US20030181984A1 - Method and instrumentation for patello-femoral joint replacement - Google Patents

Method and instrumentation for patello-femoral joint replacement Download PDF

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Publication number
US20030181984A1
US20030181984A1 US10/366,415 US36641503A US2003181984A1 US 20030181984 A1 US20030181984 A1 US 20030181984A1 US 36641503 A US36641503 A US 36641503A US 2003181984 A1 US2003181984 A1 US 2003181984A1
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Prior art keywords
guide
bone
femoral
patient
drill guide
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US10/366,415
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English (en)
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Walter Abendschein
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Biomet Manufacturing LLC
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Abendschein Walter F.
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Priority to US10/366,415 priority Critical patent/US20030181984A1/en
Publication of US20030181984A1 publication Critical patent/US20030181984A1/en
Assigned to BIOMET MANUFACTURING CORP. reassignment BIOMET MANUFACTURING CORP. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: ABENDSCHEIN, WALTER F
Assigned to BANK OF AMERICA, N.A., AS ADMINISTRATIVE AGENT FOR THE SECURED PARTIES reassignment BANK OF AMERICA, N.A., AS ADMINISTRATIVE AGENT FOR THE SECURED PARTIES SECURITY AGREEMENT Assignors: BIOMET, INC., LVB ACQUISITION, INC.
Priority to US12/553,187 priority patent/US8226726B2/en
Assigned to LVB ACQUISITION, INC., BIOMET, INC. reassignment LVB ACQUISITION, INC. RELEASE OF SECURITY INTEREST IN PATENTS RECORDED AT REEL 020362/ FRAME 0001 Assignors: BANK OF AMERICA, N.A., AS ADMINISTRATIVE AGENT
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    • 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
    • A61B17/1675—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 knee
    • A—HUMAN NECESSITIES
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    • A61B17/14—Surgical saws ; Accessories therefor
    • A61B17/15—Guides therefor
    • A61B17/154—Guides therefor for preparing bone for knee prosthesis
    • A61B17/155—Cutting femur
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    • 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
    • A61B17/1764—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the knee
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    • A61F2002/30004—Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis
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    • 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
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    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30317—The prosthesis having different structural features at different locations within the same prosthesis
    • A61F2002/30327—The prosthesis having different structural features at different locations within the same prosthesis differing in diameter
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    • 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
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    • A61F2002/30795—Blind bores, e.g. of circular cross-section
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Definitions

  • This invention relates generally to novel orthopedic joint replacement implants and methods, and particularly to an improved method and system for patello-femoral joint replacement through a simpler, less invasive surgical approach with instrumented, reproducible cuts.
  • Patello-femoral joint replacement is a well known orthopedic surgical procedure.
  • a variety of conventional joint replacement devices have been in use since the 1970's, however, unlike joint prostheses, which are typically used in total knee replacement surgery, conventional patello-femoral joint replacement devices have not been widely accepted in the orthopedic community. This may be due to the somewhat mixed clinical results that conventional patello-femoral joint prostheses have demonstrated as presented in the pertinent medical literature.
  • the conventional prostheses typically include femoral components that were larger, bulkier devices contoured to fit the trochlear groove of the femur. Their contoured geometry, however, made it almost impossible to develop a precise method of preparing the diseased surface of the femur to fit the geometry of the implant.
  • It is still further an object of this invention to provide a system of surgical instruments comprising an intramedullary guide rod; an anterior femoral cutting guide, which adapts to, and is based on the intramedullary guide rod; a guide for drilling with precision the intramedullary canal of the femur, which has means for aligning and positioning it relative to the anterior surface of the femur; a conically shaped rasp or file for finishing the anterior cut and preparing it for receiving the femoral implant; a feeler gauge for accurately positioning the cutting guide; and an impactor, as is commonly known in the art, for facilitating the final seating of the femoral implant.
  • kits which can be provided with instructions for use, bone adhesive, alternative embodiments or sizes of member components so as to allow the surgeon to modify the system to fit the immediate needs of the patient.
