MX2008005410A - Apparatus and method to obtain bone fixation - Google Patents

Abstract

The present invention relates to an apparatus and method to obtain bone fixation. More particularly, one embodiment of the present invention relates to a mechanism for achieving bone"through-growth"in a variety of orthopaedic applications. In one example (which example is intended to be illustrative and not restrictive), a prosthesis designed to achieve bone"through- growth"via one or more"windows"in a peg or keel structure may be provided (bone graft may be inserted into the peg or keel structure). In one specific example (which example is intended to be illustrative and not restrictive), a glenoid prosthesis (and associated method) maybe used to resurface the scapula. In another specific, example, the present invention may be used in the context of a partial or total shoulder arthroplasty.

Description

APPARATUS AND METHOD TO OBTAIN BONE FIXATION FIELD OF THE INVENTION The present invention relates to an apparatus and method for obtaining bone fixation. More particularly, one embodiment of the present invention relates to a mechanism for obtaining "through growth" of bone in a variety of orthopedic applications. In one example (said example is intended to be illustrative and not restrictive), a prosthesis designed to obtain "through growth" of bone through one or more "windows" in a spike or keel structure may be provided (the bone graft). it can be inserted in the structure of spike or keel). In a specific example (said example is intended to be illustrative and not restrictive), a glenoid prosthesis (and associated method) can be used to renew the surface of the scapula. In another specific example (said example is intended to be illustrative and not of restriction), the present invention can be used in the context of a partial or total shoulder arthroplasty.

BACKGROUND OF THE INVENTION Several prosthetic devices have been proposed, for example, prosthetic devices related to the shoulder. The examples include those described in the following patent publications US Patent Application 20040059424, in the name of Guedepan et al, refers to a prosthetic glenoid component with metal backing, with cemented pins and hollow metal box screw More particularly, this application relates to a prosthetic glenoid component for joining a glenoid surface of a scapula to replace a natural bracket of a shoulder and to provide a support surface for a head portion of an arm or humerus bone The glenoid component with a backrest of metal has integrally formed joining limbs, which are cemented into corresponding holes formed in the glenoid surface, and also has an opening for receiving a hollow metal box, which is screwed into the glenoid surface. US Patent Application 20050209700 , in the name of Rockwood, Jr, et al, refers to method for securing a glenoid component to a scapula More particularly, this application relates to a medical procedure that provides a prosthesis, which includes (i) a body portion having a back surface and a support surface, and (n) a spike of anchor including an arrow extending from the rear surface of the body portion, wherein the anchor post includes a plurality of fins extending backwards secured to the arrow, and further wherein the plurality of fins that extend backwards each one has a first diameter. The medical procedure also includes creating an anchor hole in a natural bone. The anchor hole possessing a second diameter, which is smaller than the first diameter. In addition, the method of the method includes placing the anchor pin within the anchor hole, so that each of the plurality of outwardly extending fins is deformed in order to possess (i) a concave side which faces the an open end of the anchor hole, and (ii) a convex side facing a closed end of the anchor hole. U.S. Patent Application 20050049709, in the name of Tornier, refers to a glenoid component of a shoulder prosthesis and complete shoulder prosthesis incorporating said component. More particularly, this application relates to a glenoid component comprising a metal body of which the internal face is adapted to be immobilized in the glenoid cavity of a shoulder and of which the outer face has a concave hinge surface adapted to cooperate with a humeral component. This articulation surface extends over the periphery through a convex surface forming, at least in part, the edge of the body. US Patent Application 20050060039, in the name of Cyprien, refers to a shoulder glenoid prosthesis with a method and tools to implement it. More particularly, this application relates to a glenoid plastic prosthesis for cementation, comprising a pear-shaped body having a concave joint face and a convex face with a horizontal keel and threaded pins. Indentations on the keel and the convex surface of the implant follow a generally fractal pattern in order to increase the abutting cement surface of the implant. Tools are provided such as a) a glenoid forming tool used to stamp glenoid subchondral bone, indentation patterns of a generally fractal nature, and b) a glenoid indentation tool used to make depressions in the glenoid cavity walls for keel in order to increase the abutting bone / cement surface. U.S. Patent 6,679,916, in the name of Frankle, et al., Refers to a shoulder prosthesis system. More particularly, this patent relates to a shoulder prosthesis system having a glenoid bracket with an inner face with couplers and an outer face being a concave articulation face with a first longitudinal radius of curvature and a second latitudinal radius of curvature. A backup plate has an external extension and an internal extension. The external extension has a cylindrical base and a depression around the periphery and a