JP2008510526A - System and method for retrograde treatment - Google Patents

Abstract

  In accordance with the present invention, systems and methods for accessing the joint surface and creating an implant site on the joint surface can be used. The method provides a retrograde joint surface replacement system that can comprise a method and apparatus for replacing at least a portion of a joint surface, including accessing a desired portion of the joint surface through a portion of bone. . Although the foregoing overview and the following specific embodiments of the system according to the present disclosure are directed to a system for replacing at least a portion of a joint surface, the system herein provides a procedure other than replacement of a portion of a joint surface Can be used with respect to. From a broad perspective, the systems disclosed herein can include positioning a portion of a joint that provides an apparatus and method for indirectly accessing bones, joints, and the like.

Description

  The present disclosure is directed to systems and methods for accessing an articulation surface. The present disclosure is further directed to methods and systems for replacing at least a portion of a joint surface.

(Cross-reference of related applications)
This application claims the benefit of US Provisional Patent Application No. 60 / 603,473, filed Aug. 20, 2004. This application is a continuation-in-part of US Patent Application No. 11/169326, filed June 28, 2005, which claims the benefit of US Provisional Patent Application No. 60 / 58,549, filed June 28, 2004. It is also an application. This application is also a continuation-in-part of US patent application Ser. No. 10 / 994,453, filed on Nov. 22, 2004. Furthermore, this application is also a continuation-in-part of US patent application Ser. The entire disclosures of all applications listed above are incorporated herein by reference as references.

  Articular cartilage found at the ends of bones that articulate within the body is generally composed of vitreous cartilage that has many unique properties that enable it to function effectively as a smooth, low-friction bearing surface. In particular, problems with vitreous cartilage in the knee, hip, and shoulder joints generally occur with rheumatoid arthritis or aging (osteoarthritis), or with acute (sudden), or recurrent and chronic (ongoing) damage. Caused by a disease that occurs next. Such cartilage disease or alteration can damage the joint surface, cause pain, and ultimately lose joint movement. As a result, various methods have been developed to treat and repair damaged or destroyed articular cartilage.

  For smaller defects, conventional options for this type of problem include living with the lesion or injury intact, or ablation arthroplasty, or ablation chondroplasty ( It includes performing a treatment called abrasion chondralplasty). The background of this treatment is the principle of trying to stimulate natural healing. The bone surface is drilled using a high speed rotary burr or shaving device, and the surgeon removes approximately 1 mm of bone from the surface of the lesion. This creates an exposed subchondral bone bed that bleeds and causes the fibrocartilage healing response. One problem with this procedure is that, after drilling and burring, where the exposed bone tends to leave a series of ridges and valleys, the bone is not as smooth as it was originally and is resistant to fibrocartilage reaction resistance. It is to have an adverse effect. Furthermore, although this treatment can provide excellent short-term results (1-3 years), fibrocartilage is almost impossible to support such body weight over a long period of time and wears and softens. Tend to be altered.

  Another procedure called Microfracture incorporates some of the principles of perforation, ablation, and chondroplasty. During the procedure, the calcified cartilage layer of the cartilage defect is removed. By inserting a metal pick or surgical awl at the minimum number of locations within the lesion, several pathways or “microfractures” are formed in the bleeding bone bed under the costal cartilage. By establishing bleeding in the lesion and by forming a pathway in the subchondral bone, a fibrocartilage healing response occurs and a replacement surface is formed. This technique can be expected to produce results similar to ablation chondroplasty.

  Another means used to treat damaged articular cartilage is cartilage transplantation. In essence, the procedure is to transfer the cartilage from an external source, or from the other knee or the same knee to the defect. Typically this is done by transferring the peg of the cartilage with the underlying bone and fixing it in place by screws or pins or press fit. While this procedure requires a donor peg that is commensurate with the recipient bed, it is useful for smaller defects, but problems arise with larger defects. If the diameter of the lesion is large, it may exceed the capacity to take from within the same knee joint, making it impossible to take from another source.

  But larger defects generally require more aggressive therapeutic intervention. In general, treatment involves replacing part or all of a joint surface with an implant or prosthesis having an outer layer of material that provides a low-friction bearing surface near a polished or intact cartilage surface. Is required. In order to replace part or all of the joint surface, the damaged area must first be cut, bored or reamed to remove the damaged cartilage. A recess for receiving the implant or prosthesis is formed at the damaged site. The implant or prosthesis is then secured to the bone at the appropriate location in the recess.

Treatment and / or replacement procedures often require direct access to the damaged surface of the cartilage. The most commonly damaged parts of some joints can be easily accessed for repair purposes using minimally invasive procedures, but are rarely accessible by some joints, for example on the upper or inner side Femoral heads, medial humeral heads, glenoids, etc. do not allow sufficient direct access to perform joint surface replacements in a minimally invasive manner. In fact, the repair of such blocked joints often requires an invasive procedure and requires the joint to be completely dislocated. Such an invasive procedure can be painful and require a long recovery period.
US Provisional Patent Application No. 60 / 603,473 US Provisional Patent Application No. 60/583549 US patent application Ser. No. 11 / 169,326 US patent application Ser. No. 10 / 994,453 US patent application Ser. No. 10 / 308,718

  Accordingly, one object of the present invention is to provide a method for replacing articulating surfaces that are less invasive than conventional procedures and may not require complete dislocation of the joint, which is difficult to see from an axial approach. It is to be.

  The subject matter of this disclosure is made clear by the description of the embodiments according to the present invention, and the description should be considered in conjunction with the accompanying drawings.

