WO2023215441A1 - Techniques et instruments d'arthroplastie du genou - Google Patents

Techniques et instruments d'arthroplastie du genou Download PDF

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Publication number
WO2023215441A1
WO2023215441A1 PCT/US2023/020942 US2023020942W WO2023215441A1 WO 2023215441 A1 WO2023215441 A1 WO 2023215441A1 US 2023020942 W US2023020942 W US 2023020942W WO 2023215441 A1 WO2023215441 A1 WO 2023215441A1
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WIPO (PCT)
Prior art keywords
anchor
channel
guide
tibial
component
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PCT/US2023/020942
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English (en)
Inventor
Christopher CYKO
Brian S. Schumacher
Daniel F. Justin
Joel BERRETTA
Original Assignee
Smith & Nephew, Inc.
Smith & Nephew Orthopaedics Ag
Smith & Nephew Asia Pacific Pte. Limited
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Application filed by Smith & Nephew, Inc., Smith & Nephew Orthopaedics Ag, Smith & Nephew Asia Pacific Pte. Limited filed Critical Smith & Nephew, Inc.
Publication of WO2023215441A1 publication Critical patent/WO2023215441A1/fr

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    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/14Surgical saws ; Accessories therefor
    • A61B17/15Guides therefor
    • A61B17/154Guides therefor for preparing bone for knee prosthesis
    • A61B17/155Cutting femur
    • AHUMAN NECESSITIES
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    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1604Chisels; Rongeurs; Punches; Stamps
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    • A61B17/1659Surgical rasps, files, planes, or scrapers
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    • A61B17/1662Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1675Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the knee
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    • 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
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    • A61F2/30771Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30878Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • A61F2002/30889Arcuate pegs
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    • 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
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    • A61F2002/30878Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • A61F2002/30891Plurality of protrusions
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    • 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
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    • A61F2002/30878Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • A61F2002/30891Plurality of protrusions
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    • A61F2/02Prostheses implantable into the body
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    • 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
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    • 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
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    • A61F2002/4658Measuring instruments used for implanting artificial joints for measuring dimensions, e.g. length
    • A61F2002/4661Measuring instruments used for implanting artificial joints for measuring dimensions, e.g. length for measuring thickness
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    • 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
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    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4681Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor by applying mechanical shocks, e.g. by hammering
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4687Mechanical guides for implantation instruments

Definitions

  • the present disclosure is directed to knee arthroplasty, and, more particularly, to instruments, systems, and techniques used to implant and/or remove knee implant components during a knee arthroplasty surgical procedure.
  • a knee arthroplasty procedure may be a partial (unicondylar or unicompartmental knee arthroplasty) procedure or a total knee arthroplasty (TKA) procedure.
  • Unicompartmental knee arthroplasty' is a surgical technique used for the treatment of one compartment of the knee (i.e., the medial compartment or the lateral compartment).
  • a TKA is used for the treatment of all three compartments of the knee (i.e., the medial, lateral, and patellofemoral compartments).
  • revision knee surgeries may be required to replace or repair implant components installed during a previous knee arthroplasty procedure.
  • an arthroplasty implant device may be in the form of a fixation element implant device that includes a baseplate and a separate fixation device.
  • the baseplate may be for a tibial component of the implant system.
  • the baseplate and the fixation device may be individual, separable, or otherwise non-integral components of the fixation element implant device.
  • the fixation device may be or may include an anchor, fastener, or other ty pe of element capable of forming a friction or press-fit with a portion of a bone.
  • anchors or the terms “anchor” or “anchored implant devices” are used in some examples, examples are not so limited, as any ty pe of fixation element capable of operating with the described examples is contemplated in the present disclosure
  • a surgical instrument may include a guide rail.
  • a guide rail may have a posterior end configured to be installed within a component (or anchor) channel of an implant component, such as a tibial baseplate, and an anterior end configured to be installed in an instrument, such as a fixation element (or anchor) guide.
  • anterior and posterior directionality of instruments may indicate a directionality when installed in a patient (e.g., posterior end is located at, faces, and/or is directed toward a posterior end of a patient and/or patient anatomy).
  • a component channel may be configured to receive a side of a fixation element opposite the side configured to be installed within patient bone to couple the fixation element to the implant component.
  • the fixation element is an anchor
  • the component channel may be configured to receive a rail of the anchor.
  • the rail of the anchor couples the anchor to the tibial baseplate and the blade of the anchor (arranged opposite the rail) couples the anchor to the patient bone, thereby coupling the tibial baseplate to the patient bone.
  • the guide rail may provide various advantages for performing an arthroplasty procedure.
  • a guide rail may operate to simplify the attachment of an anchor guide to a tibial baseplate.
  • a guide rail may provide a supportive pathway for moving the anchor guide to the correct position for engaging an instrument connection interface of a tibial baseplate.
  • a guide rail may also provide a support for holding and/or stabilizing the anchor guide during attachment to the instrument connection interface (for instance, relieving a surgeon from holding anchor guide, etc. when fastening pins, screws, and/or the like).
  • a guide rail may operate to occupy a component channel (acting as a “channel blocker”) arranged in an implant component to keep fluids, such as bone slurry used on surfaces of the implant system, or other materials from migrating into the component channel, for instance, during tibial component installation and/or impaction.
  • a guide rail may provide additional advantages, which would be known to those of skill of the art in view of the present disclosure.
  • a guide rail may include a posterior end having at least a portion configured to be installed within the component channel, and an anterior end extending outside of the component channel when the posterior end is installed within the component channel.
  • a system for knee arthroplasty of a knee joint may include a tibial component having a bone-facing side configured to be arranged on a prepared surface of a proximal end of a tibia, wherein a component channel is arranged in the bone-facing side, the component channel configured to receive a fixation element to hold the tibial component on the prepared surface of the tibia, and a guide rail, which may include a posterior end having at least a portion configured to be installed within the component channel, and an anterior end extending outside of the component channel when the posterior end is installed within the component channel.
  • the portion of the posterior end installed within the component channel may be configured to prevent material from entering the component channel during implantation of the tibial component on the proximal end of the tibia.
  • the anterior end may be configured to be installed within a guide channel of an anchor guide.
  • the anterior end may be configured to provide a path for the anchor guide to align with and engage an instrument connection interface of the tibial component.
  • the anterior end may be configured to support the anchor guide during formation of a secure engagement of the anchor guide and the tibial component via installing a shaft attaching the anchor guide to an instrument connection interface of the tibial component.
  • the anterior end may be shaped to correspond to a shape of the guide channel, the shape of the guide channel configured to receive an anchor fixation element to be implanted in the tibia.
  • the posterior end may be formed as a t-shape having a top portion configured to be arranged within the component channel and a ridge extending through a bone-facing inferior opening in the component channel.
  • a surgical instrument may include a tibial pilot cutter or tibial pilot hole cutter for cutting a pilot hole or fixation channel in a tibia for installation of a fixation element, such as an anchor.
  • a pilot cutter may include a longitudinal main body having a sharp cutting end with a horizontal cutting ridge and/or a vertical cutting ridge.
  • a depth stop may be arranged on the main body. The depth stop may prevent further movement of the pilot cutter into the tibia to enforce a length of the pilot hole or fixation channel cut into the patient.
