CN101351161A - Apparatus and method for sculpting the surface of a joint - Google Patents

Abstract

The present invention provides a method and device for restoring individual patient joint kinematics using minimally invasive surgical procedures. The instrumentation of the invention sculpts the articular surface of a first bone that normally articulates in a predetermined manner with a second bone. The instrumentation includes a bone sculpting tool and a mount for attaching the tool to the second bone. The implant system is comprised of implants that provide intraoperative surgical options for articular constraint and facilitate proper alignment and orientation of the joint to restore kinematics as defined by the individual patient anatomy.

Description

Be used for the moulding apparatus and method of articular surface

Technical field

The present invention relates to be used for the implant of Wicresoft's total knee replacement.More specifically, the present invention relates to combined support face in human joint's replacement and activity-load-bearing and fixing-load-bearing molectron.

Background technology

A joint, for example ankle joint, knee joint, hip joint or shoulder joint, perhaps spinal motion segment is made of two or more bony structures of the relative stiffness of certain relation that keep each other usually.The soft tissue structure of crossing over this bony structures maintains bony structures together, and auxiliary motion or the kinesiology of determining a bony structures to another bony structures.For example in knee joint, described bony structures is femur, tibia and patella.Cross over the soft tissue structure of knee joint (or insertion), for example muscle, ligament, tendon, meniscus and joint capsule provide strength, support and stability to help kneed motion or to move.Cross over kneed muscle and provide kinetics, thereby linear joint is stablized this joint simultaneously it is played a role with orderly fashion in a controlled manner with tendon structure (as in other joints of health).Dynamic stability is that constitutional (primary) muscle contraction is to shrink to cause producing the result of joint load in respect to the favourable para-position scope of this joint bony structures at anticipated orientation linear joint while Antagonistic muscle.It is believed that proprioceptive feedback provides part control or the balance between former flesh contraction and the Antagonistic muscle contraction.

Smooth and the whippy surface coverage of forming by articular cartilage the bony structures of junction, joint, and soft tissue structure, ring and nuclear then provide moving between the vertebral body.The articular surface of bony structures and soft tissue structure coordinate to play a role, and seal a kind of mechanism of (Envelop of motion) to form the motion that limits between the described structure.In typical motion was sealed, bony structures moved relative to each other in a predefined manner, is commonly referred to articular kinesiology.When being completed into the joint, described motion determines that the motion fully between the bony structures seals.In knee joint, cross over the soft tissue structure in this joint and the geometric shape in joint and help stabilized knee, avoid its excessive translation in the articular surface of determining by the shin femoral joint.This shin thigh stability makes that femur and tibia can be with orderly or predetermined way in slip over each other and rotations.Similarly, the soft tissue structure of joint capsule, the geometric shape in patellar ligament and quadriceps tendon and joint helps to stablize patellofemoral joint, avoids over-drastic interior outside translation (mediolateral translation).

The intraarticular stiffener (as in joint replacement) in a joint of used preparation relates to large-scale surgical exposure with the method for receiving unit.This surgical exposure, ligament are loosened and the damage of anterior cruciate ligament must be enough to allow to introduce guiding device (it places on the joint, among or be connected in this joint), and cutting assembly (cutting block) guiding is simultaneously used saw, borer and other grinding apparatus and other to be used for cutting or got instrument except that cartilage and bone (it is replaced with artificial surfaces subsequently).Knee prosthesis, distal femur can be modelled as and have flat front surface and rear surface, described surface parallels with the major axis (length) of femur usually, flat end surface is usually perpendicular to this front surface and rear surface, angled (angled) plane surface and above-mentioned surface combination are all in order to receive the purpose of prosthetic device.Usually, these are called forward and backward and far-end and angular cut.

In present total knee arthroplasty, realize appropriate knee joint line by design and the molding of x ray before performing the operation.When stretching, produce kneed anterior-posterior (A/P) and side x ray image.The mechanical axis of labelling tibia and femur on described A/P x ray image.Angle between these lines is to treat to turn in corrigent/angle of valgus deformity.In described A/P image, the angle of distal-femoral resection is set up with respect to the femur mechanical axis, so the angle of femur implant is according to the surgical technic that is used for specific implant system, with respect to femur and predefined.Similarly, the angle of tibial resection is set up with respect to the tibia mechanical axis, so the angle of tibia implant is according to the surgical technic that is used for specific implant system, with respect to tibia and predefined.The distal femoral resection guiding device is carried out on femur line, with respect to the femur mechanical axis and the para-position distal-femoral resection; Tibial resection guide is carried out on tibia line, with respect to the tibia mechanical axis and para-position proximal tibia excision; If otch is accurate, then in the A/P image, femur mechanical axis and tibia mechanical axis are just in time in line.For patella, carry out the plane excision usually at the edge, joint; Will be with respect to patella and to line excision face.This method has only solved the knee joint line when stretching fully.Knee joint line when flexing 90 is spent is left surgeon's judgement usually for, and the knee joint line in the whole range of movement is not resolved in the past as yet.When knee joint became 90 to spend, the surgeon was around mechanical axis rotation distal femoral component to a position of femur, and this position is considered to can be this kneed ligament of leap suitable tension force is provided.

The knee-joint prosthesis of the above-mentioned type is known, and is described in the United States Patent (USP) the 5th, 171, No. 244,5,171, No. 276 and 5,336, No. 266 of Caspari et.al. for example; No. the 4th, 892,547, the United States Patent (USP) of Brown; In No. the 6th, 068,658, the United States Patent (USP) of No. the 4th, 298,992, the United States Patent (USP) of Burstein et.al. and Insall et.al..

In knee prosthesis,, done a large amount of effort in order to provide with respect to the prominent suitable degree of curvature of condyle.For example, No. the 5th, 171,276, above-mentioned United States Patent (USP), 4,298,992 and 6,068,658 show, the radius of curvature of the prominent fore-and-aft direction of the condyle of femoral prosthesis is prominent anterior than bigger near the prominent rear portion of condyle near condyle.A part of having taught the prominent curvature of this condyle in No. the 5th, 824,100, the United States Patent (USP) of Kester et.al. can form the radius of a constant, and its starting point is on the line between lateral side of femur and the medial collateral ligament attachment point.

In history, developed multiple combination reparation property joint implant.Description to combined implant is specifically related to knee joint below.Be used for the design of knee implant in early days, be called the multicenter knee implant, the femur by being used for chamber between inboard and outside shin thigh and the stand-alone assembly on tibia surface are developed.In this implant, heavily do not spread chamber between (resurface) kneecap thigh.Para-position each other between the assembly separately, for example inboard and lateral femoral components is in alignment with each other, perhaps inboard or lateral tibial component is aligned with each other, in these designs, be not resolved, implement unconfined excision and usually leave the surgeon for, this causes the operation technique of a rich challenge.Occurred some afterwards such as UCI and the kneed design of Gustilo, wherein a strand condyle assembly (femoral condylar components) connects into as a whole single formula assembly, and tibial component is like this too.Next one progress in the whole knee implant design comprises patellofemoral joint, and it is by making a single formula distal femoral component of integral body heavily to spread inboard and outside thigh condyle (femoral condyles) and femur coaster (being commonly referred to the patella ditch).The implant that is used for heavily spreading patella is developed with three Room distal femoral components.In addition, developed combination type to fix-the load-bearing knee implant (be commonly referred to half limited), its have by relative stiffness the polyethylene insert that maintains.(nonuniformity, non-conforming) shin thigh contact can be held the tibia and the translation between the femur of the Lock-in with motion of knee joint and rotate with axle in these designs by the discordant to inboard and lateral condyle.Such design is tending towards having higher contact presses, and this may quicken the wearing and tearing and the degraded of polyethylene supporting surface.Replacedly, had movably load-bearing knee implant now, wherein said polyethylene supports and is built as on tibial baseplate with least commitment or slip without restrictions or mobile.These movably weighted design press and more competent design thereby form lower contact between polyethylene insert and strand condyle and have higher harmony between polyethylene insert and the tibial baseplate.And, developed meniscus load-bearing and fixed load-bearing knee implant, comprise the independent polyethylene load-bearing thing in the chamber between each inboard and outside shin thigh or be positioned at leap inboard on the metal tibial baseplate and outside shin thigh between the single polyethylene load-bearing thing of chamber.Although developed the implant system that all has fixing load bearing element or movable load bearing element on shin femoral joint medial surface and lateral surface, still untapped have a kind of one side at the shin femoral joint and have fixedly load-bearing and have the system of the combination of activity load-bearing at opposite side.

There are two kinds of main difficulties in existing joint replacement.These relate to the traumatic of operation and the bony structures that obtains and on prosthese suitable to line and kinesiology.These difficulties are present in all total joint replacements (including but not limited to ankle, knee joint, hip, shoulder, wrist and finger).And intervertebral disc replacement, nucleus substitution, facet joint displacement or their combination.

The difficulty that line is implanted combined and non-combined knee implant (having independent femur and/or tibial component) is the appropriate relation that is to obtain between the assembly always.Available up to now surgical unit also is not provided at the application of having no difficulty when implanting many parts implant, and wherein distal femur, proximal tibia and patella rear portion have been produced and have been used for accurate assembly-assembly para-position.Although to the line guiding device (to line-oriented device, alignmentguide) auxiliary relative component (opposing components) with respect to the accurate para-position of the axle of long bone to realize correct shin femur varum/turn up to the recovery of line (4-7 is outside one's consideration and turns over usually), but when placing the articular surface of a plurality of assemblies formation distal femoral components or tibial component, they only provide about correct sub-component-sub-component line limited para-position or guiding.Which piece bone such instrumentation is placed on reference to it and uncompensation or do not attempt utilizing tough belt tension to recover appropriate in the soft tissue balance in the complete knee joint of line.Yet this instrumentation depends on the surgeon and loosens ligament and soft tissue structure with the balance knee joint and adapt to the para-position of implant.For patellofemoral joint, appropriate shin thigh to line for the articular surface of the appropriate track of rebuilding patella (described track is that the layback mechanism by quadriceps femoris produces), strand kneecap ditch and to keep shin femoral joint line be essential.

Up to now, although existing operation tool turns over/turns up line in assisting accurately, about the correct flexion/extension direction of the hypsokinesis of femur, tibial component, para-position that it provides or guiding are quite limited, also are limited to the para-position that outward turning provided or the guiding of distal femoral component.For the suitableeest motion of knee joint, the soft tissue balance in the whole range of movement of knee joint is kept in distal femoral component flexion/extension and outward turning direction, tibial component hypsokinesis and the ligament co-ordination of crossing over the joint.

In appropriate knee joint to line, the mechanical axis of lower limb (from the drawn straight line in center to the center of anklebone of hip joint) is inboard through kneed center slightly partially.This to line be commonly referred to lower limb slightly to line.Implant to line influence lower limb slightly to line.If implant is unjustified, move or move outward in the mechanical axis possibility that obtains, it is load unbalanced to make that inboard or lateral condyle are born.If this imbalance seriously just may cause the early stage failure of joint replacement.

Heavily spread at a plurality of sub-components under the situation of distal femur or proximal tibia, sub-component direction relative to each other, for example inboard thigh-condyle sub-component also is not resolved to a great extent with respect to the direction of femur coaster sub-component or with respect to the direction of outside thigh-condyle sub-component.Equally, for the tibia implant, the medial tibial sub-component is not resolved to a great extent with respect to the direction of lateral tibial sub-component independently yet.And no matter distal femoral component is to have independently single chamber, two Room and/or three Room implants with respect to the para-position of corresponding tibial component, also is not resolved to a great extent.As indicated in some clinical research, this may cause the high failure rate of chamber replacement between self-supporting (single application or use in conjunction) in operation is used, and may cause the high failure rate (with respect to the complete knee joint implant) of single chamber implant.When considering the single chamber design, implant must with the homonymy condyle appropriately to line and para-position, be maintained in the appropriate kinesiology balance will cross over kneed soft tissue structure.Similarly, when considering the design of two Room, each femur sub-component and another femur sub-component and each tibia sub-component and another tibia sub-component to line and para-position, be maintained in the appropriate kinesiology balance very crucial for crossing over kneed soft tissue structure.In both cases, as in three Room knee implants, sub-component and sub-component appropriately to line and para-position for avoiding since between the assembly the caused wearing and tearing of bad connection to quicken be very crucial.

Although multiple prosthetic appliance is successful Application on one's body the patient, the structure of described prosthetic joint face and position, for example the condyle in the knee joint is predefined according to selected prosthese.For given knee joint implant system, obtainable implant has discontinuous size (size), and the ratio of the ratio of width and the front and back degree of depth was different with implant system inside and outside it for example concerned.Make its needs that adapt to each patient although made great efforts to select to make prosthese, in fact still have problems, because different patients' joint physiological change is quite big with size by appropriate prosthese.

Traumatic in order to mould the articular surface of bone rightly, usually need this joint of surgical exposure.The femur in traditional knee prosthesis for example, operation ground exposes the patellar ligament in the knee joint, and moves to joint one side, and the patella that turns up make to the anterior path in joint basically can be complete.Usually, the excision anterior cruciate ligament is to increase to the path of knee joint cavity.Surgical exposure is essential for volume that holds assembly and geometry and the instrument that is used for bone preparation.This surgical exposure and ligament loosen or excise increased hemorrhage, pain, muscle suppresses and bad kinesiology; And all these all cause the patient to leave hospital in safety going home or hospital stays before transition monitoring mechanism prolongs.Kinesiology changes and can reduce the patient knee joint is finished the confidence of the ability of laborious task, is the daily life task sometimes, and this can serious restriction life style and level of activation.

Ideally, in replacement knee in arthroplasty, ligamena collateralia or ligamentaum cruciatum all do not damage, although when being about to implement actual joint replacement, usually need the excision or the ligamentaum cruciatum of loosening.Can ligamena collateralia partly be lowerd or loosen so that the kneed suitable tension adjustment to the patient to be provided with joint replacement.As a rule, the such standard median line or inboard kneecap escribe mouth of can be by less otch but not being used for knee replacements in the past of loosening realized.