  As an overview, the present disclosure provides a retrograde joint surface replacement system that can comprise a method and apparatus for replacing at least a portion of a joint surface, including accessing a desired portion of the joint surface through a portion of bone. I will provide a. Although the foregoing overview and the following specific embodiments of the system according to the present disclosure are directed to a system for replacing at least a portion of a joint surface, the system herein provides a procedure other than replacement of a portion of a joint surface Can be used with respect to. From a broad perspective, the systems disclosed herein can provide devices and methods for indirectly accessing bones, joints, and the like.

  Turning attention to FIG. 1, one embodiment of a retrograde joint surface replacement system 10 is shown. System 10 may generally comprise a positioning device such as positioning hoop 12 coupled to a guide such as cannulated shaft 18. The positioning hoop 12 and cannulated shaft 18 can be held in a positional and angular relationship by the arm 16. According to the illustrated embodiment, the cannulated shaft 18 can be coupled to the tool support 14 and the tool support 14 can be coupled to the positioning device 12 by the arm 16. The positioning hoop 12 and cannulated shaft 18 can be placed in opposing positions around a bone 20 having an articulating surface 22.

  The positioning hoop 12 can include an opening therethrough such that a portion of the joint surface can be exposed through the opening in the positioning hoop 12 when it is positioned over the joint surface 22. Further, when the positioning hoop 12 is disposed on the joint surface 22, the positioning hoop 12 can obtain a desired orientation with respect to a portion of the joint surface 22 exposed through the opening. According to the illustrated embodiment, the positioning hoop 12 as a whole can be configured as a ring having a circular opening extending therethrough. As shown, the positioning hoop 12 can be placed on the articulating surface 22. According to one embodiment, when the positioning hoop 12 is placed on the joint surface 22, the opening axis of the positioning hoop 12 can be substantially perpendicular to the joint surface 22 at the point of intersection by the opening axis. As such, the positioning hoop 12 can be directed. According to another embodiment, the positioning hoop 12 can obtain various other desired orientations relative to the articulating surface 22.

  The tool support 14 can include an opening 24 that extends inwardly from a rear portion 26 of the tool support 14. The tool support 14 can define one or more windows 28 in the opening 24. According to one embodiment, the window 28 may comprise a transparent region of the tool support 14. For example, the window 28 can comprise an area that allows the inside of the opening 24 to be seen, such as transparent plastic, glass, or the like. Alternatively, the window 28 can be provided as an opening in a lateral region of the tool support 14. In such a configuration, the window 28 not only allows the inside of the opening 24 to be viewed, but also allows access to the interior of the opening 24 and / or the tool and / or objects within the opening 24 to the tool support. 14 can be operated from the outside.

  The tool support 14 may also include a bore 30 that extends from the opening 24 to the front region of the tool support 14. As shown, the bore 30 can be sized to receive a cannulated shaft 18 therethrough. According to one embodiment, the inner diameter of the bore 30 may be dimensioned closely to the outer diameter of the cannulated shaft 18 in order to hold the cannulated shaft 18 in substantially coaxial alignment with the bore 30. it can. In addition, the tool support 14 can include a locking mechanism 32 that can be engaged to prevent axial and / or rotational movement of the cannulated shaft 18. A suitable locking mechanism 32 can have a variety of configurations. For example, the locking mechanism 32 can be a frictional locking mechanism comprising a bearing member that can be pressed against the cannulated shaft 18 and frictionally engage it. Another suitable locking mechanism 32 may comprise a plurality of teeth that can selectively engage with a corresponding configuration, such as a circumferential groove / ridge on at least a portion of the outer portion of the cannulated shaft 18. Various other locking mechanisms can be used herein as well or instead.

  The positioning hoop 12 and the tool support 14 are connected to each other by an arm 16. The arm 16 can hold the positioning hoop 12 and the tool support 14 in a desired angular alignment and / or position relative to each other. For example, the arm 16 can point the positioning hoop 12 and tool support 14 such that the axis of the bore 30 intersects the center of the opening of the positioning hoop 12 at a desired angle. The arm 16 can also arrange the tool support 14 and the positioning hoop 12 at a predetermined relative angle such that the axis of the bore 30 does not intersect the opening of the positioning hoop 12. According to one embodiment, the positioning hoop 12 can also be oriented perpendicular to the guide shaft 18.

  According to an exemplary embodiment, the arm 16 can be a composite arcuate member having a fixed geometry. Therefore, the relationship between the positioning hoop 12 and the tool support 14 can be a fixed relationship. However, it is contemplated herein that the arm 16 can be releasably connected to the tool support 14 and / or the positioning hoop 12. In such embodiments, the tool support 14 and / or the positioning hoop 12 can be separated from the arm 16. Arm 16 replaces another arm or assembly of arm 16 and positioning hoop 12 that provides a different configuration between positioning hoop 12 and tool support 14 and / or provides different angular alignment and / or positional relationship. Can do. According to related embodiments, the arm 16 can be provided as an adjustable configuration, whereby the angular alignment and / or positional relationship between the positioning hoop 12 and the tool support 14 can be changed or replaced without replacing the arm 16. Allow correction.

