Method of arthroplastly on a knee joint and apparatus for use in same

• US 20030130665A1
• Filed: 09/10/2002
• Published: 07/10/2003
• Est. Priority Date: 03/10/2000
• Status: Active Grant

• Current Assignee: Smith & Nephew Incorporated (Smith & Nephew PLC)
• Original Assignee: Smith & Nephew Incorporated (Smith & Nephew PLC)
• Inventors: Parker, Stephen John, Pinczewski, Leo Arieh
• Granted Patent: US 7,371,240 B2
• Time in Patent Office: Days
• US Class Current: 606/88
• CPC Class Codes: A61B 17/154 for preparing bone for knee prosthesis
• CPC Class Codes: A61B 17/155 Cutting femur
• CPC Class Codes: A61B 17/157 Cutting tibia
• CPC Class Codes: A61B 17/1659 Surgical rasps, files, planes, or scrapers
• CPC Class Codes: A61B 17/1675 for the knee
• CPC Class Codes: A61B 17/1764 for the knee
• CPC Class Codes: A61B 2017/1602 Mills
• CPC Class Codes: A61F 2002/3895 unicompartimental

Abstract

A method of, and apparatus for, arthroplasty of a knee joint comprising obtaining a desired spacing of the femur from the tibia by inserting a spacer into the knee joint between the femur and the tibia. The spacer is used as a reference for securing a guide jig in position about the knee joint for guiding resection of one or both of the femur and tibia for fitting of tibial and/or femoral prostheses. A method of resecting the femur while moving the tibia through an arc of motion to remove bone to the desired depth, a method of determining the position of the guide jig, the guide jog, an alignment device and the spacer are also described.

Claims

1. A method of arthroplasty on a joint comprising first and second bones, said method comprising the steps of:

(a) obtaining a desired spacing of said first and second bones;

(b) determining depth of bone to be resected from at least one of said first and second bones to enable fitting of at least one prosthesis selected from a plurality of prostheses;

(c) resecting bone from one or both of said first and second bones substantially to the determined depth in the or each one, respectively; and

(d) fitting the or each said prosthesis.

2. A method according to claim 1 further comprising:

selecting at least one spacer for providing the desired spacing of said first bone from said second bone; and

positioning the spacer in the joint between the first and second bones to thereby obtain the desired spacing of said first bone from said second bone.

3. A method according to claim 2 wherein the selecting comprises:

(i) choosing the spacer from a range of spacers for providing different spacings of the first bone from the second bone, respectively;

(ii) moving the second bone about the first bone through at least a portion of a range of motion between partially flexed and extended positions to evaluate movement of the joint while the chosen said spacer is in position between the first and second bones.

4. A method according to claim 3 wherein the selecting further comprises repeating steps (i) and (ii) as necessary to obtain the desired spacing of the first bone from the second bone using a different spacer chosen from the range of spacers each time.

5. A method according to claim 2 further comprising placing the joint in a position of flexion whereby the second bone is arranged at an angle with respect to the first bone for the resection of the bone.

6. A method according to claim 2 further comprising:

locating a guide jig in position about the joint for guiding the resection of the bone; and

using the guide jig to guide cutting of the second bone substantially at the desired depth in a medial to lateral or lateral to medial direction in the resection of bone from the second bone.

7. A method according to claim 6 wherein the locating of the guide jig comprises utilising the spacer as a reference to determine the position of the guide jig about the joint for guiding the cutting of the second bone substantially at the desired depth.

8. A method according to claim 6 wherein the locating of the guide jig comprises coupling the guide jig with the spacer while the spacer is positioned in the joint between the first and second bones to thereby determine the position of the guide jig about the joint.

9. A method according to claim 6 further comprising using the guide jig to guide cutting of the first bone.

10. A method according to claim 6 further comprising:

locating a cutter device in position in the joint between the first and second bones; and

moving the second bone through at least a portion of a range of motion about the first bone between partially flexed and extended positions while the cutting device is being operated and located between the first and second bones, to thereby substantially remove bone substantially to the desired depth from the first bone in a direction of travel of the second bone relative to the first bone.

