US20160242833A1 - Osteoarthritis treatment and device - Google Patents

Osteoarthritis treatment and device Download PDF

Info

Publication number
US20160242833A1
US20160242833A1 US15/047,694 US201615047694A US2016242833A1 US 20160242833 A1 US20160242833 A1 US 20160242833A1 US 201615047694 A US201615047694 A US 201615047694A US 2016242833 A1 US2016242833 A1 US 2016242833A1
Authority
US
United States
Prior art keywords
method
bone marrow
bone
marrow lesion
joint
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.)
Granted
Application number
US15/047,694
Other versions
US9439703B1 (en
Inventor
Peter F. Sharkey
Charles F. Leinberry
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Zimmer Knee Creations Inc
Original Assignee
Zimmer Knee Creations Inc
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
Priority to US91446507P priority Critical
Priority to US12/110,434 priority patent/US8062364B1/en
Priority to US13/269,136 priority patent/US20120029522A1/en
Priority to US13/269,133 priority patent/US8271600B2/en
Priority to US14/138,262 priority patent/US8998998B2/en
Priority to US14/461,656 priority patent/US9636161B2/en
Priority to US14/710,750 priority patent/US9283014B2/en
Priority to US15/047,694 priority patent/US9439703B1/en
Application filed by Zimmer Knee Creations Inc filed Critical Zimmer Knee Creations Inc
Publication of US20160242833A1 publication Critical patent/US20160242833A1/en
Application granted granted Critical
Publication of US9439703B1 publication Critical patent/US9439703B1/en
Application status is Active legal-status Critical
Anticipated expiration legal-status Critical

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
    • A61F2/38Joints for elbows or knees
    • 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • 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
    • A61B17/8802Equipment for handling bone cement or other fluid fillers
    • A61B17/8805Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it
    • 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
    • A61B17/8802Equipment for handling bone cement or other fluid fillers
    • A61B17/8805Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it
    • A61B17/8811Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it characterised by the introducer tip, i.e. the part inserted into or onto the bone
    • 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
    • A61B17/8802Equipment for handling bone cement or other fluid fillers
    • A61B17/8805Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it
    • A61B17/8825Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it characterised by syringe details
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Detecting, measuring or recording for diagnostic purposes; Identification of persons
    • A61B5/05Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radiowaves
    • A61B5/055Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radiowaves involving electronic [EMR] or nuclear [NMR] magnetic resonance, e.g. magnetic resonance imaging
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Detecting, measuring or recording for diagnostic purposes; Identification of persons
    • A61B5/45For evaluating or diagnosing the musculoskeletal system or teeth
    • A61B5/4504Bones
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Detecting, measuring or recording for diagnostic purposes; Identification of persons
    • A61B5/45For evaluating or diagnosing the musculoskeletal system or teeth
    • A61B5/4538Evaluating a particular part of the muscoloskeletal system or a particular medical condition
    • A61B5/4585Evaluating the knee
    • 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
    • A61F2/28Bones
    • 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
    • A61F2/38Joints for elbows or knees
    • A61F2/389Tibial components
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION, OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS, OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS, OR SURGICAL ARTICLES
    • A61L24/00Surgical adhesives or cements; Adhesives for colostomy devices
    • A61L24/02Surgical adhesives or cements; Adhesives for colostomy devices containing inorganic materials
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION, OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS, OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS, OR SURGICAL ARTICLES
    • A61L27/00Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/02Inorganic materials
    • A61L27/12Phosphorus-containing materials, e.g. apatite
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION, OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS, OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS, OR SURGICAL ARTICLES
    • A61L27/00Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/50Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831Material properties
    • A61B2017/00933Material properties bone or bone-like
    • 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
    • A61F2/28Bones
    • A61F2002/2817Bone stimulation by chemical reactions or by osteogenic or biological products for enhancing ossification, e.g. by bone morphogenetic or morphogenic proteins [BMP] or by transforming growth factors [TGF]
    • 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
    • A61F2/28Bones
    • A61F2002/2835Bone graft implants for filling a bony defect or an endoprosthesis cavity
    • 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
    • A61F2/28Bones
    • A61F2002/2892Tibia
    • 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
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION, OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS, OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS, OR SURGICAL ARTICLES
    • A61L2400/00Materials characterised by their function or physical properties
    • A61L2400/06Flowable or injectable implant compositions
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION, OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS, OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS, OR SURGICAL ARTICLES
    • A61L2430/00Materials or treatment for tissue regeneration
    • A61L2430/02Materials or treatment for tissue regeneration for reconstruction of bones; weight-bearing implants
    • YGENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10STECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10S623/00Prosthesis, i.e. artificial body members, parts thereof, or aids and accessories therefor
    • Y10S623/902Method of implanting
    • Y10S623/908Bone

Abstract

A method for treating arthritis of a joint includes identifying a bone lesion in a bone adjacent to the joint; and implanting in the bone a reinforcing member in or adjacent to the bone lesion. A kit for conducting the method includes: (a) at least one reinforcing member having a proximal face adapted to face the joint, a distal face adapted to face away from the joint, and a wedge-shaped edge adapted to pierce bone, wherein the at least one reinforcing member is planar and sterile; and (b) a container adapted to maintain the at least one reinforcing member sterile. Another kit includes: (a) a sterile fluid; (b) a syringe for injecting the fluid into a bone; (c) a curing agent adapted to cure the fluid to polymerize and/or cross-link; and (d) a container adapted to maintain the sterility of contents of the container.