  According to the illustrated embodiment, the cannulated guide shaft 18 may generally comprise a proximal receptacle 33, a shaft portion 34, and a distal tip 36. The shaft portion 34 can comprise at least one lumen extending along the length of the cannulated shaft 18. At least a portion of the shaft 34 can be disposed within the bore 30 of the tool support 14. Desirably, the shaft 34 is dimensioned to provide minimal clearance for the bore 30. Thus, by arranging the shaft portion 34 at least partially within the bore 30, the lumen axis can be aligned with the bore 30 axis in a predetermined relationship. As previously discussed, the bore 30 can be oriented in a predetermined angular and / or positional arrangement with respect to the positioning hoop 12. The positioning hoop 12 can itself be placed in a predetermined relationship with respect to the joint surface 22. Thus, when the shaft 34 is at least partially disposed within the bore 30, the lumen of the shaft portion 34 can be disposed in a desired angular and / or positional orientation relative to the opening of the positioning hoop 12. In one embodiment, the axis of the lumen can be oriented parallel to the axis of the bore 30 when the shaft portion 34 is received at least partially within the bore 30. In another embodiment, the lumen can be oriented coaxially with the bore 30 when the shaft portion 34 is received at least partially within the bore 30.

  With further reference to the cross-sectional view of FIG. 4, the receiving portion 33 of the cannulated shaft 18 may have a cup-shaped or conical inner profile leading into the lumen of the cannulated shaft 18. The cup-shaped or conical receptacle 33 can facilitate the insertion of instruments, devices, etc. into the lumen of the cannulated shaft 18. According to the above aspect, an instrument, a device, or the like that is inserted into the lumen with the aid of the cup-shaped or conical receiving portion 33 has a predetermined orientation relative to the opening of the positioning hoop 12 depending on the orientation of the lumen with respect to the opening of the positioning hoop 12. Can be directed at least overall in a relationship. Thus, instruments, devices, etc. can be placed at least generally in a predetermined orientation and / or alignment with respect to a portion of the articulating surface 22 identified within the positioning hoop 12.

  As shown in FIG. 1, the positioning hoop 12 can be placed around a desired portion of the articular surface 22. A cannulated shaft 18 can then be inserted through the bore 30 of the tool support 14. The cannulated shaft 18 can then be positioned so that the distal tip 36 of the cannulated shaft 18 can abut against the bone 20 on the opposite side of the articulating surface 22 in a predetermined alignment with the opening of the positioning hoop 12. . As in the exemplary arrangement, when the positioning hoop 12 and the distal tip 36 of the cannulated shaft 18 are arranged to strike both sides of the bone 20, the distal tip 36 of the cannulated shaft 18 is angled. The bone 20 can be touched. In such an orientation, only a portion of the distal tip 36 can actually contact the bone 20. Partial contact between the distal tip 36 and the bone 20 may be susceptible to movement of the distal tip 36 across the surface of the bone 20, at which point the joint The position of the positioning hoop 12 on the surface 22 is changed.

  The movement of the distal tip 36 of the cannulated shaft 18 across the surface of the bone 20 can be reduced by providing a distal tip 36 having a biting configuration. For example, as shown, the tip 36 may have a notched or serrated end configuration. When the distal tip 36 is pressed against the bone 20, the knurled end configuration engages the bone 20 and can resist movement after the tip 36 is so engaged. Thus, the system 10 can be placed at a desired location and / or in alignment with the articular surface 22 by placing bone between the positioning hoop 12 and the distal tip 36 of the cannulated shaft 18. . The positioning hoop 12 and the distal tip 36 can be made to strike on both sides of the bone 20. The cannulated shaft 18 can then be locked in place using the locking mechanism 32 of the tool support 14. Thus, depending on the desired location, even if the distal end 36 of the cannulated shaft 18 is tilted to contact the bone so that only a portion of the distal end 36 contacts the bone 20, The system 10 can be held in a desired position and / or alignment with respect to the joint surface.

  Turning to FIG. 2, a system 10 consistent with FIG. 1 can be used for procedures to replace a portion of the articular surface 22. According to a treatment embodiment according to the present disclosure, after the positioning hoop 12 and the cannulated shaft 18 are oriented in a desired alignment with respect to the articular surface 22, the reference axis is set with respect to the articular surface 22. it can. According to one embodiment, setting the reference axis can include providing a passage or hole through the bone 20. The passage or hole can penetrate completely through the bone 20 and can exit the articulating surface 22. Thereby, the alignment and orientation of the reference axis with respect to the joint surface 22 can be collated.

  In accordance with the present disclosure, the reference axis can be set by drilling a hole through bone 20 in a predetermined alignment with respect to cannulated shaft 18. According to one embodiment, the holes can be aligned coaxially with the cannulated shaft 18. According to the present disclosure, the hole with respect to the reference axis can be a relatively small diameter compared to the lumen of the cannulated shaft 18. The reference shaft hole can be drilled in the desired alignment using the reducer shaft 38. The reducer shaft 38 can be a cannulated shaft having an outer diameter dimensioned to be received within the lumen of the cannulated shaft 18. The inner diameter of the lumen of the reducer shaft 38 can be dimensioned to receive and align a pilot drill bit for drilling a reference shaft hole having a desired diameter. Similar to the cannulated shaft 18, the reducer shaft 38 can include a cup-shaped or conical proximal receptacle 40. The cup-shaped or conical receptacle 40 aligns instruments, tools, and / or other devices with the lumen of the reducer shaft 38 and / or aligns such instruments, tools, and / or other devices with the reducer shaft 38. Can be easily inserted into the lumen.

