Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/30—Joints
  • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
  • A61F2/4202—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for ankles
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
  • A61B17/1613—Component parts
  • A61B17/1615—Drill bits, i.e. rotating tools extending from a handpiece to contact the worked material
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
  • A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
  • A61B17/1682—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the foot or ankle
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
  • A61B17/17—Guides or aligning means for drills, mills, pins or wires
  • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
  • A61B17/1775—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the foot or ankle
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/30—Joints
  • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
  • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
  • A61F2/4606—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of wrists or ankles; of hands, e.g. fingers; of feet, e.g. toes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
  • A61B2017/568—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor produced with shape and dimensions specific for an individual patient
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/30—Joints
  • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
  • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
  • A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/30—Joints
  • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
  • A61F2/4202—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for ankles
  • A61F2002/4205—Tibial components
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/30—Joints
  • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
  • A61F2/4202—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for ankles
  • A61F2002/4207—Talar components

Definitions

• the shape of the rotatable cutting element may be a concave shape with a maximum radius perpendicular to the length, such that the prepared surface has a cross-sectional shape with a first convex curvature with a first curvature radius substantially equal to the maximum radius, a second convex curvature with a second curvature radius substantially equal to the maximum radius, and a central expanse extending in a substantially straight line between the first convex curvature and the second convex curvature.
• the cross- sectional shape may be swept along a convex curvature.
• the first cutting guide may include a first bone attachment interface securable to the talus or the tibia, a first burr attachment interface securable to the first burr, and a first guide mechanism configured to constrain relative motion between the first burr attachment interface and the first bone attachment interface by permitting motion of the first burr attachment interface along a first direction perpendicular to a first length of the first rotatable cutting element to facilitate formation of a first prepared surface on the tibia or the talus with the first burr.
• the first prepared surface may have at least one concave curvature or one convex curvature.
• the first cutting guide may further have a first foundation with the first bone attachment interface and a first burr holder.
• the first foundation may further have a first burr holder interface.
• the first burr holder may have the first burr attachment interface, and a first foundation interface that can be coupled to the first burr holder interface.
• the second cutting guide may further have a second foundation and a second burr holder.
• the second foundation may have the second bone attachment interface and a second burr holder interface.
• the second burr holder may have the second burr attachment interface, and a second foundation interface that can be coupled to the second burr holder interface.
• the system may further include an alignment block with a third foundation interface attachable to the first foundation, and a fourth foundation interface attachable to the second foundation to facilitate positioning of the second foundation relative to the first foundation.
• the talar cutting guide may have a talar foundation and a talar tool holder.
• the talar foundation may have a talar bone attachment interface and a talar tool holder interface.
• the talar tool holder may have a talar tool attachment interface and a talar foundation interface.
• Securing the talar cutting guide to the talus may include securing the talar bone attachment interface to the talus.
• the method may further include, prior to guiding motion of the first cutting tool with the talar cutting guide, coupling the talar foundation to the talar tool holder by coupling the talar tool holder interface to the talar foundation interface, and attaching the first cutting tool to the talar tool attachment interface.
• the talar prosthesis may have a talar articular surface shaped to replace a first natural articular surface of the talus
• the tibial prosthesis may have a tibial articular surface shaped to replace a second natural articular surface of the tibia.
• the guide surface may have a planar shape.
• the cutting tool may include a burr with a cutting element that rotates about a cutting tool axis. Sliding the follower along the guide surface to constrain motion of the tool attachment interface relative to the base may include preventing motion of the cutting tool axis beyond a planar boundary to prevent excessive penetration of the bone by the burr.
• Figures 2A through 2E are cephalad perspective, caudal perspective, side elevation, lateral section, and anterior section views, respectively, of the talar prosthesis.
• Figure 12 is a perspective view depicting formation of a slot in the prepared surface of the talus, using the burr.
• Figure 17A is a perspective view of a talus, with a portion of the trial of Figures 4A through 4C positioned on the concave curvature of the talus, with a talar foundation according to one alternative embodiment.
• Figures 20A, 20B, 20C, 20D, and 20E are exploded perspective, rear elevation, front elevation, side elevation, and side elevation, exploded views, respectively, of an alignment block, according to one alternative embodiment.
• Figures 21A, 21B, 22A, 22B, and 22C are a perspective view, a side elevation view, a front elevation view, a perspective view, and a side elevation, section view of the talar foundation of Figures 17A and 17B attached to the talus, with a tibial foundation positioned relative to a tibia through the use of the alignment block and a tibial trial.
• Figures 24A, 24B, and 24C are top, bottom, and side elevation views, respectively, of a patient-specific mounting plate that may be used as part of a patient-specific guide mechanism for a talus, according to one embodiment.
• Figures 2A through 2E are cephalad perspective, caudal perspective, side elevation, lateral section, and anterior section views, respectively, of the talar prosthesis 102.
• the talar articular surface 110 may be shaped to mimic the shape of the natural talar articular surface.
• the talar articular surface 110 may have two convex talar curvatures 200 extending medial-laterally.
• the convex talar curvatures 200 may be separated from each other by a concave talar curvature 202 extending medial-laterally.
• the tibial articular surface 120 may be described as the surface formed when the cross-sectional shape defined by the medial-lateral curvatures 320 and the central expanse 322, as also shown in Figure 2E, is swept along a similar arcuate pathway.
• the keel 312 may also have a bone-sparing shape similar to that of the keel 212.