plurality of tapered holes extending through the external extension separated between the depression and the center of the backing plate. The internal extension is formed with a projection with threads adapted to be rotatably coupled to a scapula of a patient. The Couplings of the external extension are adapted to couple by jump with the depressions of the glenoid cantilever. U.S. Patent 6,406,495, in the name of Schoch, refers to a glenoid prosthesis of a modular system with glenoid prostheses. More particularly, this patent relates to this patent relates to a glenoid prosthesis that includes a support cover, the reverse side of which has a plurality of anchor pins which are disposed to each other. At least one anchor pin has a coupling element, and at least one sleeve with an adapter that can be secured to the coupling element and an external anchoring structure is provided in order to selectively allow anchoring of the anchor pin or a mechanical hammering of the pin together with the sleeve that is fixed to it. U.S. Patent 6,911,047, in the name of Rockwood, Jr., et al., Refers to an apparatus and method for securing a glenoid component without cement to a glenoid surface of a scapula. More particularly, this patent relates to a glenoid component to be secured to a glenoid surface of a scapula in order to provide a support surface for a head portion of a humerus that includes a body portion having a first surface configured to make contact with the glenoid surface of the scapula and a second surface configured to receive the head portion of the humerus. The glenoid component also includes an anchor spike extending from the first surface of the body portion to penetrate the glenoid surface of the scapula so as to secure the body portion to the glenoid surface of the scapula. The anchor peg has a first end portion and a second end portion, the first end portion of the anchor peg being secured to the first body surface of the body portion, and the second end portion of the anchor peg having a number of fins secured to it. The glenoid component also includes a first stabilizing spike extending from the first surface of the body portion to penetrate the glenoid surface of the scapula in order to prevent movement of the body portion relative to the glenoid surface of the scapula. Also disclosed is a method for securing a glenoid component to a glenoid surface of a scapula so as to provide a support surface for a head portion of a humerus. US Patent 6, 699,289, in the name of lannotti, et al., Refers to an enlarged glenoid component having an interrupted surface and associated method for securing the increased glenoid component to a glenoid surface of a scapula. More particularly, this patent relates to a glenoid component to be secured to a glenoid surface of a scapula so as to provide a support surface for a head portion of a humerus that includes a body having a first surface configured to contact with the glenoid surface of the scapula and a second surface configured to receive the head portion of the humerus The glenoid component also includes an interruption such as a support extending from the body The interruption is configured to be received in a notch of similar configuration formed on the surface glenoid of the scapula The interruption helps to prevent movement of the glenoid component relative to the glenoid surface of the scapula after implantation The body may also include an anchor that extends from the body to penetrate the glenoid surface of the scapula in order to of helping to secure the body to the glenoid surface of the scapula The glenoid component is used in one application to help correct bone defects and in another application for wear A method is also described to secure the glenoid component to a glenoid surface of a scapula in order to prop orienting a support surface for a head portion of a humerus US Patent 6,514,287, in the name of Ondrla, et al, refers to a modular glenoid assembly having a support insert More particularly, this patent relates to a modular glenoid assembly provided for attachment to a glenoid surface of a scapula The modular glenoid assembly includes a base adapted to mate with the glenoid surface and a support insert The base includes a lip defining a channel The support insert includes a surface of support adapted to attach a head portion of a humerus component and a tongue. The tongue is formed to be received within the channel and engages the lip when the insert is moved in a superior direction towards its position against the base.

BRIEF DESCRIPTION OF THE DRAWINGS Figure 1A shows a perspective view of an example of the present invention; Figure 1B shows a side view of the apparatus of Figure 1A; Figure 1C shows a bottom view of the apparatus of Figure 1 A; Figure 2A shows a perspective view of another example of the present invention; Figure 2B shows a side view of the apparatus of the Figure 2A; Figure 2C shows a bottom view of the apparatus of Figure 2A; Figure 3A shows a perspective view of another example of the present invention; Figure 3B shows a side view of the apparatus of Figure 3A; Figure 3C shows a bottom view of the apparatus of Figure 3A; Figure 4A shows a perspective view of another example of the present invention; Figure 4B shows a side view of the apparatus of Figure 4A; and Figure 4C shows a bottom view of the apparatus of Figure 4A. Among those benefits and improvements that have been described, other objects and advantages of this invention will be apparent from the following description taken together with the accompanying drawings. The drawings constitute a part of this specification and include illustrative embodiments of the present invention and illustrate various objects and features thereof.