11. A method according to claim 10 further comprising:

removing the guide jig from said position about the joint; and

inserting a trial implant in position in a recess in the second bone formed by the resection of the bone from the second bone;

wherein the trial implant is adapted for reception of the cutter device thereon and maintaining the cutter device in a desired orientation with respect to the first bone as the second bone is moved through the range of motion between the flexed and extended positions.

12. A method according to claim 11 further comprising placing the cutter device on the trial implant such that the trial implant and the cutter device are coupled together prior to moving the second bone through the range of motion.

13. A method according to claim 1 further comprising:

cutting a channel into either the first or second bone for reception of an upstanding fin of a selected prosthesis, wherein the channel when formed lies in an anterior to posterior direction.

14. A method according to claim 10 further comprising:

cutting a channel into the first bone utilising the cutter device for reception of an upstanding fin of a selected said prosthesis;

wherein the channel is cut into the first bone simultaneously with the resection of the bone from the first bone to the desired depth as the second bone is moved through the range of motion about the first bone.

15. A method according to claim 1 wherein the joint is a knee and said first and second bones are the femur and tibia, respectively.

16. A method according to claim 15 wherein the bone is resected from a lateral or medial condyle of the tibia and a corresponding condyle of the femur.

17. A method according to claim 16 further comprising resecting bone from the other condyle of the tibia and the condyle of the femur corresponding to the other tibial condyle.

18. A method according to claim 15 wherein the bone is resected from a lateral or medial condyle of the tibia only.

19. A method of arthroplasty on a knee joint, comprising the steps of:

(a) surgically providing access to the knee joint;

(b) selecting at least one spacer for providing a desired spacing of the femur from the tibia;

(c) positioning the selected spacer in the knee joint to obtain the desired spacing of the femur from the tibia;

(d) using the spacer as a reference to determine a location on each one of the tibia and the femur indicating depth of bone to be resected from each for fitting of chosen tibial and femoral prostheses;

(e) cutting the tibia and the femur substantially at the determined location on each for resection of the bone from each one to the required said depth from each one, respectively; and

(f) fitting the chosen tibial and femoral prostheses.

20. A method according to claim 19 wherein the selecting of the spacer comprises:

(i) choosing the spacer from a range of spacers for providing different spacing of the femur from the tibia, respectively; and

(ii) moving the tibia about the femur through at least a portion of a range of motion between partially flexed and extended positions to evaluate movement of the knee joint while the chosen said spacer is in position between the femur and the tibia.

21. A method according to claim 20 wherein the selecting further comprises repeating steps (i) and (ii) as necessary to obtain the desired spacing of the femur from the tibia using a different spacer from the range of spacers each time.

22. A method according to claim 19 further comprising placing the knee joint in a position of flexion whereby the tibia is arranged at an angle with respect to the femur for the resection of the bone.

23. A method according to claim 19 wherein the cutting of the femur comprises resecting a portion from the posterior of the femur.

24. A method according to claim 19 further comprising:

locating a cutting device in the knee joint between the femur and the tibia; and

moving the tibia through a range of motion about the femur between partially flexed and extended positions while the cutting device is being operated to thereby remove bone substantially to the desired depth from the femur in a direction of travel of the tibia relative to the femur.

25. A method according to claim 19 further comprising:

cutting a channel into either the femur or the tibia for reception of an upstanding fin of the femoral prosthesis, wherein the channel when formed lies in an anterior to posterior direction.

26. A method according to claim 24 further comprising:

cutting a channel into the femur utilising the cutter device for reception of an upstanding fin of the femoral prosthesis, simultaneously with the resection of the bone from the femur as the tibiais moved through the range of motion about the femur.

27. A method according to claim 19 wherein the bone is resected from a lateral or medial condyle of the tibia and a corresponding condyle of the femur.