  With the positioning hoop 12 and cannulated shaft 18 aligned and locked in the desired orientation relative to the articulating surface 22, the reducer shaft 38 is inserted into the lumen of the cannulated shaft 18 through the opening 24 at the rear of the tool support 14. it can. The reducer shaft 38 can extend through at least a portion of the lumen of the cannulated shaft 18. According to one embodiment, the reducer shaft 38 can extend through the cannulated shaft 18 to contact the bone 20 or terminate near the surface of the bone 20. In such a configuration, instruments such as pilot drill bits, tools, etc. can reach the surface of the bone 20 and be fully supported.

  The reducer shaft 38 is in place within the lumen of the cannular shaft 18 and the guide pin 42 is loaded into the lumen of the reducer shaft 38 through the opening 24 of the tool support 14. Loading the guide pin 42 into the lumen of the reducer shaft can be facilitated by the cup-shaped or conical receptacle 40 of the reducer shaft 38. Guide pin 42 may comprise a drill tip (not shown) or other cutting configuration disposed at the distal end of guide pin 42. The guide pin can be driven, for example, from the rear part 26 of the tool support 14 by a drive motor or a manual drive handle. The depth of the hole can be measured by monitoring the penetration of the guide pin 42 through the articulating surface 22 in the opening of the positioning hoop 12. Alternatively, the separation distance between the tool support 14 and the positioning hoop 12 can be known based on the configuration of the arm 16, the positioning hoop 12, and the tool support 14. In one embodiment, the guide pin 42 can be provided with an indication representing the depth of penetration. The depth of the reference shaft hole can be determined from the relationship between the guide pin 42 and at least one of the tool support 14, the reducer shaft 38, the cannulated shaft 18, and the like.

  After the guide pin 42 has been pierced into and / or through the bone 20 in the manner described above, the guide pin 42 may be inserted into / through the bone and / or articular surface 22. Can be held to extend. Guide pins 42 extending at least partially into or through the bone 20 may provide a reference axis aligned through the reducer shaft 38. Guide pin 42 can be used to position subsequent operations and / or instruments relative to the reference axis. After the guide pin 42 has been placed through the bone 20 and into the hole, the reducer shaft 38 can be withdrawn from the lumen of the cannulated shaft 18. At least a portion of the guide pin 42 may remain in a hole that extends into the bone 20. If the guide pin 42 is provided by a close fit with the hole, the guide pin 42 can be held in the desired alignment with the reference shaft.

  According to another embodiment, a drill can be used to provide a hole extending into and / or through bone 20. The reducer shaft 38 can be used to align and / or support the drill bit during the drilling operation. After the hole has been drilled into or through the bone 20, a guide pin 42 extends into or is inserted through the hole to provide a reference axis in a manner similar to that described above. it can.

  After the guide pin 42 is positioned extending from the bone 20 at a desired position relative to the reference axis, a larger hole can be drilled in the bone that receives the fixation and / or positioning elements. According to one embodiment, the hole for the fixation element can extend completely through the bone 20 and the articular surface 22. However, in another embodiment, the hole for the fixation element can extend only partially through the bone 20.

  In one embodiment, a hole or cavity for the fixation element can be drilled through at least a portion of the bone 20 using a cored drill. That is, the drill can include a lumen, or an opening therethrough. The lumen through the drill can be dimensioned to receive the guide pin 42. A guide pin 42 received through the lumen of the drill allows the drill to be carried on and supported by the guide pin so that a hole for the fixation element can be drilled into the bone 20. When the drill is thus carried on the guide pin 42, the holes for the fixing elements can be provided in the desired alignment with respect to the reference axis passing through the articulating surface 22. Further, by carrying the drill on the guide pin 42, an additional reducer tube supports the drill on its outer diameter, for example when the outer diameter of the drill is smaller than the inner diameter of the lumen of the cannulated shaft 18. You can eliminate the need. Alternatively or additionally, a reducer tube that supports the outer diameter of the drill can be used to drill the hole.

  Turning now to FIGS. 3 and 4, after a hole or cavity has been drilled through the bone 20 for the fixation element, the fixation element can be placed in the bone. Consistent with this, the fixation element can be an element adapted to maintain or assist in maintaining the implant in the bone 20. In the illustrated embodiment, the securing element is configured as a screw 44. According to one embodiment, the screw 44 can be routed through the cannulated shaft 18 to the bone 20. Thus, the outer diameter of the screw 44 can be smaller than the inner diameter of the lumen of the cannulated shaft 18, thereby allowing the screw to pass through the cannulated shaft 18 from the tool support 14. The hole through bone 20 for receiving screw 44 may have a diameter that is smaller than the outer diameter of the thread of screw 44, allowing the thread of screw 44 to engage bone 20. Various other elements or configurations can be used as fixed elements in addition or instead.

  According to an exemplary embodiment, the screw 44 can be rotationally driven into the bone using a probe-driver 46, i.e. screwable. The probe driver 46 can include a shaft 48 that is configured to extend through the lumen of the cannulated shaft 18. A distal region of shaft 48 is provided that has a configuration for engaging and / or driving screw 44. For example, the shaft 48 can comprise a corresponding hexagonal socket of the screw 44 or a hexagonal region adapted to be received by the opening. Various other forms and configurations are available that allow shaft 48 to engage and / or drive screw 44.

  The probe driver 46 can also include a knob 50 coupled to the proximal end of the shaft 48. The knob 50 can be coupled to the shaft 48 so as to resist torsion so that the shaft 48 can be rotated at the same time as the knob 50 is rotated to drive the screw 44. In addition, the probe driver can include a cylindrical region 52 that can be dimensioned to be rotatably received within the opening 24 of the tool support 14. According to one embodiment, the cylindrical region 52 may be sized relative to the opening 24 so that the probe driver 46 can be supported by the opening 24 of the tool support 14.