Description

    CROSS-REFERENCE TO RELATED APPLICATIONS
  • This is a continuation of U.S. patent application Ser. No. 13/269,133 filed yr Oct. 7, 2011 and entitled “OSTEOARTHRITIS TREATMENT AND DEVICE,” which is a divisional of U.S. patent application Ser. No. 12/110,434, now U.S. Pat. No. 8,062,364, filed on Apr. 28, 2008 and entitled “OSTEOARTHRITIS TREATMENT AND DEVICE,” which application claims priority to U.S. Provisional Application No. 60/914,465, filed on Apr. 27, 2007 and entitled “OSTEOARTHRITIS TREATMENT AND DEVICE,” the contents of which are herein incorporated by reference in their entirety.
  • FIELD
  • This invention relates to a method and device for treating osteoarthritis, particularly osteoarthritis of the knee.
  • Osteoarthritis is the most common form of arthritis, affecting the hands, knees, hips, spine and other joints. Characteristics of osteoarthritis include a loss of cartilage, seen as a reduction in the joint space, and ostetophytes (or bone spurs).
  • Arthritic pain is a leading cause of lost productivity. The cause of arthritic pain is unclear. The amount of cartilage loss correlates poorly with the severity of pain in an afflicted individual. Likewise, radiographic finding such as osteophytes (bone spurs) and thickening of subchondral bone (eburination) do not correlate with the presence or severity of pain.
  • Bone marrow lesions (or edemas) are very strongly associated with knee arthritis pain (Felson et al., “The association of bone marrow lesions with pain in knee osteoarthritis.” Ann Intern Med. 2001 Apr. 3;134(7):541.9) and disease progression (Felson et al., “Bone marrow edema and its relation to progression of knee osteoarthritis.” Ann Intern Med. 2003 Sep. 2;139(5 Pt 1)330-6). See also U.S. Pat. No. 6,564,083 to Stevens, which describes a method of identifying in a patient having joint pain the susceptibility of the patient to developing progressive osteoarthritis or loss of joint space, by determining the presence or absence of bone marrow edema about or of the joint. The determination is preferably made through the use of Magnetic Resonance Imaging (MRI).
  • The nature and cause of bone marrow lesions is poorly understood. Histologic examination of these lesions demonstrates abnormal bone with areas of fibrosis, osteonecrosis and extensive bone remodeling (Zanetti at al., “Bone Marrow Edema Pattern in Osteoarthritic Knees: Correlation between MR Imaging and Histologic Findings,” Radiology. 2000;215:835-840). It has been suggested that they are related to inflammation (Bollet, “Edema of the bone marrow can cause pain in osteoarthritis and other diseases of bone and joints.” Ann Intern Med. 2001 Apr. 3:134(7):591-3), venous hypertension (Arnoldi at al, “Intraosseous phlebography, intraosseous pressure measurements and 99mTc-polyphosphate scintigraphy in patients with various painful conditions in the hip and knee,” Acta Orthrop Scand. 1980; 51:19.-28), or impaired arterial blood flow (McAlindon et al., “Magnetic resonance imaging in osteoarthritis of the knee: correlation with radiographic and scintigraphic findings.” Ann Rheum. Dis: 1991;50:14-9. Others have suggested these lesions reflect increased bone stress and microfracture of the bone (see Felson et al. 2003, supra).
  • Knee arthritis affects millions of people and the pain associated with this disease can be disabling. Patients who initially present with painful knee arthritis are usually treated non-surgically. Non-surgical treatments are modestly effective at temporarily relieving pain, but not risk free. Pharmacologic intervention (i.e., non-steroidal anti-inflammatory drugs) has been reported to be associated with significant complications, such as gastric ulcers, strokes and heart attacks. Steroid or viscosupplement injection may lead to infection. Steroid injections may also have systemic effects such as increased blood sugar and hypertension. Generally speaking non-surgical interventions are most efficacious for early arthritic disease and do not prevent disease progression.
  • When patients fail non-surgical treatment, surgical intervention is often recommended. Arthroscopic surgery has been shown to have limited effectiveness and has a small role in the management of knee arthritis. More invasive surgical approaches such as high tibial osteotomy and partial or complete knee replacement predictably relieve pain. However, these major operations are also potentially associated with significant morbidity and occasional modality. These risks along with the limited durability of implantable devices influence patient and physicians to defer surgery until the symptoms become unbearable.
  • Accordingly, it is desired to provide an effective, surgical treatment of osteoarthritis, and particularly knee arthritis pain. It is further desired that such surgical treatment be less invasive than high tibial osteotomy and partial or complete knee replacement
  • All references cited herein are incorporated herein by reference in their entireties.
  • SUMMARY
  • Accordingly, a first aspect of the invention comprises a method for treating arthritis of a joint, said method comprising: identifying a bone lesion in a bone adjacent to the joint; and implanting in the bone a reinforcing member in or adjacent to the bone lesion. The reinforcing member as implanted is preferably free of artificial bones to the bone. The method preferably decreases pain associated with arthritis and/or slows the progression of arthritis.
  • A second aspect of the invention comprises a kit for treating arthritis of a joint, said kit comprising: (a) at least one reinforcing member comprising a proximal face adapted to face the joint, a distal face adapted to face away from the joint, and a wedge-shaped edge adapted pierce bone, wherein the at least one reinforcing member is planar and sterile; and (b) a container adapted to maintain the at least one reinforcing member sterile.
  • A third aspect of the invention comprises a kit for treating arthritis of a joint, said kit comprising: (a) a sterile (b) a syringe for injecting the fluid into a bone; (c) a curing agent adapted to cure the fluid to polymerize and/or cross-link; and (d) a container adapted to maintain the sterility of contents of the container.
  • A fourth aspect of the invention comprises a method for treating arthritis of a joint, said method comprising: (a) identifying a bone lesion in a bone adjacent to the joint; and (b) implanting in the bone a reinforcing member in or adjacent to the bone lesion, wherein the method stabilizes the bone in order to prevent further biomechanical breakdown of the bone and of adjacent meniscal tissues, and alleviates pain in the joint.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • The invention will be described in conjunction with the following drawings in which like reference numeral designate like elements and wherein:
  • FIG. 1 is a magnetic resonance image (2D IR 1900/90/25.0 COR 200×180; 4.0 FFS; 256×144 pr.) of an arthritic knee on which is overlaid a side view of an embodiment of the reinforcing member of the invention;
  • FIGS. 2A, 2B and 2C are overhead views of three embodiments of the reinforcing member of the invention; and
  • FIG. 2D is a side of the embodiment of FIG. 2B.
  • DESCRIPTION OF THE EMBODIMENTS
  • The invention is based on our theory that bone lesions detected by MRI represent overstressed bone. Bone is continuously fatigued and damaged by everyday activity. However, bone is a living tissue and bone repair occurs in concert. Certain pathological processes, such as loss of joint cartilage, can disturb the equilibrium between bone damage and bone repair. Cartilage protects underlying bone shielding it from stress. In addition, loss of cartilage leads to joint deformity further increasing bone stress. Overstressed bone sustains more damage than repair, which results pain.
