WO2021173491A1 - Positioning guide for a cemented acetabular shell - Google Patents

Abstract

An acetabular implant (200) including an acetabular shell (210), a liner, (250) and an optional cage construct (130). The acetabular implant further includes a positioning guide (300) arranged and configured to maintain a position of the liner relative to the acetabular shell while cement, which has been injected between the acetabular shell and the liner, hardens. In this manner, the positioning guide enables the liner to maintain its position (e.g., orientation, angle, etc.) without the need for the surgeon to actively hold the liner while the cement hardens. In addition, the positioning guide ensures that a space or gap is maintained between the acetabular shell and liner for receipt of the cement.

Description

POSITIONING GUIDE FOR A CEMENTED ACETABULAR SHELL

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This is a non-provisional of, and claims the benefit of the filing date of, pending U.S. provisional patent application number 62/982,179, filed February 27, 2020, entitled “Positioning Guide for a Cemented Acetabular Apparatus” the entirety of which application is incorporated by reference herein.

FIELD OF THE DISCLOSURE

[0002] The present disclosure relates generally to orthopedic apparatuses and methods to address acetabular defects, and particularly to a positioning guide used to provisionally position a liner within an acetabular shell at a desired angle of the liner relative to the acetabular shell.

BACKGROUND OF THE DISCLOSURE

[0003] Articulating regions of a patient’s anatomy can include areas where two bones or bone portions, sections, etc. (terms used interchangeably herein without the intent to limit) move relative to one another. For example, an acetabulum can provide a region for articulation with a femoral head. The articulating region, however, can become injured or worn, and thus require replacement with one or more implants. Such implants can replace the acetabulum, the femoral head, and various other portions of the femur, or other combinations thereof. The replacement of both the acetabulum and the femoral head is generally referred to as a total joint replacement.

[0004] Acetabular implants, apparatuses, prostheses, or devices (used interchangeably herein without the intent to limit) are one type of implant currently used to address acetabular defects in which large portions of a patient’s medial wall and surrounding bone are missing or a discontinuity is present. Referring to FIG. 1, and as will be readily appreciated by one of ordinary skill in the art, one method for addressing acetabular defects involves implanting an acetabular implant 100 into a patient’s acetabular region. Generally speaking, this involves implanting an acetabular shell or cup 110 (terms used interchangeably without the intent to limit) into the patient’s acetabulum. The acetabular shell 110 may be secured to the patient’s acetabulum via, for example, fasteners, adhesive, cement, or combinations thereof, etc. Next, an acetabular cage 130 may be inserted inside of an interior cavity of the acetabular shell 110. In use, the acetabular cage 130 may be coupled to the acetabular shell 110 via, for example, fasteners, adhesive, cement, or combination thereof, etc. The acetabular cage 130 generally includes a central section arranged and configured to be received within the acetabular shell 110, and superior and inferior flanges 132, 134 extending from the central section (e.g., in use, with the acetabular cage 130 positioned within the acetabular shell 110, the flanges 132, 134 protrude from a rim of the acetabular shell 110 to reach the host bone). In use, the superior and inferior flanges 132, 134 may be bent, manipulated, etc. by a surgeon in a manner that somewhat matches the patient’s bone (e.g., patient’s iliac and ischial anatomy). The flanges 132, 134 are arranged and configured to receive fasteners, screws, etc. for coupling the flanges 132, 134, and hence the acetabular implant 100, to the host bone. A liner 150 may then be inserted into the acetabular cage 130. Alternatively, the acetabular cage 130 may be omitted and the liner 150 may be inserted directly into acetabular shell 110. In use, the liner 150 may be coupled to the acetabular cage 130 and/or acetabular shell 110 via, for example, an adhesive, cement, etc. Thus, once the cement hardens, the liner 150 may be inhibited from moving, articulating, or the like, relative to the acetabular cage 130 and/or acetabular shell 110. In use, the liner 150 receives the femoral head 170 of, for example, a hip implant 175. In use, the femoral head 170 is arranged and configured to articulate within and relative to the liner 150.

[0005] One disadvantage of utilizing cemented liners 150 (e.g., implants where the liner 150 is cemented within the acetabular shell 110 and/or cage 130) is that the orientation of the acetabular shell 110 may be dictated by the necessity to secure, fixate, couple, attach, etc. (used interchangeably without the intent to limit) the acetabular shell 110 to the patient’s bone. That is, placement of the acetabular shell 110 may be dictated by the surgeon’s ability to find quality bone to receive the acetabular shell 110 (e.g., surgeons may need to implant the acetabular shell 110 in a position and/or orientation that is not optimal for the biomechanics of the patient in order to find good bone contact to secure the acetabular shell 110 to the patient). This may be especially true in a reversion surgery.

[0006] Once positioned, the liner 150 may be inserted within the acetabular shell 110 and/or cage 130. In positioning the liner 150 within the acetabular shell 110 and/or cage 130, the liner 150 may be ideally positioned to achieve proper kinematics (e.g., to achieve a desired rotation relative to the patient’s bone (e.g., pelvis)). In order to achieve proper kinematics, orientation of the liner 150 may need to be angled relative to the acetabular shell 110 (e.g., surgeons may adjust the orientation (e.g., angle, inclination, anteversion) of the liner 150 relative to the acetabular shell 110 to optimize, for example, the soft-tissue tension and the biomechanics of the joint).

[0007] To accomplish this, surgeons may position (e.g., orient, angle, incline, etc.) the liner 150 relative to the acetabular shell 110 and/or cage 130 to achieve proper kinematics. For example, surgeons may position and hold the liner 150 in a desired position to achieve the desired placement of the liner 150 relative to the acetabular shell 110 and/or cage 130 while the cement positioned within the acetabular shell 110 and/or cage 130 hardens. As such, surgeons are tasked with holding the liner 150 at a desired angle and/or desired depth relative to the acetabular shell 110 and/or cage 130 (e.g., surgeons often are tasked with orientating the liner 150 relative to the acetabular shell 110 (e.g., “eye-balling” the placement of the liner 150 relative to the acetabular shell 110) and subsequently holding the position of the liner 150 relative to the acetabular shell 110 while the cement hardens to secure the position of the liner 150 relative to the acetabular shell 110).

