, for example dextran, hetastarch, gel derived thing, poly-N-ethyl pyrrole N-pyridine ketone, poly-ethyl alcohol, poly-[N-(2-hydroxypropyl) methacryl], poly-(hydroxy acid), poly-(ε caprolactam), polylactic acid, polyglycolic acid, poly-(dimethyl ethanol acid), poly-(hydroxybutyric acid), and also can use similar polymer.

Can use any the whole bag of tricks to prepare these polymer, comprise conventional polymer treatment method.Preferable methods comprises (for example) injection moulding, and it is applicable to produces the polymer assemblies with remarkable architectural feature; And quick forming method, for example reactive injection moulding and stereosopic printing art.Substrate can have rough surface or become cellular to promote the metal coating combination by physical abrasion or chemical improvement.

Polymer can be through being injected into a mold, the appearance of its reflection articular surface or other articulation structure.

Can be used in combination more than one metal and/or polymer.And also can use liquid metal.For example, can use one or more the one or more zone of containing metal substrate of polymer-coated, perhaps, can use one or more washing to contain the one or more zone of the substrate of polymer.

Device or its part can be porous or have the porous coating.The porous surface assembly can be made by the various materials that comprise metal, pottery and polymer.These surface components can be then be enclosed in a lot of structural types of being formed by various materials in the heart by various members.Suitable porous applies and includes, but is not limited to metal, pottery, polymer (for example, for example bio-neutral elastomer of silicone rubber, polyethylene terephthalate and/or its combination) or its combination.Consult, for example JIUYUE in 1971 was given people's such as Hahn United States Patent (USP) the 3rd, 605 on the 20th, the United States Patent (USP) of giving Tronzo on April 23rd, No. 123 1 was given the United States Patent (USP) the 3rd of Tronzo on October 29th, the 3rd, 808, No. 606 1,843, the United States Patent (USP) the 3rd of Scharchach was given in No. 975, the United States Patent (USP) of giving Smith on October 26th, the 3rd, 314, No. 420 1,987, No. the 2nd, 306,552, No. 499 and German Offenlegungsschrift.Can have more than one coating and described coating and can have identical or different porous.Consult, for example gave people's such as Kahn No. the 3rd, 938,198, United States Patent (USP) on February 17th, 1976.

Can apply coating up to the coating that formation has the inside net of interconnection aperture by around core, using polymer powder and heating.The flexibility of aperture (length in path of for example passing aperture is to the measurement of diameter) is very important for the success rate that the such coating of assessment is used on the prosthetic appliance.Still consult No. 4,213,816, United States Patent (USP) giving Morris on July 22nd, 1980.Available powder and particulate form stand that as a whole the high temperature of powder-stuck on substrate is applied porous and apply.Consider the explanation of this paper and the reference of being quoted, (for example) can be determined polymer and/or powder coating are carried out suitable selection based on the melt index of each.

Any device described herein also can comprise one or more biomaterials, can use the inclusive NAND biomaterial to be used in combination separately.The limiting examples of biomaterial comprises cell (for example fetus chondrocyte), biopolymer (for example, the polysaccharide of collagen, elastin laminin, silkworm silk, keratin, gel, polyamino acid, cat internal organs structure, the stitching of cat intestinal pin, for example cellulose and starch), autograft, allograft, xenograft etc.Consult the nineteen ninety-five December and gave the 5th of people such as Slivka on the 26th, 478, December was given people's such as Naughton on the 1st in No. 739,1998,5,842, No. 477, calendar year 2001 JIUYUE gave the 6th of people such as Vibe-Hansen on the 4th, 283, No. 980 and gave the 6th, 365, No. 405 United States Patent (USP)s of people such as Salzmann on February 4th, 2002.

In certain embodiments, device can comprise one or more independently (but preferably engageable) assemblies.For example, two devices can comprise two assemblies, and wherein each assembly comprises a pairing face.Two assemblies can be interlockings.When paired with each other, the face that becomes profile toward each other and form a device, described device be installed in treat corrigent damaged in and an articular surface of simulating or duplicate the articular surface of nature is provided.Can use any suitable mutual interlocking gear, comprise removable (for example keyway) system; The interlocking button; Sphere and keyway interlock system; Groove and flanged system etc.In certain embodiments, engageable assembly surface is crooked.Curvature can reflect one or more articulation structures.

In other embodiments, device is configured in to be fit into and can changes after the joint.Thereby, device can be designed to initial structure.After the installation, described device takes (assume) to be different from the structure subsequently of initial construction.For example, described device can be the multicompartment device, and in first structure, it has little profile or little 3D shape.After the installation, the surgeon allows (or impelling) device to take second structure, and it can have bigger profile or whole three dimensional shapes.Described device can form its secondary structure voluntarily, perhaps can form the secondary structure through manipulation, for example by mechanical component (for example launching the assembly of the described device or the device respect to one another that slides so that it takes the second bigger structure).The advantage of these embodiment be need be littler otch.Described device can (for example) be installed under arthroscope by this way.Thereby, can automatically semi-automatically or manually take structure subsequently.

Described method of text and combination can be used for only replacing the part articular surface, for example, and morbidity cartilage on the articular surface or disappearance cartilage zone.In these systems, can design the articular surface repair system and only replace extensible morbidity or the disappearance cartilage of exceeding of morbidity or disappearance cartilage zone or its, for example enter the cartilage 3 or the 5mm of normal vicinity.In certain embodiments, prosthese is replaced and (for example is not more than about articular surface of 70% to 80%, the any given articular surface of single condyle of femur etc.), preferably less than about 50% to 70% (or any value wherein), preferably less than about 30% to 50% (or any value wherein), preferably less than about 20% to 30% (or any value wherein), even preferably less than about 20% articular surface.

E. substitute attachment mechanism

As be understood by those skilled in the art that, can provide various attachment mechanisms with implant attached in the target joint.For example, attachment mechanism can be other flange of ridge, pin, contact pin, cross member and engagement implant mating face.These flanges or mechanism can have different shape and cross section, comprise taper, triangle, taper shape, sphere, cylindrical, annular etc.Single attachment mechanism can be used or plurality of mechanisms can be used when needing.The combination that can use described shape is to realize better replacement.When using plurality of mechanisms, can organized form (for example, row, circle etc.) or mixed and disorderly (at random) form form described mechanism.A cone shape part is provided on the lower surface of implant.In addition, when having used more than one attachment mechanism, direction respect to one another can be parallel or nonparallel.

In an example, a cone is positioned on the lower surface of device, makes it place the bottom of the recessed portion of (for example) tibia cartilage.Cone can be the same with spheroid, also can separate by the lower surface of (for example) cylindrical element from implant.It will be apparent to those skilled in the art that the geometry that other is fit to adhere to.

