US20120116525A1 - Femoral trochlea prostheses - Google Patents
Femoral trochlea prostheses Download PDFInfo
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- US20120116525A1 US20120116525A1 US13/355,168 US201213355168A US2012116525A1 US 20120116525 A1 US20120116525 A1 US 20120116525A1 US 201213355168 A US201213355168 A US 201213355168A US 2012116525 A1 US2012116525 A1 US 2012116525A1
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- prosthesis
- anatomical structure
- resection
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- nonarticulating
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/38—Joints for elbows or knees
- A61F2/3877—Patellae or trochleae
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
- A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
- A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
- A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
- A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
- A61F2002/30891—Plurality of protrusions
- A61F2002/30892—Plurality of protrusions parallel
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/38—Joints for elbows or knees
- A61F2002/3895—Joints for elbows or knees unicompartimental
Definitions
- the present invention relates to knee joint prostheses. More particularly, the present invention relates to various embodiments of exemplary femoral trochlea prostheses.
- femoral trochlea prostheses are provided in a range of varying sizes and are selected by surgeons to best fit the anatomy of a particular patient, improvements in the design of femoral trochlea prostheses are desired.
- the present disclosure provides various embodiments of femoral trochlea prostheses useable in a knee joint.
- the knee joint includes a patella and a distal femur with a femoral trochlea, or patello-femoral groove.
- a femoral trochlea prosthesis includes a nonarticulating surface including contoured surfaces and/or planar surfaces.
- the present disclosure also provides a method for preparing a bone surface for receiving the prostheses described herein.
- the present disclosure provides a femoral trochlea prosthesis, including an articulating surface; a plurality of nonarticulating surfaces, the plurality of nonarticulating surfaces including at least one of: a first and a second planar distal nonarticulating surfaces, the first planar distal nonarticulating surface noncoplanar with the second planar distal nonarticulating surface; and a first and a second planar anterior nonarticulating surfaces, the first planar anterior nonarticulating surface noncoplanar with the second planar anterior nonarticulating surface.
- the present disclosure provides a femoral trochlea prosthesis, including an articulating surface; a plurality of nonarticulating surfaces, the plurality of nonarticulating surfaces including: a planar anterior nonarticulating surface; a first planar distal nonarticulating surface; and a second planar distal nonarticulating surface, the first planar distal nonarticulating surface noncoplanar with the second planar distal nonarticulating surface.
- the present disclosure provides a method for preparing an anatomical structure to receive a femoral trochlea prosthesis and for implanting the prosthesis in the anatomical structure, including the steps of resecting a portion of the anatomical structure by making one of a single planar resection along a line disposed at an angle with respect to a coronal plane of the anatomical structure; and at least a pair of planar resection lines, at least one of the pair of planar resection lines disposed at an angle with respect to a coronal plane of the anatomical structure; selecting a prosthesis to match the resection of the resecting step; and implanting the prosthesis with respect to the prepared anatomical structure.
- the present disclosure provides a method for preparing an anatomical structure to receive a femoral trochlea prosthesis and for implanting the prosthesis in the anatomical structure, including the steps of resecting a portion of the anatomical structure by making at least two noncoplanar cuts at a distal end of the anatomical structure, the two noncoplanar cuts defining a resected surface for a pair of distal nonarticulating surfaces of the prosthesis; selecting a femoral trochlea prosthesis to match the resection of the resecting step; and implanting the prosthesis with respect to the prepared anatomical structure.
- FIG. 1A is a perspective view of an exemplary femoral trochlea prosthesis according to one embodiment of the present disclosure
- FIG. 1B is another perspective view of the prosthesis of FIG. 1A ;
- FIG. 1C is another perspective view of the prosthesis of FIG. 1A ;
- FIG. 2A is a perspective view of an exemplary femoral trochlea prosthesis according to another embodiment of the present disclosure
- FIG. 2B is another perspective view of the prosthesis of FIG. 2A ;
- FIG. 2C is another perspective view of the prosthesis of FIG. 2A ;
- FIG. 3A is a perspective view of an exemplary femoral trochlea prosthesis according to yet another embodiment of the present disclosure
- FIG. 3B is another perspective view of the prosthesis of FIG. 3A ;
- FIG. 3C is another perspective view of the prosthesis of FIG. 3A ;
- FIG. 3D is a perspective view of the prosthesis of FIG. 3A implanted in a distal femur, further illustrating a relationship between the prosthesis and a unicondylar knee prosthesis;
- FIG. 4A is a conceptual view of a resection line on a distal femur for preparing a bone to receive a femoral trochlea prosthesis
- FIG. 4B is a conceptual view of the resection line of FIG. 4A in comparison with a bone-preserving resection line according to a method of the present disclosure
- FIG. 4C is another conceptual view of the resection line of FIG. 4A in comparison with a bone-preserving resection line according to a method of the present disclosure
- FIG. 5A is a conceptual view of a femoral trochlea prosthesis used with the resection line of FIG. 4A ;
- FIG. 5B is a conceptual view of a set of femoral trochlea prostheses used with the bone-preserving resection line of FIG. 4B ;
- FIG. 5C is a conceptual view of a set of femoral trochlea prostheses used with the bone-preserving resection line of FIG. 4C ;
- FIG. 6A is a perspective view of an exemplary femoral trochlea prosthesis according to a still further embodiment of the present disclosure
- FIG. 6B is another perspective view of the prosthesis of FIG. 6A taken along line 6 B- 6 B of FIG. 6A ;
- FIG. 7A is a conceptual view of a resection line on a distal femur for preparing a bone to receive a femoral trochlea prosthesis
- FIG. 7B is a conceptual view of the resection line of FIG. 7A in comparison with a bone-preserving resection line according to another method of the present disclosure
- FIG. 7C is another conceptual view of the resection line of FIG. 7A in comparison with a bone-preserving resection line according to another method of the present disclosure
- FIG. 8A is a conceptual view of a femoral trochlea prosthesis used with the resection line of FIG. 7A ;
- FIG. 8B is a conceptual view of a femoral trochlea prosthesis used with the bone-preserving resection line of FIG. 7B ;
- FIG. 8C is a conceptual view of a femoral trochlea prosthesis used with the bone-preserving resection line of FIG. 7C ;
- FIG. 9 is a conceptual view of a bone-preserving resection line according to yet another method of the present disclosure.
- FIG. 10 is a distal perspective view of a distal end of the femur.
- FIG. 11 is a perspective view of a distal end of the femur, further illustrating a pair of distal planar resections.
- the present disclosure provides various embodiments of femoral trochlea prostheses useable in a knee joint.