[0008] Manual placement of the liner 150 relative to the acetabular shell 130 creates numerous difficulties. For example surgeons may have difficulty maintaining proper positioning of the liner 150 relative to the acetabular shell 110 while also ensuring that the liner 150 does not contact the interior surface of the acetabular shell 110 (e.g., contacting the outer surface of the liner 150 with the interior surface of the acetabular shell 110 may lead to a cement mantle that does not extend circumferential around the liner 150).

[0009] It would be beneficial to provide an implant or instrument arranged and configured to hold the liner at a desired position and/or depth relative to the acetabular shell and/or cage while the cement hardens. It is with this in mind that the present disclosure is presented.

SUMMARY OF THE DISCLOSURE

[0010] This Summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description. This Summary is not intended to identify key features or essential features of the claimed subject matter, nor is it intended as an aid in determining the scope of the claimed subject matter.

[0011] The present disclosure provides an improved acetabular implant. In one embodiment, the acetabular implant includes an acetabular shell, a liner, and an optional acetabular cage. In addition, the acetabular implant includes a positioning guide. In use, the positioning guide is arranged and configure to maintain a position of the liner relative to the acetabular shell. In one embodiment, the positioning guide may be positioned within the acetabular shell between the acetabular shell and the liner to position the liner at a desired angle relative to the acetabular shell. In another embodiment, the positioning guide may be positioned at a rim of the acetabular shell.

[0012] In use, the positioning guide assists with maintaining the position (e.g., angle, orientation, inclination, anteversion, etc.) of the liner relative to the acetabular shell while the cement hardens without the need for the surgeon to manually hold the liner in position. In addition, and/or alternatively, the positioning guide facilitates placement of the liner at a desired spacing from the acetabular shell to ensure that a desired spacing or gap is maintained between the liner and the acetabular shell to facilitate cement injection.

[0013] In one embodiment, an acetabular implant arranged and configured to be implanted into a patient’s acetabulum is disclosed. The acetabular implant comprising an acetabular shell, a liner, and a positioning guide. The acetabular shell having a curved outer surface arranged and configured to contact a patient’s acetabulum and an interior cavity having an interior curved surface. The liner having a curved outer surface arranged and configured to be at least partially received within the interior cavity of the acetabular shell and an interior cavity having an interior curved surface arranged and configured to receive a femoral head. The positioning guide positioned within the interior cavity of the acetabular shell, the positioning guide arranged and configure to maintain a position of the liner relative to the acetabular shell.

[0014] In one embodiment, the positioning guide is positioned within the interior cavity of the acetabular shell between the interior curved surface of the acetabular shell and the curved outer surface of the liner.

[0015] In one embodiment, the positioning guide is arranged and configured to maintain a spacing of the liner relative to the interior curved surface of the acetabular shell to ensure a gap is maintained between the curved outer surface of the liner and the interior curved surface of the acetabular shell to facilitate cement injection.

[0016] In one embodiment, the positioning guide is coupled to the acetabular shell.

[0017] In one embodiment, the positioning guide is coupled to the acetabular shell via a fastener passing through an opening formed in the positioning guide and into engagement with a fastener opening formed at an apex of the acetabular shell. [0018] In one embodiment, the opening formed in the positioning guide is an elongated slot so that a position of the positioning guide can be adjusted relative to the acetabular shell.

[0019] In one embodiment, the positioning guide includes a first shell contacting surface and a second top surface opposite thereof, the first shell contacting surface including a curved or angled surface for contacting the interior surface of the acetabular shell, the second top surface including a curved or angled surface for contacting the outer surface of the liner.

[0020] In one embodiment, the second top surface of the positioning guide includes mating features formed thereon, the mating features arranged and configured to contact the outer surface of the liner, the mating features being arranged and configured to provide increased friction to maintain the position of the liner relative to the positioning guide.

[0021] In one embodiment, the first shell contacting surface of the positioning guide includes mating features formed thereon, the mating features arranged and configured to contact the interior surface of the acetabular shell, the mating features being arranged and configured to provide increased friction to maintain the position of the positioning guide relative to the acetabular shell.

[0022] In one embodiment, the mating feature are selected from one of a plurality of grooves or circles.

[0023] In one embodiment, the acetabular implant further comprises an acetabular cage having a curved outer surface arranged and configured to be at least partially received within the interior cavity of the acetabular shell and an interior cavity having an interior curved surface arranged and configured to receive the liner.

[0024] In one embodiment, the positioning guide is positioned within the interior cavity of the acetabular shell between the interior curved surface of the acetabular shell and the curved outer surface of the acetabular cage.

[0025] In one embodiment, the positioning guide is arranged and configured to maintain a spacing of the acetabular cage relative to the interior curved surface of the acetabular shell to ensure a gap is maintained between the curved outer surface of the acetabular cage and the interior curved surface of the acetabular shell to facilitate cement injection. [0026] In one embodiment, the positioning guide is positioned within the interior cavity of the acetabular cage between the interior curved surface of the acetabular cage and the curved outer surface of the liner.

[0027] In one embodiment, the positioning guide is arranged and configured to maintain a position of the liner relative to the acetabular shell while injected cement hardens.

[0028] In an alternate embodiment, a method for repairing an acetabular defect is disclosed. The method comprises inserting an acetabular shell into a patient’ s acetabulum, inserting a positioning guide into an interior cavity of the acetabular shell, inserting a liner into the interior cavity of the acetabular shell, the positioning guide being positioned between the acetabular shell and the liner, adjusting the position of the positioning guide, the liner, or a combination thereof, to adjust the position of the liner to achieve desired joint kinematics, and inserting cement into the interior cavity of the acetabular shell to secure the position of the liner relative to the acetabular shell.

[0029] Embodiments of the present disclosure provide numerous advantages. For example, by incorporating a positioning guide within the acetabular implant more consistent placement of the liner is achievable. For example, the positioning guide facilitates controlled placement of the liner without the need for the surgeon to hold the liner while the cement hardens. In addition, and/or alternatively, the positioning guide assists with maintaining a more consistent gap or spacing between the liner and the acetabular shell or cage to ensure adequate spacing for the cement to be received.