DETAILED DESCRIPTION OF THE INVENTION Detailed embodiments of the present invention are described herein; however, it should be understood that the embodiments described are merely illustrative of the invention that can be modalized in various ways. In addition, each of the examples given in relation to the various embodiments of the invention is intended to be illustrative and not restrictive. In addition, the drawings are not necessarily to scale, some features may be exaggerated to show details of particular components. Therefore, specific structural and functional details are described herein that should not be construed as limiting, but merely as a representative basis for teaching one skilled in the art to employ the present invention with variety.

An example of the present invention (said example is intended to be illustrative and not of restriction) provides a minimally-cemented glenoid prosthesis (and method and associated) that preserves glenoid cancellous bone and achieves adequate long-term fixation In a specific example (such example) pretends to be illustrative and not of restriction), this can be achieved through a UHMWPE support surface that is molded into a titanium construction. This construction can be manufactured in such a way as to allow the insertion of bone graft and allow the growth of the "passing" bone of the prosthesis. This growth of bone "passing" the prosthesis can be an addition or instead of the growth in / out that is achieved through surface textures. Of course, instead of (or in combination with) the UHMWPE support surface can be use any other biocompatible support surface (s) In addition, instead of (or in combination with) the titanium construction, any other biocompatible construction (s) may be used. Reference will now be made to Figures 1A -C, which show an example of the present invention As seen in these Figures, Prosthesis 100 may comprise a hybrid cemented / uncemented glenoid spike design, molded on a metal backing, and One piece (using a plurality of windows or holes in the spike) More particularly, the Metal Construction 102 may comprise a Frame portion 102A and a Spike portion 102B. In addition, the Support surface 104 (FIG. which may be the molded Metal Construction 102) may comprise peripheral Protrusions 104A-C (each of which may include one or more slots). If desired, an initial / supplementary fixation may be achieved by securing the Projections 104A-C to the scapula through cement (the slot (s) can help form a secure bond with the cement) Holes or spaces in the scapula can be prepared for these Projections 104A-C with a drill (before and / or after making the contour of the articular surface) A drill and / or a reamer (od? spos? t? vo (s) similar) can be used to prepare a hole or space in the scapula for the Spike Port 102B of the Metal Construction 102 graft can be inserted into the Spike Port 102B of the Metal Construction 102 (for example, to replace part or all of the cancellous bone removed) and implanted back into the prepared hole. Reference will now be made to Figures 2A-C, which show another one Example of the present invention As seen in these figures, Prosthesis 200 may comprise a keel design with cemented / non-cemented hybrid windows, molded on a one-piece metal support (the keel may include a plurality of windows or holes in the same) More particularly, the Metal Construction 202 may comprise a Frame Port 202A and a Port Portion 202B. In addition, the Support Floor 204 (which may be a Molded Construction 202) may comprise peripheral Pierces 204A-B ( each of which may include one or more slots) If desired, you can achieve a initial / supplemental fixation by securing Protrusions 204A-B to the scapula through cement (the groove (s) can help form a secure bond with the cement.) Holes or spaces in the scapula can be prepared for these Salts 204A-B with a drill (before and / or after contouring the joint surface) A feller and / or a reamer (or similar device (s)) can be used to prepare a hole or space in the scapula for the Keel Portion 202B of the Metal Construction 202. A graft can be grafted into the Keel Port 202B of the Metal Construction 202 (for example, to replace some or all of the removed cancellous bone) and implanted back into the prepared hole.