- the prostheses described herein may be useable in a knee joint in which a patella is resurfaces or a knee joint in which a patella is not resurfaced.
- the prostheses described herein may be secured to a femur with cement or, alternatively, without cement, such as with screws and/or cables, for example.
- the prostheses described herein may be formed of metal, polymer, or hydrogel.
- the prostheses do not violate a primary total knee arthroplasty (TKA) envelope, i.e., minor or no adjustments of the primary TKA technique are required to revise a failed patello-femoral joint to a TKA.
- TKA total knee arthroplasty
- femoral trochlea prosthesis 20 may include articulating surface 22 and nonarticulating surface 24 .
- Nonarticulating or bone-facing surface 24 may be contoured to have a substantially concave shape.
- articulating surface 22 may include a convex portion, thereby defining trochlea groove 26 generally corresponding to the dashed lines of FIGS. 1B and 1C .
- Nonarticulating surface 24 also may include portions having a planar configuration.
- Prosthesis 20 may define a variable thickness between articulating surface 22 and nonarticulating surface 24 .
- prosthesis 20 may be thinnest near trochlea groove 26 and thickest near medial and lateral edges 28 .
- Nonarticulating surface 24 of prosthesis 20 may include bone pegs and a distal tail substantially similar to those described in co-pending U.S. patent application entitled FEMORAL TROCHLEA PROSTHESES, Attorney Docket No. ZIM0473/ZM0827 (hereinafter “the Co-Pending Application”), filed on the same day as the present application and assigned to the assignee of the present application, the disclosure of which is expressly incorporated herein by reference.
- femoral trochlea prosthesis 30 may include a plurality of nonarticulating surfaces, anterior articulating surface or facet 32 , and distal articulating surface or facet 34 .
- Articulating surfaces 32 and 34 define patello-femoral groove 36 generally corresponding to the dashed line of FIG. 2C .
- Prosthesis 30 may include first anterior nonarticulating surface or facet 38 , second anterior nonarticulating surface or facet 40 , first distal nonarticulating surface or facet 42 , and second distal nonarticulating surface or facet 44 .
- surfaces 38 and 42 are laterally positioned and surfaces 40 and 44 are medially positioned on prosthesis 30 .
- surfaces 38 and 42 are medially positioned and surfaces 40 and 44 are laterally positioned on prosthesis 30 .
- Bone pegs 46 and distal tail 48 extending from distal nonarticulating surfaces 42 , 44 may be substantially similar to the bone pegs and distal tails described in the Co-Pending Application which may be used to provide additional fixation support and strength for the femoral trochlea prostheses described herein.
- Nonarticulating surfaces 38 , 40 , 42 , and 44 each may include pocket 50 which may be substantially similar to the pockets described in the Co-Pending Application which may be used to contain cement or porous material positioned between nonarticulating surfaces 38 , 40 , 42 , 44 and the femur.
- Prosthesis 30 defines medial/lateral edges 52 .
- Prosthesis 30 may define a variable thickness between nonarticulating surfaces 38 , 40 , 42 , 44 and articulating surfaces 32 , 34 .
- the thickness of prosthesis 30 decreases from one edge 52 inward toward groove 36 and then increases from groove 36 outward toward the other edge 52 to form groove 36 on articulating surfaces 32 , 34 .
- First anterior nonarticulating surface 38 defines a first plane
- second anterior nonarticulating surface 40 defines a second plane
- first distal nonarticulating surface 42 defines a third plane
- second distal nonarticulating surface 44 defines a fourth plane.
- the first, second, third, and fourth planes are not coplanar, i.e., each of the first, second, third, and fourth planes define unique planes which intersect each of the other three planes.
- the intersection of the first plane and the second plane defines anterior apex 54 .
- the intersection of the third plane and the fourth plane defines distal apex 56 .
- Anterior apex 54 and distal apex 56 may closely follow the deepest part of sulcus or groove 36 .
- Prosthesis 30 may be thinnest at anterior apex 54 and distal apex 56 as compared to the remainder of prosthesis 30 towards each edge 52 to facilitate the thinnest profile or thickness of prosthesis 30 along groove 36 .
- the planar facets defined by nonarticulating surfaces 38 , 40 , 42 , 44 remove the need to prepare a contoured surface on a distal femur to receive prosthesis 30 .
- femoral trochlea prosthesis 60 may include a plurality of nonarticulating surfaces, anterior articulating surface 62 , and distal articulating surface 64 .
- Articulating surfaces 62 and 64 define patello-femoral groove 66 generally corresponding to the dashed line of FIG. 3B .
- Prosthesis 60 may include anterior nonarticulating surface 68 , first distal nonarticulating surface 70 , and second distal nonarticulating surface 72 .
- Bone pegs 74 and distal tail 76 may be substantially similar to the bone pegs and distal tails described in the Co-Pending Application.
- Nonarticulating surfaces 68 , 70 , and 72 each may include pocket 78 which may be substantially similar to the pockets described in the Co-Pending Application.
- Prosthesis 60 defines medial/lateral edges 80 .
- Prosthesis 60 defines a thickness between nonarticulating surfaces 68 , 70 , 72 and articulating surfaces 62 , 64 . In an exemplary embodiment, the thickness of prosthesis 60 decreases from one edge 80 inward toward groove 66 and then increases from groove 66 outward toward the other edge 80 .
- Anterior nonarticulating surface 68 defines a first plane
- first distal nonarticulating surface 70 defines a second plane
- second distal nonarticulating surface 72 defines a third plane.
- the first, second, and third planes are not coplanar, i.e., each of the first, second, and third planes define unique planes which intersect each of the other two planes.
- Distal apex 82 may closely follow the deepest part of groove 66 .
- Prosthesis 60 is thinnest at distal apex 82 as compared to the remainder of prosthesis 60 to facilitate the thinnest profile or thickness of prosthesis 60 along groove 66 .
- planar facets defined by nonarticulating surfaces 68 , 70 , 72 remove the need to prepare a contoured surface on a distal femur to receive prosthesis 60 .
- femoral trochlea prosthesis 60 may be implanted on distal femur 84 proximate unicondylar knee prosthesis 86 .
- prosthesis 60 may include distal cutouts 88 ( FIGS. 3A-3D ) such that prosthesis 60 is spaced from and does not contact prosthesis 86 .
- cutouts or scallops 88 may eliminate interference with an anterior horn or portion of a meniscal component of the knee joint when the knee is in extension.
- distal femur 101 includes medial condyle 102 and lateral condyle 104 .
- Resection line 100 represents a typical resection line for a normal distal femur 101 .
- Distal femur 101 may not, however, always include normal anatomy. As shown in FIG.