  • The invention enhances the strength of bone, shielding bone from excessive stress. Strengthening the bone in accordance with the invention shifts the damage/repair equilibrium toward repair. In addition, strengthening the bone reduces, reverses and/or prevents the deformation of overstressed bone, which should relieve pain and slow arthritic disease progression within the underlying bone and adjacent meniscal tissues (cartilage).
  • The invention provides an additional treatment option for patients suffering with arthritic pain, particularly in the knee. Those individuals who have exhausted non-surgical care, but are not symptomatic enough or not prepared for other reasons (emotional, financial, etc.) to undergo more major surgical interventions, are ideal for treatment using the present invention. The method of the invention should be considered minor or outpatient surgery. The risk of complications if expected to be significantly less then with major arthritic surgery, such as high tibial osteotomy and partial or total knee replacement. Preferred embodiments of the inventive treatment stabilize the defect in the subchondral (underlying) bone in order to prevent further biomechanical breakdown of the bone and of the adjacent meniscal tissues, and alleviate the corresponding pain in the joint.
  • The method of the invention comprises identifying a bone lesion in a bone adjacent to the joint, and implanting in the bone a reinforcing member in or adjacent to the bone Lesions. Referring to FIG. 1, an arthritic human knee comprises femur 10 and tibia 12. Bone lesion 14 of tibia 12 presents as a focally increased signal in the marrow in an MRI of the knee. in certain embodiments, coronal spin-echo fat-saturated proton density and T2-weighted fat-saturated magnetic resonance images are preferred. Bone lesions thought to be associated with arthritic are less than 10 cm or 5 cm or cm from the joint. Thus in preferred embodiments, the invention treats bone lesions which are from 0 to 10 cm from the joint, or 0 to 5 cm from the joint, or 0 to 1 cm from the joint.
  • The bone lesion is preferably identified using MRI, but in less preferred embodiments, other identification means may be employed. For example, bone lesions can be identified using Technetium-99 bone scans, because there is a close correlation between the presence of activity noted on Technetium-99 bone scans and bone marrow lesions. In embodiments of the invention employee MRI, any MRI technology that reveals bone marrow lesions can be used, for example, open MRI, low field strength MRI, extremity MRI, whole body scanner MRI or the like.
  • Reinforcing member 14 is preferably selected in accordance with the guidance provided by the following bone lesion grading system.
  • Bone Lesion Grading System
    Bone
    Lesion
    Class Dimension Comments
    I  <1 mm Bone healing is likely and resorbable graft materials
    are appropriate. Non-limiting exemplary materials for
    use as the reinforcing member include hyaluronic acid
    (HA), calcium phosphate (CaP) grafts, and cements
    (CaP & PMMA).
    II 1-3 mm Bone healing is more challenging and a semi-structural
    graft material is appropriate. Non-limiting exemplary
    materials for use as the reinforcing mbmer include HA,
    CaP, cements (CaP & PMMA), and structural implants
    of metal and/or polymer.
    III 3-5 mm Bone healing is less likely, and thus structural non-
    resorbing support is appropriate. Non-limiting
    exemplary materials for use as the reinforcing member
    include CaP cements, PMMA cements, and structural
    implants of metal and/or polymer.
    IV  >5 mm Bone healing is unlikely, and thus a permanent
    structural implant is required. Non-limiting
    exemplary materials for use as the reinforcing member
    include PMMA cements, and structural implants of
    metal and/or polymer.
  • FIG. 1 shows a preferred example of how reinforcing member 16 could be implanted in bone lesion 14. It is also within the scope of the invention to implant the reinforcing member adjacent to the bone lesion. For example, the reinforcing member can be implanted adjacent to a side of the bone lesion proximal to the joint and/or adjacent to a side of the bone lesion distal to the joint. One or more than one, reinforcing member can be implanted in and/or adjacent to a bone lesion. A reinforcing member is adjacent to a bone lesion if it is less than 10 cm away from an outer surface of the bone lesion. Adjacent reinforcing members can be in contact with an outer surface of the bone lesion. Thus in preferred embodiments, an adjacent reinforcing member can be from 0 to 10 cm from the bone lesions, or 0 to 5 cm from the bone lesion, or 0 to 1 cm from the bone lesion.
  • It is also preferred that the reinforcing member as implanted be free of bonds to the bone. Thus, the reinforcing member is preferably not, for example, glued, cemented, stapled, stitched, clamped or screwed to the bone. However, the expression “free of artificial bonds to the bone” does not exclude from such embodiments the possibility that bonds are formed by biological processes in situ.
  • The reinforcing member is implants in the bone in or adjacent the bone lesion such that a proximal face faces the joint and a distal face faces away from the joint. Preferably, the reinforcing member is selected or modified (e.g., cut, torn, etc.) such that a maximum dimension of the proximal face exceeds a maximum dimension of the bone lesion. It is also within the scope of the invention for the maximum dimension of the bone lesion to equal or exceed a maximum dimension of the proximal face. Thus, the reinforcing member can be larger, smaller or the same size as the bone lesion. The reinforcing member is preferably implanted such that the proximal face is perpendicular to a longitudinal axis of the bone. It is preferred that the proximal and/or distal faces be the primary load bearing surfaces.
  • In certain embodiments, a syringe (optionally with a needle) can be used to inject a fluid into a bone so as to form the reinforcing member in situ. This step can be conducted with or without first creating an opening in the bone. The fluid is preferably a liquid, semi-solid, gel, hydrogel dispersion or slurry. After injection, the fluid can remain in its originally-injected state, or can cure to a less fluid state. For example, the injected fluid can cross-link or polymerize from a liquid to form a semi-solid, gel or solid. Fluids that cure in situ can be self-curing or can cure in response to curing means, such as, e.g., radiation (e.g., UV light), heat (e.g., body temperature), moisture and/or a curing agent. See, e.g., U.S. Pat. No. 6,818,018 to Sawhney and U.S. Pat. No. 6,280,474 to Cassidy et al.
  • In certain embodiments, the reinforcing member is a solid or a non-fluid material that is not amenable to injection in to the bone. In these embodiments, the surgeon creates a small opening in the vicinity of the bone lesion. Suitable surgical tools for this task include standard boric instruments (e.g., chisels, drills, etc.) and instruments specifically designed for use in the method of the invention. It is also possible to use the wedge-shaped edge of the reinforcing member to pierce the bone, preferably with assistance from a hammer.
  • Although it is within the scope of the invention for the surgeon to implant the reinforcing member by studying a previously captured image of the bone lesion and using his or her own senses to estimate the location and boundaries of the bone lesion, it is preferred that the surgeon be provided with additional guidance during surgery. For example, surgery can be conducted using real-time imaging, robotic devices, braces for maintaining the joint in a position consistent with captured images of the joint and/or labels. See, e.g., U.S. Pat. No. 6,711,432 to Krause et al. Suitable labels include but are not limited to radioactive labels, such as Technetium-99 and objects, such as fiducial markers.