For the metathetical patient of needs articular surface, comprise that those joints are not damaged or ill to the patient who needs total joint replacement, existing can be used for kneed implant system, this system has monoblock type three Room distal femoral components, monoblock type tibial component, monoblock type patella assembly and needs extensive surgical exposure could implement the instrument of described operation.The operation method that provided of expectation can be used for obtaining to prepare bony structures to the operation pathway of the articular surface that is connected, rightly with equipment, for example provide manually metal, plastics, pottery or other appropriate materials as implant or joint support face and closed surgery position, and all these all do not have remarkable infringement or wound, proper motion that struts the joint and do not destroy the patient within reason to related muscles, ligament or tendon.In order to realize this target, require implant and instrument that a kind of system and method is provided, it makes the articular surface be connected can utilize Wicresoft's equipment and step by moulding suitably, and it can be utilized be suitable for inserting, be suitable in the scope of articular cavity assembling and the implant consistent with the bone supporting surface that has prepared replaced described articular surface by little otch.

Summary of the invention

The invention provides a kind of system and method, this system and method is used for each bony surface of joint or motion segment is heavily spread the total joint replacement of (resurface), and described system and method relates to the Minimally Invasive Surgery step that comprises the implant system that can recover the single patient articular kinesiology.A feature of the present invention is the connection that comprises in an implant system (for example knee joint implant system) or a plurality of sub-components of joint.Another feature of the present invention is accurately and repeatably placing of its instrument a plurality of sub-components that can simplify in the implant system to be comprised.As using in this article, following term has following definition.

Wicresoft or low wound-in order to apply the present invention to knee prosthesis, the otch that is used for traditional total knee replacement is defined as length usually greater than 6 inches.The otch that is used for Wicresoft and low wound knee prosthesis is defined as length usually less than 6 inches.

Connect (Engage)-for purpose of the present invention, connect relate to 1) connection of implant sub-component and form implant, and 2) connection of implant assembly in the joint replacement.In both cases, connect the meaning for making machine components (mechanical part) (promptly, for example the sub-component of distal femoral component or one group of assembly for example comprise femur, tibia and patella assembly) gather together, be engaged with each other or contact with each other and play a role.Limit at least one degree of freedom between the described part in abutting connection with contact such between the part.

Engage-for purpose of the present invention, joint relates to the joint of implant sub-component to form this implant, and the meaning is machine components (that is, for example the sub-component of distal femoral component) are locked together and to limit one or more degree of freedom, to form an integral body.

Para-position-for purpose of the present invention, para-position relates to 1) para-position and 2 each other of implant sub-component) implant assembly para-position each other in the joint replacement.In both cases, the meaning of para-position is to make each part form work relationship each other, so that the assembling thing of each part can be as playing a role of being planned.

Alignment-for purpose of the present invention, alignment relates to 1) aim at the sub-component of implant to support bone and 2) aim at implant assembly in the joint replacement to support bone.In both cases, the alignment meaning is to make part enter the correct relative of supporting bone, so that this joint replacement can play a role according to plan.

Implant assembly and sub-component-for purpose of the present invention, the implant assembly is meant the part that constitutes joint replacement, and for example femur, tibia and patella assembly constitute total knee replacement.Sub-component refers to the part that constitutes the implant assembly.Each assembly is textural can be all-in-one-piece, perhaps can comprise a plurality of sub-components.

In order to describe the present invention, joint replacement comprises total joint replacement and part joint replacement (that is: hip joint, knee joint, shoulder joint, ankle joint, articulations digitorum manus etc.) and all replaces with part of intervertebral disc and facet joint.Such joint replacement system comprises femur, tibia and the load-bearing plug-in package that is used for knee prosthesis; The trunk, head, load-bearing insert and the casing assembly that are used for hip replacement; And be used for the metathetical terminal plate of vertebral body of joint of vertebral column and load-bearing insert and facet joint displacement.

The order that the assembling of sub-component and placing is supported on the bone-for purpose of the present invention, the assembling of sub-component and place the order of supporting on the bone can be different.That is to say that sub-component can be a) to adorn in the articular cavity external packet, stretch in the articular cavity, assemble and place and support on the bone; B) stretch in the articular cavity separately, assemble and place and support on the bone; C) stretch in the articular cavity separately, place and support also to assemble thereon on the bone; D) stretch in the articular cavity separately, one or more sub-components are connected in the support bone, are connected in the sub-component on the bone before one or more subsequently remaining sub-component are assembled in; Perhaps e) their any combination.

Instrument that this paper discloses and implant can realize bone and soft tissue preparation accurately, recover the anatomy para-position, soft tissue balance, kinesiology, assembly are fixed to support bone to the para-position of sub-component with to line and by limited surgical exposure with implant to the para-position of assembly with to line, sub-component.For knee prosthesis, implant system is made up of implant, wherein said implant be provided for art formula in the operation of joint constraints select and help the joint appropriately to line and para-position, recover to dissect to line, soft tissue balance and by the determined kinesiology of the dissection of this individual patient.In order to realize this target, implant provides selection in the operation for the surgeon, to rebuild stability of joint in various degree by the fixed or movable load-bearing assembly of selecting to be used for each chamber of knee joint (chamber between inboard shin thigh, outside shin thigh and kneecap thigh).In given step, the scope of implant go in the chamber between described knee joint, two or three, and can comprise the combination of fixed and movable load-carrying members.

In traditional total knee replacement, the monolithic that distal femoral component is normally whole, and the tibial baseplate assembly also is whole monolithic.Supporter is placed between femur and the tibial baseplate assembly, and the monolithic that it is normally whole can be fixed in tibial component or slides on the tibial baseplate assembly.In the present invention, distal femoral surface (femoral side) can heavily be spread (resurface) and tibial surface (tibial side) by two, three or more single sub-components and can heavily be spread by two, three or more single sub-component or integral type substrates.Alternately, distal femoral surface can heavily be spread by the assembly of integral structure, and tibial surface can heavily be spread by two or more tibial baseplate sub-components.The combined distal femoral component that is made of two or more sub-components is sized to and can inserts in the articular cavity by mini-incision, each a slice, and in operative process, assemble.Equally, the combined tibial component that constitutes by one or two polyethylene supporter and be sized to and insert in the articular cavity by mini-incision by the board unit that two or more independent sub-components constitute, each a slice, and in operative process, assemble.

Alternately, the multiple-piece tibial component can have a trunk, and it can be placed into joint position independently and be built as along the tibia pulp cavity descendingly, and can be assembled to substrate or substrate sub-component in the scope of joint position.Equally, combined distal femoral component can have a trunk, and it can be placed in the joint position individually, and is built as along femoral bone cavitas medullaris descendingly, and can be assembled to the femur sub-component.

After putting into articular cavity, the femur sub-component accurately to line to support bone and para-position each other under the situation that interconnects or do not interconnect each sub-component.Equally, put into articular cavity in an identical manner after, the tibia sub-component accurately to line to support bone and to interconnect or do not having a para-position each other under the interconnective situation.In both cases, than traditional components, the size that enters IA each assembly or sub-component significantly reduces, and can expose and the complete operation step by less and less wound.

At sub-component, comprise distal femoral component, tibial component or these two, under the interconnective situation, this connection mechanism that can be built as between the adjacent sub-component or the engagement mechanisms between the adjacent sub-component of interconnecting.Under the situation of three or more sub-components, between each adjacent sub-component, can use the combination of connection or engagement mechanisms.Alternatively, in operative process, this connection between the adjacent sub-component or joint can be fixed in them the support bone with auxiliary sub-component para-position simultaneously for temporary transient.Usually, the size of patella assembly is inserted by mini-incision for it can be used as monoblock type supporter, fixed supporter or active supporter.In one aspect of the invention, the articular surface of patella assembly can comprise independently, one sub-component, is used for the outside facet and inboard facet, its appropriate para-position but and do not engage in articular cavity.In another aspect of the present invention, independently appropriately para-position and in articular cavity, engaging of patella sub-component.In another aspect of the present invention, distal femoral component can be for flexible or comprise flexible sub-component.

Femur of the present invention, tibia and patella assembly have a surface that is used for the bone connection as using, being built as in part or total knee replacement.This connection is provided by porous or rough surface, supports can grow into this surface or grow on this surface of bone.Alternately, this connection is provided by porous or rough surface, and bone cement can be connected into this interior surface or above it.In the another one specific embodiment, with sub-component surface coated biogum or the skeletal growth factor of supporting that bone contacts, initial stability to be provided and to promote bone to integrate fast.

Appropriately can utilizing instrument and realize that wherein this instrument is guided by kneed soft tissue structure line and para-position of implant assembly and sub-component with the guiding resected bone, is used for the special anatomical knee joint of patient to line and assembly and sub-component para-position.The posterior aspecct of the tibia and outside articular surface and facies articularis patellae utilize plane excision preparation usually.Movable of inboard and outside thigh condyle and coaster ground is prepared.This operation is called and guides art (TGS), at United States Patent (USP) the 6th, 723, describes in No. 102, and its full content is incorporated into this by reference.Alternately, burst condyle inboard and outside articular surface and trochoid face can utilize a plane excision and a chamber excision to be prepared usually, as adopting usually in traditional total knee replacement.Utilize the full knee joint operation of tradition can carry out these operations, known as those skilled in the art.Alternately, by the moulding instrument of bone with tibia to be positioned at appropriate knee sprung angle with mould the plane excision that is used for back position, back chamfering and distal-femoral resection and by with patella to be positioned at appropriate knee sprung angle with mould be used for before the plane excision of chamfering and coaster excision, can utilize to guide art and realize this preparation.Therefore, the present invention is used for engaging or connecting a plurality of sub-components that the knee joint implant system comprises, and be used for simplifying a plurality of sub-components that the knee joint implant system comprises accurately and the operation that can repeat to place, be equally applicable to traditional knee implant.

Utilize TGS to operate femur, tibia and the appropriate para-position of patella excision quilt and the para-position of realization, be used for the interior anatomical knee joint of whole motion of knee joint scope line, soft tissue balance and kinesiology function.Utilize these bone seating surfaces to come para-position and para-position femur, tibia and patella assembly respectively, will keep the anatomical knee joint line, soft tissue balance and kinesiology function.Usually, tibia and patella excision are that the plane formation of corresponding implant assembly is inserted, and these assemblies have straight line plane seating surface forward.If support bone to utilize TGS to be prepared, and the condyle bone outside, condyle bone inboard and trochoid excision the relative position of each other be the kinematic function of particular patient, and then distal femoral resection can not be planar.Therefore, the femur implant must provide this transmutability, as described in this article.

Suppose that crossing over kneed soft tissue structure is used for guiding the TGS operation, then surgical technic minimum level ground destroys these tissues and avoids the dislocation of patella or turn up benefiting.Minimally Invasive Surgery otch or be used for entering kneed otch, its size and the change of motion of knee joint must be dropped to minimum with respect to the para-position of soft tissue structure.Femur, tibia and patella implant must be constructed to pass through this mini-incision.To such an extent as to being used for the traditional femur of total knee replacement and the size of tibia implant is infeasible by the mini-incision insertion too greatly.In addition, the shape of traditional distal femoral component does not allow this assembly is placed on the cut distal femur, and keeps most of soft tissue complete or do not have the dislocation of patella or turn up.And, the scope of articular cavity do not provide enough space with traditional distal femoral component far-end to line in the front and back of femur otch, on those otch, slide then.Therefore, the size of femur, tibia and patella assembly must be passed through little otch, and places on each bone seating surface or cover it.For distal femoral component, an embodiment is medial condyle, lateral condyle and a trochoid of heavily being spread distal femur by the assembly that a plurality of sub-components constitute.These sub-components are of a size of and can and can assemble in the scope of articular cavity by little otch, promptly are engaged or connect.Alternatively, in operative process, this connection between the adjacent sub-component or joint can be fixed in the support bone with the para-position of assisting sub-component simultaneously for temporary transient.

The condyle of femur sub-component and described kinesiology ground preparation and the shape of trochoid are consistent.These contact surfaces between the femur sub-component are that part is limited.Vowing that the common right and wrong of the angle of these interfaces are limited on the shape face, so that described sub-component meets coaster and condyle excision.On transverse section, vertical and axial translation and axial rotation, the angle of these interfaces is normally limited, so that the smooth translation from a sub-component to adjacent sub-component to be provided.Smooth translation provides the support of homogeneous for cooperating tibia or patella assembly.Alternately, interface between femur sub-component right and wrong on angle are limited, and on other degree of freedom, be limited, so that distal femoral component can be consistent with cut thigh condyle, and make the variation and the deflection in the tibia sub-component of condyle sub-component front and back deflection similar.Alternately, the interface between the femur sub-component is fully limited when assembling fully.Equally, the tibia sub-component is appropriately to line, to guarantee the appropriate track of femur, tibia and patella assembly each other.The tibia sub-component can be limited or non-limited each other, and mode is similar to above-mentioned femur sub-component.

Except preparation was used for the special bone to line and para-position of the patient of implant assembly, the present invention also provided further assembly para-position by the femur sub-component being engaged or linking together and the tibia sub-component connected or be bonded together.The femur sub-component can be by temporary transient or permanent connection after inserting in the articular cavity.Equally, the tibia sub-component can be by temporary transient or permanent connection after in inserting articular cavity.When sub-component during by temporary joint, can insert one or more supports between this sub-component in articular cavity, and temporarily fixing or assemble each sub-component.Support is maintained at sub-component appropriate in line and para-position each other, and for example bone screw, spike, hook etc. or bone cement or other jointing materials or process are fixed in bone with this assembly by machinery simultaneously.Support can be rigid construction, by metal for example rustless steel, cochrome, titanium or titanium alloy, pottery or other suitable materials make, or by hard plastics for example PEEK or other suitable plastic and make.Alternately, described support is flexible structure, and for example Ultimum Ti (Nitinol), NP35N and other suitable materials are made by metal; Flexible plastics are UHMW polyethylene or polyurethane for example, and perhaps knit materials for example make by Gore-Tex or other suitable materials.Each junction between sub-component is configured to the smooth translation that can keep articular surface between the adjacent sub-component with support, makes each sub-component and sclerotin supporting surface keep harmonious simultaneously.After assembly is fixed in and supports bone, striking then.Can at that time or thereafter certain time be removed falsework in operation.Alternately, described support can be configured to the sub-component of implant to keep implantation.