- distal femur 101 ′ includes medial condyle 102 ′ and lateral condyle 104 ′ which has a dysplastic condition, i.e., an abnormal anatomical condition in which lateral condyle 104 ′ includes less bone stock as compared to a normal lateral condyle.
- Resection line 100 may satisfactorily accomplish the resection required for implantation of a femoral trochlea prosthesis on distal femur 101 ′.
- Resection line 100 ′ may also accomplish the required resection while preserving bone.
- distal femur 101 ′′ includes lateral condyle 104 ′′ and medial condyle 102 ′′ which has a dysplastic condition, i.e., an abnormal anatomical condition in which medial condyle 102 ′′ includes less bone stock as compared to a normal medial condyle.
- Resection line 100 ′′ may accomplish the required resection while preserving bone.
- resection lines 100 ′ and 100 ′′ represent a surgical technique or method to cut a distal femur which accounts for variable anterior femoral anatomy while simultaneously preserving as much bone as possible.
- resection line 100 ′ extends medially/laterally across distal femur 101 ′ as close as possible to patello-femoral groove 105 ′ while also removing substantially equal amounts of bone from both medial condyle 102 ′ and lateral condyle 104 ′.
- resection line 100 ′′ extends medially/laterally across distal femur 101 ′′ as close as possible to patello-femoral groove 105 ′′ while also removing substantially equal amounts of bone from both medial condyle 102 ′′ and lateral condyle 104 ′′.
- This technique advantageously minimizes the bone removal and, consequently, preserves as much healthy bone as possible.
- a surgeon may choose to bias prostheses used with resection lines 100 , 100 ′, 100 ′′ to improve and/or restore patella subluxation resistance.
- a 0° resection may be made to femur 101 , but a 3° prosthesis may be used to bias one anterior condyle higher than the other condyle.
- Resections lines 100 , 100 ′, and 100 ′′ are shown with respect to an inferior view of distal femur 101 .
- Resection line 100 is substantially parallel to a coronal plane of femur 101 .
- Resection lines 100 ′ and 100 ′′ are disposed at an angle with respect to the coronal plane of femur 101 .
- FIGS. 5A , 5 B, and 5 C fragmentary profiles of femoral trochlea prostheses, such as those described above and in the Co-Pending Application, useable with the techniques described above with respect to FIGS. 4A , 4 B, and 4 C are shown.
- femoral trochlea prosthesis 110 including nonarticulating surface 112 may be used on distal femur 101 ( FIG. 4A ).
- Nonarticulating surface 112 abuts resection line 100 ( FIG. 4A ) on distal femur 101 when implanted on distal femur 101 .
- FIG. 5A fragmentary profiles of femoral trochlea prostheses, such as those described above and in the Co-Pending Application, useable with the techniques described above with respect to FIGS. 4A , 4 B, and 4 C are shown.
- femoral trochlea prosthesis 110 including nonarticulating surface 112 may be used on distal femur 101 ( FIG. 4
- femoral trochlea prostheses 110 a ′ and 110 b ′ including nonarticulating surfaces 112 a ′ and 112 b ′, respectively, may be used on distal femur 101 ′ ( FIG. 4B ).
- nonarticulating surfaces 112 a ′ and 112 b ′ are angled with respect to surface 112 ( FIG. 5A ) to more closely match the prepared surface of distal femur 101 ′ represented by resection line 100 ′.
- Prostheses 110 a ′ and 110 b ′ may include a thicker lateral condyle portion to account for the dysplastic condition and to more closely replicate normal anatomy when implanted on distal femur 101 ′.
- femoral trochlea prostheses 110 a ′′ and 110 b ′′ including nonarticulating surfaces 112 a ′′ and 112 b ′′, respectively, may be used on distal femur 101 ′′ ( FIG. 4C ).
- nonarticulating surfaces 112 a ′′ and 112 b ′′ are angled with respect to surface 112 ( FIG. 5A ) to more closely match the prepared surface of distal femur 101 ′′ represented by resection line 100 ′′.
- Prostheses 110 a ′′ and 110 b ′′ may include a thicker medial condyle portion to account for the dysplastic condition and to more closely replicate normal anatomy when implanted on distal femur 101 ′′.
- prostheses 110 , 110 a ′, 110 b ′, 110 a ′′, and 110 b ′′ are also bone conserving due to the thin nature of the prostheses.
- femoral trochlea prosthesis 120 is shown which is substantially similar to prosthesis 60 , described above with respect to FIGS. 3A-3D .
- Prosthesis 120 exemplifies the concepts illustrated in the fragmentary conceptual profiles of prostheses 110 , 110 a , and 110 b , described above with respect to FIGS. 5A-5C .
- Femoral trochlea prosthesis 120 includes substantially the same components as prosthesis 60 except as described below.
- Anterior nonarticulating surface 122 of prosthesis 120 is angled as compared to anterior nonarticulating surface 68 ( FIGS. 3A-3C ). In this manner, anterior nonarticulating surface 122 may be configured to match the angle of resection lines 100 ′ ( FIG. 4B ) or 100 ′′ ( FIG. 4C ), for example, while simultaneously replicating a normal anatomy of a distal femur on which prosthesis 120 is implanted.
- distal femur 131 typically includes medial condyle 132 and lateral condyle 134 .
- Resection line 130 represents a typical resection line for a normal distal femur 131 .
- Distal femur 131 may not, however, always include normal anatomy. As shown in FIG.
- distal femur 131 ′ includes medial condyle 132 ′ and lateral condyle 134 ′ which has a dysplastic condition, i.e., an abnormal anatomical condition.
- Resection line 130 may satisfactorily accomplish the resection required for implantation of a femoral trochlea prosthesis on distal femur 131 ′.
- Resection line 130 ′ may also accomplish the required resection while preserving bone.
- resection line 130 ′ is formed as two noncolinear line segments, one of which extends as a beveled cut on the normal side of distal femur 131 ′, i.e., medial condyle 132 ′, and the other of which extends across the dysplastic side of distal femur 131 ′, i.e., lateral condyle 134 ′, which is substantially coincident with resection line 130 .
- distal femur 131 ′′ includes lateral condyle 134 ′′ and medial condyle 132 ′′ which has a dysplastic condition.
- Resection line 130 ′′ may accomplish the required resection while preserving bone.
- resection line 130 ′′ is formed as two noncolinear line segments, one of which extends as a beveled cut on the normal side of distal femur 131 ′′, i.e., lateral condyle 134 ′′, and the other of which extends across the dysplastic side of distal femur 131 ′′, i.e., medial condyle 132 ′′, which is substantially coincident with resection line 130 .