  According to one embodiment, the probe driver 46 and the cylindrical region 52 of the tool support 14 cooperate to display the depth of penetration of the cylindrical region 52 into the opening 24 of the tool support 14 ( (Not shown). In one embodiment, the indication can be associated with the depth of insertion of the screw 44 into the bone 20. Thus, the depth of attachment of the screw 44 into the bone 20 can be controlled and / or verified. Cooperative displays can include, for example, a scale and reference unit, a vernier scale, or other system of reference marks.

  According to certain embodiments, the indication can be associated with the depth of the screw 44 below the articular surface 22. Such association can be achieved based on a known distance between the articulating surface 22 as established by the positioning hoop 12 and the tool support 14 established by the arm 16. A screw 44 having a known length of screw on the shaft 48 of the probe driver 46 and a predetermined installation height can be used to drive the screw 44 into the bone 20 at a predetermined distance from the articular surface 22. be able to.

  Further, referring to FIGS. 5 and 6, the distal end of the shaft 48 can comprise a probe configuration 54. As shown, the probe configuration 54 can extend through the screw 44 a predetermined distance beyond the end of the screw 44. According to the embodiment illustrated in FIG. 5, the probe configuration 54 can be used to place the screw 44 at a predetermined depth within the bone 20 relative to the positioning hoop 12. The screw 44 can be provided with a known length and can be configured to be installed on the shaft 48 of the probe driver 46 at a known distance from the distal tip of the shaft 48. The known length and known installation height of the screw 44 can be based on predetermined design characteristics and / or measurements made prior to installation of the screw 44. According to the embodiment of FIG. 5, the screw 44 can be placed at a predetermined depth relative to the positioning hoop 12 by driving the screw 44 until the probe configuration 54 reaches a predetermined height relative to the positioning hoop 12. For example, the screw 44 can be driven into the bone until the tip of the probe 54 at the distal end of the shaft 48 of the probe driver 46 is flush with the top of the positioning hoop 12, as shown. Various other alignment relationships with the tip of the probe 54 on the shaft 48 of the probe driver 46 may be used to position the screw 44 at a desired depth within the bone 20 as well or instead. it can.

  In the related embodiment illustrated in FIG. 6, the probe configuration 54 of the probe driver 46 can be used to place the screw 44 at a predetermined depth relative to the articular surface 22. For example, the screw 44 can be disposed at a predetermined depth relative to the original articular surface 22 or can be disposed at a predetermined depth relative to the articular surface 22 surrounding the hole that receives the screw 44. Either embodiment may provide a screw 44 having a predetermined length and having a predetermined installation height on the distal end of the shaft 48. The screw 44 can then be driven into the bone 20 until the probe configuration 54 reaches a predetermined height relative to the articular surface 22.

  Embodiments can be provided that combine the co-operative representation of the probe driver 46 and tool support 14 described above, and various aspects of the probe configuration 54 of the shaft 48 of the probe driver 46. Such an embodiment combining these aspects can be used to place the screw at a predetermined depth relative to at least one of the positioning hoop 12 and the articulating surface 22.

  According to another embodiment, a fixation element such as a screw 44 can be inserted from the articular surface 22 into the bone. According to such an embodiment, after a hole has been drilled through the articulating surface 22, a screw 44 is fed into the articulating surface 22 and directed into the hole therein. For example, a wire such as a metal wire, plastic filament, etc. passes through the hole and screw 44 or is attached to the screw 44 and passes through the hole. The screw 44 can then be pulled into the hole in the articular surface 22. The screw 44 can then be driven into the articular surface in a manner similar to the previous embodiment, for example, using a driving shaft that extends through a hole in the bone 20.

  After the screw 44 is attached to the desired location within the bone 20, the region of the articular surface 22 surrounding the axis of the screw 44 can be excised to provide an implant site. The articulating surface 22 can be ablated using a rotating cutting device that can be positioned so that the rotational axis of the cutting device is generally aligned with the axis of the opening through the screw 44. According to one embodiment, wires such as metal wires, plastic filaments, etc. can pass through the bone 20 such that they extend from the articular surface 22 and the opposite side of the bone. The wire can pass through or be coupled to the cutting device along its axis of rotation. The cutting device can then be pulled toward the joint surface by retracting the wire through the bone or by sliding the cutting device along the wire toward the joint surface. In either case, the wire passing through the bone 20 can serve to align the axis of rotation of the cutting device with the axis of the opening through the screw 44. Another method of positioning the cutting device relative to the joint surface can also be used in accordance with the present disclosure, including manually positioning the cutting device.

  According to one embodiment, the cutting device can comprise a socket or opening along its axis of rotation. For example, the cutting device can comprise a hexagonal socket along its axis of rotation. A socket or opening along the axis of rotation of the cutting device can be rotationally driveable so that the cutting device ablate at least a portion of the articular surface. Once the cutting device's rotational axis is aligned with the opening through the screw 44 as a whole and the cutting device is placed on the joint surface, the driving shaft can be inserted through the hole through the bone and the opening through the screw. Can engage with the cutting device. For example, if the cutting device has a hexagonal socket, the drive shaft can comprise a hexagonal shape adapted to be received within the hexagonal socket of the cutting device.