Reference will now be made to Figures 3A-C, which show another example of the present invention. As seen in these Figures, Prosthesis 300 may comprise a glenoid, metal backing, modular design (using a plurality of windows or holes in the spike). More particularly, the Metal Construction 302 may comprise Past Holes 302A, 302B and a Spike Port 302C. In addition, the Support Surface 304 (which can be modular) can be joined in any desired way to the Metal Construction 302. If desired, an initial / supplemental fixation can be obtained by securing the Screws 305A, 305B to the scapula ( in this way reducing or eliminating the need for cement). Holes or spaces in the scapula can be prepared for these Screws 305A, 305B with a drill (before and / or after contouring the joint surface). A drill can be used and / or a reamer (or similar device (s)) to prepare a hole or space in the scapula for the Spike Port 302C of the Metal Construction 302. A graft can be inserted in the Spike Port 302C of the Metal Construction 302 (for example, to replace some or all of the removed cancellous bone) and implant it back into the prepared hole. Reference will now be made to Figures 4A-C, which show another example of the present invention. As seen in these Figures, the Prosthesis 400 may comprise a modular, metal backing window keel design (the keel may include a plurality of windows or holes therein). More particularly, Metal Construction 402 may comprise Holes Past 402A, 402B and the Portion of Keel 402C. In addition, the Support Surface 404 (which can be modular) can be attached in any desired way to the Metal Construction 402. If desired, an initial / supplemental fixation can be obtained by securing the 405A, 405B Screws to the scapula ( reducing or eliminating the need for cement). You can prepare holes or spaces in the scapula for these Screws 405A, 405B with a drill (before and / or after contouring the joint surface). A drill and / or a reamer (or similar device (s)) can be used to prepare a hole or space in the scapula for the Keel Port 402C of the Metal Construction 402. A graft can be inserted in the Keel Portion 402C Metal Construction 402 (for example, to replace some or all of the cancellous bone removed) and implant it back into the prepared hole. As described above, the present invention may help to obtain, in one example, long-term scapular fixation of the glenoid component without removing a large supply portion of glenoid cancellous bone (of course, long-term fixation of other components to others bones can be provided by the present invention). In addition, the present invention can provide the use of a minimum amount of cement (for example, to reduce thermally induced bone necrosis and / or time in the operating room). In addition, the present invention can provide the use of a thin support component (e.g., to reduce joint stiffness). Also as described above, various embodiments of the present invention can: (a) provide a "windowed" fixation device (e.g., that preserves the supply of glenoid cancellous bone), (b) induce bone growth and / or provide initial / supplemental fixation. In addition, various embodiments of the present invention can provide bone graft insertion and / or "through or past growth" of bone. Of course, you can use one or more windows or holes, either all the same size / shape or sizes / shapes (for example, the prosthesis can use windows or holes of multiple sizes / shapes that vary from very large to very In another modality, the characteristic with windows or with holes (e.g., spike or keel) of the present invention can be designed and manufactured in any desired shape and / or size and can be one or several in number to improve fixation (e.g., based on the availability of glenoid cancellous bone) ). In addition, the characteristic with windows or with holes (for example, spike or keel) can be placed in the center of the prosthesis, move from the center of the prosthesis, or both (for example, the case of multiple features). In another embodiment, the present invention can be designed and manufactured in such a way as to maximize the surface area of the graft (eg, for a given volume of bone removed) that contacts the existing bone (e.g. scapula). In this way, this can increase the likelihood of internal growth of native bone through the graft and reduce the likelihood of graft resorption. In another embodiment, the present invention can be manufactured / formed in an integral shape, thus allowing a molded metal design (which, it is believed, is not associated with dissociation or over-rigidity). In another embodiment, the present invention may be used in accordance with a traditional partial or total shoulder arthroplasty surgical technique (e.g., countersinking, drilling and reaming) and may not necessarily require a non-traditional surgical technique (e.g. core countersink). In another embodiment, the present invention can provide the ability to check the support element (eg, poly) if it needs to be without disturbing a well-fixed metal backing component (particularly in the context of the modular metal backing example) Of course, in the backup example of modular metal the possibility of dissociation of the liner and the possibility of an over-stiffness of the joint due to an increased thickness of the device must be taken into account. In another embodiment, the present invention may use various shapes, sizes and numbers of features in the form of window and various shapes, sizes and numbers of doors, windows, holes and patterns in the window-shaped features to optimize the insertion of the graft and improve fixation (for example, obtaining a more reliable "throughput" of the bone) Another embodiment, the present invention can use the characteristic (s) of windows or holes that are designed and manufactured in such a way that an om The features with windows or holes are malleable (for example, thus enabling the surgeon to shape the structure to the anatomy of the patient) In another embodiment, the present invention provides for the introduction of one or more therapeutic agents (eg, graft, antibiotics, growth factors) and / or non-therapeutic agents (eg. example, cement) in a prepared "bone hollow", so that the device in its own way functions as a scaffold or delivery vehicle. In this regard, the device may have a near and / or distant opening for the insertion of the therapeutic and / or non-therapeutic agents, there. In another embodiment, a prosthesis for attaching to a bone of a patient is