WO2013086174A1 - Bone-conserving orthopedic augments - Google Patents

Bone-conserving orthopedic augments Download PDF

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Publication number
WO2013086174A1
WO2013086174A1 PCT/US2012/068222 US2012068222W WO2013086174A1 WO 2013086174 A1 WO2013086174 A1 WO 2013086174A1 US 2012068222 W US2012068222 W US 2012068222W WO 2013086174 A1 WO2013086174 A1 WO 2013086174A1
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WO
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Patent type
Prior art keywords
opening
fastener
aperture
augment
device
Prior art date
Application number
PCT/US2012/068222
Other languages
French (fr)
Inventor
Jeffrey J. Shea
Nathaniel M. QUINN
Daniel R. Goldberg
Original Assignee
Smith & Nephew, Inc.
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Filing date
Publication date

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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
    • A61F2/30721Accessories
    • A61F2/30734Modular inserts, sleeves or augments, e.g. placed on proximal part of stem for fixation purposes or wedges for bridging a bone defect
    • 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
    • A61B17/80Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8052Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates immobilised relative to screws by interlocking form of the heads and plate holes, e.g. conical or threaded
    • 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
    • A61B17/84Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86Threaded wires, pins or screws; Nuts therefor
    • 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
    • A61F2/32Joints for the hip
    • A61F2/34Acetabular cups
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, E.G. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30576Special structural features of bone or joint prostheses not otherwise provided for with extending fixation tabs
    • A61F2002/30578Special structural features of bone or joint prostheses not otherwise provided for with extending fixation tabs having apertures, e.g. for receiving fixation screws
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, E.G. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30767Special external and/or bone-contacting surfaces, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external and/or bone-contacting surfaces, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes, grooves
    • A61F2002/3082Grooves

Abstract

Disclosed herein are systems, devices, and methods for orthopedic augments having apertures structured to receive bone fixation devices. The apertures generally include insertion sites that are at least partially open on a plurality of sides to enable use of a wider fastener for improved bone fixation with augments that have a lower cross-sectional thickness to conserve bone and reduce bone reaming. In certain embodiments, the systems, devices, and methods include an augment having one or more apertures structured to retain a fastener.

Description

BONE-CONSERVING ORTHOPEDIC AUGMENTS

Cross-Reference to Related Applications

[0001] This application claims the benefit of United States Provisional Patent Application No. 61/567,978, filed December 7, 2011, which is hereby incorporated by reference herein in its entirety.

Background

[0ΘΘ2] Joints undergo degenerative changes due to a variety of reasons. When joint degeneration becomes advanced or irreversible, it may become necessary to replace the natural joint with a prosthetic joint. Artificial implants, including hip joints, shoulder joints, and knee joints are widely used in orthopedic surgery. Specifically, hip joint prostheses are common. The human hip joint acts mechanically as a ball and socket joint, wherein the ball- shaped head of the femur is positioned within the socket-shaped acetabulum of the pelvis. Various degenerative diseases and injuries may require replacement of all or a portion of a hip using synthetic materials, typically metals, ceramics, or plastics.

[0003] More particularly, natural hips often undergo degenerative changes, requiring replacement of the hip joint with a prosthetic joint. Often, a cup or shell is placed within the acetabulum to reconstruct the acetabulum surface. The acetabular shell or cup may be formed of metal, ceramic material, or another suitable material. A liner (conventionally formed of polyethylene material such as ultra high molecular weight polyethylene, a ceramic material, or in some cases, even a metal liner) is then fit tightly within the shell to provide an inner bearing surface that receives and cooperates with an artificial femoral head in an articulating relationship to track and accommodate the relative movement between the femur and the acetabulum. A secure fit between the cup and acetabulum is critical for successful joint replacement. [0004] Minimizing reaming to conserve bone can help improve patient outcomes.