  • Postoperatively, patients may be required to maintain partial weight bearing and use ambulatory aids. Depending upon the physician's direction, full weight bearing may be possible. Routine post intervention physical therapy will likely be required. Additionally, patients will need routine post intervention care, observation and follow-up.
  • FIG. 2 shows several different embodiments of reinforcing members of the invention. FIG. 2A shows reinforcing member 16 having a triangular profile, FIG. 2B shows reinforcing member 16 having a rectangular profile and FIG. 2C shows reinforcing member 16 having a circular profile. Reinforcing member 16 is preferably planar, as been from FIG. 2D, which shows a side view of the rectangular embodiment of FIG. 2C. The term “planar” as used herein refers to three-dimensional objects which are relatively long in two dimensions and relatively short in a third dimension. Planar reinforcing members in accordance with the invention can have a thickness which is ≦50% of the length and ≦50% of the width of a rectangular reinforcing member (or ≦50% of the diameter in the case of a circular reinforcing member or ≦50% of the height and ≦50% of the base in the case of a triangular reinforcing member).
  • As can be seen in FIG. 2D, reinforcing member 6 has wedge-shaped edge 18 on at least one edge thereof. Wedge-shaped edge 18 is adapted to facilitate the step of driving reinforcing member 18 into the bone. Thus, the particular angle and other dimensions of the wedge are dictated by factors that are known in the art. Preferably, wedge-shaped edge 18 is similar to that found on standard surgical tools such as osteotomes or on implants such as blade plates or osteotomy staples.
  • Reinforcing member 16 comprises a physiologically compatible material that has sufficient durability to reinforce the overstressed bone of the bone lesion and bear physiologic loads. Preferred materials for the reinforcing member include metals, such as titanium, stainless steel, alloys of cobalt and chrome, tantalum, alloys of titanium and nickel and other superelastic metal alloys, such as taught by U.S. Pat. No. 6,527,810. Titanium “foam”, tantalum, trabecular metals, nanoceramics or other hightly porous nanomaterials, and chrome cobalt are particularly preferred. Other embodiments comprise the use of bone, such as autografts, allografts, and artificial or synthetic bone substitutes. Certain embodiments comprise the use of polymeric materials.
  • Reinforcing member 16 is preferably osteogenic, osteoconductive and/or osteoinductive. The term “osteogenic” as used herein refers to the ability of the reinforcing member to promote the growth of new bone tissue. The term “osteoinductive” as used herein refers to the ability of the reinforcing member to recruit cells from the host that have the potential for forming new bone and repairing bone tissue. The term “osteoconductive” as used herein refers to the ability of a non-osteoinductive reinforcing member to serve as a substrate supporting bone growth. Osteoconductive materials that are suitable for use in the present invention are biologically acceptable and include but are not limited to collagen and the various forms of calcium phosphates including hydroxyapatite, tricalcium phosphate, and fluorapatite. Suitable osteoinductive substances include but are not limited to bone morphogenetic proteins (e.g., rhBMP-2) demineralized bone matrix, transforming growth factors (e.g., TGF-beta), osteoblast cells, and various other organic species known to induce bone formation. The osteoconductive and osteoinductive properties may be provided by bone marrow, blood plasma, or morselized bone of the patient, or commercially available materials. Osteoinductive materials such as BMP may be applied to articles of the invention, for example, by immersing the article in an aqueous solution of this material in a dilute suspension of type I collagen. Osteoinductive materials such as TGF-beta may be applied to an article of the invention from a saline solution containing effective concentration of TGF-beta, or may be carried in the resilient material.
  • The reinforcing member can be resorbable, but is preferably non-resorbable, particularly when used to treat a chronic condition, such as osteoarthritis.
  • In certain embodiments, electrical stimulation is applied to the bone to promote bone healing.
  • The reinforcing member can be provided alone or in a kit according to the invention. A first embodiment of the kit includes at least one reinforcing member, which is sterile, and a container adapted to maintain the sterility of the at least one reinforcing member. Preferably, the containers are sealed flexible bags. The term “sterile” as used herein denotes a condition in which an object has a sterility assurance level (SAL) or 10−3 or less (preferably 10−3 of less) in accordance with current FDA guidelines for medical devices and as measured by AAMI/ISO 11607-1.
  • The first embodiment of the kid can optionally include an assortment of reinforcing members of various sizes and/or shapes appropriate for use with a variety of bone lesions. The kit can also include instructions for use, e.g., printed on the container and/or on inserts within the container. The kit can still further include a tool for adjusting the size of the reinforcing member, a hammer for driving the reinforcing member into the bone and/or a bone filler to seal the open end of the channel in the bone in which the reinforcing member resides. Suitable bone fillers include but are not limited to materials comprising beta-tricalcium phosphate (e.g., VITOSS, PROOSTEON 500R made by E-Interpore-Cross International), hydroxyapatite (e.g., OSTEOGRAF made by Ceramed Denta, Inc., Lakewood, Colo.), calcium carbonate, calcium sulfate (e.g., OSTEOSET and ALLOMATRIX made by Wright Medical Technology, Inc.), calcium phosphate (e.g., CALCIBON made by Merck & Co. Inc., Whitehouse Station, N.J., and NORIAN SRS made by Synthes-Strates, Switzerland), synthetic bone fillers e.g., CORTOSS) and/or processed bone fillers (e.g., BIOOSS made by Geistlich Biomaterials, Inc., Switzerland). See U.S. Pat. No. 7,166,570.
  • A second embodiment of the kit includes a fluid, a syringe for injecting the fluid into a bone and a container adapted to maintain the sterility of the contents of the container. This embodiment of the kit can further comprise a needle and premeasure portions of ingredients in a plurality of separate vials. As with the first embodiment of the kit, this embodiment can optionally include instructions for use, e.g., printed on the container and/or on inserts within the container. The kit can further include bone tools for providing a channel in the bone in which the fluid is injected and/or a bone filler to seal the open end of the channel in the bone in which the reinforcing member resides. The kit can include curing agents (i.e., polymerizing agents, catalysts and/or crosslinking agents) as separate ingredients to be added to the injected fluid. The kit can include other curing means, such as a UV light source or other device for generating radiation. The fluid can be preloaded in the syringe for injection. In some embodiments, a multiple barrel syringe can be included for in situ mixing of ingredients that must be stored separately in different barrels of the syringe (e.g., monomers and polymerizing agent, or polymers and crosslinking agent, etc.).
  • While the invention is described in the context of osteoarthritis of the knee, it is not limited to such condition. Other conditions that can be treated in accordance with the invention include but are not limited to osteoarthritic of joints other than the knee.
  • While the invention has been described in detail and with reference to specific examples thereof, it will be apparent to one skilled in the art that various changes and modifications can be made therein without departing from the spirit and scope thereof.

