New! View global litigation for patent families

US20070016305A1 - Humeral implant for minimally invasive shoulder replacement surgery - Google Patents

Humeral implant for minimally invasive shoulder replacement surgery Download PDF

Info

Publication number
US20070016305A1
US20070016305A1 US11525629 US52562906A US2007016305A1 US 20070016305 A1 US20070016305 A1 US 20070016305A1 US 11525629 US11525629 US 11525629 US 52562906 A US52562906 A US 52562906A US 2007016305 A1 US2007016305 A1 US 2007016305A1
Authority
US
Grant status
Application
Patent type
Prior art keywords
glenoid
surface
humeral
transhumeral
implant
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
US11525629
Inventor
Steven Chudik
Original Assignee
Chudik Steven C
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date

Links

Images

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/40Joints for shoulders
    • A61F2/4003Replacing only the epiphyseal or metaphyseal parts of the humerus, i.e. endoprosthesis not comprising an entire humeral shaft
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1662Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1684Bone 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 shoulder
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • A61B17/1703Guides or aligning means for drills, mills, pins or wires using imaging means, e.g. by X-rays
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • A61B17/1721Guides or aligning means for drills, mills, pins or wires for applying pins along or parallel to the axis of the femoral neck
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1778Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the shoulder
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8875Screwdrivers, spanners or wrenches
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603Special 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
    • A61F2/4612Special 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 shoulders
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1604Chisels; Rongeurs; Punches; Stamps
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1604Chisels; Rongeurs; Punches; Stamps
    • A61B17/1606Chisels; Rongeurs; Punches; Stamps of forceps type, i.e. having two jaw elements moving relative to each other
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1613Component parts
    • A61B17/1615Drill bits, i.e. rotating tools extending from a handpiece to contact the worked material
    • A61B17/1617Drill bits, i.e. rotating tools extending from a handpiece to contact the worked material with mobile or detachable parts
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1637Hollow drills or saws producing a curved cut, e.g. cylindrical
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • A61B17/1735Guides or aligning means for drills, mills, pins or wires for rasps or chisels
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/06Measuring instruments not otherwise provided for
    • A61B2090/061Measuring instruments not otherwise provided for for measuring dimensions, e.g. length
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08Accessories or related features not otherwise provided for
    • A61B2090/0801Prevention of accidental cutting or pricking
    • A61B2090/08021Prevention of accidental cutting or pricking of the patient or his organs
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30767Special external and/or bone-contacting surfaces, e.g. coating for improving bone ingrowth
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/40Joints for shoulders
    • A61F2/4081Glenoid components, e.g. cups
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4684Trial or dummy prostheses
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316The 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
    • A61F2002/30535Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30604Special structural features of bone or joint prostheses not otherwise provided for modular
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30767Special external and/or bone-contacting surfaces, e.g. coating for improving bone ingrowth
    • A61F2002/30934Special articulating surfaces
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/40Joints for shoulders
    • A61F2/4014Humeral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic humeral shafts
    • A61F2002/4018Heads or epiphyseal parts of humerus
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4635Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor using minimally invasive surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00011Metals or alloys
    • A61F2310/00017Iron- or Fe-based alloys, e.g. stainless steel
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00011Metals or alloys
    • A61F2310/00023Titanium or titanium-based alloys, e.g. Ti-Ni alloys
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00011Metals or alloys
    • A61F2310/00035Other metals or alloys
    • A61F2310/00131Tantalum or Ta-based alloys
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00179Ceramics or ceramic-like structures

Abstract

The present invention provides a method and devices for shoulder replacement surgery that spares the rotator cuff. The method utilizes two anterosuperior passages to gain access to the glenohumeral joint, neither of which requires transaction of the rotator cuff. In addition a transhumeral portal created through the second anterosuperior passage for use as a working tunnel. Specialized instruments and implants are provided to work through both the anterosuperior passage as well as the transhumeral portal.

