WO1999040864A1 - Guide de resection tibiale - Google Patents

Guide de resection tibiale Download PDF

Info

Publication number
WO1999040864A1
WO1999040864A1 PCT/US1998/002819 US9802819W WO9940864A1 WO 1999040864 A1 WO1999040864 A1 WO 1999040864A1 US 9802819 W US9802819 W US 9802819W WO 9940864 A1 WO9940864 A1 WO 9940864A1
Authority
WO
WIPO (PCT)
Prior art keywords
resecting
guide
guide system
cutting guide
cutting
Prior art date
Application number
PCT/US1998/002819
Other languages
English (en)
Inventor
Ramon B. Gustilo
William D. Lew
Richard S. Hammett
Douglas W. Cooper
Original Assignee
Midwest Orthopaedic Research Foundation
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
Application filed by Midwest Orthopaedic Research Foundation filed Critical Midwest Orthopaedic Research Foundation
Priority to PCT/US1998/002819 priority Critical patent/WO1999040864A1/fr
Publication of WO1999040864A1 publication Critical patent/WO1999040864A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/14—Surgical saws ; Accessories therefor
    • A61B17/15—Guides therefor
    • A61B17/154—Guides therefor for preparing bone for knee prosthesis
    • A61B17/157—Cutting tibia

Definitions

  • the invention relates to joint arthroplasty, especially knee arthroplasty and total knee arthroplasty. More specifically, the invention relates to devices which enable the surgeon to efficiently and accurately resect proximal tibial portions prior to placing prostheses thereon.
  • the knee joint enables a person's leg to flex or articulate during movement.
  • a lower bone tibia
  • femur Proximate the knee, the femur has two projections known as femoral condyles.
  • Femoral condyles engage fibrocartilage at the upper end of the tibia.
  • the knee joint is held together by ligaments, capsule, muscle, and tendons.
  • Four ligaments are especially prominent in knee structure, with one ligament on either side of the knee and two ligaments in the center. Of the center ligaments, one ligament is oriented toward the front and one toward the back.
  • the patella or knee cap is a piece of bone supported in front of the knee joint. Functionally, the patella acts as a shield.
  • the knee joint may be rendered nearly or totally inoperative by extended and heavy use, disease, or trauma. Often, the best therapy is total replacement (arthroplasty).
  • arthroplasty total knee arthroplasty, the femoral and tibial surfaces joined at the knee are totally replaced.
  • the first step in this process is the removal of the condylar surfaces and some underlying portions thereof.
  • the distal end of the femur is resected to provide clearance for a femoral prosthetic component.
  • a proximal portion of the tibia is resected to provide a relatively flat surface for a tibial prosthetic component.
  • a person's weight is transferred from the head of the femur proximate the hip to the ankle. Proper alignment of the knee must be maintained when femoral and tibial prosthetic devices are installed to - 2 -
  • femoral and tibial surfaces arising from these resections must be correctly aligned. These surfaces must also be the proper distance apart so that the planned prostheses will fit and function properly.
  • Alignment of resecting guides prior to surgical resection has traditionally been done by using a long straight metal rod.
  • One end of the metal rod is aligned with the center of the femoral head.
  • the other end is aligned with the center of the ankle.
  • the center of the femoral head is determined either from an X-ray or, less preferably, estimated by establishing a point located the width of three fingers medial to the superior iliac spine.
  • the rod should bisect the center of the knee components and should be generally perpendicular to a tibial and femoral resection plane.
  • Arthritic knees may have varus or valgus deformities and corresponding bone defects or gaps.
  • Resection planes in which these defective portions are exposed may not be satisfactory for supporting replacement prostheses.
  • the surgeon must either install a prosthetic device over a resected bone with an exposed defective gap and fill the defect under the component with bone cement or a spacer, for example, or resect the tibia still farther away from the knee to remove the defect or gap and insert a thicker prosthetic component. If the surgeon makes a further resection, a guide would be desirable so as to ensure that the resected portion is the correct shape and size.
  • a resection guide system which enables the surgeon to quickly and efficiently align a cutting block so that installed prostheses will fit and operate correctly.
  • a resection guide system which will enable a surgeon to quickly and accurately determine where to vertically situate a resection so that the resection removes only as much bone tissue as necessary.
  • the resected portion being a desired size and shape.
  • the present invention meets these needs by providing a resecting guide system to enable a surgeon to resect a portion of a bone proximate an articulating joint of a patient.
  • the resection forms at least one planar surface for placing a replacement prosthesis thereon.
  • the resecting guide system may include a cutting guide, means for aligning the cutting guide, and means for vertically adjusting the cutting guide.
  • the cutting guide may be affixable to an exterior portion of the bone.
  • the cutting guide may include means for guiding the resection such that the resection results in, or forms, the planar surface.
  • the means for aligning the cutting guide are configured such that the planar surface will be generally perpendicular to an anatomical alignment feature of the patient.
  • the resection guiding means may include a first saw slot.
  • the resecting guide system may be configured such that the saw slot is generally perpendicular to the aligning means.
  • the resection guiding means may include a second saw slot.
  • the second saw slot may be distally inclined from an anterior bone surface.
  • the angle of inclination may be between about 0° and 10°, between about 4° and 8°, or about 4°.
  • the cutting guide may be detachable from a remainder of the resecting guide system after being affixed to the exterior portion of the bone.
  • the aligning means may include an intramedullary alignment rod.
  • the aligning means may further include means for extramedullary alignment.
  • the extramedullary aligning means may include an extramedullary alignment rod, an alignment rod with a telescoping section, or a light strip alignment device.
  • the resecting guide system may further include means for determining a vertical location of the planar surface.
  • the vertical location determining means may include means for continuous vertical adjustment.
  • the continuous vertical adjustment means may include a - 4 -
  • the vertical location determining means may be incremental and may include a spring plunger cooperating with a vertical member, the vertical member with a plurality of bores defined therein, the plunger being biased in one of the bores.
  • the resecting guide system may further include means for determining a distance between the cutting guide and a surface of the bone to be resected.
  • the distance determining means may include a pivotable member, the pivotable member being disposable on the cutting guide.
  • the distance determining means may further include depth determining means, the depth determining means disposable proximate the pivotable member.