28. A method of arthroplasty on a knee joint, comprising the steps of:

(a) locating a cutting device in position in a knee joint between the femur and the tibia; and

(b) moving the tibia through a range of motion about the femur between at least partially flexed and extended positions while the cutting device is being operated to thereby remove bone substantially to a desired depth from the femur in a direction of travel of the tibia relative to the femur, for enabling fitting of a femoral prosthesis to the femur.

29. A method according to claim 28 further comprising:

resecting bone from the tibia to a desired depth to provide a prepared surface for placement of a tibial implant or trial;

fixing the tibial implant or trial in position on the prepared surface of the tibia, and

placing the cutter device on the tibial implant or trial prior to moving the tibia through the range of motion about the femur.

30. A method according to claim 29 wherein the tibial implant or trial is adapted for mating with the cutter device and the placing of the cutter device on the tibial implant or trial comprises mating the tibial implant or trial and the cutter device together such that the cutter device is maintained in a desired orientation with respect to the femur as the tibia is moved through the range of motion between the flexed and extended positions.

31. A method according to claim 29 wherein the resection of bone from the tibia comprises cutting the tibia substantially at the desired depth to thereby provide the prepared surface for placement of the tibial implant.

32. A method according to claim 28 wherein the resection of the bone comprises forming a recess in the tibia in which the tibial implant is disposed in position in the recess.

33. A method according to claim 28 further comprising forming a recess in the uppermost end of the tibia to a desired depth for reception of the cutting device for removing the bone to the desired depth from the femur.

34. A method according to claim 28 further comprising cutting a channel into either bone utilising the cutting device for reception of an upstanding fin of the femoral prosthesis, wherein the channel is cut into said bone simultaneously with the resection of the bone from the femur as the tibia is moved through the range of motion about the femur.

35. A method of determining the position of a guide jig about a knee joint for subsequently guiding cutting of one or both of the tibia and the femur at a desired depth in either one respectively, the method comprising:

(a) locating a selected spacer in the knee joint to obtain a desired spacing of the femur from the tibia; and

(b) arranging the guide jig and the spacer together to thereby determine the position of the guide jig about the knee joint for guiding the cutting of either one of the tibia and the femur.

36. A method according to claim 35 wherein the spacer is selected from a range of spacers and the selecting of the spacer comprises:

(i) choosing the thickness of the spacer from a range of spacer thicknesses for providing different spacings of the femur from the tibia, respectively;

(ii) moving the tibia about the femur through a range of motion between at least partially flexed and extended positions to evaluate movement of the knee joint while the selected spacer is in position between the femur and the tibia.

37. A method according to claim 36 wherein the selecting further comprises repeating steps (i) and (ii) as necessary to obtain the desired spacing of the femur from the tibia using a different spacer thickness chosen from the range of spacer thicknesses each time.

38. A method according to claim 35 wherein the arranging of the guide jig with the spacer comprises coupling the guide jig and the spacer together.

39. A method according to claim 38 wherein the coupling of the guide jig with the spacer comprises sliding the guide jig onto a protruding end region of the spacer protruding from the knee joint.

40. A method according to claim 35 further comprising:

coupling the guide jig with an alignment component for aligning the guide jig relative to the knee joint at a desired angle in an anterior to posterior direction of the knee joint; and

securing the guide jig in said position such that the guide jig is aligned at the desired angle.

41. A method according to claim 40 wherein the alignment component is capable of being withdrawn from the guide jig leaving the guide jig behind secured in said position about the knee joint.

42. A method according to claim 40 wherein the alignment component for aligning the guide jig at the desired angle is arranged between the knee joint and the guide jig when the guide jig is secured in said position at the desired angle.

43. A method according to claim 35 further comprising:

arranging the guide jig in a desired medial to lateral orientation with respect to the knee joint.

44. A method according to claim 43 wherein the arranging of the guide jig in the desired medial to lateral orientation comprises utilising an alignment guide for aligning the guide jig with respect to the tibia.