Description

    CLAIM FOR PRIORITY
  • [0001]
    This application is a division of application Ser. No. 10/917,266, filed Aug. 11, 2004. As set forth in that parent application, applicant claims, under 35 U.S.C. §119(e), the benefit of priority of: 1) the filing date of Aug. 11, 2003 of U.S. Provisional Application No. 60/494,289, 2) the filing date of Oct. 8, 2003 of U.S. Provisional Application No. 60/509,655, 3) the filing date of Oct. 16, 2003 of U.S. Provisional Application No. 60/511,805, 4) the filing date of Nov. 19, 2003 of U.S. Provisional Application No. 60/523,401, 5) the filing date of Jun. 15, 2004 of U.S. Provisional Application No. 60/579,893 and 6) the filing date of Jul. 2, 2004 of U.S. Provisional Application No. 60/585,033, the entire contents of each of which, including said parent application, are incorporated herein by reference.
  • BACKGROUND OF THE INVENTION
  • [0002]
    1. Field of the Invention
  • [0003]
    The present invention relates to methods, instrumentation, and implants for orthopaedic surgery and, more specifically, to rotator cuff sparing procedures and associated devices for shoulder replacement surgery.
  • [0004]
    2. Discussion of Related Art
  • [0005]
    Orthopaedic surgeons perform joint replacement surgery for patients who suffer pain and physical limitations caused by joint surfaces that have been damaged by degenerative, traumatic, or other pathologic processes. The functional outcome from these joint replacement surgeries is directly related to the degree of morbidity associated with the surgical method and the ability of the method to best restore the natural anatomy and biomechanics of the joint. Orthopaedic surgeons are continually searching for ways to improve outcomes for joint replacement surgery by developing methods of less invasive surgery to limit surgical morbidity and by developing novel methods and implants to better restore the native joint anatomy.
  • [0006]
    Conventional shoulder replacement surgery has several limitations. It requires an extensive exposure that irreversibly damages the rotator cuff and still fails to gain sufficient joint access to properly restore the native anatomic relationships of both the humeral head and glenoid surfaces. Also, there remain issues with glenoid implant fixation and early loosening.
  • [0007]
    Conventional methods utilize a large anterior deltopectoral exposure. The anterior humeral circumflex blood vessels are typically ligated and the anterior (subscapularis) musculotendinous unit is transected. The shoulder must then completely dislocated both anteriorly and posteriorly to prepare the humeral and glenoid joint surfaces. This can cause excessive traction on the arm which has resulted in injury to the nerves of the brachial plexus (Lynch N M, Cofield R H, Silbert P L, et al. Neurologic complications after total shoulder arthroplasty. J Shoulder Elbow Surg 1996; 5(1):53-61.).
  • [0008]
    With regards to shoulder replacement surgery, all conventional methods require surgical transection of a rotator cuff tendon to gain sufficient exposure of the joint surfaces of the shoulder (See U.S. Pat. No. 4,550,450, entitled, “Total Shoulder Prosthesis System”, the entire contents of which are incorporated herein by reference). After the joint surfaces are replaced, the rotator cuff tendon must be surgically repaired with suture material. This tenuous repair necessitates an obligatory period of approximately six weeks for the rotator cuff tendon to heal before advanced shoulder rehabilitation can be performed. This surgical transection and subsequent repair, as well as the delay in rehabilitation, hold significant consequences for the functional outcome of the shoulder replacement including permanent weakness and decreased range of motion (Miller S L et al., “Loss of subscapularis function after total shoulder replacement: A seldom recognized problem”, J Shoulder Elbow Surg. 2003 January-February;12(1):29-34).
  • [0009]
    Additionally, despite the extensive exposure, conventional methods for shoulder replacement surgery still fail to properly restore the native anatomic relationships of the joint surfaces of the shoulder. Conventional methods prepare the humeral surfaces of the shoulder joint by referencing off the intramedullary axis of the humeral shaft. This poses great difficulty for the surgeon since the intramedullary axis has an inconsistent relationship to the humeral surface. The humeral joint surface also possesses a complex anatomy with significant variability which cannot be entirely restored with conventional methods and implants. There exists much variability in the humeral head neck-shaft angle, posterior and medial offset, version (rotation), height, thickness, and radius, of curvature. (Boileau P, Walch G, “The Three-Dimensional Geometry of the Proximal humerus”, J Bone Joint Surg Br 1997; 79B: 857-865; Iannotti J P, et al. “The Normal Glenohumeral Relationships. An Anatomic Study of One Hundred and Forty Shoulders”, J Bone Joint Surg 1992; 74A(4):491-500; McPherson E J, et al. “Anthropometric Study of Normal Glenohumeral Relationships”, J Shoulder Elbow Surg 1997; 6:105-112; Soslowsky L J, et al. “Articular geometry of the glenohumeral joint”, Clin Orthop 1992; 285:181-190). The failure to restore the native anatomic relationships and biomechanics to the shoulder joint has proven to result in a significantly lesser functional and durable outcome (Williams G R, et al. “The effect of articular malposition and shoulder arthroplasty on glenohumeral translations, range of motion, and subacromial impingement”, J Shoulder Elbow Surg. 2001; 10(5):399-409).
  • [0010]
    Conventional methods of shoulder replacement surgery also have difficulty gaining access to the glenoid joint surface. The glenoid surface of the shoulder joint is best prepared by working along an axis perpendicular to its surface. Because the humeral head sits in the way, this is a nearly impossible task with conventional methods. The humeral head has to be partially removed, the subscapularis (anterior shoulder rotator cuff muscle) transected, and the proximal humerus dislocated to even get close to working along this axis. Because of this difficulty, a majority of orthopaedic surgeons still choose not to replace the glenoid surface despite clinically proven results of improved pain relief and function for shoulder replacement surgery when both the humeral and glenoid surfaces are replaced. (Boyd A D, Thomas W H, Scott R D, et al. “Total shoulder arthoplasty versus hemiarthroplasty—indications for glenoid resurfacing”, J of Arthroplasty 1990; 5(4):329-336; Gartsman G M, Roddey T S, Hammerman S M. J Bone Joint Surg 2000; 82A(1):26-34; Edwards T B, Kadakia N R, Boulahia A, et al., “A comparison of hemiarthoplasty and total shoulder arthroplasty in the treatment of primary glenohumeral osteoarthritis: Results of a multicenter study”, J Shoulder Elbow Surg 2003; 12(3):207-13; Orfaly R M, Rockwood C A, Esenyel C Z, et al., “A prospective functional outcome study of shoulder arthoplasty for osteoarthritis with an intact rotator cuff”, J Shoulder Elbow Surg 2003; 12(3):214-21.)
  • [0011]
    Despite improved results of conventional methods when both the humerus and glenoid surfaces are replaced, there still remains limitations with regard to glenoid fixation and early glenoid implant loosening (Boileau P, Avidor C, Krishnan S G, et al., “Cemented polyethylene versus uncemented metal-backed glenoid components in total shoulder arthroplasty: a prospective, double-blind, randomized study”, J Shoulder Elbow Surg 2002; 11(4):351-9.). Both, cemented polyethylene and metal backed glenoid components are used in conventional methods. The cemented implant never incorporates with the glenoid bone and with time, the cement-bone interface eventually fails and the implant comes loose. Conversely, the metal-backed glenoid prosthesis has an unacceptable rate of early loosening, at least 20% in one study. However, if the metal-backed implant can remain rigidly fixed to the bone for a sufficient period of time, the bone of the glenoid will eventually adhere to the metal-backed surface and long-term studies have revealed little evidence for late clinical loosening in these cases. Failure of the metal-backed glenoid implant appears to be related to the limitations in achieving sufficiently rigid and durable initial fixation
  • [0012]
    While performing shoulder replacement surgery for arthritis, associated rotator cuff tears are sometimes discovered and should be repaired when possible. If a less invasive surgical approach is employed to perform the shoulder replacement surgery, a less invasive method of rotator cuff repair that is compatible with the method shoulder replacement surgery must be to be available to simultaneously address these associated rotator cuff tears.
  • BRIEF SUMMARY OF THE INVENTION
  • [0013]
    One aspect of the present invention regards a method for shoulder replacement surgery. Utilizing the method of the present invention, a portal is created along a central axis of a neck of a proximal humerus that is associated with a shoulder of a patient. An implant is subsequently implanted into the shoulder of the patient, however a component of that implant is not passed through the portal. The rotator cuff is spared in the process.
  • [0014]
    One advantage provided by the above mentioned aspect of the present invention is that it allows determination of a central axis in the proximal humerus which allows simple and less invasive perpendicular access to the humeral and glenoid joint surfaces. An additional advantage is it offers a simple and reliable means of restoring the native anatomy and biomechanical relationships, allowing for an improved functional and durable outcome.
  • [0015]
    A further advantage is that it spares the rotator cuff tendons and allows for a quicker and more functional recovery
  • [0016]
    Another aspect of the present invention regards a humeral implant with one component that is removably attached to a second component.
  • [0017]
    Another aspect of the present invention provides a glenoid implant. The glenoid implant includes an ingrowth shell, a wear-resistant surface that is removably attached to the ingrowth shell. An advantage is that the ingrowth shell provides novel geometry and superior fixation to the glenoid.
  • [0018]
    An additional aspect of the invention regards a transhumeral portal sleeve with a bullet shaped guide that has a central and a peripheral longitudinal cannulation. An advantage is that it safely creates a working portal along the central axis of the proximal humerus.
  • [0019]
    In another aspect of the present invention, there is provided a transhumeral humeral reamer that has a working head and a removably attached transhumeral shaft with a diameter of from 0.1 to 5 cm.
  • [0020]
    Another aspect of the present invention regards a transhumeral glenoid reamer with a working head and a removably attached transhumeral shaft that has a diameter of from 0.1 to 5 cm.
  • [0021]
    In another aspect, a transhumeral protective sheath is provided that is a tube of material with a diameter of from 0.1 to 5 cm.
  • [0022]
    Another aspect of the invention regards a glenoid surface protective guard that has a protective surface and a removably attached handle.
  • [0023]
    In another aspect, a humeral head surface protective guard is provided that has a protective surface and a removably attached handle.
  • [0024]
    An additional aspect of the invention regards a glenoid sizer and centering hole guide that has a surface that contacts the glenoid of a shoulder and a removably attached handle.
  • [0025]
    In another aspect, a drill guide with a guiding surface and a removably attached handle is provided. The guiding surface has a centering hole and is available in sizes equivalent to the respective glenoid implants.
  • [0026]
    In another aspect, the invention regards a transhumeral glenoid drill with a working surface and a removably attached shaft.
  • [0027]
    In another aspect, a transhumeral burr is provided. The transhumeral burr has a high speed working burr surface and a removably attached shaft.
  • [0028]
    An additional aspect of the invention regards a glenoid keel punch with a working head and a removably attached shaft. The working head has a keel shape and cutting teeth.
  • [0029]
    In another aspect, a transhumeral irrigation and suction catheter is provided. The catheter is a semi-rigid plastic tubing removably attached to either a fluid pump or a suction device.
  • [0030]
    In another aspect, a transhumeral cementation device is provided that has a semi-rigid catheter removably attached to a head.
  • [0031]
    An additional aspect provides a transhumeral glenoid impactor with a dome-shaped head and a removably attached shaft.
  • [0032]
    Another aspect of the invention regards a transhumeral screw driver with a working head and a removably attached shaft.
  • [0033]
    In another aspect, the present invention provides a rotator interval retractor with a first blade dimensioned to interact with a supraspinatus and a second blade dimensioned to interact with a subscapularis.
  • [0034]
    Another aspect of the invention regards a glenohumeral joint with a transhumeral portal along a central axis of a neck of a proximal humerus as well as an implant.
  • [0035]
    Further advantages as well as details of the present invention ensue from the following description of a preferred embodiment represented in the drawings.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • [0036]
    FIG. 1 is a schematic of a patient positioned with fluoroscopy C-arm unit that may be used in conjunction with the present inventions;
  • [0037]
    FIGS. 2 a and b are plan views of an embodiment of a rotator interval retractor with specialized supraspinatus and subscapularis blades (FIG. 2 b) in accordance with the present invention;
  • [0038]
    FIG. 3 a is a perspective view of an embodiment of a transhumeral portal drill guide and protective sleeve in accordance with the present invention.
  • [0039]
    FIG. 3 b is a top plan view of the transhumeral portal drill guide of FIG. 3 a;
  • [0040]
    FIG. 3 c is a side plan view of the protective sleeve of the transhumeral portal drill guide and sleeve of FIG. 3 a in accordance with the present invention;
  • [0041]
    FIG. 4 a is a schematic of an embodiment of an insertion procedure of a proximal humeral guide pin and measurement of humeral head depth after placement of a second guide pin in accordance with the present invention;
  • [0042]
    FIG. 4 b is a schematic of the insertion of FIG. 4 a using an optional embodiment of a radiolucent guide attachment to assist with a guide pin insertion procedure in accordance with the present invention;
  • [0043]
    FIG. 5 is a schematic of an embodiment of a drilling procedure for forming an embodiment of a transhumeral portal in accordance with the present invention;
  • [0044]
    FIG. 6 is a schematic of a preliminary cut of a humeral head joint surface during an embodiment of a surgical procedure in accordance with the present invention;
  • [0045]
    FIG. 7 a is a schematic showing a possible way of preparing the humeral head with a transhumeral humeral head reamer in preparation for a conventional proximal humeral implant during an embodiment of a surgical procedure in accordance with the present invention;
  • [0046]
    FIG. 7 b is a schematic showing a possible way of preparing the humeral head with a novel transhumeral humeral reamer in preparation for a novel proximal humeral implant during an embodiment of a surgical procedure in accordance with the present invention;
  • [0047]
    FIG. 7 c is a perspective view of an embodiment of a novel transhumeral humeral reamer head to be used in an embodiment of a surgical technique in accordance with the present invention;
  • [0048]
    FIG. 7 d is a perspective view of an embodiment of a glenoid protective cap to be used in an embodiment of a surgical technique in accordance with the present invention;
  • [0049]
    FIG. 8 a is a schematic showing a possible way of drilling a glenoid centering hole and placing a transhumeral glenoid guide wire with a glenoid sizing and centering guide which can be used for both a left and a right shoulder for a conventional proximal humeral implant in an embodiment of a surgical procedure in accordance with the present invention.
  • [0050]
    FIG. 8 b is a schematic showing a possible way of drilling a glenoid centering hole and placing a transhumeral glenoid guide wire with a glenoid sizing and centering guide which can be used for both a right and a left shoulder for a novel proximal humeral implant during an embodiment of a surgical procedure in accordance with the present invention;
  • [0051]
    FIG. 8 c is a perspective view of an embodiment of a head of a glenoid sizing and centering guide in accordance with the present invention;
  • [0052]
    FIG. 9 a is a schematic of a way of preparing a glenoid with a cannulated transhumeral glenoid reamer for conventional proximal humeral implant during an embodiment of a surgical technique in accordance with the present invention;
  • [0053]
    FIG. 9 b is a schematic of a way of preparing a glenoid with a cannulated transhumeral glenoid reamer for a novel proximal humeral implant during an embodiment of a surgical technique in accordance with the present invention;
  • [0054]
    FIG. 10 a is a schematic of a way of preparing a glenoid with a transhumeral glenoid keel/peg drill and a glenoid peg or keel guide for a conventional proximal humeral implant during an embodiment of a surgical technique in accordance with the present invention;
  • [0055]
    FIG. 10 b is a perspective view of a peg or keel guide for a conventional glenoid implant to be used in an embodiment of a surgical technique in accordance with the present invention;
  • [0056]
    FIG. 10 c is a schematic of a way of preparing a glenoid with a transhumeral keel/peg glenoid drill and a glenoid peg or keel guide for a novel proximal humeral implant during an embodiment of a surgical technique in accordance with the present invention;
  • [0057]
    FIG. 11 a is a schematic of a way of preparing a glenoid to accept a conventional keel glenoid implant with a transhumeral burr for a conventional proximal humeral implant during an embodiment of a surgical technique in accordance with the present invention;
  • [0058]
    FIG. 11 b is a schematic of a way of preparing a glenoid to accept a conventional keel glenoid implant with a transhumeral burr for a novel proximal humeral implant during an embodiment of a surgical technique in accordance with the present invention;
  • [0059]
    FIG. 12 a is a schematic of a way of preparing a glenoid to accept a conventional keel glenoid implant with a transhumeral keel punch for a conventional proximal humeral implant to be used in an embodiment of a surgical procedure in accordance with the present invention;
  • [0060]
    FIG. 12 b is a schematic of a way of preparing a glenoid to accept a conventional keel glenoid implant with a transhumeral keel punch for a novel proximal humeral implant to be used in an embodiment of a surgical technique in accordance with the present invention;
  • [0061]
    FIG. 13 a is a schematic a way of utilizing an embodiment of a transhumeral cementation catheter and glenoid cement pressurizer for a conventional proximal humeral implant to be used during a surgical procedure in accordance with the present invention;
  • [0062]
    FIG. 13 b is a perspective view of an embodiment of a modular glenoid cement pressurizer tip for a keel implant and a catheter in accordance with the procedure shown in FIG. 13 a;
  • [0063]
    FIG. 13 c is an exploded view of an embodiment of a glenoid cement pressurizer tip of FIGS. 13 a and b in accordance with the present invention;
  • [0064]
    FIG. 13 d is an exploded view of an embodiment of a glenoid cement pressurizer tip for a peg implant of FIGS. 13 a and c, in accordance with the present invention;
  • [0065]
    FIG. 13 e is a schematic of a way of utilizing an embodiment of a transhumeral cementation catheter and glenoid cement pressurizer for a novel proximal humeral implant to be used during a surgical procedure in accordance with the present invention;
  • [0066]
    FIG. 14 a a schematic of a way of utilizing an embodiment of a transhumeral glenoid impactor for a conventional humeral implant during a surgical procedure of the present invention;
  • [0067]
    FIG. 14 b is a schematic of a way of utilizing an embodiment of a transhumeral glenoid impactor for a novel humeral implant during a surgical procedure of the present invention;
  • [0068]
    FIG. 15 a is a exploded view of humeral implant in accordance with the present invention;
  • [0069]
    FIG. 15 b is a bottom plan view of a humeral implant in accordance with the present invention;
  • [0070]
    FIG. 16 is a schematic of an embodiment of a humeral surface implant, Example A, in accordance with the present invention;
  • [0071]
    FIG. 17 a is schematic of an embodiment of a humeral surface implant, Example B, in accordance with the present invention;
  • [0072]
    FIG. 17 b is a perspective view of an embodiment of a stem with inner cement channels in accordance with the present invention;
  • [0073]
    FIG. 17 c is an perspective view of an embodiment of a endcap of the novel transhumeral stem of FIG. 17 b in accordance with the present invention;
  • [0074]
    FIG. 18 a is a schematic of a way of removing an embodiment of a humeral surface implant, Step 1, Example B, during an embodiment of a surgical procedure in accordance with the present invention;
  • [0075]
    FIG. 18 b is a schematic of a way of performing Step 2 of removing an embodiment of a humeral surface implant of FIG. 18 a during an embodiment of a surgical procedure in accordance with the present invention;
  • [0076]
    FIG. 19 a is a schematic of inserting an embodiment of a humeral surface implant, Example C in accordance with the present invention;
  • [0077]
    FIG. 19 b is a perspective view of a stem of an embodiment of a humeral implant of FIG. 19 a that is inflatable in accordance with the present invention;
  • [0078]
    FIG. 20 a is a schematic a way of inserting a multiple peg glenoid surface to be used in an embodiment of a surgical technique in accordance with the present invention;
  • [0079]
    FIG. 20 b is a side plan view of a glenoid peg to be used in during a surgical technique in accordance with the present invention;
  • [0080]
    FIG. 20 c is a perspective view of a multiple peg glenoid guide of FIG. 20 a in accordance with the present invention;
  • [0081]
    FIG. 21 is a side perspective view of an embodiment of a novel transhumeral glenoid reamer in accordance with the present invention;
  • [0082]
    FIG. 22 is a schematic of a way of utilizing a novel glenoid reamer in an embodiment of a surgical technique in accordance with the present invention;
  • [0083]
    FIG. 23 a is a perspective view of an embodiment of a shell component of a novel glenoid implant in accordance with the present invention;
  • [0084]
    FIG. 23 b is a bottom plan view of a shell component of a novel glenoid implant of FIG. 23 a;
  • [0085]
    FIG. 24 a is a schematic of a way of drilling screw holes into a glenoid utilizing a glenoid drill guide sleeve and glenoid screw guide sleeve in an embodiment of a surgical technique of the present invention;
  • [0086]
    FIG. 24 b is an exploded view of the glenoid drill guide sleeve interfit with the glenoid screw guide sleeve of FIG. 24 a;
  • [0087]
    FIG. 25 a is a schematic of a way of utilizing a glenoid screw guide sleeve and transhumeral screwdriver in accordance with an embodiment of a surgical technique of the present invention;
  • [0088]
    FIG. 25 b is an exploded view of the glenoid screw guide sleeve of FIG. 25 a;
  • [0089]
    FIG. 26 a is a schematic of utilizing a transhumeral impactor to secure a novel wear-resistant glenoid surface into an ingrowth shell of the novel glenoid implant in accordance with an embodiment of the present invention;
  • [0090]
    FIG. 26 b is an exploded view of the novel glenoid implant of FIG. 26 a;
  • [0091]
    FIG. 27 a is a side view of an embodiment of a novel glenoid implant in accordance with the present invention;
  • [0092]
    FIG. 27 b is a top plan view of an embodiment of a novel wear-resistant surface the novel glenoid implant of FIG. 27 a;
  • [0093]
    FIG. 27 c is a bottom plan view of an embodiment of the novel wear-resistant surface of novel glenoid implant of FIGS. 27 a and b.
  • [0094]
    FIG. 28 a is a perspective view of an embodiment of an insertional guide in accordance with the present invention;
  • [0095]
    FIG. 28 b is a perspective view of an embodiment of a flexible inner trocar of an embodiment of an insertion guide in accordance with the present invention;
  • [0096]
    FIG. 29 is a perspective view of an embodiment of a suture pin of the present invention;
  • [0097]
    FIG. 30 is a schematic of a way of performing an embodiment of a surgical technique using the insertion guide of FIGS. 28-29 to bore into a greater tuberosity of proximal humerus in accordance with the present invention;
  • [0098]
    FIG. 31 is a schematic of a way of performing an embodiment of a surgical technique using the insertion guide of FIGS. 28-29 to advance the suture-pin device through the greater tuberosity of the proximal humerus and leading edge of rotator cuff tendon in accordance with the present invention;
  • [0099]
    FIG. 32 is a schematic of a way of performing an embodiment of a surgical technique using a pin director to guide the pin out from the shoulder in accordance with the present invention
  • [0100]
    FIG. 33 is a schematic of a way of performing an embodiment of a surgical technique and tying the passed suture of the suture pin device after removing the pin component in accordance with the present invention.
  • DETAILED DESCRIPTION OF THE DRAWINGS AND THE PRESENTLY PREFERRED EMBODIMENTS
  • [0101]
    The present invention relates to methods, instrumentation, and implants for performing rotator cuff sparing shoulder replacement surgery. Both, total shoulder arthroplasty, where both the humeral and glenoid joint surfaces are replaced, and shoulder hemiarthroplasty, where only the humeral joint surface is replaced, can be performed as indicated. The present invention utilizes among other things: a novel surgical exposure including an optional method of arthroscopic anterior contracture release, posterior capsular tightening, osteophyte resection, and glenoid soft-tissue clearance; two limited incisions, a transhumeral portal and a deep rotator cuff sparing exposure; novel transhumeral instrumentation with modular working components, protective guides, sleeves, sheaths, and retractors; conventional or novel implants, and an associated method of rotator cuff repair.
  • [0102]
    Utilizing the method of the present invention, a portal is created along a central axis of a neck of a proximal humerus that is associated with a shoulder of a patient. This portal provides superior perpendicular access to both the humeral and glenoid joint surfaces in a less invasive manner to allow more anatomic replacement surgery to occur. The axis of the humeral head and the axis of the glenoid have a sufficiently consistent natural relationship such that simple positioning of the arm can allow a surgeon to easily align the central axis perpendicular to the humeral head with the axis perpendicular to the glenoid. Research has shown that there exists a natural relationship between the orientation of the humeral and glenoid surfaces (De Wilde, L F, et al., “Glenohumeral Relationship in the Transverse Plane of the Body”, J Shoulder Elbow Surg 2003; 12(3):260-267). Therefore, I have determined that with consistent positioning of the arm, these axes will be co-linear.
  • [0103]
    Accordingly, the present invention provides a reliable way of reestablishing the proper orientation of the humeral and glenoid joint surfaces without the associated surgical morbidity of conventional methods, i.e., a large exposure, dislocation of the humerus, or transection of the rotator cuff, as will be described below. Note that in the description to follow there will be mention made of transhumeral instruments. Such transhumeral instruments include transhumeral proximal humerus and glenoid reamers, drills, burrs, guides, protective guards, sheaths, sleeves, cementation tools, glenoid peg and keel punches, and glenoid implant insertor and impactor.
  • [0104]
    Shown in FIGS. 4 a-b, 5, 6, 7 a-b, 8 a-b, 9 a-b, 10 a-c, 11 a-b, 12 a-b, 13 a, 13 e, 14 a-b, 16, 17 a, 18 a-b, 19 a, 20 a, 22, 24 a, 25 a, and 26 a, is a possible medical procedure according to the present invention. Preoperatively, two orthogonal radiographic images should be taken including a Grashey anteroposterior view with the patient's shoulder held in neutral rotation to slight external rotation and an axiliary lateral view. Next, two-dimensional transparencies with representations of different sizes of the humeral and glenoid implants/templates are placed over the x-rays to evaluate the patients bony anatomy and estimate the size of the implants to be used. From these radiographic images, preoperative measurements can be taken of the humeral head diameter and depth, the humeral neck angle, glenoid size and version, and the amount of scapular bone available to fix the implants to be used in the surgical procedure. A preoperative CT scan of the shoulder can also be useful when plain radiographs do not offer sufficient detail.
  • [0105]
    After interscalene regional block and general anesthesia are administered by the anesthesiologist, the patient 1 is positioned in a sitting position with a beach chair postioner 3 as shown in FIG. 1. Prior to prepping and draping the patient 1, a fluoroscopic C-arm machine 7 is positioned accordingly to the patient 1 to obtain a Grashey anteroposterior radiographic view and a modified axiliary lateral view using rotation of the shoulder and slight repositioning of the fluoroscopic machine 7. After the fluoroscopic views are confirmed, the fluoroscopic machine 7 is backed away from the patient 1 and the shoulder and upper extremity are prepped and draped in sterile fashion.