provided, comprising: a metal construction comprising a frame portion with a front part and a rear part and a tang portion extending from the rear part of the frame. frame portion; and a non-metallic support surface with a front portion and a rear portion comprising at least one projection that is not metal extending from the rear of the support surface; wherein the support surface is attached to the frame portion; wherein the spigot portion is configured to be disposed within a first space formed in the bone; and wherein at least one projection is configured to be disposed within a second space formed in the bone. In one example, the spigot portion may have a shape selected from the group consisting of: cylindrical, square, rectangular and elliptical. In another example, the spigot portion can be essentially hollow. In another example, the spigot portion may have a near end and a distal end, wherein the near end of the spigot portion may be attached to the frame portion, and wherein at least one of the near end and end distant may be substantially open. In another embodiment, the opening in at least one of the The near end and the distal end may provide access to an interior of the ear portion for placement of at least one of: (a) a therapeutic agent; and (b) a non-therapeutic agent. In another example, the therapeutic agent can be selected from the group including: (a) at least one supplementary graft material; (b) at least one antibiotic; and (c) at least one growth factor. In another example, the non-therapeutic agent may comprise cement. In another example, the spigot portion may have a plurality of holes around its perimeter. In another example, the plurality of holes around the perimeter of the spigot portion can provide access to an interior of the spike portion for bone growth from the bone to the spike portion. In another example, the support surface and at least one projection may comprise UHMWPE. In another example, the support surface may be attached to the frame portion through a mechanism selected from the group including: (a) at least one adjacent dovetail surface; (b) at least one abutting surface of rapid placement; (c) at least one threaded fastener; and (d) being molded. In another example, the bone can be a scapula and the prosthesis can be a glenoid prosthesis In another embodiment, a prosthesis is provided for joining a bone of a patient, comprising a metal construction comprising a frame portion with a front part and a rear part and a keel portion extending from the rear part of the frame portion, and a non-metallic support surface with a front part and a rear part comprising at least one projection that is not metal extending from the rear part of the support surface, wherein the The support surface is attached to the frame portion, wherein the keel portion is configured to be disposed within a first space formed in the bone, and wherein at least one projection is configured to be disposed within a second space. formed in the bone In one example, the keel portion may extend into at least one of (a) an anterior / posterior direction, and (b) an intermediate direction. a / lateral In another example, the keel portion may be essentially hollow In another example, the keel portion may have a near end and a distal end, wherein the near end of the keel portion may be attached to the portion of the keel portion. frame, and wherein at least one of the near end and the far end may be substantially open In another example, a height dimension of the portion of The keel may taper from larger to smaller in a direction that moves from the near end of the keel portion to the distant end of the keel portion. In another example, the opening in at least one of the near end and the distal end may provide access to an interior of the keel portion for placement of at least one of: (a) a therapeutic agent; and (b) a non-therapeutic agent. In another example, the therapeutic agent can be selected from the group including: (a) at least one supplementary graft material; (b) by at least one antibiotic; and (c) at least one growth factor. In another example, the non-therapeutic agent may comprise cement. In another example, the keel portion may have a plurality of holes around a perimeter thereof. In another example, the plurality of holes around the perimeter of the keel portion can provide access to an interior of the keel portion for the growth of bone from the bone to the keel portion. In another example, the support surface and at least one projection may comprise UHMWPE. In another example, the support surface may be attached to the frame portion through a mechanism selected from the group including: (a) at least one adjacent dovetail surface; (b) at least one adjacent area of placement fast; (c) at least one threaded fastener; and (d) being molded. In another example, the bone may be a scapula and the prosthesis may be a glenoid prosthesis. In another embodiment, a prosthesis for attachment to a bone of a patient is provided, comprising: a metal construction comprising a frame portion with a front part and a rear part and a keel portion extending from the rear part of the frame. frame portion; and a non-metallic support surface with a front part and a rear part; wherein the support surface is attached to the frame portion; wherein the keel portion is configured is configured to be disposed within a space formed in the bone; wherein the keel portion has a near end and a distal end, wherein the near end of the keel portion is attached to the frame portion, and wherein at least one of the near end and the far end is substantially open; wherein the opening of at least the near end and the distal end provides access to an interior of the keel portion for placement of at least one of: (a) a therapeutic agent and (b) a non-therapeutic agent; and wherein the keel portion has a shape that is not cylindrical. In another example, the keel portion can be essentially hollow. In another example, the keel portion can be extended so less in one of (a) an anterior / posterior direction, and (b) a medium / lateral direction In another example, a height dimension of the keel portion tapers from larger to smaller in a direction that moves from the near end of the keel portion to the distal end of the keel portion In another example, the therapeutic agent can be selected from the group including (a) at least one supplementary graft material, (b) at least one antibiotic, and (c) at least one growth factor In another example, the non-therapeutic agent