  • a tool interface may be arranged on an end of the main body opposite the cutting end. For example, the tool interface may be used for impaction by a hammer or to receive a connection with a slap hammer for removing the pilot cutter from the patient bone.
  • the pilot cutter may be configured to cut a pilot hole or fixation channel for an anchor fixation element.
  • the pilot cutter may be configured to cut a pilot hole or fixation channel of various lengths or lengths of fixation element (for instance, an anchor).
  • the pilot hole length may be about 10 mm, about 20 mm, about 30 mm, about 36 mm, about 40 mm, about 44 mm, about 50 mm, about 60 mm, about 100 mm, or any value or range between any two of these values (including endpoints).
  • the pilot hole may be cut for a fixation element, such as an anchor, having a length of about 10 mm, about 20 mm, about 30 mm, about 36 mm, about 40 mm, about 44 mm, about 50 mm, about 60 mm, about 100 mm, or any value or range between any two of these values (including endpoints).
  • a fixation element such as an anchor, having a length of about 10 mm, about 20 mm, about 30 mm, about 36 mm, about 40 mm, about 44 mm, about 50 mm, about 60 mm, about 100 mm, or any value or range between any two of these values (including endpoints).
  • a surgical instrument may include a cutter block, such as a tibial pilot cutter block.
  • the tibial pilot cutter block may operate to provide a different depth stop length, and, therefore, pilot channel length.
  • a tibial pilot cutter block may be configured to be installed on the anterior side of an anchor (or pilot cutter tool) guide to increase the length of the anchor guide in the anterior direction
  • the depth stop of the pilot cutter will engage an anterior side of the tibial pilot cutter block instead of an anterior side of the anchor guide, thereby shortening the pilot channel by a thickness of the tibial pilot cutter block on the anterior side.
  • a pilot cutter for a larger tibial tray and/or anchor may be used for a smaller tibial tray and/or anchor (e.g., a size 3, 4, 3/4, etc.; a length of 30 mm; and/or the like).
  • a system for knee arthroplasty of a knee joint may include a tibial component having a bone-facing side configured to be arranged on a prepared surface of a proximal end of a tibia, wherein a component channel is arranged in the bone-facing side, the component channel configured to receive a fixation element to hold the tibial component on the prepared surface of the tibia, an anchor guide coupled to the tibial component comprising a posterior side coupled to the tibial component, an anterior side opposite the posterior side, and a guide channel, a pilot hole cutter configured to be installed in the anchor guide and impacted toward the tibia to cut a fixation channel for the fixation element in the tibia, the pilot hole cutter comprising a depth stop, the pilot hole cutter associated with a size indicating a length of the fixation channel when the depth stop engages the anterior surface of the anchor guide, and a pilot cutter block configured to be arranged on the anterior side of
  • the pilot cutter block may include a plurality of projections configured to slide over a portion of the anchor guide to couple the pilot cutter block to the anchor guide.
  • the pilot cutter block may include an instrument opening that allows for anterior access to the guide channel of the anchor guide.
  • a surgical instrument may include a fixation element (or anchor) removal cutter.
  • an anchor removal cutter may be configured as an instrument used during a surgical procedure to remove a fixation element, such as an anchor implanted in a patient.
  • a system for knee arthroplasty of a knee joint may include an anchor removal guide configured to be coupled to an anterior side of a tibial component, in which the tibial component may include a bone-facing side configured to be arranged on a prepared surface of a proximal end of a tibia, the tibial component may include a component channel arranged on the bone-facing side configured to receive an anchor to hold the tibial component on the prepared surface of the tibia, the anchor removal guide may include a guide channel arranged longitudinally through the anchor removal guide, and an anchor removal cutter configured to be moved through the guide channel and to be impacted into the tibia, the anchor removal cutter may include a cutting end configured to cut tibial bone to increase a size of the fixation channel to facilitate removal of the anchor, the cutting end may include a horizontal cutting ridge and a vertical cutting ridge.
  • the horizontal cutting ridge and the vertical cutting ridge may be arranged to form a shape corresponding to a t-shape.
  • the horizontal cutting ridge may be configured to cut a portion of the fixation channel occupied by the support member of the anchor and the vertical cutting ridge may be configured to cut a portion of the fixation channel occupied by a blade of the anchor.
  • the cutting end may have a shape that corresponds with a contour of an anterior edge of the anchor.
  • the anchor removal cutter may include a depth stop configured to engage an anterior portion of the anchor removal guide.
  • a surgical instrument may include a cutting block handle configured to facilitate manual manipulation and support of a femoral cutting block during installation, for instance, on a tensor block.
  • a cutting block handle may be arranged and configured to engage a femoral cutting block to assist with positioning the femoral cutting block during use.
  • a cutting block handle may operate to make it easier and more efficient for a surgeon to hold and/or position the femoral cutting block
  • a cutting block handle may include a main body having a tab.
  • the tab may include a spring.
  • the tab may be arranged and configured to be received within a slot (or “mating slot”) or other opening formed in the femoral cutting block.
  • the spring may operate to provide tension to hold the tab within the slot.
  • a system for knee arthroplasty of a knee joint may include a tensor block configured to be arranged between the prepared surfaces of a proximal end of a tibia and a distal end of a femur, a femoral cutting block configured to be coupled to the tensor block, the femoral cutting block comprising a mating slot, and a cutting block handle having a main body and a tab end, the tab end configured to be inserted within the mating slot of the femoral cutting block to couple the cutting block handle to the femoral cutting block, wherein the cutting block handle is configured to facilitate manual manipulation of the femoral cutting block prior to coupling to the tensor block.
  • the tab end may include a spring configured to provide tension to hold the tab end within the slot.
  • the tab end may be coupled via a friction fit within the slot.
  • the slot may be formed from a first surface and a second surface extending from an anterior side of the femoral cutting block.
  • a surgical technique may include an anchored implant device installed with an adjustable engagement in a patient tibia in accordance with the present disclosure.
  • an adjustable fixation channel (or adjustable channel) may have additional bone removed in one or more dimensions to allow for movement of anchor in that dimension.
  • an adjustable channel may be formed to allow' an anchor, and therefore, the corresponding baseplate member to move in a dimension, such as in an inferior direction, for instance, to maintain flush contact between the baseplate and the prepared tibial surface.
  • a distal or inferior side of an anchor blade may be free to move in an inferior direction (and in a superior direction when at the inferior limit, for instance, the bottom of adjustment channel).
  • a method for knee arthroplasty of a knee joint may include implanting a tibial component on a prepared surface of a proximal end of a tibia, in which the tibial component may include a bone-facing side configured to be arranged on the prepared surface, and a component channel arranged in the bone-facing side, the component channel configured to receive a fixation element to hold the tibial component on the prepared surface of the tibia, cutting a fixation channel for the fixation element, wherein, in at least one dimension, the fixation channel is configured to facilitate adjustable movement of the fixation element within the fixation channel, and installing the fixation element in the fixation channel.