- resection lines 130 ′ and 130 ′′ are formed by two planar cuts formed with an obtuse, oblique angle between the planes.
- resection lines 130 ′ and 130 ′′ may substantially overlap or coincide with resection line 130 , as shown in FIGS. 7B and 7C .
- resection lines 130 ′ (FIG. 7 B) and 130 ′′ ( FIG. 7B ) represent a surgical technique or method to cut a distal femur which accounts for variable anterior femoral anatomy while simultaneously preserving as much bone as possible.
- resection line 130 ′ extends medially/laterally across distal femur 131 ′ as close as possible to patello-femoral groove 135 ′ while also removing substantially equal amounts of bone from both medial condyle 132 ′ and lateral condyle 134 ′.
- resection line 130 ′′ extends medially/laterally across distal femur 132 ′′ as close as possible to patello-femoral groove 135 ′′ while also removing substantially equal amounts of bone from both medial condyle 132 ′′ and lateral condyle 134 ′′.
- This technique advantageously minimizes the bone removal and, consequently, preserves as much healthy bone as possible.
- femoral trochlea prostheses useable with the techniques described above with respect to FIGS. 7A , 7 B, and 7 C are shown.
- femoral trochlea prosthesis 140 including nonarticulating surface 142 may be used on distal femur 131 ( FIG. 7A ).
- Nonarticulating surface 142 abuts resection line 130 ( FIG. 7A ) on distal femur 131 when implanted on distal femur 131 .
- FIG. 8A femoral trochlea prostheses useable with the techniques described above with respect to FIGS. 7A , 7 B, and 7 C are shown.
- femoral trochlea prosthesis 140 including nonarticulating surface 142 may be used on distal femur 131 ( FIG. 7A ).
- Nonarticulating surface 142 abuts resection line 130 ( FIG. 7A ) on distal femur 131 when implanted on distal femur
- femoral trochlea prosthesis 140 ′ including nonarticulating surface 142 ′ may be used on distal femur 131 ′ ( FIG. 7B ).
- nonarticulating surface 142 ′ is beveled to more closely match the prepared surface of distal femur 131 ′ represented by resection line 130 ′.
- Prosthesis 140 ′ may include a thicker lateral condyle portion to account for the dysplastic condition and to more closely replicate normal anatomy when implanted on distal femur 131 ′.
- femoral trochlea prosthesis 140 ′′ including nonarticulating surface 142 ′′ may be used on distal femur 131 ′′ ( FIG.
- nonarticulating surface 142 ′′ is beveled to more closely match the prepared surface of distal femur 131 ′′ represented by resection line 130 ′′.
- Prosthesis 140 ′′ may include a thicker medial condyle portion to account for the dysplastic condition and to more closely replicate normal anatomy when implanted on distal femur 131 ′′.
- augment 150 may be used with any of the femoral trochlea prostheses described herein and in the Co-Pending Application to facilitate a more accurate fit with and orientation relative to a patient's anatomy and to more fully support a prosthesis when implanted.
- Augment 150 may have a generally triangular-shaped cross-section.
- Augment 150 may be formed of material such as, but not limited to, metal, polymethylmethacrylate (PMMA), polymer, a cobalt chromium alloy, or an open-cell porous metal such as a material made using Trabecular MetalTM technology, available from Zimmer, Inc. of Warsaw, Ind., for example.
- Augment 150 may placed proximate a medial condyle and/or a lateral condyle.
- Distal femur 155 may include resection lines 157 a , 157 b , and 157 c , similar to resection lines 100 ′, 100 ′′, 130 ′, 130 ′′, described above with reference to FIGS. 4B-4C and 7 B- 7 C.
- Resection lines 157 a , 157 b , and 157 c facilitate a bone-preserving bone resection surgical technique.
- resection lines 157 a , 157 b , and 157 c define unique planes.
- a plane defined by resection line 157 a forms an oblique angle with a plane defined by resection line 157 b .
- the plane defined by resection line 157 b forms an oblique angle with a plane defined by resection line 157 c .
- a surgical technique employing resection lines 157 a , 157 b , and 157 c advantageously preserves bone while simultaneously prepares a surface of distal femur 155 to receive a femoral trochlea prosthesis.
- any of the femoral trochlea prostheses described herein or in the Co-Pending Application may be used with a femur prepared with resection lines 157 a , 157 b , and 157 c .
- a femoral trochlea prosthesis having at least five or six total facets on a nonarticulating surface thereof may be used with the surgical technique illustrated by resection lines 157 a , 157 b , and 157 c .
- any prosthesis used with resection lines 157 a , 157 b , 157 c may be dimensioned, for example, smaller than the cavity created by resection lines 157 a , 157 b , 157 c , to permit subtle medial-lateral adjustment/movement of the prosthesis and to permit adjustment of the sulcus or trochlear groove angle of the prosthesis.
- Augment 150 ( FIG. 8B ) may be used with a prosthesis implanted after resection lines 157 a , 157 b , 157 c are created. Augment 150 may be used proximate a medial condyle and/or a lateral condyle. Also, augment 150 may be used proximate resection line 157 b , e.g., medially/laterally equidistant on distal femur 155 .
- FIG. 11 illustrates an exemplary resection for receipt of the distal nonarticulating surfaces described herein.
- distal femur 161 may include planar cuts 163 , 165 for receipt of distal nonarticulating surfaces 42 , 44 ( FIG. 2B ) or 70 , 72 ( FIG. 3A ).
- All of the prostheses disclosed herein and in the Co-Pending Application may be specifically designed for gender specific applications.
- the prostheses may be specifically designed for female anatomy and therefore include a greater lateral trochlear groove angle and a thinner anterior flange as compared to traditional prostheses.
- the prostheses may be specifically designed for male anatomy and therefore include a smaller lateral trochlear groove angle and a thicker anterior flange as compared to traditional prostheses.
Abstract
Various embodiments of femoral trochlea prostheses useable in a knee joint. The knee joint includes a patella and a distal femur with a femoral trochlea, or patello-femoral groove. In one embodiment, a femoral trochlea prosthesis includes a nonarticulating surface including contoured surfaces and/or planar surfaces. The present disclosure also provides a method for preparing a bone surface for receiving the prostheses described herein.
Description
- 1. Field of the Invention
- The present invention relates to knee joint prostheses. More particularly, the present invention relates to various embodiments of exemplary femoral trochlea prostheses.
- 2. Description of the Related Art
- Disease and trauma affecting the patello-femoral joint of a knee are commonly treated by surgically replacing the femoral trochlea with femoral trochlea implants or prostheses according to a procedure known as a patello-femoral joint (PFJ) replacement. Although femoral trochlea prostheses are provided in a range of varying sizes and are selected by surgeons to best fit the anatomy of a particular patient, improvements in the design of femoral trochlea prostheses are desired.