  • the depth measuring means may include a depressible element, which contacts the bone surface.
  • the depressible element may include a scale for measuring the distance.
  • the resecting guide system may further include a surface reference with a reference edge for referencing a first resected planar surface.
  • the cutting guide may display a cutting guide surface, the cutting guide surface being vertically and angularly adjustable with respect to the reference edge.
  • the cutting guide surface serves as a guide for resecting the second planar surface.
  • the resecting guide system may further include means for positioning said surface reference, with the surface reference positioning means being disposable in an intramedullary canal and detachably and adjustably connectable to the surface reference.
  • the resecting guide system may further include means for transferring a bone measurement to be used in resecting the second planar surface, the transferring means determining the vertical and angular relationship of the cutting guide surface relative to the reference edge.
  • the transferring means may include a reference block with reference surfaces.
  • the reference surfaces may include an angular surface and a slot.
  • the slot includes a planar surface.
  • the angular surface may be generally horizontal to the planar surface of the slot. The angular surface is disposed against the cutting guide surface and a portion of the reference edge is disposed in the slot when the cutting guide is being vertically and angularly adjusted relative to the reference - 5 -
  • the process includes the steps of: providing a cutting guide with a cutting guide surface; disposing the cutting guide on the articulating surface, the cutting guide surface being oriented in a first vertical plane; positioning the cutting guide proximate the articulating surface; aligning the cutting guide; and affixing the cutting guide to the bone.
  • the process may further include the step of determining a first distance from the reference edge to a point on the articulating surface.
  • the process may further include the step of vertically aligning the cutting guide a second distance from the first vertical plane, the second distance including the first distance.
  • the process may further include the step of resecting a spine from an articulating surface of the bone.
  • the process may still further include the step of determining the alignment of the cutting guide with an anatomical feature.
  • the cutting guide includes a guide surface, the cutting guide being detachably and adjustably connectable to a member with a planar surface guide.
  • the cutting guide also being detachably and adjustably connectable to a generally elongated member.
  • the process includes the steps of: defining a longitudinal cavity in the bone; adjusting the cutting guide surface relative to the planar reference guide; disposing the elongated member in the longitudinal cavity; and affixing the cutting guide to a surface of the bone.
  • the process may further include the step of detaching the cutting guide from the member with the planar surface and the elongated member.
  • the cutting guide surface may be adjusted by using a reference block.
  • the reference block displaying a slot and an angular surface, the reference edge of the planar surface guide being disposed in the slot and the angular surface being disposed against the guide surface.
  • Figure 1 is a perspective exploded view of a proximal resection guide system of the invention and a proximal portion of a tibia to be resected;
  • Figure 2 is a perspective view of an upper horizontal member of the invention
  • Figure 3 is a perspective view of a lower horizontal member of the invention
  • Figure 4 is a perspective view of the cutting block of Figure 1;
  • Figure 5 is a perspective sectional view of an extramedullary alignment rod of Figure 1;
  • Figure 6 is a perspective sectional view of another embodiment of an extramedullary alignment rod of Figure 1;
  • Figure 7 is a perspective view of the guide of Figure 1;
  • Figure 8 is a perspective view of a depth probe of Figure 1;
  • Figure 9 is a perspective view of another embodiment of a depth probe of Figure 1;
  • Figure 10 is an exploded perspective view of a second embodiment of the upper and lower horizontal members of Figure 1;
  • Figure 11 is an exploded perspective view of a third embodiment of the upper and lower horizontal members of Figure 1;
  • Figure 12 is a perspective view of a proximal tibial spine being resected
  • Figure 13 is a perspective view of a sizing insert being placed over a partially resected proximal portion of the tibia of Figure 12;
  • Figure 14 is a perspective view of an intermedullary tibial canal being drilled to accommodate insertion of an intramedullary alignment rod of Figure 1;
  • Figure 15 is a perspective view of the proximal resection guide system of Figure 1 assembled and, in its collapsed configuration, the cutting block to be affixed on an anterior proximal surface of a tibia to be - 7 -
  • Figure 16 is a perspective view of the proximal resection guide system of Figure 15 being affixed to the anterior surface of the tibia to be resected;
  • Figure 17 is a perspective view of the cutting block of Figure 1 being examined for proper alignment when affixed to an anterior surface of a tibia, the knee portion thereof magnified;
  • Figure 18 is a perspective view of a proximal tibial section being resected by a surgical saw, the surgical saw applied through slots within the cutting block of Figure 1;
  • Figure 19 is an exploded perspective view of another embodiment of a tibial resection guide system and of a portion of a tibia to be resected;
  • Figure 20 is a perspective view of the stem member of the tibial resection guide system of Figure 19;
  • Figure 21 is a perspective view of the tibial surface reference of the angular tibial resection guide of Figure 19;
  • Figure 22 is a perspective view of the cutting guide of the angular tibial resection guide of Figure 19;
  • Figure 23 is a perspective view of the link of Figure 19;
  • Figure 24 is a perspective view of one embodiment of the reference block of Figure 19;
  • Figure 25 is a perspective view of the angular tibial resection guide of Figure 19 assembled prior to adjustment;
  • Figure 26 is a perspective view of the angular tibial resection guide of Figure 19 being adjusted for a tibial resection;
  • Figure 27 is a perspective view of the angular tibial resection guide of Figure 19 affixed to an anterior surface of a tibia to be resected;
  • Figure 28 is a perspective view of the tibia being resected using the cutting guide of Figure 19;
  • Figure 29 is a perspective exploded view of a resected tibia and a - 8 -
  • the tibial prosthesis including a wedge component
  • Figure 30 is a fragmentary side plan view of an alternate embodiment of a tip of a depth probe of Figure 8.
  • Proximal tibial resection guide 100 includes upper horizontal member 110, lower horizontal member 112, cutting block (guide) 114, continuous advancing screw 116, intramedullary alignment rod 118, extramedullary alignment rod 120, guide 122, and depth probe 124.
  • upper horizontal member 110 includes first (hereinafter distal) block 132, connecting element 134, and second (hereinafter proximal) block 136.