may comprise cement In another example, the keel portion may have a plurality of holes around its perimeter In another example, the plurality of holes around the perimeter of the keel portion can provide access to an interior of the keel portion for bone growth from the bone to the keel portion. In another example, the support surface can UHMWPE In another example, the support surface may be attached to the frame portion through a mechanism selected from the group including (a) at least one adjacent dovetail surface, (b) at least one surface adjacent rapid placement, (c) at least one threaded fastener, and (d) being molded. In another example, the bone may be a scapula and the prosthesis may be a glenoid prosthesis. In another embodiment, a method is provided for attaching a prosthesis to a patient's bone, comprising: forming a space in the bone; inserting a keel portion of a metal construction into the space formed in the bone, wherein the metal construction comprises a frame portion with a front part and a rear part and the keel portion extending from the rear part of the frame. portion of frame, and inserting in an interior of the keel portion through an opening at a near end of the keel portion at least one of: (a) a therapeutic agent; and (b) a non-therapeutic agent; wherein the insertion into the keel portion through the opening at the near end of the keel portion of at least one of: (a) the therapeutic agent; and (b) the non-therapeutic agent is delivered after the keel portion is inserted into the space formed in the bone.

In one example, the keel portion may have a shape that is not cylindrical. In another example, the therapeutic agent can be selected from the group including: (a) at least one supplementary graft material; (b) at least one antibiotic; and (c) at least one growth factor. In another example, the non-therapeutic agent may comprise cement.

In another example, the method can comprise joining a non-metallic support surface to the frame portion after insertion into the interior of the keel portion through the opening at the near end of the keel portion, at least one of (a) the therapeutic agent, and (b) the non-therapeutic agent. In another example, the support surface may be attached to the frame portion through a mechanism selected from the group including (a) at least one adjacent dovetail surface, (b) at least one abutting quick-fitting surface and (c) at least one threaded fastener In another example, the bone may be a scapula and the prosthesis may be a glenoid prosthesis. In another example , the spigot portion may extend from the frame portion in a generally perpendicular direction. In another example, the spigot portion may extend from the frame portion at an angle other than 90 degrees In another example For example, at least one projection may have a generally cylindrical shape. In another example, at least one projection may comprise at least one groove around its perimeter. In another example, the prosthesis may comprise a plurality of projections extending from the rear part of the projection. the support surface In another example, the frame portion and the spigot portion can be formed from the same material In another example, the frame portion and the spigot portion can be formed of different materials. In another example, the ear portion may be malleable. In another example, the shank portion and the keel portion can be formed from the same material. In another example, the frame portion and the keel portion can be formed of different materials. In another example, the keel portion may be malleable. Although a number of embodiments of the present invention have been described, it should be understood that these embodiments are illustrative only, and not restrictive, and that many modifications may become apparent to those skilled in the art. For example, any element described herein may be provided in any desired size (e.g., any element described herein may be provided in any desired custom size or any element described herein may be provided in any desired size selected from a "family" of sizes, such as small, medium, large). In addition, one or more of the components can be made from any of the following materials: (a) any biocompatible material (said biocompatible material can be treated to allow internal growth of bone on the surface or prohibit the internal growth of bone on the surface, depending on the desire of the surgeon); (b) a plastic; (c) a fiber; (d) a polymer; (e) a metal (a pure metal such as titanium and / or an alloy such as Ti-AI-Nb-Ti-6A1 -4V, stainless steel); (f) any combination of them. Furthermore, the metal construction can be a machined metal construction. Moreover, several spike designs can be used (for example, square / elliptical / angled spikes). Furthermore, various keel designs can be used (eg, anterior / posterior keel, middle / lateral keel, dorsal keel and angled keel). In addition, the prosthesis may use one or more modular elements. Moreover, any desired number of spike (s) and / or keel (s) with a given prosthesis can be used. Still further, any number of projections (eg, such as for initial fixation by forming a bond with cement and / or such as for supplemental fixation by forming a bond with cement) can be used with a given prosthesis. In addition, any number of female features that increase the cement mantle can be used with a given prosthesis. Furthermore, any number of female features that can puncture the bone so that initial / supplemental fixation can be improved can be used with a given prosthesis. Still further, any number of bone screws (e.g., such as for initial fixation and / or such as for supplemental fixation) can be used with a given prosthesis. Still further, a support surface (e.g., a poly support surface) can be attached (e.g., molded) directly to the rear side of the shank or keel box (i.e., without a metal construction (e.g. skeleton type metal construction) between the support surface and the shank or keel box). In addition, the projection (s) of the Support surface may be separate components that are attached to the support surface and / or may be formed as an integral part of the support surface. Moreover, the projection (s) of the support surface can be flexible (for example, to assist the surgeon in the placement of the prosthesis in the body). Furthermore, any of the steps described here can be performed in any desired order (and any additional steps can be added as desired and any steps can be eliminated as desired).