Augments are used to improve the fit of the cup within the acetabulum and provide additional support. Augments are used to compensate for defects or abnormal shapes at the bone interface, and can be used to reduce bone reaming for a secure fit. For example, a surgeon may choose to use augments to adjust the acetabular interface instead of conducting additional bone reaming for placement of a larger cup. Keeping as much of the patient's bone intact as possible can provide better structural integrity.

[0ΘΘ5] Subsequent revision surgeries may become necessary due to degeneration of bone over time or advancement of a degenerative disease. For example, bone is often lost around the rim of the acetabulum, and this may provide less rim coverage to securely place a press- fit cup. If excessive reaming was undertaken with the previous procedures, the bone loss due to the combination of reaming and additional degeneration may significantly impair the likelihood of success in the revision surgery. Therefore, systems and methods to conserve bone can be important for successful patient outcomes.

[0006] Augments are frequently fixed to bone with screws. In general, a larger screw provides improved bone fixation compared to a relatively smaller screw. However, with current augments, increasing the screw size increases the corresponding screw hole size and the augment profile (size or thickness). A larger profile augment may, in turn, require increased bone reaming for fitting of the augment and placement of the screw, which can be detrimental to the patient. Accordingly, improved augments are needed to better fix the implant while reducing bone reaming requirements.

Summary

[0ΘΘ7] Disclosed herein are systems, devices, and methods for orthopedic augments having one or more apertures structured to receive bone fixation devices. The apertures generally include an insertion site that is at least partially open on a plurality' of sides to enable use of a wider fastener for improved bone fixation with augments that have a lower cross-sectional thickness to conserve bone and reduce bone reammg. In certain embodiments, the systems, devices, and methods include an augment having a plurality of apertures structured to retain a fastener. An aperture has a first opening and a second opening on at least two different portions of the augment. In certain embodiments, the fastener is a screw inserted through the aperture in a selected position. In certain embodiments, a portion of the shaft of the screw extends out of the second opening. The augment may have a plurality of apertures. The augment may have various structures to attach to the patient's bone. [0008] The aperture has one or more structures or features to retain the fastener. In certain embodiments the aperture is structured to retain a fastener in a plurality of positions. The aperture may be substantially arcuate. The fastener may be a screw, and the aperture may have a plurality of fins structured to mate with the threads of the screw. The first opening and second opening may be contiguous and form a retaining edge. In certain embodiments, the augment has a ridge, such as a flange, structured to interface with a patient's acetabular rim. The ridge may be tapered. The head of a screw may extend beyond the ridge and may directly abut the patient's bone or tissue. The aperture may have a third opening on a surface of the augment that attaches to the patient's bone.

[0009] In certain embodiments, methods for implanting an orthopedic augment include providing an augment having an aperture with a first opening and a second opening on at l east two different portions of the augment and structured to retain a fastener, inserting the fastener into the first opening, and extending a portion of the fastener through the second opening. The method may further include adjusting the fastener such that the head abuts the augment surface and the tip extends beyond the aperture. The fastener may be a screw, and the aperture may have a plurality of fins structured to mate with the threads of the screw. The augment may have a plurality of apertures, and the method may further include inserting a plurality of fasteners into respective ones of the plurality of apertures.

[0010] Variations and modifications of these embodiments will occur to those of skill in the art after reviewing this disclosure. The foregoing features and aspects may be

implemented, in any combination and subcombinations (including multiple dependent combinations and subcombinations), with one or more other features described herein. The various features described or illustrated above, including any components thereof, may be combined or integrated in other systems. Moreover, certain features may be omitted or not implemented.

Brief Description of the Drawings

[0011] The foregoing and other objects and advantages will be apparent upon consideration of the following detailed description, taken in conjunction with the accompanying drawings, in which like reference characters refer to like parts throughout, and in which:

[0012] FIGS. I A-1D show an illustrative low profile orthopedic augment with an aperture configured to retain a fastener for secure fixation to bone.