[0030] Further features and advantages of at least some of the embodiments of the present disclosure, as well as the structure and operation of various embodiments of the present disclosure, are described in detail below with reference to the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

[0031] By way of example, a specific embodiment of the disclosed device will now be described, with reference to the accompanying drawings, in which:

[0032] FIG. 1 shows a perspective view of a conventional acetabular implant (e.g., a convention cup-cage acetabular implant); [0033] FIG. 2 shows a perspective view of an example of an embodiment of an acetabular implant in accordance with features of the present disclosure;

[0034] FIG. 3 shows a cross-sectional view of the acetabular implant shown in FIG. 2, the cross-sectional view taken along line III-III in FIG. 2;

[0035] FIG. 4 shows a cross-sectional view of the acetabular implant shown in FIG. 2, the cross-sectional view taken along line IV-IV in FIG. 2, the cross-sectional view shown with the liner removed;

[0036] FIG. 5 shows a top, perspective view of the acetabular implant shown in FIG. 2, the perspective view shown with the liner removed;

[0037] FIG. 6 shows a cross-sectional view of an acetabular implant including an alternate example embodiment of a positioning guide in accordance with features of the present disclosure;

[0038] FIG. 7 shows a top, perspective view of the acetabular implant shown in FIG. 6, the perspective view shown with the liner removed;

[0039] FIG. 8A shows a top view of the positioning guide shown in FIG. 6;

[0040] FIG. 8B shows a side view of the positioning guide shown in FIG. 6;

[0041] FIG. 9 shows a perspective view of an alternate example of an embodiment of an acetabular implant in accordance with features of the present disclosure, the acetabular implant including a rim guided positioning guide;

[0042] FIG. 10 shows a perspective view of an example of an embodiment of a rim guided positioning guide used the acetabular implant shown in FIG. 9;

[0043] FIG. 11A shows a cross-sectional view of the acetabular implant shown in FIG. 9, the cross-sectional view taken along line XIA-XIA in FIG. 9;

[0044] FIG. 1 IB shows a detailed view of FIG. 11 A ;

[0045] FIG. 12 shows a cross-sectional view of an alternate example of an embodiment of an acetabular implant in accordance with features of the present disclosure, the acetabular implant including a rim guided positioning guide; and [0046] FIG. 13 shows a cross-sectional view of an alternate example of an embodiment of an acetabular implant in accordance with features of the present disclosure, the acetabular implant including a rim guided positioning guide.

[0047] The drawings are not necessarily to scale. The drawings are merely representations, not intended to portray specific parameters of the disclosure. The drawings are intended to depict example embodiments of the disclosure, and therefore are not considered as limiting in scope. In the drawings, like numbering represents like elements.

[0048] Furthermore, certain elements in some of the figures may be omitted, or illustrated not-to-scale, for illustrative clarity. The cross-sectional views may be in the form of "slices", or "near-sighted" cross-sectional views, omitting certain background lines otherwise visible in a "true" cross-sectional view, for illustrative clarity. Furthermore, for clarity, some reference numbers may be omitted in certain drawings.

DETAILED DESCRIPTION

[0049] Embodiments of an improved acetabular implant for hip surgery will now be described more fully hereinafter with reference to the accompanying drawings, in which preferred embodiments of the present disclosure are presented. As will be described and illustrated, in various embodiments, the acetabular implant includes a positioning guide, wedge, etc. (used interchangeably without the intent to limit) for temporarily positioning and/or spacing a liner from an interior surface of an acetabular shell and/or cage. In one embodiment, during use, the positioning guide holds or maintains the position of the liner at a desired orientation relative to the acetabular shell and/or cage while the cement hardens.

Thus arranged, the surgeon does not need to hold the liner in position while the cement hardens.

[0050] Referring to FIGS. 2-5 a non-limiting example embodiment of an acetabular implant 200 in accordance with one or more features of the present disclosure is illustrated.

In use, the acetabular implant 200 may be used in place of a conventional acetabular implant such as, for example, acetabular implant 100 illustrated in FIG. 1. As such, in use, the acetabular implant 200 is arranged and configured to be used in combination with a femoral or hip implant such as, for example, femoral or hip implant 175 illustrated in FIG. 1.

[0051] Referring to FIGS. 2-5, in accordance with one or more features of the present disclosure, the acetabular implant 200 includes, in one embodiment, an acetabular shell 210, a liner 250, and a positioning guide 300 positioned between the acetabular shell 210 and the liner 250. While the acetabular implant 200 will be shown and described without a cage, it should be appreciated that the acetabular implant 200 may also include an optional cage such as cage 130 shown in FIG. 1.

[0052] As illustrated, in one embodiment, the acetabular implant 200 includes an acetabular shell 210. In use, the acetabular shell 210 is arranged and configured to be implanted into the patient’s acetabular region (e.g., patient’s acetabulum). The acetabular shell 210 may be secured to the patient’s acetabulum via, for example, fasteners, adhesive, cement, or combinations thereof, etc. For example, the acetabular shell 210 may include a hollow body (hereinafter “body”) 212 extending from an equatorial rim 214 to an apex or polar end 216 thereof. The body 212 including a hollow interior cavity 218. As shown, the body 212 may define a generally curved or convex outer exterior surface 220 and a generally curved or concave interior surface 222.

[0053] In addition, as shown, the acetabular shell 210 may include one or more fastener openings 224 arranged and configured to receive one or more bone fasteners (not shown). In use, the fastener openings 224 may be locking or non-locking. For example, in one embodiment, the fastener openings 224 may be threaded or the like for receiving locking screws. Alternatively, the fastener openings 224 may be non-threaded or the like for receiving non-locking screws. In various non-limiting embodiments, as shown, the fastener openings 224 formed in the acetabular shell 210 may include fins or projections that extend radially inward from an inner surface of the openings and into an interior region thereof. The fins are configured to engage or cooperate with a head of a fastener (not shown) in order to secure the fastener at a desired position and at a desired angular orientation within the opening. In some embodiments, the fastener openings 224 may be provided with a relatively jagged or undulating inner circumference formed by the inwardly protruding fins, and concavities or indentations are formed between adjacent pairs of the fins which extend to a location adjacent the inner surface of the openings. Additionally, the inner surface may have a generally round configuration wherein the fins define convex protrusions extending inwardly into the openings. However, other shapes and configurations of the openings and/or the flexible fins are also contemplated.

[0054] As will be appreciated by one of ordinary skill in the art, the number, size, position, and/or configuration of the fastener openings 224 provided in the acetabular shell 210 may be provided in any number, size, position and/or configuration. As such, the present disclosure should not be limited to any particular arrangement or configuration of fastener openings.