  • a method for knee arthroplasty of a knee joint may include implanting a tibial component on a prepared surface of a proximal end of a tibia, the tibial component including a bone-facing side configured to be arranged on the prepared surface, and a component channel arranged in the bone-facing side, the component channel configured to receive a fixation element to hold the tibial component on the prepared surface of the tibia, cutting a fixation channel in the prepared surface of the tibia for the fixation element to be installed within the prepared surface of the tibia, wherein, in at least one dimension of the fixation channel, the fixation channel may be configured to facilitate adjustable movement of the fixation element within the fixation channel when the fixation element is installed within the fixation channel.
  • the fixation element may include an anchor.
  • the adjustable movement may allow movement of the fixation element in a superior-inferior direction.
  • FIGS. 1A-1E illustrate various views of an example implant system in accordance with one or more features of the present disclosure, the implant system including a femoral component and a tibial component;
  • FIGS. 2A-2E illustrate various views of an example guide rail in accordance with one or more features of the present disclosure
  • FIGS. 3A-3C illustrate various views of an example guide rail installed within a baseplate of a tibial component in accordance with one or more features of the present disclosure
  • FIGS. 4A-4D illustrates an example of a technique of installing a tibial component using a guide rail in accordance with one or more features of the present disclosure
  • FIGS. 5A-5E illustrate an example of an anchor guide in accordance with one or more features of the present disclosure
  • FIGS. 6A-6D illustrate an example technique for installing an anchor guide onto a tibial component in accordance with one or more features of the present disclosure
  • FIGS. 7A and 7B illustrate views of an example of an assembled combination of a guide rail, a tibial component, and an anchor guide with an anchor guide shaft in accordance with one or more features of the present disclosure
  • FIG. 8 illustrates an example of a tibial pilot cutter in accordance with one or more features of the present disclosure
  • FIGS. 9A-9C illustrate an example technique for cutting a fixation element channel using a tibial pilot in accordance with one or more features of the present disclosure
  • FIGS. 10A and 10B illustrate an example of fixation channel formation using a tibial pilot cutter in accordance with the present disclosure
  • FIG. 11A illustrates an example of a tibial pilot cutter block in accordance with one or more features of the present disclosure
  • FIGS. 11B-11D depict a tibial pilot block in combination w ith an anchor guide in accordance with one or more features of the present disclosure
  • FIG. 12 illustrates an example of a fixation element removal cutter in accordance with one or more features of the present disclosure
  • FIGS. 13A-13C illustrate an example of an anchor removal process using an anchor removal cutter in accordance with one or more features of the present disclosure
  • FIGS. 14A and 14B illustrate views of an example anchor removal cutter installed within an anchor channel in accordance with one or more features of the present disclosure
  • FIG. 15 illustrates an example anchored implant device installed with ridged anchor engagement in a patient tibia in accordance with the present disclosure
  • FIG. 16 illustrates an example anchored implant device installed with an adjustable engagement in a patient tibia in accordance with the present disclosure
  • FIG. 17 illustrates an example of a femoral cutting block handle in accordance with one or more features of the present disclosure.
  • FIGS. 18A-18D illustrate an example femoral cutting block installation process using a cutting block handle in accordance with one or more features of the present disclosure.
  • Anterior means toward the front of a body. Posterior means toward the back of a body. Superior or cephalad means toward the head. Inferior or caudal means toward the feet or tail. Medial means toward the midline of a body, particularly toward a plane of bilateral symmetry of the body. Lateral means away from the midline of a body or away from a plane of bilateral symmetry of the body. Proximal means toward the trunk of the body. Proximal may also mean toward a user or operator. Distal means away from the trunk. Distal may also mean away from a user or operator.
  • an arthroplasty system including one or more features for facilitating, inter alia, increased efficiency and effectiveness for a surgeon to implement an arthroplasty surgery .
  • the arthroplasty system may include specialized and unique surgical instruments that operate to reduce or even eliminate human error and increase the precision of a surgeon when performing certain surgical steps.
  • the surgical instruments may be configured to enforce the performance of a surgical step, such as bone cutting, component or device placement, and/or the like, according to a surgical plan. In this manner, surgeons using an arthroplasty system according to some examples may be able to achieve more consistent results and achieve improved patient outcomes compared with conventional surgical instruments.
  • the implant devices and/or instruments described in the present disclosure may include any now known or hereafter developed additional features.
  • the implant device and/or instruments may be manufactured from any suitable material now known or hereafter developed, including, for example, metals, polymers, plastics, ceramics, resorbable, non-resorbable, composite materials, etc.
  • Suitable materials may include, for example, titanium, stainless steel, cobalt chrome, poly etheretherketone (PEEK), polyethylene, ultra-high molecular weight polyethylene (UHMWPE), resorbable polylactic acid (PLA), polyglycolic acid (PGA), combinations or alloys of such materials or any other appropriate material that has sufficient strength to be secured to and hold bone, while also having sufficient biocompatibility to be implanted into a patient’s body.
  • PEEK poly etheretherketone
  • UHMWPE ultra-high molecular weight polyethylene
  • PLA resorbable polylactic acid
  • PGA polyglycolic acid
  • unicompartmental implant devices and tibial devices are used in some examples in the present disclosure, examples are not so limited. Therefore, it should be appreciated that the present disclosure should not be limited to any particular configuration of implant device and/or insertion procedure unless specifically claimed.
  • the present disclosure will be described and shown as being directed to a unicompartmental tibial implant component, it should be appreciated that features of the present disclosure have applicability and may be used in connection with other implant devices such as, a femur component, a TKA implant system, a revision system, and/or the like.
  • FIG. 1 A illustrates a front view of implant system 100 implanted in a knee joint
  • FIGS. IB and 1C depict side and perspective views of implant system 100
  • FIG. ID depicts a perspective view of a tibial plate 104 of implant system 100
  • FIG. IE depicts a perspective view of an anchor 122 of implant system 100.
  • Implant system 100 is configured as a unicompartmental knee replacement in accordance with one or more features of the present disclosure.
  • a unicompartmental system may be used to illustrate various features in the present disclosure, examples are not so limited, as example implant devices and instruments may be used with various types of systems, including a total knee arthroplasty (TKA) system, revision systems, and/or the like.
  • TKA total knee arthroplasty
  • implant 100 may include a femoral component 102 and a tibial component 104.
  • Femoral component 102 may be configured to be operably mounted or otherwise secured to a prepared distal femur portion 114 of femur 111, while tibial component 104 may be configured to be operably mounted or otherwise secured to a prepared proximal tibia portion 115 of tibia 112.
  • tibial component 104 may include a tibial baseplate 108 and an insert 106 that contacts or articulates against a femoral articular surface of femoral component 102.
  • Tibial baseplate 108 and insert 106 may be separate components that are constructed from different materials.
  • insert 106 may include one or more trial inserts that is/are used at least temporarily during the implantation procedure or surgery, as well as inserts that are selected for final implantation with implant 100.
  • Tibial component 104 may include an anterior side 162, a posterior side 161, a superior or femur-facing side 160, and an inferior or tibia-facing side 156.
  • fixation member(s) 123 may include, or be configured for use, as part of a cemented or cementless fixation system according to various examples described in the present disclosure.
  • fixation members 123 include, but are not limited to, one or more screws, pegs, posts, fins, rails, cavities, anchors, protrusions, concave surfaces, convex surfaces, grooves, projections, bumps, and/or a combination thereof.
  • At least certain types of fixation members 123 can be configured to provide features or a geometry to tibia baseplate 108 that may provide for rigid, cementless fixation to tibia 112.