- The present disclosure provides various embodiments of femoral trochlea prostheses useable in a knee joint. The knee joint includes a patella and a distal femur with a femoral trochlea, or patello-femoral groove. In one embodiment, a femoral trochlea prosthesis includes a nonarticulating surface including contoured surfaces and/or planar surfaces. The present disclosure also provides a method for preparing a bone surface for receiving the prostheses described herein.
- In one form thereof, the present disclosure provides a femoral trochlea prosthesis, including an articulating surface; a plurality of nonarticulating surfaces, the plurality of nonarticulating surfaces including at least one of: a first and a second planar distal nonarticulating surfaces, the first planar distal nonarticulating surface noncoplanar with the second planar distal nonarticulating surface; and a first and a second planar anterior nonarticulating surfaces, the first planar anterior nonarticulating surface noncoplanar with the second planar anterior nonarticulating surface.
- In another form thereof, the present disclosure provides a femoral trochlea prosthesis, including an articulating surface; a plurality of nonarticulating surfaces, the plurality of nonarticulating surfaces including: a planar anterior nonarticulating surface; a first planar distal nonarticulating surface; and a second planar distal nonarticulating surface, the first planar distal nonarticulating surface noncoplanar with the second planar distal nonarticulating surface.
- In yet another form thereof, the present disclosure provides a method for preparing an anatomical structure to receive a femoral trochlea prosthesis and for implanting the prosthesis in the anatomical structure, including the steps of resecting a portion of the anatomical structure by making one of a single planar resection along a line disposed at an angle with respect to a coronal plane of the anatomical structure; and at least a pair of planar resection lines, at least one of the pair of planar resection lines disposed at an angle with respect to a coronal plane of the anatomical structure; selecting a prosthesis to match the resection of the resecting step; and implanting the prosthesis with respect to the prepared anatomical structure.
- In a still further form thereof, the present disclosure provides a method for preparing an anatomical structure to receive a femoral trochlea prosthesis and for implanting the prosthesis in the anatomical structure, including the steps of resecting a portion of the anatomical structure by making at least two noncoplanar cuts at a distal end of the anatomical structure, the two noncoplanar cuts defining a resected surface for a pair of distal nonarticulating surfaces of the prosthesis; selecting a femoral trochlea prosthesis to match the resection of the resecting step; and implanting the prosthesis with respect to the prepared anatomical structure.
- The above-mentioned and other features of this disclosure, and the manner of attaining them, will become more apparent and will be better understood by reference to the following description of embodiments of the disclosure taken in conjunction with the accompanying drawings, wherein:
-
FIG. 1A is a perspective view of an exemplary femoral trochlea prosthesis according to one embodiment of the present disclosure; -
FIG. 1B is another perspective view of the prosthesis ofFIG. 1A ; -
FIG. 1C is another perspective view of the prosthesis ofFIG. 1A ; -
FIG. 2A is a perspective view of an exemplary femoral trochlea prosthesis according to another embodiment of the present disclosure; -
FIG. 2B is another perspective view of the prosthesis ofFIG. 2A ; -
FIG. 2C is another perspective view of the prosthesis ofFIG. 2A ; -
FIG. 3A is a perspective view of an exemplary femoral trochlea prosthesis according to yet another embodiment of the present disclosure; -
FIG. 3B is another perspective view of the prosthesis ofFIG. 3A ; -
FIG. 3C is another perspective view of the prosthesis ofFIG. 3A ; -
FIG. 3D is a perspective view of the prosthesis ofFIG. 3A implanted in a distal femur, further illustrating a relationship between the prosthesis and a unicondylar knee prosthesis; -
FIG. 4A is a conceptual view of a resection line on a distal femur for preparing a bone to receive a femoral trochlea prosthesis; -
FIG. 4B is a conceptual view of the resection line ofFIG. 4A in comparison with a bone-preserving resection line according to a method of the present disclosure; -
FIG. 4C is another conceptual view of the resection line ofFIG. 4A in comparison with a bone-preserving resection line according to a method of the present disclosure; -
FIG. 5A is a conceptual view of a femoral trochlea prosthesis used with the resection line ofFIG. 4A ; -
FIG. 5B is a conceptual view of a set of femoral trochlea prostheses used with the bone-preserving resection line ofFIG. 4B ; -
FIG. 5C is a conceptual view of a set of femoral trochlea prostheses used with the bone-preserving resection line ofFIG. 4C ; -
FIG. 6A is a perspective view of an exemplary femoral trochlea prosthesis according to a still further embodiment of the present disclosure; -
FIG. 6B is another perspective view of the prosthesis ofFIG. 6A taken alongline 6B-6B ofFIG. 6A ; -
FIG. 7A is a conceptual view of a resection line on a distal femur for preparing a bone to receive a femoral trochlea prosthesis; -
FIG. 7B is a conceptual view of the resection line ofFIG. 7A in comparison with a bone-preserving resection line according to another method of the present disclosure; -
FIG. 7C is another conceptual view of the resection line ofFIG. 7A in comparison with a bone-preserving resection line according to another method of the present disclosure; -
FIG. 8A is a conceptual view of a femoral trochlea prosthesis used with the resection line ofFIG. 7A ; -
FIG. 8B is a conceptual view of a femoral trochlea prosthesis used with the bone-preserving resection line ofFIG. 7B ; -
FIG. 8C is a conceptual view of a femoral trochlea prosthesis used with the bone-preserving resection line ofFIG. 7C ; -
FIG. 9 is a conceptual view of a bone-preserving resection line according to yet another method of the present disclosure; -
FIG. 10 is a distal perspective view of a distal end of the femur; and -
FIG. 11 is a perspective view of a distal end of the femur, further illustrating a pair of distal planar resections. - Corresponding reference characters indicate corresponding parts throughout the several views. The exemplifications set out herein illustrate embodiments of the disclosure and such exemplifications are not to be construed as limiting the scope of the invention in any manner.
- The present disclosure provides various embodiments of femoral trochlea prostheses useable in a knee joint. The prostheses described herein may be useable in a knee joint in which a patella is resurfaces or a knee joint in which a patella is not resurfaced. The prostheses described herein may be secured to a femur with cement or, alternatively, without cement, such as with screws and/or cables, for example. The prostheses described herein may be formed of metal, polymer, or hydrogel. Moreover, due to the relatively small thicknesses of the prostheses described herein, the prostheses do not violate a primary total knee arthroplasty (TKA) envelope, i.e., minor or no adjustments of the primary TKA technique are required to revise a failed patello-femoral joint to a TKA.