In another example, on the surface of implant, provide one or more cylindric or columned contact pins of cardinal principle.Make each contact pin parallel with other contact pin at least the contact pin location.

In another example, a semifixed attachment mechanism of magnet places the below of subchondral bone layer, for example in the tibia.Another magnet or magnetic material embed or are attached on the lower surface of device, then are fixed by first magnet.As be understood by those skilled in the art that, can use inter-related plurality of magnets.In addition, can use the combination of magnet, making each surface have has one or more magnets and one or more magnets that second utmost point is arranged of first utmost point, and uses the magnet of opposite magnetic pole to make described surface and magnet engagement on (or on surface related with it) on the facing surfaces.This is arranged in needs anti-locking apparatus to guarantee simultaneously that in the intraarticular rotation two contacts place between the surface are useful.

In another example, this attachment mechanism is a screw or anchor, and it can insert the subchondral bone of tibia in the bottom of the recessed portion of tibia cartilage.Described device can be fixed to screw or anchor maybe can have a semifixed design, for example by being incorporated in the slit that slides in screw or anchor top.

The height of scalable implant come the topological structure of orthotic joint undesired or the axle depart from.For example, in knee joint, scalable joint height is corrected bowleg or pes valgus deformity.Can use the measurement of joint and adjacent segment axle to determine to correct.For example, can use the heavy burden X-ray photograph of CT or MRI scanning or extremity for this purpose.

Also can select or regulate the phenomenon that implant thickness is corrected laxity of ligament.In knee joint, for example, the problem that can select a thick slightly implant to solve the lax of one or more crosswises or indirect ligament or tear.The increase of implant thickness can be even or uneven, for example mainly at periphery.The surgeon can use one or more to test prostheses when surgical operation or actual implant can generation and joint and the lax relevant optimum of implant to test the sort of implant thickness.

V. implant

Usually with device implantation joint defect area as herein described.Use the cartilage replacement or still can carry out implantation attached to basic material or from the regrown material that basic material removes.Any suitable method and apparatus can be used for implanting, for example, give people's such as Hangody United States Patent (USP) the 6th in April, 2002,375, gave on March 19th, No. 658 1 the 6th, 358, No. 253 of people such as Torrie, calendar year 2001 December gave the 6th of people such as Hardwick on the 11st, 328, No. 765 and March calendar year 2001 people such as disclosed Cummings on the 22nd the open case WO 01/19254 in the world described in device.

Can use the auxiliary implant of inserting of arthroscope.Described device need be in some one-sided and whole knee endoprosthesis appearance with 15 to 30cm otch.In local anesthesia, normally carry out program under the situation of exterior dura anesthesia.Can use tourniquet to the extremity proximal part.Use disinfection technology to prepare and hide the body region that (drape) has joint to be repaired.Under the situation of knee, for example, use conventional arthroscopic techniques, the mouth that available probe (stylette) causes two little 2mm in the preceding inboard and the preceding outside in joint.Insert arthroscope by the side mouth.Insert the arthroscope instrument by intermediary mouthful.Use arthroscope can see cartilage defect.The cartilage defect positioner can place in the morbidity cartilage.Described probe can be U-shaped, and its first arm can contact the central area of IA morbidity cartilage and second arm of U is stayed outside the joint.Second arm indication cartilage of U is with respect to the position of skin.The surgeon marks the position to cartilage defect on skin.Leave the otch of a 3cm above damaged.Insert tissue retractor and see damaged.

Then implant is inserted in the joint.The implant front can be marked with colour with the position back.For example, can be red and the pin of a little letter " A " labelling front, the pin of back can be a green and with little letter " P " labelling simultaneously.Similarly, the centre of implant can be marked with yellow and with little letter ' M ' labelling, simultaneously letter " L " labelling that the side of implant can be little.

Can lack with detecting and/or morbidity cartilage zone in imaging cartilage as described herein zone.Can determine the cartilage of contiguous diseased region and the edge and the shape of subchondral bone.Can determine the thickness of cartilage.Can determine the shape of meniscus or other articulation structure.Can determine the size and the shape of device according to one or more above-mentioned measurements.In detail, can or use the CAD/CAM technology to customize (according to the most suitable) selection repair system from the catalogue of existing or ready-made implant with different sizes and curvature scope by customer requirement design or patient.Can use one or more to generate the implant that designs by customer requirement by the parameter that patient decides.Can use the measurement in one or more patients joint to be repaired to obtain described parameter of deciding by patient.In addition, the existing shape library rank of 30 sizes of can having an appointment.As be understood by those skilled in the art that, under the situation that does not break away from category of the present invention, can contain when described storehouse needs more than 30 shape or less than 30 shapes.

In more detail, implant in the hip joint in order to install, as indicated above, the surgeon can scratch an osculum.Can use the tissue retractor and other surgical unit that are generally used for hip surgery to expose hip joint to the open air.Can open capsule subsequently.Second surgeon can pull on femur or tibia to open the space between femoral head and the acetabular bone.First doctor of performing a programme can then insert intraarticular with arthroplasty device.In case of necessity, the surgeon can excise ligament of head of femur (ligamentum capitis femoris) and remove articular surface part (for example) to remove upper lip (labral) tissue or cartilage flap (cartilage flap).The surgeon also has the selection that removes the fat that is arranged in territory, thalamus occipital region.

Perhaps, in comprising the arthroplasty system of stretching material (for example Nitinol) voluntarily, the surgeon can be entered hip joint by arthroscope method standard or through revising.Can transmit implant by identical or second inlet or by a little otch.In case arrived in the joint, implant is extensible and become its final shape.In order to promote the replacement of extensible implant, can use conduit or mold.Conduit or mold can be fit to the 3D profile of femur or acetabular bone articular surface and can place the precalculated position of implant.Implant can then be advanced along conduit, or advances in (for example) cavity in conduit or mold.In case implant arrives its precalculated position, removable conduit or mold and implant is stayed in place.

VI. The device mold

In another embodiment of the present invention, can form the container of selecting specification or the material that wellhole (for example) is mated the special object needs or the reparation of formation all size and/or the deposit of material.Size and shape that thickness that use obtains from the joint with from cartilage defect and curvature information are come design containers.In more detail, the inside of the container that can formalize to be to meet any selected measurement, for example, and the measurement that obtains as cartilage defect from special object.Can be by alternate material filling containers (mold) to form with implanted device.

Use any suitable technique to generate mold, described technology can for example be computer installation and control automatically, for example computer-aided design (CAD) and (for example) area of computer aided mold (CAM).Because the material of gained meets the in-profile of container usually, so it can mate damaged better and promote integrated.