In knee replacements, implant comprises the second bone substrate, supports the insert and first bone implant.The second bone substrate can be single piece type, covers the surface that second bone (linking to each other with this joint) prepared usually, perhaps is independent substrate, uses as utilizing in the active or fixed load-bearing prosthesis assembly.Alternatively, described single piece type substrate or a plurality of substrate sub-component can be built into and be assembled to the trunk sub-component in the scope of articular cavity.For single piece type substrate or a plurality of substrate sub-component, the load-bearing insert can be monolithic construction.Alternately, the load-bearing insert can be independent insert.In addition, the second bone board unit can hold independent fixed or active load-bearing insert, is respectively applied in the inboard and outside combination of fixing-fixing, movable-fixing, fixing-activity and Active-Active load-bearing insert.

When a plurality of sub-components of assembling are with formation distal femoral component or tibial component in the scope at articular cavity, make up connection or engagement device to realize angulation and translation between sub-component in the assembling process, subsequently when assembling fully, then according to femur or the necessary restriction of tibial component, making up connection or engagement device, is useful.This one-tenth angle in the assembling process between the adjacent sub-component and translation is unrestricted or part is limited is as far as possible easily to be fit to the assembling of sub-component for the surgeon.For this restriction of the assembly of assembling fully, comprise between two or more sub-components non-limited, part is limited and fully limited being connected or engagement device, and non-limited, part is limited or the fully limited connection or the combination of engagement device, described device is connected to form a plurality of sub-components of implant assembly.

The present invention is built as permission in the step existence accommodation that is used for implanting a plurality of sub-components that constitute femur or tibial component.Usually, distal femoral component was implanted before tibial component, because after putting into one of them assembly, the space in the articular cavity is more limited.The common shape of femur sub-component is huger than the shape of tibial baseplate sub-component, and therefore at first the implanted femur sub-component is more beneficial.Alternately, the tibia sub-component can be implanted earlier.In an alternative embodiment of the present invention (it comprises tibia trunk sub-component or femur trunk sub-component, or the two includes interior), at first insert the trunk sub-component in the femoral canal, in the shin pipe or be more useful in femoral canal and the shin pipe.Insert strand condyle sub-component and coaster sub-component then, insert tibial baseplate sub-component and load-bearing insert then.Alternately, at first implanted unit condyle sub-component and coaster sub-component are inserted the tibial baseplate sub-component then, and next inserts femur trunk sub-component or tibia trunk sub-component or these two, inserts the load-bearing insert again.Usually, implant the patella assembly at last.Alternately, be assembled to before each adjacent sub-component, can be with the one or more support bones that are fixed in femur sub-component or the tibia sub-component.At articular cavity external packet dress femur sub-component or tibia sub-component, also be useful, for example the condylus medialis femoris sub-component is inserted in the articular cavity, then the lateral condyle sub-component is assembled to the coaster sub-component and also this composite set is inserted in articular cavity to be assembled to the medial condyle sub-component.

In three Room knee replacements, the articular surface of tibia and patella utilizes plane excision excision, and aspect the profile of plane excision, it has minimum local difference usually.Yet, to keep aspect the anterior cruciate ligament, the inboard and outside shin articular surface of independent excision may be more favourable, and it can cause the variation of the plane of the plane excision of inboard shin articular surface and outside shin articular surface between excising.The articular surface of distal femur, it is inboard and lateral condyle bone and trochoid, can independently be moulded.Support the local configuration (Regional contour) of bone, i.e. the profile that cut bone in (referring to chamber between chamber between chamber between inboard shin thigh, outside shin thigh and kneecap thigh) of each chamber is with the profile close fit of each sub-component; Yet, since indoor at each to independently the moulding of femur, may between each indoor bone surface that has prepared, there are differences.In addition, part limits the interface of having assembled between the sub-component, helps sharing load between the complete resection surface of supporting bone.

The mode that is used to engage the limited interface of part between the sub-component includes but not limited to sphere, netted, cylindricality, plane, linearity and some contact interface; " T " ditch seam (" T " slots); Dovetail lock (dovetail locks); Cylindricality interlocking (cylindrical interlock); The push button interlocking; Spherical interlocking (spherical interlock); Or the combination of these modes, or other are used for connecting two parts or manifold connected mode.Be used to engage the combination that the instrument of complete limited interface between the sub-component includes but not limited to threaded fastener (threaded fastener), cylindrical pin (cylindrical pin), conical lock (conical taper lock), square or rectangle taper lock (taper lock), tether cable (tether cable) or line lock (wire lock) or these instruments, or other are used for connecting two parts or manifold setting tool.

In the separate substrates sub-component that is not bonded together, have an energy and will be connected in single sub-component to keep appropriate each other para-position, they are fixed in the support of supporting bone simultaneously, are useful.The instrument that support is connected in the substrate sub-component comprises threaded fastener (threaded fastener), clamping device (clamping device), dovetail lock, trinkle lock, tether cable or wire-connecting device or these combination, or other are used for connecting two parts or manifold setting tool.Alternatively, can make up a handle being connected in support, described sub-component be inserted process in the articular cavity thereby simplify.

First bone implant is made of to replace the supporting surface of this first bone a plurality of sub-components.In the appropriate para-position of sub-component quilt of distal femoral component and under the situation that intraarticular engages, be used for the setting tool that single sub-component is bonded together is comprised the combination of threaded fastener, cylindrical pin, conical lock, square or rectangle taper lock, tether cable or line lock (wire lock) or aforementioned these instruments, or any such can be used to connect two parts or manifold other setting tools.Under the situation that sub-component is not bonded together, have one and be connected in sub-component and simultaneously they be fixed in the support of supporting bone they are kept each other appropriate para-position, be useful.The instrument that support is connected in sub-component comprises the combination of threaded fastener, clamping device, dovetail lock, trinkle lock, tether cable or wire-connecting device or these instruments, or other are used for connecting two parts or manifold setting tool.

Particularly, for example in knee prosthesis, the present invention can be used for replacing the surface of femur, tibia, patella or its combination.Therefore, the femur implant with a plurality of sub-components, the patella assembly that has the tibial baseplate of a plurality of sub-components and have a plurality of sub-components are provided.Tibial baseplate assembly and patella assembly can have fixed load carrier and active load carrier.Alternatively, each assembly of tibial baseplate or patella all has fixed load carrier and active load carrier.Alternately, tibial component and load carrier can be monolithic construction, and patella assembly and load carrier can be monolithic construction.Alternatively, femur of the present invention and tibial component can use with combined femur and tibia trunk respectively.

The present invention be used for engaging or connect a plurality of sub-components that a plurality of sub-components of being included in the knee joint implant system and simplification be included in the knee joint implant system accurately and repeatable operation of placing, be applicable to femur, tibia, patella and the load-bearing plug-in package of knee joint implant system.In addition, this embodiment of the present invention is applicable to other joint implants, includes but not limited to hip, takes on, refers to and ankle; Be applicable to that spinal implant includes but not limited to intervertebral disc replacement, facet joint displacement and spinal fusion; And be applicable to the orthopaedic trauma product, include but not limited to bone fracture fixation system.

Description of drawings

Fig. 1 is kneed plan view.

Fig. 2 illustrates a kind of kneed traditional median line otch that is used to enter in the process of total knee arthroplasty.

Fig. 3 has described a kind of kneed otch that is used to enter in the process of total knee arthroplasty, it can be used with method and apparatus of the present invention.

Fig. 4 illustrates a kind of kneed alternative otch that enters in the process of total knee arthroplasty, it can be used with method and apparatus of the present invention.

Fig. 5 is the plan view according to the femur otch of an embodiment of the invention formation.

Fig. 6 is the plan view of the femur otch that forms according to one of the present invention alternative embodiments that comprises the femur implant.

Fig. 7 comprises the plan view of the femur otch that the alternative embodiments of femur implant forms according to of the present invention another.

Fig. 8 is the plan view according to the alternative embodiments of the tibial baseplate of an embodiment of the invention.

Fig. 9 is according to an embodiment of the invention, is used for heavily spreading the plan view of femur implant of the femur otch of Fig. 6.

Figure 10 is according to an embodiment of the invention, is used for heavily spreading the plan view of femur implant of the femur otch of Fig. 7.

Figure 11 is the plan view according to the femur implant of an embodiment of the invention.

Figure 12 is according to the embodiment of the present invention, is used for the end-view of the femur implant of inboard and lateral condyle sub-component and coaster sub-component.

Figure 13 is according to the embodiment of the present invention, is used for the end-view of the femur implant of medial condyle sub-component and monoblock type lateral condyle and coaster sub-component.

Figure 14 is according to the embodiment of the present invention, is used for the end-view of the femur implant of inboard and lateral condyle sub-component and coaster sub-component.

Figure 15 is according to the embodiment of the present invention, is used for the end-view of the femur implant of medial condyle sub-component and monoblock type lateral condyle and coaster sub-component.

Figure 16 A is according to the embodiment of the present invention, is used for the end-view of the femur implant of inboard and lateral condyle sub-component and coaster sub-component.

Figure 16 B has described according to an embodiment of the invention, is used for heavily spreading a plurality of soleplate sub-components of vertebral body far-end soleplate and vertebral body near-end soleplate.

Figure 17 illustrates femur, tibia and the patella implant according to an embodiment of the invention.

Figure 18 illustrates femur, tibia and patella implant according to another implementation of the invention.

Figure 19 A and 19B are respectively according to the decomposition of the tibia insertion instrument of one embodiment of the present invention and the front view of assembling.

Figure 20 A and 20B are respectively according to the decomposition of the femur insertion instrument of one embodiment of the present invention and the front view of assembling.

Figure 21 is the side view according to the distal femoral component of an embodiment of the invention on the femur that has prepared.

Figure 22 is the front view according to the distal femoral component with a condyle sub-component of an embodiment of the invention.

Figure 23 is the plane graph according to Figure 22 of an embodiment of the invention.

Figure 24 is the front view according to the distal femoral component that two condyle sub-components are arranged of an embodiment of the invention.

Figure 25 is the plane graph according to Figure 24 of one embodiment of the present invention.

Figure 26 is the front view according to the distal femoral component with condyle sub-component of being made up of inboard and outside thigh condyle of one embodiment of the present invention.

Figure 27 is the plane graph according to Figure 26 of an embodiment of the invention.

Figure 28 is the close up view of facing according to the interface between the femur sub-component of an embodiment of the invention.

Figure 29 is the plane graph according to Figure 28 of an embodiment of the invention.

Figure 30 is the close up view of facing according to another contact surface between the femur sub-component of an embodiment of the invention.

Figure 31 is the plane graph according to Figure 30 of an embodiment of the invention.

Figure 32 A and 32B are the front views according to the another one interface between the femur sub-component of an embodiment of the invention.

Figure 33 is the cross-sectional view according to Figure 32 of an embodiment of the invention.

Figure 34 A and 34B are the front views according to an interface between the femur sub-component of an embodiment of the invention.

Figure 35 is the cross-sectional view according to Figure 34 of an embodiment of the invention.

Figure 36 A and 36B are the front views according to another interface between the femur sub-component of an embodiment of the invention.

Figure 37 is the cross-sectional view according to Figure 36 of an embodiment of the invention.

Figure 38 A and 38B are the front views according to the another one interface between the femur sub-component of an embodiment of the invention.

Figure 39 is the sketch map that the implant sub-component is maintained interface support together according to an embodiment of the invention.

Figure 40 is the cross-sectional view according to Figure 38 of an embodiment of the invention.

Figure 41 is the cross-sectional view according to a limited interface between the tibia sub-component of an embodiment of the invention.

Figure 42 is the cross-sectional view according to another the limited contact surface between the tibia sub-component of an embodiment of the invention.

Figure 43 is the plane graph according to the tibia implant that has the monoblock type substrate of an embodiment of the invention.

Figure 44 is the front view according to the tibia implant that has the two-piece type bonded substrate of an embodiment of the invention.

Figure 45 is the front view of tibia implant that is engaged in the monoblock type substrate of trunk according to having of an embodiment of the invention.

Figure 46 is the exploded view according to Figure 45 of an embodiment of the invention.

Figure 47 is the front view of another tibia implant that is engaged in the monoblock type substrate of trunk according to having of an embodiment of the invention.

Figure 48 is the front view according to the femur implant with coaster, medial condyle and lateral condyle sub-component of an embodiment of the invention.

Figure 49 A and 49B are the front views according to the distal femoral component of an embodiment of the invention.

Figure 50 is the front view according to the tibia implant of one embodiment of the present invention, the substrate sub-component that this tibia implant has the monoblock type trunk of covering tibial plateau (tibial plateau) and substrate and covers chamber between the tibial plateau homonymy.

Figure 51 A and 51B are the front views according to the tibia implant of one embodiment of the present invention.

Figure 52 is the side view according to the distal femoral component on the femur that has prepared of one embodiment of the present invention.

Figure 53 is according to Figure 49 A of the distal femoral component of one embodiment of the present invention and the cross-sectional view of 49B.

Figure 54 is the cross-sectional view according to the distal femoral component of an embodiment of the invention.

Figure 55 is the exploded view with instrument that the tibia of line guiding device is inserted according to one embodiment of the present invention.

Figure 56 is the exploded view with instrument that the femur of line guiding device is inserted according to one embodiment of the present invention.

Figure 57 is the exploded view that inserts instrument according to the tibia with surgical navigational tracker of one embodiment of the present invention.

Figure 58 is the exploded view that inserts instrument according to the femur with surgical navigational tracker of one embodiment of the present invention.