  After the driving shaft is engaged with the cutting device, the cutting device can be driven to rotate by the driving shaft. The drive shaft, and thus the cutting device, can be driven manually, for example by rotating a handle proximate to the cutting device, and can be mechanically driven, for example by a drive motor or drill device. Although the cutting device is driven for rotation by the driving shaft, the cutting device can also be retracted into the articulating surface 22 thereby cutting away the articulating surface to form a generally circular implant site.

  The depth of the implant site can vary, including visually inspecting the implant site and / or the depth of the cutting device within the implant site, the indication of the drive shaft indicating the depth at which the cutting device is pulled into the joint surface, etc. Can be controlled in different ways. According to one embodiment, the depth of the implant site can be controlled by screws 44 or other fixation elements. The screw 44 may comprise an upper bearing surface 56 generally shown in FIG. The cutting device can have a corresponding lower bearing surface adjacent to the screw 44. The cutting device can be driven to rotate and retract into the articulating surface 22 until the lower bearing surface of the cutting device abuts the upper bearing surface 56 of the screw 44. Thus, a cutting site having a predetermined depth relative to the screw can be provided.

  Depending on the diameter of the implant site, the positioning hoop 12 and / or tool support 14 can be removed from the bone 20 prior to cutting the implant site. For example, if the diameter of the implant site is greater than or equal to the inner diameter of the positioning hoop 12, it may be desirable to remove the positioning hoop from the region of the articular surface 22 that is to be excised prior to excising the implant site. However, if the implant site diameter is smaller than the inner diameter of the positioning hoop 12, the positioning hoop 12 can optionally be held in place on the articular surface 22. If the positioning hoop 12, tool support 14, etc. are removed during the excision of the implant site, the openings extending through the screw 44 can serve as an alignment feature. That is, the diameter of the drive shaft is dimensioned with respect to the opening through the screw 44 such that the opening through the screw 44 can generally hold the drive shaft in the desired alignment during cutting of the implant site. Can do.

  According to another embodiment, the implant site can be excised prior to or without attachment of a fixation element such as a screw. In such embodiments, the depth of the implant site can be provided using visual inspection, indication on the drive shaft, and / or a cutting device or the like. The direction of resection can be controlled by the tool support 14, for example through guiding a cannulated shaft or other guiding configuration, or by a hole through the bone. In either case, a cutting device can be rotatably driven to provide an implant site in the manner described above to ablate a desired portion of the articular surface 22 and / or underlying bone 20.

  As shown in FIG. 7, after the implant site is excised, an implant 58 that replaces at least a portion of the articular surface 22 can be installed in the implant site. A wide variety of implants and / or implants having a variety of different properties can be suitably used to replace at least a portion of a joint surface according to the present disclosure. Accordingly, the disclosure herein should not be regarded as limited to a particular implant. According to one embodiment, a suitable implant can have a generally circular shape. However, other various implant shapes may be required depending on the shape of the implant site. If at least a portion of the cutting path of the cutting device does not contact the joint surface or bone, it can be an implant site having a non-circular shape. For example, an implant site having a truncated circle can be provided if the joint surface depth is less than the cutting radius of the cutting device at the depth of the implant site. Depending on the contour of the joint surface at the depth of the implant and the radius of the cutting path of the cutting device used to cut the implant site, there will be various other shaped implant sites.

  Referring again to FIG. 7, an implant 58 having a load bearing surface 60 can be provided that can approximate the geometry or curvature of the articular surface replaced by the implant, according to an exemplary embodiment of the present disclosure. In one embodiment, the bearing surface geometry can be based on the actual articular surface being replaced. For example, mapping techniques well known in the art can be used to measure the geometry of the area of the actual joint surface to be replaced. The implant can then be constructed or selected from a set of implants having a predetermined geometric shape. Alternatively, an implant for a particular application can be made or selected from a set of standard sized / shaped implants to provide an overall approximation of the joint surface to be replaced. The selection or manufacture of the implant may depend on varying degrees of quantitative reference to the joint surface to be replaced, including no quantitative reference to the joint surface.

  According to one aspect, the system herein can be used to provide information regarding the curvature of the articular surface 22. According to one embodiment, the curvature of the articular surface 22 can be measured and approximated using the positioning hoop 12. The positioning hoop 12 can contact the articulating surface continuously at a plurality of positions around the circumference of the bottom of the positioning hoop 12 and / or around the circumference of the bottom of the positioning hoop 12. The height of the articular surface 22 at the center of the positioning hoop 12 can be measured relative to the circumference of the bottom of the positioning hoop 12 by using, for example, a probe driver 46. The two generally opposite contact points between the circumference of the bottom of the positioning hoop 12 with the radius of the positioning hoop 12 and the height of the articular surface 22 at the approximate center of the positioning hoop 12 is approximately the curvature of the joint surface. Three points on the matching curve can be defined. The geometry of the articular surface 22 can be mapped or approximated by forming one or more such curves that approximate the curvature of the articular surface. Mapping or approximation of the curvature of the articular surface 22 can be used to select and / or manufacture an implant that can appropriately replace the desired portion of the articular surface 22.

  One implant 58 is maintained in the implant site by various mechanisms. For example, the implant can comprise one or more forms adapted to interact with a fixation element to maintain it within the implant site. According to an exemplary embodiment, the screw 44 can include an opening extending therein. At least a portion of the opening can be configured with a precision taper. The implant 58 can include a post 62 having a precision taper that is adapted to mate with the taper of the opening of the screw 44. The implant 58 inserts the tapered post 62 of the implant 58 into the tapered opening of the screw 44 and applies axial pressure or impact to the implant 58, thereby tapering the tapered post 62. It can be maintained in the implant site by installing it in the opening.