[0055] As previously mentioned, and as will be readily appreciated by one of ordinary skill in the art, in one embodiment, although not shown, the acetabular implant 200 may include an acetabular cage such as cage 130 in FIG. 1. In use, the acetabular cage may be inserted inside of the interior cavity 218 of the shell 210. In use, the acetabular cage may be coupled to the acetabular shell 210 via, for example, fasteners, adhesive, cement, or combination thereof, etc. The acetabular cage generally includes a central section arranged and configured to be received within the shell 210, and one or more flanges extending from the central section (e.g., in use, with the cage positioned within the shell 210, the flanges protrude from the equatorial rim 214 of the shell 210 to reach the host bone). In use, the flanges may be bent, manipulated, etc. by a surgeon in a manner that somewhat matches the patient’s bone (e.g., patient’s iliac and ischial anatomy). The flanges may be arranged and configured to receive screws for coupling the flanges, and hence the acetabular implant 200, to the host bone. For example, the acetabular flanges may include a plurality of fastener openings for receiving corresponding fasteners. In use, the fasteners extend through the openings for engagement with host bone. The fastener openings may be any now known or hereafter developed openings for receiving fasteners and may be locking or non-locking screw holes. For example, in one embodiment, the openings may be threaded or the like for receiving locking screws. Alternatively, the openings may be non-threaded or the like for receiving non-locking screws. Alternatively, in various non-limiting embodiments, the fastener openings formed in the cage and/or flanges may include fins or projections as previously described. In use, the fasteners extend through the openings for engagement with the patient’s host bone.

[0056] Referring to FIGS. 2 and 3, as illustrated, in one embodiment, the acetabular implant 200 may also include a liner 250. In use, the liner 250 may be arranged and configured to be inserted into the interior cavity 218 of the acetabular shell 210.

Alternatively, if present, the liner 250 may be arranged and configured to be inserted into an interior cavity formed in the cage, which is inserted into the interior cavity 218 of the acetabular shell 210. The liner 250 may be coupled to the cage and/or acetabular shell 210 via, for example, an adhesive, cement, etc. Thus, once the cement hardens, the liner 250 may be inhibited from moving, articulating, or the like, relative to the cage and/or acetabular shell 210. For example, the liner 250 may include a hollow body (hereinafter “body”) 252 extending from an equatorial rim 254 to an apex or polar end 256 thereof. The body 252 including a hollow interior cavity 258. As shown, the body 252 may define a generally curved or convex outer exterior surface 260 and a generally curved or concave interior surface 262. Irrespective, in use, the liner 250 (e.g., the interior cavity 258) is arranged and configured to receive the femoral head 170 of, for example, the hip or femoral implant 175.

In use, the femoral head 170 is arranged and configured to articulate within and relative to the liner 250.

[0057] Referring to FIGS. 2-5, in accordance with one or more features of the present disclosure, the acetabular implant 200 includes a positioning guide 300. In use, the positioning guide 300 is arranged and configured to maintain a position of the liner 250 relative to, for example, the acetabular shell 210. In use, in one embodiment, the positioning guide 300 is arranged and configured to maintain the position (e.g., angle, orientation, etc.) of the liner 250 relative to the acetabular shell 210 and/or the distance or spacing between the interior surface 222 of the acetabular shell 210 and the outer surface 260 of the liner 250.

Thus arranged, the positioning guide 300 is arranged and configured to maintain a desired position of the liner 250 relative to, for example, the acetabular shell 210 while the cement is hardening. In this manner, the need for the surgeon to maintain the liner 250 in its desired position during cement hardening is eliminated, or at least minimized (e.g., by selecting the appropriate positioning guide 300 to achieve the desired kinematics and subsequently implanting the positioning guide 300 to, for example, clock and cant the liner 250 in the desired position, the need for the surgeon to temporarily hold the liner 250 in position while the cement hardens is eliminated, or at least minimized). Thus arranged, the positioning guide 300 helps ensure that the liner 250 is positioned such that there is no contact between the outer surface 260 of the liner 250 and the interior surface 222 of the acetabular shell 210 thus resulting in a circumferential cemented mantle. In addition, and/or alternatively, the positioning guide 300 facilitates placement of the liner 250 at a desired angle relative to the acetabular shell 210 without the need for the surgeon to hold the liner 250 in position while the cement hardens. In use, the positioning guide 300 remains in place, implanted within the acetabular implant 200.

[0058] As illustrated, in one embodiment, the positioning guide 300 is arranged and configured to be coupled to, for example, the acetabular shell 210. The positioning guide 300 may be coupled to the acetabular shell 210 by any now known or hereafter developed mechanism. For example, as illustrated, the positioning guide 300 may be arranged and configured to be coupled to the acetabular shell 210 via a fastener such as, for example, screw 305. In one embodiment, as illustrated and as will be described in greater detail below, the positioning guide 300 is arranged and configured to be positioned adjacent to the interior surface 222 of the acetabular shell 210. Thus arranged, the positioning guide 300 may be coupled to the acetabular shell 210 using, for example, the fastener opening 224 formed at the apex 216 of the acetabular shell 210, although in other embodiments, it is envisioned that the positioning guide 300 may be arranged and configured to be coupled to the acetabular shell 210 utilizing alternate fastener openings 224. In use, utilizing the fastener opening 224 at the apex 216 of the acetabular shell 210 enables the positioning guide 300 to be rotated about a center axis of the acetabular shell 210 to adjust the orientation of the positioning guide 300, and hence the liner 250, relative to the acetabular shell 210.

[0059] As previously mentioned, the acetabular implant 200 is shown and described without a cage. However, as will be appreciated by one of ordinary skill in the art, the acetabular implant 200 may include an optional cage. If incorporated, in one embodiment, the positioning guide 300 may be positioned between the interior surface 222 of the acetabular shell 210 and the outer surface of the cage. Alternatively, in one embodiment, the positioning guide 300 may be positioned between the interior surface of the cage and the outer surface 260 of the liner 250.

[0060] In the illustrated example embodiment, the positioning guide 300 includes a first, bottom, or shell contacting surface 310 and a second, top, or liner contacting surface 320 (terms used interchangeably herein without the intent to limit). In one embodiment, the first surface 310 may have an angled, wedged, curved, arcuate, or the like surface for contacting the interior surface 222 of the acetabular shell 210. Similarly, the second surface 320 may have an angled, wedged, curved, arcuate, or the like surface for contacting the outer surface 260 of the liner 250. Thus arranged, the positioning guide 300 can conform or mate with the interior surface 222 of the acetabular shell 210 and the outer surface 260 of the liner 250.