  • baseplate 108 may include an instrument connection interface 121 on anterior side 162 for connecting to various surgical instruments that may be used during installation of the tibial component 104.
  • a surgical instrument that may be coupled to baseplate via instrument connection interface 121 may include an anchor guide (see FIGS. 6A-6D).
  • implant system 100 may include a fixation element configured to couple baseplate 108 to prepared proximal tibia portion 115.
  • the fixation element may be configured as an anchor 122.
  • an anchor may be used as an illustrative fixation element in the present disclosure, examples are not so limited, as various types of fixation elements may be used according to various described examples.
  • implant system 100 may be in the form of an anchored implant device that includes baseplate 108 and a separate anchor 122.
  • anchor 122 may include a rail 133 configured to be inserted through a channel opening 124 of baseplate 108 and seated within a channel 125 (e.g., a component channel or rail channel) on bone-facing side 156 of baseplate 108.
  • Anchor 122 may include a blade 131 and a support 132 connecting blade 131 to rail 133.
  • Blade 131 and support 132 may form a cross member that extends from inferior or bottom opening 126 of channel 125, while rail 133 is arranged within channel 125, coupling anchor 122 to baseplate 108.
  • channel 125 may be defined between first and second walls 177, 178.
  • channel 125 may have an inferior or bottom opening 126 that extends along channel 125 between first and second walls 177, 178.
  • Baseplate 108 and anchor 122 may be individual components that are configured to be separately installed in or on the bone of the patient.
  • Anchor 122 may be configured to provide fixation, for instance, cementless fixation, of baseplate 108 to tibia 112.
  • anchors and/or anchored implant devices may be the same or similar to implant devices described in U.S. Patent Application Publication No. 2021/0290410, titled “Unicompartmental Knee Arthroplasty,” U.S. Patent Application Publication No. 2022/0339004, titled “Unicompartmental Knee Arthroplasty” (the ‘004 Application), and/or International PCT Patent Application Publication No. WO 2023/003929, titled “Arthroplasty Knee Implant Devices,” all of which are incorporated by reference as if fully set forth in the present disclosure.
  • An anchored implant configured according to some examples may operate to provide improved fixation over conventional systems, while requiring removal of less bone stock, avoiding violation of the bony cortex, and providing increased residual bony strength after implantation.
  • FIGS. 2A-2E an example of a guide rail 200 in accordance with one or more features of the present disclosure will now be shown and described. More specifically, FIG. 2A depicts a perspective view of guide rail 200; FIG. 2B depicts a top view of guide rail 200; FIG. 2C depicts a bottom view of guide rail 200; FIG. 2D depicts a front view of guide rail 200; and FIG. 2E depicts a back view of guide rail 200.
  • guide rail 200 may be configured as an arthroplasty procedure surgical instrument.
  • Guide rail 200 may include a posterior end 214 configured to be inserted within channel 125 of baseplate 108 (see, for example, FIGS. 3A-3C and 4A-4D).
  • An anterior end 215 of guide rail 200 may be configured to be inserted within an anchor guide (see, for example, FIGS. 6A-6D, 7A, and 7B).
  • anterior and posterior directionality of instruments, such as guide rail 200 may indicate a directionality when installed in a patient (e.g., posterior end 214 is located at, faces, and/or is directed toward a posterior end of a patient and/or patient anatomy).
  • Guide rail 200 may provide various advantages for performing an arthroplasty procedure.
  • guide rail 200 may operate to simplify the attachment of an anchor guide to tibial baseplate 108.
  • guide rail 200 may provide a supportive pathway for moving the anchor guide to the correct position for engaging instrument connection interface 121 of tibial baseplate 108.
  • Guide rail 200 may also provide a support for holding and/or stabilizing the anchor guide during attachment to instrument connection interface 121 (for instance, relieving a surgeon from holding anchor guide, etc. when fastening pins, screws, and/or the like).
  • guide rail 200 may operate to occupy channel 125 (a “channel blocker”) to keep fluids, such as bone slurry used on surfaces of implant system 100, or other materials from migrating into channel 125, for instance, during tibial component installation and/or impaction.
  • Guide rail 200 may provide additional advantages, which would be known to those of skill of the art in view of the present disclosure.
  • Guide rail 200 may include a channel portion 201 shaped, at least in part, to correspond with channel 125 of baseplate 108 and an anchor guide portion 202 shaped, at least in part, to correspond with a guide channel of an anchor guide (see, for example, guide channel 502 of anchor guide 500 depicted in FIGS. 5A-5C).
  • Channel portion 201 may have various shapes configured to allow for insertion within channel 125.
  • Channel portion 201 may be configured to have a certain fit within channel 125, such as a clearance fit, an interference fit, or a transition fit.
  • channel portion 201 may be configured to have a clearance fit, for instance, channel portion 201 is able to slide in and out of channel 125 without obstruction, and where alignment can be loosely guided but does not require tight precision.
  • channel portion 201 may be configured to have an interference fit (press fit or friction fit), for instance, requiring some manual force to connect/disconnect channel portion 201 from channel 125.
  • channel portion 201 may be configured to have a transition fit, for instance, between the tolerances of a clearance fit and an interference fit.
  • Channel portion 201 may occupy an entirety or substantially an entirety of channel 125 when installed in channel 125 of baseplate 108.
  • channel portion 201 may be formed generally as an elongated “t- shape” with a ridge 220 extending from a top surface 221 on a superior side 216 of guide rail 200.
  • channel portion 201 may be installed to occupy an entirety (or substantially an entirety ) of channel 125.
  • top surface 221 may be arranged within channel 125, for instance, within the volume of channel 125 within the inferior or bone-facing side 156 of baseplate 108 defined by walls 177 and 178.
  • ridge 220 may extend through opening 126 in channel, for instance, extending in an inferior direction from the inferior or bone-facing side 156 of baseplate 108, through opening 126 and beyond walls 177 and 178.
  • posterior end 214 of guide rail 200 may be inserted into channel opening
  • channel portion 201 may slide through channel
  • guide rail 200 may include a portion inserted within channel 125 and a remaining portion that is external to channel 125 when channel portion 201 is installed within channel 125.
  • Anchor guide portion 202 may have various shapes configured to allow for insertion within a guide channel of an anchor guide.
  • Anchor guide portion 201 may be configured to have a certain fit within the guide channel, such as a clearance fit, an interference fit, or a transition fit.
  • anchor guide portion 201 may be formed generally as an elongated “t-shape” with a ridge 210 extending from a bottom surface 211 on an inferior side 217 of guide rail 200.
  • FIGS. 4A-4D an example portion of a technique of a tibial component installation with a guide rail in accordance with one or more features of the present disclosure will now be shown and described.
  • the technique illustrated in FIGS. 4A-4D may be a cementless procedure.
  • guide rail 200 may be installed in tibial component 104 prior to implanting tibial component 104 onto tibia portion 115 of tibia 112.
  • channel portion 201 of channel guide 200 may be inserted into channel opening 124 and pushed into channel 125.
  • pegs 123 of tibial component 104 may be aligned with corresponding prepared holes in prepared tibia portion 115 and a manual force may be applied for initial placement of tibial component 104.