- Referring to
FIGS. 1A , 1B, and 1C,femoral trochlea prosthesis 20 may include articulatingsurface 22 andnonarticulating surface 24. Nonarticulating or bone-facingsurface 24 may be contoured to have a substantially concave shape. Similarly, articulatingsurface 22 may include a convex portion, thereby definingtrochlea groove 26 generally corresponding to the dashed lines ofFIGS. 1B and 1C .Nonarticulating surface 24 also may include portions having a planar configuration.Prosthesis 20 may define a variable thickness between articulatingsurface 22 andnonarticulating surface 24. For example,prosthesis 20 may be thinnest neartrochlea groove 26 and thickest near medial and lateral edges 28. Alternatively, the thickness ofprosthesis 20 may be substantially uniform.Nonarticulating surface 24 ofprosthesis 20 may include bone pegs and a distal tail substantially similar to those described in co-pending U.S. patent application entitled FEMORAL TROCHLEA PROSTHESES, Attorney Docket No. ZIM0473/ZM0827 (hereinafter “the Co-Pending Application”), filed on the same day as the present application and assigned to the assignee of the present application, the disclosure of which is expressly incorporated herein by reference. - Referring to
FIGS. 2A , 2B, and 2C,femoral trochlea prosthesis 30 may include a plurality of nonarticulating surfaces, anterior articulating surface orfacet 32, and distal articulating surface orfacet 34. Articulatingsurfaces femoral groove 36 generally corresponding to the dashed line ofFIG. 2C .Prosthesis 30 may include first anterior nonarticulating surface orfacet 38, second anterior nonarticulating surface orfacet 40, first distal nonarticulating surface orfacet 42, and second distal nonarticulating surface orfacet 44. In one embodiment, surfaces 38 and 42 are laterally positioned and surfaces 40 and 44 are medially positioned onprosthesis 30. In another embodiment, surfaces 38 and 42 are medially positioned and surfaces 40 and 44 are laterally positioned onprosthesis 30. Bone pegs 46 anddistal tail 48 extending from distal nonarticulating surfaces 42, 44 may be substantially similar to the bone pegs and distal tails described in the Co-Pending Application which may be used to provide additional fixation support and strength for the femoral trochlea prostheses described herein. Nonarticulating surfaces 38, 40, 42, and 44 each may includepocket 50 which may be substantially similar to the pockets described in the Co-Pending Application which may be used to contain cement or porous material positioned between nonarticulating surfaces 38, 40, 42, 44 and the femur.Prosthesis 30 defines medial/lateral edges 52.Prosthesis 30 may define a variable thickness between nonarticulating surfaces 38, 40, 42, 44 and articulatingsurfaces prosthesis 30 decreases from oneedge 52 inward towardgroove 36 and then increases fromgroove 36 outward toward theother edge 52 to formgroove 36 on articulatingsurfaces - First
anterior nonarticulating surface 38 defines a first plane, secondanterior nonarticulating surface 40 defines a second plane, firstdistal nonarticulating surface 42 defines a third plane, and seconddistal nonarticulating surface 44 defines a fourth plane. In an exemplary embodiment, the first, second, third, and fourth planes are not coplanar, i.e., each of the first, second, third, and fourth planes define unique planes which intersect each of the other three planes. - The intersection of the first plane and the second plane defines
anterior apex 54. The intersection of the third plane and the fourth plane definesdistal apex 56.Anterior apex 54 anddistal apex 56 may closely follow the deepest part of sulcus orgroove 36.Prosthesis 30 may be thinnest atanterior apex 54 anddistal apex 56 as compared to the remainder ofprosthesis 30 towards eachedge 52 to facilitate the thinnest profile or thickness ofprosthesis 30 alonggroove 36. Furthermore, the planar facets defined by nonarticulatingsurfaces prosthesis 30. - Referring to
FIGS. 3A , 3B, and 3C,femoral trochlea prosthesis 60 may include a plurality of nonarticulating surfaces, anterior articulatingsurface 62, and distal articulatingsurface 64. Articulatingsurfaces femoral groove 66 generally corresponding to the dashed line ofFIG. 3B .Prosthesis 60 may includeanterior nonarticulating surface 68, firstdistal nonarticulating surface 70, and seconddistal nonarticulating surface 72. Bone pegs 74 anddistal tail 76 may be substantially similar to the bone pegs and distal tails described in the Co-Pending Application. Nonarticulating surfaces 68, 70, and 72 each may includepocket 78 which may be substantially similar to the pockets described in the Co-Pending Application.Prosthesis 60 defines medial/lateral edges 80.Prosthesis 60 defines a thickness between nonarticulating surfaces 68, 70, 72 and articulatingsurfaces prosthesis 60 decreases from oneedge 80 inward towardgroove 66 and then increases fromgroove 66 outward toward theother edge 80. -
Anterior nonarticulating surface 68 defines a first plane, firstdistal nonarticulating surface 70 defines a second plane, and seconddistal nonarticulating surface 72 defines a third plane. In an exemplary embodiment, the first, second, and third planes are not coplanar, i.e., each of the first, second, and third planes define unique planes which intersect each of the other two planes. - The intersection of the second plane and the third plane defines
distal apex 82.Distal apex 82 may closely follow the deepest part ofgroove 66.Prosthesis 60 is thinnest at distal apex 82 as compared to the remainder ofprosthesis 60 to facilitate the thinnest profile or thickness ofprosthesis 60 alonggroove 66. Furthermore, the planar facets defined by nonarticulatingsurfaces prosthesis 60. - Referring now to
FIG. 3D ,femoral trochlea prosthesis 60 may be implanted ondistal femur 84 proximateunicondylar knee prosthesis 86. Advantageously,prosthesis 60 may include distal cutouts 88 (FIGS. 3A-3D ) such thatprosthesis 60 is spaced from and does not contactprosthesis 86. Furthermore, cutouts orscallops 88 may eliminate interference with an anterior horn or portion of a meniscal component of the knee joint when the knee is in extension. - Referring now to