The specific embodiment

Knee-joint anatomy and operation pathway Fig. 1 show kneed general anatomy.Femur 10 has the outside strand condyle 12 and inboard strand condyle 14 on its knee joint joint face.Tibia 16 has lateral meniscus 22 (relative with described outside thigh condyle 12 usually) and medial meniscus 20 (relative with described inboard strand condyle 14 usually) on its knee joint joint face.Ligament comprises anterior cruciate ligament 24, posterior cruciate ligament 28, medial collateral ligament 26 and lateral collateral ligament 27.Inboard shin condyle 30 and outside shin condyle 32 support meniscus 20 and 22, and the latter then supports femur 10.In addition, fibula 34 connects tibia 16.

Typically, total knee replacement relates to the joint joint face of the displacement outside strand condyle 12, inboard strand condyle 14, inboard shin condyle 30 and outside shin condyle 32.Take out lateral meniscus 22 and medial meniscus 20.Ideally, neither destroy ligamena collateralia 26 and 27, also do not destroy ligamentaum cruciatum 24 and 28.Yet, after finishing joint replacement, ligamena collateralia 26 and 27 partly can be lowerd, so that the kneed appropriate tension adjustment to the patient to be provided.Such structure is included in the complete articular cavity, and articular cavity is made of knee joint synovial membrane capsule (not shown).

Referring to Fig. 2, show the traditional median line otch 40 that is used for total knee arthroplasty.Otch 40 is vertically extending up and down along the joint joint face between femur and the tibia basically.Usually, incision length is about 8-15 centimetre.Otch 40 must be greatly to can exposing whole knee joint joint face, and SLP or dislocation.In addition, otch must hold the insertion of assembly down, and this assembly can cover femur end, tibia top and patella bottom surface fully.The maximum quantity of institute's implant assembly will comprise femur and the tibial component that is used for chamber between the shin thigh of the outside, femur and the patella assembly that is used for the femur and the tibial component of chamber between inboard shin thigh and is used for patellofemoral joint.Alternately, outside thigh condyle and patella ditch can be covered by common implant.Knee joint cavity is opened by otch 40 basically, and the knee joint joint face that is exposed stretches out articular cavity, to hold current resected bone instrument (instrument) and to cover the plug-in package of femur end, tibia top and patella bottom surface fully.

As in Fig. 3, can fully finding out, are a kind of selections that are used for the present invention's operation along the horizontally extending cross sections 42 of knee joint.Otch 42 can cutting perpendicularly to expose between inboard shin thigh the articular surface of chamber between chamber and outside shin thigh, do not make dislocation of the patella simultaneously.This keeps contacting of patella and femur in operating process.The assembly of operation and implant are of a size of and are suitable for Minimally Invasive Surgery, therefore can be contained in the little otch.The wound that little otch causes reduces, and causes rehabilitation faster and better usually, and this can increase the effectiveness of knee joint implant usually.

Referring to Fig. 4, show and be used for a kind of substituting form of cut or cuts of the present invention, can form two parallel vertically extending otch 44 and 46 in the patella both sides.These otch 44 are relative with 46 shorter, and its traumatic horizontal cut that is similar among Fig. 3.Each otch 44 and 46 penetrates joint capsule respectively, and the chamber does not make dislocation of the patella simultaneously between inboard and outside shin thigh to expose.In an embodiment of the invention, this operation is implemented by the little otch 46 of patella inboard.

As shown in Figure 5, a strand condyle can be independent of the femur coaster and is prepared.Lateral condyle otch 130 and medial condyle otch 132 can utilize the moulding instrument that places on the femur to extend in whole shin thigh contacts the scope of (coming from knee joint bends and stretches).In case preparation, the condyle otch receives lateral condyle sub-component 131 and medial condyle sub-component assembly and femur coaster sub-component 134 respectively, and each is limited with respect to the equal right and wrong of adjacent sub-component in the described sub-component, as shown in Figure 6.In a substitutability embodiment of the present invention, lateral condyle and femur coaster heavily shop property implant make up with monoblock type sub-component 136, and wherein sub-component 136 is heavily spread lateral condyle and trochoid, as shown in Figure 7.Medial condyle sub-component 133 is independently with non-limited with respect to lateral condyle-coaster sub-component.Alternatively, lateral condyle-coaster sub-component 136 can be implanted by complete medial condyle, need not preparation and heavily spreads medial condyle.Alternately, medial condyle and femur coaster heavily shop property implant can be built as the monoblock type sub-component, and this sub-component is heavily spread medial condyle and femur coaster, and in this case, the lateral condyle sub-component is independent of medial condyle-coaster sub-component.Alternatively, medial condyle-coaster sub-component can be implanted by complete lateral condyle, need not preparation and heavily spreads lateral condyle.

Can implement operation technique by one or more mini-incisions, need not SLP or dislocation.Therefore, implant such as femur, tibia or patella implant are configured to and can install by mini-incision, consistent with the bone supporting surface of kinesiology preparation and in knee joint to line, para-position and connection or joint.Femur and tibia implant can be connected in bone by traditional adhesive method, such as but not limited to polymethyl methacrylate, or by being directly connected in bone such as but not limited to the inside growing surface of porous type.

Insert more useful by little otch whole implants.As seen in fig. 9, the femur implant comprises first sub-component 131 (heavily spreading the joint joint face of lateral condyle), second sub-component 133 (heavily spreading the joint joint face of medial condyle) and the 3rd sub-component 134 (heavily spreading the femur coaster).Alternately, as shown in Figure 12, the femur implant is mounted together, and right and wrong are limited, and wherein first sub-component 431 is heavily spread lateral condyle, and second sub-component 433 is heavily spread medial condyle, and the 3rd sub-component 434 is heavily spread the femur coaster.Alternatively, as seen in fig. 10, the femur implant can comprise first sub-component 133 (heavily spreading the joint joint face of medial condyle) and second sub-component 136 (heavily spreading the joint joint face of lateral condyle and femur coaster).Alternately, as shown in Figure 13, the femur implant is installed together, and right and wrong are limited, and wherein first sub-component 433 is heavily spread medial condyle, and second sub-component 436 is heavily spread lateral condyle and femur coaster.In an interchangeable embodiment, the interface between the femur sub-component utilizes network structure 530 to connect, so that the homogeneous translation of patella joint on the distal femoral component between coaster sub-component 534 and each the condyle sub-component 531 and 533 to be provided, as shown in Figure 14.As shown in figure 15, can between coaster-condyle sub-component 536 and adjacent condyle sub-component 533, make up a network interface 530.

Alternately, as shown in Figure 16 A, because have higher kneecap thigh load along the coaster lateral surface, netted contact surface 530 can be used for the translation of lateral condyle sub-component 631 to coaster sub-component 634, independent and non-limited medial condyle sub-component 633 then is used for heavily spreading medial condyle.Referring to Figure 14,15 and 16, network interface 530 structures provide the connection between the adjacent sub-component, and it limits the relative translation in sub-component inboard each other to the outside usually.Figure 11 illustrates the optional strand of condyle sub-component that is configured to flexible implant.The outer surface of this condyle implant is a sheeting, and inner surface can be ridge shape thing 170.Shown in Figure 16 B, a plurality of soleplate sub-components 241 and 242 are heavily spread the far-end soleplate of vertebral body L4250 and the near-end soleplate of vertebral body L5249.As in above-mentioned femur sub-component, the soleplate sub-component can be connected with 252 by network interface 251.Intervertebral disc replacement is by L4 soleplate sub-component 241 and 242, L5 soleplate sub-component 247 and 248, L4 facet joint plate 243 and 244, L5 facet joint plate 245 and 246, constitute at two facet joint supporters 253 between every group of facet joint plate and intervertebral disc supporting surface 254 (between the soleplate sub-component that soleplate sub-component that L4 has connected and L5 have connected).Each facet joint all uses superior articular surface (superior facet) plate 244, facet joint supporting surface 253 and inferior articular surface (inferior facet) soleplate 246 to replace.Finishing the facet joint of the motion segment between L4 and the L5 heavily spreads with facet joint plate 243,244,245 and 246.According to by soft tissue structure of crossing over vertebral body and the determined kinesiology of supporting surface that is provided by terminal plate of vertebral body and facet joint, spinal motion segment forms the joint in a predefined manner.This dynamic motion (kinematic motion) can be used to line and para-position are used for intervertebral disc and the facet joint implant that the proper motion of described spinal motion segment is learned.

Referring to Figure 17 and 18, according to the present invention, total knee arthroplasty is made of the implant of heavily spreading strand condyle and coaster and tibial prosthesis face.In Figure 17, the femur F condyle is heavily spread with condyle sub-component 436 (inboards) and 435 (outsides), and tibia T articular surface is heavily spread with shin sub-component 437 (inboards) and 430 (outsides).Tibial component is made of load-bearing insert 438 and substrate sub-component 432.Patella P heavily spreads with patella assembly 439.Alternatively, as shown in figure 17, the femur coaster is not heavily spread.In Figure 18, a strand condyle is heavily spread with the condyle sub-component of the structure (inboard) 441 of one.Lateral condyle sub-component 440 and coaster assembly are one, and the tibial prosthesis face is heavily spread with tibia sub-component 442 (inboards) and 444 (outsides).Patella is heavily spread with patella assembly 443.

Shown in Figure 17 and 18, according to the present invention, total knee arthroplasty is made of the implant of heavily spreading strand condyle and coaster and tibial prosthesis face.In Figure 17, the femur F condyle is heavily spread with condyle sub-component 436 (inboards) and 435 (outsides), and tibia T articular surface is heavily spread with shin sub-component 437 (inboards) and 430 (outsides).Tibial component is made of load-bearing insert 438 and substrate sub-component 432.Patella P heavily spreads with patella assembly 439.Alternatively, as shown in Figure 17, the femur coaster is not heavily spread.In Figure 18, a strand condyle is heavily spread with the condyle sub-component of integrative-structure 441 (inboard).Lateral condyle sub-component 440 and coaster assembly are one, and the tibial prosthesis face is heavily spread with tibia sub-component 442 (inboards) and 444 (outsides).Patella is heavily spread with patella assembly 443.

Referring to Figure 21, utilize TGS to prepare distal femoral F.Distal femoral component 909 is heavily spread distal femoral F, and comprises a plurality of sub-components 910,911 and 912, and each all has inner surface 917 and relative articular surface 915.Described inner surface 917 and articular surface 915 extend between inward flange and outward flange.The inner surface of each sub-component all has one or more fixed legs 916.Alternately, the condyle sub-component has a stabilizer vane (Stabilizing fin) (not shown) usually in the arrow shape face of inner surface 917.

Alternately, as described previously and shown in Figure 52, distal femur can be prepared by the plane excision, forms posterior incision 925, inclination angle, far-end rear portion otch (distal posterior chamfer resection) 924, distal incision 923, distal front chamfering otch (distal anterior chamfer resection) 922 and anterior cut 921.Distal femoral component 926 is made of coaster sub-component 927, and it has inner surface 935 (structure is used to be connected to the femur coaster that has prepared) and interface 931 (structure is used for being connected or engages adjacent condyle sub-component 928 and 929).Coaster sub-component 927 has extrinsic articulation joint face 930, and patella forms the joint on this extrinsic articulation joint face.During flexing, kneecap thigh contact area moves to the thigh condyle sub-component 928 and 929 that strides across interface 931 from coaster sub-component 927.Coaster sub-component 927 can be configured to has one or more posts 934, so that the stability between implant and the support bone to be provided.Condyle sub-component 928 and 929 has inner surface 936 (structure is used to be connected to the thigh condyle that has prepared) and interface 931 (structure is used for being connected or engages coaster sub-component 927).Hereinafter will describe coaster-condyle sub-component interface in detail.Alternatively, when assembling fully, coaster-condyle sub-component interface can be for non-limited or that part is limited or fully limited.The condyle sub-component can be constructed as has one or more posts 934 on each sub-component, so that the stability between implant and the support bone to be provided.Alternately, can on the inner surface of condyle sub-component, be assemblied in a blade (not shown) of vowing substantially in the shape face, so that the stability between implant and the support bone to be provided.For tibial component, as describing in Fig. 8, tibial baseplate sub-component 151 and 153 can be constructed as independently tibial baseplate, is used for chamber between the inboard and the outside.

Usually referring to Figure 22 to 27, distal femoral component of the present invention can separate (sectioned) at different positions, to help entering articular cavity by little otch.Shown in Figure 22 and 23, coaster sub-component 910 and lateral condyle sub-component 911 are monolithic construction, and medial condyle sub-component 912 engages or connects thereon.Interface 913 right and wrong between the sub-component are limited, make sub-component stand independently upright (free standing).Alternately, As described in detail below, interface 913 is that part is limited.In the another one embodiment, As described in detail below, when fitting together, described interface 913 is fully limited.Alternately, coaster sub-component 910 and medial condyle sub-component 912 are monolithic constructions, and lateral condyle sub-component 911 engages or connects thereon.Combined interface 913 between the sub-component can reduce to minimum with the translation effect that will mate on patella or patella assembly or the tibial component to being positioned at " tidemark (tide mark) " district of distal femur face.Coaster sub-component 910 that an embodiment of the invention provide and lateral condyle sub-component 911 are monoblock type sub-components, insert and provide a continuous surface along the lateral surface of patella ditch by the little otch of patella inboard helping, and are used for the track of unified patella.In normal knee joint kinesiology, " Q " angle of quadriceps femoris structure pulls to patella the outside on distal femoral component.Therefore, along the lateral surface of patella ditch, there is higher contact force.Alternately, if kneed pathology is so not serious, then may have function by a outside strand condyle, inboard strand condyle and coaster are then easily suffered from arthritis.In this case, can use a monoblock type femur sub-component displacement coaster and inboard strand condyle.