[0013] FIGS. 2A-2C show illustrative fins within an aperture on an augment for retaining a fastener in a plurality of positions. [0014] FIGS. 3A-3C show an illustrative cross-sectional view of an augment with a plurality of fins and a screw fastener inserted at a range of angles.

[0015] FIGS. 4A-4C show an illustrative augment secured to a patient's acetabulum and coupled with an acetabular cup.

[001 ] FIG. 5 shows an illustrative augment with a flange.

[0017] FIG. 6A-6C show an illustrative cross-sectional view of an augment with a flange and screw fastener inserted at a range of angles.

Detailed Description

[0018] To provide an overall understanding of the systems, devices, and methods described herein, certain illustrative embodiments will be described. Although the embodiments and features described herein are specifically described for use in connection with orthopedic hip replacement systems, it will be understood that ail the components, connection mechanisms, adjustable systems, manufacturing methods, and other features outlined below may be combined with one another in any suitable manner and may be adapted and applied to medical devices and implants to be used in other surgical procedures, including, but not limited to acetabular procedures, knee procedures, spine arthroplasty, cranio-maxillofacial surgical procedures, hip arthroplasty, shoulder arthroplasty, as well as foot, ankle, hand, and other extremity procedures.

[0019] Disclosed herein are systems, devices, and methods for orthopedic augments having apertures structured to receive bone fixation devices. The apertures generally include insertion sites that are at least partially open on a plurality of sides to enable use of a wider fastener for improved bone fixation with augments that have a lower cross-sectional thickness to conserve bone and reduce bone reaming. In certain embodiments, the systems, devices, and methods include an augment having one or more apertures structured to retain a fastener. In certain embodiments, the augment has a ridge structured to interface with a patient's acetabular rim.

[0020] FIGS. 1A-1D show front, rear, top, and cross-sectional perspective views of a representative orthopedic augment 100 with a plurality of apertures configured to retain a fastener to securely fix the augment to a patient's bone. The augment 100 has a plurality of apertures 108a and 108b, but any number of apertures may be used within the scope of the systems and methods described herein. The augment 100 has a first surface 101 shown in FIG. IB configured to mate with an implant, such as an acetabular shell, a second surface 102 shown in FIG. 1 A configured to mate with the bone, and an intermediate portion 104 shown in FIG. 1A and FIG. IB disposed between the first surface 101 and the second surface 102.

[0021] In general, one or more surfaces of the augment are substantially arcuate so it can mate with an orthopedic implant such as an acetabular cup or shell. As seen in FIG. 1C, the first surface 101 is substantially arcuate in a substantially horizontal direction and, as seen in FIG. ID, the first surface 101 is substantially arcuate in a substantially vertical direction. The first surface 101 may further include other structures, materials, or fasteners in order to facilitate secure coupling to an orthopedic implant. In certain embodiments, the second surface 102 is substantially arcuate, so it can mate with a patient's bone, such as an acetabulum. As seen in FIG. IC, the second surface 102 is substantially arcuate in a substantially horizontal direction and, as seen in FIG. ID, the second surface 102 is substantially arcuate in a substantially vertical direction. The second surface 102 may also have other shapes, structures, materials, or features to provide adequate coupling with the bone,

[0Θ22] The intermediate portion 104 provides structural strength for the augment to retain a fastener and couple with an orthopedic implant and bone. The aperture 108a (or 108b) is disposed on the upper face 106 of the intermediate portion 104, and is thereby positioned to retain a screw 122 having a post 130, or other fastener. In particular, a first opening 1 10a of the aperture 108a is disposed along the perimeter edge 1 14 of the face 106 and a second opening 112a is disposed on the second surface 102. The second opening 112a intersects with the first opening 110 and the perimeter edge 1 14 of the face 106. The screw 122 fits within the first opening 110a and is exposed through the second opening 112a. The intersection of the first opening 110a with the second opening 1 12a forms a retaining edge 118a having end points 119, 121 that are spaced relative to each other so as to retain the post 130 of the fastener. In certain embodiments, apertures 108a and 108b have substantially similar structures. However, each of the plurality of apertures may have different structural features or sizes for appropriate!)' retaining a desired fastener and anchoring the augment to the bone or tissue.

