US20020016634A1 - Device and method for positioning an eccentric humeral head of a humerus prothesis for a shoulder arthroplasty - Google Patents

Device and method for positioning an eccentric humeral head of a humerus prothesis for a shoulder arthroplasty Download PDF

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Publication number
US20020016634A1
US20020016634A1 US09/904,752 US90475201A US2002016634A1 US 20020016634 A1 US20020016634 A1 US 20020016634A1 US 90475201 A US90475201 A US 90475201A US 2002016634 A1 US2002016634 A1 US 2002016634A1
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United States
Prior art keywords
trial
final
head
body portion
indicia
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Abandoned
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US09/904,752
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English (en)
Inventor
Brian Maroney
Michael Coon
Jeffrey Ondrla
Todd Durniak
Joseph Iannotti
Gerald Williams
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DePuy Orthopaedics Inc
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DePuy Orthopaedics Inc
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Priority to US09/904,752 priority Critical patent/US20020016634A1/en
Assigned to DEPUY ORTHOPAEDIC, INC. reassignment DEPUY ORTHOPAEDIC, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: WILLIAMS, GERALD, M.D., IANNOTTI, M.D., PH.D., JOSEPH, COON, MICHAEL, DURNIAK, TODD, MARONEY, BRIAN, ONDRLA, JEFFREY
Publication of US20020016634A1 publication Critical patent/US20020016634A1/en
Priority to US10/844,208 priority patent/US7431736B2/en
Abandoned legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
    • A61B17/1662—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1684—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans for particular parts of the body for the shoulder
    • A—HUMAN NECESSITIES
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    • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
    • A61B17/1659—Surgical rasps, files, planes, or scrapers
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Definitions

  • the present invention relates to prostheses for reconstructive surgery of a gleno-humeral joint and, more particularly, to the positioning of an eccentric head of a humerus prostheses for reconstructive surgery of a gleno-humeral joint.
  • Each shoulder arthroplasty needs to be adapted to the patient's unique combination of soft tissue and bone anatomy.
  • the patient typically has high expectations of the function and durability of the arthroplasty.
  • the implant and the implant technique must be precise.
  • the present invention is a method, apparatus and corresponding implant for positioning an eccentric head on a trail implant/broach and transferring or translating the eccentric position of the head onto the actual or definitive implant.
  • the present invention allows the eccentric head to be positioned in an infinite amount of positions or orientations to best reproduce the articular geometry of the patient. The infinite dialability is optimum for reconstruction purposes.
  • each shoulder arthroplasty needs to be adapted to the patient's unique combination of soft tissue and bone anatomy
  • the present system maximizes the surgeon's flexibility in matching a wide variety of anatomic requirements.
  • the present invention places a premium on secure fixation, conservation of bone and optimization of mechanics.
  • the humeral head trial is lockable into one of an infinite variety of rotational positions (a set orientation) that then may be transferred to the definitive humeral head of the definitive implant.
  • a means is provided for locking the eccentric trial head to the trial/broach in a set orientation that allows for the trialing process to occur without spinning of the eccentric trial head in the broach taper. In one form, this is accomplished via a captured screw in the eccentric trial head that extends beyond the taper of a neck of the eccentric trial head. The captured screw engages threads in a bottom of a bore in a taper in the broach.
  • the eccentric head Once the eccentric head has been threaded onto the trial broach, it is rotated into a correct position covering the resected humeral head surface.
  • the eccentric head may be rotated into an infinite number of positions on the trail broach without having to be locked in any particular orientation. Once the eccentric head is in position, the captured screw is tightened or locked. Trial reduction is carried out and if deemed satisfactory, the broach/eccentric head trail head assembly (or trial assembly) is removed as a one piece unit from the humerus of the patient.
  • the eccentric head includes a mark or indicia showing the position of maximum offset.
  • the trial assembly is then removed from the impaction stand and the appropriate size of the definitive implant is placed in the impaction stand.
  • An appropriate size of definitive eccentric head is placed on the definitive implant.
  • the definitive eccentric head includes an indicia either as an etched or otherwise arrow or other marking on the nonarticulating surface (or by a removable sticker or the like on the articulating surface) showing the position of maximum offset (in like manner to the trial eccentric head).
  • the indicia of the definitive eccentric head is orientated or aligned with the scale to the same number or marking as the trial eccentric head.