  • Distal block 132 displays upper and lower surfaces 140, 142 and proximal and distal ends 144, 146.
  • Distal block 132 further defines bore 148. Bore 148 extends from upper to lower surfaces 140, 142. In this embodiment bore 148 is generally centrally disposed.
  • exemplary connecting element 134 extends between distal block 132 and proximal block 136.
  • Connecting element 134 in this embodiment, extends from an upper portion of proximal end 144 of distal block 132.
  • Connecting element 134 defines slot 152 and exterior and interior surfaces 154, 156.
  • certain other shapes for connecting element 134 are possible while achieving the objectives of this invention.
  • Proximal block 136 displays upper and lower surfaces 160, 162, first - 9 -
  • connecting element 134 is formed as an extension from a lower portion of proximal block 136 at second end 166.
  • Bore 170 extends from upper surface 160 and opens into cavity 172.
  • Cavity 172 further extends from bore 170 to lower surface 162.
  • Threads 174 are present on the periphery of bore 170.
  • Opening 176 extends from front surface 168 and opens into a lower portion of cavity 172. Bore 170 and cavity 172 are generally disposed within proximal block 136 and are generally coaxially aligned.
  • lower horizontal member 112 generally includes horizontal bar 180, vertical bar 182, and first (hereinafter proximal) element 184.
  • horizontal bar 180, vertical bar 182 and proximal element 184 are unitary.
  • Scale 190 is present on front surface 186.
  • Vertical bar 182 defines generally cylindrical bore 192, which preferably extends from top surface 188 to a lower surface of horizontal bar 180.
  • Proximal element 184 displays respective upper, front, and side surfaces 196, 198, 200 and a lower surface.
  • First and second bores 202, 204 are defined in proximal element 184 and extend from upper surface 196 to the lower surface thereof. Threaded openings 206, 208 are also defined in proximal element 184 and extend from surface 200 and open into respective bores 202, 204. Threaded opening 210 extends from side surface 200 and opens into bore 192. As depicted in Figures 10 and 11, ball plungers (or set screws) 211 or the like may be used within openings 206, 208.
  • unitary cutting block 114 may include lower portion 212 and slot portion 214.
  • Cutting block 114 presents a left surface and opposing right surface 216, and rear surface 218. If cutting block 114 is viewed from above, rear surface 218 is preferably arcuate, thereby giving the rear portion of cutting block 114 a generally concave - 10 -
  • Lower portion 212 presents front surface 220 and defines cavity 222 and bores 224, 226.
  • Cavity 222 is generally square or rectangular in cross section and is bordered by margin 228 proximate front surface 220 in this embodiment. Cavity 222 extends through lower portion 212 between margin 228 and rear surface 218, and is configured to accommodate horizontal bar 180 of lower horizontal member 112.
  • one or more bores 224 flank cavity 222. Bores 224 extend between front surface 220 and rear surface 218 and are generally parallel to cavity 222 in this embodiment.
  • lower portion 212 defines bores 226 extending between the left surface of cutting block 114 and rear surface 218 and between right surface 216 and rear surface 218. Bores 226 may angle inwardly as they approach rear surface 218.
  • Slot portion 214 generally includes respective lower, middle, and upper leaves 230, 232, 234, each having front edges 236, 238, 240, respectively.
  • Upper leaf 234 further displays upper surface 242.
  • a bevel may be present proximate front edges 236-240 and the left surface of cutting block 114 and between front edges 236-240 and right surface 216.
  • front edge 236 of lower leaf 230 is generally continuous with margin 228.
  • Leaves 230-234 generally present a stepped appearance to facilitate access and use.
  • Leaves 230-234 provide cutting guide surfaces and are unitarily joined proximate the left and right surfaces of cutting block 114. Respective lower and upper saw slots 244, 246 are defined between lower leaf 230 and middle leaf 232 and between middle leaf 232 and upper leaf 234. Lower saw slot 244 extends generally horizontally and is parallel to cavity 222. The plane of saw slot 244 may be orthogonal to axis 286 when tibial resection guide system 100 is assembled.
  • Upper saw slot 246 inclines toward lower saw slot 244 as viewed from front surface 220.
  • the incline of upper saw slot 246 may be between about 0° and 10°, about 4° and 8°, or about 4° from the plane of saw slot 244.
  • Bores 248 are defined within leaves 230-234. In this embodiment, a bore - 11 -
  • exemplary advancing screw 116 includes knurled head 260 and shaft 262.
  • Shaft 262 further includes threaded portion 263 and tip 264. Threaded portion 263 and tip 264 are separated by constriction 266. Threads are present on portion 263 and annular ribs are defined on tip 264.
  • intramedullary alignment rod 118 includes handle 280 and shaft 282.
  • Handle 280 and shaft 282 are unitary in this embodiment. However, there are a number of ways of functionally joining handle 280 and shaft 282. Also in this embodiment, shaft 282 terminates in rounded tip 284.
  • extramedullary alignment rod 120 includes outer telescoping section 290 and inner telescoping section 292.
  • Inner telescoping section 292 terminates in tip 294. Tip 294 and the remainder of inner telescoping section 292 are separated by constriction 296.
  • tip 294 is generally spherically shaped. However, tip 294 may assume any of a number of differing geometries to facilitate ease of use.
  • An additional inner telescoping section 292 may extend from the other end of outer telescoping section 290 in some embodiments. Swagging means may be present to prevent inner and outer telescoping sections 290, 292 from being separated in this or other embodiments.
  • Outer telescoping section 290 is sized and shaped such that it is snugly accommodated within either of bores 202, 204 of lower horizontal member 112.
  • Extramedullary alignment rod 300 includes outer telescoping section 302, middle telescoping section 304, and inner telescoping section 306.
  • Inner telescoping section 306 terminates in - 12 -
  • Tip 308 is separated from the remainder of inner telescoping section 306 by constriction 310.
  • outer telescoping section 302 is accommodated snugly within bores 202, 204.
  • extramedullary alignment rod 300 includes sections 304, 306, it should be appreciated that any number of telescoping sections may be present.
  • guide 122 generally includes guide member 314 and cylindrical (anchoring) member 316.
  • Guide member 314 displays upper surface 318 and a lower surface.
  • One or more bores 322 are defined in guide member 314. Bores 322 extend between upper surface 318 and the lower surface of guide member 314. However, a slot may be present in place of bores 322.
  • Cylindrical member 316 terminates in first end 324 and rounded tip 326.
  • Collar 328 is affixed, or unitary, to an approximate midpoint of cylindrical member 316.
  • a fastener such as screw 330 may be present to mate guide member 314 and cylindrical member 316. The portion of cylindrical member 316 between tip 326 and collar 328 fits snugly in bore 248 of cutting block 214.
  • a depth probe 124 includes outer casing 340, inner portion 342, and collar 344.