[0023] As shown in FIGS. 1A-1C, the first opening 110a has a shape substantially similar to a partial circle encompassing greater than about 180° and can receive a substantially rounded post 130 of the screw 122. As shown in FIG. IC, the aperture is substantially concave and arcuate so it can mate with a cylindrical fastener, such as the head 126 and post 130 of screw 122. However, the aperture may also have other shapes or features, such as threads or fins, for retaining a fastener. As shown in FIG. IC, the diameter Dl of the first opening 1 10a is larger than the diameter D2 of the second opening 1 12a. Preferably, Dl is wide enough to receive the post 130 of the screw, such as a 6,5mm or larger cancellous bone screw, D2 is sufficiently narrow to retain the post 130 from pulling away from the platform 105 through the second opening 112a but is sufficiently wide to allow at least a portion of the screw post to extend partially beyond the end points 1 19, 121 (e.g., see also 219 and 221 of Fig. 2B). Thus the second opening 112 allows the surgeon to install the fastener closer to the bone, thereby helping to reduce the size requirement of the augment but allows th e use of a l arger screw.

[0024] FIG. ID depicts a cross-sectional view through line ID-ID of FIG. 1C, showing the aperture in relation to other elements of the augment. For example, the second opening 112b of aperture 108b extends through second surface 102 and the perimeter edge 114 of the upper face 106. in general, the second opening 1 12b is not substantially parallel to the first opening 110b. The first opening 110b and the second opening 112b are also contiguous. As described above, this structure allows for retaining a fastener, for example at end points 119, 121, while also allowing a portion of the fastener, such as post 130, to extend through and beyond the second opening 112b. In practice, the tip 128 of the screw 122 is inserted through the first opening 110 and the second opening 112 for securing to the bone.

[0025] The aperture may also include other features to retain a fastener. For example, FIG. 2A shows an illustrative plurality of fins 220a-220b within the aperture that can interface with the threads of a fastener. In the depicted embodiment, the aperture has a plurality of fins 220a-d. FIG. 2A illustrates four fins, but one or more fins may be used. In certain embodiments, as shown in FIG. 2A and FIG. 2B, the fins 220a-220d are curved. For example, fin 220a includes concave portion 225a. Each fin 220a-220d may include similar concave portions 225a-225d, The concave portion 225a of the fin 220a provides increased structural strength for coupling with the screw 222 to prevent undesired deformity during insertion of the screw 222 through the aperture 208, to securely retain the screw 222 in a selected position, and, in turn, to securely anchor the augment to the bone. As illustrated in FIG. 2C, when the screw 222 is inserted through the aperture 208 and rotated at head 226, the fins 220a-d engage the threads 224 of the screw 222 and thereby retain the screw 222 as it is tightened. The tip extends through the aperture to engage the bone. The end points 219, 221 partially enclose the post 230 to retain the screw 228 within the aperture 208, while a portion of the post 230 extends through the second opening 212 of the aperture 208. The aperture structure thus allows for a lower profile augment because less augment structure is needed for the connection point to the implant. [0026] In certain embodiments the fastener, such as a screw, can be inserted into and retained by the aperture in a plurality of selected positions and angles with respect to the augment. For example, FIGS. 3A-3C show cross-sectional perspectives of an illustrative augment 300 including an aperture 308 with fins 320a, 320b and a screw fastener 322.