  • the definitive eccentric head Once the definitive eccentric head has been properly aligned, the definitive eccentric humeral head is impacted into place onto the definitive implant while on the impaction stand. In this manner, the appropriate position of the humeral head for the definitive implant has been successfully transferred from the trial assembly.
  • the eccentric head may be rotationally positioned in an infinite number of positions, both during trialing and during the final implant.
  • a method of implanting a final prosthesis assembly in a resected bone includes the step of positioning a trial assembly in the resected bone, the trial assembly including a trial body portion having a trial bore defined therein, and a trial head portion having (i) a trial head member which includes a trial offset indicia, and (ii) an eccentrically located trial head stem extending from the trial head member, the trial head stem being configured to be received within the trial bore.
  • the method further includes the step of rotating the trial head portion relative to the trial body portion while the trial assembly is positioned in the resected bone so as to position the trial head portion relative to the trial body portion at an aligned orientation whereby the trial head portion covers a resected surface of the resected bone.
  • the method includes the step of removing the trial assembly from the resected bone after the rotating step.
  • the method also includes the step of positioning the trial assembly in a scale mechanism whereby the trial offset indicia of the trial head portion aligns with a value on the scale mechanism.
  • the method includes the step of securing a final head portion to a final body portion based on the value so as to form the final prosthesis assembly.
  • the method includes the step of implanting the final prosthesis assembly in the resected bone after the securing step.
  • a method of implanting a final prosthesis assembly in a resected bone includes the step of providing a trail assembly which includes a trial body portion having a trial bore defined therein, and a trial head portion having (i) a trial head member which includes a trial offset indicia, and (ii) an eccentrically located trial head stem extending from the trial head member.
  • the method further includes the step of positioning the trial body portion in the resected bone. Also, the method includes the step of positioning the trial stem in the trial bore after the trial body positioning step.
  • the method includes the step of moving the trial head portion in relation to the trial body portion after the trial stem positioning step so as to locate the trial head portion relative to the trial body portion at a user-selected orientation.
  • the method also includes the step of securing the trial head portion to the trial body portion at the user-selected orientation.
  • the method includes the step of removing the trial assembly from the resected bone after the securing step.
  • the method includes the step of positioning the trial assembly in a scale mechanism after the removing step whereby the trial offset indicia of the trial head portion aligns with a value on the scale mechanism.
  • the method includes the step of attaching a final head portion in fixed relation to a final body portion based on the value so as to form the final prosthesis assembly.
  • the method also includes the step of implanting the final prosthesis assembly in the resected bone after the attaching step.
  • kits used during the implantation of a prosthesis includes a trial assembly including a trial body portion having a trial bore defined therein, and a trial head portion having (i) a trail head member which includes a trial offset indicia, and (ii) an eccentrically located trial stem extending from the trial head member, the trial head stem being configured to be received within the trial bore.
  • the kit also includes a final prosthesis assembly including a final body portion having a final bore defined therein, and a final head portion having (i) a final head member which includes a final offset indicia, and (ii) an eccentrically located final head stem extending from the final head portion, the final head stem being configured to be received within the final bore.
  • kits which includes a trial assembly including (i) a trial body portion, (ii) a trial head portion which includes a trial offset indicia, and (iii) a fastener for securing the trial head portion to the trial body portion.
  • the kit further includes a final prosthesis assembly including a final body portion having a final bore defined therein, and a final head portion having (i) a final head member which includes a final offset indicia, and (ii) an eccentrically located final head stem extending from the final head portion, the final head stem being configured to be received within the final bore.