Claims (39)

1-16. (canceled)
17. A method of reinforcing bone located in a targeted bone marrow lesion in a subchondral region of a first bone adjacent a joint in a patient for treating the targeted bone marrow lesion, the method comprising:
identifying a bone marrow lesion in a subchondral region of a first bone adjacent a joint in a patient so as to establish a targeted bone marrow lesion for receiving treatment, the subchondral region of the first bone occurring under an articular surface of the first bone;
creating, in the first bone that contains the targeted bone marrow lesion in the subchondral region, a subchondral injection path to an area in and/or adjacent to the targeted bone marrow lesion for injecting an injectable fluid material into said area for reinforcing bone located in the targeted bone marrow lesion, wherein said creating preserves an existing condition of the overlying articular cartilage of the first bone adjacent the joint; and
injecting an injectable and curable fluid material into said area via the subchondral injection path, wherein the injectable fluid material is a bone reinforcing material that is left in the area for becoming less fluid in the area so as to form, in situ, a bone reinforcing member for reinforcing bone located in the targeted bone marrow lesion, wherein the injectable fluid material is left in the area without also delivering and leaving a solid structural implant in arid/or adjacent to the targeted bone marrow lesion in addition to the injectable fluid material.
18. The method of claim 17, wherein the joint is a knee joint.
19. The method of claim 18, wherein the targeted bone marrow lesion is in a proximal tibia.
20. The method of claim 18, wherein the targeted bone marrow lesion is in a distal femur.
21. The method of claim 17, wherein the joint is other than a knee joint.
22. The method of claim 17, wherein said identifying includes identifying the bone marrow lesion through use of magnetic resonance imaging (MRI) of the joint.
23. The method of claim 22, wherein said identifying the bone marrow lesion through use of magnetic resonance imaging (MRI) of the joint is viewing the bone marrow lesion on an MRI of the joint.
24. The method of claim 17, wherein said identifying includes identifying with non-Mill identification means.
25. The method of claim 17, wherein said creating is conducted without further creating a void inside the first bone in or adjacent to the targeted bone marrow lesion.
26. The method of claim 17, wherein said area is in the targeted bone marrow lesion.
27. The method of claim 17, wherein said area is adjacent to the targeted bone marrow lesion.
28. The method of claim 17, wherein said area is up to 1 cm from the targeted bone marrow lesion.
29. The method of claim 17, wherein the targeted bone marrow lesion is less than 1 cm from the joint.
30. The method of claim 17 providing only a single bone reinforcing member in said area.
31. The method of claim 17, wherein said injectable fluid material includes a calcium phosphate.
32. The method of claim 31, wherein said calcium phosphate comprises a calcium phosphate cement.
33. The method of claim 17, wherein said injecting includes injecting the injectable fluid material from a pre-loaded syringe.
34. The method of claim 33, wherein said pre-loaded syringe includes a needle.
35. The method of claim 17, wherein said injectable fluid material includes a non-resorbable material.
36. The method of claim 17, wherein said area is in and adjacent to the targeted bone marrow lesion.
37. A method of reinforcing bone located in a targeted bone marrow lesion in a subchondral region of a first bone adjacent a joint in a patient for treating the targeted bone marrow lesion, the method comprising:
identifying a bone marrow lesion in a subchondral region of a first bone adjacent a joint in a patient through use of magnetic resonance imaging (MRI) of the joint so as to establish a targeted bone marrow lesion for receiving treatment, the subchondral region of the first bone occurring under an articular surface of the first bone;
creating, in the first bone that contains the targeted bone marrow lesion in the subchondral region, a subchondral injection path to an area in and/or adjacent to the targeted bone marrow lesion for injecting an injectable fluid material into said area for reinforcing bone located in the targeted bone marrow lesion, wherein said creating preserves an existing condition of the overlying articular cartilage of the first bone adjacent the joint; and
injecting an injectable and curable fluid material into the targeted bone marrow lesion via the subchondral injection path, wherein the injectable fluid material is a bone reinforcing material that is left in the targeted bone marrow lesion for becoming less fluid in the targeted bone marrow lesion so as to form, in situ, a bone reinforcing member for reinforcing bone located in the targeted bone marrow lesion, wherein the injectable fluid material is left in the targeted bone marrow lesion without also delivering and leaving a solid structural implant in and/or adjacent to the targeted hone marrow lesion in addition to the injectable fluid material.
38. The method of claim 37, wherein the joint is a knee joint.
39. The method of claim 38, wherein the targeted bone marrow lesion is in a proximal tibia.
40. The method of claim 38, wherein the targeted bone marrow lesion is in a distal femur.
41. The method of claim 37, wherein the joint is other than a knee joint.
42. The method of claim 37, wherein said identifying the bone marrow lesion through use of magnetic resonance imaging (MRI) of the joint is viewing the bone marrow lesion on an MRI of the joint.
43. The method of claim 37, wherein said creating is conducted without further creating a void inside the first hone in or adjacent to the targeted bone marrow lesion.
44. The method of claim 37, wherein said area is in the targeted bone marrow lesion.
45. The method of claim 37, wherein said area is adjacent to the targeted bone marrow lesion.
46. The method of claim 37, wherein said area is up to 1 cm from the targeted bone marrow lesion.
47. The method of claim 37, wherein the targeted bone marrow lesion is less than 1 cm from the joint.
48. The method of claim 37 providing only a single bone reinforcing member in the targeted bone marrow lesion.
49. The method of claim 37, wherein said injectable fluid material includes a ca. phosphate.
50. The method of claim 49, wherein said calcium phosphate comprises a calcium phosphate cement.
51. The method of claim 37, wherein said injecting includes injecting the injectable fluid material from a pre-loaded syringe.
52. The method of claim 51, wherein said pre-loaded syringe includes a needle.
53. The method of claim 37, wherein said injectable fluid material includes a non-resorbable material.
54. The method of claim 37, wherein said area is in and adjacent to the targeted bone marrow lesion.
US15/047,694 2005-04-07 2016-02-19 Osteoarthritis treatment and device Active US9439703B1 (en)

Priority Applications (8)

Application Number Priority Date Filing Date Title
US91446507P true 2007-04-27 2007-04-27
US12/110,434 US8062364B1 (en) 2007-04-27 2008-04-28 Osteoarthritis treatment and device
US13/269,136 US20120029522A1 (en) 2007-04-27 2011-10-07 Osteoarthritis treatment and device
US13/269,133 US8271600B2 (en) 2005-04-07 2011-10-07 Using automated agents to facilitate chat communications
US14/138,262 US8998998B2 (en) 2007-04-27 2013-12-23 Osteoarthritis treatment and device
US14/461,656 US9636161B2 (en) 2007-04-27 2014-08-18 Osteoarthritis treatment and device
US14/710,750 US9283014B2 (en) 2007-04-27 2015-05-13 Osteoarthritis treatment and device
US15/047,694 US9439703B1 (en) 2007-04-27 2016-02-19 Osteoarthritis treatment and device

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
US15/047,694 US9439703B1 (en) 2007-04-27 2016-02-19 Osteoarthritis treatment and device

Related Parent Applications (1)

Application Number Title Priority Date Filing Date
US14/710,750 Continuation US9283014B2 (en) 2007-04-27 2015-05-13 Osteoarthritis treatment and device

Publications (2)

Publication Number Publication Date
US20160242833A1 true US20160242833A1 (en) 2016-08-25
US9439703B1 US9439703B1 (en) 2016-09-13

Family

ID=44936757

Family Applications (13)