During surgery, the surgeon may select any insertion angle (e.g. al , a.2, etc.) within a range of angles a relative to the face 306, as depicted in FIG. 3A. As shown in FIG. 3B, the tip portion 328 of the screw 322 is inserted through the aperture 308 at the selected angle, and the fins 320a-320b engage the threads 324 to retain the screw 322 in the selected angle al or a2 as the screw engages the bone to secure the augment to the bone. As shown in FIG. 3C, the post 330 of the screw is not fully enclosed by the aperture 308, and a portion of the post 330 extends through the second opening 312 beyond end point 319. Since a portion of the post 330 of the screw 322 extends beyond end point 119, a relatively larger screw may be used and adjusted for an appropriate engagement angle for fixation to the bone.

[0027] The low profile augment may be used to provide stabilization of an implant, such as an acetabular shell, where conventionally structured augments would not fit, or where additional reaming would be required for fitting a conventional augment. The secure placement of the augment to the bone provides stable fixation of the augment and, in turn, the acetabular cup.

[0028] FIG. 4A shows an illustrative augment secured to a patient's acetabulum and coupled with an acetabular cup. The first surface 401 of the augment 400 is coupled to the cup edge 438 of the acetabular cup 436. The second surface 402 of the augment 400 is coupled to the wall 434 of the acetabulum 432. As shown, the screw 422 has been inserted through the aperture 408 at a selected angle βΐ for anchoring to the bone of the patient. The tabs 420 of the aperture engage the threads 424 of the screw 422 for retaining the screw 422 within the aperture 408, and the head 426 of the fastener 422 abuts the face 406 of the augment 400. As shown in FIG. 4B, a portion of the post 430 of the screw 422 extends beyond the end point 419 of the augment 400. In certain embodiments, the edge 427 of the head 426 extends beyond end point 419 to abut the bone 432. The overhanging edge 427 provides a stable surface for supporting the augment 400 along a plurality of sides, and particularly, along the both the wall 434 and rim 440 of the acetabulum 432. The head 426 of the screw 422 also clamps the augment 400 to the acetabulum 432 for secure fixation.

[0029] FIG. 4C shows the illustrative augment 400 of FIG. 4 A from a top perspective. Augment 400 is secured to the bone with a plurality of screws 422 and 452. During a surgery, the surgeon selects appropriate insertion angles βΐ, β2 for screws 422, 452. In certain embodiments, the insertion angles βΐ , β2 are substantially different and can be selected by the surgeon for secure placement of the augment 400. As shown in FIG. 4C, the end points 419, 421 partially enclose the post 430 to retain the screw 422 within the aperture, but a portion of the screw post 430 extends beyond the perimeter edge 14 of the augment 400.

[0Θ30] In alternative embodiments, as illustrated, for example, in FIG. 5, an augment 500 may include a flange, such as ridge 516 that extends outwardly from the second surface 502 and contains an aperture 508 as described above. As seen in the cross-sectional perspective of FIG. 5, the aperture 508 is disposed within the ridge 516 and is exposed to an upper face 506 of the intermediate portion 504. The second opening 512 of aperture 508 extends through an edge 517 of the ridge 516. In general, the second opening 512 is not substantially parallel to the first opening 510. As shown, the second opening 512 extends on the edge 517 of the ridge 516 in a plane that is substantially perpendicular to the plane of the first opening 510. The first opening 510 and the second opening 512 are also contiguous. As described above, this structure allows for retaining a fastener, while also allowing a portion of the fastener, such as the post of a screw fastener, to extend through and beyond the second opening 512.

[0031] In certain embodiments, the aperture 508 has a third opening 513 disposed on a lower surface 523 of the ridge 516. As shown, the third opening 513 and first opening 510 are substantially parallel, but may be offset at different angles. The lower surface 523 of the ridge 516 is contiguous with the second surface 502 of the augment 500 and, as shown in

FIG. 5, the first opening 510, second opening 512, and third opening 513 are contiguous. In certain implementations, the ridge 516 is configured to be placed over the acetabular rim of the patient. The ridge 516 may also have a narrowing taper to the ridge edge 517 to reduce the augment profile. A narrow ridge edge 517 allows the head of fastener to closely abut the bone or tissue, if desired. In practice, the tip of a screw is inserted through the first opening 510 and through the third opening 513 for securing to the bone.