  • Outer casing 340 displays first end 346 and a second end threadably received in collar 344.
  • Outer casing 340 further defines central cavity 350.
  • References 352 are formed by a bevel proximate first end 346.
  • Inner portion 342 may be envisioned as including upper portion 356 and lower portion 358.
  • Upper portion 356 displays surface 360.
  • Scale 362 is present on surface 360.
  • both cavity 350 and upper portion 356 are semicircular in cross section. However, it should be appreciated that other cross sectional geometries are suitable.
  • Upper portion 356 is shaped to be accommodated snugly within central cavity 350.
  • Exemplary lower portion 358 is generally cylindrical and terminates in tip 364. Collar 344 is threadably received proximate the second end of outer casing 340.
  • upper and lower portions 356, 358 are unitary and may include a collar proximate the junction thereof.
  • a coiled spring may be - 13 -
  • Collar 344 is unitary in the embodiment shown in Figure 8. However, collar 344 may include cylindrical member 365 and extension 366. Cylindrical member 365 defines threads present on an interior surface thereof. These threads mate with threads proximate the second end of outer casing 340. In this embodiment, extension 366 fits snugly into bores 322 of guide 122. Extension 366 defines an opening through which lower portion 358 is slidably received. The opening admits portion 358, but will not admit the spring. Thus, the spring serves to bias lower portion 358 toward first end 346.
  • Tip 367 includes shaft 368 and angled member 369. Shaft 368 and angled member 369 are joined at bend 371. Member 369 terminates in tip 373. Tip 367 is especially useful when depth probe 124 cannot be positioned directly over a tibial surface.
  • Depth probe 370 broadly includes head 372 and shaft 374.
  • head 372 is knurled.
  • Shaft 374 displays outer surface 376.
  • Scale 378 is present on outer surface 376.
  • upper and lower horizontal members 110, 112 are mated.
  • Upper and lower horizontal members 110, 112 are mated by disposing vertical bar 182 into cavity 172 such that scale 190 is visible through opening 176.
  • Advancing screw 116 is then threaded into bore 170 and through bore 192 until constriction 266 is aligned with opening 210.
  • Fastening means such as set screw 382, is received into opening 210, thereby fixing screw 116 in place, yet allowing it to be rotated.
  • Guide system 100 is further assembled by inserting horizontal bar 180 into cavity 222. Alternate embodiments to upper and lower horizontal members
  • Embodiment 400 includes upper - 14 -
  • Upper horizontal member 402 includes first (hereinafter distal) block 406, connecting element 408, and second (hereinafter proximal) block 410.
  • Distal block 406 and connecting element 408 are generally similar to distal block 132 and connecting element 134 discussed above.
  • Proximal block 410 displays upper and lower surfaces 416, 418, first and second ends 420, 422 and front and right surfaces 424, 425.
  • Bore 426 and cavity 428 are defined within proximal block 410. Bore 426 extends from right surface 425 and opens into cavity 428. Cavity 428 extends from upper surface 416 to lower surface 418. Opening 432 extends from front surface 424 and opens into cavity 428.
  • Spring plunger 436 includes head 438, shaft 440, and element 442. Tip 443 of element 442 is visible in Figure 10. Element 442 is slidingly disposed within shaft 440 as is a spring. Element 442 is affixed to head 438. The spring thus biases head 438 to shaft 440. Threads 444 are defined on the exterior surface of shaft 440.
  • Lower horizontal member 404 includes horizontal bar 449, vertical bar 450 and first (hereinafter proximal) element 451.
  • Horizontal bar 449 and proximal element 451 may be configured similarly to horizontal bar 180 and proximal element 184 in lower horizontal member 112.
  • Vertical bar 450 displays front surface 452 and right surface 453.
  • Scale 454 is present on front surface 452.
  • a multiplicity of generally linearly aligned bores 456 are formed in vertical bar 450. Bores 456 extend inwardly from right surface 453. Bores 456 are generally overlapping in this embodiment. However, it should be appreciated that various spacings for bores 456 are possible.
  • cutting block 114 and horizontal bar 180 are mated as discussed above.
  • vertical bar 450 is disposed into cavity 428.
  • Spring plunger 436 is threadably received in bore 426 until tip 443 is disposed in one of bores 456.
  • head 438 of spring plunger 436 is pulled away from proximal block 410.
  • Upper and lower horizontal members 402, 404 then - 15 -
  • Embodiment 400 enables a user to adjust upper and lower horizontal members 402, 404 to discrete distances therebetween.
  • Adjusting mechanism 470 includes upper horizontal member 472, lower horizontal member 474, and pinion mechanism 476.
  • Upper horizontal member 472 includes first (hereinafter distal) block 480, connecting element 482, and second (hereinafter proximal) bracket 484.
  • Distal block 480 is generally similar to distal blocks 406 and 132.
  • Connecting element 482 includes first connector arm 492 and second connector arm 494.
  • Second connector arm 494 includes section 495. Section 495 is disposed at a greater distance from first connector arm 492 than is the remainder of second connector arm 494.
  • First and second connector arms 492, 494 define cavity 496. An enlarged portion 497 of cavity 496 is defined between section 495 and first connector arm 492.
  • First connector arm 492 and section 495 also define linearly aligned apertures 498.
  • Exemplary proximal bracket 484 includes frame 504.
  • Frame 504 generally defines opening 506. While unitary in this embodiment, frame 504 may be envisioned as including horizontal frame members 507, 508 and vertical frame members 509, 510.
  • Frame 504 is generally perpendicular to connecting element 482.
  • Lower horizontal member 474 includes horizontal bar 511, vertical bar 512, and first (hereinafter proximal) element 513. Horizontal bar 511 and proximal element 513 may be similar to horizontal bar 180 and proximal element 184.
  • Vertical bar 512 displays front surface 514 and a rear surface. Scale 518 is present on front surface 514.
  • Rack 520 is mounted proximate the rear surface of vertical bar 512.
  • Rack 520 defines a multiplicity of generally horizontal ribs 522.
  • Pinion mechanism 476 includes pinion 530, knob 532, - 16 -
  • pinion 530 may be envisioned as including large and small diameter portions 538, 540.
  • a multiplicity of ribs (or teeth) 542 extend generally longitudinally from the surface of large diameter portion 538.
  • Bore 544 is generally coaxially defined within pinion 530 in this embodiment.
  • Knob 532 defines bore 548.
  • Small diameter portion 540 fits snugly within bore 548 in this embodiment.
  • pin 534 disposes snugly within bore 544.
  • cutting block 114 is mated to horizontal bar 449 as described above.
  • Upper horizontal member 472 is mated to lower horizontal member 474 by extending vertical bar 512 into cavity 497 proximate frame 504.
  • Upper and lower horizontal members 472, 474 are then secured together in an adjustable relationship by installing pinion mechanism 476.
  • Pinion mechanism 476 is installed by mating pinion 530 and knob 532.
  • Pinion 530 and knob 532 are mated by disposing small diameter portion 540 of pinion 530 within bore 548 of knob 532.