Constitute by three sub-components referring to Figure 24 and 25, one embodiments that are used for distal femoral component, independently coaster 910, medial condyle 912 and lateral condyle 911 sub-components and the combined interface 913 that is usually located at the preceding remote area of distal femoral component are wherein arranged.The joint joint face that matching component slides thereon provides to stride across combined interface 913 and to the shaped profile surface of line, so that the smooth translation of matching component to be provided.The order of implanted femur sub-component is at first to insert condyle sub-component 911 and 912, follows by the coaster sub-component.The coaster sub-component is by little otch or mini-incision and outside being engaged in on the medial condyle sub-component.When being bonded together, described three sub-components are on the appropriate position of distal femur, along with described assembly is assembled and when being fixed in femur, then described three sub-components are forced into the final position fully.As described previously, the interface between the sub-component 913 can be for non-limited or that stand alone, that part is limited or fully limited.In these embodiments each all will be described in more detail below, and all is applicable in the distal femoral component embodiment of the present invention each.In another one distal femoral component embodiment, shown in Figure 26 and 27, coaster sub-component independently can be engaged or be connected in independently condyle sub-component, it is made of monoblock type inboard and lateral condyle sub-component, wherein has interface 913 between two sub-components in the distal front zone of described distal femoral component usually.

Pay special attention to the embodiment of sub-component interface, as mentioned above, when each femur or tibia sub-component are assembled fully, be present between the femur sub-component and the interface between the tibia sub-component can for non-limited, part is limited or fully limited.In addition, in assembling process, described interface can be for non-limited or part is limited, supports on the bone surface to help in articular cavity assembling and to be assembled to.Along with adjacent sub-component in assembling process is more approaching each other, can be configured to connecting device or engagement device more limited.Shown in Figure 49 A and 49B, tapered protrusion 962, be similar to above-described and Figure 32 A and 32B shown in, be configured to and allow condyle sub-component 928 on the cross section, to become the angle substantially with 929.Refer again to Figure 49 A and 49B, condyle sub-component 928 and 929 inwardly becomes the angle with the gap between the adjacent sub-component 963.Alternately, condyle sub-component 928 can outwards become the angle with 929, or becomes the angle with respect to the coaster sub-component with similar interior extremely outer direction, with the assembling of femur sub-component in the scope that is reduced at articular cavity.

When assembling in the scope of articular cavity, allowing the condyle sub-component to become angle and translation each other, is useful.Referring to Figure 53, it is the cross-sectional view of Figure 49 A and 49B, can make up projection 962 by rectangular cross section and inside tapered opposite face.Reception bag 964 is configured to and receives projection 962 suitably when assembling fully, but non-limited interface is provided between coaster sub-component 927 and condyle sub-component 928, is used for assembling in the scope of articular cavity because these sub-components are put together at first.Therefore, the coaster sub-component can become angle and translation with respect to condyle sub-component one or both of by the surgeon, to help assembling.Alternately, shown in Figure 54, projection 965 on the coaster sub-component 927 can have rectangular cross section and parallel opposite flank, and be built as in the reception bag 966 of condyle sub-component 928 loosely and install, be used at the non-limited interface of assembling process or non-limited or part is limited when assembling fully.After on being assembled to the support bone, if keep gap 963 between sub-component, then the interface right and wrong of the coaster sub-component of assembling and condyle sub-component are limited fully.Alternately, be assembled to support on the bone after, when the gap between sub-component 963 is closed, then the interface of coaster sub-component and condyle sub-component is that part is limited.In this case, adjacent sub-component can translation in interface plane.Alternatively, the upper surface 967 of projection 965 can be constructed as in relative upper surface 971 that receives bag 966 and lower surface 972 with lower surface 968 and cosily slides, to provide part limited connection contact surface mechanism, prevent relative translation up and down and Cheng Jiao between the adjacent sub-component.Alternately, the vertical side of projection 965 can be configured in the relative vertical side that receives bag 966 and cosily slide, and to provide part limited connecting interface device, prevents inside and outside relative translation and Cheng Jiao between the adjacent sub-component.At last, support bone by growing into and each femur sub-component 927,928 and 929 is fixed to it with bone cement bonding or by bone.

In three Room knee prosthesises, it is useful reproducing proper motion.That realizes each femur sub-component is optimized to keep suitable tough belt tension peace weighing apparatus in the whole motion of knee joint scope to line and para-position.Therefore, each sub-component and adjacent sub-component is crucial to line and para-position and distal femoral component and tibia and patella assembly to line and para-position.Shown in Figure 28 and 29, the interlocking between coaster sub-component 910 and condyle sub-component 911 and 912 is to utilize interlock projection 72 and 73.End play between the sub-component (axial clearance) 74 is built as and allows usually in vowing shape face appropriateness to become the angle and limited axle translation and the limited angle that becomes in cross section.Alternatively, can increase end play 74 to allow bigger axle translation and the Cheng Jiao in vowing the shape face usually.In addition, on two projectioies 72 and 73 corner and certain scope (radius) is set in the relative corner can increases angled in the sagittal plane usually.Implant is fixed in support bone before, axle rotation and quadrature translation right and wrong are limited, this is useful when assembling described sub-component in articular cavity.In case be fixed in bone, 73 of condyle sub-component projectioies are caught coaster sub-component projection near supporting bone.Alternately, coaster projection 72 can be placed apart from condyle sub-component projection at a distance, in this case, it will catch this condyle sub-component projection.Alternatively, as shown in Figure 30 and 31,, can limit the orthogonal translation of above-below direction usually by part dovetail 78 being added to condyle sub-component projection 76 and coaster sub-component 77.Usually the orthogonal translation of inward-outward direction keeps non-constrained state, and helps the medial surface and the lateral surface of coaster sub-component from femur placed on inboard and the lateral condyle sub-component.The condyle sub-component is being fixed in the thigh condyle that has prepared as mentioned above separately, when putting into the coaster sub-component subsequently, since its can be between patella and femur slip coaster sub-component, connect the projection 76 and 77 of interlocking simultaneously, this may be useful with coaster sub-component to the assembling of condyle sub-component.

Referring to Figure 34 and 35, alternatively, by admitting the projection 450 of rectangular cross section in the reception bag 31 of formed form fit and rectangular cross section in condyle sub-component 911 or 912 and stretching out from coaster sub-component 910, quadrature translation on the sagittal plane and axle rotate and can be restricted.Alternately, projection can be positioned at condyle sub-component 911 or 912 and the pocket of coaster sub-component 910 on.In either case, need relatively short projection in joint capsule, to assemble helping.Alternately, shown in Figure 32 and 33, the projection 80 of coaster sub-component 910 is tapered in the sagittal transverse section, and the taper of the respective bag 81 in condyle sub-component 911 or 912 also is tapered, cosily to receive coaster sub-component projection 80, the restriction that is subjected to when allowing to become the angle usually in sagittal plane to be installed together along with the sub-component that combines is less, and this can help intracapsular assembling and be completely fixed at the taper connection place limited interface is provided when putting in place.Alternatively, projection also can be tapered in the transverse section, so that usually non-limited one-tenth angle to be provided in the transverse section, thereby helps the assembling in the articular cavity.Put in place along with projection 80 and bag 81 are fixed, it is limited all the more that this interface becomes, limited fully until becoming when being completely fixed.Alternately, projection 80 and receive bag 81 and can be annular, ellipse or other the suitable cross sections that is complementary, this cross section is configured to have or not to have taper, and described bag be built as and can cosily receive described projection.

In order to simplify the stability of assembling and increase interface, double pointed nail 84 can be pressed in the coaster sub-component, it is received by the mating holes in the condyle sub-component 83.Alternatively, the coaster sub-component can be configured to has mesopore 86 to hold threaded fastener 85, and it penetrates in the screw thread receiver hole 82 and provides a kind of measure to apply compressibility retentivity (retaining force) across the sub-component contact surface.For fear of the joint joint face that destroys the coaster sub-component, 86 pairs of described mesopores are positioned at the inboard or the outside of the joint passage of patella assembly or tibia load-bearing assembly.Securing member can include but not limited to interaction, screw and threaded fastener, expander pin or bar (expanding pins or bars), press-fit pin or bar (press fit pinsor bars), other clamp devices or its combination of conical component.

Referring to Figure 32, alternately, can discharge its upper surface and lower surface by the basilar part at conical component again, be flexible on sagittal plane and projection 80 is configured to usually.Admit on the distal femur supporting surface of kinesiology ground preparation aspect the localized variation, it is favourable that this elasticity between the adjacent sub-component interconnects.

As described above, having elasticity between adjacent sub-component interconnects and may relatively have superiority.Referring to Figure 36 and 37,, flexible and be inserted between coaster sub-component and the adjacent condyle sub-component 911 and 912 to line contact pin (tab) the 451st.Line contact pin (tab) 451 is made by the flexibility material, for example polyethylene, urethane or other suitable plastic material; Or metal for example NP35N, rustless steel, nickel chromium triangle memorial alloy or be configured to flexible other suitable metals.To line contact pin 451 are columns.Alternately, can be ellipse, rectangle or any appropriate shape or transverse section to line contact pin 451.Reception bag 31 in condyle sub-component 911 and 912 is built as and the shape and the transverse section of line contact pin 451 is complementary, to provide the stable slip interface between line contact pin and the sub-component.Alternately, line contact pin 451 is stretched to the condyle sub-component along with it or the coaster sub-component can inwardly be tapered, receive bag 31 and 451 and then be configured to and meet this taper, providing weak point to cooperate between line contact pin and coupling condyle sub-component and the coupling coaster sub-component.

It is favourable will temporarily inserting in the sub-component line contact pin, to be reduced at intracapsular assembling and to be connected in the support bone.Referring to Figure 38,39 and 40, at first, bone cement be placed on the sub-component inner surface and the distal femur surface that prepared on, and with condyle sub-component 911 and 912 and coaster sub-component 910 insert in the articular cavity and support on the bone.Described sub-component utilizes subsequently flexiblely to be assembled line contact pin 453, and line contact pin 453 is placed in the matching slot 457 in coaster sub-component and the condyle sub-component.Need two 453, one of line contact pin are used for medial condyle sub-component 912 is connected in coaster sub-component 910 (it is put into from medial surface), one is used for lateral condyle sub-component 911 is connected in coaster sub-component 910 (it is put into from lateral surface).During knee sprung, compress the condyle sub-component, when knee joint is stretched, then compress the coaster sub-component subsequently.Remove unnecessary bone cement, and described cement can solidify.Can put into experimental tibia implant and experimental patella implant, so that the compressibility load of femur sub-component to be provided, simultaneously described bone cement solidifies.In the embodiment that goes out as shown in figure 38, line contact pin 453 is had cylinder edge 455, it is configured to the groove 457 that can slip in condyle sub-component and the coaster sub-component structure, with shape and the transverse section of coupling to line contact pin 453.Described cylinder edge 455 to line contact pin can be configured to the cylindrical groove 456 that connects in condyle sub-component and the coaster sub-component.

Alternately, can be configured to one of them cylinder edge collapsible and stretching, extension, to simplify the installation of sub-component in the articular cavity to line contact pin 453.Referring to Figure 39, the extensible edge 459 of line contact pin is built as has the groove 458 that extends along major axis line contact pin.To put into one of them receiving slit 457 of coaster sub-component or condyle sub-component to the cylinder edge 455 of line contact pin 453, slip into then in the receiving slit 457 of the sub-component that is complementary.Expander pin 460 is inserted in the groove 458, thereby can expand edge 459 joint pin connected in star 456 in the sub-component that is complementary with expansion.Another condyle sub-component is repeated this process, and distal femoral component is fixed in the femur that has prepared as indicated above.After bone cement fully solidifies, then can move line contact pin 453 by hooking mobile hole 454.Alternately, can on mobile hole, bind suture, easily mobile to help to line contact pin 453.Alternately, can utilize the tether equipment of describing for the 11/186th, No. 485 as U.S. Patent application line contact pin 453 to be inserted in the receiver hole 457 with described.

About the tibia implant, as described above, as shown in Figure 43, the tibial baseplate assembly can be monolithic construction, to cover the surface of the tibial plateau relevant with knee joint that has prepared.Inboard substrate 328 and outside substrate 326 can be symmetric, to allow to use the design of one of right knee joint or left knee joint.Alternately, inboard substrate 328 and outside substrate 326 can need left side design and right side design for asymmetrical.Can see, bridge 324 between inboard 328 and the outside 326 substrates has a narrow scope from front to back, insert bridge 324 so that can insert the place ahead, be maintained at the complete knee joint design that anterior cruciate ligament keeps (anterior cruciate sparing) will support bone at anterior cruciate ligament.Alternatively, (not shown) can be moved backward in the rear surface of bridge 330, is used for the complete knee joint design that anterior cruciate ligament damages (sacrificing).Alternatively, (not shown) can further be moved backward in the rear surface of described bridge, is used for the complete knee joint design that ligamentaum cruciatum damages (preceding and posterior cruciate ligament), is commonly referred to the complete knee joint of posterior stabilization.The recessed while of proximal end face of inboard 328 and the outside 326 substrates has shoulder and divides 322 around groove, a kind of acquisition equipment or limiter of form is provided, and is used for tibia load-bearing insert (not shown).Other insert the tibia load-bearing insert of the locking device of substrate, known in the art, comprise dovetail device, locking plate (locking tab), locking spoon (locking key) and pin and other securing members, tibia load-bearing insert is fixed on the substrate.

If be configured to an integral component, then tibial baseplate provides a kind of acquisition equipment that is used for fixing load-bearing or activity load-bearing insert, and described insert is used for chamber between inboard or outside shin thigh.As a kind of selection, can make up single platform, fixedly load-bearing acquisition equipment and active load-bearing acquisition equipment to be provided for chamber between inboard shin thigh perhaps make up simple platform, are used for the activity load-bearing insert of chamber between the shin thigh of the outside with reception.Because need right side and left side tibial baseplate, therefore same substrate can be used for inboard insert of active load-bearing and fixed load-bearing outside insert.