[0032] In certain embodiments a fastener, such as a screw, can be inserted into and retained by the aperture within the ridge in a plurality of selected positions and angles with respect to the augment. For example, FIG. 6A-6C show cross-sectional perspectives of an illustrative augment 600 including an aperture 608 with fins 620a, 620b and a screw fastener 622.

During surgery, the surgeon may select any insertion angle (e.g. yl, γ 2, etc.) within a range of angles γ relative to the face 606, as depicted in FIG. 6A. As shown in FIG. 6B, the tip portion 628 of the screw 622 is inserted through the aperture 608 at the selected angle, and the fins 620a-620b engage the threads 624 to retain the screw 622 in the selected angle γΐ or y2 as the screw engages the bone to secure the augment to the bone.

[0033] FIG. 6C shows the augment 600 secured to a patient's acetabulum 632. The second surface 602 of the augment 600 is coupled to a wall 634 of the acetabulum 632. The ridge 616 of the augment 600 interfaces with the acetabular rim 440. In certain embodiments, the ridge 616 is tapered from the intermediate portion 604 to the ridge edge 617 to further reduce the profile of the augment 600 while maintaining the ability to use a larger bone screw to securely fix the augment to the bone. As shown in FIG. 6C, the post 630 of the screw is not fully enclosed by the aperture 608, and a portion of the post 630 extends beyond the edge 617 of the ridge 616 and through the second opening 612. Since a portion of the post 630 of the screw 622 extends through the second opening 612, a relatively larger screw may be used and adjusted for an appropriate engagement angle for fixation to the bone. In certain

embodiments, the edge 627 of the head 626 extends beyond the edge 617 of the augment ridge 616 like an overhanging cliff. The overhanging edge 627 provides a stable surface for supporting the augment 600 along a plurality of sides, and particularly, along the both the wall 634 and rim 640 of the acetabulum 632, The head 626 of the screw 622 also clamps the augment 600 to the acetabulum 632 for secure fixation.

[0034] The foregoing is merely illustrative of the principles of the disclosure, and the systems, devices, and methods can be practiced by other than the described embodiments, which are presented for purposes of illustration and not of limitation. It is to be understood that the systems, devices, and methods disclosed herein, while shown for use in hip systems, may be applied to systems, devices, and methods to be used in other surgical procedures including, but not limited to, spine arthroplasty, cranio-maxiilofacial surgical procedures, hip arthroplasty, shoulder arthroplasty, as well as foot, ankle, hand, and extremities procedures.

[0035] Variations and modifications will occur to those of skill in the art after reviewing this disclosure. The disclosed features may be implemented, in any combination and subcombination (including multiple dependent combinations and subcombinations), with one or more other features described herein. The various features described or illustrated above, including any components thereof, may be combined or integrated in other systems.

Moreover, certain features may be omitted or not implemented.

[0036] Examples of changes, substitutions, and alterations are ascertainable by one skilled in the art and could be made without departing from the scope of the information disclosed herein. All references cited herein are incorporated by reference in their entirety and made part of this application.