FIGS. 4A , 4B, and 4C, bone-conserving resections are shown for a distal femur for receipt of any of the prostheses described herein and in the Co-Pending Application. As shown inFIG. 4A ,distal femur 101 includesmedial condyle 102 andlateral condyle 104.Resection line 100 represents a typical resection line for a normaldistal femur 101.Distal femur 101 may not, however, always include normal anatomy. As shown inFIG. 4B ,distal femur 101′ includesmedial condyle 102′ andlateral condyle 104′ which has a dysplastic condition, i.e., an abnormal anatomical condition in whichlateral condyle 104′ includes less bone stock as compared to a normal lateral condyle.Resection line 100 may satisfactorily accomplish the resection required for implantation of a femoral trochlea prosthesis ondistal femur 101′.Resection line 100′, however, may also accomplish the required resection while preserving bone. Similarly, as shown inFIG. 4C ,distal femur 101″ includeslateral condyle 104″ andmedial condyle 102″ which has a dysplastic condition, i.e., an abnormal anatomical condition in whichmedial condyle 102″ includes less bone stock as compared to a normal medial condyle.Resection line 100″ may accomplish the required resection while preserving bone. Advantageously,resection lines 100′ and 100″ represent a surgical technique or method to cut a distal femur which accounts for variable anterior femoral anatomy while simultaneously preserving as much bone as possible. For example,resection line 100′ extends medially/laterally acrossdistal femur 101′ as close as possible to patello-femoral groove 105′ while also removing substantially equal amounts of bone from bothmedial condyle 102′ andlateral condyle 104′. Similarly,resection line 100″ extends medially/laterally acrossdistal femur 101″ as close as possible to patello-femoral groove 105″ while also removing substantially equal amounts of bone from bothmedial condyle 102″ andlateral condyle 104″. This technique advantageously minimizes the bone removal and, consequently, preserves as much healthy bone as possible. In an alternative embodiment, a surgeon may choose to bias prostheses used withresection lines femur 101, but a 3° prosthesis may be used to bias one anterior condyle higher than the other condyle. - As shown in
FIG. 10 ,resections lines distal femur 101.Resection line 100 is substantially parallel to a coronal plane offemur 101.Resection lines 100′ and 100″ are disposed at an angle with respect to the coronal plane offemur 101. - Referring to
FIGS. 5A , 5B, and 5C, fragmentary profiles of femoral trochlea prostheses, such as those described above and in the Co-Pending Application, useable with the techniques described above with respect toFIGS. 4A , 4B, and 4C are shown. As shown inFIG. 5A , femoral trochlea prosthesis 110 including nonarticulating surface 112 may be used on distal femur 101 (FIG. 4A ). Nonarticulating surface 112 abuts resection line 100 (FIG. 4A ) ondistal femur 101 when implanted ondistal femur 101. As shown inFIG. 5B , femoral trochlea prostheses 110 a′ and 110 b′ including nonarticulating surfaces 112 a′ and 112 b′, respectively, may be used ondistal femur 101′ (FIG. 4B ). Advantageously, nonarticulating surfaces 112 a′ and 112 b′ are angled with respect to surface 112 (FIG. 5A ) to more closely match the prepared surface ofdistal femur 101′ represented byresection line 100′. Prostheses 110 a′ and 110 b′ may include a thicker lateral condyle portion to account for the dysplastic condition and to more closely replicate normal anatomy when implanted ondistal femur 101′. As shown inFIG. 5C , femoral trochlea prostheses 110 a″ and 110 b″ including nonarticulating surfaces 112 a″ and 112 b″, respectively, may be used ondistal femur 101″ (FIG. 4C ). Advantageously, nonarticulating surfaces 112 a″ and 112 b″ are angled with respect to surface 112 (FIG. 5A ) to more closely match the prepared surface ofdistal femur 101″ represented byresection line 100″. Prostheses 110 a″ and 110 b″ may include a thicker medial condyle portion to account for the dysplastic condition and to more closely replicate normal anatomy when implanted ondistal femur 101″. Advantageously, prostheses 110, 110 a′, 110 b′, 110 a″, and 110 b″ are also bone conserving due to the thin nature of the prostheses. - As shown in
FIGS. 6A and 6B ,femoral trochlea prosthesis 120 is shown which is substantially similar toprosthesis 60, described above with respect toFIGS. 3A-3D .Prosthesis 120 exemplifies the concepts illustrated in the fragmentary conceptual profiles of prostheses 110, 110 a, and 110 b, described above with respect toFIGS. 5A-5C .Femoral trochlea prosthesis 120 includes substantially the same components asprosthesis 60 except as described below.Anterior nonarticulating surface 122 ofprosthesis 120 is angled as compared to anterior nonarticulating surface 68 (FIGS. 3A-3C ). In this manner,anterior nonarticulating surface 122 may be configured to match the angle ofresection lines 100′ (FIG. 4B ) or 100″ (FIG. 4C ), for example, while simultaneously replicating a normal anatomy of a distal femur on which prosthesis 120 is implanted. - Referring now to
FIGS. 7A , 7B, and 7C, a bone-conserving resection is shown for a distal femur for receipt of any of the prostheses described herein and in the Co-Pending Application. As shown inFIG. 7A ,distal femur 131 typically includesmedial condyle 132 andlateral condyle 134.Resection line 130 represents a typical resection line for a normaldistal femur 131.Distal femur 131 may not, however, always include normal anatomy. As shown inFIG. 7B ,distal femur 131′ includesmedial condyle 132′ andlateral condyle 134′ which has a dysplastic condition, i.e., an abnormal anatomical condition.Resection line 130 may satisfactorily accomplish the resection required for implantation of a femoral trochlea prosthesis ondistal femur 131′.Resection line 130′, however, may also accomplish the required resection while preserving bone. In an exemplary embodiment,resection line 130′ is formed as two noncolinear line segments, one of which extends as a beveled cut on the normal side ofdistal femur 131′, i.e.,medial condyle 132′, and the other of which extends across the dysplastic side ofdistal femur 131′, i.e.,lateral condyle 134′, which is substantially coincident withresection line 130. Similarly, as shown inFIG. 4C ,distal femur 131″ includeslateral condyle 134″ andmedial condyle 132″ which has a dysplastic condition.Resection line 130″ may accomplish the required resection while preserving bone. In an exemplary embodiment,resection line 130″ is formed as two noncolinear line segments, one of which extends as a beveled cut on the normal side ofdistal femur 131″, i.e.,lateral condyle 134″, and the other of which extends across the dysplastic side ofdistal femur 131″, i.e.,medial condyle 132″, which is substantially coincident withresection line 130. Thus,resection lines 130′ and 130″ are formed by two planar cuts formed with an obtuse, oblique angle between the planes. A portion ofresection lines 130′ and 130″ may substantially overlap or coincide withresection line 130, as shown inFIGS. 7B and 7C . Advantageously,resection lines 130′ (FIG. 7B) and 130″ (FIG. 7B ) represent a surgical technique or method to cut a distal femur which accounts for variable anterior femoral anatomy while simultaneously preserving as much bone as possible. For example,resection line 130′ extends medially/laterally acrossdistal femur 131′ as close as possible to patello-femoral groove 135′ while also removing substantially equal amounts of bone from bothmedial condyle 132′ andlateral condyle 134′. Similarly,resection line 130″ extends medially/laterally acrossdistal femur 132″ as close as possible to patello-femoral groove 135″ while also removing substantially equal amounts of bone from bothmedial condyle 132″ andlateral condyle 134″. This technique advantageously minimizes the bone removal and, consequently, preserves as much healthy bone as possible. - Referring to