• the keel 312 may have a base portion 340 that is integrally formed with the remainder of the tibial prosthesis 104, and a penetrating portion 342 extending from the base portion 340 to penetrate the bone of the talus.
• the penetrating portion 342 may have, at its cephalad end, a generally semicircular perimeter 344.
• fixation pegs may be used to anchor the tibial prosthesis 104 to the adjoining bone, as described above in connection with the talar prosthesis 102.
• the stationary member 500 may have a bone attachment interface that facilitates attachment of the stationary member 500 to the talus 420.
• Any bone attachment feature known in the art may be used; in the embodiment of Figures 5A through 5C, the bone attachment interface may take the form of a series of passageways 510 through which the pins 480 are inserted.
• the passageways 510 may be oriented obliquely relative to each other so that the pins 480 are nonparallel to each other.
• the position and orientation of the talar foundation 410 may substantially fixed relative to the talus 420.
• the cutting element 720 may have an arcuate concave profile with a radius 782 defined by the change in diameter of the cutting element 720, from the proximal end 750 to the intermediate portion 770, and then to the distal end 760.
• the radius 782 may be substantially the same as the radius of an anterior-posterior curvature present in the prepared surface 620 to be formed on the talus 420 by the cutting element 720.
• Figures 8A through 8C are side elevation views of a burr 800, a burr 830, and a burr 860, respectively, according to various embodiments.
• the burr 800, the burr 830, and the burr 860 may each be used in conjunction with an adapter 730 like that of Figures 7A through 7C, and may have components similar to those of the burr 610, including a body 700 and a shaft 710.
• Each of the burr 800, the burr 830, and the burr 860 may be configured for rotation about a cutting tool axis 740 like that of the burr 610.
• the cutting elements of the burr 800, the burr 830, and the burr 860 may be configured differently.
• One or more snap features may optionally cause the adapter 730 to snap in place in the attachment cannula 970.
• the combination of axial translation and rotation needed to attach the adapter 730 to the attachment cannula 970 may ensure that the cutting tool is securely held relative to the first arm member 950, until the insertion motion is made in reverse.
• the prepared surface 620 may have two convex anterior-posterior curvatures 1110, which may have the same radius as the portions of the talar bone engagement surface 112 that lie anterior and posterior to the anterior-posterior curvature 230.
• the tibial foundation 1300 may have a bone attachment interface that facilitates attachment of the tibial foundation 1300 to the tibia 1320.
• Any bone attachment feature known in the art may be used; in the embodiment of Figures 13A through 13C, the bone attachment interface may take the form of a series of passageways 1330 through which the pins 480 are inserted.
• the passageways 1330 may be oriented obliquely relative to each other so that the pins 480 are nonparallel to each other.
• the position and orientation of the tibial foundation 1300 may substantially fixed relative to the tibia 1320.
• the various curvatures of the prepared surface 620 and the prepared surface 1420, along with the matching curvatures of the talar bone engagement surface 112 and the tibial bone engagement surface 122, may help keep the talar prosthesis 102 and the tibial prosthesis 104 in place, while preserving sufficient healthy bone to tolerate the stresses incurred during use of the joint.
• surgical navigation and/or surgical robotics systems may be used to facilitate preparation of the talus 420 and/or the tibia 1320. Some of the steps set forth above may be automated. Surgical navigation systems, surface mapping systems, and/or the like may be used to ascertain the locations and dimensions of the cuts to be made.
• Figure 17B is a perspective view of the talar foundation 1710 of Figure 17A, with the talar foundation 1710 fixed to the talus 420.
• the talar foundation 1710 may have a configuration similar to that of the talar foundation 410.
• the talar foundation 1710 may have a stationary member 1700 and a mobile member 1702 that are configured somewhat differently from their counterparts of the talar foundation 410.
• the detents 1718 may be used to fix the position of the mobile member 1702 relative to the stationary member 1700 at the center points of the arcuate slots 1712, for example, when the tibial foundation is to be located relative to the talar foundation 1710.
• Circular fasteners (not shown) may be coupled to the mobile member 1702, and may reside within the detents 1718 to lock the mobile member 1702 in place relative to the stationary member 1700.
• the mobile member 1702 may have rollers 530 that roll within the arcuate slots 1712 to permit the mobile member 1702 to pivot about the axis 514.
• the talar foundation 1710 and the talar burr holder 1800 may cooperate to function in a manner similar to that of the talar foundation 410 and the talar burr holder 600 described previously.
• the talar burr holder 1800 may have an arm 640 that moves relative to the base 1830, with constraints provided by the linkage between the arm 640 and the base 1830.
• the arm 640 may be coupled to a burr 610 (or any of the other types of burrs described previously) to guide motion of the burr 610 to resect the talus 420, forming the prepared surface 620.
• the tibial burr holder 2300 may have a base 2330 that is fixedly secured to the mobile member 2102 of the tibial foundation 2110, and an arm 2340 that moves relative to the base 2330. Motion of the arm 2340 relative to the base 2330 may enable the burr 860 to move medial-laterally on the tibia 1320, in addition to the anterior-posterior rotation provided by the motion of the mobile member 2102 relative to the tibia 1320.
• the base coupling feature may be configured in a variety of ways, and may be designed to cooperate with an arm coupling feature of the base 2330.
• the base coupling feature may optionally include a slot and cradle like the slot 960 and the cradle 962 of Figures 9 A through 9C.
• the guide surface 2332 on the top of the rectangular recess 2328 may prevent the cutting tool axis 740 of the burr 860, the burr 800, or the burr 830 from moving closer to the tibia 1320 than a planar boundary.
• the guide surfaces 2332 on the sides of the rectangular recess 2328 may prevent the cutting tool axis 740 of the burr 860, the burr 800, or the burr 830 from moving further medially or laterally than additional planar boundaries.
• the post 2380 of the arm 2340 may cooperate with the rectangular recess 2328 of the base 2330 to ensure that the prepared surface of the tibia 1320 has the desired depth, width, and overall shape.
• measurements may be made to determine not just the shape of the contoured surface 2470, but also the exact position and orientation of the contoured surface 2470 within the patient-specific mounting plate 2400, that will result in the formation of a prepared surface at the proper position and orientation on the talus 420.
• the patient-specific mounting plate 2400 and the stationary component 2500 may cooperate with a mobile member to define a talar foundation 2510.
• the mobile member may be similar or identical to the mobile member 1702 of the talar foundation 1710 of Figures 17A and 17B.
• the talar foundation 2510 of Figure 25B may be similar in operation to the talar foundation 1710 of Figures 17A and 17B, and may guide rotation of a burr around an axis 2114.