VII. implantation catheter and operation tool

Above-mentioned mold also can be used for design operation implantation catheter and instrument, and it has the profile of at least one outer surface coupling or approximate match hypozygal surface (skeleton and/or cartilage).In certain embodiments, the corresponding articular surface of two or more outer surface couplings.Entire tool can be circle, annular, ellipse, ellipsoid, crooked or irregular shape.Can select or regulate shape with coupling or around morbidity cartilage zone or be slightly larger than the zone of morbidity cartilage.Perhaps, instrument can be designed to greater than morbidity cartilage zone.Instrument can be designed to comprise most or whole articular surface.Can be used for two or more articular surfaces in conjunction with two or more instruments (for example).

Can obtain one or more electronic images so that coordinates of targets to be provided, it has defined joint and/or bone surface and shape.For example, use imaging test (for example CT or the MRI scanning or the heavy burden x-ray scanning of standing) also can define the bio-mechanical axle in joint.For example, if knee joint is contained in operation, can obtain the CT scan of CT scan or spiral by knee joint.CT scan can be limited to knee joint zone and distal femur and proximal tibia.Perhaps, scanning can comprise image that passes hip joint and the image that also can comprise ankle joint according to circumstances.By this way, can define anatomical axis and can selecting is used to perform the operation and replaces the preferred planar of knee implant.Scanning can be contiguous.

Perhaps, can pass hip and ankle joint area and obtain the selected plane of scanning motion to define anatomical axis.CT scan can be developed to manage and be combined so that articular cartilage is visual with intrinsic articulation.In another example, can use non-development CT scan.If use non-development, can (for example) age, the reference database of the individuality of sex, race, height and body weight coupling assesses remaining cartilage thickness.In severe arthritis, can show the minimizing of normal cartilage thickness.For example, in knee joint, cartilage thickness can show as zero or approaching zero in having the arthritic patient's of severe heavy burden zone, and 2mm or littler value can be selected in non-heavy burden zone at the rear portion.Can be then add in the curvature of subchondral bone the cartilage thickness of these assessments to assessment with the shape that relevant articular surface is provided.If use MRI, can pass the scanning that knee that the surgeon having an operation obtains fine definition.This scanning helps defining joint geometry.High-definition scanning can be attached with the scanning of using low definition by adjacency joint and skeleton to define anatomical axis.

If contained whole knee arthroplasty, in knee joint, can need the scanning of fine definition, at hip joint, and in ankle joint, can need the scanning of lower resolution according to circumstances.Can use body coil or imperfect phased-array coil to obtain this lower resolution scanning.

Also can be with the imaging test combination.For example, can use knee MRI to scan and define the kneed 3D joint geometry that comprises subchondral bone and cartilage.Knee MRI scanning can with the extremity of having described anatomical axis stand, the heavy burden X-ray combines.By this way, can obtain coordinates of targets and anatomical axis, it can be used for defining the preferred planar that operation gets involved.

Coordinates of targets can be used for (for example, use CAD/CAM technology) shaping device with the dissection that is fit to patient or select to be fit to the fabricated device that dissect in patient's joint.As mentioned, instrument can have the surface and the shape of coupling all or part joint or bone surface and shape, for example, is similar to " mirror image " of device to be implanted.Instrument can comprise hole, groove and/or hole to hold for example surgical unit of awl and saw etc., and instrument can be used for the joint of part and replaces and all joint replacements.For example, in whole knee endoprosthesis neoplasty, instrument can be used for implant and inserts the required planar accurate layout of otch.By this way, can realize how reproducible implantation position, and the potential clinical effectiveness that improves is survived with long-term implant.

Instrument can have one, two or more assemblies.Part instrument can be made of metal, and other parts can be made of plastics simultaneously.For example, can be made of plastics on the surface of intra-operative contact articular surface.By this way, just can be easily and with the low cost manufacturing, for example use Rapid Prototyping technique.Can be each patient makes plastic assembly individually or selects in advance from existing magnitude range.Articular surface shows that the plastic assembly part can have identical morphology in any patient, and is for example block.By this way, can use ready-made metal assembly to plastic assembly.Metal assembly can comprise surgical catheters, for example the opening of saw or awl.Plastic assembly can have opening usually, and surgical unit can be shifted to skeleton or cartilage and not damage plastics by these openings.

Plastic assembly determines that metal assembly and surgical catheters are relevant to the position of articular surface.Between two kinds of assemblies, can introduce partition (for example) to regulate the degree of depth of skeleton otch.Thereby in knee joint, the surgeon can use the crooked and expansion space of partition test, regulates the space and also selects optimal incisal plane.In addition, if use two or more assemblies, between assembly, can allow rotation to regulate.By this way, the surgeon can (for example) in the middle of the balance and lateral interval in knee joint.After having finished any optional rotation adjusting, before the surgeon cuts or does any other operation, assembly relative to each other or with respect to skeleton or cartilage can be fixed up.

Assembly and instrument can be designed to coordinate mutually with the existing surgical unit external member that is used for arthroplasty (for example, whole knee endoprosthesis appearance).The instrument of it should be noted that can help to reduce the quantity of the surgical unit that is used for arthroplasty.Finally, this embodiment can help to improve the postoperative arrangement of the implant relative with desired position and anatomical axis, so reduce that prosthese is lax, the pressure in the implant wearing and tearing, skeleton and and then improve long-term effect.

Usually, chosen position can cause required incisal plane or the boring direction of dissection that is used for laying subsequently implant.In addition, can design pipe guide, make that the degree of depth of awl or saw is controlled, for example awl or saw can not enter than by the darker tissue of the degree of depth that device thickness defined, and the big I in the hole in the block is designed to the big or small essence coupling with implant.When selecting the direction in these grooves or hole, can comprise and relevant other joint or the information of axle and the arrangement information of joint or extremity.Can prepare conduit and be used for any implant of the present invention.

Forward the instantiation of the implantation catheter shown in Figure 28 and Figure 17 now to, provide these examples to be used for illustration purpose.Figure 28 explanation is applicable to the implantation catheter 1100 that uses together with the implant shown in Fig. 8 L.Arthroplasty main body 1110 is provided.The arthroplasty main body can be configured to have the outer surface structure of at least one outer surface that mates implant 100 to be used structure.Providing a handle 1112 that user conduit can be placed on will be mounted with in the joint of implant 100.In addition, provide a grappling conduit 1114.In this example, grappling conduit 1114 is in the opening in the main body 1110 in cross.As be understood by those skilled in the art that grappling conduit 1114 can take various suitable shapes so that conduit can be carried out its predetermined function.In this example, cross can be discerned the articular surface in joint by user, and wherein anchor 112 (shown in Fig. 3 L) is oriented on the joint.In case conduit 1100 is put on the target articular surface, and grappling conduit 1114 can be used for: the labelling anchor can enter the position in joint; Determine that anchor can enter the position in joint; Prepare articular surface in the position that can place anchor; Or its combination.