  • [0106]
    Initially, an optional arthroscopic procedure may be performed using conventional arthroscopic tools to release the anterior capsular contractures, tighten the posterior capsule, resect osteophytes, and clear the glenoid soft-tissue for exposure. The procedure is begun by placing an arthroscope in the shoulder joint through a standard posterior portal and making an anterior rotator interval passage under needle localization. Standard diagnostic arthroscopy is performed and the posterosuperior, superior, and anterior labrum are excised or ablated; the biceps tendon may be released from the superior glenoid; and the anterior and anteroinferior ligamentous and capsular attachments are released from the glenoid. Then an accessory posterior passage is made under needle localization and an arthroscopic burr is inserted to remove the inferior humeral neck osteophytes. From the same accessory posterior passage, the posterior, posteroinferior and inferior labrum are excised or ablated and the posteroinferior and inferior ligamentous and capsular attachments to the glenoid are released from 7 O'clock anteriorly on a right shoulder or 5 O'clock anteriorly on a left shoulder. Gentle manipulation of the shoulder can also be performed if necessary to complete the soft-tissue release. Any posterior capsular redundancy can be addressed by techniques of capsular plication (tightening with arthroscopic sutures).
  • [0107]
    After the optional arthroscopic procedure is performed, an anterosuperior passage is formed to expose the glenohumeral joint. In particular, an anterosuperior incision is made either obliquely running over the anterolateral border of the acromion over the tip of the coracoid or longitudinally from just inferior to the clavicle running between the coracoid and the AC joint distally. Deep dissection is continued through the deltopectoral interval or a limited muscular split running in line with the deltoid muscle fibers. The clavipectoral fascia is incised, the coracoacromial ligament is released from the coracoid, and the subdeltoid and subacromial adhesions are released. Bony and soft-tissue subacromial decompression and distal clavicle excision should be performed if secondary conditions of impingement, rotator cuff tears, or acromioclavicular joint arthritis are present. The anterior circumflex blood vessels are ligated only as needed. The rotator interval is opened completely around both sides of the coracoid and distally into the biceps sheath. The supraspinatus and subscapularis muscles are bluntly released from the glenoid superior and anterior surfaces, respectively. A biceps tenodesis may be performed by simply sewing it to the tissue of the biceps sheath and excising the intraarticular portion of the tendon. At this point, a novel rotator interval retractor 5 with specialized supraspinatus 2 and subscapularis 4 blades is inserted (FIG. 2 a-b). The blades connect to separate arms of a self-retaining device which allow it to hold open the interval between the supraspinatus and the subscapularis rotator cuff musculotendinous units.
  • [0108]
    If necessary, a secondary rotator interval can be made by splitting the subscapularis in line with its fibers.
  • [0109]
    Note, that the anterosuperior passage described above and below can be performed without the aid of the previously described arthroscopic procedure. If the arthroscopic procedure is not performed, joint capsular contractures are released, posterior capsule is tightened (if needed), osteophytes are resected, and the soft-tissue surrounding the glenoid is excised as described above using open rather than arthroscopic instruments.
  • [0110]
    The surgical method next involves creating a transhumeral portal 30. The transhumeral portal 30 is a cylindrical-like tunnel that is parallel to the neck of the humerus from the anterolateral bony cortex of the proximal humerus through the center of the humeral head. Creation of the transhumeral portal 30 first involves obtaining an anteroposterior view of the proximal humerus via the fluoroscopic C-arm machine 7 shown in FIG. 1. The shoulder is externally rotated between 20 and 40 degrees relative to the plane of the fluoroscope 7 to achieve a view perpendicular to the neck of the humerus. A free radioopaque guide pin is placed over the anterior shoulder along the axis of the humerus neck. By using fluoroscopy, a guide pin in that position defines a line to be used as a guideline that is marked/drawn along the anterior skin. A second small anterosuperior incision is made longitudinally, 1 centimeter lateral to the biceps tendon centered on the point of intersection with the drawn guideline marking the humeral neck axis. This second incision lies just inferolateral to the first. Via the second anterosuperior path, the deep deltoid muscle is split bluntly along its fibers to protect the motor branch of the axillary nerve and the transhumeral portal drill guide 14 and protective sleeve 15 (FIGS. 3 a-c) are inserted down to the anterolateral cortex of the humerus, approximately 1 cm lateral to the biceps groove. Using intraoperative fluoroscopy, a small guide pin 16 is inserted through the transhumeral portal drill guide 14 and sleeve 15 from the anterolateral humeral cortex along the central axis of the humeral neck into the center of the articular surface of the humeral head (FIG. 4 a). Anteroposterior and modified axillary lateral fluoroscopic images are taken to confirm proper positioning of the guide pin 16. The guide pin 16 is repositioned as necessary until the pin runs centrally through the humeral neck and head on all fluoroscopic views.
  • [0111]
    Note, a specialized transhumeral portal drill guide 14 may be used to help direct the guide pin 16 into the center of the humeral head 20 (FIG. 4 a). The transhumeral portal drill guide 14 is a bullet shaped object with multiple longitudinal cannulations to direct guide 16, 18. It fits into a protective sleeve 15 which has a handle 6 that is inserted into the second anterosuperior passage to the anterolateral cortex of the proximal humerus 20. This sleeve 15 and guide 14 protect the surrounding soft-tissue and axillary nerve from harm. There is a radiolucent guide attachment 21 which rigidly connects to the handle 6 of the protective sleeve 15 of the transhumeral portal drill guide 14. The radiolucent guide attachment 21 has a radiolucent arm 23 which runs parallel with the cannulations 10,12 in the transhumeral portal guide 14 and connects to a radiolucent tip 25 which can be any suitable shape, for example, hemispheric (FIG. 4 b). Once the guide is assembled, the central cannulation 12 of the transhumeral portal guide 14 will direct a guide pin 16 to the center of the hemispheric tip 25. The arm 23 of the guide attachment 21 is sufficiently long to allow significant adjustments in length to accommodate variations in size of the proximal humerus. After the tip 25 of the transhumeral portal drill guide 14 is placed on the humeral surface through the first anterosuperior passage, the radiolucent arm 23 containing a radiopaque reference line can also be aligned with the central axis of the neck of the proximal humerus 20 under fluoroscopy to assist in directing the guide pin 16 to the center of the humeral 20 surface.
  • [0112]
    The guide pin 16 is advanced through the transhumeral drill guide 14 and protective sleeve 15 such that it travels toward the glenohumeral joint 9, along the central axis of the neck of the humerus and perpendicular to the humeral 20 joint surface. The guide pin 16 is advanced such that the tip of the pin stops right at the humeral 20 joint surface. A second pin 18 of equal length is inserted through one of the peripheral holes 10 in the transhumeral portal drill guide 14 and sleeve 15 until it stops at the lateral humeral cortex. Measuring the difference in exposed length between the pins 16, 18 closely estimates the length of the transhumeral portal 30. This measurement assists the surgeon in creating and using the transhumeral portal 30 more safely as well as providing the size of the modular stem 98 used for the proximal humeral implant 94. Then, the second guide pin 18 is advanced into the bone until it reaches the level of the anatomic neck 13 of the humerus. Measuring the difference in exposed length between the pins 16, 18 provides an accurate measurement of humeral head 20 depth (FIG. 4 a-b). Using the actual humeral depth measured by the difference between the pins 16, 18 and that measured on the fluoroscopic screen, the actual humeral head diameter can be determined from measurements on the fluoroscopic screen. These measurements help in selecting the proper size transhumeral humeral reamers and final humeral implant later in the procedure.
  • [0113]
    Based on the actual measured transhumeral portal 30 length, the transhumeral portal 30 is created by drilling with an approximately 1 centimeter diameter or less cannulated drill bit 26 through the transhumeral portal protective sleeve 15 over the first guide pin 16 from the anterolateral humeral cortex and into the joint (FIG. 5). The transhumeral portal 30 defines an opening of any suitable shape (such as circular, square, triangular, etc), having a diameter with a range of 0.1 to 5 cm, more preferably, a range of 0.1 to 1 cm, and most preferably, a range of 0.5 to 1.0 cm. The first guide pin 16 is removed along with the cannulated drill bit 26 and the second guide pin 18 may remain as a guide for later humeral head resection.
  • [0114]
    With the formation of the transhumeral portal 30, the humeral 20 and glenoid 22 surfaces can be prepared as explained hereafter. Note that the order of preparing either the humeral 20 or glenoid 22 surfaces may be altered depending on the proximal humeral 20 bone quality. If there are concerns about the quality of the proximal humeral 20 bone, the humeral 20 surface can be prepared last, after the glenoid 22, to avoid weakening the proximal humeral bone 20 and jeopardizing the integrity of the transhumeral portal 30. Also, if hemiarthroplasty is indicated, the humeral 20 surface may solely be prepared and replaced.
  • [0115]
    Assuming that it is determined to prepare the humeral 20 surface first, the articular surface of the humeral head 20 may either be resected and replaced to the level of the anatomic neck 13 for the insertion of a conventional proximal humeral implant, or merely resected and replaced to the level of the subchondral bone for the insertion of a novel proximal humeral implant 94. To insert a conventional humeral implant in accordance with the present invention, a preliminary humeral head 20 cut can be made to improve visualization and expedite resection. From the anterosuperior passage previously formed, a long oscillating saw 28 is used to safely resect a limited portion of the humeral head 20 joint surface perpendicular to the portal (FIG. 6).
  • [0116]
    A transhumeral protective sheath 38 used during the procedure of the present invention is then threaded or press-fit into the transhumeral portal 30 through the second anterosuperior passage using the transhumeral portal drill guide protective sleeve 15 to safely direct it. It is inserted to the level of the anatomic neck 13 of the proximal humerus 20 in preparation for a conventional humeral implant or to the level of the humeral 20 joint surface for a novel humeral implant 94 (FIG. 7 a). An embodiment of the transhumeral protective sheath 38 of the present invention provides protection for the bone within which the transhumeral portal sits. The transhumeral sheath 38 is a tube of such shape, inner and outer diameter, and thickness such that it interfits securely within the transhumeral portal 30 along the central axis of the neck of the humerus 20, allows easy passage and use of all transhumeral instruments and sleeves while protecting the remaining bone of the proximal humerus 20 from harm. The transhumeral sheath 38 may be metal, plastic, or other semi-rigid, wear-resistant material and may be slid or threaded into the transhumeral portal.
  • [0117]
    Next, a transhumeral reamer shaft 34 is placed through the protective sheath 38 and assembled in the joint with the appropriately sized modular humeral reamer head 36 inserted through the anterosuperior passage (FIGS. 7 a-d). A novel transhumeral humeral reamer 32, in one embodiment of the present invention, includes a reaming surface 36 and a transhumeral shaft 34. The transhumeral reamer 32 is designed so that the shaft 34 interfits securely within the transhumeral portal 30, and more specifically, within the transhumeral protective sheath 38 within the transhumeral portal 30, such that there is no shaking or toggling while the reamer is being used. Therefore the diameter of the shaft 34 is from 0.1 to 5 cm and slightly smaller than the inner diameter of the transhumeral protective sheath 38 through which it traverses. For a conventional humeral prosthesis, a flat reaming head surface 36 with sizes similar to the diameter of the humerus and surgical neck are used. The flat reamer removes bone of the humeral head down to the level of the anatomic neck 13 of the humerus. For a novel humeral implant 94, a hemispherically shaped reaming surface 37, sized similarly to a novel humeral surface 96 implant component is used, having similar depth and radius of curvature (FIG. 7 c). The hemispherically shaped reaming surface 37 removes a minimal amount of bone. The amount of bone removed is roughly equivalent to the thickness of the humeral surface 96 component of the implant 94.
  • [0118]
    A protective guard 40 may be placed over the glenoid through the anterosuperior passage during reaming (FIG. 7 d). The protective guard 40 is introduced through the first anterosuperior passage by a handle 44. In one embodiment of the present invention, the guard 40 is shaped like the glenoid and is available in small, medium and large sizes. The guard is made of a solid metal surface with an elevated peripheral edge that fits over the glenoid surface. The guard has a thickness of about 0.1 to 2 mm. The handle 44 is removable and can be attached to the guard at different positions to allow it to be inserted from variable angles through the anterosuperior passage.
  • [0119]
    After the guard 40 is in place, the orthopaedic surgeon grasps the protective sheath 38 and pulls the running reamer 32 back onto the humeral head until it cuts to the level of the anatomic neck 13 for a conventional humeral implant (FIG. 7 a). Live fluoroscopy may be used to assist with making the cut and insuring that the reamer stays parallel to the second guide pin 18 and stops before its tip. The bone debris from the cutting is removed with thorough irrigation from the anterosuperior passage. Any remaining humeral osteophytes may be removed with a small rongeur from the anterosuperior passage.
  • [0120]
    To insert a novel proximal humeral implant 94, the transhumeral protective sheath 38 and reamer shaft 34 are inserted as described above (FIGS. 7 a-d). Alternatively, the appropriate size novel modular humeral reamer head 37 is inserted through the anterosuperior passage into the joint and assembled with the transhumeral shaft 34. A protective guard 40 may be placed over the glenoid 22 through the anterosuperior passage during reaming. Again, the orthopaedic surgeon grasps the protective sheath 38 and pulls the running reamer 32 back onto the humeral head until the novel humeral reamer has removed just enough bone to restore the proper humeral head dimensions (FIG. 7 b). Openings 39 in the reamer head can help the surgeon determine the proper amount reaming. Also, live fluoroscopy may be used to assist with making the cut and insuring that the reamer 32 stays parallel to the second guide pin 18 and stops at the appropriate level. The bone debris from the cutting is removed with thorough irrigation and suction from the anterosuperior passage. Any remaining humeral osteophytes may be removed with a small rongeur from the anterosuperior passage.
  • [0121]
    After the reamer 32 has prepared the humeral head, either for a conventional or a novel proximal humeral implant 94, the glenoid 22 of the shoulder joint can then prepared for the placement of a conventional glenoid implant 115 (FIG. 8 a). Any remaining soft-tissue obstructing the glenoid surface 22 should be excised. The humerus is abducted, rotated, and laterally distracted to direct the transhumeral portal 30 such that its path lies perpendicular to and centered on the glenoid surface 22. A glenoid sizing and centering hole guide 46 is placed from the anterosuperior passage (FIG. 8 a-c). In another embodiment of the present invention, a glenoid sizer and centering hole guide 46 includes a working surface 52 and a handle 53. The guide 46 is shaped and sized according to the shape and size of the glenoid 22 to be prepared. The working surface 52 is inserted through the first anterosuperior passage by its handle 53. The handle 53 is removable and can be attached to the working surface 52 at different positions 56 to allow it to be inserted from variable angles through the anterosuperior passage. The working surface 52 is approximately 0.1 to 10 mm thick and flat and has a central hole 54.
  • [0122]
    Utilizing the appropriately sized glenoid sizing and centering guide 46, a transhumeral guide wire 50 is inserted into the transhumeral portal 30 through the transhumeral protective sheath 38 to to drill a centering hole in the glenoid surface 22 regardless of whether a conventional or novel humeral implant is being inserted (FIGS. 8 a-b). After the centering hole has been started, the guide wire 50 is backed up to allow the removal of the glenoid sizing and centering guide 46. A cannulated flat or hemispherical humeral head guard 64, followed by a cannulated glenoid surface cutting reamer head 60, is inserted through the anterosuperior passage and the guidewire 50 is advanced through cannulations in both instruments back into the centering hole in the glenoid.
  • [0123]
    In another embodiment of the present invention, a humeral head surface protective guard 64 may be used (FIGS. 9 a-b). This protective guard 64 includes a protective metal surface which is flat or hemispheric in shape corresponding to the prepared end of the proximal humerus for a conventional or novel humeral implant, respectively. The protective guard 64 is inserted via the first anterosuperior passage and fits over the humeral surface 20 and the shaft 62 of the transhumeral glenoid reamer 58. The shaft 62 of the transhumeral glenoid reamer 58, described below, passes through a central cannulation of the guard 64 to prepare the glenoid 22. The humeral head surface protective guard 64 is sized according to need, such as small, medium, and large. The guard 64 is approximately 0.1 to 2.0 mm thick. Optionally, the guard 64 may be used with a handle.
  • [0124]
    The present invention also provides a transhumeral glenoid reamer 58 (FIGS. 9 a-b, 21, 22, 23 a-b). The glenoid reamer 58 has a shaft 62 and a working head 60. The shaft 62 is designed to interfit securely within the transhumeral portal 30, and more specifically, within the transhumeral protective sheath 38 within the transhumeral portal 30, such that there is no shaking or toggling of the shaft 62 within the transhumeral portal 30 while the transhumeral glenoid reamer 58 is in use. Therefore, the outer diameter of the shaft 62 is approximately 0.1 to 5 cm, and slightly less than the inner diameter of the transhumeral protective sheath 38 within which the shaft 62 is used. The working glenoid reamer heads 60, 61 and shaft 62 are cannulated to fit over a central glenoid guide wire 50. There is also a non-cannulated reamer head with a leading central peg which can fit into a central glenoid hole and allow some redirection of the reamer as necessary.
  • [0125]
    For a conventional glenoid implant 115 (shown in FIG. 14 a), a nearly flat, slightly convex, reaming head surface 60 is used with sizes being similar to that of a glenoid. The radius of curvature of the reamer surface matches that of the non-articular side of the conventional glenoid implant. The flat reaming head 60 removes a minimal thickness of bone. The same flat reaming head 60 as used for a conventional glenoid implant 115 may also be used before inserting the multiple pegged glenoid implant 117.
  • [0126]
    For a novel glenoid implant 118, the glenoid reamer head 61 includes a peripherally flat, less aggressive surface 116 and a centrally raised surface 114 which has a more aggressive reaming surface (FIG. 23 a-b). The centrally raised surface 114 may be a convex dome, a square, triangle, pyramid, or any other shape that matches the protruding surface of the novel glenoid implant 118 to be implanted within the glenoid, as described below. The peripheral glenoid reaming surface 116 removes a minimal amount of bone from the peripheral surface of the glenoid to just correct the version (orientation) of the glenoid surface. In one embodiment, the central reaming surface 114 removes a spherically shaped area of bone such that a central concave glenoid surface is created which fits an ingrowth shell component 120 of a novel glenoid implant 118 in accordance with the present invention. The concavity is slightly undersized to allow a pressfit of the ingrowth shell 120.
  • [0127]
    To prepare the glenoid 22 for a conventional prosthesis 115, the cannulated transhumeral glenoid reamer shaft 62 is positioned over the guidewire 50 and through the transhumeral protective sheath 38 from the second anterosuperior passage. The transhumeral reamer shaft 62 is assembled in the shoulder joint with its glenoid surface cutting reamer head 60 and the reamer 58 is advanced along the guide wire 50 removing as little bone as possible to correct the profile of the worn glenoid 22 and create the proper radius of curvature on the surface to match that of the non-articular surface of the conventional glenoid implant 115. The guide wire 50 must be inserted initially in the proper orientation to direct the cut appropriately. There is also an optional glenoid cutting surface head with a central peg that can be used without the guidewire 50 and can be inserted directly into the glenoid centering hole while the surgeon runs the transhumeral glenoid reamer 58 (FIGS. 9 a, b). The bone debris from the cutting is removed with thorough irrigation from the anterosuperior passage. Any remaining glenoid osteophytes may be removed with a small rongeur from the anterosuperior passage.
  • [0128]
    The glenoid 22 can be prepared for implantation of either a conventional pegged or keeled glenoid implant 115, a multiple peg glenoid implant 117 (FIG. 20 b), or a novel glenoid implant 118. In the case of implanting a conventional peg or keel glenoid implant 115, the appropriately sized (according to the previously used glenoid sizer and centering hole guide), peg glenoid or keel guide 68 is inserted through the anterosuperior passage and centered by placing its peg 72 into the previously created glenoid centering hole (FIG. 10 a). The transhumeral glenoid drill 66 is placed through the transhumeral protective sheath 38 within the transhumeral portal 30 from the second anterosuperior passage. In one embodiment of the present invention, a glenoid keel drill guide 68 has a working surface 69 and a handle 70. The working surface 69 is introduced via the first anterosuperior passage by its handle 70. The handle 70 is removable and can be attached to the guide 68 at different positions to allow it to be inserted from variable angles through the anterosuperior passage. This drill guide 68 is shaped and sized similarly to the glenoid sizing and centering hole guide 46, discussed above. The working surface 69 of the guide 68 has a central peg 72 that fits into a centering hole in the glenoid bone. The drill guide 68 for the conventional keel glenoid implant has two converging holes, one superior and one inferior, directed toward each other to direct a transhumeral glenoid drill 66 to cut a keel shape into the glenoid bone (FIG. 10 b).
  • [0129]
    The previously mentioned glenoid peg drill guide 68 has a working surface 69 and a handle 70. The working surface 69 is inserted through the first anterosuperior passage by its handle 70. The handle 70 is removable and can be attached to the guide surface 69 at different positions to allow it to be inserted from variable angles through the anterosuperior passage. This drill guide 68 is sized and shaped similarly to the glenoid sizing and centering hole guide 46, discussed above. The working surface 69 of the guide 68 has a central peg 72 that fits into a centering hole in the glenoid bone. The working surface is approximately 0.1 to 5 mm thick and has peripheral holes in parallel configuration to drill holes with a transhumeral glenoid drill 66 for pegs in a glenoid.
  • [0130]
    In one embodiment, the above-mentioned transhumeral keel/peg glenoid drill 66 has a working surface 67 and a removably attached transhumeral shaft 65. The working surface 67 is a drill bit (or tip) for drilling holes in the glenoid for keels or pegs of the conventional glenoid implant 115. The drill bit 67 (or tip) is larger for drilling holes for a keel or a peg than a bit used for drilling holes for screws.
  • [0131]
    To further prepare the glenoid surface for a conventional glenoid implant, the humerus is positioned and translated such that the transhumeral keel/glenoid glenoid drill 66 is maintained perpendicular to the glenoid peg/keel guide surface 69. With the gleonid drill introduced through the the transhumeral protective sheath 38 of the transumeral portal 30 and the glenoid drill guide 68 postioned from the first anterosuperior passage, holes are drilled into the glenoid (FIGS. 10 a-c). To prepare the glenoid to accept a keel glenoid implant, the transhumeral burr 74 is inserted into the transhumeral portal 30 through the transhumeral protective sheath 38 and used to connect the drilled holes in the glenoid 22 surface (FIGS. 11 a-b).
  • [0132]
    In one embodiment, the transhumeral burr 74 has a transhumeral shaft 75 removably attached to a high speed burr tip 73 with different sizes used for cutting holes in a glenoid 22, particularly for a keel.
  • [0133]
    A modular keel punch 76 is used to finish the glenoid keel cut. In an embodiment, where a glenoid keel punch 76 is used, the keel punch 76 has a working surface 77 and a removably attached transhumeral shaft 78 (FIGS. 12 a-b). The working surface 77 (also referred to as a punch head,) is inserted through the first anterosuperior passage and the shaft 78 is introduced through the second anterosuperior passage and the transhumeral protective sheath 38. The shaft 78 is assembled with the working surface 77 in the glenohumeral joint. The working surface 77 is a head shaped like a keel with cutting teeth to cut a keel shape into a glenoid surface 22. The punch 76 is struck with a hammer to complete the keel shaped cut into the glenoid (FIGS. 12 a-b).
  • [0134]
    The humeral head and glenoid trial implants are inserted through the anterosuperior passage and the rotator interval retractor 5 (FIG. 2) is temporarily removed. There are different humeral trial implants that can be used, one for the conventional implant and one for a novel implant. In either case, both can mate with trial modular stems through the transhumeral portal. If there is not sufficient bone available to stabilize the conventional humeral trial with a transhumeral trial stem or the humeral surface is too far offset from the intramedullary axis of the humeral shaft to accurately trial, the intramedullary canal of the humerus can be prepared and fitted with a conventional intramedullary stem trial using conventional techniques and instruments from the anterosuperior passage. Because the rotator cuff has not been transected, it is much simpler to determine the proper size implant required to restore the normal musculotendinous length and tension in the rotator cuff and thus, more accurately restore the native anatomical dimensions of the joint. Fluoroscopy can also be used to judge proper implant size.
  • [0135]
    Next, the glenoid 22 is prepared to affix its conventional implant 115 using transhumeral cementation tools 80 (FIGS. 13 a-e). A transhumeral irrigation and suction catheter is inserted into the transhumeral portal 30 through the novel transhumeral protective sheath 38 and used to irrigate and suck the prepared glenoid 22 holes dry. A transhumeral irrigation and suction catheter is used in yet another embodiment of the present invention. The irrigation and suction catheter includes semi-rigid tubing that is inserted through the second anterosuperior passage and the transhumeral protective sheath 38 in the transhumeral portal 30 in order to irrigate or suction the prepared glenoid surface. The catheter attaches to both, a fluid pump and suction tubing, and may be easily switched between the two with a stopcock-like device.
  • [0136]
    The peg or keel holes are temporarily packed with thrombin soaked gel pads or epinephrine soaked gauze using a novel transhumeral forceps device. The transhumeral irrigation and suction catheter is used again to clean and dry the holes and a transhumeral cementation catheter 84 is inserted through the transhumeral portal 30 and protective sheath 38 to place the cement.
  • [0137]