Landscapes

• Health & Medical Sciences (AREA)
• Life Sciences & Earth Sciences (AREA)
• Orthopedic Medicine & Surgery (AREA)
• Surgery (AREA)
• Animal Behavior & Ethology (AREA)
• Veterinary Medicine (AREA)
• Public Health (AREA)
• Engineering & Computer Science (AREA)
• Biomedical Technology (AREA)
• Heart & Thoracic Surgery (AREA)
• General Health & Medical Sciences (AREA)
• Oral & Maxillofacial Surgery (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Medical Informatics (AREA)
• Molecular Biology (AREA)
• Dentistry (AREA)
• Transplantation (AREA)
• Vascular Medicine (AREA)
• Cardiology (AREA)
• Physical Education & Sports Medicine (AREA)
• Prostheses (AREA)
• Surgical Instruments (AREA)

Applications Claiming Priority (5)

Publications (1)

Family

ID=63490778

Family Applications (1)

Country Status (6)

Cited By (3)

Family Cites Families (13)

• 2018
  • 2018-08-24 WO PCT/US2018/047944 patent/WO2019040865A1/en active Application Filing
  • 2018-08-24 CN CN201880069415.0A patent/CN111356419B/zh active Active
  • 2018-08-24 BR BR112020003815-6A patent/BR112020003815A2/pt unknown
  • 2018-08-24 JP JP2020511438A patent/JP2020531166A/ja active Pending
  • 2018-08-24 AU AU2018322380A patent/AU2018322380B2/en active Active
  • 2018-08-24 EP EP18765333.2A patent/EP3672535A1/en active Pending

Also Published As

Similar Documents

Legal Events