  • a femoral implant which is the femoral resurfacing component of the present invention, the implant requiring only one cutting step for the bone to be prepared for implantation, incorporating a geometry that facilitates later revision to a total knee, if necessary, and articulating with a patellar component that incorporates a mating, reciprocal, articular surface.
  • FIGS. 1A, 1B, 1 C shows a front, side and back view respectively of one embodiment of the femoral implant component of the present invention.
  • FIGS. 2A, 2B shows a front and side view of one embodiment of the patellar implant component of the present invention.
  • FIG. 3 shows an isometric view of one embodiment of the cutting guide component of the present invention.
  • FIG. 4 shows an exploded view of the embodiment of the cutting guide component of the present invention shown in FIG. 3.
  • FIG. 5 shows the cutting guide component of the present invention shown in FIGS. 3 and 4 operationally disposed in contact with the distal end of a femur.
  • FIGS. 6A, 6B show a plan and side view of one embodiment of the feeler gauge component of the present invention.
  • FIG. 7 shows a side view of the drill guide component of the present invention in place against the distal end of a femur for drilling the intramedullary canal.
  • FIG. 8 shows a prospective view of the distal portion of one embodiment of the bone rasp component of the present invention.
  • the present invention provides a system, including a patello-femoral joint replacement device, a series of instruments, and a method of use of those instruments for implanting the patello-femoral joint replacement device.
  • the patello-femoral joint replacement device is made up generally of two articulating components, a femoral implant, best demonstrated in FIGS. 1 A-C and generally shown at ( 10 ) and a patellar implant, best demonstrated in FIGS. 2 A-B and generally shown at ( 12 ).
  • the femoral implant ( 10 ) is designed to replace the anterior surface of the distal portion of the patient's femur.
  • the femoral implant ( 10 ) includes an anatomically shaped upper surface ( 14 ) with a centrally and longitudinally oriented articulating groove ( 16 ) of a generally concave configuration.
  • the underside ( 18 ) of the femoral implant ( 10 ) includes at least one, but preferably multiple recessed pockets ( 20 ), at least one intramedullary stem ( 22 ), and a circumferentially disposed undercut edge ( 24 ). At least a portion and preferably the majority of the underside generally shown at ( 18 ) of the femoral implant ( 10 ) is provided with a roughened surface ( 26 ). A porous coating or the use of at least one, preferably multiple spikes or pegs ( 27 ) to improve attachment and adhesion can also be employed.
  • the recessed pockets ( 20 ), undercut edge ( 24 ), and the roughened surface ( 26 ) individually and together provide a configuration that facilitates a firm and lasting connection of an adhesive that serves to bond the underside ( 18 ) of the femoral implant ( 10 ) to the prepared anterior surface of the distal portion of the femur.
  • any adhesive in the practice of the method of implanting the present invention in a patient.
  • a bone cement will be employed.
  • the articulating groove ( 16 ) continues without interruption from the upper surface ( 14 ) to distally extending projection ( 28 ) that terminates angling slightly superiorly at an articulating groove distal terminus ( 30 ).
  • This distal terminus ( 30 ) by presenting a slightly superior angle enables the patello-femoral joint replacement device to have smooth tracking of the patellar implant ( 12 ) in the articulating groove ( 16 ) through the full range of motion of the joint, that is in extremes of flexion.
  • the articulating surface ( 32 ) can include a circumferentially disposed annular border ( 34 ) having a slightly different geometry than that of the articulating surface ( 32 ) and composed of different materials than that of the articulating surface ( 32 ).
  • a securing surface ( 36 ) disposed on the opposite side of the patellar articulating surface ( 32 ) is configured to facilitate secure attachment to bone and can include a patellar roughened surface ( 38 ) to facilitate bonding of an adhesive.
  • the securing surface also includes at least one bone anchor ( 40 ) that can be configured to include an annular retaining groove ( 42 ).
  • the patellar roughened surface ( 38 ), the bone anchor ( 40 ), and the annular retaining groove ( 42 ) independently and collectively serve to facilitate a strong adhesive bond between the patellar implant ( 12 ) and bone material. It is within the concept of the present invention that the patellar implant ( 12 ) can have additional pegs on the securing surface ( 36 ) to facilitate strong adhesion to the bone.