  • FIGS. 1A and 1B are elevational views of exemplary humerus prostheses/trail broach bodies used in conjunction with the eccentric head of the present invention
  • FIG. 2 is an enlarged, side sectional view of a partial humerus with a portion of the humerus head resected (removed) and a trail broach inserted into the humerus;
  • FIG. 3 is a bottom plan view of an eccentric trail humerus head
  • FIG. 4 is a side elevational view of the eccentric trial humerus head of FIG. 3;
  • FIG. 5 is a front elevational view of a partial humerus with the humerus head resected
  • FIG. 6 is a front elevational view of the partial humerus of FIG. 5 showing a trial standard humerus head that exposes a portion of the surface of the resected humerus head;
  • FIG. 7 is a front elevational view of the partial humerus of FIG. 5 showing the trial eccentric humerus head covering the surface of the resected humerus head;
  • FIG. 8 is an enlarged side elevational view of the trial eccentric humerus head of FIGS. 3 and 4 having a seating screw extending therefrom;
  • FIG. 9 is an enlarged perspective view of the seating screw of FIG. 8;
  • FIG. 10 is a perspective view of a trial eccentric head being attached to the trial broach via a driver;
  • FIG. 11 is an enlarged, side sectional view of a partial humerus with the trail assembly (broach and eccentric head inserted into the humerus;
  • FIG. 12 is a top perspective view of an impaction stand
  • FIG. 13 is a bottom perspective view of the impaction stand of FIG. 12;
  • FIG. 14 is a side elevational view of the impaction stand of FIGS. 12 and 13;
  • FIG. 15 is a top plan view of the impaction stand of FIGS. 12 - 14 ;
  • FIG. 16 is a bottom plan view of the impaction stand of FIGS. 12 - 14 ;
  • FIG. 17 is a perspective view of the impaction stand with a broach or implant seated thereon;
  • FIG. 18 is an enlarged top plan view of a trial assembly seated on the impaction stand with the indicia (notch) of the trial eccentric head positioned at “5”;
  • FIG. 19 is a perspective view of the impaction stand with a definitive implant seated thereon with a definitive eccentric humerus head ready to be impacted onto the implant.
  • the humerus prostheses/trial broach 20 includes a stem 22 extending from a neck 24 .
  • the neck 24 terminates in a generally flat surface 26 that is adapted to be seated on a surface of a resected humerus head of a patient's humerus.
  • FIG. 1B there is shown an exemplary, 138 mm humerus prosthesis or trial broach generally designated 28 .
  • the humerus prostheses/trial broach 28 includes a stem 30 extending from a neck 32 .
  • the neck 32 terminates in a generally flat surface 34 that is adapted to be seated on a surface of a resected humerus head of a patient's humerus.
  • FIG. 2 there is shown a patient's humerus 36 wherein the humerus head 38 has been resected in accordance with standard shoulder arthroplasty surgery. It is beyond the scope of the present invention to discuss humerus head resection. Various texts and papers may be consulted for this procedure. After the humerus head 38 has been resected, the humerus head must be sized for a prosthetic head of the implant. Various sizes are available such as 44, 48 and 52 mm. It will be assumed that an eccentric head will be chosen.
  • the medullary canal of the humerus 36 has been reamed and the trial broach 20 has been placed thereon. The flat 26 is in contact with a surface 40 of the resected humerus head 38 .
  • the trial broach 20 is ready to be fitted with a trial eccentric head.
  • Humerus 36 Preoperative evaluation of the Humerus 36 with templates (not shown) helps determine the size of the prostheses and level of humerus head resection.
  • Humeral head resection is accomplished as is known in the art or with other methods the detail of which is beyond the scope of the present invention and this disclosure.
  • FIGS. 5 - 7 there is shown a reason for selecting an eccentric head.
  • FIG. 5 shows the humerus 36 whose humerus head 38 has been resected. It is now necessary to find a trial head that will cover the humerus surface 40 formed by the resection.
  • FIG. 6 a trail standard head 60 having a tapered stem 62 is shown in position over the surface 40 . It can be seen that the surface 40 is visible around the periphery of the trial standard head 60 .
  • a centerline shows how the trial standard head 60 fits over the surface 40 . Even with rotation of the trial standard head 60 , the surface 40 is exposed. Thus, the trial standard head 60 is not appropriate.
  • FIG. 5 shows the humerus 36 whose humerus head 38 has been resected. It is now necessary to find a trial head that will cover the humerus surface 40 formed by the resection.
  • FIG. 6 a trail standard head 60 having a tapered stem 62 is shown in position over the surface 40
  • a trial eccentric head 42 having a tapered stem 46 is shown in position over the surface 40 . It can be seen that with the correct rotation/orientation/placement of the trial eccentric head 42 , the entire surface 40 is covered. With an infinite number of rotational positions, an eccentric head is thus appropriate.
  • a trial eccentric head 42 in accordance with the principles of the present invention is shown.
  • the trial eccentric head 42 includes a tapered stem 46 that is positioned off center (approximately a 4 mm offset) such that an eccentricity during rotation thereabout is defined or formed.