  • Mated pinion 530 and knob 532 are then placed within enlarged portion 497 such that teeth 542 of pinion 530 mesh with ribs 522 of rack 520 and such that bore 544 of pinion 530 aligns with apertures 498 on arms 492, 494.
  • Pin 534 is disposed through apertures 498 and bore 544, then affixed in place by any number of methods known to the art.
  • Knob 532 and small diameter portion 540 may also define radially oriented bores which align when pinion 532 and knob 540 are mated. These bores are first aligned and knob 532 is then affixed to pinion 532 by installing set screw 536. Once firmly affixed, rotating knob 532 will also rotate pinion 530, thereby vertically adjusting upper and lower horizontal members 472, 474.
  • a proximal tibial portion is resected according to the present invention by a process beginning with a step depicted in Figure 12.
  • the middle of the upper portion of tibia 580 is relatively flat.
  • the proximal end of tibia 580 is then sized by fitting various sizes of insert 594 thereover. - 17 -
  • inserts 594 are conveniently available in small, medium, large, extra-large, magnum, and magnum-plus sizes. Insert 594 may be manipulated easily by fitting a tip of advancing lever 596 into an outer aperture therein. Insert 594 defines central aperture 598 and a plurality of smaller apertures 600.
  • This and other embodiments of exemplary insert 594 and advancing lever 596 are disclosed in above- referenced U.S. Patent Application No. 08/529,243, now U.S. Patent No.
  • insert 594 is secured to the proximal tibia by installing fixation spike 602 through each aperture 600 as shown in Figure 14. With plastic insert 594 now in place, drill bushing 606 is placed in aperture 598. Drill bit 608 is then inserted into bore 607 and used to drill and ream the intramedullary canal. In this embodiment bit 608 is approximately 9.5 ( ⁇ 1.0) mm in diameter, although this may vary. Insert 594 is then removed from the proximal tibia and a proximal tibial resection guide such as the embodiment generally depicted at 100 is placed thereon, as depicted in Figure 15.
  • Shaft 282 of intramedullary alignment rod 118 is inserted into bore 148 of horizontal upper member 110 and into the newly drilled intramedullary canal of tibia 580.
  • Upper horizontal member 110 is then lowered until lower surface 142 of distal block 132 contacts the top of the recently resected proximal tibia.
  • Upper horizontal member 110 is further adjusted to contact upper surface 242 of cutting block 214. Adjustment is by means of rotating advancing screw 116 in this embodiment.
  • saw slots 244, 246 within cutting block 114 are located some unknown distance above the medial and lateral articular surfaces.
  • Guide 122 is installed by inserting cylindrical or anchoring member
  • depth probe 124 are then pivoted until depth probe 124 is positioned above the lowest point on the tibial articular surface. Inner portion 342 is then depressed until tip 364 contacts the tibial surface. A reading is made by means of aligning references 352 with marks on scale 362. In this example, scale 362 is graduated in millimeters. Guide and depth probe 122, 124 are then removed and placed similarly in bore 248 on the other side of cutting block 114 and the procedure is repeated. Thus, the distance from lower saw slot 244 to the lowest tibial point has been determined. Proximal resection guide system 100 will now be configured to resect tibia 580 proximate the lowest articular point thereon. If depth probe 370 is used in lieu of depth probe 124, shaft 374 is accommodated in one of bores 322. Tip 379 is allowed to rest on the tibial surface. Scale 378 is read where it intersects surface 318.
  • the measured distance from saw slot 244 to the lowest condylar point is determined per above. Once determined, the measured distance is added to a thickness of the tibial component to be placed thereon. The total of the distance and tibial component thickness determines the total depth of resection on proximal tibia 580.
  • Cutting block 116 and mated lower horizontal member 112 are lowered by rotating advancing screw 116 until the predetermined distance is reflected by reading scale 190.
  • a plurality of drill bits 612 are inserted through apertures 224 and drilled into the anterior tibia, thus fixing cutting block 114 to tibia 580.
  • extramedullary alignment rods 120 are then placed in each of bores 202, 204, kept in position with ball plungers 211, and extended.
  • cutting block 114 Proper positioning of cutting block 114 is then determined by alignment with an anatomical feature. For example, tip 294 of extramedullary alignment rod 120 would be disposed directly above a midpoint 588 on the ankle of the patient and tip 294 of the other extramedullary alignment rod 120 would be disposed above ball joint (femoral head) 589 of the patient's femur. If the alignment is not correct, one or both bits 612 are removed and cutting block 114 is repositioned and - 19 -
  • cutting block 114 may be further affixed to tibia 580 by means of placing one or more fixation spikes 602 into bores 224, 244.
  • a light strip alignment device could be used in conjunction with, or in place of, alignment rods 120.
  • One example of such a light strip alignment device is generally disclosed in the above-referenced U.S. Patent Application No. 08/529,243.
  • Proximal resection guide system 100 is prepared as a cutting guide by removing upper and lower horizontal members 110, 112 and intermedullary alignment rod 118 from cutting block 114, now secured to tibia 580. However, alignment may be checked at any time by reinserting lower horizontal member 112 and extramedullary alignment rod 120 as described above.
  • a level resection may be made through saw slot 244.
  • a resection with an angled, posterior tilt may be made through inclined upper saw slot 246.
  • a cut through inclined slot 246 would meet a cut through level saw slot 244 approximately in the middle of the tibial plateau if slot 244 angles toward slot 242 at 4°.
  • a wedge or generally rectangular augmentation device may be used under the tibial component of the prosthesis.
  • These augmentation devices may have varying thicknesses and shapes corresponding to tibial prosthetic components for differently sized knees.
  • These augmentation devices may be located in either the medial or lateral condyles of either right or left knees. These augmentation devices are generally discussed below and may be made in varying thicknesses and shapes.
  • thicknesses of 10 mm and 15 mm have proven to be useful.
  • These augmentation devices may also be made to correspond to knee and prosthetic device sizes, such as small, medium, large, extra-large, magnum and magnum-plus.
  • Tibial resection guide 700 broadly includes adjustable tibial trial tension (ATTT) device upper platform 702, stem member 704, tibial surface reference 706, cutting guide 708, link 710, adjustment knobs 712, and one or more reference blocks 714.
  • ATTT device upper platform 702 is disclosed in the above-referenced U.S. Patent Application 08/529,243.
  • ATTT device upper platform 702 includes a cylindrical projection which disposes in the pre-drilled intramedullary canal. Bore 703 is defined in the cylindrical projection of platform 702.
  • An antirotation key extends from the cylindrical projection. The antirotation key is configured to mate into slot 732 (described below).