Thus arranged, in one embodiment, the surgeon can position the positioning guide 300 relative to the acetabular shell 210 and liner 250 to provide the desired orientation, angle, etc. of the liner 250 relative to the acetabular shell 210 (e.g., positioning guide 300 temporarily holds, maintains, controls, etc. the position of the liner 250 relative to the acetabular shell 210 while the cement hardens). In addition, in use, the positioning guide 300 spaces the outer surface 260 of the liner 250 from the interior surface 222 of the acetabular shell 210. Thus arranged, the positioning guide 300 facilitates creation of a gap or space between the liner 250 and the shell 210 for receipt of the cement (e.g., positioning guide 300 helps prevent accidental or unintentional contact between the liner 250 and the shell 210). [0061] Referring to FIGS. 6-8B, an acetabular implant 200’ including an alternate example embodiment of a positioning guide 300’ is shown. In use, the positioning guide 300’ is substantially similar to the positioning guide 300 shown and described above in connection with FIGS. 2-5 except as described herein.

[0062] Similar to positioning guide 300 previously described, the positioning guide 300’ is arranged and configured to be positioned between an acetabular shell such as, for example, acetabular shell 210, and a liner such as, for example, liner 250. Once again, while the acetabular implant 200’ including the positioning guide 300’ will be shown and described without a cage, it should be appreciated that the acetabular implant 200’ may also include an optional cage such as cage 130 shown in FIG. 1. If incorporated, in one embodiment, the positioning guide 300’ may be positioned between the acetabular shell 210 and the cage. Alternatively, in one embodiment, the positioning guide 300’ may be positioned between the cage and the liner 250.

[0063] In accordance with one or more features of the present disclosure, as previously described, in use, the positioning guide 300’ is arranged and configured to maintain a position of the liner 250 relative to, for example, the acetabular shell 210. In use, in one embodiment, the positioning guide 300’ is arranged and configured to maintain the position (e.g., angle, orientation, etc.) of the liner 250 relative to the acetabular shell 210 and/or the distance or spacing between the interior surface 222 of the acetabular shell 210 and the outer surface 260 of the liner 250. Thus arranged, the positioning guide 300’ is arranged and configured to maintain a desired position of the liner 250 relative to, for example, the acetabular shell 210 while the cement is hardening. In this manner, the need for the surgeon to maintain the liner 250 in its desired position during cement hardening is eliminated, or at least minimized (e.g., by selecting the appropriate positioning guide 300’ to achieve the desired kinematics and subsequently implanting the positioning guide 300’ to, for example, clock and cant the liner 250 in the desired position, the need for the surgeon to temporarily hold the liner 250 in position while the cement hardens is eliminated, or at least minimized). Thus arranged, the positioning guide 300’ helps ensure that the liner 250 is positioned such that there is no contact between the outer surface 260 of the liner 250 and the interior surface 222 of the acetabular shell 210 thus resulting in a circumferential cemented mantle. In addition, and/or alternatively, the positioning guide 300’ facilitates placement of the liner 250 at a desired angle relative to the acetabular shell 210 without the need for the surgeon to hold the liner 250 in position while the cement hardens. In use, the positioning guide 300’ remains in place, implanted within the acetabular implant 200’. [0064] As illustrated, in one embodiment, the positioning guide 300’ is arranged and configured to be coupled to, for example, the acetabular shell 210. The positioning guide 300’ may be coupled to the acetabular shell 210 by any now known or hereafter developed mechanism. For example, as illustrated, the positioning guide 300’ may be arranged and configured to be coupled to the acetabular shell 210 via a fastener such as, for example, screw 305. In one embodiment, as illustrated and as will be described in greater detail below, the positioning guide 300’ is arranged and configured to be positioned adjacent to the interior surface 222 of the acetabular shell 210. Thus arranged, the positioning guide 300’ may be coupled to the acetabular shell 210 using, for example, the fastener opening 224 formed at the apex 216 of the acetabular shell 210, although in other embodiments, it is envisioned that the positioning guide 300’ may be arranged and configured to be coupled to the acetabular shell 210 utilizing alternate fastener openings 224. In use, utilizing the fastener opening 224 at the apex 216 of the acetabular shell 210 enables the positioning guide 300’ to be rotated about a center axis of the acetabular shell 210 to adjust the orientation of the positioning guide 300’, and hence the liner 250, relative to the acetabular shell 210.

[0065] In the illustrated example embodiment, the positioning guide 300’ includes a first, bottom, or shell contacting surface 310 and a second, top, or liner contacting surface 320 (terms used interchangeably herein without the intent to limit). In one embodiment, the first surface 310 may have an angled, wedged, curved, arcuate, or the like surface for contacting the interior surface 222 of the acetabular shell 210. Similarly, the second surface 320 may have an angled, wedged, curved, arcuate, or the like surface for contacting the outer surface 260 of the liner 250. Thus arranged, the positioning guide 300’ can conform or mate with the interior surface 222 of the acetabular shell 210 and the outer surface 260 of the liner 250.

Thus arranged, the surgeon can position the positioning guide 300’ relative to the acetabular shell 210 and liner 250 to provide the desired orientation, angle, etc. of the liner 250 relative to the acetabular shell 210 (e.g., positioning guide 300’ temporarily holds, maintains, controls, etc. the position of the liner 250 relative to the acetabular shell 210 while the cement hardens). In addition, in use, the positioning guide 300’ spaces the outer surface 260 of the liner 250 from the interior surface 222 of the acetabular shell 210. Thus arranged, the positioning guide 300’ facilitates creation of a gap or space between the liner 250 and the shell 210 for receipt of the cement (e.g., positioning guide 300’ helps prevent accidental or unintentional contact between the liner 250 and the shell 210).