  • a compactor 401 may be used to apply a compaction force for final placement of tibial component 104, for instance, where tibial component is flush (or substantially flush) with the surface of prepared tibia portion 115 (e.g., as indicated via use of an angel wing instrument).
  • guide rail 200 may prevent fluid or other material from entering channel 125.
  • guide rail 200 may form a seal with the walls of channel 125.
  • a trial insert 402 may be inserted into superior side 160 of tibial component and a compression block 403 may be inserted between trial insert and prepared femoral surface 114 to create a tight fit.
  • compression block 403 is intended to stabilize tibial component 104 (and trial insert 402), for instance, during installation of anchor 122.
  • FIGS. 5A-5E an example of an anchor guide 500 in accordance with one or more features of the present disclosure will now be shown and described. More specifically, FIG. 5A depicts a perspective view of anchor guide 500; FIG. 5B depicts a back view of anchor guide 500; FIG. 5C depicts a front view of anchor guide 500; FIG. 5D depicts a perspective view of a shaft 530 of anchor guide; and FIG. 5E depicts a perspective view of anchor guide 500 with shaft 530.
  • anchor guide 500 may have a size that corresponds with a size of tibial component 104.
  • anchor guide 500 may be configured to be coupled to tibia component 104 to facilitate the cutting of an anchor channel in prepared tibia portion 115 and the installation of anchor 222 within channel 125.
  • anchor guide 500 may include a housing 511 and one or more tray connection features 514 for coupling with connection interface 121 of tibial component 104.
  • Anchor guide 500 may have a posterior or bone-facing side 509, an anterior side (facing away from the knee joint when installed) 508, a superior side 503, and an inferior side 504.
  • a longitudinal hole 501 may extend through the housing 511 to receive the shaft 530.
  • Hole 501 may be located with tray connection feature 514 and extends longitudinally through anchor guide 500.
  • Hole 501 may have a smaller diameter at tray connection features 514 and a larger diameter opposite tray connection features 514, at an opening on the anterior side 508.
  • An instrument guide hole 502 may extend through housing 508 adjacent to hole 501 to receive anchor guide 200, for example, anchor guide portion 202 of anchor guide 200.
  • Instrument hole 502 may be configured to receive other types of instruments in addition to anchor guide, such as an anchor tamp, cutters, and an anchor.
  • instrument hole 502 may have a shape that corresponds or substantially corresponds to be complimentary with certain portions of surgical instruments, such as anchor guide portion 202, pilot hole cutters (see FIG. 8), and anchor 122.
  • instrument hole 502 may have a non-circular shape, for instance, a “t-shape” (or upside-down “t-shape”) or substantially “t-shape” that is configured to correspond to and slide over a complementary portion of a surgical instrument, such as anchor guide portion 202.
  • a “t-shape” or upside-down “t-shape”
  • substantially “t-shape” that is configured to correspond to and slide over a complementary portion of a surgical instrument, such as anchor guide portion 202.
  • shaft 530 may include an externally threaded tip 534 at a posterior or bone-facing end 531 and a knob 533 at an opposite anterior end 532.
  • Knob 533 may include a tool input feature 535, for example, a socket for receiving a Phillips (or cross head) bit, torque bit, Allen bit, and/or the like, to receive torque from a tool such as a screwdriver.
  • FIG. 5E illustrates shaft 530 installed in anchor guide 500.
  • FIGS. 6A-6D an example portion of a technique for installing anchor guide 500 onto tibial component 104 using guide rail 200 in accordance with one or more features of the present disclosure will now be shown and described.
  • anchor guide 500 may be aligned with guide rail 200 such that instrument hole 502 will slide over anchor guide portion 202 until anchor guide 500 engages anterior side 162 of tibial component 104.
  • anchor guide 500 may slide over guide rail 200 until tray connection features 514 engage instrument connection interface 121.
  • FIGS. 6B and 6C therein is depicted a perspective and a side view, respectively, of an initial connection of anchor guide 500 with tibial component 104.
  • tray connection features 514 may engage corresponding features of instrument connection interface 121 (e.g., recesses, cavities, holes, and/or the like).
  • guide rail 200 may provide a supportive guide or track for anchor guide 500 to be pushed along by a surgeon to engage anchor guide 500 with tibial component 104.
  • Guide rail 200 may facilitate proper alignment and/or orientation of tray connection features 514 with instrument connection interface 121, alleviating the surgeon from the mental and physical effort to ensure proper alignment. Rather, the surgeon only needs to slide anchor guide 500 along guide rail 200 to achieve a proper connection between anchor guide 500 and instrument connection interface 121.
  • guide rail 200 may operate to hold anchor guide 500 in place during an initial connection, for instance, while a surgeon performs other steps or obtains tools for implementing a secure connection between anchor guide 500 and tibial component 104.
  • a surgeon is not required to concentrate on getting the proper alignment and/or orientation of tray connection features 514 with instrument connection interface 121, as these are imposed by the positioning of guide rail 200 when coupled with tibial component 104.
  • a surgeon is not required to hold anchor guide 500 in place during the initial (non-secure) connection between anchor guide 500 and tibial component 104 (e.g., when anchor guide 500 and tibial component 104 are only engaged via tray connection features 514 and instrument connection interface 121, such as posts or other projections interfacing with corresponding holes).
  • a secure connection may be formed between anchor guide 500 and tibial component 104 via fastening shaft 530 to a corresponding opening of instrument connection interface 121.
  • instrument connection interface 121 may include a threaded hole with internal threads that correspond to externally threaded tip 534.
  • a tool 600 may engage tool input feature 535 of knob 533 to thread externally threaded tip 534 into the threaded hole of instrument connection interface 121 to tighten anchor guide 500 to tibial component 104.
  • FIGS. 7A and 7B depict a top perspective view and a bottom perspective view, respectively, of an example of the assembled combination of guide rail 200, tibial component 104, anchor guide 500, and shaft 530.
  • guide rail 200 may be removed from tibial component 104 and anchor guide 500.
  • guide rail 200 may be pulled anteriorly (e.g., away from the knee joint) until guide rail 200 is free of tibial component 104 and anchor guide 500.
  • FIG. 8 depicts an example of a tibial pilot cutter or tibial pilot hole cutter 800 in accordance with one or more features of the present disclosure.
  • a tibial pilot cutter 800 may include a longitudinal main body 802 having a sharp cutting end 801 with a horizontal cutting ridge 810 and/or a vertical cutting ridge 811.
  • a depth stop 803 may be arranged on main body 802.
  • a tool interface 804 may be arranged on an end of main body 802 opposite cutting end 801.
  • tibial pilot cutter 800 may be used to cut a pilot channel for a fixation element, such as anchor 122.
  • tibial pilot cutter 800 may be moved through anchor guide 500 to impact against tibial bone to cut the fixation channel.
  • the pilot channel may extend just beyond the anterior cortex.
  • a portion of tibial pilot cutter 800 such as cutting end 801 and/or a portion of main body 802 may have a shape that corresponds with guide channel 502 of anchor guide 500 (i.e., so that tibial pilot cutter 800 may be guided through anchor guide 500 to the tibial bone).