FIGS. 8A , 8B, and 8C, femoral trochlea prostheses useable with the techniques described above with respect toFIGS. 7A , 7B, and 7C are shown. As shown inFIG. 8A ,femoral trochlea prosthesis 140 includingnonarticulating surface 142 may be used on distal femur 131 (FIG. 7A ).Nonarticulating surface 142 abuts resection line 130 (FIG. 7A ) ondistal femur 131 when implanted ondistal femur 131. As shown inFIG. 8B ,femoral trochlea prosthesis 140′ includingnonarticulating surface 142′ may be used ondistal femur 131′ (FIG. 7B ). Advantageously,nonarticulating surface 142′ is beveled to more closely match the prepared surface ofdistal femur 131′ represented byresection line 130′.Prosthesis 140′ may include a thicker lateral condyle portion to account for the dysplastic condition and to more closely replicate normal anatomy when implanted ondistal femur 131′. As shown inFIG. 8C ,femoral trochlea prosthesis 140″ includingnonarticulating surface 142″ may be used ondistal femur 131″ (FIG. 7C ). Advantageously,nonarticulating surface 142″ is beveled to more closely match the prepared surface ofdistal femur 131″ represented byresection line 130″.Prosthesis 140″ may include a thicker medial condyle portion to account for the dysplastic condition and to more closely replicate normal anatomy when implanted ondistal femur 131″. - As shown in
FIG. 8B , augment 150 may be used with any of the femoral trochlea prostheses described herein and in the Co-Pending Application to facilitate a more accurate fit with and orientation relative to a patient's anatomy and to more fully support a prosthesis when implanted. Augment 150 may have a generally triangular-shaped cross-section. Augment 150 may be formed of material such as, but not limited to, metal, polymethylmethacrylate (PMMA), polymer, a cobalt chromium alloy, or an open-cell porous metal such as a material made using Trabecular Metal™ technology, available from Zimmer, Inc. of Warsaw, Ind., for example. Augment 150 may placed proximate a medial condyle and/or a lateral condyle. - Referring to
FIG. 9 ,distal femur 155 is shown.Distal femur 155 may includeresection lines resection lines 100′, 100″, 130′, 130″, described above with reference toFIGS. 4B-4C and 7B-7C.Resection lines resection lines resection line 157 a forms an oblique angle with a plane defined by resection line 157 b. The plane defined by resection line 157 b forms an oblique angle with a plane defined byresection line 157 c. A surgical technique employingresection lines distal femur 155 to receive a femoral trochlea prosthesis. Any of the femoral trochlea prostheses described herein or in the Co-Pending Application may be used with a femur prepared withresection lines resection lines resection lines resection lines FIG. 8B ) may be used with a prosthesis implanted afterresection lines distal femur 155. -
FIG. 11 illustrates an exemplary resection for receipt of the distal nonarticulating surfaces described herein. For example,distal femur 161 may includeplanar cuts FIG. 2B ) or 70, 72 (FIG. 3A ). - All of the prostheses disclosed herein and in the Co-Pending Application may be specifically designed for gender specific applications. For example, the prostheses may be specifically designed for female anatomy and therefore include a greater lateral trochlear groove angle and a thinner anterior flange as compared to traditional prostheses. Further, for example, the prostheses may be specifically designed for male anatomy and therefore include a smaller lateral trochlear groove angle and a thicker anterior flange as compared to traditional prostheses.
- While this disclosure has been described as having exemplary designs, the present disclosure can be further modified within the spirit and scope of this disclosure. This application is therefore intended to cover any variations, uses, or adaptations of the disclosure using its general principles. Further, this application is intended to cover such departures from the present disclosure as come within known or customary practice in the art to which this disclosure pertains and which fall within the limits of the appended claims.
Claims (9)
1-11. (canceled)
12. A method for preparing an anatomical structure to receive a femoral trochlea prosthesis and for implanting the prosthesis in the anatomical structure, comprising the steps of:
resecting a portion of the anatomical structure by making one of:
a single planar resection along a line disposed at an angle with respect to a coronal plane of the anatomical structure; and
at least a pair of planar resection lines, at least one of said pair of planar resection lines disposed at an angle with respect to a coronal plane of the anatomical structure;
selecting a prosthesis to match the resection of said resecting step; and
implanting the prosthesis with respect to the prepared anatomical structure.
13. The method of claim 12 , further comprising the step of implanting an augment prosthesis between the prosthesis and the anatomical structure.
14. The method of claim 13 , wherein said step of implanting the prosthesis with respect to the prepared anatomical structure precedes said step of implanting an augment prosthesis between the prosthesis and the anatomical structure.
15. The method of claim 12 , wherein said resecting step defines a resected surface for an anterior nonarticulating surface of the prosthesis.
16. The method of claim 15 , wherein said resecting step further comprises two planar cuts defining a resected surface for a pair of distal nonarticulating surfaces of the prosthesis.
17. A method for preparing an anatomical structure to receive a femoral trochlea prosthesis and for implanting the prosthesis in the anatomical structure, comprising the steps of:
resecting a portion of the anatomical structure by making at least two noncoplanar cuts at a distal end of the anatomical structure, the two noncoplanar cuts defining a resected surface for a pair of distal nonarticulating surfaces of the prosthesis;
selecting a femoral trochlea prosthesis to match the resection of said resecting step; and
implanting the prosthesis with respect to the prepared anatomical structure.
18. The method of claim 17 , further comprising the step of implanting an augment prosthesis between the prosthesis and the anatomical structure.
19. The method of claim 18 , wherein said step of implanting the prosthesis with respect to the prepared anatomical structure precedes said step of implanting an augment prosthesis between the prosthesis and the anatomical structure.
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Also Published As
Publication number | Publication date |
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CA2602262C (en) | 2016-08-02 |
EP1955676A1 (en) | 2008-08-13 |
US20080188855A1 (en) | 2008-08-07 |
US8128704B2 (en) | 2012-03-06 |
CA2602262A1 (en) | 2008-08-06 |
DE602008005653D1 (en) | 2011-05-05 |
EP1955676B1 (en) | 2011-03-23 |
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