45. A guide jig for use in a method of arthroplasty on a knee joint of a patient, wherein the guide jig is adapted for guiding cutting of at least one of the tibia and the femur in resection of bone therefrom for enabling fitting of one or both of a tibia and a femoral prosthesis, and wherein the guide jig is further adapted for being arranged with a selected spacer for spacing the femur from the tibia and for being secured about the knee joint in a position determined by the spacer to guide cutting of at least one of the tibia and the femur, respectively, substantially at a desired depth.

46. A guide jig according to claim 45 wherein the guide jig is adapted for receiving the spacer for thereby determining the position of the guide jig about the knee joint.

47. A guide jig according to claim 46 wherein the guide jig has a through passageway for reception of the spacer for thereby determining the position of the guide jig about the knee joint.

48. A guide according to claim 45 wherein the guide jig is adapted for guiding cutting of the tibia when secured about the knee joint is said position.

49. A guide jig according to claim 45 wherein the guide jig is adapted for guiding cutting of both the tibia and the femur.

50. A guide jig according to claim 48 wherein the guide jig is adapted for guiding the cutting of the tibia and the femur at a fixed predetermined spacing from one another, respectively.

51. A guide jig according to claim 45 wherein the guide jig is adapted for guiding the cutting of at least one of the tibia and the femur substantially in a medial to lateral or lateral to medial direction when secured about the knee joint in said position.

52. A guide jig according to claim 51 wherein the guide jig is a cutting block with a through slot for guiding the cutting of the tibia.

53. A guide jig according to claim 52 wherein the guide jig has a further through slot for guiding the cutting of the femur.

54. A guide jig according to claim 45 wherein the guide jig is further adapted for guiding cutting in a direction along the tibia for removing a segment of bone from the tibia.

55. A guide jig according to claim 54 wherein the guide jig is provided with at least one channel for guiding the cutting along the tibia for removing a portion of the segment of bone and extending from front through to the rear of the guide jig.

56. A guide jig according to claim 55 wherein the guide jig is provided with a pair of spaced apart said channels, one channel being defined in each one of opposite side regions of the guide jig, respectively.

57. A guide jig according to claim 55 wherein the or each said channel slopes inwardly at a desired angle with distance from an upperside to an opposite underside of the jig.

58. A guide jig according to claim 45 wherein the guide jig is adapted for guiding the cutting of the tibia to provide a tibial surface sloping downwardly in an anterior to posterior direction of the knee joint when secured in position about the knee joint.

59. An alignment device for aligning a guide jig in position about a knee joint for guiding cutting of at least one of the tibia and the femur at a desired location on the or each one respectively during arthroplasty on the knee joint, and comprising:

a body for receiving the guide jig and coupling the guide jig with an alignment guide for aligning the guide jig in a desired medial to lateral orientation with respect to the knee joint;

and wherein the body is adapted for aligning the guide jig at a desired angle in an anterior to posterior direction of the knee joint and for securing of the guide jig at the desired angle prior to removal of the body from about the knee joint for allowing cutting of the one or both of the tibia and the femur to be guided by the guide jig.

60. An alignment device according to claim 59 wherein the body is adapted for aligning the guide jig at a downward said angle in the anterior to posterior direction.

61. An alignment device according to claim 59 wherein the body is adapted for being coupled with the guide jig for aligning the guide jig in position about the knee joint.

62. An alignment device according to claim 59 wherein the body is adapted for being arranged between the guide jig and the alignment guide for enabling the alignment guide and the body to be removed from about the knee joint while the guide jig remains behind in position about the knee joint.

63. An alignment device according to claim 59 wherein the body incorporates a first mating mechanism for being received by the guide jig and facilitating the alignment for the guide jig in the anterior to posterior direction.

64. An alignment device according to claim 63 wherein the first mating mechanism is arranged for projecting toward the knee joint when the body is received by the guide jig and the guide jig is secured about the knee at the desired angle.

65. An alignment according to claim 63 wherein the body incorporates a second mating mechanism for reception by the alignment guide for achieving the coupling of the body and the alignment guide, and wherein the second mating mechanism is arranged for projecting away from the knee.