  • cutting end 801 may have a shape that corresponds with a portion of the fixation element that will be implanted within the tibial bone, for instance for example, so that the fixation element may be forced into the pilot channel created by cutting end 801 to form a friction fit between the fixation element and the tibial bone of the pilot channel.
  • tibial pilot cutter 800 may cut a pilot hole (or fixation channel) that is smaller than the cross-member of anchor 122 (i.e., so that anchor 122 must, at least partially, cut its own path through tibial bone during installation). In some examples, tibial pilot cutter 800 may cut a pilot hole that is essentially the same size as the cross-member of anchor 122. In various examples, tibial pilot cutter 800 may cut a pilot hole that is larger than the cross-member of anchor 122. In some examples, the pilot hole may be larger in one dimension (e.g., support 132) and smaller in another dimension (e.g., blade 131), for instance, so that only one portion (e.g., blade 131) has to cut through the bone).
  • the pilot hole may be larger in one dimension (e.g., support 132) and smaller in another dimension (e.g., blade 131), for instance, so that only one portion (e.g., blade 131) has to cut through the bone).
  • horizontal cutting ridge 810 and vertical cutting ridge 811 may form a “t-shaped” or substantially “t-shaped” cutting end 801.
  • the “t-shape” may facilitate cutting end 801 being guided through guide channel 502 of anchor guide 500 and to cut a “t-shaped” channel that corresponds to blade 131 and support 132 of anchor 122.
  • a portion of main body 802 may have a “t-shape” or substantially “t-shape” so that the portion may pass through guide channel 502 of anchor guide 500 until, for instance, depth stop 802 engages an outer surface of anchor guide 500.
  • fixation element may be or may be similar to an anchor according to some examples, such as anchor 122.
  • an arthroplasty procedure may be in a step in which anchor 500 has formed a secure connection with tibial component 104 (see, for example, FIG. 6D).
  • Tibial pilot cutter 800 for example, with the knee joint in flexion and insert trial 402 and compression block 403 in place, may be moved to align with guide channel 502 of anchor guide.
  • tibial pilot cutter 800 may be forced into tibia 112 just below prepared proximal tibia surface 115 to form a pilot channel 901.
  • tibial pilot cutter 800 may be impacted into tibia 112, for instance, using a hammer or other tool.
  • Tibial pilot cutter 800 may be forced into tibia 112 until engagement of depth stop 803 with anterior side 508 of anchor guide 00 prevents further posterior movement of tibial pilot cutter 800.
  • tibial pilot cutter 800 may be removed, for instance, using a slap-hammer 900 coupled to tool interface 804.
  • FIGS. 10A and 10B depict fixation channel formation using a tibial pilot cutter in accordance with the present disclosure.
  • tibial pilot cutter 800 is fully installed within tibial bone up to depth stop 803.
  • tibial pilot cutter 800 creates a pilot channel that is shorter than blade 131.
  • anchor 122 is moved through guide channel 502 of anchor guide 500 and forced through and beyond the pilot channel, cutting through the tibial bone to create a channel for blade 131 implementing a friction fit between blade 131 and the tibial bone.
  • FIG. 10A depicts a standard pilot cutter for an anchored implant device and FIG. 10B depicts a Pilot Cutter 5/6 Long (or “long pilot cutter”) for a size 6 tibial tray and size 5/6 anchor of an EngageTM cementless partial knee system provided by Smith & Nephew, Inc. of Cordova, Tennessee, United States.
  • the long pilot cutter has a greater cutting end length compared with a standard pilot cutter, allowing for longer pilot channel formation.
  • pilot cutter 800 of FIG. 1 OB may be configured to cut to the tip of a 5/6 anchor of the EngageTM cementless partial knee system.
  • a size 1-2 anchor may have a length of about 30 mm long
  • a size 3-4 anchor may have a length of about 36 mm long
  • a size 5-6 anchor may have a length of about 44 mm.
  • a pilot cutter such as pilot cutter 800, may be configured to cut a pilot hole or fixation channel for an anchor fixation element.
  • the pilot cutter may be configured to cut a pilot hole or fixation channel of various lengths or lengths of fixation element (for instance, an anchor).
  • the pilot hole length may be about 10 mm, about 20 mm, about 30 mm, about 36 mm, about 40 mm, about 44 mm, about 50 mm, about 60 mm, about 100 mm, or any value or range between any two of these values (including endpoints).
  • the pilot hole may be cut for a fixation element, such as an anchor, having a length of about 10 mm, about 20 mm, about 30 mm, about 36 mm, about 40 mm, about 44 mm, about 50 mm, about 60 mm, about 100 mm, or any value or range between any two of these values (including endpoints).
  • a fixation element such as an anchor, having a length of about 10 mm, about 20 mm, about 30 mm, about 36 mm, about 40 mm, about 44 mm, about 50 mm, about 60 mm, about 100 mm, or any value or range between any two of these values (including endpoints).
  • FIG. 11A depicts an example of a tibial pilot cutter block 1100 in accordance with one or more features of the present disclosure.
  • Tibial pilot cutter block 1100 may be configured to be installed on anterior end 508 of anchor guide 500.
  • engagement features 1102 of tibial pilot cutter block 1100 may be configured to slide over and engage anterior end 508 of anchor guide 508 to secure tibial pilot cutter block 1100 to anchor guide 500, for instance, with an interference fit.
  • engagement features 1102 may include a ridge, flange, fingers, projections, collar, and/or the like configured to slide over a portion of anterior end 508 to hold tibial pilot cutter block onto anchor guide 500.
  • Tibial pilot cutter block 1100 may include an instrument opening 1103 that allows for access to guide channel 502 of anchor guide 500.
  • tibial pilot cutter 800 may be installed through anchor guide 500, for instance, to cut a pilot hole or fixation channel, through tibial pilot cutter block 1100.
  • tibial pilot cutter block 1100 may operate to provide a different depth stop length, and, therefore, pilot channel length. For example, when tibial pilot cutter 800 is being impacted through anchor guide 500 to form the pilot channel, depth stop 803 will engage an anterior side 1108 of tibial pilot cutter block 1100 instead of anterior side 508 of anchor guide 500, thereby shortening the pilot channel by a thickness 1110 of tibial pilot cutter block 1100.
  • a pilot cutter for a larger tibial tray and/or anchor may be used for a smaller tibial tray and/or anchor (e.g., a size 3, 4, 3/4, etc.; a length of 30 mm; and/or the like).
  • tibial pilot cutter block 1100 may be associated with a size, such as pilot channel size for a tibial tray size and/or an anchor size. Tibial pilot cutter block 1100 may enforce cutting of a pilot channel of a specific smaller size when using a larger pilot cutter size.
  • pilot cutter 800 may be a Pilot Cutter 5/6 long, for instance, for a size 5/6 tibial tray and/or size 5/6 anchor for an EngageTM system (e.g., a pilot channel length of about 44 mm), and tibial pilot cutter block 1100 may be for a size 4 tibial tray and/or size 3/4 anchor for an EngageTM system (e.g., a pilot channel length of about 36 mm).
  • tibial pilot cutter block 1100 may be associated with a specific size conversion or reduction, for instance, tibial pilot cutter block 1100 may be configured as a ’’size
  • tibial pilot cutter block 1100 may allow a surgeon to precisely and efficiently use a single cutter (e.g., a long cutter for a larger or maximum size) to be used for multiple different sizes. For instance, a size
  • pilot cutter may be used for a size 5 anchor, a size 4 anchor, and a size 3 anchor via employment of the appropnate tibial pilot cutter block 1100.