    Note that the above-described transhumeral cementation tool 80 includes a keel glenoid or peg glenoid cement pressurizer head 86 and a cementation catheter 84. The transhumeral cementation catheter 84 includes semi-rigid tubing which connects to a conventional cement gun 104 to deliver cement to the site of implant fixation to bone. The head 86 includes a keel glenoid or peg glenoid cement pressurizer tip 82 that is cannulated and fits into a respective keel or peg-shaped prepared hole in the glenoid surface to dispense cementation material under pressure into that hole in the glenoid surface 22. The pressurizer heads 86 are shaped similar to a glenoid implant with a smaller keel or single peg. The radius of curvature of the periphery of the tip 82 matches that of the reamed bony glenoid surface 22 to help seal the hole during cement insertion. These heads 86 are inserted through the first anterosuperior passage by their handles 88 and are attached to the transhumeral cementation catheter 84 within the glenohumeral joint 9 to pressurize the cement in the glenoid 22 holes. The handle 88 is removable and can be attached to the head 86 at different positions to allow it to be inserted from variable angles through the anterosuperior passage. The cementation head 86 limits the escape of cementation material from the hole and allows pressure to build up which forces the cement deep into the interstices of the trabecular bone to allow improved fixation. A cement pressurizer tip 82 may be inserted into the joint through the anterosuperior passage and assembled with the transhumeral cementation catheter 84. There are different pressurizer tips 82 to match either the pegged or keeled glenoid. The conventional glenoid implant 115 is inserted through the anterosuperior passage, is seated and held in place until the cement dries with a modular transhumeral glenoid impactor 90. Excess cement is removed and the joint is irrigated
  • [0138]
    The transhumeral glenoid impactor 90 includes a transhumeral shaft 92 which removably attaches to a working head 91. The working head 91 has a convex surface that approximates the radius of curvature of the articular surface of the glenoid implant. The shaft 92 is introduced through transhumeral protective sheath 38 within the transhumeral portal 30. The working head 91 is introduced through the first anterosuperior passage and mated with the transhumeral shaft 92. Force can then be applied to the handle 89 of the impactor 90 to seat the glenoid implant 115.
  • [0139]
    In accordance with an embodiment of the present invention, a multiple peg glenoid implant 117 (FIGS. 20 a-c) or a novel modular ingrowth glenoid implant 118 (FIGS. 26 a-b, 27 a-c) can also be inserted.
  • [0140]
    After the glenoid surface 22 has been reamed by a glenoid reamer 58 as described previously, the multiple glenoid pegs 117 can be introduced with a novel multiple peg guide 72 through the anterosuperior passage and inserted into the prepared surface of the glenoid 22 using a transhumeral insertor device 79 (FIG. 20 a). In another embodiment, a multiple peg glenoid insertor 79 and insertor guide 72 are used. The multiple peg glenoid insertor guide 72 includes a handle 73 and a guiding surface 71. The guiding surface 71 is sized and shaped as the glenoid peg drill guide surface 69 discussed above. The guide 72 is introduced via the first anterosuperior passage and holds multiple pegs 117 to be inserted into the glenoid 22. The guiding surface 71 of the guide 72 controls the depth and location of insertion of the multiple pegs 117.
  • [0141]
    The multiple peg glenoid insertor 79 is inserted via the second anterosuperior passage and through the transhumeral protective sheath 38 in the transhumeral portal 30. It is used to engage the pegs 117 located within the multiple peg insertor guide working surface 71 and then drives them into the glenoid 22 one at a time. The insertor 79 stops when it hits the guide surface 71 to control the depth of peg 117 insertion. Drilling pilot holes through a separate guide with a special transhumeral drill can precede this step. The guide surface 71, preloaded with the implant pegs 117 controls the position, direction and depth of peg 117 insertion. The guide surface 71 has a protruding centering peg which fits into the centering hole of the glenoid to help center and position the guide surface 71.
  • [0142]
    After the multiple peg prosthesis is implanted, trialing of a conventional or novel humeral implant can be performed as described previously.
  • [0143]
    Alternatively, a novel ingrowth glenoid implant 118 can be implanted after reaming the glenoid with a novel transhumeral glenoid reamer 57 as described previously. The novel modular ingrowth glenoid implant 118 has an ingrowth shell 120 and modular wear-resistant articulating surface 122 (FIGS. 23 a-b, 26 a-b, 27 a-c)
  • [0144]
    The ingrowth shell 120 of the glenoid implant 118 is a cannulated shallow shell with a protruding surface 119 that sits within the concavity of the reamed glenoid surface. The protruding surface is surrounded by a flat outer surface 121 (or brim). The protruding surface 119 may be any shape such as a square, pyramidal, hemispheric, triangular or any other suitable shape. The protruding surface 119 protrudes into the glenoid 22 to a specified depth. The depth is such that it is enough for the ingrowth shell 120 to be securely seated within the glenoid 22 and for the wear-resistant surface 122 to fit therein (as described below) and yet not so deep that a large amount of subchondral bone must be reamed from the glenoid 22. Preferably, the shape of the previously described novel glenoid reamer 57 is the same as the shape of the protruding surface 119 of the ingrowth shell 120 such that there will be a secure fit when the ingrowth shell 120 is seated within the glenoid 22. As the ingrowth shell 120 is pressed into the glenoid, the flat surface (or annular brim) 121 of the ingrowth shell 120 also makes contact with the peripheral glenoid surface 22, and in fact, provides a stopping point of insertion. The ingrowth shell 120 is made of suitable material, examples of which include, but are not limited to metal, tantalum, porous metal, trabecular metal, ceramic materials, and titanium. The protruding surface 119 and the annular brim 121 of the shell 120 may also maintain a surface of a bony ingrowth material, as described in connection with the humeral implant below. This ingrowth material promotes bone growth and adhesion of the shell to the glenoid surface. The ingrowth shell 120 has a thickness of 0.1 to 10 mm, preferably from 0.1 to 2 mm. The ingrowth shell 120 has holes for fixation. These holes may be central 124 and peripheral 126 and may further be smooth, threaded or a combination thereof. In one embodiment, a shell has a central hole 124 and multiple peripheral holes 126, for example three peripheral holes 126. The central hole 124 is preferably smooth and the peripheral holes 126 are preferably threaded.
  • [0145]
    After reaming, the ingrowth shell 120 is inserted through the anterosuperior passage and impacted into the concavity (which matches the shape of the reamer head 61 and that of the protruding surface 119 of the ingrowth shell 120 to be implanted,) of the reamed glenoid with a transhumeral impacting device 90. The concavity is slightly undersized to attain a tight fit upon impaction. The ingrowth glenoid shell 120 is then fixed to the glenoid 22 using screws 133, 135. In one embodiment, a central compression screw 133 is first used to compress the ingrowth shell into the concavity created in the glenoid and affix the ingrowth shell 120 to the glenoid and then fixed angle peripheral screws 135 are used to lock the ingrowth shell into place (FIGS. 25 a-b, 26 a-b).
  • [0146]
    The transhumeral glenoid drill 49 is used along with a transhumeral glenoid drill sleeve 48 (FIGS. 24 a-b) to make the holes for the glenoid screws 133, 135. The transhumeral glenoid drill sleeve 48 fits into a transhumeral glenoid screw sleeve 128 which fits into the protective transhumeral sheath 38 in the transhumeral portal 30. The drill sleeve 48 mates with the holes 124, 126 in the ingrowth shell component 120 of the novel glenoid implant 118 to direct the drill 49 in the proper orientation. The shaft of the transhumeral glenoid drill 49 just fits within the inner diameter of the transhumeral glenoid drill sleeve 48 and has visible markings on it that allow one to measure the depth of the hole off the distant edge of the transhumeral drill sleeve 48 (FIGS. 24 a-b). The drill 49 is advanced until the far cortex of the glenoid and scapula is reached. At which point, the surgeon reads the mark on the drill at the level of the glenoid drill guide sleeve 48. Approximately 5 mm is added to the screw length to determine the length of screw used. The drill 49 is then advanced through the far cortex to complete the screw hole in the glenoid 22.
  • [0147]
    In one embodiment of the present invention, a novel transhumeral screw driver 130 and transhumeral glenoid screw guide sleeve 128 are used to place the above described screws 133, 135. After drilling, the surgeon removes the inner transhumeral glenoid drill guide sleeve 48 and the transhumeral screwdriver 130 is inserted through the previously positioned transhumeral glenoid screw guide sleeve 48. The screw driver shaft 130 fits snuggly within a transhumeral glenoid screwdriver guide sleeve 128. The screwdriver 130 is then advanced to place a screw 133, 135 through a hole 124 or 126 of the ingrowth shell 120 of a novel glenoid implant 118 into the drilled glenoid bone 22. As briefly described above, a central screw 133 is first inserted through a central smooth hole 124 in the glenoid shell 120 to initially compress the ingrowth shell 120 firmly into the glenoid surface 22. The glenoid ingrowth shell 120 is then locked into place by at least one peripheral screw 135, preferably three (FIGS. 25 a-b, 26 a-b). For example, if three peripheral screws 135 are utilized, one is placed anterosuperiorly, one is placed posterosuperiorly, and one is placed inferiorly. The threads of the screws 135 engage the threading of the peripheral holes 126 in the glenoid ingrowth shell 120 as well as the drilled outer cortical surface of the glenoid 22 and scapula. The peripheral holes 126 of the shell 120 direct the screws 135 into a fixed divergent pattern.
  • [0148]
    After the glenoid ingrowth shell 120 is well fixed, the modular wear-resistant glenoid surface 122 is inserted though the anterosuperior passage and impacted into the shell 120 with a transhumeral glenoid impactor 90 (FIGS. 14 a-b, 26 a-b) as described previously.
  • [0149]
    The wear-resistant surface 122 of the glenoid implant 118 has a convex surface which mates with the concave side of the protruding surface 119 of the ingrowth shell 120 and forms the articulating surface of the glenoid implant 118. The protruding surface 119 of the ingrowth shell 120 is of thin dimension such that it simultaneously provides 1) fixation to the glenoid bone; 2) an ingrowth surface; 3) provides a support surface for the wear-resistant surface 122; and 4) a recessed coupling device which maximizes the thickness of the wear-resistant surface 122 for durability and while still maintaining proper anatomic glenohumeral surface relationships. The wear-resistant surface 122 may include, but is not limited to polyethylene, plastic, ceramic material, metals, and magnetic materials. At a minimum, the wear-resistant surface 122 has a thickness of 0.1 to 15 mm, preferably 4 to 7 mm, if composed of currently available forms of polyethylene, protruding above the glenoid bony surface and flat outer surface (or annular brim) 121 of the ingrowth shell 120. It may have variable thickness along its dimension to correct version of glenoid. The wear-resistant surface 122 of the glenoid implant 118, which is approximately pear shaped, has both a superior-inferior dimension and an anterior-posterior dimension. The superior-inferior axis has a suitable range of from about 20 to 60 mm, preferably from about 30 to 48 mm. The anterior-posterior axis defines an upper half and a lower half. The lower half anterior-posterior axis has a range of about 15 to 50 mm, preferably from about 21 to 35 mm. The upper half has a range of from about 10 to 50, preferably 18 to 33 mm. The ratio of the upper half to the lower half is approximately 0.8 to 1.0. The ratio of the lower half of the anterior-posterior axis to the superior-inferior axis is approximately 0.7 to 1.0, whereas the ratio of the upper half of the anterior-posterior axis to the superior-inferior axis is approximately 0.6 to 1.0. In addition, the radius of curvature of the superior-inferior axis of the glenoid surface is greater than the coronal radius of curvature of the humeral surface of the humeral implant with which the glenoid implant articulates. The anterior-posterior radius of curvature of the glenoid surface is larger than the axial radius of curvature of the humeral surface. It may have variable thickness along its dimension to correct version of glenoid.
  • [0150]
    To prepare the humerus for a conventional humeral implant, the humerus is adducted and extended to line up the axis of the intramedullary canal with the first anterosuperior passage. With the self-retaining rotator interval retractor 5 in place, the humeral canal is prepared using conventional instruments, trials are used to determine the proper fit and size of the implants, and the proper conventional humeral implant with an intramedullary stem is either cemented or press-fit into the proximal humerus 20 in accordance with the present.
  • [0151]
    For the novel humeral implant 94, the humerus does not require special positioning. After humeral trialing, the novel humeral stem 98 is placed in the transhumeral portal 30 from either the first or second anterosuperior passages and the novel modular head 96 is inserted through the anterosuperior passage. The two components 96, 98 are then mated together.
  • [0152]
    The novel humeral implant 94 in accordance with the present invention is modular and includes a humeral surface 96 component, a roughly hemispheric shaped surface with a short central mating device 100, and a transhumeral stem 98 which fills the transhumeral portal 30 (FIG. 15 a-b). Alternatively, a novel humeral surface implant that includes only a humeral surface 96, with no stem 98 may be used when warranted. Preferably, however, a novel humeral implant 94 with two components 96, 98 is used. The two components, the humeral surface 96 and stem 98, are removably attached to one another. The humeral surface 96 has a coronal radius of curvature and an axial radius of curvature. The humeral surface can be spherical in shape. Preferably the humeral surface can be more anatomic being spherical, with equal coronal and axial radii of curvature, in the center and elliptical, with larger coronal than axial radii of curvature, at the periphery. A suitable range for the coronal radius of curvature is from 10 to 50 mm, preferably from 19 to 28 mm, with approximately 81% of all men having a coronal radius of curvature ranging from 23-28 mm, and 79% of all women having coronal radius of curvature ranging from 19-22 mm. A suitable range for the axial radius of curvature of the humeral surface of the implant is from 10 to 50 mm, preferably from 18 to 26 mm. The humeral surface 96 of the implant 94 also has a depth and thickness. A suitable range for the depth of the humeral implant 94 is from 5 to 40 mm, preferably from 15 to 24 mm, and the depth is the same in both the coronal and axial planes. The humeral surface 96 thickness has a range of from 0.1 to 5 mm, preferably from 1 to 3 mm. The ratio of the depth to the coronal radius of curvature is approximately 0.7 to 0.9. See Table 1.
    TABLE 1
    Table 1 shows suitable and preferred ranges of radius of curvature
    and depth for the humeral surface of the humeral implant. (See
    lannotti JP, Gabriel JP, Schneck SL, et al. The normal glenohumeral
    relationships: an anatomical study of one hundred and forty
    shoulders. J Bone Joint Surg 1992; 74A(4): 491-500.)
    Radius of Depth (mm)
    curvature (mm) 15-17 18-20 21-24
    19-20 10 3 2
    21-22 7 18 3
    23-24 0 9 18
    25-26 0 8 14
    27-28 0 0 4
  • [0153]
    The humeral surface 96 of the humeral implant 94 may be spherically shaped or more of an elliptical shape which better approximates the anatomy of a natural humeral head. The humeral surface 96 may be made of a variety of materials including, but not limited to cobalt-chrome alloys, ceramic materials, metals, and magnetic materials. It is contemplated that the humeral surface may also have fins, spikes, or other protuberances on its concave, non-articular surface to enhance rotational stability. Additionally, the concave, non-articular surface may also contain a bony ingrowth material. A bony ingrowth material allows the bone to which the implant is attached to grow into the implant and aids in attaining long-lasting fixation of the implant. These ingrowth materials, include, but are not limited to autologous and allograft osteoprogenitor cells and tissues, bone-morphogenic proteins, hydroxyapaptite coating, trabecular metal, porous metal, porous metal coating, and tantalum. It is contemplated that the surface of the humeral surface component 96 of the implant 94 that articulates with the glenoid or the glenoid implant, is smooth with a low coefficient of friction.
  • [0154]
    The stem 98 of the modular humeral implant 94 is sized to fit within the transhumeral portal 30 located along the central axis of the neck of the humerus. By fitting, it is meant that the stem 98 fits in a tight manner and is stable in that location. As it is contemplated that the transhumeral portal 30 has a diameter of from 0.1 to 5 cm, the diameter of the stem 98 is also from 0.1 to 5 cm, and is dimensioned to fit within the transhumeral portal 30. The stem 98 may be composed of any suitable materials including, but not limited to titanium, stainless steel, cobalt-chrome alloy. The stem 98 may be smooth, textured, or threaded. Smooth glass bead blast finishes are another possibility. Threads may be uniform or may vary in width along the length of the stem. Further, the shape of the stem 98 is intended to accommodate the shape of the transhumeral portal 30, therefore it may be round, square, triangular, or any other geometric shape that may comprise the transhumeral portal 30. The main body of the stem 98 has a consistent cross-sectional shape and size along its straight longitudinal axis. Therefore, unlike conventional humeral implant stems, which are tapered and bowed to fit within the dimensions of the metaphysis and diaphysis of the humerus, the stem 98 of the present invention maintains a uniform diameter and is linear from end to end. As such, the stem is dimensioned to sit within the epiphyseal and metaphyseal portions of the humerus. As described for the humeral surface 96, the stem 98 may also contain fins or spikes to aid rotational stability, and it may also possess a bony ingrowth material surface, as describe above.
  • [0155]
    The stem 98 may be of varying lengths, a suitable range of which is from about 4 to 7 cm. The preferred length is dimensioned to extend from the lateral cortex of the humerus to the center of a humeral head. It is intended that this stem 98 be introduced into the transhumeral portal 30 via the second anterosuperior incision and advanced through the transhumeral portal 30 to a position that is suitable for mating with the humeral surface 96 which is inserted via the anterosuperior incision, described above. If appropriate, the stem 98 may also be inserted from the articular surface of the proximal humerus through the first anterosuperior passage.
  • [0156]
    The humeral surface 96 and stem 98 of the humeral implant 94 connect to one another via a mating site 100. The humeral surface 96 and stem 98 are joined within the glenohumeral joint space. They may be press fit, screwed together, or joined by morse taper, as well as any other suitable locking mechanism. It is possible for the male or female counterpart to be on either the stem 98 or the humeral surface 96, so long as one male counterpart and one female counterpart are present in the humeral implant 94.
  • [0157]
    The humeral surface 96 component is inserted through the anterosuperior passage and mated with its stem 98 placed through the transhumeral portal 30. The humeral surface 96 and modular stem 98 implant can be cemented or press-fit to the prepared humeral surface and there are many possible variations of the implant 94. Examples A, B, and C are various embodiments of a humeral implant 94 in accordance with the present invention. Example A includes a hemisphere shaped humeral surface 96 and a threaded transhumeral stem 98 (FIG. 16). The humeral surface 96 component is inserted through the anterosuperior passage and is either cemented or press-fit onto the humeral surface 20 and then impacted on the prepared humeral surface against the glenoid 22. The hemisphere shaped surface 96 is rotationally stabilized with a rod inserted into a hole at a peripheral edge of the hemisphere shaped surface 96 while the threaded humeral stem 98 is advanced through the protective sleeve 15 from the transhumeral portal guide 14 and up the transhumeral portal 30 to engage with the non-articular side of the hemisphere shaped humeral surface 96. The threaded stem 98 has a double pitch with finer pitched but deeper cancellous threads that engage and fill the transhumeral portal 30 and slightly wider pitched more shallow threads on the narrower diameter tip which engages the humeral surface 96 component so as to secure the humeral surface 96 component. Should it be necessary, removal of the example A implant 94 is conducted by recreating both anterosuperior passages, inserting a driver for the threaded stem 98 through the second anterosuperior passage, inserting a stabilizing rod into a peripheral edge of the humeral surface 96 component from the first anterosuperior passage and backing out the stem through the protective sleeve 15 from the transhumeral portal guide 14. The humeral surface 96 component is then removed by sawing across the base of the humeral surface 96 component at the anatomic neck of the humerus with a power or Gigli saw.
  • [0158]
    Example B includes a similar humeral surface 96 component and a cemented transhumeral stem 98 (FIGS. 17 a-c). Again, the humeral surface component 96 is inserted through the anterosuperior passage, is either cemented or press-fit onto the prepared humeral surface 20 and impacted on the prepared humeral surface 20 against the glenoid 22. Another transhumeral stem 98 which possesses the male end of a morse taper is inserted into the female end on the non-articular side of the humeral surface component 96 and impacted against the glenoid. This stem 98 may be press-fit or cemented to the bony transhumeral portal. An endcap 106 is threaded into the non-articular side of the stem 98 to assist with later removal of the humeral surface implant 94. To fix with cement, a cementation catheter 84 is assembled to an opening in the endcap 106 and cement is injected through the cannulated transhumeral stem 98 exiting holes 99 at its articular end. The cement is injected until it becomes visible around the non-articular end of the stem 98. Should it be necessary, removal of the example B implant is conducted by recreating the anterosuperior passages, removing the endcap with a T-handled wrench, threading the removal shaft 111 into the stem 98, drilling out the cement-implant interface with a coring reamer 110 over the stem 98, and disimpacting the stem 98 from the humeral surface component 96 with a disimpaction sleeve 112 (FIGS. 18 a-b). The humeral surface component 96 is removed by sawing across the base of the humeral surface component 96 at the anatomic neck of the humerus with a power or Gigli saw.
  • [0159]
    Example C includes a similar humeral surface 96 component and an inflatable transhumeral stem 98 (FIGS. 19 a-b) similar to technology used in the FIXION™ IM Nail (See “A New Expandable Implant for the Repair of Long Bone Fractures”, Sinha, Anjoy M. D. et al, published in www.Healthfocus.com). Again, the humeral surface component 96 is inserted through the anterosuperior passage and either cemented or press-fit, and further impacted on the prepared humeral surface 20 against the glenoid 22. Another transhumeral stem 98 which possesses the male end of a morse taper is inserted into the female end on the non-articular side of the humeral surface 96 component and impacted against the glenoid 22. The inflatable stem 98 is an expandable tube that is reinforced with longitudinal bars and has a one-way valve system on the end that doesn't mate with the humeral surface component. Once positioned, the stem 98 is inflated or expanded from its collapsed position with a specialized saline pump to fill the stem 98, within the transhumeral portal 30, and gain purchase. The stem 98 can be removed by deflating it with the same pump and disimpacting the stem 98 from the humeral surface 96 component with a disimpaction sleeve 112. The humeral surface component 96 is removed by sawing across the base of the humeral surface 96 component at the anatomic neck of the humerus with a power or Gigli saw.
  • [0160]
    After the prosthetic implants, either humeral or glenoid, novel or conventional, are inserted as described above, the soft-tissue tension is evaluated, and the wounds are copiously irrigated, the deep passages, subcutaneous tissue, and skin are closed with sutures.
  • [0161]
    In yet another embodiment, the present invention is a glenohumeral joint with a transhumeral portal 30 along the central axis of the neck of the humerus and at least one implant. The implant may be a humeral implant 94, a glenoid implant 118 or both. The implants may be conventional implant or novel 94,118 described herein.
  • [0162]
    In an alternative embodiment of the present invention, there is provided a method of repairing a rotator cuff, tear as shown in FIGS. 28-33. This procedure may be utilized in conjunction with the above described method of shoulder replacement or it may be used as a stand-alone procedure. In this method standard positioning and techniques for arthroscopic or open rotator cuff exposure are employed. If performed in conjunction with the previously described methods of shoulder replacement surgery, the anterosuperior passages may be used. If performed in isolation, an open deltoid split or arthroscopic subacromial exposure used for rotator cuff repair is performed in standard fashion. A small longitudinal stab is made through the skin and superficial deltoid fascia approximately 5-12 cm below the level of the anterolateral edge of the acromion.
  • [0163]
    In one embodiment of the rotator cuff repair method, an insertional guide 134 is inserted with a protective inner sheath 137 (FIGS. 28 a-b). The insertional guide 134 includes a cannulated handle 141 and a cannulated tip 148. The cannulated tip 148 is an elongated rigid tube with a sharp trocar tip 150. The diameter of the rigid tube and trocar tip 150 is slightly larger than that of the suture pin, 140 (FIG. 29) described below, and is approximately 1.0 to 5.0 mm. An inner protective sheath 137 may be used with the insertional guide 134 (FIG. 28 b). The inner protective sheath 137 screws into the handle 141 of the insertional guide 134. The inner protective sheath 137 has a handle 138 that acts as a stop and prevents the inner protective sheath 137 from extending further into the insertional guide 134 than the level of the protective sheath handle 138. The inner sheath 137 has a blunt end 139 that extends beyond the level of the sharp trocar 150 of the insertional guide 134, providing a non-sharp surface with which to enter the tissue. When the surgeon is prepared to use the sharp trocar tip 150 of the insertional guide 134, the inner protective sheath 137 is removed by unscrewing the handle 138 and sliding it out of the insertional guide 134. Optionally, an outer protective sheath may be used that extends over the tip of the insertional guide 134 and provides a blunt end as well. In this embodiment, the outer protective sheath has a longitudinal split so that it may be peeled off of the insertional guide when the surgeon is ready to use the sharp trocar tip 150 of the insertional guide 134. The bore tip 150 is extended into the lateral humeral 20 cortex under direct or arthroscopic visualization (FIG. 30). An arthroscopic retractor 136 may assist the process. Directed by an insertional guide 134, a suture-pin 140 is advanced by a drill through the greater tuberosity of the proximal humerus to exit into an anteromedial supraspinatus rotator cuff footprint. The next step is to reduce the torn edge of the supraspinatus tendon with a soft tissue grasper 138. The suture-pin 140 is advanced through the cuff (FIG. 31) and out through the superior soft-tissue and skin using a pin director 142 as needed (FIG. 32). The suture-pins 141 may pass through the acromion or deltoid as necessary. The drill is switched to a suture-pin leading tip and the pin component 140 is removed from the body. The pin 140 is cut from the suture 144. The above steps may be repeated as often as necessary to provide sufficient sutures 144 to secure the torn rotator cuff. For the arthroscopic technique, a tying cannula 146 is then inserted. The sutures 144 are retrieved and passed in modified Mason-Allen fashion if desired, using free needles (open technique) or an arthroscopic suture passing device. The sutures 144 are tied and the tying steps are repeated. The repair may be reinforced with lateral suture anchors as needed before or after tying the transosseous sutures 144 (FIG. 33).
  • [0164]
    The suture-pin device 141 comprises two components, a leading flexible pin 140 and a swedged on suture 144. The suture 144 is preferably a durable size #2 suture 144. The pin 140 has a sharp slightly larger diameter trocar tip 154 on its leading end. The remaining pin 140 has a diameter closer to that of the suture 144. The pin 140 is sufficiently long to enter the anterolateral surface of the shoulder, pass through the proximal humerus, rotator cuff, and exit the superior surface of the shoulder with both its leading and trailing ends are exposed. The suture 144 is of similar length.
  • [0165]
    It is therefore intended that the foregoing detailed description be regarded as illustrative rather than limiting, and that it be understood that it is the following claims, including all equivalents, that are intended to define the spirit and scope of this invention.