  Various other features and methods can be used to maintain the implant within the implant site. The implant and fixation element can comprise interacting or cooperating forms other than tapered posts and tapered openings. For example, the fixation elements and implants can have conventional compression fit configurations, snap fits, and the like. In embodiments that do not use a separate fixation element, the implant is in the form of an inverted post that can engage the side of the implant site, and / or a hole that is drilled into or through the bone. Can be provided. Bone cement can additionally or alternatively be used to secure the implant to the implant site.

  According to related embodiments, the positioning hoop 12 and the tool support 14 can be removed after the guide pin 42 is installed in the bone 20. As discussed above, the guide pin 42 can establish a reference axis for performing the steps of a subsequent articular surface replacement procedure. For example, the guide pin can establish a reference axis for guiding the cored drill bit described above. A cored drill can be used to provide a cavity for a fixation element that can include an opening or configuration oriented in a predetermined relationship to a reference shaft. According to one embodiment, the opening or form in the fixation element can be used to position and align subsequent operations, instruments, and / or devices.

  Focusing on FIGS. 8 and 9, the versatility of the joint surface replacement system 10a is shown. In the illustrated embodiment, a joint surface replacement system 10a is shown positioned to replace at least a portion of a joint configuration, such as the femoral head 102. Similar to the previous embodiment, the system 10a as a whole can include a positioning hoop 12a connected to the tool support 14a in a predetermined orientation and alignment by an arm 16a. The tool support 14a can arrange the cannulated shaft 18a in a predetermined orientation and alignment with the positioning hoop 12a.

  According to the illustrated embodiment, the biting configuration of the distal tip 36a of the cannulated shaft 18a may cause undesirable movement of the cannulated shaft 18a relative to the femoral head 102 or similar steep arc or angled surface. Can be particularly useful in reducing or preventing. As also shown in the illustrated embodiment, the joint replacement system 10a is suitable for replacing the femoral head 102, or a portion of a similarly configured joint, without reference to the joint neck axis. Can be used for This aspect of the present disclosure can allow minimizing the amount of articular surface that is replaced.

  With reference to FIGS. 10-13, a further embodiment of a joint surface replacement system is shown. In a further embodiment, a joint surface replacement system according to the present disclosure can be used to access the joint surface at least partially by passing a hole through adjacent bone. In the illustrated embodiment, a portion of the glenoid articular surface 62 is accessible through the humerus 20a and a portion of its articular surface 22. For clarity and ease of understanding, the glenoid joint surface 62 and the surrounding structure are not shown in full and complete structure of the scapula, but are only shown in a simplified manner. Absent. Similarly, the humeral and glenoid structures and relationships are also typically shown in at least slightly disassembled form for clarity and detailed illustration. Although the exemplary embodiments are shown with respect to the articular surface of the humeral head and glenoid, the systems herein can be used in the context of various other bones, joints, and articular surfaces.

  Referring first to FIG. 10, a system 10a generally comprising a positioning hoop 12a connected to a tool holder (not shown) via an arm 16a will be generally described with reference to the previous embodiment. Can be used to position the cannulated shaft 18a in a desired relationship relative to a defect in the articular surface 22a of the humerus 20a or the articular surface 62 of the glenoid. In particular, the positioning hoop 12a can be placed in or in a desired relationship with the defect in the surface of the joint to be replaced or in a part thereof. According to exemplary embodiments, the defect or portion to be replaced can be positioned in the articular surface 22a of the humerus or in the articular surface 62 of the glenoid. According to embodiments herein, corresponding portions of each articular surface 22a, 62 can be replaced.

  As shown, using a cannulated shaft 18a for directing and supporting the guide pin 42a by a positioning hoop 12a placed in a desired relationship with the defect or portion of the articular surface 62 to be replaced. The guide pin 42a can penetrate through the humerus 20a and its joint surface 22a. The guide pin 42a can provide a reference axis for performing subsequent procedures. According to one embodiment, the guide pin 42a is perforated at least partially into the glenoid articular surface 62 to record the intersection of the glenoid articular surface 62 and the reference axis.

  Turning now to FIG. 11, an implant site 64 can be formed in the articular surface 62 of the glenoid after a reference axis has been provided through the humerus 20a. The implant site 64 can be provided by supplying a rotating cutter between the articular surface 62 of the glenoid and the articular surface 22a of the humerus 20a. The rotary cutter can include a socket or opening for receiving the driving shaft 65 therein. The drive shaft 65 is provided extending through the humerus 20a and is rotatably engageable with a rotary cutter between the articular surface 22a of the humerus 20a and the articular surface 62 of the glenoid. The rotary cutter can be manually and mechanically driven and pushed into the glenoid articular surface 62 to excise the glenoid articular surface 62 and the underlying bone region. As foreseen, the rotary cutter can generate an implant site 64 in the glenoid articular surface 62 having a generally circular geometry.

  Referring to FIGS. 12 and 13, after the implant site 64 has been excised, an implant 66 can be inserted therein. According to the illustrated embodiment, the implant 66 can have a generally circular cross-section and can have an outer surface that can replace the ablated region of the articular surface 62 of the glenoid. The outer surface of the implant 66 can be provided to generally correspond to the original glenoid articular surface 62 based on various degrees of quantitative and / or qualitative comparison. Alternatively or additionally, the implant 66 can have an outer surface adapted to provide the desired interaction with a cooperating implant that is mounted in the articular surface 22a or the humerus 20a. Implant 66 may be used within implant site 64 using a variety of techniques including bone cement, separate fixation elements, one or more features on the implant that engage the wall of the resection site, and the like. Can be attached to.