Turn to Figure 25 A to the conduit 1200 shown in Figure 25 B now, it has shown the plane graph that is fit to the conduit that uses to the implant shown in Fig. 9 C with Fig. 9 A.The provider 1210.Described main body is configured to have the outer surface structure of the outer surface structure of at least one coupling or approximate match implant 150 to be implanted.Provide a handle 1212 that user conduit can be placed on the articular surface that is mounted with implant 150.In addition, provide one or more grappling conduits 1214.In this example, the grappling conduit (1214 ', 1214 ", 1214 ) be annular or annular substantially; the diameter of the opening in the main body 1210 is enough big to be used for the drill bit of holing at skeleton to hold, and will be placed with the contact pin of the anchor 156 of implant 150 in described skeleton.As be understood by those skilled in the art that grappling conduit 1214 can show various suitable shapes so that conduit can be carried out its intended function.Extra conduit 1216 can be provided.Described extra conduit can be carried out with first conduit 1214 the same functions maybe can carry out a secondary function.In this example, grappling conduit 1214 can be used for discerning the articular surface in joint, and wherein anchor 156 (Fig. 9 B is to shown in Fig. 9 C) is oriented on the joint.In case conduit 1200 is put on the target articular surface, and grappling conduit 1214 can be used for: the labelling anchor can enter the position in joint; Determine that anchor can enter the position in joint; Prepare articular surface in the position that can place anchor; Or its combination.In addition, conduit 1216 can be used for the position that the labelling anchor can enter the joint; Determine that anchor can enter the position in joint; Prepare articular surface in the position that can place anchor; Or its combination.

In another embodiment, can be to skeleton in the zone in morbidity skeleton or cartilage zone or cartilage are not used a framework.Described framework can comprise holder and the conduit that is used for surgical unit.Framework can be attached on one or the preferred anatomical reference points that more early defines.Perhaps, use imaging test (for example desired one or more fluoroscopic image in the operation), the position of framework can be with respect to one, and preferred more anatomical landmarks is carried out cross and aimed at.Can obtain one or more electronic images so that the coordinates of targets that defines joint and/or bone surface and shape to be provided.These coordinates of targets can (for example) manually or with electronics mode or its combination and import or transfer in the device, and information can be used for mobile surgical unit used one or more holder or conduit.Usually, selected position can produce in the operation that is used for placing subsequently or other implant or dissect and go up desired incisal plane or drill bit direction, and described implant comprises half side, one-sided or total joint appearance.When selecting the direction in these grooves or hole, can comprise the information relevant and the arrangement information of joint or extremity with other joint or axle.

Because the dissection on itself and selected hypozygal surface arranges that available proper implements produces saw conduit, drill bit or is used for the optimum position and the direction of the conduit of expanding unit.In the operation, articular surface is used the operation aid, realize being close to perfectly or perfectly dissect and install with it.The surgeon can then introduce saw (or other instrument) and prepare the joint that is used for this program by conduit.Cut cartilage and/or skeleton by the plane of defining along dissection, can realize how reproducible position, it finally can cause by optimization bio-mechanical pressure and improve postoperative effect.

Can and can make by several different methods construction dissection correction tool as herein described by any material, transparent material preferably, for example plastics, lucite, silicone rubber, SLA etc., and be block usually before mold.In addition, can make and use reusable instrument (for example mold).The unrestricted type example of reusable material comprises puttee and other deformable material (for example, string can be configured to mate the contact pin that the scalable of the configuration of articular surface closely is separated by).In these embodiments, for example use one or more computer programs to determine to define the surface profile in joint and these coordinates (are for example shifted, dial in) to the coordinates of targets of instrument, can produce die casting from the joint at intra-operative, perhaps the image from the joint produces die casting.Therefore subsequently, instrument can accurately be positioned on the joint, and can be more accurately awl and implant be put into articular surface its top that neutralizes.

In disposable use and reusable embodiment, instrument can be designed so that the degree of depth control awl of block or the degree of depth of saw, that is to say that awl or saw can not be darker than the degree of depth of block, and the big I in the hole in the block is designed to mate with the big or small essence of implant.Instrument can be used for general prosthese to be implanted, and includes, but is not limited to joint repair implant as herein described and is used in half side or one-sided or total joint appearance or comprises under the situation of other articular system that repair biology and expand bone marrow.

These operation tools also can be used for removing the bigger zone in morbidity cartilage zone or ratio morbidity cartilage zone.

Can by image guide surgery systems (operation guiding system) support to implant a little identification and the insertion of preparation and implant.In such system, the position and the direction of can be in real time following the tracks of the surgical unit relevant with one dimension or 2D or 3D rendering with patient's dissection.Can from the image that the back of performing the operation is obtained, (for example MR or CT image) calculate these 2D or 3D rendering.By position and the direction of determining surgical unit attached to the labelling on the instrument.Use (for example) optics, acoustics or electromagnetic signal these labellings can be located by detector.Under the situation that does not have the image guiding, also can use operation guiding system, for example, discern anatomical axis by the motion study of using extremity.

In other embodiments, operation tool as herein described can comprise one or more the material of sclerosis with a mold forming articular surface.Described can be in the original place hardened multiple material, it comprises can be through exciting to stand the polymer of phase change, the for example polymer of liquid or semi-liquid polymer and by being exposed to air, applying ultraviolet, visible light, being exposed to blood, water or other ion and changing the polymer that hardens into solid or gelinite.(consulting United States Patent (USP) the 6th, 443, No. 988 and the document wherein quoted).Suitable curable (curable) and the limiting examples of hardened material comprise that (for example JIUYUE in 2002 was given people's such as Felt No. the 6th, 443,988, United States Patent (USP) on the 3rd to polyurethane material; Gave the 5th of people such as Khalil on February 22nd, 1994,288, gave the 4th of people such as Graham on July 4th, No. 797 1,098, No. 626 and gave the 4th of people such as Chapin on June 10th, 1986, the porous that (2000) biomaterial (BioMaterials) 21 (15) of people such as 594, No. 380 and Lu: 1595-1605 describes poly-(L-lactide acid foam); For example gave the hydrophilic polymer that discloses in people's such as Rhee No. the 5th, 162,430, the United States Patent (USP) on November 10th, 1992; People's such as Wake (1995) " cell transplantation (Cell Transplantation) " 4 (3): people's such as 275-279, Wiese (2001) " J. biomedical material research (J.Biomedical Materials Research) " 54 (2): people's such as 179-188 and Marier (2000) " plastics reconstruction operations (Plastic Reconstruct.Surgery) " 105 (6): the hydrogel material described in the 2049-2058; Hyaluronic acid material (people (1998) such as Duranti " dermatosis operation (DermatologicSurgery) " 24 (12) for example: 1317-1325); The expansion pearl of shelly pearl ((2001) " J. biomedical material research (J.Biomedical Materials Research) " 54 (1) of people such as Yusof for example: 59-68) for example; And/or the material that is used for dental applications (is consulted, " dental applications (Dental the Applications) " pp.257-258 of Brauer in " concise encyclopedia of polymer science and engineering (Concise Encyclopedia of Polymer Science andEngineering) " and Antonucci and give the United States Patent (USP) the 4th of Weissman January 11 nineteen eighty-three for example, 368, No. 040).Can use any bio-compatible material, described material should have sufficient flowability to allow it and be delivered to the joint and to stand to cure completely former being under the receivable condition of pathophysiology.Material can also be biological decomposable.