As shown in figure 44, alternatively tibial baseplate is configured to the two-piece type assembly, wherein sub-component engages in the scope of articular cavity.Slit 323 between inboard substrate 328 and the outside substrate 326 can be positioned at the inboard of bridge 324; Yet slit 323 can be positioned at along any position of bridge and with respect to any angle in the sagittal plane inboard or the outside, and is perhaps in parallel.Slit 323 is placed the inboard and becomes the angle that the benefit of three aspects is arranged, at first it is provided for the extra area of section of interconnection device, second, it is by being used for the inboard kneecap escribe mouth that securing member is inserted, convenient path perpendicular to slit 322 is provided, the 3rd, it provides a prolongation, insert can be connected in this, help lateral tibial substrate sub-component 326 is inserted by inboard kneecap escribe mouth.Alternately, inboard substrate sub-component 328 is limited fully with interconnecting of outside substrate sub-component 326 322 places in the slit, can be maintained at common plane with the outside 326 sub-components with inboard 328, and make the fixed angle that is inclined to of described sub-component.Alternatively, interconnecting of 323 places, slit is that part is limited.

Figure 41, double pointed nail 344, threaded fastener 345.

As in the femur sub-component, tibial baseplate can be constructed as a whole chip or a plurality of sub-component.In the situation of back, the contact surface between the tibial baseplate sub-component can right and wrong limited, part is limited or fully limited.The described embodiment that is used for the sub-component contact surface of femur sub-component is applicable to and engages or connection tibia sub-component that this point list of references comprises.In addition, the described embodiment that is used for the sub-component contact surface of tibial baseplate sub-component is applicable to and engages or connection femur sub-component that it can be with above-described different.The tibial baseplate sub-component can comprise cobalt chromium alloy, titanium or titanium alloy or rustless steel by the proper metal manufacturing; Or by zirconium oxide or alumina ceramics manufacturing.Sub-component can be machine-building or casting or molded.Manufacture method comprises machining, line cutting and drilling cutting (wire andplunge EDM) and other suitable processing methods.

Referring to Figure 41 and 42, in a substitutability embodiment, tibial baseplate among the opening that is used for the tibia knuckle a side and separate, wherein the interface between sub-component leaves sagittal plane (it passes the knee joint center) and forms the angle.In a substitutability embodiment, the interface between the sub-component is towards medial condyle, with the side of described interface to the following and patellar ligament that is positioned at operative incision.As shown in figure 41, projection 340 is stretched out from bridge 324.Projection 340 cross sections can be rectangle.In the zone of bridge 324, the size up and down of projection 340 is less than the corresponding size up and down of tibial baseplate sub-component 326 and 328.Have parallel surfaces by the opposite face that projection 340 is configured in this projection (its interface surface from outside sub-component 326 is outstanding), can make up the sub-component interface and be used for limited relatively assembling.Can bag 342 be configured to its shape and the transverse section slidably cooperates to property with the projection 340 of coupling with receiving.Yet, by projection 340 is tapered, can simplify the assembling process in the articular cavity, allowing becoming the angle between the sub-component in the assembling process, and be completely fixed the back that puts in place at sub-component and form limited interface.Alternatively, shown in Figure 51 A and 51B, projection 340 has parallel surfaces on upper surface and lower surface, and has inside tapered surface on vertical plane 341, so that the lower limit that becomes the angle in restriction that becomes the angle up and down between the sub-component and the base plan to be provided in assembling process.In an alternative embodiment, the interlocking between the sub-component can comprise double pointed nail 344 and threaded fastener 345 as shown in figure 41, perhaps not shown in image pattern 51A and the 51B.Refer again to Figure 51 A and 51B, the substrate sub-component can utilize protruding 340 para-positions, projection 340 parts are engaged in and receive in the bag 342 (seeing Figure 41), make sub-component can become the angle usually in the transverse section each other, to determine the direction of sub-component with respect to the geometric shape of the support bone of tibial plateau.

When assembling in the scope of articular cavity, allowing the substrate sub-component is favourable each other in angle and translation.Referring to Figure 51 A and 51B, projection 340 can be configured to has rectangular cross section and inside tapered opposite face.Receive bag 342 (seeing Figure 41) and be configured to and when assembling fully, can cosily receive projection 342, but along with sub-component is put together at first and is used for assembling in the scope of articular cavity and non-limited contact surface is provided between adjacent sub-component 326 and 328.Therefore, the substrate sub-component can become angle and translation by the surgeon each other, to help assembling.Alternately, projection 340 has rectangular cross section and parallel opposite face, and be configured in receiving bag 342 and install loosely, be used at the non-limited interface of assembling process and the non-limited or limited interface of part when assembling fully, projection 340 and receive bags 342 similar in the above-described structure that is used for femur sub-component (it is relevant with Figure 54).After being assembled on the support bone, keep gap 323 between the sub-component, then the interface right and wrong of the substrate sub-component of assembling and sub-component are limited fully.Alternately, be assembled to support on the bone after, gap 323 sealings between the sub-component, then substrate sub-component and sub-component interface are that part is limited.In this case, adjacent sub-component can translation in the plane of interface.Alternatively, projection 340 upper surface and lower surface can be configured in receiving relative upper surface of bag 342 and lower surface and cosily slide, and to provide part limited connection contact surface device, prevent the relative translation up and down between the adjacent sub-component and become the angle.Alternately, the vertical side surface of projection 340 can be configured in receiving bag 342 opposing vertical side surfaces and cosily slide, and to provide part limited connection contact surface device, prevents the inside and outside relative translation between the adjacent sub-component and becomes the angle.Finally, by growing into and soleplate sub-component 328 and 326 be fixed in the support bone with bone cement bonding or by bone.

Alternatively, projection 340 can have inside tapered surperficial (not shown) and vertical surface 341 on upper surface and lower surface, to be provided at the lower limit that becomes the angle in the articular cavity in the assembling process on any direction between the sub-component.In two embodiments, receive that bag 342 is configured to its shape that has and can cosily match with coupling projection 340 in the transverse section, thereby be completely fixed when putting in place at sub-component, limited interface fully is provided.Alternately, projection 340 can be configured to appropriate shape of column or truncated cone or other and transverse section, is used for connecting or engaging described sub-component, and reception bag 342 then is configured to its shape that has and can cosily match with the projection 340 of coupling in the transverse section.Alternately, can have a plurality of protruding (not shown), it is outstanding from outside substrate sub-component and the interface surface that receives bag, and wherein said reception bag is configured to its shape and can cosily match with the coupling projection in other sub-components in the transverse section.Alternately, projection can be outstanding from inboard substrate sub-component, wherein receives bag and be positioned at outside substrate sub-component.

Referring to Figure 41, double pointed nail 344 can press fit in the receiver hole 340 of outside substrate sub-component 326.For easy to assembly, the receiver hole 343 that is used for the double pointed nail 344 in the inboard substrate sub-component provides a kind of and has been slidingly matched.Alternately, double pointed nail 344 can press fit in the inboard substrate sub-component, and in the outside substrate sub-component that is slidingly installed.It is favourable fully to fix tapered interface and sub-component mechanical caging each other is provided that a kind of pressure is provided.In one embodiment, threaded fastener 345 is put into the receiver hole 348 of outside substrate sub-component, and penetrate in the screw thread receiver hole of inboard substrate sub-component.The open front that enlarges mesopore (clearance hole) 346 is to be provided for the countersunk of threaded fastener 345 heads.Referring to Figure 42, threaded fastener 345, mesopore 348 and 346 and screw thread receiver hole 347 can be configured to and can and receive bag 342 by projection 340, another double pointed nail 349 is pressed fit in the receiver hole 350 of outside substrate sub-component with permission, thereby when the reception that places inboard substrate sub-component was slidingly matched hole 351, docking port provided extra stability.

As mentioned above, may there be patient's indication, wherein needs a post to be connected in tibial baseplate and to stretch in the tibia pulp cavity, so that the additional stability to implant to be provided.Similarly, sometimes for some indication of distal femoral component, wherein need a post to be connected in distal femoral component or sub-component and to stretch in the femoral bone cavitas medullaris, so that the additional stability to implant to be provided.Traditional tibia and femur knee implant are configured to combined post and use, and it is suitable for assembling outside articular cavity.There are many problems in such design in less and Wicresoft's knee replacements, because the assembly that limited surgical exposure does not allow enough spaces to have assembled is inserted in the articular cavity.In the present invention, people have found that limited surgical exposure can allow enough spaces that a trunk is inserted in the tibia pulp cavity.Similarly, for the femur side, people have found that limited surgical exposure can allow enough spaces that a trunk is inserted in the femoral bone cavitas medullaris.Therefore, in an embodiment of the invention, trunk penetrates in the articular cavity and enters in the hole that has prepared in the tibial plateau that extends to medullary cavity.Subsequently, can will insert in the articular cavity according to tibial component of the present invention mentioned above or sub-component and be assembled to trunk.For distal femoral component, in an embodiment of the invention, trunk penetrates in the articular cavity and enters in the hole that extends to the distal femur that has prepared in the medullary cavity similarly.Subsequently, can will insert in the articular cavity according to distal femoral component of the present invention mentioned above or sub-component and be assembled to trunk.In an embodiment of the invention, at first inserting the femur trunk, follow by tibia trunk and femur sub-component, is the tibia sub-component at last.Alternately, at first inserting the femur trunk, follow by femur sub-component and tibia trunk, is the tibia sub-component at last.

Normally, referring to Figure 45 and 46, in a replaceable embodiment of the present invention, tibial component is made up of trunk sub-component 940 and monoblock type substrate sub-component 941.Alternately, inboard as indicated above and outside substrate sub-component can be used with trunk sub-component 940, wherein described trunk sub-component 940 is inserted in the tibia, and be inboard substrate sub-component subsequently, be outside substrate sub-component then.Then, the tibia sub-component is assembled in articular cavity, and alternately, outside substrate sub-component can be inserted before inboard substrate sub-component.

Extremely greater than 90 degree, can be the trunk sub-component provides passage with the preparation receiver hole in proximal tibia with knee joint bending.Tibia template or experiment and punching are known for the those of skill in the art in this area, are used for preparing receiver hole.Referring to Figure 46, trunk sub-component 940 is inserted in the tibia, knee joint is crooked similarly simultaneously.If trunk fully admittedly may be more useful to the short about 2-6mm in position than it, help the implant with bone cement is inserted, as hereinafter explaining.If the employing bone cement then is used for bone cement the bottom surface of substrate sub-component and above the tibial plateau.When knee joint stretches, pass near the otch of patellar ligament inboard and be placed on the trunk sub-component 940, substrate sub-component 941 can be inserted in the articular cavity by the outer surface that makes substrate sub-component 941.Rotate subsequently described substrate sub-component 941 with tibial plateau to line, and pulling forward empties trunk capture board 944 until receiving contact pin 953.Subsequently substrate sub-component 941 is lowered to the level that receives contact pin 953, in bonded assemblies, 953 pairs of contact pin are positioned at a little higher than tibial plateau, substrate sub-component 941 are placed on the trunk helping, and place on the substrate sub-component before not destroying and tibial plateau on bone cement.With substrate sub-component 941 to pusher, with the reception ditch 949 in the engage proximal trunk sub-component slidably, and utilize threaded fastener 946 to be fixed in trunk sub-component 940, wherein threaded fastener 946 is inserted in the substrate sub-component 941 by reception mesopore 947 and is penetrated in the screw thread receiver hole 950 of trunk sub-component.Alternately, can adopt other clamp devices as known in the art, for example crosshead pin, snap fit, cone pin or other appropriate connectable units.Alternately, capture board 944 can be for combined, permission places substrate sub-component 941 on the trunk sub-component 940 to receiving on the post by the substrate sub-component 941 of loweing, subsequently by placing capture board 944 and by one or more threaded fasteners (it passes capture board and goes forward side by side interior into trunk sub-component 940) capture board 944 being fixed.The substrate sub-component is fixed in after the trunk sub-component, knee joint bending to greater than 90 degree, being provided for the passage of compaction tool, and is compressed to tibial component on the tibial plateau.If the employing bone cement is removed unnecessary bone cement after then compressing again.

Referring to Figure 45 and 46, the trunk sub-component is made up with pin 951, when it connects with the support bone photo, provide rotational stabilization, and provide support for substrate sub-component 941.The bottom surface of substrate sub-component 941 is supported by the proximal end face 952 of described pin 951.Alternately, as shown in figure 50, outside substrate sub-component 326 and trunk sub-component 940 can be configured to the monoblock type sub-component with inboard substrate sub-component 328 (be configured to be connected or be engaged in above it).

Referring to Figure 47 and 48, in yet another embodiment of the present invention, support 953 can be used to substrate sub-component 941 is fixed in trunk sub-component 940.Substrate sub-component 941 is placed on the trunk sub-component 940, as indicated above.After substrate sub-component 941 has placed on the trunk sub-component 940, support 953 can be placed the trunk sub-component in the depressed area 956 and the front surface of substrate sub-component 940, and fix with threaded fastener 952, wherein threaded fastener 952 is inserted in the screw thread receiver hole 955 in the trunk sub-component of going forward side by side by the gap-acceptance holes 954 in the support 953.The substrate sub-component is fixed in after the trunk sub-component, knee sprung to greater than 90 degree, being provided for the passage of compaction tool, and is compressed to tibial component on the tibial plateau.If the employing bone cement then compresses the back and removes unnecessary bone cement.Other features and the function of the embodiment shown in Figure 47 and 48 are as indicated above, and shown in Figure 45 and 46.

As indicated above, constitute the sub-component para-position each other of femur and tibial component, form femur and tibial component respectively.Can simplify sub-component is inserted articular cavity, it is connected to each other to line and para-position, with it or is engaged and be fixed in the process of supporting bone, and strengthen: utilize instrument that one or more sub-components are maintained together by following steps, simultaneously they are inserted in the articular cavity, and in assembling process with the appropriate para-position of two or more sub-components or be fixed in the support bone simultaneously.