  • the stem 46 extends essentially perpendicularly from a bottom surface 43 of the trial eccentric head 42 and includes a bore 48 that extends through the stem 46 and the head 42 .
  • the trial eccentric head 42 includes an indicia (here a notch) 44 that indicates a maximum offset position for the eccentric head 42 . It should be appreciated that other types of indicia may be used.
  • the notch 44 is located on the edge of the articular surface of the eccentric head 42 .
  • a retaining screw or the like 50 for the trial assembly (trial eccentric head and trial broach) is shown.
  • the retaining screw 50 includes a head 52 having an opening 54 for receiving a screw driver or the like. The opening may be hex shape or otherwise. Extending from the head 52 is a shank 56 terminating in threads 58 .
  • the retaining screw 50 is designed to fit into the bore 48 of the trial eccentric head 42 with its threads 58 extending therefrom (see FIG. 8).
  • the trial broach 20 is shown wherein the trial eccentric head 42 is ready to be attached thereto.
  • the eccentric trial head 42 is attached to the trial broach by threading the screw 50 into a complementary threaded bore 64 in the flat 26 .
  • the screw 50 may be loosened to rotate the eccentric head 42 to a proper orientation. Once a proper rotational orientation has been achieved, the screw 50 is tightened.
  • the trial prosthesis may now be removed from the humerus 36 .
  • the impaction stand 70 may be made of a suitable plastic or the like and is essentially a hexagonal cylinder.
  • the impaction stand 70 is designed to accommodate various sizes of trail broaches/final prostheses.
  • the impaction stand 70 has two faces or surfaces 76 and 78 on opposite sides thereof. Extending diagonally from the surface 76 to an outside surface of the cylinder is a first channel 72 . Extending diagonally from the surface 78 , opposite in orientation to the first channel 72 , is a second channel 74 .
  • the second channel 74 extends to an outside surface of the cylinder.
  • the first and second channels 72 and 74 and their respective surfaces 76 and 78 are designed to accommodate various sizes of trial broaches/final prostheses.
  • surface 76 /channel 72 is designed to hold trial broaches/final prostheses of sizes 6 mm, 8, and 10 mm
  • the surface 78 /channel 74 is designed to hold trial broaches/final prostheses of sizes 12 mm, 14 mm, and 16 mm.
  • the impaction block 70 may be designed for other sizes, or several blocks for the various sizes.
  • Each surface 76 and 78 includes an indicia or scale in the manner of a clock or the like that divides the periphery thereof into sections.
  • the scale is used to reference the position of the notch 44 of the trial eccentric head 42 when the trial assembly is place in the impaction stand (as well as the final assembly as indicated below).
  • the trial assembly is placed into the impaction stand 70 (in FIG. 17, the eccentric head is not present to illustrate how the body 22 fits in the impaction stand 70 /channel 74 ).
  • the position of the notch 44 in the trial eccentric head 42 is noted (here at position 5 ) for transference or reproduction onto the final prosthesis.
  • the final step is to fit the final eccentric head onto the final humeral stem (of the same size as the trial broach).
  • the trial assembly is removed from the impaction stand 70 and the final humeral stem/body is placed therein (see FIG. 17).
  • a final eccentric head 80 is chosen of the same size as the trial eccentric head 42 .
  • the final eccentric head 80 is held by an impactor 86 such as a Delrin-tipped impactor.
  • the final eccentric head includes an indicia, either as a permanent mark or the like on the nonarticulating surface thereof or as a removable sticker or the like on the articulating surface thereof, that indicates the maximum offset in like manner to the trial eccentric head 42 .
  • the indicia of the final eccentric head 80 is aligned with the marking or indicia on the scale of the surface 78 that is the same as that noted above (here “5”).
  • the taper 82 of the eccentric head 80 is inserted into a complementary tapered bore 84 . Keeping the indicia of the eccentric head 80 as noted, the final eccentric head 80 is impacted onto the final humeral stem with a mallet (not shown) onto the impactor 86 .
  • the final assembly is now ready to be inserted back into the patient's humerus.

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US09/904,752 2000-07-28 2001-07-13 Device and method for positioning an eccentric humeral head of a humerus prothesis for a shoulder arthroplasty Abandoned US20020016634A1 (en)

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US10/844,208 US7431736B2 (en) 2000-07-28 2004-05-12 Device and method for positioning an eccentric humeral head of a humerus prosthesis for a shoulder arthroplasty

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