Curable materials can be used in combination with operation tool as herein described.For example, operation tool can comprise therein that one or more are used to receive the hole of injection, and can curable materials be injected into by described hole.Before solidified the original place, material can be consistent with the articular surface facing to operation tool, and therefore can form the impression on surface by sclerosis, and then produce a normal or approximate normal articular surface again.In addition, for example pass through according to described material of arthrosis image mold or operation tool, curable materials or operation tool also can be used in combination with imaging test as herein described and analysis.

Forward Figure 27 A now to 27D, it has shown the step of implanting the method for the device that the present invention explained.At first, user is scratched an otch with target approach joint 2610.Use implantation catheter prepare articular surface 2620 thereafter.The preparation articular surface can comprise the position of (for example) identification implant in the joint, the place that the labelling implant can be adhered to, and/or the preparation articular surface is to receive implant.Can repeat this preparation process in case of necessity.As be understood by those skilled in the art that in the process of preparation articular surface, user can at first be discerned the local of implant and then by the labelling articular surface or remove skeleton or cartilage prepares the surface.In case prepare articular surface, implant 2640 just be installed.Can upward or by implant being bonded at the surface implant be installed upward by using the techniques described herein to place the implant at the surface.After implant is installed in intraarticular, sew up wound 2650.

Forward the step shown in Figure 27 B now to, user is scratched an otch with target approach joint 2610.Thereafter, with a framework attached on the joint 2660.Although do not show, but the step in the preparation joint shown in the execution graph 27A at this flow chart.Then implant is installed on the framework 2665.After being installed in implant in the joint, sew up wound 2650.

Forward the step shown in Figure 27 C now to, user is scratched an otch with target approach joint 2610.From joint remove morbidity cartilage 2670 thereafter.Although in this flow chart, do not show, under the situation that does not break away from category of the present invention, but the also extra step in the preparation joint shown in the execution graph 27A.Implant 2675 is installed then.After implant is installed in intraarticular, sew up wound 2650.

Forward the step shown in Figure 27 D now to, user is scratched an otch with target approach joint 2610.Although in this flow chart, do not show, under the situation that does not break away from category of the present invention, but the also additional step in the preparation joint shown in the execution graph 27A.Insert implant 2680 thereafter.Then the position of implant is optionally regulated 2682.After inserting and locating implant, regulate the profile 2684 of implant.Be installed in implant in the joint and after regulating, sew up wound 2650.Can select the implant height selected or profile to change heavy burden ability with respect to the joint.In addition, the height of scalable implant is to solve the abnormal problem of dissection topological structure of skeleton or articulation structure.

VII. external member

This paper has also described external member, and it comprises one or more methods as herein described, system and/or compositions.In detail, external member can comprise one or more following each things: the instruction of electron gain image (method); The system or the instruction of assessment electronic image; Can analyze or handle one or more computer component of electronic image; And/or be used to implant one or more operation tools of implant.External member can comprise other material, for example, and instruction, reagent, container and/or imaging aid (for example, film, holder, digital converter etc.).

Comprise that following example illustrates the present invention more fully.In addition, these examples provide the preferred embodiments of the present invention and and do not mean that and limit its category.

For illustrating and describe the previous description that purpose provides embodiments of the invention.This does not mean detailed or the present invention is limited in the clear and definite form that is disclosed.Many modifications and variations will become apparent for the practitioner in affiliated field.Select and describe embodiment to practice, and then other personnel in field understand the present invention and various embodiment under making, and contained the various corrections that are applicable to specific use to explain principle of the present invention and its best.Hope is defined category of the present invention by following claim and its equivalent.

Claims (157)

1. joint implant with a first surface and a second surface, one first articular surface in the relative joint of wherein said first surface and a second joint surface in the described relatively joint of described second surface, and further, wherein said first or second surface in a part of one or at least a portion have with described first and second articular surfaces in one the shape 3D shape of fully mating.

2. joint implant with a first surface and a second surface, one first articular surface in the relative joint of wherein said first surface and a second joint surface in the described relatively joint of described second surface, and further, wherein said first or second surface at least one at least a portion have the 3D shape that approaches one shape in described first and second articular surfaces.

3. cartilage defect shaping implant with a first surface and a second surface, one first articular surface in the relative joint of wherein said first surface and a second joint surface in the described relatively joint of described second surface, and further, wherein said first or second surface at least one at least a portion have with described first and second articular surfaces in one the shape 3D shape of fully mating.

4. cartilage defect shaping implant with a first surface and a second surface, one first articular surface in the relative joint of wherein said first surface and a second joint surface in the described relatively joint of described second surface, and further, wherein said first or second surface at least one at least a portion have of approaching in described first and second articular surfaces 3D shape.

5. cartilage projection implant with a first surface and a second surface, one first articular surface in the relative joint of wherein said first surface and a second joint surface in the described relatively joint of described second surface, and further, wherein said first or second surface at least one at least a portion have with described first and second articular surfaces in one the shape 3D shape of fully mating.

6. cartilage projection implant with a first surface and a second surface, one first articular surface in the relative joint of wherein said first surface and a second joint surface in the described relatively joint of described second surface, and further, wherein said first or second surface at least one at least a portion have the 3D shape that approaches one shape in described first and second articular surfaces.

7. subchondral bone shaping implant with a first surface and a second surface, one first articular surface in the relative joint of wherein said first surface and a second joint surface in the described relatively joint of described second surface, and further, wherein said first or second surface at least a portion of one have one with described first and second articular surfaces in one the shape 3D shape of fully mating.

8. subchondral bone shaping implant with a first surface and a second surface, one first articular surface in the relative joint of wherein said first surface and a second joint surface in the described relatively joint of described second surface, and further, wherein said first or second surface at least a portion of one have the 3D shape that approaches one shape in described first and second articular surfaces.

9. subchondral bone projection implant with a first surface and a second surface, one first articular surface in the relative joint of wherein said first surface and a second joint surface in the described relatively joint of described second surface, and further, wherein said first or second surface at least a portion of one have with described first and second articular surfaces in one the shape 3D shape of fully mating.