Application Number Title Priority Date Filing Date
US12/110,434 Active 2029-04-27 US8062364B1 (en) 2007-04-27 2008-04-28 Osteoarthritis treatment and device
US13/269,136 Abandoned US20120029522A1 (en) 2007-04-27 2011-10-07 Osteoarthritis treatment and device
US13/273,903 Active 2028-08-01 US8551178B2 (en) 2007-04-27 2011-10-14 Osteoarthritis treatment and device
US13/273,912 Active US8574303B2 (en) 2007-04-27 2011-10-14 Osteoarthritis treatment and device
US14/138,262 Active US8998998B2 (en) 2007-04-27 2013-12-23 Osteoarthritis treatment and device
US14/169,281 Active US8882848B2 (en) 2007-04-27 2014-01-31 Osteoarthritis treatment and device
US14/461,656 Active US9636161B2 (en) 2007-04-27 2014-08-18 Osteoarthritis treatment and device
US14/710,750 Active US9283014B2 (en) 2007-04-27 2015-05-13 Osteoarthritis treatment and device
US15/047,694 Active US9439703B1 (en) 2005-04-07 2016-02-19 Osteoarthritis treatment and device
US15/470,017 Active US9757239B2 (en) 2007-04-27 2017-03-27 Osteoarthritis treatment and device
US15/668,898 Active US9956082B2 (en) 2007-04-27 2017-08-04 Osteoarthritis treatment and device
US15/945,403 Active US10182916B2 (en) 2007-04-27 2018-04-04 Osteoarthritis treatment and device
US16/225,756 Pending US20190125540A1 (en) 2007-04-27 2018-12-19 Osteoarthritis treatment and device

Family Applications Before (8)

Application Number Title Priority Date Filing Date
US12/110,434 Active 2029-04-27 US8062364B1 (en) 2007-04-27 2008-04-28 Osteoarthritis treatment and device
US13/269,136 Abandoned US20120029522A1 (en) 2007-04-27 2011-10-07 Osteoarthritis treatment and device
US13/273,903 Active 2028-08-01 US8551178B2 (en) 2007-04-27 2011-10-14 Osteoarthritis treatment and device
US13/273,912 Active US8574303B2 (en) 2007-04-27 2011-10-14 Osteoarthritis treatment and device
US14/138,262 Active US8998998B2 (en) 2007-04-27 2013-12-23 Osteoarthritis treatment and device
US14/169,281 Active US8882848B2 (en) 2007-04-27 2014-01-31 Osteoarthritis treatment and device
US14/461,656 Active US9636161B2 (en) 2007-04-27 2014-08-18 Osteoarthritis treatment and device
US14/710,750 Active US9283014B2 (en) 2007-04-27 2015-05-13 Osteoarthritis treatment and device

Family Applications After (4)

Application Number Title Priority Date Filing Date
US15/470,017 Active US9757239B2 (en) 2007-04-27 2017-03-27 Osteoarthritis treatment and device
US15/668,898 Active US9956082B2 (en) 2007-04-27 2017-08-04 Osteoarthritis treatment and device
US15/945,403 Active US10182916B2 (en) 2007-04-27 2018-04-04 Osteoarthritis treatment and device
US16/225,756 Pending US20190125540A1 (en) 2007-04-27 2018-12-19 Osteoarthritis treatment and device

Country Status (1)

Country Link
US (13) US8062364B1 (en)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9636161B2 (en) 2007-04-27 2017-05-02 Zimmer Knee Creations, Inc. Osteoarthritis treatment and device

Families Citing this family (28)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2007089739A2 (en) * 2006-01-27 2007-08-09 Stryker Corporation Low pressure delivery system and method for delivering a solid and liquid mixture into a target site for medical treatment
US10231791B2 (en) 2012-06-21 2019-03-19 Globus Medical, Inc. Infrared signal based position recognition system for use with a robot-assisted surgery
US8219178B2 (en) 2007-02-16 2012-07-10 Catholic Healthcare West Method and system for performing invasive medical procedures using a surgical robot
US10136954B2 (en) 2012-06-21 2018-11-27 Globus Medical, Inc. Surgical tool systems and method
JP2013511357A (en) 2009-11-20 2013-04-04 ニー・クリエイションズ・リミテッド・ライアビリティ・カンパニーKnee Creations,Llc Coordinate mapping system for the joint treatment
US8951261B2 (en) 2009-11-20 2015-02-10 Zimmer Knee Creations, Inc. Subchondral treatment of joint pain
WO2011063281A1 (en) 2009-11-20 2011-05-26 Knee Creations, Llc Navigation and positioning instruments for joint repair
WO2011063260A1 (en) 2009-11-20 2011-05-26 Knee Creations, Llc Bone-derived implantable devices for subchondral treatment of joint pain
WO2011063250A1 (en) * 2009-11-20 2011-05-26 Knee Creations, Llc Implantable devices for subchondral treatment of joint pain
US8821504B2 (en) 2009-11-20 2014-09-02 Zimmer Knee Creations, Inc. Method for treating joint pain and associated instruments
US9259257B2 (en) * 2009-11-20 2016-02-16 Zimmer Knee Creations, Inc. Instruments for targeting a joint defect
AU2010321822A1 (en) 2009-11-20 2012-07-12 Knee Creations, Llc Instruments for a variable angle approach to a joint
WO2011063240A1 (en) 2009-11-20 2011-05-26 Knee Creations, Llc Implantable devices for subchondral treatment of joint pain
AU2012220633A1 (en) 2011-02-22 2013-08-29 Jamie A. CARROLL Navigation and positioning systems and guide instruments for joint repair
CA2838816C (en) 2011-06-09 2017-08-15 Zimmer Gmbh Instruments and devices for subchondral joint repair
US20120316571A1 (en) 2011-06-10 2012-12-13 Knee Creations, Llc Subchondral treatment of osteoarthritis in joints
US9119646B2 (en) 2011-08-07 2015-09-01 Zimmer Knee Creations, Inc. Subchondral treatment to prevent the progression of osteoarthritis of the joint
CA2851363A1 (en) 2011-10-11 2013-04-18 Shaun B. Hanson Methods and instruments for subchondral treatment of osteoarthritis in a small joint
EP2863827A4 (en) 2012-06-21 2016-04-20 Globus Medical Inc Surgical robot platform
US9339294B2 (en) 2012-09-07 2016-05-17 Zimmer Knee Creations, Inc. Instruments for controlled delivery of injectable materials into bone
WO2014039998A1 (en) 2012-09-07 2014-03-13 Zimmer Knee Creations, Inc. Subchondral treatment of bone defects with bone-derived implant
EP2892445B1 (en) 2012-09-07 2016-08-24 Zimmer Knee Creations, Inc. Navigation instruments for subchondral bone treatment
WO2014159913A1 (en) 2013-03-14 2014-10-02 Zimmer Knee Creations, Inc. Surgical access tools, guide instruments and accessories for subchondral treatment of bone
US9498272B2 (en) 2013-03-14 2016-11-22 Zimmer Knee Creations, Inc. Methods and instruments for subchondral treatment of joint defects near peripheral articular surface
US9351843B2 (en) 2013-03-14 2016-05-31 Zimmer Knee Creations, Inc. Systems and methods for joint repair including subchondral treatment of bone
EP3134022B1 (en) 2014-04-24 2018-01-10 KB Medical SA Surgical instrument holder for use with a robotic surgical system
US10080615B2 (en) 2015-08-12 2018-09-25 Globus Medical, Inc. Devices and methods for temporary mounting of parts to bone
US10117632B2 (en) 2016-02-03 2018-11-06 Globus Medical, Inc. Portable medical imaging system with beam scanning collimator