Claims (32)

  1. 1. A humeral implant comprising a first component removably attached to a second component.
  2. 2. The humeral implant of claim 1 wherein said first component is a humeral surface and said second component is a removably attachable stem.
  3. 3. The implant of claim 2 wherein said humeral surface has a coronal radius of curvature and an axial radius of curvature.
  4. 4. The implant of claim 3 wherein said coronal radius of curvature has a range of 10 to 50 mm.
  5. 5. The implant of claim 3 wherein said axial radius of curvature has a range of from 10 to 50 mm.
  6. 6. The implant of claim 3 wherein said humeral surface has a depth with a range of from 5 to 40 mm.
  7. 7. The implant of claim 3 wherein said humeral surface has a thickness with a range of from 0.1 to 10 mm.
  8. 8. The implant of claim 3 wherein a ratio of a depth of said humeral surface to said coronal radius of curvature is from about 0.7 to about 0.9.
  9. 9. The implant of claim 3 wherein said humeral surface is spherically or elliptically shaped.
  10. 10. The implant of claim 3 wherein said humeral surface is made of a material selected from the group consisting of cobalt chrome alloy, ceramic, metal, and magnet materials.
  11. 11. The implant of claim 3 wherein said humeral surface further comprises fins or spikes on a concave undersurface of said humeral surface.
  12. 12. The implant of claim 3 further comprising a concave undersurface for bony ingrowth material.
  13. 13. The implant of claim 3 wherein said humeral surface has a smooth articulating surface.
  14. 14. The implant of claim 3 wherein said attachable stem has a diameter with a range of from 0.1 to 5.0 cm.
  15. 15. The implant of claim 14 wherein said attachable stem is made of a material selected from the group consisting of titanium, stainless steel, tantalum, porous metal and trabecular metal.
  16. 16. The implant of claim 15 wherein said removably attached stem further comprises a smooth, textured or threaded surface.
  17. 17. The implant of claim 16 wherein said removably attached stem is round, square, or triangular.
  18. 18. The implant of claim 17 wherein said removably attached stem further comprises fins.
  19. 19. The implant of claim 17 wherein said removably attached stem further comprises a bony ingrowth surface.
  20. 20. The implant of claim 2 wherein said removably attached stem has a variable length wherein said stem extends from a lateral cortex of said humerus to a center of a head of said humerus.
  21. 21. The implant of claim 2 wherein said humeral surface connects to said removably attached stem.
  22. 22. The implant of claim 21 wherein said humeral surface connects to said removably attached stem by a technique selected from the group consisting of morse taper, and a screw.
  23. 23. A humeral head surface protective guard comprising a protective surface.
  24. 24. The protective guard of claim 23 further comprising a handle.
  25. 25. The protective guard of claim 23 wherein said protective surface comprises a shell that is centrally cannulated.
  26. 26. The protective guard of claim 25 wherein said protective surface has a thickness with a range of from 0.1 to 2.0 mm.
  27. 27. A glenohumeral joint comprising a transhumeral portal along a central axis of a neck of a proximal humerus and an implant.
  28. 28. The glenohumeral joint of claim 27 wherein said implant is a humeral implant
  29. 29. A repaired humerus bone comprising a modular implant with a humeral surface and a stem, wherein said stem is anchored in the epiphyseal-metaphyseal portion of said humerus bone.
  30. 30. The repaired humerus bone of claim 29 wherein said stem has a diameter with a range of from 0.1 to 5.0 cm.
  31. 31. The repaired humerus bone of claim 30 wherein said stem is linear.
  32. 32. A humeral implant comprising a humeral surface component and no stem.
US11525629 2003-08-11 2006-09-25 Humeral implant for minimally invasive shoulder replacement surgery Pending US20070016305A1 (en)

Priority Applications (8)

Application Number Priority Date Filing Date Title
US49428903 true 2003-08-11 2003-08-11
US50965503 true 2003-10-08 2003-10-08
US51180503 true 2003-10-16 2003-10-16
US52340103 true 2003-11-19 2003-11-19
US57989304 true 2004-06-15 2004-06-15
US58503304 true 2004-07-02 2004-07-02
US10917266 US20050043805A1 (en) 2003-08-11 2004-08-11 Devices and methods used for shoulder replacement
US11525629 US20070016305A1 (en) 2003-08-11 2006-09-25 Humeral implant for minimally invasive shoulder replacement surgery

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US11525629 US20070016305A1 (en) 2003-08-11 2006-09-25 Humeral implant for minimally invasive shoulder replacement surgery
US13068309 US20120041563A1 (en) 2003-08-11 2011-05-09 Resurfacing implant for a humeral head

Related Parent Applications (1)

Application Number Title Priority Date Filing Date
US10917266 Division US20050043805A1 (en) 2003-08-11 2004-08-11 Devices and methods used for shoulder replacement

Related Child Applications (1)

Application Number Title Priority Date Filing Date
US13068309 Division US20120041563A1 (en) 2003-08-11 2011-05-09 Resurfacing implant for a humeral head

Publications (1)

Publication Number Publication Date
US20070016305A1 true true US20070016305A1 (en) 2007-01-18

Family

ID=34199387

Family Applications (8)

Application Number Title Priority Date Filing Date
US10917266 Abandoned US20050043805A1 (en) 2003-08-11 2004-08-11 Devices and methods used for shoulder replacement
US11518021 Active 2030-12-19 US9445910B2 (en) 2003-08-11 2006-09-11 Method of minimally invasive shoulder replacement surgery
US11525631 Pending US20070016304A1 (en) 2003-08-11 2006-09-25 Glenoid implant for minimally invasive shoulder replacement surgery
US11525629 Pending US20070016305A1 (en) 2003-08-11 2006-09-25 Humeral implant for minimally invasive shoulder replacement surgery
US11529197 Pending US20070027417A1 (en) 2003-08-11 2006-09-29 Guide for shoulder surgery
US11529185 Pending US20070027477A1 (en) 2003-08-11 2006-09-29 Suture pin device
US11585041 Active 2030-05-18 US8540737B2 (en) 2003-08-11 2006-10-24 Method of arthroscopic or open rotator cuff repair using an insertional guide for delivering a suture pin
US13068309 Pending US20120041563A1 (en) 2003-08-11 2011-05-09 Resurfacing implant for a humeral head

Family Applications Before (3)

Application Number Title Priority Date Filing Date
US10917266 Abandoned US20050043805A1 (en) 2003-08-11 2004-08-11 Devices and methods used for shoulder replacement
US11518021 Active 2030-12-19 US9445910B2 (en) 2003-08-11 2006-09-11 Method of minimally invasive shoulder replacement surgery
US11525631 Pending US20070016304A1 (en) 2003-08-11 2006-09-25 Glenoid implant for minimally invasive shoulder replacement surgery

Family Applications After (4)