[0066] As shown, the positioning guide 300’ may include an elongated slot 350 for receiving the fastener 305 for coupling the positioning guide 300’ to the acetabular shell 210. By providing an elongated slot 350, the position of the positioning guide 300’ may be adjusted relative to the acetabular shell 210. That is, incorporation of an elongated slot 350’ enables the position of the positioning guide 300’ to be adjustable relative to the acetabular shell 210 (e.g., enables placement of the positioning guide 300’ on the interior curved surface 222 of the acetabular shell 210 to be adjusted), which enables the position of the liner 250 to change relative to the acetabular shell 210. Thus arranged, by adjusting the position of the positioning guide 300’ relative to the interior curved surface 222 of the acetabular shell 210, the angle of the positioning guide 300’, and hence the angle of the liner 250, can be adjusted relative to the acetabular shell 210 using a single positioning guide (e.g., as surgeon varies the position of the positioning guide 300’ relative to the interior curved surface 222 of the acetabular shell 210, the angle of the positioning guide 300’ will vary and thus vary the angle of the liner 250 relative to the acetabular shell 210).

[0067] In one embodiment, the positioning guide 300, 300’ may include mating features 330 on the top surface 320 thereof. In addition, and/or alternatively, the positioning guide 300, 300’ may include mating features on the bottom surface 310 thereof. In use, the mating features 330 are arranged and configured to contact, for example, the outer surface 260 of the liner 250 and/or the interior surface 222 of the acetabular shell 210 to provided increased resistance, friction, etc. to help maintain the position of the liner 250 relative to the positioning guide 300, 300’ and/or the position of the positioning guide 300, 300’ relative to the acetabular shell 210. As shown, in one embodiment, the mating feature 330 may be in the form of a plurality of grooves or circles for interacting with corresponding grooves or circles formed on, for example, the outer surface 260 of the liner 250. However, it should be appreciated that the mating features 330 may have other suitable forms including, for example, interacting pegs and holes, slots and bosses, projections, ridges, serrations, or other macro-features, etc.

[0068] In use, in one embodiment, it is envisioned that a plurality of positioning guides 300, 300’ may be provided in a kit. In use, each positioning guide 300, 300’ may include a different size, curvature, angle, etc. so that upon determining the desired position of the liner 250 relative to the acetabular shell 210 to achieve the desired or optimal kinematics, the surgeon may select and install the appropriate positioning guide 300, 300’ to position the liner 250 relative to the acetabular shell 210.

[0069] Alternatively, in one embodiment, it is envisioned that a plurality of trial positioning guides may be provided in a kit. As will be appreciated by one of ordinary skill in the art, a trial may be used during surgery to size and/or test the fit, alignment, etc. of an implant relative to a bone prior to implantation of the actual implant. A trial is typically not configured and composed for permanent implantation. In use, the surgeon may, utilizing one or more trial positioning guides, select and position the trial positioning guide and liner 250 until the desired orientation of the liner 250 relative to the acetabular shell 210 is determined. Thereafter, utilizing that information, the surgeon may remove the trial positioning guide and select a corresponding positioning guide 300, 300’ from, for example, a plurality of positioning guides provided in a kit.

[0070] Referring to FIGS. 9-13, in an alternate example embodiment, the positioning guide 400 may be in the form of a rim guide element, member, or the like (referred to herein as a rim guided positioning guide). In use, the rim guided positioning guide 400 is arranged and configured to be coupled to the rim 214 of the acetabular shell 210. For example, as will be described in greater detail below, the rim guided positioning guide 400 may be arranged and configured to sit or rest on the rim 214 of the acetabular shell 210.

[0071] In one embodiment, as illustrated, the rim guided positioning guide 400 may be in the form of a semi-circular body member, slice, crescent moon-shaped member, or the like.

In use, the rim guided positioning guide 400 includes interacting interfaces or structure arranged and configured to interact with the acetabular shell 210 and the liner 250 to temporarily maintain the position of the liner 250 relative to the acetabular shell 210 while the cement hardens. For example, as illustrated, in one embodiment, the rim guided positioning guide 400 includes a top surface 402, a rim contacting, bottom surface 404, an outer surface 406, and an inner surface 408. A plurality of interfaces or structure 410 may be formed on the inner surface 408 of the rim guided positioning guide 400. As illustrated, in one embodiment, the plurality of interfaces or structure 410 may be in the form of step-like structures for interacting with the liner 250, although other suitable structure for coupling with the liner may be used.

[0072] Thus arranged, in one embodiment, the rim guided positioning guide 400 can be positioned on the rim 214 of the acetabular shell 210. In use, the inner surface 408 of the rim guided positioning guide 400 can interface with the liner 250 to position the liner 250 relative to the acetabular shell 210. In use, the inner surface 408 of the rim guided positioning guide 400 can interface with the rim of the liner if one is present. Alternatively, if the liner is a rimless liner, the inner surface 408 of the rim guided positioning guide 400 can interact with the outer surface of the liner adjacent to the opening of the liner. [0073] In use, the rim guided positioning guide 400 may be coupled to the rim 214 of the acetabular shell 210 by any coupling mechanism now known or hereafter developed. For example, referring to FIG. 12, the rim guided positioning guide 400 may include an overhang or projection 420 extending therefrom to interface with an edge of the rim 214 or a corresponding structure formed on the acetabular shell 210 to stabilize the rim guided positioning guide 400. Alternatively, for example, referring to FIG. 13, the rim guided positioning guide 400 and the acetabular shell 210 may include interacting structure 430 for coupling the rim guided positioning guide 400 to the acetabular shell 210. For example, as shown, the rim guided positioning guide 400 may include guides, pegs, extrusions, or the like that are arranged and configured to interface with features on the acetabular shell to provide stability during placement of the liner 250.

[0074] In one embodiment, the rim guided positioning guide 400 may incorporate one or more features such as, for example, cemented ports or pockets to allow for a controlled way to facilitate cement injection between the liner and the acetabular shell.

[0075] Additionally, and/or alternatively, the rim guided positioning guide 400 may be removable so that once the cement hardens, the rim guided positioning guide 400 could be removed from the acetabular shell. In one embodiment, the rim guided positioning guide 400 may be manufactured from a material that resists cement adhesion and/or be coated with a material that prevents cement adhesion. In one embodiment, the rim guided positioning guide 400 may be disposable. Alternatively, the rim guided positioning guide 400 may be reusable.

[0076] Moreover, in one embodiment, the rim guided positioning guide 400 may be provided in a kit providing a number of fixed increments or angles for positioning the liner relative to the acetabular shell. Alternatively, the rim guided positioning guide 400 may be adjustable so that the surgeon can adjust the angle of the rim guided positioning guide 400 to position the liner at the desired angle relative to the acetabular shell.