Family Cites Families (61)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5273964A (en) 1985-03-20 1993-12-28 Lemons J E Inorganic and organic composition for treatment of bone lesions
US5514137A (en) 1993-12-06 1996-05-07 Coutts; Richard D. Fixation of orthopedic devices
DE69535492D1 (en) 1994-01-26 2007-06-14 Kyphon Inc Improved inflatable device for use in surgical methods for fixing bone
US6248110B1 (en) 1994-01-26 2001-06-19 Kyphon, Inc. Systems and methods for treating fractured or diseased bone using expandable bodies
US5556429A (en) * 1994-05-06 1996-09-17 Advanced Bio Surfaces, Inc. Joint resurfacing system
US6140452A (en) 1994-05-06 2000-10-31 Advanced Bio Surfaces, Inc. Biomaterial for in situ tissue repair
WO1996039974A1 (en) 1995-06-07 1996-12-19 Implex Corporation Femoral head core channel filling prosthesis
WO1998020939A2 (en) 1996-11-15 1998-05-22 Advanced Bio Surfaces, Inc. Biomaterial system for in situ tissue repair
US5902825A (en) 1997-01-07 1999-05-11 Mitreoak, Ltd. Composition and method for the palliation of pain associated with diseases of the bone and bone joints
WO1998030252A1 (en) 1997-01-09 1998-07-16 Cohesion Technologies, Inc. Methods and apparatuses for making swellable uniformly shaped devices from polymeric materials
US6048346A (en) 1997-08-13 2000-04-11 Kyphon Inc. Systems and methods for injecting flowable materials into bones
US6296667B1 (en) 1997-10-01 2001-10-02 Phillips-Origen Ceramic Technology, Llc Bone substitutes
US6726691B2 (en) 1998-08-14 2004-04-27 Kyphon Inc. Methods for treating fractured and/or diseased bone
US6818018B1 (en) 1998-08-14 2004-11-16 Incept Llc In situ polymerizable hydrogels
US6241734B1 (en) 1998-08-14 2001-06-05 Kyphon, Inc. Systems and methods for placing materials into bone
US6395007B1 (en) 1999-03-16 2002-05-28 American Osteomedix, Inc. Apparatus and method for fixation of osteoporotic bone
RU2161929C1 (en) 1999-04-21 2001-01-20 Новокузнецкий государственный институт усовершенствования врачей Method for stabilizing subchondrous cortical plate of femoral condyles in the cases of degenerative osteoporosis
US6458162B1 (en) 1999-08-13 2002-10-01 Vita Special Purpose Corporation Composite shaped bodies and methods for their production and use
US7485119B2 (en) 2000-03-07 2009-02-03 Zimmer Technology, Inc. Method and apparatus for reducing femoral fractures
US6692526B1 (en) * 2000-03-15 2004-02-17 Michael E. Snyder Ophthalmological surgery colorant and delivery system
AR027685A1 (en) 2000-03-22 2003-04-09 Synthes Ag Fabric form and method for doing
US6711432B1 (en) 2000-10-23 2004-03-23 Carnegie Mellon University Computer-aided orthopedic surgery
US6564083B2 (en) 2000-12-18 2003-05-13 Hoffmann-La Roche Inc. Bone marrow edema as predictive of susceptibility to developing progressive osteoarthritis
HU0303013A3 (en) 2001-02-06 2007-06-28 Royal Alexandra Hosp Children A drug for treatment of osteonecrosis and for the management of patients at risk developing osteonecrosis
US6746451B2 (en) 2001-06-01 2004-06-08 Lance M. Middleton Tissue cavitation device and method
US20030055431A1 (en) 2001-09-19 2003-03-20 James Kevin Brannon Bone cutting assembly
US20030055316A1 (en) 2001-09-19 2003-03-20 Brannon James Kevin Endoscopic bone debridement
US6607561B2 (en) 2001-10-02 2003-08-19 James Kevin Brannon Biaxial core compression
US20030032963A1 (en) 2001-10-24 2003-02-13 Kyphon Inc. Devices and methods using an expandable body with internal restraint for compressing cancellous bone
US6827720B2 (en) 2002-01-15 2004-12-07 Alejandro Leali System and method for treating osteonecrosis
US20030135214A1 (en) 2002-01-15 2003-07-17 Fetto Joseph F. System, device, composition and method for treating and preventing avascular or osteonecrosis
ITPD20020064A1 (en) * 2002-03-12 2003-09-12 Fidia Advanced Biopolymers Srl Ester derivatives of hyaluronic acid for the preparation of idrogelda use in the biomedical field, sanitary and surgical and how sistem
US20050101673A1 (en) 2002-06-06 2005-05-12 Schering Ag Use of orally available prostacyclin derivatives for the production of a pharmaceutical agent for treating diseases that are associated with bone marrow edemas
WO2004080384A2 (en) 2003-03-12 2004-09-23 Yissum Research Development Company Of The Hebrew University Of Jerusalem Method of treating chronic joint pain
WO2005065079A2 (en) 2003-11-10 2005-07-21 Angiotech International Ag Medical implants and fibrosis-inducing agents
US7442196B2 (en) * 2004-02-06 2008-10-28 Synvasive Technology, Inc. Dynamic knee balancer
WO2005105170A1 (en) 2004-04-27 2005-11-10 Kyphon Inc. Bone substitute compositions and method of use
ITTO20040292A1 (en) * 2004-05-06 2004-08-06 Ezio Visentin Liaison body adapted to be introduced inside a bone structure of a human or animal body and system for the detection of at least one predetermined reference point of the connecting organ itself.
US8163030B2 (en) 2004-05-06 2012-04-24 Degradable Solutions Ag Biocompatible bone implant compositions and methods for repairing a bone defect
ES2245879B1 (en) 2004-05-21 2006-12-16 Universidad De Malaga Composition for bone or cartilage repair.
US20060057184A1 (en) 2004-09-16 2006-03-16 Nycz Jeffrey H Process to treat avascular necrosis (AVN) with osteoinductive materials
WO2006066440A2 (en) * 2004-12-23 2006-06-29 Staeubli Hans Ulrich Bone fixing device
WO2006073711A2 (en) 2005-01-06 2006-07-13 Kuros Biosurgery Ag Use of a matrix comprising a contrast agent in soft tissues
US8137664B2 (en) 2005-02-02 2012-03-20 Sdgi Holdings, Inc. Method and kit for repairing a defect in bone
US7867235B2 (en) 2005-06-14 2011-01-11 Fell Barry M System and method for joint restoration by extracapsular means
WO2007001624A2 (en) * 2005-06-28 2007-01-04 Microchips, Inc. Medical and dental implant devices for controlled drug delivery
US7442195B1 (en) 2005-09-12 2008-10-28 Behrens Alfred F Apparatus and method for the reduction of bone fractures
US7819876B2 (en) 2005-10-25 2010-10-26 Zimmer Technology, Inc. Orthopaedic pin driver
CA2640794C (en) 2006-02-16 2015-04-14 Universite Libre De Bruxelles A method for osteogenic differentiation of bone marrow stem cells (bmsc) and uses thereof
US7572291B2 (en) * 2006-03-28 2009-08-11 Warsaw Orthopedic, Inc. Osteochondral repair assembly including retracting spacer, kit and method
EP2012586A4 (en) 2006-04-10 2010-08-18 Abbott Biotech Ltd Uses and compositions for treatment of ankylosing spondylitis
US20070287988A1 (en) 2006-04-12 2007-12-13 Trebing Linda M Method and composition for treating osteonecrosis and/or avascular necrosis
CA2650490A1 (en) 2006-04-26 2007-11-08 Illuminoss Medical, Inc. Apparatus and methods for reinforcing bone
US7833270B2 (en) 2006-05-05 2010-11-16 Warsaw Orthopedic, Inc Implant depots to deliver growth factors to treat osteoporotic bone
MX2008014852A (en) 2006-05-26 2008-12-05 Baxter Int Injectable fibrin composition for bone augmentation.
WO2008033501A2 (en) 2006-09-14 2008-03-20 Spineology, Inc. Absorbent fabric implant
IL181211D0 (en) 2007-02-07 2007-07-04 Nmb Medical Applic Ltd Device and methods for strengthening long bones
EP2124783B1 (en) 2007-02-23 2018-04-11 Zimmer GmbH Implant for fracture care
US8062364B1 (en) 2007-04-27 2011-11-22 Knee Creations, Llc Osteoarthritis treatment and device
US8092452B2 (en) 2007-05-21 2012-01-10 Warsaw Orthopedic, Inc. Percutaneous delivery system for treatment of osteonecrosis of the hip and methods of use thereof
US20100145451A1 (en) 2008-12-04 2010-06-10 Derek Dee Joint support and subchondral support system