10. subchondral bone projection implant with a first surface and a second surface, one first articular surface in the relative joint of wherein said first surface and a second joint surface in the described relatively joint of described second surface, and further, wherein said first or second surface at least a portion of one have the 3D shape that approaches one shape in described first and second articular surfaces.

11. joint implant with a first surface and a second surface, one first articular surface in the relative joint of wherein said first surface and a second joint surface in the described relatively joint of second surface, and further, wherein said first or second surface at least a portion of one have with described first and second articular surfaces in one the shape 3D shape of fully mating, and further, wherein said implant recovery joint motions can return to 90% to 99.9% of natural joint motility.

12. implant with a first surface and a second surface, one first articular surface in the relative joint of wherein said first surface and a second joint surface in the described relatively joint of second surface, and further, wherein said first or second surface at least a portion of one have with described first and second articular surfaces in one the shape 3D shape of fully mating, and further wherein said implant can be born 100% of the shearing force that puts on described joint.

13. implant that is applicable to a mammiferous joint, wherein said joint has one first articular surface and a second joint surface, wherein said implant has a first surface and a second surface, the at least a portion at least a portion of relative one first articular surface of wherein said first surface and the relative second joint surface of described second surface, and further, wherein said first or second surface at least one at least a portion have with described first articular surface and described second joint surface in one the shape 3D shape of fully mating.

The intraarticular in the group that 14. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant is placed in and is selected from by knee joint, hip, shoulder, elbow, wrist, refers to, toe and ankle are formed.

15. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said upper surface and described lower surface have with described articular surface in one the shape 3D shape of fully mating.

16. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant has patient's cartilage defect thickness.

17. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant has 85% of patient's cartilage defect thickness.

18. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant has 65% to 100% of patient's cartilage defect thickness.

19. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant has patient's cartilage defect thickness, adds a deviant.

20. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant has 85% of patient's cartilage defect thickness, adds a deviant.

21. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant has 65% to 100% of patient's cartilage defect thickness, adds a deviant.

22. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant is constructed by the material that comprises metal or metal alloy.

23. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said material comprises one or more bioactive materials.

24. implant according to claim 22, wherein said implant is covered by a biological active material.

25. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant comprises metal or metal alloy and polymer.

26. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, it further has attached to being selected from described first surface in the group that is made up of ridge, pin, contact pin, cross member, tooth and projection or the structure in the described second surface at least one.

27. implant according to claim 26, it further has a plurality of structures that are used to adhere to.

28. implant according to claim 27, the relative orientation that wherein is used to the structure of adhering to are selected from by symmetrical, asymmetric, capable, round, triangle and the group that forms arbitrarily.

29. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, it further has a peripheral structure that is selected from the group that is made up of ridge and edge.

30. implant according to claim 29, wherein said peripheral structure is extended along the whole girth of described implant.

31. implant according to claim 30, wherein said peripheral structure is extended along its perimeter of described implant.

32. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, each of wherein said first surface and second surface has the slope about the longitudinal axis that passes described implant, and further, wherein be selected from the group that forms by positive and negative and zero about the first surface slope of described second surface slope.

33. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant is near one shape in described first and second articular surfaces.

34. implant according to claim 33, wherein said implant are selected from an implant storehouse.

35. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant has changed configuration after inserting a joint.

36. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant changes configuration at loading days.

37. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant further comprises one first assembly and one second assembly.

38. implant according to claim 36, wherein said first and second assemblies are monolithic molding, indivisible shaping, interconnection be shaped and interdepend be shaped in one.

39. implant according to claim 36, wherein said first assembly with regularly, slidably, at least one and the engagement of described joint in rotatably.

40. implant according to claim 36, wherein said second assembly with regularly, slidably, in rotatably at least one come and the engagement of described joint.

41. according to claim 36,37,38 and 39 described implants, wherein said first assembly and the engagement of described second assembly.

42. according to claim 36,37,38 and 39 described implants, wherein said first assembled is in described second assembly.

43. according to claim 36,37,38 and 39 described implants, wherein said first assembly meshes with described second assembly slidably.

44. according to claim 36,37,38 and 39 described implants, wherein said first assembly meshes with described second assembly rotatably.

45. according to claim 36,37,38 and 39 described implants, the part of wherein said implant has a magnet.

46. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant has plurality of element.

47. according to the described implant of claim 46, one first assembly of wherein said plurality of element with regularly, slidably, at least one and the engagement of described joint in rotatably.

48. according to the described implant of claim 46, one second assembly of wherein said plurality of element with regularly, slidably, at least one and the engagement of described joint in rotatably.

49. according to claim 46,47 and 48 described implants, first assembly of wherein said plurality of element meshes second assembly of described plurality of element.

50. according to claim 46,47 and 48 described implants, first assembled of wherein said plurality of element is in second assembly of described plurality of element.

51. according to claim 46,47 and 48 described implants, first assembly of wherein said plurality of element meshes second assembly of described plurality of element slidably.

52. according to claim 46,47 and 48 described implants, first assembly of wherein said plurality of element meshes second assembly of described plurality of element rotatably.

53. according to claim 46,47 and 48 described implants, first assembly of wherein said plurality of element meshes second assembly of described plurality of element rotatably and slidably.

54. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant has one along being selected from by circle, ellipse, avette, kidney shape, circle substantially, ellipse substantially, the shape that girth in the group that substantially kidney shape avette, substantially is formed forms.

55. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant has one and is selected from by sphere, hemispherical, aspheric surface, convex surface, concave surface, substantially convex surface and lower surface in the group that forms of concave surface substantially and at least one the shape of cross section in the upper surface.

56. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant is a cartilage defect shaping implant.

57. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant is a cartilage projection implant.

58. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant is a subchondral bone shaping implant.

59. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant is implanted via a 10cm or littler otch on surgery.

60. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant is implanted via a 6cm or littler otch on surgery.

61. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said implant is implanted via a 4cm or littler otch on surgery.

62. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, the range of activity in wherein said joint is restored to natural joint active 80% to 99.9%.

63. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, the range of activity in wherein said joint is restored to natural joint activity 90% to 99.9%.

64. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, the range of activity in wherein said joint is restored to natural joint active 95% to 99.9%.

65. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, the range of activity in wherein said joint is restored to natural joint active 98% to 99.9%.

66. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said joint is a knee joint, and wherein shape forms along being selected from by circle, ellipse, avette, kidney shape, circle substantially, ellipse substantially, the girth in the group that substantially kidney shape avette, substantially is formed.

67. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said joint is a knee joint, and the upper surface of wherein said implant is a convex surface substantially.

68. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said joint is a knee joint, and the lower surface of wherein said implant is a concave surface substantially.

69. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said joint is a knee joint, and the upper surface of wherein said implant comprises convex surface and concave surface cross section.

70. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said joint is that the lower surface of knee joint and described implant is concave surface substantially.

71. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, wherein said joint is a knee joint, and the cross section of wherein said implant is selected from the group that is made up of spherical and aspheric surface.

72. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, the periphery of described implant has the thickness thicker than the middle body of described implant.

73. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants, the middle body of described implant has the thickness thicker than periphery.

74. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants with previous section, aft section, lateral parts and mid portion, wherein said implant has along the thickness of the aft section of described device, and it is equal to or greater than at least one the thickness in side, centre and the previous section of described implant.

75. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants with previous section, aft section, lateral parts and mid portion, wherein said implant has along the thickness of the aft section of described device, and it is equal to or less than at least one the thickness in side, centre and the previous section of described implant.

76. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants with previous section, aft section, lateral parts and mid portion, wherein said implant has along the thickness of the mid portion of described device, and it is equal to or less than at least one the thickness in previous section, aft section and the lateral parts.

77. according to claim 1,2,3,4,5,6,7,8,9,10,11,12 and 13 described implants with previous section, aft section, lateral parts and mid portion, wherein said implant has along the thickness of the mid portion of described device, and it is equal to or greater than at least one the thickness in previous section, aft section and the lateral parts.

78. according to claim 37 and 46 described implants with previous section, aft section, lateral parts and mid portion, at least one assembly of wherein said implant has along the thickness of the aft section of described device, and it is equal to or greater than at least one the thickness in side, centre and the previous section of described implant.

79. according to claim 37 and 46 described implants with previous section, aft section, lateral parts and mid portion, at least one assembly of wherein said implant has along the thickness of the aft section of described device, and it is equal to or less than at least one the thickness in side, centre and the previous section of described implant.

80. according to claim 37 and 46 described implants with previous section, aft section, lateral parts and mid portion, at least one assembly of wherein said implant has along the thickness of the mid portion of described device, and it is equal to or less than at least one the thickness in previous section, aft section and the lateral parts.

81. according to claim 37 and 46 described implants with previous section, aft section, lateral parts and mid portion, at least one assembly of wherein said implant has along the thickness of the mid portion of described device, and it is equal to or greater than at least one the thickness in previous section, aft section and the lateral parts.

82. program that is used to repair the joint, it is included under the arthroscopy implants or with the auxiliary step of implanting the implant with first and second surfaces of arthroscope, wherein said first or second surface at least one have the 3D shape of fully mating with the shape of an articular surface.

83. 2 described programs according to Claim 8, and further be included in the step of analyzing the image in described joint before implanting.

84. 2 described programs according to Claim 8, wherein said image is the 3-D view that is selected from by in MRI, CT, X-ray and its group that forms.

85. 2 described programs according to Claim 8, it further comprises the step of doing 10cm or littler otch.

86. 2 described programs according to Claim 8, it further comprises the step of doing 6cm or littler otch.

87. 2 described programs according to Claim 8, it further comprises the step of doing 4cm or littler otch.

88. a manufacturing is suitable for the method for the implant in a joint, said method comprising the steps of:

Judge the 3D shape of the one or more articular surface in described joint; With

Manufacturing has the implant of a first surface and a second surface, first and second articular surfaces in wherein said first surface and the relative described joint of second surface, and further, wherein said first or second surface at least one a part or the 3D shape of whole and described articular surface fully mate.

89. 8 described methods according to Claim 8, wherein said 3D shape is by the image decision that obtains described joint.

90. 9 described methods according to Claim 8, wherein said image is selected from by MRI, CT, X-ray and its group that forms.

91. kneed implant that is suitable for having upper surface and lower surface, wherein said upper surface is with respect at least a portion of femur and at least a portion on the relative tibia of described lower surface surface, and further, at least one in wherein said upper surface or the lower surface have with described femur and tibia surface in one the shape 3D shape of fully mating.

92. implant that is suitable for having the hip joint of upper surface and lower surface, the at least a portion and the described lower surface of wherein said upper surface engagement acetabular bone mesh capital at least a portion, and further, at least a portion of at least one in wherein said upper surface or the lower surface have with described acetabular bone and described femoral head surface in one the shape 3D shape of fully mating.

93. implant that is suitable for having the hip joint of upper surface and lower surface, wherein said upper surface mesh described shin bone at least a portion and at least a portion of described lower surface engagement acetabular bone, and further, at least a portion of at least one in wherein said upper surface or the lower surface have with described acetabular bone and described femoral head surface in one the shape 3D shape of fully mating.

94. implant that is suitable for having the ankle joint of upper surface and lower surface, at least a portion of at least a portion of wherein said upper surface engagement distal tibial and described lower surface engagement tibial astragaloid joint face, and further, at least a portion of at least one in wherein said upper surface or the lower surface have with described distal tibial and tibial astragaloid joint face surface in one the shape 3D shape of fully mating.

95. implant that is suitable for having the ankle joint of upper surface and lower surface, at least a portion of wherein said upper surface engagement tibial astragaloid joint face and at least a portion of described lower surface engagement distal tibial, and further, at least a portion of at least one in wherein said upper surface or the lower surface have with described distal tibial and tibial astragaloid joint face surface in one the shape 3D shape of fully mating.

96. implant that is suitable for having the toe joint of a proximal end face and a distal surface, at least a portion of at least a portion of wherein said proximal end face engagement head of metatarsal bone and described distal surface engagement proximal phalanx, and further, at least a portion of at least one in wherein said near-end or the distal surface have with described head of metatarsal bone and proximal phalanx surface in one the shape two-dimensional shapes of fully mating.

97. implant that is suitable for having the shoulder joint of a first surface and a second surface, at least a portion of at least a portion of wherein said first surface engagement upper arm head and described second surface engagement shoulder mortar, and further, wherein said first or second surface at least one at least a portion have with described upper arm head and shoulder mortar surface in one the shape two-dimensional shapes of fully mating.

98. implant that is suitable for having the elbow joint of a first surface and a second surface, wherein said first surface meshes at least one at least a portion at least a portion of a distal humerus and described second surface engagement ulna and the radius, and further, wherein said first or second surface at least one at least a portion have with described distal humerus, ulna and radius surface in one the shape 3D shape of fully mating.

99. carpal implant that is suitable for having a first surface and a second surface, at least a portion of at least a portion of wherein said first surface engagement distal radius and described second surface engagement ulna far-end, and further, wherein said first or second surface at least one at least a portion have with described distal radius and ulna distal surface in one the shape 3D shape of fully mating.