  • Tibial pilot cutter block 1100 may be used with different size anchor guides.
  • FIG. 11C depicts tibial pilot cutter block 1100 coupled to a small anchor guide
  • FIG. 1 ID depicts tibial pilot cutter block 1100 coupled to a large anchor guide.
  • FIG. 12 depicts an example of a fixation element (or anchor) removal cutter 1200 in accordance with one or more features of the present disclosure.
  • anchor removal cutter 1200 may be configured as an instrument used during a surgical procedure to remove a fixation element, such as anchor 122 implanted in a patient.
  • anchor removal cutter 1200 may be arranged and configured to remove bone positioned anteriorly of anchor 122 to assist with removal of anchor 122 as part of a revision surgery.
  • anchor removal cutter 1200 may include a main body 1202 having a depth stop 1203 and a cutting end 1201.
  • cutting end 1201 may include a horizontal cutting ridge 1210 and vertical cutting ridge 1211 configured to form a “t-shaped” (or upside down “t-shape”) or substantially “t-shaped” cutting end 1201 .
  • the shape of cutting end 1201 may correspond with the shape of the fixation channel where an anchor to be removed is installed.
  • cutting end 1201 may include a leading sharp edge 1221 and various cutting elements 1220, such as teeth, small cutting edges, ridges, projections, and/or the like to facilitate cutting of patient bone during an anchor removal process.
  • FIGS. 13A-13C an example portion of a technique for using an anchor removal cutter 1200 during an anchor removal process in accordance with one or more features of the present disclosure will now be shown and described.
  • an anchor removal guide 1300 may be attached to tibial component 1300.
  • anchor removal guide 1300 may include engagement elements 1321, such as posts, recesses, projections, and/or the like configured to engage corresponding elements of instrument connection interface 121 of tibial component 104.
  • a pin, screw, or other fastener 1303 arranged longitudinally through anchor removal guide 1300 may be used to rigidly couple anchor removal guide 1300 to tibial component 104, for instance, via tightening using a tool 1350, such as a screwdriver and/or the like within a corresponding structure of instrument connection interface 121.
  • anchor removal cutter 1200 may be inserted through a guide channel 1302 of anchor removal guide 1300.
  • Guide channel 1302 may engage a guide ridge 1206 of anchor removal cutter 1200 to suspend or otherwise hold anchor removal cutter 1200 engaged with anchor removal guide 1300.
  • guide ridge 1206 may be formed with a dovetail shape, such as a dovetail boss protruding from main body 1202, and guide channel 1302 may have a corresponding shape that allows for guide ridge 1206 to slide through guide channel 1302 while holding anchor removal cutter 1200 in place in engagement with anchor removal guide 1300.
  • anchor removal cuter 1200 may be installed using impaction until depth stop 1203 engages anchor removal guide 1300.
  • cuting end 1201 may have a shape that corresponds with a contour of an anterior edge 180 of anchor 122. In this manner, cuting end 1201 is able to cut through the anchor channel and reach an anterior side of blade 131.
  • cutting end 1201 may operate to remove bone anterior to anchor 122.
  • cuting end 1201, including horizontal cuting ridge 1210 and/or vertical cutting ridge 1211 may be wider than blade 131 and support 132 to overcut the anterior portion of the anchor channel to be wider than blade 131 and support 132.
  • anchor removal cuter 1200 may be removed from the anchor channel, for instance, via a slap hammer or other tool.
  • anchor removal cuter 1200 may be one of multiple cuting, chiseling, or other instruments used to alter the anchor channel as part of an anchor removal procedure.
  • a chisel tool with a horizontal cutting surface may also be impacted within the anchor channel for further bone removal to facilitate removal of anchor 122.
  • a hook instrument may be used to hook onto or otherwise engage a portion of anchor 122 to pull anchor through the anchor channel widened via anchor removal cuter 1200, a chisel, and/or the like.
  • Chisel and hook instruments may be the same or similar to anchor removal chisel and anchor removal tool described in the ‘004 Application.
  • FIG. 15 depicts an anchored implant device installed with rigid anchor engagement in a patient tibia in accordance with the present disclosure.
  • anchor 122 is implanted with blade 131 press fit into anchor channel 1510.
  • anchor 122 includes a cross member formed via blade 131 and support 132 that operates to control the fit between tibia bone 115 and tibial baseplate 108.
  • Bone preparation for installing anchor 122 may include forming channel 1510 or a pilot version of channel 1510 (for instance, via tibial pilot cuter 800) having an area that is either less than or substantially equal to the area occupied by the anchor cross member (e.g., blade 131 and/or support 132) and/or at most a line-to-line condition with the anchor cross member in the superior-inferior (S/I) direction such that the cross member prepared its own path (e.g., widened the pilot channel) as anchor 122 entered the bone and would be fully supported on both a proximal and distal sides.
  • the anchor cross member e.g., blade 131 and/or support 132
  • S/I superior-inferior
  • anchor 122 would be rigidly implanted within channel 1510 and with a ridged engagement that is incapable of movement, such as in a superior and/or inferior direction. This could allow forces to be transmitted through the anchor to the baseplate in either an inferior direction or relieved within channel 125.
  • FIG. 16 depicts an anchored implant device installed with an adjustable engagement in a patient tibia in accordance with the present disclosure. As shown in FIG. 16, anchor 122 is implanted with blade 131 press fit into adjustable channel 1610.
  • adjustable channel 1610 may have additional bone removed in one or more dimensions to allow for movement of anchor in that dimension.
  • adjustable channel 1610 may be formed (for instance, via pilot bone cutter 800 and/or other cutting tools) to fully prepare the bone in the anterior-posterior (AP) and medial-lateral (ML) dimensions intended to be occupied by anchor cross member as well as a line-to-line or press fit condition on the superior side of the anchor cross member, with additional bone removed on the inferior side of the cross member.
  • the resulting implanted condition of anchor 122 may be out of contact with the prepared bone distal to the anchor 122 at initial placement.
  • the preparation could be relieved on the superior side to encourage load distribution through the anchor cross member.
  • adjustable channel 1610 may be formed to allow anchor 122, and therefore, baseplate 108 member to move in an inferior direction to maintain flush contact between baseplate 108 and prepared tibial surface 115.
  • a distal or inferior side of blade 131 may be free to move in an inferior direction (and in a superior direction when at the inferior limit, for instance, the bottom of adjustment channel 1620).
  • pilot bone cutter 800 and/or other cutting tools may be configured and/or used to prepare adjustable channel 1620 that provides an adjustable space 1630 for movement of anchor 122, for instance, in an inferior direction.
  • sharp cutting end 801 of tibial pilot cutter 800 may be sized in one or more dimensions (for instance, horizontal cutting ridge 810 and/or a vertical cutting ridge 811) to cut an anchor channel that has a tolerance or is larger than the cross member of the anchor by an adjustment distance.
  • adjustable space 1630 may allow for an adjustment distance (for instance, in an inferior direction) of about 0.25 mm, about 0.5 mm, about 1 mm, about 1.5 mm, about 2 mm, about 2.5 mm, about 3 mm, about 4 mm, about 5 mm, about 10 mm, or any value or range between any two of these values (including endpoints).