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9636161B2 (en) 2007-04-27 2017-05-02 Zimmer Knee Creations, Inc. Osteoarthritis treatment and device
US9757239B2 (en) 2007-04-27 2017-09-12 Zimmer Knee Creations, Inc. Osteoarthritis treatment and device
US9956082B2 (en) 2007-04-27 2018-05-01 Zimmer Knee Creations, Inc. Osteoarthritis treatment and device
US10182916B2 (en) 2007-04-27 2019-01-22 Zimmer Knee Creations, Inc. Osteoarthritis treatment and device

Also Published As

Publication number Publication date
US8062364B1 (en) 2011-11-22
US8882848B2 (en) 2014-11-11
US20170196695A1 (en) 2017-07-13
US8574303B2 (en) 2013-11-05
US9956082B2 (en) 2018-05-01
US20140107795A1 (en) 2014-04-17
US20170354506A1 (en) 2017-12-14
US9439703B1 (en) 2016-09-13
US9283014B2 (en) 2016-03-15
US20120035609A1 (en) 2012-02-09
US20150238239A1 (en) 2015-08-27
US9636161B2 (en) 2017-05-02
US20120035673A1 (en) 2012-02-09
US8551178B2 (en) 2013-10-08
US20190125540A1 (en) 2019-05-02
US20120029522A1 (en) 2012-02-02
US20140148910A1 (en) 2014-05-29
US20180221159A1 (en) 2018-08-09
US10182916B2 (en) 2019-01-22
US20150148909A1 (en) 2015-05-28
US8998998B2 (en) 2015-04-07
US9757239B2 (en) 2017-09-12

Similar Documents

Publication Publication Date Title
Kempf et al. Closed locked intramedullary nailing. Its application to comminuted fractures of the femur.
Tiedeman et al. The role of a composite, demineralized bone matrix and bone marrow in the treatment of osseous defects
Simmermacher et al. The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures
Schütz et al. Revolution in plate osteosynthesis: new internal fixator systems
Krettek et al. Evolution of minimally invasive plate osteosynthesis (MIPO) in the femur
Welch et al. Clinical outcomes of the Dynesys dynamic neutralization system: 1-year preliminary results
Edwards et al. Adverse reactions to an absorbable shoulder fixation device
AU2006203902B2 (en) Three-dimensional implantable bone support
Freeman et al. The management of infected total knee replacements
Müller et al. Technique of internal fixation of fractures
CN102781348B (en) Navigation and positioning instruments for joint repair
Krettek et al. The use of Poller screws as blocking screws in stabilising tibial fractures treated with small diameter intramedullary nails
Caspari et al. The role of arthroscopy in the management of tibial plateau fractures
Claes et al. Influence of size and stability of the osteotomy gap on the success of fracture healing
Bostman et al. Biodegradable internal fixation for malleolar fractures. A prospective randomised trial
Brandt et al. Percutaneous compression plating (PCCP) versus the dynamic hip screw for pertrochanteric hip fractures: preliminary results
US9867642B2 (en) Method and apparatus for repairing the mid-foot region via an intramedullary nail
Cole et al. The intramedullary skeletal kinetic distractor (ISKD): first clinical results of a new intramedullary nail for lengthening of the femur and tibia
Müller et al. Manual of internal fixation: techniques recommended by the AO-ASIF group
Asik et al. Arthroscopy-assisted operative management of tibial plateau fractures
Bostman et al. Transphyseal fracture fixation using biodegradable pins
Hoffmeyer The operative management of displaced fractures of the proximal humerus
US20110125264A1 (en) Implantable devices for subchondral treatment of joint pain
Park et al. Treatment of intertrochanteric fracture with the Gamma AP locking nail or by a compression hip screw–a randomised prospective trial
Jupiter et al. Blade plate fixation of proximal humeral non-unions

Legal Events

Date Code Title Description
STCF Information on status: patent grant

Free format text: PATENTED CASE

CC Certificate of correction