Application Number Title Priority Date Filing Date
US11529197 Pending US20070027417A1 (en) 2003-08-11 2006-09-29 Guide for shoulder surgery
US11529185 Pending US20070027477A1 (en) 2003-08-11 2006-09-29 Suture pin device
US11585041 Active 2030-05-18 US8540737B2 (en) 2003-08-11 2006-10-24 Method of arthroscopic or open rotator cuff repair using an insertional guide for delivering a suture pin
US13068309 Pending US20120041563A1 (en) 2003-08-11 2011-05-09 Resurfacing implant for a humeral head

Country Status (2)

Country Link
US (8) US20050043805A1 (en)
WO (1) WO2005016123A3 (en)

Cited By (55)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20050277961A1 (en) * 2004-06-09 2005-12-15 Arthrotek, Inc. Method and apparatus for soft tissue fixation
US20060282085A1 (en) * 2004-11-09 2006-12-14 Arthrotek, Inc. Soft tissue conduit device
US20070049944A1 (en) * 2004-06-09 2007-03-01 Arthrotek, Inc. Method and apparatus for soft tissue fixation
US20080027446A1 (en) * 2006-02-03 2008-01-31 Biomet Sports Medicine, Inc. Soft Tissue Repair and Conduit Device
US20080065114A1 (en) * 2006-02-03 2008-03-13 Biomet Sports Medicine, Inc. Method for Tissue Fixation
US20080082128A1 (en) * 2006-09-29 2008-04-03 Arthrotek, Inc. Method and apparatus for forming a self-locking adjustable suture loop
US20080140092A1 (en) * 2006-02-03 2008-06-12 Stone Kevin T Soft tissue repair device and associated methods
US20080140093A1 (en) * 2006-02-03 2008-06-12 Stone Kevin T Soft tissue repair device and associated methods
US20090054928A1 (en) * 2004-11-05 2009-02-26 Biomet Sports Medicine, Llc Method and apparatus for coupling anatomical features
US20090062854A1 (en) * 2004-11-05 2009-03-05 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to bone
US20090082805A1 (en) * 2006-09-29 2009-03-26 Biomet Sports Medicine, Llc Adjustable knotless loops
US20090192468A1 (en) * 2004-11-09 2009-07-30 Biomet Sports Medicine, Llc Soft tissue conduit device and method
US20090254091A1 (en) * 2008-04-04 2009-10-08 Long Jack F Humeral rotating burr guide
US20090306711A1 (en) * 2006-02-03 2009-12-10 Biomet Sports Medicine, Llc Method for Tissue Fixation
US20090318961A1 (en) * 2006-02-03 2009-12-24 Biomet Sports Medicine,Llc Method and Apparatus for Coupling Soft Tissue to a Bone
US20100042114A1 (en) * 2004-02-20 2010-02-18 Biomet Sports Medicine, Llc Apparatus for Performing Meniscus Repair
US7695503B1 (en) 2004-06-09 2010-04-13 Biomet Sports Medicine, Llc Method and apparatus for soft tissue attachment
US7749250B2 (en) 2006-02-03 2010-07-06 Biomet Sports Medicine, Llc Soft tissue repair assembly and associated method
US20100211075A1 (en) * 2006-09-29 2010-08-19 Biomet Sports Medicine, Llc Fracture Fixation Device
US7828820B2 (en) 2006-03-21 2010-11-09 Biomet Sports Medicine, Llc Method and apparatuses for securing suture
US20100292792A1 (en) * 2006-09-29 2010-11-18 Biomet Sports Medicine, Llc Prosthetic Ligament System for Knee Joint
US20100305698A1 (en) * 2009-05-28 2010-12-02 Biomet Manufacturing Corp. Knee Prosthesis Assembly With Ligament Link
US20100305709A1 (en) * 2006-09-29 2010-12-02 Biomet Manufacturing Corp. Knee Prosthesis Assembly With Ligament Link
US7967843B2 (en) 2004-06-09 2011-06-28 Biomet Sports Medicine, Llc Method for soft tissue attachment
US20110185560A1 (en) * 2008-08-18 2011-08-04 Qioptiq Photonics Gmbh & Co. Kg Method for producing an objective
US20110218625A1 (en) * 2006-02-03 2011-09-08 Biomet Sports Medicine, Llc Method and Apparatus for Fixation of an ACL Graft
US8088130B2 (en) 2006-02-03 2012-01-03 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to a bone
US8118836B2 (en) 2004-11-05 2012-02-21 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to a bone
US8251998B2 (en) 2006-08-16 2012-08-28 Biomet Sports Medicine, Llc Chondral defect repair
US8303604B2 (en) 2004-11-05 2012-11-06 Biomet Sports Medicine, Llc Soft tissue repair device and method
US8506597B2 (en) 2011-10-25 2013-08-13 Biomet Sports Medicine, Llc Method and apparatus for interosseous membrane reconstruction
US8562647B2 (en) 2006-09-29 2013-10-22 Biomet Sports Medicine, Llc Method and apparatus for securing soft tissue to bone
US8562645B2 (en) 2006-09-29 2013-10-22 Biomet Sports Medicine, Llc Method and apparatus for forming a self-locking adjustable loop
US8574235B2 (en) 2006-02-03 2013-11-05 Biomet Sports Medicine, Llc Method for trochanteric reattachment
US8597327B2 (en) 2006-02-03 2013-12-03 Biomet Manufacturing, Llc Method and apparatus for sternal closure
US8652171B2 (en) 2006-02-03 2014-02-18 Biomet Sports Medicine, Llc Method and apparatus for soft tissue fixation
US8652172B2 (en) 2006-02-03 2014-02-18 Biomet Sports Medicine, Llc Flexible anchors for tissue fixation
US8672969B2 (en) 2006-09-29 2014-03-18 Biomet Sports Medicine, Llc Fracture fixation device
US8771352B2 (en) 2011-05-17 2014-07-08 Biomet Sports Medicine, Llc Method and apparatus for tibial fixation of an ACL graft
US8936621B2 (en) 2006-02-03 2015-01-20 Biomet Sports Medicine, Llc Method and apparatus for forming a self-locking adjustable loop
US9017381B2 (en) 2007-04-10 2015-04-28 Biomet Sports Medicine, Llc Adjustable knotless loops
US9149267B2 (en) 2006-02-03 2015-10-06 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to a bone
US9259217B2 (en) 2012-01-03 2016-02-16 Biomet Manufacturing, Llc Suture Button
US9271713B2 (en) 2006-02-03 2016-03-01 Biomet Sports Medicine, Llc Method and apparatus for tensioning a suture
US9314241B2 (en) 2011-11-10 2016-04-19 Biomet Sports Medicine, Llc Apparatus for coupling soft tissue to a bone
US9357991B2 (en) 2011-11-03 2016-06-07 Biomet Sports Medicine, Llc Method and apparatus for stitching tendons
US9364333B1 (en) 2011-04-01 2016-06-14 The Lonnie and Shannon Paulos Trust Transosseous methods and systems for joint repair
US9370350B2 (en) 2011-11-10 2016-06-21 Biomet Sports Medicine, Llc Apparatus for coupling soft tissue to a bone
US9381013B2 (en) 2011-11-10 2016-07-05 Biomet Sports Medicine, Llc Method for coupling soft tissue to a bone
US9538998B2 (en) 2006-02-03 2017-01-10 Biomet Sports Medicine, Llc Method and apparatus for fracture fixation
US9615822B2 (en) 2014-05-30 2017-04-11 Biomet Sports Medicine, Llc Insertion tools and method for soft anchor
US9700291B2 (en) 2014-06-03 2017-07-11 Biomet Sports Medicine, Llc Capsule retractor
US9757119B2 (en) 2013-03-08 2017-09-12 Biomet Sports Medicine, Llc Visual aid for identifying suture limbs arthroscopically
US9918827B2 (en) 2013-03-14 2018-03-20 Biomet Sports Medicine, Llc Scaffold for spring ligament repair
US9918826B2 (en) 2006-09-29 2018-03-20 Biomet Sports Medicine, Llc Scaffold for spring ligament repair

Families Citing this family (113)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6520964B2 (en) 2000-05-01 2003-02-18 Std Manufacturing, Inc. System and method for joint resurface repair
US8388624B2 (en) 2003-02-24 2013-03-05 Arthrosurface Incorporated Trochlear resurfacing system and method
US6610067B2 (en) 2000-05-01 2003-08-26 Arthrosurface, Incorporated System and method for joint resurface repair
US7678151B2 (en) 2000-05-01 2010-03-16 Ek Steven W System and method for joint resurface repair
US8177841B2 (en) 2000-05-01 2012-05-15 Arthrosurface Inc. System and method for joint resurface repair
US20030055316A1 (en) * 2001-09-19 2003-03-20 Brannon James Kevin Endoscopic bone debridement
US7901408B2 (en) * 2002-12-03 2011-03-08 Arthrosurface, Inc. System and method for retrograde procedure
EP1845890A4 (en) 2003-11-20 2010-06-09 Arthrosurface Inc System and method for retrograde procedure
US7828853B2 (en) 2004-11-22 2010-11-09 Arthrosurface, Inc. Articular surface implant and delivery system
EP1765201A4 (en) 2004-06-28 2013-01-23 Arthrosurface Inc System for articular surface replacement
US7951163B2 (en) 2003-11-20 2011-05-31 Arthrosurface, Inc. Retrograde excision system and apparatus
US7163541B2 (en) 2002-12-03 2007-01-16 Arthrosurface Incorporated Tibial resurfacing system
US7887544B2 (en) * 2003-03-10 2011-02-15 Tornier Sas Ancillary tool for positioning a glenoid implant
FR2859099B1 (en) * 2003-08-25 2006-01-06 Tornier Sa Glenoid component of shoulder prosthesis and total shoulder prosthesis incorporating such a component
JP2007512108A (en) 2003-11-20 2007-05-17 アースロサーフィス・インコーポレーテッド Degeneracy specific delivery of surface re-forming device
US8182485B1 (en) 2003-11-21 2012-05-22 Toby Orthopaedics, Llc Fracture fixation system
EP2338442B1 (en) 2003-12-11 2013-01-30 Isto Technologies Inc. Particulate cartilage system
FR2863865B1 (en) * 2003-12-19 2006-10-06 Tornier Sa Prothese of shoulder or hip and assembly PROCESS
US7407511B2 (en) * 2004-05-13 2008-08-05 Wright Medical Technology Inc Methods and materials for connective tissue repair
US7294133B2 (en) * 2004-06-03 2007-11-13 Zimmer Technology, Inc. Method and apparatus for preparing a glenoid surface
EP1607069B1 (en) * 2004-06-15 2009-12-23 Tornier Inverse-type total shoulder prosthesis
FR2871371B1 (en) * 2004-06-15 2007-04-06 Tornier Sas Glenoid component for shoulder prosthesis, of components set of such a component and total shoulder prosthesis incorporating such a component
US8303665B2 (en) 2004-06-15 2012-11-06 Tornier Sas Glenoidal component, set of such components and shoulder prosthesis incorporating such a glenoidal component
US8778028B2 (en) * 2005-02-25 2014-07-15 Shoulder Innovations, Inc. Methods and devices for less invasive glenoid replacement
US8007538B2 (en) * 2005-02-25 2011-08-30 Shoulder Innovations, Llc Shoulder implant for glenoid replacement
US20060241775A1 (en) * 2005-04-21 2006-10-26 Buss Daniel D Humeral joint prosthesis
WO2007025290A3 (en) * 2005-08-26 2007-10-18 H Davis Adkisson Iv Implants and methods for repair, replacement and treatment of joint disease
US9474619B2 (en) * 2006-03-21 2016-10-25 Tornier, Inc. Glenoid component with improved fixation stability
WO2007109340A3 (en) * 2006-03-21 2008-07-24 Axiom Orthopaedics Inc Femoral and humeral stem geometry and implantation method for orthopedic joint reconstruction
US9433507B2 (en) * 2006-03-21 2016-09-06 Tornier, Inc. Non-spherical articulating surfaces in shoulder and hip replacement
FR2899790B1 (en) * 2006-04-13 2008-06-13 Tornier Sas Glenoid component for total shoulder prosthesis, game such components, and total shoulder prosthesis comprising such a component
FR2900045B1 (en) * 2006-04-21 2009-01-16 Tornier Sas Prothese of shoulder or hip
US20080021564A1 (en) * 2006-07-20 2008-01-24 Gunther Stephen B Humeral head resurfacing implant and methods of use thereof
WO2008073404A3 (en) 2006-12-11 2008-08-21 Arthrosurface Inc Retrograde resection apparatus and method
US8163549B2 (en) 2006-12-20 2012-04-24 Zimmer Orthobiologics, Inc. Method of obtaining viable small tissue particles and use for tissue repair
US20080154233A1 (en) * 2006-12-20 2008-06-26 Zimmer Orthobiologics, Inc. Apparatus for delivering a biocompatible material to a surgical site and method of using same
US20090287309A1 (en) * 2007-01-30 2009-11-19 Tornier Sas Intra-articular joint replacement
FR2911773B1 (en) * 2007-01-30 2009-03-27 Tornier Sas Method and set of surgical instrumentation to ask a total prosthesis of inverted shoulder, and corresponding prosthesis
CA2684040C (en) 2007-04-12 2016-12-06 Isto Technologies, Inc. Method of forming an implant using a mold that mimics the shape of the tissue defect site and implant formed therefrom
EP1990026B1 (en) * 2007-05-01 2014-03-12 Arthrex, Inc. Prosthetic for replacing a portion of a bone
US8845685B2 (en) * 2007-05-03 2014-09-30 Biomet Sports Medicine, Llc Anchor assembly and method of use
US20090005794A1 (en) * 2007-06-28 2009-01-01 Biomet Sports Medicine, Inc. Suture Holding Device
US9072509B2 (en) 2007-10-12 2015-07-07 Howmedica Osteonics Corp. Toggle bolt suture anchor kit
US8157866B2 (en) * 2007-11-05 2012-04-17 Biomet Manufacturing Corp. Method and apparatus for performing a less invasive shoulder procedure
EP2057970B1 (en) * 2007-11-07 2016-01-06 Arthrex, Inc. Hybrid glenoid for shoulder arthroplasty
JP6017759B2 (en) * 2007-12-21 2016-11-02 スミス アンド ネフュー インコーポレーテッドSmith & Nephew,Inc. Cannula
EP2262448A4 (en) 2008-03-03 2014-03-26 Arthrosurface Inc Bone resurfacing system and method
US20090228010A1 (en) 2008-03-10 2009-09-10 Eduardo Gonzalez-Hernandez Bone fixation system
WO2009128846A1 (en) 2008-04-17 2009-10-22 Mgh Meddesign, Llc Soft tissue attachment system and clip
US8454703B2 (en) * 2008-05-21 2013-06-04 Linares Medical Devices, Llc Shoulder implant with first and second composite sub-assemblies and improved mounting anchors for establishing a secure joint
US8556911B2 (en) 2009-01-27 2013-10-15 Vishal M. Mehta Arthroscopic tunnel guide for rotator cuff repair
WO2010088561A3 (en) 2009-01-30 2010-10-07 Kfx Medical Corporation System and method for attaching soft tissue to bone
US9833327B2 (en) 2009-03-20 2017-12-05 DePuy Synthes Products, Inc. Glenoid component for use in shoulder arthroplasty
WO2010120346A1 (en) * 2009-04-13 2010-10-21 George John Lian Custom radiographically designed cutting guides and instruments for use in total ankle replacement surgery
US9662126B2 (en) * 2009-04-17 2017-05-30 Arthrosurface Incorporated Glenoid resurfacing system and method
WO2010121246A1 (en) * 2009-04-17 2010-10-21 Arthrosurface Incorporated Glenoid resurfacing system and method
WO2010132506A1 (en) * 2009-05-13 2010-11-18 Crisco L Van Thomas Radial cardiac catheterization board
US8700131B2 (en) * 2009-05-13 2014-04-15 Merit Medical Systems, Inc. Radial cardiac catheterization board
US8696680B2 (en) 2009-08-11 2014-04-15 The Cleveland Clinic Foundation Method and apparatus for insertion of an elongate pin into a surface
WO2011019797A3 (en) * 2009-08-11 2011-07-21 The Cleveland Clinic Foundation Method and apparatus for insertion of an elongate pin into a surface
EP2488118A4 (en) * 2009-10-13 2017-01-04 Conmed Corp System and method for securing tissue to bone
CN102740786A (en) * 2009-12-22 2012-10-17 托比骨科有限公司 Bone plate and tool assembly and method for use thereof
US8506569B2 (en) 2009-12-31 2013-08-13 DePuy Synthes Products, LLC Reciprocating rasps for use in an orthopaedic surgical procedure
US8556901B2 (en) 2009-12-31 2013-10-15 DePuy Synthes Products, LLC Reciprocating rasps for use in an orthopaedic surgical procedure
GB2479017B (en) * 2010-03-17 2012-02-08 Thomas Maurice Stewart Gregory Shoulder replacement apparatus
US9408652B2 (en) 2010-04-27 2016-08-09 Tornier Sas Intra-articular joint replacement and method
WO2012021241A3 (en) * 2010-08-12 2012-05-10 Smith & Nephew, Inc. Methods and devices for installing standard and reverse shoulder implants
JP2014504161A (en) * 2010-09-01 2014-02-20 メイヨ フォンデーシヨン フォー メディカル エジュケーション アンド リサーチ Optimization method arthroplasty Component Design
US9320608B2 (en) 2010-09-01 2016-04-26 Mayo Foundation For Medical Education And Research Method for optimization of joint arthroplasty component design
US8961573B2 (en) 2010-10-05 2015-02-24 Toby Orthopaedics, Inc. System and method for facilitating repair and reattachment of comminuted bone portions
US9044313B2 (en) 2010-10-08 2015-06-02 Kfx Medical Corporation System and method for securing tissue to bone
US8870963B2 (en) 2010-10-27 2014-10-28 Toby Orthopaedics, Inc. System and method for fracture replacement of comminuted bone fractures or portions thereof adjacent bone joints
DE102010054663B3 (en) * 2010-12-15 2012-06-28 Heraeus Medical Gmbh Mold for molding an acetabulum
US9713463B2 (en) 2011-01-13 2017-07-25 Howmedica Osteonics Corp Toggle bolt assembly and method of assembly
US8486076B2 (en) 2011-01-28 2013-07-16 DePuy Synthes Products, LLC Oscillating rasp for use in an orthopaedic surgical procedure
CN103945780B (en) 2011-02-22 2016-12-07 齐默尔膝部创造物公司 Navigation and positioning system and a guide device for joint repair
WO2012119146A3 (en) 2011-03-03 2012-10-26 Toby Orthopaedics, Llc Anterior lesser tuberosity fixed angle fixation device and method of use associated therewith
US9820758B2 (en) 2011-03-18 2017-11-21 DePuy Synthes Products, Inc. Combination reamer/drill bit for shoulder arthoplasty
US8551177B2 (en) * 2011-03-18 2013-10-08 DePuy Synthes Products, LLC Revision glenoid kit
US9226830B2 (en) 2011-03-18 2016-01-05 DePuy Synthes Products, Inc. Device and method for retroversion correction for shoulder arthroplasty
US8764836B2 (en) * 2011-03-18 2014-07-01 Lieven de Wilde Circular glenoid method for shoulder arthroplasty
US9763679B2 (en) 2011-03-18 2017-09-19 DePuy Synthes Products, Inc. Combination driver/anti-rotation handle for shoulder arthroplasty
US8840644B2 (en) 2011-03-24 2014-09-23 Howmedica Osteonics Corp. Toggle bolt suture anchor
US9066716B2 (en) 2011-03-30 2015-06-30 Arthrosurface Incorporated Suture coil and suture sheath for tissue repair
US20160143749A1 (en) * 2011-04-08 2016-05-26 The General Hospital Corporation Glenoid component installation procedure and tooling for shoulder arthroplasty
US8702800B2 (en) 2011-08-23 2014-04-22 Linares Medical Devices, Llc Multi-component shoulder implant assembly with dual articulating surfaces
US8864835B2 (en) 2011-08-24 2014-10-21 Linares Medical Devices, Llc Multi-component knee implant assembly with multiple articulating and traveling surfaces
US8702802B2 (en) 2011-08-29 2014-04-22 Linares Medical Devices, Llc Knee implant assembly with rotary bearing supported and traveling surfaces
US8753403B2 (en) 2011-08-30 2014-06-17 Linares Medical Devices, Llc Multi-component knee implant assembly with combined articulating and belt support and traveling surfaces
CA2850812A1 (en) 2011-10-04 2013-04-11 Kfx Medical Corporation Dual expansion anchor
US9730797B2 (en) 2011-10-27 2017-08-15 Toby Orthopaedics, Inc. Bone joint replacement and repair assembly and method of repairing and replacing a bone joint
US9271772B2 (en) 2011-10-27 2016-03-01 Toby Orthopaedics, Inc. System and method for fracture replacement of comminuted bone fractures or portions thereof adjacent bone joints
US9402667B2 (en) 2011-11-09 2016-08-02 Eduardo Gonzalez-Hernandez Apparatus and method for use of the apparatus for fracture fixation of the distal humerus
US9782165B2 (en) 2011-11-11 2017-10-10 VentureMD Innovations, LLC Transosseous attachment
US9078673B2 (en) * 2012-01-18 2015-07-14 Ortho Innovations, Inc. Method of humeral head resurfacing and/or replacement and system for accomplishing the method
US9498334B2 (en) * 2012-03-27 2016-11-22 DePuy Synthes Products, Inc. Glenoid defect-filling component
US9468448B2 (en) 2012-07-03 2016-10-18 Arthrosurface Incorporated System and method for joint resurfacing and repair
US9125784B2 (en) 2012-08-28 2015-09-08 Merit Medical Systems, Inc. Arm positioning cushion
US9610084B2 (en) * 2012-09-12 2017-04-04 Peter Michael Sutherland Walker Method and apparatus for hip replacements
US20140094822A1 (en) * 2012-09-21 2014-04-03 Atlas Spine, Inc. Minimally invasive spine surgery instruments: guide wire handle with a guide wire locking mechanism
US8936645B1 (en) 2012-11-01 2015-01-20 Marcos V. Masson Surgical process for resurfacing a humeral head
US9283008B2 (en) 2012-12-17 2016-03-15 Toby Orthopaedics, Inc. Bone plate for plate osteosynthesis and method for use thereof
US9687221B2 (en) 2013-02-13 2017-06-27 Venture MD Innovations, LLC Method of anchoring a suture
US9839438B2 (en) * 2013-03-11 2017-12-12 Biomet Manufacturing, Llc Patient-specific glenoid guide with a reusable guide holder
JP2016511090A (en) 2013-03-15 2016-04-14 ケーエフエックス・メディカル・エルエルシー The systems and methods for securing tissue to bone
US9333014B2 (en) 2013-03-15 2016-05-10 Eduardo Gonzalez-Hernandez Bone fixation and reduction apparatus and method for fixation and reduction of a distal bone fracture and malunion
US9492200B2 (en) 2013-04-16 2016-11-15 Arthrosurface Incorporated Suture system and method
JP2016518929A (en) * 2013-04-26 2016-06-30 ニューヨーク・ソサイエティ・フォー・ザ・ラプチャード・アンド・クリップルド・メインテイニング・ザ・ホスピタル・フォー・スペシャル・サージェリー Multielement nonbiodegradable implants, manufacturing method, and transplantation methods
EP3089709A1 (en) 2014-01-03 2016-11-09 Tornier, Inc. Reverse shoulder systems
US20150250594A1 (en) 2014-03-07 2015-09-10 Arthrosurface Incorporated System and method for repairing articular surfaces
WO2015200266A1 (en) * 2014-06-23 2015-12-30 Community Blood Center Cellular-scale surface modification for increased osteogenic protein expression
US20170273801A1 (en) * 2016-03-25 2017-09-28 Tornier, Inc. Surgical instrumentation assembly, set and surgical shoulder repair method
US9737313B1 (en) 2016-11-07 2017-08-22 Roger C. Sohn Shoulder reamer devices, systems including the same, and related methods