[0077] In either embodiment, by incorporating a positioning guide in accordance with one or more features of the present disclosure, better control over the positioning of the liner relative to the acetabular shell can be achieved. For example, in one embodiment, if the acetabular shell was implanted with, for example, 55 degrees of inclination and 5 degrees of anteversion but the surgeon desires to orient the articular surface at 40 degrees of inclination and 20 degrees of anteversion, the positioning guide can be angled relative to the acetabular shell to allow for the surgeon to place the liner into the desired position.

[0078] A non-limiting example embodiment of a method is provided. In use, the patient’s acetabulum may be exposed and assessed identifying the location of quality bone. As needed, the acetabulum may be reconstructed and/or prepared using various instruments such as, impactors, burrs, reamers, etc. Next, once the bone has been prepared, the surgeon can determine the optimum or desired position of the acetabular shell based on, for example, bone quality for stable fixation. In addition, the surgeon can determine the necessity for incorporation, if needed, of an acetabular augments, or cage / flange construct. If needed, the surgeon can determine the optimum or desired position for the acetabular flanges.

[0079] Thereafter, the surgeon can determine the optimal or desired position of the liner to achieve proper joint kinematics. In use, the surgeon can implant a positioning guide, for example, between the acetabular shell and the liner if no acetabular cage is utilized, or between the acetabular shell and acetabular cage or between the acetabular cage and liner if an acetabular cage is utilized. Alternatively, a positioning guide arranged and configured to interact with the rim of the acetabular shell and liner can be utilized.

[0080] In any event, the positioning guide helps maintain the optimal or desired position of the liner relative to the acetabular shell while the cement hardens thereby eliminating, or at least minimizing, the need for the surgeon to hold the liner in position relative to the shell while the cement hardens.

[0081] In one embodiment, cement may be inserted, injected, or the like onto the outer surface of the liner to, inter alia, facilitate better coupling between the liner and the acetabular shell and/or cage. Alternatively, it should be appreciated that the cement may be inserted, injected, or the like prior to insertion of the liner into the acetabular shell and/or cage. It should be appreciated that cement may be applied, inserted, injected, or the like into the acetabular shell and/or cage before, after, or both in relation to timing of liner placement.

[0082] In one embodiment, the positioning guide may be used with a custom acetabular implant. In use, custom acetabular implants are designed and configured to be patient specific. As such, custom acetabular implants generally utilize pre-operative imaging. Utilizing the pre-operative imaging, the positioning guide may be designed patient specific.

In use, the positioning guide may be arranged and configured to be coupled to the acetabular implant such as, the acetabular shell via, for example, snap-in features, clamp on features, or any other now known or hereafter developed mechanism. Thereafter, the positioning guide may be arranged and configured to be removed once the cement hardens.

[0083] As described herein, the optimal or desired position of the liner relative to the acetabular shell can be determined by any now known or hereafter developed procedure. For example, in one embodiment, the surgeon may utilize multiple positioning guides or trial positioning guides to determine the desired position of the liner relative to the acetabular shell (e.g., trial and error approach). Alternatively, the surgeon may, based on prior experiences, determine the desired position of the liner relative to the acetabular shell and based on that experience select the desired positioning guide. Alternatively, in one embodiment, the surgeon may utilize computer implemented surgical techniques to, for example, take measurements of the patient to determine the appropriate positioning guide required to achieve the desired or optimal kinematics. For example, computer implemented surgical techniques could be utilized to measure an angle of the acetabular shell. Using that information, the computerized technique can select the appropriate positioning guide to provide the desired angle of the liner relative to the acetabular shell to create the optimal or desired kinematics.

[0084] In one embodiment, for example, a tracking array may be coupled to a patient’ s bone (e.g., pelvis). Using traditional methods, the patient’s bony anatomy may be registered to establish anatomical reference planes. Additionally, for example, the position of the acetabular shell may be registered to provide guidance during placement of the liner. During liner placement, a tracker may be attached to the implant insertion instrument to provide real time feedback regarding component orientation. Alternatively, in one embodiment, the position of the acetabular shell may be registered and used to provide information to the surgeon regarding how much orientation adjustment is needed to position the liner relative to the acetabular shell to achieve the desired kinematics. Subsequently, the appropriate positioning guide could be selected to provide the needed angulation. For example, in one embodiment, computerized implemented surgical techniques could calculate which positioning guide should be used based on the position of the acetabular shell relative to the patient’s pelvis. Thereafter, the computerized implemented surgical techniques could be used to position the positioning guide in the appropriate orientation.

[0085] Although non-limiting, the acetabular shell, the positioning guide, and if incorporated the optional cage and/or flange may be manufactured from any suitable material including titanium, cobalt chrome, stainless steel, oxidized zirconium, a plastic (e.g., a cross- linked polyethylene (XLPE), a polyphenylsulfone (e.g., PPSU), a polypropylene (e.g., PP), etc.) or other biocompatible material. In some embodiments, the bone contacting and/or outer surface of, for example, the acetabular shell and/or flanges may be porous and may be comprised of titanium, cobalt chrome, polymer or other biocompatible material. In addition, the acetabular components may be a combination of different biocompatible materials. For example, the acetabular shell, cage, and/or flanges may be cobalt chrome (or titanium) with a titanium porous coating on the outer or bone contacting surface. Various manufacturing techniques may be used to manufacture the acetabular shell, the positioning guide, cage, and/or flange. For example, the acetabular shell, positioning guide, cage, and/or flange can be cast, additively manufactured, machined, stamped, or the like.

[0086] In some embodiments, an outer surface of the liner and an inner surface of the interior cavity of the acetabular shell and/or cage may include surface features adapted and configured to allow for improved cement adhesion between the liner and acetabular shell and/or cage. The surface features may be provided in any suitable manner now known or hereafter developed including, for example, grooves, recesses, indentations, etc., formed along an outer surface of the liner. The surface features may be oriented radially, spherically, or both.

[0087] In use, the acetabular shell, the positioning guide, the acetabular cage, the acetabular flanges, and the liner can have any suitable size (e.g., length, width, thickness) and/or shape. For example, in some embodiments, the size of each acetabular flange may be based, for example, on the size of the acetabular shell.