  • an inferior or superior-inferior direction is not restricted to a rigid inferior or superior-inferior axis; rather, an inferior or superior-inferior direction may include a substantially inferior or superior-inferior direction or axis.
  • FIG. 17 depicts an example of a femoral cutting block handle 1700 in accordance with one or more features of the present disclosure.
  • cutting block handle 1700 may be arranged and configured to engage a femoral cutting block to assist with positioning the femoral cutting block during use.
  • cutting block handle 1700 may operate to make it easier and more efficient for a surgeon to hold and/or position the femoral cutting block.
  • cutting block handle 1700 may include a main body 1702 having a tab 1701.
  • tab 1701 may include a spring 1703.
  • tab 1701 may be arranged and configured to be received within a slot (or “mating slot”) or other opening formed in the femoral cutting block.
  • spring 1703 may operate to provide tension to hold tab 1701 within the slot.
  • FIGS. 18A-18D an example portion of a technique for using cutting block handle 1700 during a femoral cutting block installation process in accordance with one or more features of the present disclosure will now be shown and described
  • a tensor block 1810 (for instance, with a tensor shim) may be inserted between prepared femoral surface 114 and prepared tibial surface 115.
  • Tensor block 1810 may be the same or similar to the tensor block described in the ‘004 Application.
  • Cutting block handle 1700 may be coupled to a femoral cutting block 1820.
  • tab 1701 may be inserted within slot 1825, for instance, formed between surfaces 1823 and 1824 (for instance, a first surface and a second surface extending from an anterior side of femoral cutting block 1820).
  • Tab 1701 may be coupled via a friction or press fit (e.g., press fit .009” to .017”) within slot 1825.
  • spring 1703 may provide tension between one or more of surfaces 1823 and/or 1824 to facilitate the friction fit.
  • Femoral cutting block 1820 may be the same or similar to portions of the femoral cutting block described in the ‘004 Application. However, femoral cutting block 1820 may include slot 1825 for engaging cutting block handle 1700.
  • cutting block handle 1700 may be coupled to femoral cutting block 1820.
  • Main body 1702 may be manually manipulated by a surgeon to position femoral cutting block 1820 onto tensor block 1810, for instance, by engaging mating interface components 1821 of femoral cutting block 1820 with corresponding interface components 1811 of tensor block 1810.
  • Femoral cutting block 1820 may then be properly aligned and affixed to prepared femur surface 114 (for instance, via pms, fasteners, and/or the like) to be used for cutting, for example, peg holes or other formations, in prepared femur surface 114.
  • cutting block handle 1700 may be removed from femoral cutting block 1820, for instance, by pulling cutting block handle 1700 away from femoral cutting block 1820 to release the friction fit.
  • Femoral cutting block 1820 may then be used as a cutting guide or template, for instance, for cutting peg holes or other structures in prepared femur surface 114.
  • Directional terms such as top, bottom, superior, inferior, medial, lateral, anterior, posterior, proximal, distal, upper, lower, upward, downward, left, right, longitudinal, front, back, above, below vertical, horizontal, radial, axial, clockwise, and counter-clockwise) and the like may have been used herein. Such directional references are only used for identification purposes to aid the reader’s understanding of the present disclosure.
  • distal may refer to the end farthest away from the medical professional/operator when introducing a device into a patient
  • proximal may refer to the end closest to the medical professional when introducing a device into a patient.
  • an “example” may refer to an illustrative representation of an environment or article or component in which a disclosed concept or feature may be provided or embodied, or to the representation of a manner in which just the concept or feature may be provided or embodied.
  • such illustrated examples are to be understood as instances, configurations, specimens, illustrations, models, examples, and/or the like (unless otherwise stated), and other manners of embodying the described concepts or features, such as may be understood by one of ordinary skill in the art upon learning the concepts or features from the present disclosure, are within the scope of the disclosure.
  • references to “one example,” and “preceding or subsequent examples” of the present disclosure are not intended to be interpreted as excluding the existence of additional examples that also incorporate the recited features.
  • Connection references e.g., engaged, attached, coupled, connected, and joined
  • connection references do not necessarily infer that two elements are directly connected and in fixed relation to each other.
  • Identification references e.g., primary, secondary, first, second, third, fourth, etc.
  • 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.

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

Abstract

L'invention concerne des techniques et des instruments chirurgicaux destinés à une intervention d'arthroplastie du genou, comprenant une intervention d'implant tibial reposant sur un ancrage. Par exemple, un rail de guidage (200) peut être installé dans un canal de composant (125) d'une plaque de base tibiale (108) pour empêcher qu'un matériau ne pénètre le canal et/ou pour fournir un trajet de support à un guide d'ancrage à accoupler à la plaque de base. Un bloc de coupe pilote (1100) peut être accouplé à un guide d'ancrage (500) pour faciliter l'utilisation efficace de dispositifs de coupe d'avant-trous plus longs (800) pour des avant-trous d'ancrage plus petits. Un dispositif de coupe de retrait d'ancrage (1200) peut comprendre une extrémité de coupe façonnée pour correspondre à des dimensions horizontales et verticales d'un canal de fixation d'ancrage. Une poignée de bloc de coupe (1700) peut être conçue pour être accouplée à un bloc de coupe fémoral (1820) de façon à faciliter une manipulation manuelle du bloc de coupe. Une technique peut consister à couper un canal d'ancrage pour permettre un déplacement réglable de l'ancrage, par exemple, dans une direction supérieure-inférieure.
PCT/US2023/020942 2022-05-06 2023-05-04 Techniques et instruments d'arthroplastie du genou WO2023215441A1 (fr)

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Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20120191204A1 (en) * 2010-12-16 2012-07-26 Hyun Bae Arthroplasty systems and methods
US20180078374A1 (en) * 2016-09-22 2018-03-22 Engage Medical Holdings, Llc Bone implants
CN112220592A (zh) * 2020-11-05 2021-01-15 嘉思特华剑医疗器材(天津)有限公司 一种生物型单间室膝关节机械加压胫骨平台
US20210290410A1 (en) 2017-03-03 2021-09-23 Engage Uni Llc Unicompartmental knee arthroplasty
WO2023003929A1 (fr) 2021-07-23 2023-01-26 Smith & Nephew, Inc. Dispositifs d'arthroplastie de genou

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20120191204A1 (en) * 2010-12-16 2012-07-26 Hyun Bae Arthroplasty systems and methods
US20180078374A1 (en) * 2016-09-22 2018-03-22 Engage Medical Holdings, Llc Bone implants
US20210290410A1 (en) 2017-03-03 2021-09-23 Engage Uni Llc Unicompartmental knee arthroplasty
US20220339004A1 (en) 2017-03-03 2022-10-27 Engage Uni Llc Unicompartmental knee arthroplasty
CN112220592A (zh) * 2020-11-05 2021-01-15 嘉思特华剑医疗器材(天津)有限公司 一种生物型单间室膝关节机械加压胫骨平台
WO2023003929A1 (fr) 2021-07-23 2023-01-26 Smith & Nephew, Inc. Dispositifs d'arthroplastie de genou

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