66. An alignment device according to claim 59 wherein the body is further adapted for allowing reception of a selected spacer projecting from between the tibia and the femur by the guide jig while the guide jig is received by the body and aligned at the desired angle relative to the knee joint.

67. An alignment device for supporting a cutting device for resecting bone from the tibia to a desired depth to form a recess in the tibia during arthroplasty on a knee joint, and comprising:

a body for receiving a guide jig for guiding cutting of the tibia and coupling the guide jig with an alignment guide for aligning the guide jig in a desired medial to lateral orientation with respect to the knee joint;

and wherein the body is adapted for aligning the guide jig at a desired angle relative to the knee joint in an anterior to posterior direction and for being secured about the knee joint in a position determined by the guide jig for supporting the cutting device following removal of the guide jig from the body.

68. An alignment device according to claim 67 wherein the body is adapted for aligning the guide jig at a downward said angle in the anterior to posterior direction of the knee.

69. An alignment device according to claim 67 wherein the body is adapted for being coupled with the guide jig for aligning the guide jig in position about the knee joint.

70. An alignment device according to claim 67 wherein the body incorporates a first mating mechanism for being received by the guide jig and facilitating the alignment of the guide jig.

71. An alignment device according to claim 70 wherein the first mating mechanism is arranged for projecting away from the knee joint when the body is located about the knee joint.

72. An alignment device according to claim 70 wherein the body incorporates a second mating mechanism for reception by the alignment guide for achieving the coupling of the body and the alignment guide, and wherein the first mating mechanism overlies the second mating mechanism.

73. A spacer for being inserted into a knee joint to provide a desired spacing of the femur from the tibia in arthroplasty on the knee joint, comprising an elongate member with a leading end region adapted for being inserted between the tibia and the femur to thereby obtain the desired spacing of the femur from the tibia, and an opposite end region adapted for coupling with a guide jig for guiding the cutting of the or each one of the tibia and the femur in the resection of the bone.

74. A spacer according to claim 73 wherein the leading end region of the spacer is adapted for retaining the spacer in the knee joint.

75. A spacer according to claim 73 wherein the leading end region of the spacer is adapted for receiving the medial or lateral condyle of the femur for thereby retaining the spacer in the knee joint.

76. A spacer according to claim 74 wherein a concave trough is defined in the leading end region of the spacer for receiving the medial or lateral condyle of the femur and thereby retaining the spacer in the knee joint.

77. A spacer according to claim 76 wherein a raised ridge orientated in a direction across the spacer is defined on the leading end region, and the leading end region is scooped forward of the ridge thereby defining the concave trough for reception of the medial or lateral condyle of the femur.

78. A spacer according to claim 73 wherein the leading end region of the spacer has an upperside and an opposite underside, and a protuberance for being seated on an articulating surface of the tibia is defined on the underside for providing the desired spacing of the femur from the tibia.

79. A spacer according to claim 78 wherein the protuberance is a bulbous protuberance for being seated on a low region of the tibia under the medial or lateral condyle of the femur.

80. A set of spacers for allowing selection of at least one of the spacers for insertion into a knee joint to provide a desired spacing of the femur from the tibia in arthroplasty on the knee joint, each said spacer respectively comprising a leading end region adapted for being inserted between the tibia and the femur to thereby space the femur from the tibia, and an opposite end region adapted for protruding from the knee joint and coupling with a guide jig for guiding cutting of the or each one of the tibia and the femur in the resection of the bone, wherein the spacers have a different thickness to one another for providing different spacings of the femur from the tibia.

81. A set of spacers according to claim 80 wherein the leading end region of each said spacer is adapted for retaining the spacer in the knee joint, respectively.

82. A set of spacers according to claim 80 wherein the leading end region of each said spacer is adapted for receiving the medial or lateral condyle of the femur and thereby retaining the spacer in the knee joint, respectively.

83. A set of spacers according to claim 80 wherein the leading end region of each said spacer has an upperside and an opposite underside, and a protuberance for being seated on an articulating surface of the tibia is defined on the underside of each for spacing the femur from the tibia.