Referring to Figure 19 A and 19B,, tibial baseplate sub-component 314 and 315 is independently maintained each other in appropriate direction by substrate insert (plug-in unit) 316.In one embodiment, tibia insert 316 by along its separately front surface 317 support 302 of crossing over substrate sub-components 314 and 315 constitute.Each match surface 308 on the cross bar 302 is consistent with this prebasal plate sub-component surface 317, rotates with the axle that prevents in inserting the process of articular cavity separate substrates sub-component 314 and 315.By threaded fastener 304 the substrate sub-component is fixed on the support 302, and threaded fastener 304 is to insert support 302 by mesopore 305, and penetrates inboard 315 and the interior screw thread receiver hole 301 of the outside 314 substrate sub-components.In an alternative embodiment, insert axostylus axostyle 303 and be connected in support 302 in interior the place ahead of inboard substrate sub-component 315, allow by easily put into substrate sub-component 314 and 315 and tibia insert 316 along the vertical incision of medial patellar traveling.Alternately, inserting axostylus axostyle can be connected in along the centre position of support 302 or be connected on the lateral surface of support 302.In a substitutability embodiment of the present invention,, support 302 can be connected in single substrate sub-component by snap fit connecting device, trinkle lock, dovetail connecting device or other devices that connects the two portions together.Insert axostylus axostyle 303 and can have Quick Connect Kit, for example be implemented in the trinkle lock 312 in the square drive (square drive) 310, axostylus axostyle 303 is inserted in its clamping in the square receiver hole 311 of support 302, and receiver hole 311 has the indenture of reception (not shown) to receive trinkle lock 312, and the axle that while square drive 310 prevents to insert between axostylus axostyle 303 and the support 302 rotates.Usually, trinkle lock 312 locks, and can by on button release (release button) 309 to pulling back, and can open it.Expect that detachable insertion axostylus axostyle can be pulled down and insert axostylus axostyle 303 and simultaneously support 302 is stayed original position, can stablizing each substrate sub-component in the scope of whole locomotion evaluation or in adherent process, and it helps to make the otch sealing and patella is moved in coaster in adherent process.Alternately, inserting axostylus axostyle 303 can be one with support 302.Usually, support 302 has multiple size to adapt to different substrate sub-component sizes and interior external series gap.Alternately, by comprising a kind of axial slip or retractor device, support 302 can be configured to different length.The substrate insert can by suitable metal for example rustless steel make.Alternatively, handle 306 can be made by appropriate plastics, for example acetyl plastics (acetyl), Ultem or celcon (celcon) or bakelite.

In yet another embodiment of the present invention, if the additional stability between inboard 315 and the outside 314 substrate sub-components is useful, then can be configured to support 302 implantable.In this case, support 302 and fixture be screw 304 for example, can be made by suitable implantable material, for example titanium, titanium alloy, rustless steel, cobalt chromium alloy; Or by suitable polymer for example PEEK or polyethylene are made.

In a kind of using method, wherein substrate sub-component 314 and 315 will utilize bone cement and be fixed in the support bone, then at first inboard substrate sub-component 315 will be connected in support 302.Experimental femur sub-component (not shown) is placed on the outside and the inboard strand condyle.Bone cement puts on the bottom surface of substrate sub-component 314 and 315, and will be independently outside substrate 314 insert between the kneed outside in the chamber.Inboard substrate 305 can be inserted chamber between the inboard down the auxiliary of tibia insert 316, can be by the receiver hole in the support 302 305 and the screw thread receiver hole 301 in the substrate sub-component 314 outside entering until threaded fastener 304.Experimental insertion supporter (not shown) is placed on substrate sub-component 314 and 315, and extended knee is to provide compression stress to tibial component.Alternatively, tibia insert 316 can utilize wire conductor together with reference to kneed mechanical axis and making up, with auxiliary tibial component to line.Alternately, tibia insert 316 can make up with the navigation tracker, can realize tibia insert 316 and substrate sub-component 314 that links to each other and 315 surgical navigational, be used in the articular cavity appropriately to line.Can remove inserting axostylus axostyle 303, and support 302 is stayed original position, enter articular cavity with improvement and carry out the passage that cement is removed.Inserting axostylus axostyle 303 can be by removing to the trinkle lock button release 309 of pulling back.In case cement solidifies, then dismountable support 302.

Alternatively, tibia insert 316 can be configured to connection to wire conductor.Referring to Figure 55, by being connected in tibia insert 316 to wire conductor 201, then have to line rod 202 to wire conductor 201 can be used to check tibial baseplate 314 and 315 with respect to the lower limb mechanical axis to the line situation, this connection can be configured to a groove 204 in the base 203 of wire conductor 201, it slidably is matched with on the axostylus axostyle 303, being stable at appropriate in line states with respect to tibia insert 316 to wire conductor 201.Can will be connected in the tibia insert by threaded fastener 304, and 304 can and pierce in the screw thread receiver hole 301 that inserts axostylus axostyle 303 by the gap receiver hole 305 in the base 203 to wire conductor 201.By be connected in tibia insert 316 to wire conductor 201 and the tibia sub-component that places the tibia otch that has prepared, can check tibia sub-component 314 and 315 to the line situation.Insert femur experiment material and experimental insertion load-bearing thing, and complete straighten knee joint.When appropriately to line, line rod 202 is passed through hip joint center, knee joint center and ankle joint center.

Alternatively, tibia insert 316 structures can be used to connect the surgical navigational tracker, and use with operation guiding system.Referring to Figure 57, surgical navigational tracker 205 has three reflection spheres 208 (being supported on the support 207) and a base 206, by surgical navigational tracker 205 is connected in tibia insert 316, can be used to check tibial baseplate sub-component 314 and 315 with respect to the lower limb mechanical axis to the line situation, this connection can be configured to a groove 204 in surgical navigational guide 205 bases 206, it slidably is matched with on the axle 303, to be stable at the surgical navigational guide appropriate in line states with respect to tibia insert 316.Surgical navigational guide 205 can be connected in the tibia insert by threaded fastener 304, and threaded fastener 304 can pierce into by the gap receiver hole 305 in the base 206 in the screw thread receiver hole 301 that inserts axostylus axostyle 303.By surgical navigational guide 205 that is connected in tibia insert 316 and the tibia sub-component that places the tibia otch that has prepared, can check tibia sub-component 314 and 315 to the line situation.Insert femur experiment material and experimental insertion load-bearing thing, and complete straighten knee joint.Operation guiding system will be measured kneed to the line situation and provide portion to report to the surgeon.Alternately, can be configured to wire conductor 201 and surgical navigational tracker 205 and to be connected to tibia insert 316, utilize the combination of " T " groove, dovetail lock, cylindricality interlocking, button interlocking, spherical interlocking or these modes, perhaps other is used for connecting the connecting device of two or more parts.

As indicated above, embodiment that is used for the femoral joint face will heavily be spread between inboard and the outside shin thigh chamber between chamber and kneecap thigh; If adopt bone cement that implant is fixed in the support bone, then the implantation process with described assembly is good stage by stage.Referring to Figure 20 A and 20B, independently medial condyle sub-component 912 and lateral condyle sub-component 911 can be bonded in appropriate position before the coaster sub-component.In an embodiment of the invention, these condyle sub-components are used to insert in the articular cavity by femur insert 920 para-position each other.In one embodiment, femur insert 920 is made of support 36, and support 36 is crossed over medial condyle sub-component 912 and lateral condyle sub-component 911 along front surface 933 separately.Support 36 is built as has outstanding contact pin 35, and the latter can be slip-fitted into respectively in the reception bag 31 of medial condyle sub-component 912 and lateral condyle sub-component 911, prevents that in inserting the process of articular cavity the axle of each condyle sub-component from rotating.Condyle sub-component 911 and 912 can be fixed in support 36 by threaded fastener 33, and threaded fastener 33 is inserted and is entered in the screw thread receiver hole 932 of each condyle sub-component 911 and 912 by the mesopore 34 in the support 36.In an interchangeable embodiment, insert axostylus axostyle 39 and be connected in support 36 in interior the place ahead of medial condyle sub-component 912, realize by can easily put into condyle sub-component 911 and 912 and femur insert 920 along the vertical incision of medial patellar traveling.Alternately, inserting axostylus axostyle 39 can be connected in along the centre position of support 36 or be connected on the lateral surface of support 36.In a substitutability embodiment of the present invention,, support 36 can be connected in single condyle sub-component by snap fit connecting device, trinkle lock, dovetail connecting device or other devices that connects the two portions together.Insert axostylus axostyle 39 and can have Quick Connect Kit, for example be implemented in the trinkle lock 38 in the square drive 37, axostylus axostyle 39 is inserted in its clamping in the square receiver hole 41 of support 36, and receiver hole 41 has the indenture of reception (not shown) to receive trinkle lock 38, and the axle that while square drive 37 prevents to insert between axostylus axostyle 39 and the support 36 rotates.Usually, trinkle lock 38 locks, and by past pulling back on button release 41, can open it.Expect that detachable insertion axostylus axostyle 39 can be pulled down and insert axostylus axostyle 39 and simultaneously support 36 is stayed original position, can stablizing each condyle sub-component 911 and 912 in the scope of whole locomotion evaluation or in adherent process, and it helps to make the otch sealing and patella is moved in coaster in adherent process.Alternately, inserting axostylus axostyle 39 can become one with support 36.Usually, support 36 has multiple size to adapt to different condyle sub-component sizes and interior external series gap.Alternately, by comprising a kind of endwisely slipping or retractor device, support 36 can be configured to different length.The femur insert can be made by suitable metal, for example rustless steel.Alternatively, handle 43 can be made by suitable plastic, for example acetyl plastics (acetyl), Ultem or celcon or bakelite.

In a kind of using method, wherein bone cement is used for distal femoral component is fixed in the support bone, and the first step is the receiver hole that is used for the post 916 on single condyle sub-component 911 and 912 in the distal femur preparation.Boring machine and drill guide (not shown) can be used to prepare the interior receiver hole of thigh condyle of the post 916 that is used on inboard and the lateral condyle sub-component.Alternatively, the lateral condyle sub-component is connected in the outer insertion instrument 920 of articular cavity.Cement is put on inboard and the lateral condyle that has prepared and is used for medial condyle sub-component 912 and the inner surface 917 of lateral condyle sub-component 911.Medial condyle sub-component 912 is placed on the medial condyle, and insertion instrument 920 is used for lateral condyle sub-component 911 is placed kneecap ligament below and enters between the shin thigh of the outside indoor.When lateral condyle sub-component during, then, be assembled to the medial condyle sub-component and will insert instrument 920 by threaded fastener 33 is advanced in the receiver hole 932 of sub-components at correct position.By fitting in the compatible bag 31 wherein, be connected inboard and lateral condyle sub-component respectively with outside tab 35 from support 36 outstanding inboards.The shape of this contact pin 35 and cross section are configured to can provide a plurality of reception bags in the condyle sub-component, as mentioned below.Experimental tibial baseplate sub-component and experimental tibia insert (not shown) are placed on the outside and medial tibial level ground that has prepared.Alternatively, be configured to reference to the mechanical axis of femur and tibia and receive wire conductor with inserting axostylus axostyle 39, with auxiliary with condyle sub-component 911 and 912 alignment.Extended knee is with the load implant.Remove too much bone cement.Can will insert handle 43 and insert axostylus axostyle 39 and remove, and support 36 is stayed original position, entering articular cavity with improvement carries out the passage that cement is removed, and checks range of movement and structural equation.

Can be thereby insert handle 43 and insert axostylus axostyle 39 by on trinkle button release 41, removing to the release trinkle lock 38 of pulling back, wherein this lock will insert axostylus axostyle 39 and be connected in support 36 in the square receiver hole 41 of support 36.After bone cement was fixing, then striking 36.Coaster sub-component 910, see Figure 21, implant in a similar fashion now, process is as follows: at first utilize the preparation of boring machine and drill guide (not shown) to be used for the receiver hole of coaster sub-component 910 inner surface upper props 916, bone cement is placed on the thigh coaster that has prepared and on the inner surface 917 of coaster sub-component, as shown in figure 21.Referring to Figure 34 A and 34B, to be configured to from rear port surface 461 two outstanding projectioies 450 of coaster sub-component 910 and be used for each projection 450, so that each receives the condyle sub-component 911 or 912 in the bag 31 in the front port surface of each coaster sub-component 911 or 912, thus with coaster sub-component 910 appropriately to being positioned at condyle sub-component 911 and 912.The coaster sub-component is compacted on strand coaster subsequently, makes up the kinesiology para-position of coaster sub-component.Shaping compressor (not shown) is used for fixing the coaster sub-component and puts in place.Then remove unnecessary bone cement after compressing.Patella assembly or patella experiment material are placed on the patella, bend and stretch range of movement and soft tissue balance that knee joint is assessed examine.

Alternatively, femur insert 920 can be configured to connection to wire conductor.Referring to Figure 56, by being connected in femur insert 920 to wire conductor 201, have to line rod 202 to wire conductor 201 can be used to check strand condyle sub-component 911 and 912 with respect to the lower limb mechanical axis to the line situation, this connection can be configured to a groove 204 in wire conductor 201 bases 203, it slidably is matched with on the axostylus axostyle 39, being stable at appropriate in line states with respect to femur insert 920 to wire conductor 201.Can the femur insert will be connected in to wire conductor by threaded fastener 304, and threaded fastener 304 can and pierce in the screw thread receiver hole 301 that inserts axostylus axostyle 39 by the gap receiver hole 305 in the base 203.By be connected in femur insert 920 to wire conductor 201 and the thigh condyle sub-component that places the femur otch that prepared, can check strand condyle sub-component 314 and 315 to the line situation.Insert tibial baseplate experiment material and experimental insertion load-bearing thing, and complete straighten knee joint.When appropriately to line, line rod 202 is passed through hip joint center, knee joint center and ankle joint center.

Alternatively, femur insert 920 structures can be used to connect the surgical navigational tracker, and use with operation guiding system.Referring to Figure 58, surgical navigational tracker 205 has three reflection spheres 208 (being supported on the support 207) and base 206, by surgical navigational tracker 205 is connected in femur insert 920, can be used to check strand condyle sub-component 911 and 912 with respect to the lower limb mechanical axis to the line situation, this connection can be configured to a groove 204 in surgical navigational guide 205 bases 206, it slidably is matched with on the axostylus axostyle 39, to be stable at the surgical navigational guide appropriate in line states with respect to femur insert 920.Surgical navigational guide 205 can be connected in the tibia insert by threaded fastener 304, and threaded fastener 304 can and pierce in the screw thread receiver hole 301 that inserts axostylus axostyle 39 by the gap receiver hole 305 in the base 206.By surgical navigational guide 205 that is connected in femur insert 920 and the tibia sub-component that places the tibia otch that has prepared, can check strand condyle sub-component 911 and 912 to the line situation.Insert tibial baseplate experiment material and experimental insertion load-bearing thing, and complete straighten knee joint.Operation guiding system will be measured kneed to the line situation and provide portion to report to the surgeon.Alternately, can make up wire conductor 201 and surgical navigational tracker 205 and to be used to be connected to femur insert 920, wherein utilize the combination of " T " groove, dovetail lock, cylindricality interlocking, button interlocking, spherical interlocking or these modes, perhaps other is used for connecting the connecting device of two or more parts.