  • stem member 704 includes head 720 and shaft 722.
  • Head 720 may be envisioned as including threaded portion 724, flange 726, and collar 728. Threads 729 are formed on the radial exterior of threaded portion 724.
  • Shaft 722 terminates in rounded tip 730. Slot 732 is defined within shaft 722 and may extend from tip 730 to an approximate mid-point of shaft 722.
  • tibial surface reference 706 includes link 740 and vertical member 742. Slot 743 is defined by link 740.
  • Vertical member 742 displays lower edge 744 and includes upper cylindrical member 746.
  • Cylindrical member 746 defines bore 748. Threads 750 are defined within cylindrical member 746 proximate bore 748.
  • cutting guide 708 is generally triangular in cross section.
  • Cutting guide 708 displays a pair of upper sloping surfaces 760 and lower surface 762.
  • Cutting guide 708 defines bore 764 and a multiplicity of apertures 766.
  • Bore 764 is disposed proximate the apex of cutting guide 708.
  • Threads 768 are formed in cutting guide 708 proximate bore 764.
  • Link 710 is depicted in Figure 23 and defines bore 782 and slot 780.
  • Adjustment knobs 712 are generally depicted in Figure 19.
  • Reference knobs 712 may be male or female as needed in assembling and adjusting resection guide 700 as described below. - 21 -
  • each of reference blocks 714 are unitary in this embodiment. However, each reference block 714 may be envisioned as including middle portion 786 and two end portions 788, 790. Each end portion 788, 790 has been machined to form a specific set of reference surfaces with angular and dimensional surfaces for conforming cutting guide 708 as will be described below. For example, end portion 790 has been machined to form four planar surfaces 792, 794, 796, 798. Each planar surface 792-798 terminates in extensions 800, 802, 804, 806. Extensions 800-806 extend beyond adjacent planar surfaces 792-798. Triangular projections 808, 810 are shown in Figure 24. Two other triangular projections cannot be seen.
  • Slots 812, 814 are formed between triangular projections 808, 810 and extensions 800-806. Angular surfaces 816, 818 and two other angular surfaces not depicted in Figure 24 are also present on triangular projections 808, 810 and are opposite slots 812, 814.
  • Various bone deformities may intersect the resection planes made by using resection guide system 100.
  • Resection guide system 700 enables the surgeon to make further resections to remove these deformities. These further resections may be either wedge-shaped or rectangular when viewed anteriorly.
  • exemplary reference block 714 enable cutting block 708 to be adjusted relative tibial surface reference 706 to accommodate small, medium, large, extra-large, magnum, and magnum-plus sized tibial trays 594 and wedges 820.
  • different embodiments of reference block 714 may be made to accommodate either left or right joints and to accommodate either wedge or rectangular prosthetic augmentation members. These prosthetic augmentation members are positioned and secured between insert 594 (or some other prosthetic device) and the remaining tibia If the resected area is generally rectangular instead of generally triangular in cross section, angled surfaces such as surface 816 will be generally parallel to corresponding planar surface 792.
  • Resection guide 700 may be assembled as depicted in Figure 19. Threaded portion 724 of stem member 704 is passed through link 740 until - 22 -
  • link 740 abuts collar 728. At this point flange 726 will be disposed and aligned within slot 743.
  • a female adjustment knob 712 is then received onto threaded portion 724.
  • a threaded portion of another adjustment knob 712 is passed through slot 780 of link 710 and threaded into bore 748.
  • Another male adjustment knob is passed through bore 782 and threaded into bore 764 of cutting guide 708.
  • the location, amount, and shape of the portion of the tibia to be further resected will have been determined previously.
  • the predetermined angular measurement is translated from the tibia to angular tibial resection guide 700 by the following procedure depicted in Figures 25 and 26.
  • Proximal resection guide system 100 may have been used to size the tibial plateau, make the proximal tibial cut, and determine the thickness and geometry of a selected tibial augmentation wedge to be used.
  • lower edge 744 of the tibial surface reference 706 is slid onto slot 812 on reference block 714.
  • Reference block 714 is selected for the appropriate condyle and tibial tray size.
  • Cutting block 708 is then adjusted by loosening and tightening knobs 712 and by translating vertical link 710. Adjustment continues until cutting edge 760 of cutting block 708 is brought into contact with angular surface 818 on reference block 708. Thus, the correct angle for the chosen wedge resection has been translated thereby. Knobs 712 are then tightened to maintain the relationship between tibial surface reference 706 and cutting block 708.
  • Resection guide 700 without reference block 714, is then used as a guide in tibial resection. Shaft 722 of stem member 704 is inserted into the threaded bushing of ATTT device 702 and rotated until the antirotation key present in platform 702 is seated into slot 732. Cutting block 708, in its prescribed orientation, is maneuvered as close as possible to the anterior surface of tibia 580.
  • cutting block 708 is then affixed to the anterior tibial surface with fixation spikes or drill bits 612. Knobs 712 are then loosened and the remainder of resection system 700 is then removed, leaving cutting block 708 affixed in place. The resection then proceeds with the surgeon resecting a pre-designated portion of tibia 580 by using - 23 -
  • prosthesis 594 or some other prosthetic device may be installed on resected tibia 580.
  • wedge (augmentation member) 820 will be affixed over the further resected tibial area.
  • Wedge 820 is generally triangular in vertical cross section.
  • Member 822 is generally rectangular in cross section. Member 822 is used when the subsequent resection results in a similarly-shaped plurality of surfaces on tibia 580.
  • Components of the resection guide systems of the invention may be made from materials known to the art as capable of undergoing sterilization and possessing sufficient strength and rigidity for use, such as stainless steel and aluminum.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Dentistry (AREA)
  • Biomedical Technology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Transplantation (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un système (100) guide de résection pour articulations qui se prête particulièrement à la résection du tibia proximal. Selon un mode de réalisation, le système guide de résection comprend un bloc de coupe (114) et une structure permettant de placer verticalement le bloc de coupe (114) et de l'aligner pour qu'il s'adapte à l'anatomie de la jambe du patient. Selon un autre mode de réalisation, on prévoit un guide permettant à un chirurgien d'effectuer une résection des parties du tibia croisant la surface plane tibiale ayant subi une résection. Le guide transfère une mesure à l'os et guide la résection.
PCT/US1998/002819 1998-02-12 1998-02-12 Guide de resection tibiale WO1999040864A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/US1998/002819 WO1999040864A1 (fr) 1998-02-12 1998-02-12 Guide de resection tibiale