  • the system of the present invention includes several instruments which provide the using surgeon with the ability to precisely drill and cut bone material of the distal portion of the femur in such a way as to provide contact with the femoral implant ( 10 ) that is far superior to conventional bone preparation methods.
  • the present invention provides a bone cutting guide, generally shown at 44 , that includes an intramedullary rod ( 46 ) sized and configured for insertion into the intramedullary space of a femur that has been prepared to receive the same.
  • the intramedullary rod ( 46 ) can be configured with one or more groves ( 48 ) so as to provide a fluted surface along the longitudinal axis of the intramedullary rod ( 46 ). This fluted surface can facilitate insertion of the intramedullary rod ( 46 ) into the bone so as to reduce the pressure imposed on the marrow of the bone and thus reduce or avoid the pressure-induced result of material being forced into the circulation system of the patient.
  • the intramedullary rod ( 46 ) is fixedly connected to cutting guide ( 44 ). It is, however, entirely within the scope of the invention to configure the intramedullary rod ( 46 ) to be releasably engaged to the cutting guide ( 44 ) by a rod gripping member ( 50 ) that can be selectively secured by means of a gripping member actuator ( 52 ). Such an alternative embodiment of the cutting guide ( 44 ) can permit removal and replacement of the intramedullary rod ( 46 ) with rods of different configuration or different size.
  • the intramedullary rod ( 46 ) is releasably connected to a saw guide member by at least one, preferably two cutting guide assembly rods ( 56 ), which are sized and configured to slidably engage a like number of assembly rod receiving portals ( 58 ).
  • An assembly securing member ( 60 ) is configured to releasably engage a securing member portal ( 62 ) in such a manner so as to cause the receiving portal ( 58 ) to secure the assembly rods ( 56 ) to the saw guide member ( 54 ).
  • the saw guide member ( 54 ) is provided with a anchor portal ( 64 ) that is sized and configured to receive a stylus arm anchor rod ( 66 ).
  • the stylus arm anchor rod ( 66 ) can be integrally connected to the saw guide member ( 54 ) or preferably can be releasably secured into the anchor portal ( 64 ) by passage of the assembly securing member ( 60 ) through an anchor rod passage ( 68 ).
  • a freely rotating stylus ( 70 ) is sized and configured to provide at a distal end a stylus-femoral contact point ( 72 ).
  • the proximal end of the stylus ( 70 ) is attached at approximately a right angle to a stylus rotation sleeve ( 74 ), which is sized and configured to be circumferentially disposed and freely rotate around the stylus arm anchor rod ( 66 ).
  • a stylus retainer member ( 76 ) can be provided to releasably retain the stylus ( 70 ) in its rotatable configuration around the stylus arm anchor rod ( 66 ).
  • the saw guide member ( 54 ) is preferably partially bifurcated by a saw guide slot ( 78 ) sized and configured to allow slidable passage of a bone saw such as is commonly known in the art.
  • the distal end of the bifurcated portion of the saw guide member ( 54 ) includes a guide connecting member ( 80 ) that can be a permanent connection at or near the terminus of the saw guide member ( 54 ) or can be a pin, screw, rivet, or any other connecting means that serves to attach the ends of the bifurcated saw guide member ( 54 ).
  • Disposed on the outer surface of the bifurcated saw guide member ( 54 ) is at least one, preferably two, anchor guides ( 82 ), which individually define anchor guide portals ( 84 ).
  • anchor guide portals are sized and configured to facilitate passage of a drill bit that can be used by a surgeon to bore an anchoring hole, such as an intramedullary canal, into the bone of a patient.
  • the surgeon can employ the anchor guide portals ( 84 ) as securing points through which securing bone screws or the like can be passed to provide additional attachment points for the cutting guide to the bone of the patient during operation.