Also can implement within the scope of the invention as other assembly well known by persons skilled in the art or step.And, implement in the one or more programs that need not within the scope of the invention in listed step or the assembly.Although described the preferred specific embodiment, should be appreciated that and to carry out multiple variation, improvement and change, and do not depart from the scope of spirit of the present invention and appended claims.

Claims (46)

1. device that is used to replace the articular surface between first bone and second bone, described first bone moves with second bone in a predefined manner, described device comprises first osteoarthrosis substitute, described first osteoarthrosis substitute comprises a plurality of independent sub-component that is configured to the supporting surface that is used to simulate and replace described first bone, in described a plurality of independent sub-component each all has relative motion each other, and the relative motion right and wrong between each in wherein said a plurality of independent sub-components are limited.

2. device according to claim 1, wherein said first osteoarthrosis substitute comprises a plurality of independent distal femoral components.

3. device according to claim 2, the relative motion right and wrong between two or more in wherein said a plurality of independent sub-components are limited.

4. device according to claim 2, the relative motion between two or more in wherein said a plurality of independent sub-components is that part is limited.

5. device that is used to replace the articular surface between first bone and second bone, described first bone moves with second bone in a predefined manner, described device comprises first osteoarthrosis substitute, described first osteoarthrosis substitute comprises a plurality of independent sub-component that is configured to the supporting surface that is used to simulate and replace described first bone, in described a plurality of independent sub-component each all has relative motion each other, and the relative motion between each in wherein said a plurality of independent sub-components is that part is limited.

6. device according to claim 5, wherein said first osteoarthrosis substitute comprises a plurality of independent distal femoral components.

7. device according to claim 6, the relative motion between two or more in wherein said a plurality of independent sub-components is that part is limited.

8. device that is used to replace the articular surface between first bone and second bone, described first bone moves with second bone in a predefined manner, described device comprises first osteoarthrosis substitute, described first osteoarthrosis substitute comprises a plurality of independent sub-component that is configured to the supporting surface that is used to simulate and replace described first bone, in described a plurality of independent sub-component each all has relative motion each other, and the relative motion between each in wherein said a plurality of independent sub-components is limited.

9. device according to claim 8, wherein said first osteoarthrosis substitute comprises a plurality of independent distal femoral components.

10. device that is used to replace the articular surface between first bone and second bone, described first bone moves with second bone in a predefined manner, described device comprises first osteoarthrosis substitute, described first osteoarthrosis substitute comprises a plurality of independent sub-component that is configured to the supporting surface that is used to simulate and replace described first bone, in described a plurality of independent sub-component each all has an inner surface and an outer surface, and wherein said inner surface is configured to and is fixed in described first bone; And

Second osteoarthrosis substitute, comprise a plurality of independent sub-component that is configured to each supporting surface that is used to simulate and replace described second bone, the outer surface of the described a plurality of independent sub-component of wherein said first osteoarthrosis substitute contacts described second osteoarthrosis substitute, and in wherein said a plurality of independent first bone sub-component each to be built as in articular cavity in the assembling process right and wrong limited, and be limited when in described articular cavity, assembling fully, the structure of resulting described first osteoarthrosis substitute and second osteoarthrosis substitute forms the joint in a predefined manner, thereby recovers normal kinesiology.

11. device that is used to replace the articular surface between first bone and second bone, described first bone in a predefined manner with second bone formation joint, described device comprises first osteoarthrosis substitute, described first osteoarthrosis substitute comprises a plurality of independent sub-component that is configured to the supporting surface that is used to simulate and replace described first bone, in described a plurality of independent sub-component each all has inner surface and outer surface, and wherein said inner surface is built as and is fixed in described first bone; And

Second osteoarthrosis substitute, be built into each supporting surface that is used to simulate and replace described second bone, the described outer surface of the described a plurality of independent sub-component of wherein said first osteoarthrosis substitute contacts described second osteoarthrosis substitute, and each the assembling process right and wrong that are built as in articular cavity in the described a plurality of independent sub-component of wherein said first osteoarthrosis substitute are limited, and be that part is limited when in articular cavity, assembling fully, the structure of resulting described first osteoarthrosis substitute and second osteoarthrosis substitute forms the joint in a predefined manner, thereby recovers normal kinesiology.

12. device that is used to replace the articular surface between first bone and second bone, described first bone moves with second bone in a predefined manner, described device comprises second osteoarthrosis substitute, described second osteoarthrosis substitute comprises a plurality of independent sub-component that is configured to the supporting surface that is used to simulate and replace described second bone, in described a plurality of independent sub-component each all has relative motion each other, and the relative motion right and wrong between each in wherein said a plurality of independent sub-components are limited.

13. device according to claim 12, wherein said second osteoarthrosis substitute comprises a plurality of independent tibia sub-components.

14. device that is used to replace the articular surface between first bone and second bone, described first bone moves with second bone in a predefined manner, described device comprises second osteoarthrosis substitute, described second osteoarthrosis substitute comprises a plurality of independent sub-component that is configured to the supporting surface that is used to simulate and replace described second bone, in described a plurality of independent sub-component each all has relative motion each other, and the relative motion between each in wherein said a plurality of independent sub-components is that part is limited.

15. device according to claim 14, wherein said second osteoarthrosis substitute comprises a plurality of independent tibial components.

16. device according to claim 15, the relative motion between two or more in wherein said a plurality of independent sub-components is that part is limited.

17. device that is used to replace the articular surface between first bone and second bone, described first bone in a predefined manner with second bone formation joint, described device comprises second osteoarthrosis substitute, described second osteoarthrosis substitute comprises a plurality of independent sub-component that is configured to the supporting surface that is used to simulate and replace described second bone, in described a plurality of independent sub-component each all has relative motion each other, and the relative motion between each in wherein said a plurality of independent sub-components is limited.

18. device according to claim 17, wherein said second osteoarthrosis substitute comprises a plurality of independent tibial components.

19. device according to claim 18, the relative motion between two or more in wherein said a plurality of independent sub-components is that part is limited.

20. device that is used to replace the articular surface between first bone and second bone, described first bone moves with second bone in a predefined manner, described device comprises first osteoarthrosis substitute, described first osteoarthrosis substitute comprises a plurality of independent sub-component that is configured to the supporting surface that is used to simulate and replace described first bone, in described a plurality of independent assembly each all has inner surface and outer surface, and wherein said inner surface is fit to be fixed in described first bone; And

Second osteoarthrosis substitute, comprise the constructed a plurality of independent sub-component of each supporting surface that is used to simulate and replace described second bone, the described outer surface of the described a plurality of independent sub-component of wherein said first osteoarthrosis substitute contacts described a plurality of sub-components of described second osteoarthrosis substitute, and each the assembling right and wrong that are constructed in articular cavity in a plurality of independent sub-component of wherein said first bone are limited, and be limited when in articular cavity, assembling fully, the structure of resulting described first osteoarthrosis substitute and second osteoarthrosis substitute forms the joint in a predefined manner, thereby recovers normal kinesiology.

21. device according to claim 20, wherein said a plurality of second independent bone sub-component are included in and are used on its front surface receiving the screw thread receiver hole that inserts apparatus with matching relationship.

22. comprising, device according to claim 20, wherein said a plurality of first independent bone sub-component be used in its surface receiving compatible bag and the screw thread receiver hole that inserts apparatus with matching relationship.

23. device according to claim 21, wherein said insertion apparatus comprises support, described support comprises and is configured to the contact surface that is used to contact described a plurality of independent second bone sub-component and threaded fastener, with at the described support of described screw thread receiver hole internal fixation, described support be shaped as complete limited lock between described support and described a plurality of independent second bone sub-component.

24. device according to claim 22, wherein said insertion apparatus comprises support, and described support comprises: the contact surface that (a) is built into the described a plurality of first bone sub-component separately of contact; (b), be used to insert described compatible bag from inboard and outside projection that described support stretches out; And (c) be used for threaded fastener at the described support of described screw thread receiver hole internal fixation, described support be shaped as complete limited lock between described support and described a plurality of independent first bone sub-component.

25. device that is used to replace the articular surface between first bone and second bone, described first bone in a predefined manner with second bone formation joint, described device comprises first osteoarthrosis substitute, described first osteoarthrosis substitute comprises a plurality of independent sub-component that is configured to the supporting surface that is used to simulate and replace described first bone, in described a plurality of independent sub-component each all has inner surface and outer surface, and wherein said inner surface is fit to be fixed in described first bone; And

Second osteoarthrosis substitute, comprise a plurality of sub-components that are configured to each supporting surface that is used to simulate and replace described second bone, the described outer surface of the described a plurality of independent sub-component of wherein said first osteoarthrosis substitute contacts a plurality of independent sub-component of described second osteoarthrosis substitute, and in the described a plurality of independent sub-component of wherein said first bone substitute each all to be constructed to be limited in the assembling process in articular cavity, then be that part is limited when in articular cavity, assembling fully, the structure of resulting described first osteoarthrosis substitute and second osteoarthrosis substitute forms the joint in a predefined manner, thereby recovers normal kinesiology.

26. one kind is used for a plurality of first independent bone sub-component each other to the device of line and para-position, comprises:

The exercisable handle of user comprises lock-switch above the described handle;

Functionally be connected in the support of described handle by releasable connecting device, described support comprises a plurality of threaded fasteners;

Wherein, each other to line and after to bit-by-bit, described connecting device is released, and described support connects described independent sub-component at described device and described a plurality of first independent bone sub-component.

27. device according to claim 26, wherein said connecting device makes described handle be connected in described support by the dovetail lock.

28. device according to claim 26, wherein said connecting device comprises axostylus axostyle.

29. device according to claim 26, wherein said connecting device is connected in described support by the trinkle lock with described handle.

30. device according to claim 26, wherein said handle and described support are the structures of one.

31. one kind is used for a plurality of second independent bone sub-component each other to the device of line and para-position, comprises:

The exercisable handle of user comprises lock-switch above the described handle;

Functionally be connected in the support of described handle by releasable connecting device, described support comprises a plurality of threaded fasteners;

Wherein, after described device and described a plurality of second independent bone sub-component were each other to line and para-position, described connecting device was released, and described support connects described independent sub-component.

32. device according to claim 31, wherein said connecting device is connected in described support by the dovetail lock with described handle.

33. device according to claim 31, wherein said connecting device comprises axostylus axostyle.

34. device according to claim 31, wherein said connecting device is connected in described support by the trinkle lock with described handle.

35. device according to claim 31, wherein said handle and described support are the structures of one.

36. device according to claim 26, wherein said support is configured to the sub-component of described first osteoarthrosis substitute.

37. device according to claim 31, wherein said support is configured to the sub-component of described second osteoarthrosis substitute.

38. device according to claim 26, wherein said handle comprise in its surface with the screw thread receiver hole of matching relationship reception to the line guiding device.

39. device according to claim 26, wherein said handle comprise the screw thread receiver hole that receives the surgical navigational tracker in its surface with matching relationship.

40. device according to claim 31, wherein said handle comprise in its surface with the screw thread receiver hole of matching relationship reception to the line guiding device.

41. device according to claim 31, wherein said handle comprise the screw thread receiver hole that receives the surgical navigational tracker in its surface with matching relationship.

42. device that is used for intervertebral disc replacement, comprise first osteoarthrosis substitute, described joint replacement thing comprises a plurality of independent sub-components, in described a plurality of independent sub-component each all has relative motion each other, and the relative motion between each in wherein said a plurality of independent sub-components is selected from the group of being made up of limited, non-relative motion limited and that part is limited.

43. according to the described device of claim 42, wherein said first osteoarthrosis substitute comprises that at least one is used to replace the intervertebral disc implant on described intervertebral disc surface.

44. according to the described device of claim 42, wherein said first osteoarthrosis substitute comprises at least one facet joint implant.

45. according to the described device of claim 43, the described independent sub-component of wherein said intervertebral disc joint substitute comprises terminal plate of vertebral body and load-bearing insert.

46. surface-supported device that is used to replace between the adjacent vertebral bodies, first and second vertebral body relative to each other move in a predefined manner, described device comprises the external member of first vertebral body implant, comprise two facet joint assemblies and an endplate assemblies, described endplate assemblies is configured to have a plurality of independent soleplate sub-components, in described facet joint assembly and the described a plurality of independent soleplate sub-component each all has inner surface and outer surface, wherein said inner surface is fit to be fixed in described first bone, and the external member of described first vertebral body implant is built into the supporting surface that is used to simulate and replace described first vertebral body; And

The external member of second vertebral body implant, be used for simulation and replace described second each supporting surface of vertebral body, described external member comprises two facet joint assemblies and an endplate assemblies, described endplate assemblies is configured to has a plurality of independent soleplate sub-components, in described facet joint assembly and the described a plurality of independent soleplate sub-component each all has inner surface and outer surface, wherein said inner surface is fit to be fixed in described first bone, the external member of described second vertebral body implant is built into the described supporting surface that is used to simulate and replace described second vertebral body, the described outer surface of the external member of wherein said first vertebral body implant contacts described second vertebral body implant, and in the independent soleplate sub-component of wherein said a plurality of first and second vertebral bodys each to be built as in intervertebral disc in the assembling process right and wrong limited, when in intervertebral disc, assembling fully, then be limited, the structure of the external member of the external member of resulting described first vertebral body implant and second vertebral body implant forms the joint in a predefined manner, thereby recovers normal kinesiology.

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