Claims (43)

1. CLAIMS 1. A prosthesis for joining a bone of a patient, comprising: a metal construction comprising a frame portion with a front part and a rear part and a tang portion extending from the rear of the frame portion; (and a non-metallic support surface with a front portion and a back portion comprising at least one non-metallic projection extending from the rear of the support surface, wherein the support surface is attached to the frame portion; wherein the spigot portion is configured to be disposed with a first space formed in the bone, and wherein at least one protrusion is configured to be disposed within a second space formed in the bone 2. The prosthesis according to claim 1, wherein the spigot portion has a shape selected from the group consisting of: cylindrical, square, rectangular and elliptical 3. The prosthesis according to claim 1, wherein the spigot portion is essentially hollow. The prosthesis according to claim 3, wherein the spigot portion has a near end and a distal end, wherein the near end of the spigot portion is attached to the frame portion, and wherein at least one of the near end and the distal end is substantially open. The prosthesis according to claim 4, wherein the opening in at least one of the near end and the distal end provides access to an interior of the ear portion for placement of at least one of: (a) a therapeutic agent; and (b) a non-therapeutic agent. The prosthesis according to claim 5, wherein the therapeutic agent is selected from the group consisting of: (a) at least one supplementary graft material; (b) at least one antibiotic; and (c) at least one growth factor. The prosthesis according to claim 5, wherein the non-therapeutic agent comprises cement. The prosthesis according to claim 2, wherein the spike portion has a plurality of holes around its perimeter. The prosthesis according to claim 8, wherein the plurality of holes around the perimeter of the spike portion provides access to an interior of the spike portion for bone growth from the bone to the spike portion. The prosthesis according to claim 1, wherein the support surface and at least one projection comprise UHMWPE. The prosthesis according to claim 1, wherein the support surface is attached to the frame portion through a mechanism selected from the group consisting of (a) at least one adjacent dovetail surface, (b) ) at least one abutting surface for rapid placement, (c) at least one threaded fastener, and (d) the prosthesis being molded according to claim 1, wherein the bone is a scapula and the prosthesis is a prosthesis. glenoid 13 A prosthesis for joining a bone of a patient, comprising a metal construction comprising a frame portion with a front part and a rear part and a keel portion extending from the rear part of the frame portion, and a non-metallic support surface with a front part and a rear part comprising at least one non-metallic projection extending from the rear part of the support surface, wherein the surface of support is attached to the frame portion, wherein the keel portion is configured to be disposed within a first space formed in the bone, and wherein at least one projection is configured to be disposed within a second space formed in the bone 14 The prosthesis according to claim 13, wherein the keel portion extends into at least one of (a) a anterior / posterior direction, and (b) a medial / lateral direction 15 The prosthesis according to claim 13, wherein the keel portion is essentially hollow 16 The prosthesis according to claim 15, wherein the keel portion has a proximal end and a distal end, wherein the near end of the keel portion is attached to the frame portion, and wherein at least one of the near end and the distal end is substantially open. 17 The prosthesis according to FIG. claim 16, wherein a height dimension of the keel portion tapers from larger to smaller in a direction that moves from the near end of the keel portion toward the distal end of the keel portion 18 according to claim 16, wherein the opening in at least one of the near end and the distal end provides access to an interior of the keel portion for placement. of at least one of (a) a therapeutic agent, and (b) a non-therapeutic agent. The prosthesis according to claim 18, wherein the therapeutic agent is selected from the group consisting of (a) at least a supplementary graft material, (b) at least one antibiotic, and (c) at least one growth factor 20 The prosthesis according to claim 18, wherein the non-therapeutic agent comprises cement 21 The prosthesis according to Claim 13, wherein the keel portion has a plurality of holes around its perimeter. The prosthesis according to claim 21, wherein the plurality of holes around the perimeter of the keel portion provides access to an interior of the keel portion for bone growth from the bone to the keel portion. 