[0088] While the present disclosure refers to certain embodiments, numerous modifications, alterations, and changes to the described embodiments are possible without departing from the sphere and scope of the present disclosure, as defined in the appended claim(s). Accordingly, it is intended that the present disclosure not be limited to the described embodiments, but that it has the full scope defined by the language of the following claims, and equivalents thereof. The discussion of any embodiment is meant only to be explanatory and is not intended to suggest that the scope of the disclosure, including the claims, is limited to these embodiments. In other words, while illustrative embodiments of the disclosure have been described in detail herein, it is to be understood that the inventive concepts may be otherwise variously embodied and employed, and that the appended claims are intended to be construed to include such variations, except as limited by the prior art. [0089] The foregoing discussion has been presented for purposes of illustration and description and is not intended to limit the disclosure to the form or forms disclosed herein. For example, various features of the disclosure are grouped together in one or more embodiments or configurations for the purpose of streamlining the disclosure. However, it should be understood that various features of the certain embodiments or configurations of the disclosure may be combined in alternate embodiments, or configurations.

[0090] As used herein, an element or step recited in the singular and proceeded with the word “a” or “an” should be understood as not excluding plural elements or steps, unless such exclusion is explicitly recited. Furthermore, references to “one embodiment” of the present disclosure are not intended to be interpreted as excluding the existence of additional embodiments that also incorporate the recited features.

[0091] The phrases “at least one”, “one or more”, and “and/or”, as used herein, are open- ended expressions that are both conjunctive and disjunctive in operation. The terms “a” (or “an”), “one or more” and “at least one” can be used interchangeably herein. All directional references (e.g., proximal, distal, upper, lower, upward, downward, left, right, lateral, longitudinal, front, back, top, bottom, above, below, vertical, horizontal, radial, axial, clockwise, and counterclockwise) are only used for identification purposes to aid the reader’s understanding of the present disclosure, and do not create limitations, particularly as to the position, orientation, or use of this disclosure.

[0092] Connection references (e.g., engaged, attached, coupled, connected, and joined) are to be construed broadly and may include intermediate members between a collection of elements and relative to movement between elements unless otherwise indicated. As such, connection references do not necessarily infer that two elements are directly connected and in fixed relation to each other. All rotational references describe relative movement between the various elements. Identification references (e.g., primary, secondary, first, second, third, fourth, etc.) are not intended to connote importance or priority but are used to distinguish one feature from another. The drawings are for purposes of illustration only and the dimensions, positions, order and relative to sizes reflected in the drawings attached hereto may vary.

Claims

1. An acetabular implant arranged and configured to be implanted into a patient’s acetabulum, the acetabular implant comprising: an acetabular shell having a curved outer surface arranged and configured to contact a patient’s acetabulum and an interior cavity having an interior curved surface; a liner having a curved outer surface arranged and configured to be at least partially received within the interior cavity of the acetabular shell and an interior cavity having an interior curved surface arranged and configured to receive a femoral head; and a positioning guide positioned within the interior cavity of the acetabular shell, the positioning guide arranged and configure to maintain a position of the liner relative to the acetabular shell.

2. The acetabular implant of claim 1, wherein the positioning guide is positioned within the interior cavity of the acetabular shell between the interior curved surface of the acetabular shell and the curved outer surface of the liner.

3. The acetabular implant of claim 2, wherein the positioning guide is arranged and configured to maintain a spacing of the liner relative to the interior curved surface of the acetabular shell to ensure a gap is maintained between the curved outer surface of the liner and the interior curved surface of the acetabular shell to facilitate cement injection.

4. The acetabular implant according to any of the preceding claims, wherein the positioning guide is coupled to the acetabular shell.

5. The acetabular implant of claim 4, wherein the positioning guide is coupled to the acetabular shell via a fastener passing through an opening formed in the positioning guide and into engagement with a fastener opening formed at an apex of the acetabular shell.

6. The acetabular implant of claim 5, wherein the opening formed in the positioning guide is an elongated slot so that a position of the positioning guide can be adjusted relative to the acetabular shell.

7. The acetabular implant according to any of the preceding claims, wherein the positioning guide includes a first shell contacting surface and a second top surface opposite thereof, the first shell contacting surface including a curved or angled surface for contacting the interior surface of the acetabular shell, the second top surface including a curved or angled surface for contacting the outer surface of the liner.

8. The acetabular implant of claim 7, wherein the second top surface of the positioning guide includes mating features formed thereon, the mating features arranged and configured to contact the outer surface of the liner, the mating features being arranged and configured to provide increased friction to maintain the position of the liner relative to the positioning guide.

9. The acetabular implant according to claims 7 or 8, wherein the first shell contacting surface of the positioning guide includes mating features formed thereon, the mating features arranged and configured to contact the interior surface of the acetabular shell, the mating features being arranged and configured to provide increased friction to maintain the position of the positioning guide relative to the acetabular shell.

10. The acetabular implant according to claims 8 or 9, wherein the mating feature are selected from one of a plurality of grooves or circles.

11. The acetabular implant of claim 1, further comprising an acetabular cage having a curved outer surface arranged and configured to be at least partially received within the interior cavity of the acetabular shell and an interior cavity having an interior curved surface arranged and configured to receive the liner.

12. The acetabular implant of claim 11, wherein the positioning guide is positioned within the interior cavity of the acetabular shell between the interior curved surface of the acetabular shell and the curved outer surface of the acetabular cage.

13. The acetabular implant of claim 12, wherein the positioning guide is arranged and configured to maintain a spacing of the acetabular cage relative to the interior curved surface of the acetabular shell to ensure a gap is maintained between the curved outer surface of the acetabular cage and the interior curved surface of the acetabular shell to facilitate cement injection.

14. The acetabular implant of claim 11, wherein the positioning guide is positioned within the interior cavity of the acetabular cage between the interior curved surface of the acetabular cage and the curved outer surface of the liner.

15. The acetabular implant according to any of the preceding claims, wherein the positioning guide is arranged and configured to maintain a position of the liner relative to the acetabular shell while injected cement hardens.

16. A method for repairing an acetabular defect, the method comprising: inserting an acetabular shell into a patient’s acetabulum; inserting a positioning guide into an interior cavity of the acetabular shell; inserting a liner into the interior cavity of the acetabular shell, the positioning guide being positioned between the acetabular shell and the liner; adjusting the position of the positioning guide, the liner, or a combination thereof, to adjust the position of the liner to achieve desired joint kinematics; and inserting cement into the interior cavity of the acetabular shell to secure the position of the liner relative to the acetabular shell.