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/US1998/002819 WO1999040864A1 (fr) 1998-02-12 1998-02-12 Guide de resection tibiale

Publications (1)

Publication Number Publication Date
WO1999040864A1 true WO1999040864A1 (fr) 1999-08-19

Family

ID=22266384

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US1998/002819 WO1999040864A1 (fr) 1998-02-12 1998-02-12 Guide de resection tibiale

Country Status (1)

Country Link
WO (1) WO1999040864A1 (fr)

Cited By (18)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP2434964A2 (fr) * 2009-05-29 2012-04-04 Smith&Nephew, Inc. Méthodes et appareil permettant de réaliser une arthroplastie du genou
EP2292189A3 (fr) * 2002-11-27 2012-05-23 ConforMIS, Inc. Outils chirurgicaux pouvant etre selectionnes en fonction du patient
US8834490B2 (en) 2001-08-28 2014-09-16 Bonutti Skeletal Innovations Llc Method for robotic arthroplasty using navigation
US8862202B2 (en) 1998-09-14 2014-10-14 The Board Of Trustees Of The Leland Stanford Junior University Assessing the condition of a joint and preventing damage
US8951259B2 (en) 2001-05-25 2015-02-10 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools
US8951260B2 (en) 2001-05-25 2015-02-10 Conformis, Inc. Surgical cutting guide
WO2015027288A1 (fr) * 2013-09-02 2015-03-05 The Australian On-Line Prosthetic Company Guide de coupe comprenant des repères de mesure pour la vérification de résections pré-planifiées
US9023050B2 (en) 2001-05-25 2015-05-05 Conformis, Inc. Surgical tools for arthroplasty
US9055953B2 (en) 2001-05-25 2015-06-16 Conformis, Inc. Methods and compositions for articular repair
US9066728B2 (en) 2001-05-25 2015-06-30 Conformis, Inc. Surgical tools facilitating increased accuracy, speed and simplicity in performing joint arthroplasty
US9101443B2 (en) 2000-01-14 2015-08-11 Bonutti Skeletal Innovations Llc Methods for robotic arthroplasty
US9308053B2 (en) 2006-02-06 2016-04-12 Conformis, Inc. Patient-specific joint arthroplasty devices for ligament repair
US9326780B2 (en) 2006-02-06 2016-05-03 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools incorporating anatomical relief
US9486226B2 (en) 2012-04-18 2016-11-08 Conformis, Inc. Tibial guides, tools, and techniques for resecting the tibial plateau
US9579110B2 (en) 2001-05-25 2017-02-28 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools
US9675471B2 (en) 2012-06-11 2017-06-13 Conformis, Inc. Devices, techniques and methods for assessing joint spacing, balancing soft tissues and obtaining desired kinematics for joint implant components
CN108272486A (zh) * 2012-05-03 2018-07-13 新特斯有限责任公司 切除引导架
US11666346B2 (en) 2007-03-23 2023-06-06 Xiros Limited Surgical templates

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4952213A (en) * 1989-02-03 1990-08-28 Boehringer Mannheim Corporation Tibial cutting guide
US5667511A (en) * 1995-02-15 1997-09-16 Smith & Nephew Richards Inc. Tibial resection instrumentation and surgical method
US5681316A (en) * 1996-08-22 1997-10-28 Johnson & Johnson Professional, Inc. Tibial resection guide

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4952213A (en) * 1989-02-03 1990-08-28 Boehringer Mannheim Corporation Tibial cutting guide
US5667511A (en) * 1995-02-15 1997-09-16 Smith & Nephew Richards Inc. Tibial resection instrumentation and surgical method
US5681316A (en) * 1996-08-22 1997-10-28 Johnson & Johnson Professional, Inc. Tibial resection guide