23. The prosthesis according to claim 13, wherein the support surface and at least one projection comprise UHMWPE. The prosthesis according to claim 13, wherein the support surface is attached to the frame portion through a mechanism selected from the group consisting of: (a) at least one adjacent dovetail surface; (b) at least one abutting surface of rapid placement; (c) at least one threaded fastener; and (d) being molded. 25. The prosthesis according to claim 13, wherein the bone is a scapula and the prosthesis is a glenoid prosthesis. 26. A prosthesis for joining a bone of a patient, comprising: a metal construction comprising a frame portion with a front part and a rear part and a keel portion extending from the rear part of the frame portion; and a non-metallic support surface with a front part and a rear part; wherein the support surface is attached to the portion of framework; wherein the keel portion is configured to be disposed within a space formed in the bone; wherein the keel portion has a near end and a distal end, wherein the near end of the keel portion is attached to the frame portion, and wherein at least one of the near end and the far end is substantially open; wherein the opening in at least one near end and the distal end provides access to an interior of the keel portion for placement of at least one of: (a) a therapeutic agent; and (b) a non-therapeutic agent; and wherein the keel portion has a shape that is not cylindrical. 27. The prosthesis according to claim 26, wherein the keel portion is essentially hollow. The prosthesis according to claim 26, wherein the keel portion extends at least one of: (a) a front / rear direction; and (b) a middle / lateral direction. 29. The prosthesis according to claim 26, wherein a height dimension of the keel portion tapers from larger to smaller in a direction that moves from the near end of the keel portion toward the distal end of the keel portion. the keel portion. 30. The prosthesis according to claim 26, wherein The therapeutic agent is selected from the group consisting of: (a) at least one supplementary graft material; (b) at least one antibiotic; and (c) at least one growth factor. 31. The prosthesis according to claim 26, wherein the non-therapeutic agent comprises cement. 32. The prosthesis according to claim 26, wherein the keel portion has a plurality of holes around its perimeter. 33. The prosthesis according to claim 32, wherein the plurality of holes around the perimeter of the keel portion provides access to an interior of the keel portion for bone growth from the bone to the keel portion. 34. The prosthesis according to claim 36, wherein the support surface comprises UHMWPE. 35. The prosthesis according to claim 26, wherein the support surface is attached to the frame portion through a mechanism selected from the group consisting of: (a) at least one adjacent dovetail surface; (b) at least one abutting surface of rapid placement; (c) at least one threaded fastener; and (d) being molded. 36. The prosthesis according to claim 26, wherein the bone is a scapula and the prosthesis is a glenoid prosthesis. 37. A method for joining a bone of a patient, comprising: forming a space in the bone; inserting a keel portion of a metal construction into the space formed in the bone, wherein the metal construction comprises a keel portion with a front and a rear part and the keel portion extending from the rear of the frame portion; and inserting into an interior of the keel portion through an opening at the near end of the keel portion at least one of: (a) a therapeutic agent; and (b) a non-therapeutic agent; wherein the insertion into the interior of the keel portion through the opening at the near end of the keel portion of at least one of: (a) the therapeutic agent; and (b) the non-therapeutic agent is performed after the keel portion is inserted into the space formed in the bone. 38. The method according to claim 37, wherein the keel portion has a shape that is not cylindrical. 39. The method according to claim 37, wherein the therapeutic agent is selected from the group consisting of: (a) at least one supplementary graft material; (b) at least one antibiotic; and (c) at least one growth factor. 40. The method according to claim 37, wherein the non-therapeutic agent comprises cement. 41. The method according to claim 37, further comprising attaching a non-metallic support surface to the frame portion after insertion into the interior of the keel portion through the opening at the near end of the portion. keel at least one of: (a) the therapeutic agent; and (b) the non-therapeutic agent. 42. The method according to claim 41, wherein the support surface is attached to the frame portion through a mechanism selected from the group consisting of: (a) at least one adjacent dovetail surface; (b) at least one abutting surface of rapid placement; and (c) at least one threaded fastener. 43. The method according to claim 37, wherein the bone is a scapula and the prosthesis is a glenoid prosthesis.