  • the surgeon can employ the stylus femoral contact point ( 72 ), and the two anchor guide portals ( 84 ) to provide three separate securing points for the cutting guide member to the bone. By this means, the surgeon can ensure a stable and well-positioned cutting guide is in place prior to employing a bone saw through the saw guide slot ( 78 ).
  • the system of the present invention can also include a drill guide, as seen in FIG. 7 and generally shown at ( 90 ).
  • the drill guide ( 90 ) includes a drill guide block ( 92 ) that defines a drill guide passage ( 94 ).
  • the drill guide block ( 92 ) is connected to a drill guide handle ( 96 ) by which the surgeon can manipulate and steady the drill guide ( 90 ) during operation.
  • a drill guide stylus ( 98 ) can be provided as attached to the drill guide block ( 92 ) at a proximal end and terminating at a drill guide stylus-femoral contact point ( 100 ) at a distal end.
  • the drill guide block can be provided with at least one, preferably two drill guide securing points ( 102 ) by which the using surgeon can obtain additional stability of the drill guide ( 90 ) during operation.
  • the drill guide ( 90 ) of the present invention can be provided with three stabilizing points during operation: the drill guide stylus and the two drill guide securing points. Once positioned and secured, the drill guide ( 90 ) can be employed by the surgeon to facilitate the proper alignment and accurate drilling of the intramedullary canal. Once properly drilled, the cutting guide ( 44 ) of the present invention can be inserted and accurately positioned for use.
  • the system of the present invention can also include a bone rasp ( 104 ).
  • the bone rasp ( 104 ) can be conically shaped and at least a portion of the conical terminus can be provided with an abrasive surface as is well known in the art.
  • the bone rasp ( 104 ) is configured to facilitate the removal of any burrs, osteophytes or remaining projections of bone after the cutting step of the method of the present invention.
  • each of the components described above are used as indicated to systematically prepare the femur for receiving the patello-femoral joint replacement device described herein.
  • the drill guide ( 90 ) after being properly positioned and used by the surgeon to facilitate the drilling of the femur and the formation of a receiving point for the intramedullary rod ( 46 ) is removed.
  • the cutting guide ( 44 ) of the system of the present invention is then positioned with the aid of the feeler gauge ( 88 ) as described above and used by the surgeon to facilitate a accurate cutting of the bone to remove the anterior surface of the distal end of the femur thus providing a substantially flat receiving surface on the bone.
  • the femoral implant ( 10 ) After removal of the cutting guide ( 44 ) the femoral implant ( 10 ) is positioned and fixedly attached to the anterior surface of the femur wherein the intramedullary stem ( 22 ) of the femoral implant ( 10 ) is now positioned in the hole earlier drilled by the surgeon and earlier used to assist in the securing of the cutting guide ( 44 ).
  • the patellar implant ( 12 ) is then implanted by the surgeon and placed in articulating engagement with the femoral implant ( 10 ) so as to provide a fully articulating and functional patello-femoral joint replacement device.
  • the components can be integrally formed or separately formed and assembled using permanent or temporary connections as are well known in the art.
  • the implant components would be manufactured from implantable grades of ultra-high molecular weight polyethylene and cobalt chromium molybdenum alloy.
  • the instruments of the system would be manufactured from surgical grade stainless steels. It is within the concept of the present invention that the components may be manufactured from any implantable materials or surgically acceptable materials known in the art, such as, for example titanium alloys, ceramics, composites, or the like.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
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  • Orthopedic Medicine & Surgery (AREA)
  • General Health & Medical Sciences (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
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  • Heart & Thoracic Surgery (AREA)
  • Public Health (AREA)
  • Animal Behavior & Ethology (AREA)
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  • Physical Education & Sports Medicine (AREA)
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  • Cardiology (AREA)
  • Prostheses (AREA)
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US10/366,415 2002-02-14 2003-02-14 Method and instrumentation for patello-femoral joint replacement Abandoned US20030181984A1 (en)

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US20090326660A1 (en) 2009-12-31
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CN1633265A (zh) 2005-06-29
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AU2003219773B2 (en) 2007-02-01
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WO2003068119A3 (en) 2003-12-04
US8226726B2 (en) 2012-07-24

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