Cited By (57)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8862202B2 (en) 1998-09-14 2014-10-14 The Board Of Trustees Of The Leland Stanford Junior University Assessing the condition of a joint and preventing damage
US9192459B2 (en) 2000-01-14 2015-11-24 Bonutti Skeletal Innovations Llc Method of performing total knee arthroplasty
US9795394B2 (en) 2000-01-14 2017-10-24 Bonutti Skeletal Innovations Llc Method for placing implant using robotic system
US9101443B2 (en) 2000-01-14 2015-08-11 Bonutti Skeletal Innovations Llc Methods for robotic arthroplasty
US9107679B2 (en) 2001-05-25 2015-08-18 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools
US9072531B2 (en) 2001-05-25 2015-07-07 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools
US9358018B2 (en) 2001-05-25 2016-06-07 Conformis, Inc. Joint arthroplasty devices and surgical tools
US9579110B2 (en) 2001-05-25 2017-02-28 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools
US8951259B2 (en) 2001-05-25 2015-02-10 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools
US8951260B2 (en) 2001-05-25 2015-02-10 Conformis, Inc. Surgical cutting guide
US9216025B2 (en) 2001-05-25 2015-12-22 Conformis, Inc. Joint arthroplasty devices and surgical tools
US8998915B2 (en) 2001-05-25 2015-04-07 Conformis, Inc. Joint arthroplasty devices and surgical tools
US9023050B2 (en) 2001-05-25 2015-05-05 Conformis, Inc. Surgical tools for arthroplasty
US9186161B2 (en) 2001-05-25 2015-11-17 Conformis, Inc. Surgical tools for arthroplasty
US9055953B2 (en) 2001-05-25 2015-06-16 Conformis, Inc. Methods and compositions for articular repair
US9125672B2 (en) 2001-05-25 2015-09-08 Conformis, Inc. Joint arthroplasty devices and surgical tools
US9066728B2 (en) 2001-05-25 2015-06-30 Conformis, Inc. Surgical tools facilitating increased accuracy, speed and simplicity in performing joint arthroplasty
US9125673B2 (en) 2001-05-25 2015-09-08 Conformis, Inc. Joint arthroplasty devices and surgical tools
US9084617B2 (en) 2001-05-25 2015-07-21 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools
US9295482B2 (en) 2001-05-25 2016-03-29 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools
US9107680B2 (en) 2001-05-25 2015-08-18 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools
US8834490B2 (en) 2001-08-28 2014-09-16 Bonutti Skeletal Innovations Llc Method for robotic arthroplasty using navigation
US8840629B2 (en) 2001-08-28 2014-09-23 Bonutti Skeletal Innovations Llc Robotic arthroplasty system including navigation
US9060797B2 (en) 2001-08-28 2015-06-23 Bonutti Skeletal Innovations Llc Method of preparing a femur and tibia in knee arthroplasty
US10231739B1 (en) 2001-08-28 2019-03-19 Bonutti Skeletal Innovations Llc System and method for robotic surgery
US10321918B2 (en) 2001-08-28 2019-06-18 Bonutti Skeletal Innovations Llc Methods for robotic surgery using a cannula
US9763683B2 (en) 2001-08-28 2017-09-19 Bonutti Skeletal Innovations Llc Method for performing surgical procedures using optical cutting guides
US10470780B2 (en) 2001-08-28 2019-11-12 Bonutti Skeletal Innovations Llc Systems and methods for ligament balancing in robotic surgery
US8858557B2 (en) 2001-08-28 2014-10-14 Bonutti Skeletal Innovations Llc Method of preparing a femur and tibia in knee arthroplasty
EP2292188A3 (fr) * 2002-11-27 2012-05-23 ConforMIS, Inc. Outils chirurgicaux pouvant etre selectionnes en fonction du patient
EP2292189A3 (fr) * 2002-11-27 2012-05-23 ConforMIS, Inc. Outils chirurgicaux pouvant etre selectionnes en fonction du patient
US9408615B2 (en) 2003-11-25 2016-08-09 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools
US9381025B2 (en) 2003-11-25 2016-07-05 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools
US9241725B2 (en) 2003-11-25 2016-01-26 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools
US9308005B2 (en) 2003-11-25 2016-04-12 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools
US9113921B2 (en) 2003-11-25 2015-08-25 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools
US9314256B2 (en) 2003-11-25 2016-04-19 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools
US9295481B2 (en) 2003-11-25 2016-03-29 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools
US9241724B2 (en) 2003-11-25 2016-01-26 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools
US9375222B2 (en) 2003-11-25 2016-06-28 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools
US9308053B2 (en) 2006-02-06 2016-04-12 Conformis, Inc. Patient-specific joint arthroplasty devices for ligament repair
US9220516B2 (en) 2006-02-06 2015-12-29 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools
US9326780B2 (en) 2006-02-06 2016-05-03 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools incorporating anatomical relief
US9220517B2 (en) 2006-02-06 2015-12-29 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools
US11672548B2 (en) 2007-03-23 2023-06-13 Xiros Limited Surgical templates
US11666346B2 (en) 2007-03-23 2023-06-06 Xiros Limited Surgical templates
JP2015097819A (ja) * 2009-05-29 2015-05-28 スミス アンド ネフュー インコーポレーテッド 膝関節形成術を実施するための方法および器具
KR101761934B1 (ko) 2009-05-29 2017-08-04 스미스 앤드 네퓨, 인크. 슬관절 치환술을 수행하기 위한 방법 및 장치
KR20170087542A (ko) * 2009-05-29 2017-07-28 스미스 앤드 네퓨, 인크. 슬관절 치환술을 수행하기 위한 방법 및 장치
KR102024021B1 (ko) 2009-05-29 2019-09-24 스미스 앤드 네퓨, 인크. 슬관절 치환술을 수행하기 위한 방법 및 장치
EP2434964A4 (fr) * 2009-05-29 2014-10-22 Smith & Nephew Inc Méthodes et appareil permettant de réaliser une arthroplastie du genou
EP2434964A2 (fr) * 2009-05-29 2012-04-04 Smith&Nephew, Inc. Méthodes et appareil permettant de réaliser une arthroplastie du genou
US9486226B2 (en) 2012-04-18 2016-11-08 Conformis, Inc. Tibial guides, tools, and techniques for resecting the tibial plateau
CN108272486A (zh) * 2012-05-03 2018-07-13 新特斯有限责任公司 切除引导架
CN108272486B (zh) * 2012-05-03 2021-11-09 新特斯有限责任公司 切除引导架
US9675471B2 (en) 2012-06-11 2017-06-13 Conformis, Inc. Devices, techniques and methods for assessing joint spacing, balancing soft tissues and obtaining desired kinematics for joint implant components
WO2015027288A1 (fr) * 2013-09-02 2015-03-05 The Australian On-Line Prosthetic Company Guide de coupe comprenant des repères de mesure pour la vérification de résections pré-planifiées

Similar Documents

Publication Publication Date Title
AU762838B2 (en) Tibial plateau resection guide
US11690636B2 (en) Fixation apparatus and method for total ankle replacement
AU696251B2 (en) Distal femoral cutting guide
US5702460A (en) Revision femoral trial prosthesis
US5720752A (en) Distal femoral cutting guide apparatus with anterior or posterior referencing for use in knee joint replacement surgery
US4759350A (en) Instruments for shaping distal femoral and proximal tibial surfaces
US5569261A (en) Distal femoral cutting guide apparatus with anterior or posterior referencing for use in knee joint replacement surgery
US5916219A (en) Tibial plateau resection guide
US7628793B2 (en) Knee balancing block
US6059788A (en) Method and apparatus for locating bone cuts at the distal condylar femur region to receive a femoral prosthesis and properly articulated with patellar and tibial prosthesis
EP0384562B1 (fr) Guide pour façonner la surface du tibia pour recevoir une prothèse de genou
AU784909B2 (en) Femoral knee saw guide and method
US5925049A (en) Device and method for distal femur cutting and prosthesis measuring
US20040153066A1 (en) Apparatus for knee surgery and method of use
WO1999040864A1 (fr) Guide de resection tibiale
US20100010493A1 (en) Orthopaedic cutting guide instrument
US7670344B2 (en) Finely adjustable resection assembly
EP1480549A2 (fr) Methode d'arthroplastie totale du genou a effraction minimale
WO1997030640A9 (fr) Instrument de section femorale a guidage distal
WO2003063682A2 (fr) Guide d'alignement fluoroscopique extramedullaire

Legal Events

Date Code Title Description
AK Designated states

Kind code of ref document: A1

Designated state(s): JP

AL Designated countries for regional patents

Kind code of ref document: A1

Designated state(s): AT BE CH DE DK ES FI FR GB GR IE IT LU MC NL PT SE

121 Ep: the epo has been informed by wipo that ep was designated in this application
122 Ep: pct application non-entry in european phase