100. implant that is suitable for having the articulations digitorum manus of a first surface and a second surface, at least a portion of at least a portion of wherein said first surface engagement head of metacarpal bone and described second surface engagement proximal extremity of phalanx of finger bottom, and further, wherein said first or second surface at least one at least a portion have with described head of metacarpal bone and proximal extremity of phalanx of finger surface in one the shape 3D shape of fully mating.

101. kneed interpolation implant that is suitable for having upper surface and lower surface, wherein said upper surface is with respect at least a portion of femur and at least a portion on the relative tibia surface of described lower surface, and further, at least a portion of at least one in wherein said upper surface or the lower surface have with described femur and tibia surface in one the shape 3D shape of fully mating.

102. one kind is suitable for mammiferous implant with joint of a first surface and a second surface, wherein said first surface is with respect at least a portion of first articular surface and at least a portion on the relative second joint of described second surface surface, and further, wherein said first or second surface at least one at least a portion have with described femur and tibia surface in one the shape 3D shape of fully mating.

103. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said upper surface and described lower surface have the 3D shape of fully mating with at least one shape of the articular surface of the lower surface adjacency of the upper surface abut of described implant and described implant.

104. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said implant has the thickness of patient's cartilage defect.

105. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said implant has 85% of patient's cartilage defect thickness.

106. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said implant has 65% to 100% of patient's cartilage defect thickness.

107. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said implant has the thickness of cartilage defect, adds a predetermined deviant.

108., wherein can select for use described deviant to adjust malalignement according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants.

109. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said implant is by the material structure that comprises metal or metal alloy.

110. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said material comprises one or more bioactive materials.

111. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said implant covers with bioactive materials.

112. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said implant comprises metal or metal alloy and polymer.

113., and further have at least one the structure that is used for attached in described upper surface that is selected from the group that forms by ridge, pin, contact pin, cross member, tooth and projection and the described lower surface according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants.

114. according to the described implant of claim 113, it further has a plurality of structures that are used to adhere to.

115. according to the described implant of claim 114, the relative orientation that wherein is used for the structure of adnexa is selected from by symmetrical, asymmetric, capable, round, triangle and the group that forms arbitrarily.

116. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, it further has the peripheral structure that is selected from the group that is made up of ridge and edge.

117. according to the described implant of claim 116, wherein said peripheral structure is extended along the whole girth of described implant.

118. according to the described implant of claim 116, wherein said peripheral structure is extended along its perimeter of described implant.

119. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, each of wherein said upper surface and lower surface has the slope about the longitudinal axis of at least a portion of passing described implant, and further, wherein be selected from the group that forms by positive and negative and zero about the slope of the first surface of described slope at lower surface.

120. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said implant is near one shape in described first and second articular surfaces.

121. according to the described implant of claim 120, wherein said implant is selected from an implant storehouse.

122. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said implant has changed configuration after inserting the joint.

123. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said implant further comprises one first assembly and one second assembly.

124. according to the described implant of claim 123, wherein said first and second assemblies are in integrally formed, indivisible shaping, interconnection shaping and the shaping that interdepends.

125. according to the described implant of claim 123, wherein said first assembly with regularly, slidably, at least one and the engagement of described joint in rotatably.

126. according to the described implant of claim 123, wherein said second assembly with regularly, slidably, at least one and the engagement of described joint in rotatably.

127. according to claim 123,124,125 and 126 described implants, wherein said first assembly meshes described second assembly.

128. according to claim 123,124,125 and 126 described implants, wherein said first assembled is in described second assembly.

129. according to claim 123,124,125 and 126 described implants, wherein said first assembly meshes described second assembly slidably.

130. according to claim 123,124,125 and 126 described implants, wherein said first assembly meshes described second assembly rotatably.

131. according to claim 123,124,125 and 126 described implants, the part of wherein said implant has a magnet.

132. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said implant has plurality of element.

133. according to the described implant of claim 132, one first assembly of wherein said plurality of element with regularly, slidably, at least one and the engagement of described joint in rotatably.

134. according to the described implant of claim 132, one second assembly of wherein said plurality of element with regularly, slidably, at least one and the engagement of described joint in rotatably.

135. according to claim 132,133 and 134 described implants, first assembly of wherein said plurality of element meshes second assembly of described plurality of element.

136. according to claim 132,133 and 134 described implants, first assembled of wherein said plurality of element is in second assembly of described plurality of element.

137. according to claim 132,133 and 134 described implants, first assembly of wherein said plurality of element meshes second assembly of described plurality of element slidably.

138. according to claim 132,133 and 134 described implants, first assembly of wherein said plurality of element meshes second assembly of described plurality of element rotatably.

139. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said implant has along being selected from by circle, ellipse, avette, kidney shape, square, rectangle, circle substantially, ellipse substantially, avette, substantially kidney shape substantially, square substantially, the shape that girth in the group that substantially rectangle is formed forms.

140. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said implant has and is selected from by sphere, hemispherical, aspheric surface, convex surface, concave surface, substantially convex surface and lower surface in the group that forms of concave surface substantially and at least one the shape of cross section in the upper surface.

141. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said implant is a cartilage defect shaping implant.

142. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said implant is a cartilage projection implant.

143. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said implant is a subchondral bone shaping implant.

144. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said implant is via 10cm or littler otch and surgical operation is implanted.

145. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said implant is via 6cm or littler otch and surgical operation is implanted.

146. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said implant is via 4cm or littler otch and surgical operation is implanted.

147. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, the active scope in wherein said joint is restored to natural joint active 80% to 99.9%.

148. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, the active scope in wherein said joint is restored to natural joint active 90% to 99.9%.

149. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, the active scope in wherein said joint is restored to natural joint active 95% to 99.9%.

150. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, the active scope in wherein said joint is restored between the natural joint active 98% to 99.9%.

151. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, at least a portion of the periphery of described implant has the thickness thicker than the middle body of described implant.

152. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, the middle body of described implant has the thickness thicker than at least a portion of periphery.

153. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, the edge of wherein said implant is around one or more position.

154. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said top edge further extends in centre, side, front and/or the back of lower limb.

155. according to claim 91,92,93,94,95,96,97,98,99,100,101 and 102 described implants, wherein said lower limb further on top extend by the centre of edge, side, front and/or back.

156. according to claim 91,123 and 132 described implants with previous section, aft section, lateral parts and mid portion, wherein said implant has at least one the thickness in previous section, aft section, lateral parts and the mid portion along described device, and it is equal to or greater than at least one the thickness in the side, centre, front and back part of described implant.

157. according to claim 91,123 and 132 described implants with previous section, aft section, lateral parts and mid portion, wherein said implant has at least one the thickness in previous section, aft section, lateral parts and the mid portion along described device, and it is equal to or less than at least one the thickness in the side, centre, front and back part of described implant.

Images