Claims

What is Claimed is:
1. An orthopedic device comprising:
an augment having a first surface configured to attach to an implant, a second surface configured to attach to a patient's bone, an intermediate portion disposed between the first and second surfaces, and an aperture structured to retain a fastener, the aperture having a first opening disposed on a face of the intermediate portion and a second opening that intersects a perimeter edge of the face of the intermediate portion,
2. The device of claim 1, wherein the first opening and the second opening are contiguous.
3. The device of claim 1 , wherem the aperture is structured to retain the fastener in a plurality of positions.
4. The device of claim 1, wherein the aperture comprises a plurality of fins, the fins structured to mate with and retain the fastener.
5. The device of claim 4, wherein the fastener is a screw, the screw having threads stractured to mate with the fins in a plurality of positions.
6. The device of claim 1, wherein the aperture is substantially arcuate.
7. The device of any of claims 1-6, comprising a plurality of apertures.
8. The device of any of claims 1-6, wherein the intermediate portion has a ridge, and the aperture is disposed on the ridge.
9. The device of claim 8, wherein the ridge is structured to interface with a patient's bone.
10. The device of claim 9, wherein the ridge is tapered.
11. The device of any of claims 1 -6, wherein the diameter of the first opening is larger than the diameter of the second opening.
12. The device of any of claims 1-6, wherem the aperture has a retaining edge.
13. The device of any of claims 1-6, wherem the aperture has a third opening.
14. The device of claim 13, wherein the first opening, second opening, and third opening are contiguous.
15. The device of any of claims 1-6, wherein the first surface is substantially arcuate.
16. The device of any of any of claims 1-6, wherein the second surface is substantially arcuate.
17. An orthopedic device comprising any of claims 1-6, or any combination of such claims.
18. A method of fastening an orthopedic augment comprising:
providing an augment having a first surface configured to attach to an implant, a second surface extending away from the first surface and having an aperture structured to retain a fastener, the aperture having a first opening disposed on a face of the augment, and a second opening that is not substantially parallel to the first opening; and
inserting a fastener into the first opening, and extending at least a portion of the fastener through the second opening.
19. The method of claim 18, wherein the augment has an intermediate portion, and the aperture is disposed on the intermediate portion.
20. The method of claim 18, comprising selecting an insertion angle between the fastener and the first surface.
21. The method of claim 18, comprising adjusting the fastener relative to the augment such that the head portion of the fastener abuts the face of the intermediate portion and the tip portion of the fastener extends beyond the aperture.
22. The method of claim 18, wherein the aperture has fins, and the fastener has threads, and further comprising rotating the fastener such that the fins couple with threads and retain the fastener in a selected position.
23. The method of claim 18, wherein the augment has a plurality of apertures.
24. The method of claim 22, comprising providing a plurality of fasteners and inserting respective ones of the plurality of fasteners into respective ones of the plurality of apertures.
25. An orthopedic device, comprising:
an augment for improving the fit of an orthopedic implant;
a means for fastening the augment to the patient's bone or tissue; and a means for retaining the fastening means in a selected position.
PCT/US2012/068222 2011-12-07 2012-12-06 Bone-conserving orthopedic augments WO2013086174A1 (en)

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US61/567,978 2011-12-07

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Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5176711A (en) * 1991-03-06 1993-01-05 Grimes James B Acetabular revision system
US6666870B2 (en) * 2001-01-05 2003-12-23 Robert A Dixon Method utilizing chemical bonding to improve the bone screw fixation interface
US7682393B2 (en) * 2004-10-14 2010-03-23 Warsaw Orthopedic, Inc. Implant system, method, and instrument for augmentation or reconstruction of intervertebral disc
US7794502B2 (en) * 2001-01-23 2010-09-14 Warsaw Orthopedic, Inc. Implant with openings adapted to receive bone screws
US7993408B2 (en) * 2008-02-12 2011-08-09 Biomet Manufacturing Corp. Acetabular cup having an adjustable modular augment

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5176711A (en) * 1991-03-06 1993-01-05 Grimes James B Acetabular revision system
US6666870B2 (en) * 2001-01-05 2003-12-23 Robert A Dixon Method utilizing chemical bonding to improve the bone screw fixation interface
US7794502B2 (en) * 2001-01-23 2010-09-14 Warsaw Orthopedic, Inc. Implant with openings adapted to receive bone screws
US7682393B2 (en) * 2004-10-14 2010-03-23 Warsaw Orthopedic, Inc. Implant system, method, and instrument for augmentation or reconstruction of intervertebral disc
US7993408B2 (en) * 2008-02-12 2011-08-09 Biomet Manufacturing Corp. Acetabular cup having an adjustable modular augment

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