Citations (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3987499A (en) * 1973-08-10 1976-10-26 Sybron Corporation Surgical implant and method for its production
US4919670A (en) * 1988-02-03 1990-04-24 Intermedics Orthopedics, Inc. Modular humeral prosthesis
US5314479A (en) * 1986-08-15 1994-05-24 Depuy Inc. Modular prosthesis
US5358526A (en) * 1991-12-27 1994-10-25 Etablissements Tornier Modular shoulder prosthesis
US5376125A (en) * 1991-01-25 1994-12-27 Winkler; Heinz Hip joint endoprosthesis
US5489309A (en) * 1993-01-06 1996-02-06 Smith & Nephew Richards Inc. Modular humeral component system
US5702486A (en) * 1994-02-22 1997-12-30 Kirschner Medical Corporation Modular humeral prosthesis for reconstruction of the humerus
US6045552A (en) * 1998-03-18 2000-04-04 St. Francis Medical Technologies, Inc. Spine fixation plate system
US6783549B1 (en) * 2001-07-27 2004-08-31 Biomet, Inc. Modular humeral head resurfacing system
US20040193278A1 (en) * 2003-03-31 2004-09-30 Maroney Brian J. Articulating surface replacement prosthesis
US7128763B1 (en) * 1995-05-26 2006-10-31 Gerald Blatt Joint treating method

Family Cites Families (51)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB1528471A (en) * 1975-03-13 1978-10-11 Nat Res Dev Prosthetic shoulder joint devices
US4261062A (en) * 1979-03-22 1981-04-14 The Regents Of The University Of California Natural shoulder joint prosthesis
US4383527A (en) * 1981-02-20 1983-05-17 Howmedica, Inc. Device for guiding the insertion of surgical wires into bone tissue
GB2117646B (en) * 1982-04-07 1985-04-11 Nat Res Dev Endprosthetic bone joint devices
US5417691A (en) * 1982-05-20 1995-05-23 Hayhurst; John O. Apparatus and method for manipulating and anchoring tissue
US4550450A (en) * 1984-07-24 1985-11-05 Kinnett James G Total shoulder prosthesis system
FR2579454A1 (en) * 1985-03-28 1986-10-03 Rambert Andre Glenohumeral prosthesis
NL8501786A (en) * 1985-06-21 1987-01-16 Drukker D & Zn Nv Method for the production of microsurgical suture needles, as well as thus obtained microsurgical suture needles.
EP0328847A1 (en) * 1988-01-14 1989-08-23 Gebrüder Sulzer Aktiengesellschaft Endoprosthesis for reinforcement of pelvis bone edge
US5080673A (en) * 1988-02-03 1992-01-14 Intermedics Orthopedics, Inc. Glenoid prosthesis and method of use
US5102421A (en) * 1990-06-14 1992-04-07 Wm. E. Anpach, III Suture anchor and method of forming
DE9101037U1 (en) * 1991-01-30 1991-04-18 Howmedica Gmbh, 2314 Schoenkirchen, De
US5226917A (en) * 1991-02-14 1993-07-13 Smith & Nephew Richards Inc. Acetabular prosthesis with anchoring pegs
US5147367A (en) * 1991-02-22 1992-09-15 Ellis Alfred B Drill pin guide and method for orthopedic surgery
DE4238832C1 (en) * 1992-11-17 1994-08-11 Plus Endoprothetik Ag Shoulder endoprosthesis
US5584839A (en) * 1994-12-12 1996-12-17 Gieringer; Robert E. Intraarticular drill guide and arthroscopic methods
WO1997007743A1 (en) * 1995-08-25 1997-03-06 Grotz R Thomas Stabilizer for human joints
US5681333A (en) * 1995-11-08 1997-10-28 Arthrex, Inc. Method and apparatus for arthroscopic rotator cuff repair utilizing bone tunnels for suture attachment
DE19680996D2 (en) * 1995-11-20 1999-01-28 Artos Med Produkte modular endoprosthesis
US6491714B1 (en) * 1996-05-03 2002-12-10 William F. Bennett Surgical tissue repair and attachment apparatus and method
FR2749753B1 (en) * 1996-06-14 1998-12-24 Mosseri Raphael Total hip prosthesis destiny has to be asked by endo-articularly and its auxiliary device
US5779710A (en) * 1996-06-21 1998-07-14 Matsen, Iii; Frederick A. Joint replacement method and apparatus
US5948000A (en) * 1996-10-03 1999-09-07 United States Surgical Corporation System for suture anchor placement
US5800551A (en) * 1997-03-10 1998-09-01 Biomet, Inc. Apparatus and method for shoulder arthroplasty
US6013083A (en) * 1997-05-02 2000-01-11 Bennett; William F. Arthroscopic rotator cuff repair apparatus and method
US6027503A (en) * 1997-10-17 2000-02-22 Johnson & Johnson Professional, Inc. Orthopedic reaming instrument
US6036696A (en) * 1997-12-19 2000-03-14 Stryker Technologies Corporation Guide-pin placement device and method of use
US5961555A (en) * 1998-03-17 1999-10-05 Huebner; Randall J. Modular shoulder prosthesis
US6228119B1 (en) * 1998-06-09 2001-05-08 Depuy Orthopaedics, Inc. Modular glenoid assembly
EP1013246B1 (en) * 1998-12-22 2003-10-01 Centerpulse Orthopedics Ltd. Glenoid prosthesis and modular system with glenoid prostheses
US6368353B1 (en) * 1999-02-24 2002-04-09 Michel A. Arcand Shoulder prosthesis apparatus and methods
US6200322B1 (en) * 1999-08-13 2001-03-13 Sdgi Holdings, Inc. Minimal exposure posterior spinal interbody instrumentation and technique
FR2802799B1 (en) * 1999-12-23 2002-08-16 Depuy France Shoulder prosthesis assembly of
US6514274B1 (en) * 2000-02-25 2003-02-04 Arthrotek, Inc. Method and apparatus for rotator cuff repair
JP2002018870A (en) * 2000-06-21 2002-01-22 Leadtek Research Inc Method for manufacturing keypad
US6589281B2 (en) * 2001-01-16 2003-07-08 Edward R. Hyde, Jr. Transosseous core approach and instrumentation for joint replacement and repair
US6770076B2 (en) * 2001-02-12 2004-08-03 Opus Medical, Inc. Method and apparatus for attaching connective tissues to bone using a knotless suture anchoring device
US6884249B2 (en) * 2001-02-16 2005-04-26 Depuy Mitek, Inc. Surgical knot pusher and method of use
US7364541B2 (en) * 2001-03-09 2008-04-29 Boston Scientific Scimed, Inc. Systems, methods and devices relating to delivery of medical implants
FR2825263A1 (en) * 2001-05-30 2002-12-06 Tecknimed Shoulder joint prosthesis has cap on humerus to engage socket with movement limiting stop surfaces
EP1408856B1 (en) * 2001-06-27 2010-12-01 DePuy Products, Inc. Minimally invasive orthopaedic apparatus
US6840941B2 (en) * 2001-10-31 2005-01-11 Depuy Acromed, Inc. Vertebral endplate chisel
US6712854B2 (en) * 2002-01-25 2004-03-30 Roger A Rogalski Acromial-humeral prosthesis and method of implantation
US6855157B2 (en) * 2002-02-04 2005-02-15 Arthrocare Corporation Method and apparatus for attaching connective tissues to bone using a knotless suture anchoring device
US6916342B2 (en) * 2002-04-01 2005-07-12 Smith & Nephew, Inc. Liner assembly for prosthetic components
US20040122519A1 (en) * 2002-12-20 2004-06-24 Wiley Roy C. Prosthetic glenoid
US20040193276A1 (en) * 2003-03-31 2004-09-30 Maroney Brian J. Modular articulating surface replacement prosthesis
US7186269B2 (en) * 2003-05-16 2007-03-06 Jean-Maxwell Cyprien Composite shoulder prosthesis
US7585327B2 (en) * 2003-09-24 2009-09-08 Biomet Manufacturing Corp. Extended articular surface resurfacing head
JP2007512108A (en) 2003-11-20 2007-05-17 アースロサーフィス・インコーポレーテッド Degeneracy specific delivery of surface re-forming device
US7886885B2 (en) * 2006-10-16 2011-02-15 GM Global Technology Operations LLC Clutch for a transmission

Patent Citations (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3987499A (en) * 1973-08-10 1976-10-26 Sybron Corporation Surgical implant and method for its production
US5314479A (en) * 1986-08-15 1994-05-24 Depuy Inc. Modular prosthesis
US4919670A (en) * 1988-02-03 1990-04-24 Intermedics Orthopedics, Inc. Modular humeral prosthesis
US5376125A (en) * 1991-01-25 1994-12-27 Winkler; Heinz Hip joint endoprosthesis
US5358526A (en) * 1991-12-27 1994-10-25 Etablissements Tornier Modular shoulder prosthesis
US5489309A (en) * 1993-01-06 1996-02-06 Smith & Nephew Richards Inc. Modular humeral component system
US5702486A (en) * 1994-02-22 1997-12-30 Kirschner Medical Corporation Modular humeral prosthesis for reconstruction of the humerus
US7128763B1 (en) * 1995-05-26 2006-10-31 Gerald Blatt Joint treating method
US6045552A (en) * 1998-03-18 2000-04-04 St. Francis Medical Technologies, Inc. Spine fixation plate system
US6783549B1 (en) * 2001-07-27 2004-08-31 Biomet, Inc. Modular humeral head resurfacing system
US20040193278A1 (en) * 2003-03-31 2004-09-30 Maroney Brian J. Articulating surface replacement prosthesis