  An implant site can be formed in the articular surface 22a of the humerus 20a to provide an implant in the articular surface 22a of the humerus 20a that can interact with the implant 66 in the articular surface 62 of the glenoid. Such an implant site can be formed as described with reference to FIGS. The implant site in the humerus 20a can be provided before or after the implant site 64 in the articular surface 62 of the glenoid.

  Various other features and advantages of the joint replacement system described herein will be appreciated by those skilled in the art. Similarly, the systems described herein can be subject to many changes and modifications without substantially departing from the spirit of the disclosure.

FIG. 3 illustrates one embodiment of a retrograde joint surface replacement system according to the present disclosure. FIG. 2 shows the use of the retrograde joint surface replacement system of FIG. 1 to place a guide pin in the bone. FIG. 3 illustrates a fixation element positioned under a joint surface using a retrograde joint surface replacement system according to the present disclosure. FIG. 4 is a cross-sectional view of the retrograde joint surface replacement system shown in FIG. 3. FIG. 5 is an enlarged cross-sectional view of a portion of the retrograde joint surface replacement system of FIG. 4 adjacent to a positioning hoop. 1 is an enlarged cross-sectional view of a portion of a retrograde joint surface replacement system according to the present disclosure comprising a depth probe. FIG. 1 is a representative cross-sectional view of a joint surface having an implant mounted therein using a retrograde joint surface replacement system according to the present disclosure. FIG. 1 is a perspective view of a retrograde joint surface replacement system according to the present disclosure applied to a joint surface of a femoral head. FIG. FIG. 9 is an enlarged view of a portion of the joint surface replacement system of FIG. 8 adjacent to the articular surface of the femoral head. 1 is a perspective view of an embodiment of a joint surface replacement system in use to replace cooperating joint surfaces according to the present disclosure. FIG. FIG. 4 illustrates an implant site that is excised at a cooperating joint surface according to the present disclosure. FIG. 6 shows an implant on a joint surface attached to a cooperating joint surface. It is sectional drawing of the joint surface of FIG.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 system 10a system 12 positioning hoop 12a positioning hoop 14 tool support part 14a tool support part 16 arm 16a arm 18 shaft 18a shaft 20 bone 20a humerus 22 joint surface 22a joint surface 24 opening 26 back part 28 window 30 bore 32 locking mechanism 33 Position receiving portion 34 Shaft portion 36 Distal tip 36a Distal tip 38 Reducer shaft 40 Proximal receiving portion 42 Guide pin 42a Guide pin 44 Screw 44a Screw 46 Probe driver 48 Shaft 50 Knob 52 Cylindrical region 54 Probe configuration 56 Bearing surface 58 Implant 60 Load bearing surface 62 Post 64 Implant site 65 Driving shaft 66 Implant 102 Femoral head

Claims (20)

A device for retrograde access to the joint surface,
A positioning device positionable on a portion of the joint surface;
A guide that can provide an axis for the positioning device that penetrates the articulating surface;
An arm capable of connecting the positioning device to the guide portion and capable of maintaining a positional and angular relationship between the positioning form and the guide portion. A device characterized by.   The apparatus of claim 1, wherein the positioning device comprises a positioning hoop having an opening capable of exposing a portion of the articulating surface.   The apparatus of claim 1, wherein the positioning device is capable of measuring a geometry of the joint surface.   The apparatus of claim 1, wherein the guide comprises a cannulated shaft.   5. A device according to claim 4, wherein the axis of the cannulated shaft intersects the positioning hoop.   5. The apparatus of claim 4, wherein a cannulated shaft is extendable from a tool support connected to the arm. A method for replacing a portion of a joint surface comprising:
Positioning a portion of the joint surface;
Forming a passage through the bone behind the joint surface, the passage extending toward the joint surface;
Cutting the implant site on the articular surface with respect to the passage.   8. The method of claim 7, wherein forming the passage through the bone behind the joint surface includes setting a reference axis extending through the joint surface.   The method of claim 8, wherein the reference axis intersects the portion of the joint surface.   9. The method of claim 8, wherein setting the reference axis includes inserting a guide pin that extends at least partially into the bone.   The method of claim 10, wherein forming the passage comprises drilling over the guide pin using a cored drill.   8. The method of claim 7, further comprising the step of attaching a threaded element at least partially within the passage, the threaded element having an opening extending therein. .   The method of claim 12, wherein the depth of the implant site is controlled relative to the threaded element.   The method of claim 8, wherein the implant site extends radially about the reference axis.   The method of claim 14, wherein cutting the implant site includes rotating a cutter about the reference axis.   8. The method of claim 7, further comprising attaching an implant within the implant site. A method of accessing a joint surface,
Positioning a positioning device adjacent to the first articular surface;
Aligning a guide with the positioning device, the guide providing an axis to the positioning device;
Forming a passage through a second bone and a second joint surface of the second bone, wherein the second joint surface faces the first joint surface;
Accessing the first articulating surface through the passage.   Forming a passage through the second bone and the second articular surface provides a reference axis extending through the second bone and the second articular surface; 18. The method of claim 17, comprising drilling a hole extending along.   Providing the reference axis includes inserting a guide pin extending at least partially into the second bone, the guide pin being directed along the reference axis. The method according to claim 18.   18. The method of claim 17, wherein accessing the first articular surface comprises ablating the first articular surface implant through the passage.

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