Cited By (138)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8221454B2 (en) 2004-02-20 2012-07-17 Biomet Sports Medicine, Llc Apparatus for performing meniscus repair
US20100042114A1 (en) * 2004-02-20 2010-02-18 Biomet Sports Medicine, Llc Apparatus for Performing Meniscus Repair
US8109965B2 (en) 2004-06-09 2012-02-07 Biomet Sports Medicine, LLP Method and apparatus for soft tissue fixation
US20100312341A1 (en) * 2004-06-09 2010-12-09 Biomet Sports Medicine, Llc Method for Soft Tissue Attachment
US8491632B2 (en) 2004-06-09 2013-07-23 Biomet Sports Medicine, Llc Method and apparatus for soft tissue fixation
US7695503B1 (en) 2004-06-09 2010-04-13 Biomet Sports Medicine, Llc Method and apparatus for soft tissue attachment
US8308780B2 (en) 2004-06-09 2012-11-13 Biomet Sports Medicine, Llc Method for soft tissue attachment
US20070049944A1 (en) * 2004-06-09 2007-03-01 Arthrotek, Inc. Method and apparatus for soft tissue fixation
US20050277961A1 (en) * 2004-06-09 2005-12-15 Arthrotek, Inc. Method and apparatus for soft tissue fixation
US7776077B2 (en) 2004-06-09 2010-08-17 Biomet Sports Medicince, LLC Method for soft tissue attachment
US7967843B2 (en) 2004-06-09 2011-06-28 Biomet Sports Medicine, Llc Method for soft tissue attachment
US7819898B2 (en) 2004-06-09 2010-10-26 Biomet Sports Medicine, Llc Method and apparatus for soft tissue fixation
US9622851B2 (en) 2004-06-09 2017-04-18 Biomet Sports Medicine, Llc Method and apparatus for soft tissue attachment
US8128658B2 (en) 2004-11-05 2012-03-06 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to bone
US8118836B2 (en) 2004-11-05 2012-02-21 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to a bone
US9504460B2 (en) 2004-11-05 2016-11-29 Biomet Sports Medicine, LLC. Soft tissue repair device and method
US20090062854A1 (en) * 2004-11-05 2009-03-05 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to bone
US8137382B2 (en) 2004-11-05 2012-03-20 Biomet Sports Medicine, Llc Method and apparatus for coupling anatomical features
US8303604B2 (en) 2004-11-05 2012-11-06 Biomet Sports Medicine, Llc Soft tissue repair device and method
US9801708B2 (en) 2004-11-05 2017-10-31 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to a bone
US8551140B2 (en) 2004-11-05 2013-10-08 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to bone
US8840645B2 (en) 2004-11-05 2014-09-23 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to a bone
US9572655B2 (en) 2004-11-05 2017-02-21 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to a bone
US20090054928A1 (en) * 2004-11-05 2009-02-26 Biomet Sports Medicine, Llc Method and apparatus for coupling anatomical features
US20090192468A1 (en) * 2004-11-09 2009-07-30 Biomet Sports Medicine, Llc Soft tissue conduit device and method
US20060282085A1 (en) * 2004-11-09 2006-12-14 Arthrotek, Inc. Soft tissue conduit device
US8998949B2 (en) 2004-11-09 2015-04-07 Biomet Sports Medicine, Llc Soft tissue conduit device
US8317825B2 (en) 2004-11-09 2012-11-27 Biomet Sports Medicine, Llc Soft tissue conduit device and method
US20100268275A1 (en) * 2006-02-03 2010-10-21 Biomet Sports Medicine, Llc Soft Tissue Repair Assembly and Associated Method
US7749250B2 (en) 2006-02-03 2010-07-06 Biomet Sports Medicine, Llc Soft tissue repair assembly and associated method
US8771316B2 (en) 2006-02-03 2014-07-08 Biomet Sports Medicine, Llc Method and apparatus for coupling anatomical features
US9532777B2 (en) 2006-02-03 2017-01-03 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to a bone
US7905903B2 (en) 2006-02-03 2011-03-15 Biomet Sports Medicine, Llc Method for tissue fixation
US7905904B2 (en) 2006-02-03 2011-03-15 Biomet Sports Medicine, Llc Soft tissue repair device and associated methods
US9510821B2 (en) 2006-02-03 2016-12-06 Biomet Sports Medicine, Llc Method and apparatus for coupling anatomical features
US9510819B2 (en) 2006-02-03 2016-12-06 Biomet Sports Medicine, Llc Soft tissue repair device and associated methods
US20090318961A1 (en) * 2006-02-03 2009-12-24 Biomet Sports Medicine,Llc Method and Apparatus for Coupling Soft Tissue to a Bone
US20110160767A1 (en) * 2006-02-03 2011-06-30 Biomet Sports Medicine, Llc Soft Tissue Repair Device and Associated Methods
US20110160768A1 (en) * 2006-02-03 2011-06-30 Biomet Sports Medicine, Llc Soft Tissue Repair Device and Associated Methods
US20090306711A1 (en) * 2006-02-03 2009-12-10 Biomet Sports Medicine, Llc Method for Tissue Fixation
US9498204B2 (en) 2006-02-03 2016-11-22 Biomet Sports Medicine, Llc Method and apparatus for coupling anatomical features
US20110218625A1 (en) * 2006-02-03 2011-09-08 Biomet Sports Medicine, Llc Method and Apparatus for Fixation of an ACL Graft
US8088130B2 (en) 2006-02-03 2012-01-03 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to a bone
US9642661B2 (en) 2006-02-03 2017-05-09 Biomet Sports Medicine, Llc Method and Apparatus for Sternal Closure
US9492158B2 (en) 2006-02-03 2016-11-15 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to a bone
US9538998B2 (en) 2006-02-03 2017-01-10 Biomet Sports Medicine, Llc Method and apparatus for fracture fixation
US9763656B2 (en) 2006-02-03 2017-09-19 Biomet Sports Medicine, Llc Method and apparatus for soft tissue fixation
US20080140093A1 (en) * 2006-02-03 2008-06-12 Stone Kevin T Soft tissue repair device and associated methods
US7857830B2 (en) 2006-02-03 2010-12-28 Biomet Sports Medicine, Llc Soft tissue repair and conduit device
US9468433B2 (en) 2006-02-03 2016-10-18 Biomet Sports Medicine, Llc Method and apparatus for forming a self-locking adjustable loop
US9414833B2 (en) 2006-02-03 2016-08-16 Biomet Sports Medicine, Llc Soft tissue repair assembly and associated method
US9561025B2 (en) 2006-02-03 2017-02-07 Biomet Sports Medicine, Llc Soft tissue repair device and associated methods
US8273106B2 (en) 2006-02-03 2012-09-25 Biomet Sports Medicine, Llc Soft tissue repair and conduit device
US8292921B2 (en) 2006-02-03 2012-10-23 Biomet Sports Medicine, Llc Soft tissue repair device and associated methods
US8298262B2 (en) 2006-02-03 2012-10-30 Biomet Sports Medicine, Llc Method for tissue fixation
US20080140092A1 (en) * 2006-02-03 2008-06-12 Stone Kevin T Soft tissue repair device and associated methods
US9801620B2 (en) 2006-02-03 2017-10-31 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to bone
US9402621B2 (en) 2006-02-03 2016-08-02 Biomet Sports Medicine, LLC. Method for tissue fixation
US8337525B2 (en) 2006-02-03 2012-12-25 Biomet Sports Medicine, Llc Soft tissue repair device and associated methods
US9271713B2 (en) 2006-02-03 2016-03-01 Biomet Sports Medicine, Llc Method and apparatus for tensioning a suture
US8361113B2 (en) 2006-02-03 2013-01-29 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to a bone
US8409253B2 (en) 2006-02-03 2013-04-02 Biomet Sports Medicine, Llc Soft tissue repair assembly and associated method
US20080065114A1 (en) * 2006-02-03 2008-03-13 Biomet Sports Medicine, Inc. Method for Tissue Fixation
US9173651B2 (en) 2006-02-03 2015-11-03 Biomet Sports Medicine, Llc Soft tissue repair device and associated methods
US9149267B2 (en) 2006-02-03 2015-10-06 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to a bone
US9005287B2 (en) 2006-02-03 2015-04-14 Biomet Sports Medicine, Llc Method for bone reattachment
US20080027446A1 (en) * 2006-02-03 2008-01-31 Biomet Sports Medicine, Inc. Soft Tissue Repair and Conduit Device
US9622736B2 (en) 2006-02-03 2017-04-18 Biomet Sports Medicine, Llc Soft tissue repair device and associated methods
US8968364B2 (en) 2006-02-03 2015-03-03 Biomet Sports Medicine, Llc Method and apparatus for fixation of an ACL graft
US8574235B2 (en) 2006-02-03 2013-11-05 Biomet Sports Medicine, Llc Method for trochanteric reattachment
US8597327B2 (en) 2006-02-03 2013-12-03 Biomet Manufacturing, Llc Method and apparatus for sternal closure
US8608777B2 (en) 2006-02-03 2013-12-17 Biomet Sports Medicine Method and apparatus for coupling soft tissue to a bone
US8632569B2 (en) 2006-02-03 2014-01-21 Biomet Sports Medicine, Llc Soft tissue repair device and associated methods
US8652171B2 (en) 2006-02-03 2014-02-18 Biomet Sports Medicine, Llc Method and apparatus for soft tissue fixation
US8652172B2 (en) 2006-02-03 2014-02-18 Biomet Sports Medicine, Llc Flexible anchors for tissue fixation
US8936621B2 (en) 2006-02-03 2015-01-20 Biomet Sports Medicine, Llc Method and apparatus for forming a self-locking adjustable loop
US8932331B2 (en) 2006-02-03 2015-01-13 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to bone
US9603591B2 (en) 2006-02-03 2017-03-28 Biomet Sports Medicine, Llc Flexible anchors for tissue fixation
US8721684B2 (en) 2006-02-03 2014-05-13 Biomet Sports Medicine, Llc Method and apparatus for coupling anatomical features
US7909851B2 (en) 2006-02-03 2011-03-22 Biomet Sports Medicine, Llc Soft tissue repair device and associated methods
US8506596B2 (en) 2006-03-21 2013-08-13 Biomet Sports Medicine, Llc Methods and apparatuses for securing suture
US20110054526A1 (en) * 2006-03-21 2011-03-03 Biomet Sports Medicine, Llc Methods and Apparatuses for Securing Suture
US7828820B2 (en) 2006-03-21 2010-11-09 Biomet Sports Medicine, Llc Method and apparatuses for securing suture
US8777956B2 (en) 2006-08-16 2014-07-15 Biomet Sports Medicine, Llc Chondral defect repair
US8251998B2 (en) 2006-08-16 2012-08-28 Biomet Sports Medicine, Llc Chondral defect repair
US8231654B2 (en) 2006-09-29 2012-07-31 Biomet Sports Medicine, Llc Adjustable knotless loops
US8672968B2 (en) 2006-09-29 2014-03-18 Biomet Sports Medicine, Llc Method for implanting soft tissue
US8500818B2 (en) 2006-09-29 2013-08-06 Biomet Manufacturing, Llc Knee prosthesis assembly with ligament link
US8562645B2 (en) 2006-09-29 2013-10-22 Biomet Sports Medicine, Llc Method and apparatus for forming a self-locking adjustable loop
US8562647B2 (en) 2006-09-29 2013-10-22 Biomet Sports Medicine, Llc Method and apparatus for securing soft tissue to bone
US20080082127A1 (en) * 2006-09-29 2008-04-03 Arthrotek, Inc. Method for implanting soft tissue
US9788876B2 (en) 2006-09-29 2017-10-17 Biomet Sports Medicine, Llc Fracture fixation device
US9078644B2 (en) 2006-09-29 2015-07-14 Biomet Sports Medicine, Llc Fracture fixation device
US20080082128A1 (en) * 2006-09-29 2008-04-03 Arthrotek, Inc. Method and apparatus for forming a self-locking adjustable suture loop
US20090082805A1 (en) * 2006-09-29 2009-03-26 Biomet Sports Medicine, Llc Adjustable knotless loops
US9724090B2 (en) 2006-09-29 2017-08-08 Biomet Manufacturing, Llc Method and apparatus for attaching soft tissue to bone
US9681940B2 (en) 2006-09-29 2017-06-20 Biomet Sports Medicine, Llc Ligament system for knee joint
US20100211075A1 (en) * 2006-09-29 2010-08-19 Biomet Sports Medicine, Llc Fracture Fixation Device
US9833230B2 (en) 2006-09-29 2017-12-05 Biomet Sports Medicine, Llc Fracture fixation device
US20100292792A1 (en) * 2006-09-29 2010-11-18 Biomet Sports Medicine, Llc Prosthetic Ligament System for Knee Joint
US9539003B2 (en) 2006-09-29 2017-01-10 Biomet Sports Medicine, LLC. Method and apparatus for forming a self-locking adjustable loop
US20100305709A1 (en) * 2006-09-29 2010-12-02 Biomet Manufacturing Corp. Knee Prosthesis Assembly With Ligament Link
US8672969B2 (en) 2006-09-29 2014-03-18 Biomet Sports Medicine, Llc Fracture fixation device
US7658751B2 (en) 2006-09-29 2010-02-09 Biomet Sports Medicine, Llc Method for implanting soft tissue
US8801783B2 (en) 2006-09-29 2014-08-12 Biomet Sports Medicine, Llc Prosthetic ligament system for knee joint
US7959650B2 (en) 2006-09-29 2011-06-14 Biomet Sports Medicine, Llc Adjustable knotless loops
US9414925B2 (en) 2006-09-29 2016-08-16 Biomet Manufacturing, Llc Method of implanting a knee prosthesis assembly with a ligament link
US20110213416A1 (en) * 2006-09-29 2011-09-01 Biomet Sports Medicine, Llc Adjustable Knotless Loops
US9486211B2 (en) 2006-09-29 2016-11-08 Biomet Sports Medicine, Llc Method for implanting soft tissue
US9918826B2 (en) 2006-09-29 2018-03-20 Biomet Sports Medicine, Llc Scaffold for spring ligament repair
US9861351B2 (en) 2007-04-10 2018-01-09 Biomet Sports Medicine, Llc Adjustable knotless loops
US9017381B2 (en) 2007-04-10 2015-04-28 Biomet Sports Medicine, Llc Adjustable knotless loops
US20090264889A1 (en) * 2008-04-04 2009-10-22 Depuy Products, Inc. Humeral rotating burr guide
US8114087B2 (en) 2008-04-04 2012-02-14 Depuy Products, Inc. Humeral rotating burr guide
US8845643B2 (en) 2008-04-04 2014-09-30 DePuy Synthes Products, LLC Humeral rotating burr guide
US8231630B2 (en) 2008-04-04 2012-07-31 Depuy Products, Inc. Humeral rotating burr guide
US20090254091A1 (en) * 2008-04-04 2009-10-08 Long Jack F Humeral rotating burr guide
US8657828B2 (en) 2008-04-04 2014-02-25 DePuy Synthes Products, LLC Humeral rotating burr guide
US20110185560A1 (en) * 2008-08-18 2011-08-04 Qioptiq Photonics Gmbh & Co. Kg Method for producing an objective
US20100305698A1 (en) * 2009-05-28 2010-12-02 Biomet Manufacturing Corp. Knee Prosthesis Assembly With Ligament Link
US8900314B2 (en) 2009-05-28 2014-12-02 Biomet Manufacturing, Llc Method of implanting a prosthetic knee joint assembly
US8343227B2 (en) 2009-05-28 2013-01-01 Biomet Manufacturing Corp. Knee prosthesis assembly with ligament link
US9364333B1 (en) 2011-04-01 2016-06-14 The Lonnie and Shannon Paulos Trust Transosseous methods and systems for joint repair
US9216078B2 (en) 2011-05-17 2015-12-22 Biomet Sports Medicine, Llc Method and apparatus for tibial fixation of an ACL graft
US8771352B2 (en) 2011-05-17 2014-07-08 Biomet Sports Medicine, Llc Method and apparatus for tibial fixation of an ACL graft
US8506597B2 (en) 2011-10-25 2013-08-13 Biomet Sports Medicine, Llc Method and apparatus for interosseous membrane reconstruction
US9445827B2 (en) 2011-10-25 2016-09-20 Biomet Sports Medicine, Llc Method and apparatus for intraosseous membrane reconstruction
US9357991B2 (en) 2011-11-03 2016-06-07 Biomet Sports Medicine, Llc Method and apparatus for stitching tendons
US9314241B2 (en) 2011-11-10 2016-04-19 Biomet Sports Medicine, Llc Apparatus for coupling soft tissue to a bone
US9357992B2 (en) 2011-11-10 2016-06-07 Biomet Sports Medicine, Llc Method for coupling soft tissue to a bone
US9370350B2 (en) 2011-11-10 2016-06-21 Biomet Sports Medicine, Llc Apparatus for coupling soft tissue to a bone
US9381013B2 (en) 2011-11-10 2016-07-05 Biomet Sports Medicine, Llc Method for coupling soft tissue to a bone
US9433407B2 (en) 2012-01-03 2016-09-06 Biomet Manufacturing, Llc Method of implanting a bone fixation assembly
US9259217B2 (en) 2012-01-03 2016-02-16 Biomet Manufacturing, Llc Suture Button
US9757119B2 (en) 2013-03-08 2017-09-12 Biomet Sports Medicine, Llc Visual aid for identifying suture limbs arthroscopically
US9918827B2 (en) 2013-03-14 2018-03-20 Biomet Sports Medicine, Llc Scaffold for spring ligament repair
US9615822B2 (en) 2014-05-30 2017-04-11 Biomet Sports Medicine, Llc Insertion tools and method for soft anchor
US9700291B2 (en) 2014-06-03 2017-07-11 Biomet Sports Medicine, Llc Capsule retractor

Also Published As

Publication number Publication date Type
US8540737B2 (en) 2013-09-24 grant
US20120041563A1 (en) 2012-02-16 application
US20050043805A1 (en) 2005-02-24 application
US20070016304A1 (en) 2007-01-18 application
WO2005016123A3 (en) 2007-03-22 application
US20070100353A1 (en) 2007-05-03 application
WO2005016123A2 (en) 2005-02-24 application
US20070005074A1 (en) 2007-01-04 application
US20070027417A1 (en) 2007-02-01 application
US20070027477A1 (en) 2007-02-01 application
US9445910B2 (en) 2016-09-20 grant

Similar Documents

Publication Publication Date Title
US7837736B2 (en) Minimally invasive surgical systems and methods
US4123806A (en) Total hip joint replacement
US6302915B1 (en) Ulnar implant system
US7481814B1 (en) Method and apparatus for use of a mill or reamer
US7601155B2 (en) Instruments and method for minimally invasive surgery for total hips
EP0903127B1 (en) Anatomic glenoid shoulder prosthesis together with methods and tools for implanting same
US6984248B2 (en) Transosseous core approach and instrumentation for joint replacement and repair
US5320625A (en) Apparatus and method for implanting a prosthetic acetabular cup and then testing the stability of the implant
US6723102B2 (en) Apparatus and method for minimally invasive total joint replacement
US8623030B2 (en) Robotic arthroplasty system including navigation
US7896885B2 (en) Retrograde delivery of resurfacing devices
US7591821B2 (en) Surgical technique and instrumentation for minimal incision hip arthroplasty surgery
US20070038302A1 (en) Method and apparatus for the preparation of an inlaid glenoid
US20090131986A1 (en) Method and apparatus for spinal facet joint fusion using irregularly shaped cortical bone implants
US20090105837A1 (en) Instrument for use in a joint replacement procedure
US7815645B2 (en) Methods and apparatus for pinplasty bone resection
US20030050704A1 (en) Prosthesis
US20060079963A1 (en) Semiconstrained shoulder prosthetic for treatment of rotator cuff arthropathy
US20080086139A1 (en) Toe deformity repair using bioabsorbable pin
US5342369A (en) System for repair of bankart lesions
US20050267482A1 (en) Bone treatment method with implants and instrumentation
US20030181984A1 (en) Method and instrumentation for patello-femoral joint replacement
US20090138018A1 (en) Methods and apparatus for pivotable guide surfaces for arthroplasty
US6875218B2 (en) Elongated driving bit attachable to a driving instrument and method of use for minimally invasive hip surgery
US6827741B2 (en) Method for preparing radial and carpal bones for a wrist prosthesis