Apparatus for knee surgery and method of use
First Claim
1. A patella resection guide for guiding a cutter to cut a patella having an anterior side, an opposite posterior side, a medial side and a lateral side, the patella resection guide comprising:
- a first jaw for engaging said medial side of said patella;
a second jaw for engaging said lateral side of said patella;
means for moving the first jaw relative to the second jaw from a first position in which the jaws are disengaged from said medial and lateral sides of said patella to a second position in which the jaws are engaged with said medial and lateral sides of said patella, the means being actuable from a location that is medial or lateral of said patella; and
means for guiding a cutter to cut said patella.
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Accused Products
Abstract
The present invention comprises a set of instruments and a method for their use in preparing a knee joint to receive knee implants. The inventive instruments and method are generally suitable for knee joint surgery. Furthermore, they include features that make them suitable for performing a minimally invasive knee surgery in which a smaller than normal incision is made and oriented to preserve the quadriceps mechanism and protect the suprapatellar pouch. The instruments permit switching from a minimally invasive technique to a standard open technique at any point in the procedure. An illustrative set of instruments for total knee arthroplasty and an associated minimally invasive technique are described.
281 Citations
114 Claims
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1. A patella resection guide for guiding a cutter to cut a patella having an anterior side, an opposite posterior side, a medial side and a lateral side, the patella resection guide comprising:
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a first jaw for engaging said medial side of said patella;
a second jaw for engaging said lateral side of said patella;
means for moving the first jaw relative to the second jaw from a first position in which the jaws are disengaged from said medial and lateral sides of said patella to a second position in which the jaws are engaged with said medial and lateral sides of said patella, the means being actuable from a location that is medial or lateral of said patella; and
means for guiding a cutter to cut said patella. - View Dependent Claims (2, 3)
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4. A patella resection guide for guiding a cutter to cut a patella having an anterior side, an opposite posterior side, a medial side and a lateral side, the patella resection guide comprising:
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a first jaw shaped to engage said medial side of said patella;
a second jaw shaped to engage said lateral side of said patella;
a handle connecting the first and second jaws in translating relationship, the handle being actuable to move the jaws from a first position in which the jaws are disengaged from said medial and lateral sides of said patella to a second position in which the jaws are engaged with said medial and lateral sides of said patella, the handle being actuable from a location that is medial or lateral of said patella. - View Dependent Claims (5, 6, 7, 8, 9, 10, 11, 12)
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13. A patella resection guide comprising:
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a first side;
a second side; and
a depth gauge removably mountable on the first side of the resection guide to indicate the amount of bone to be removed from said patella and alternately mountable on the second side of the resection guide to indicate the amount of bone to remain on said patella.
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14. A patella resection guide for guiding a cutter to cut a patella having an anterior side, an opposite posterior side, and a periphery around the patella, the patella resection guide comprising:
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a first jaw member shaped to engage said periphery of said patella;
a second jaw member shaped to engage said periphery of said patella, the second jaw member connected to the first jaw member in translating relation;
a first handle connected to the first jaw member;
a second handle connected to the second jaw member, the second handle being actuable to move the second jaw member in a motion plane toward and away from the first handle; and
a cutter guide adjacent the jaws, the cutter guide able to guide a cutter to cut in a plane parallel to the jaw motion plane.
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15. A patella resection guide for guiding a cutter to cut a patella having an anterior side, an opposite posterior side, and a periphery around the patella, the patella resection guide comprising:
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a first jaw member shaped to grip said periphery of said patella;
a second jaw member shaped to grip said periphery of said patella;
a support member connecting the first jaw member in translating relationship to the second jaw member, the support constraining the jaw members to remain parallel when they move relative to one another;
a handle actuable to move the first and second jaw members in a motion plane from a first position in which the jaw members are further from one another to a second position in which the jaw members are nearer one another;
a cutter guide adjacent the jaws, the cutter guide able to guide a cutter to cut in a plane parallel to the jaw motion plane.
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16. A method comprising the steps of:
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providing a patella resection guide having patella gripping jaws and a cutter guide;
making an incision on at least one of the medial and lateral sides of a knee to expose said patella from the side;
gripping the medial and lateral sides of the patella with the jaws of the patella resection guide while the patella remains in its normal orientation relative to the femur; and
guiding a cutter with the cutter guide through the incision from the side of the knee to resect the patella. - View Dependent Claims (17)
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18. A femoral distal cut guide for cutting a femur, the femur having a frontal plane, a sagittal plane, a femoral head adjacent a hip joint, a femoral shaft with an intramedullary canal, a condylar portion adjacent a knee joint having a medial side and a lateral side, an anatomic axis lying along the intramedullary canal, and a mechanical axis lying along a line from the center of the femoral head to the center of the knee joint, the cut guide comprising:
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an intramedullary rod having a longitudinal rod axis; and
a distal cut guide, the distal cut guide mounted on the intramedullary rod at an angle to the longitudinal rod axis, as measured in the frontal plane, so that aligning the intramedullary rod with the anatomic axis and extending the distal cut guide toward the side of the knee orients the distal cut guide to guide a cutter from the side of the knee to cut the distal femur perpendicular to the mechanical axis. - View Dependent Claims (19, 20, 21, 22)
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23. A method of cutting a distal femur comprising the steps of:
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providing a distal cut guide having an intramedullary rod;
making an incision on at least one of the medial and lateral sides of a knee to expose the distal femur from the side;
inserting the intramedullary rod into an intramedullary canal of the femur;
orienting the distal cut guide so that it extends toward one of the medial and lateral sides of the femur; and
guiding a cutter with the cutter guide to cut the distal femur from the side to form a planar distal surface. - View Dependent Claims (24, 25, 26)
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27. A tibial cut guide assembly comprising:
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a support having a longitudinal support axis;
a cross member mounted on the support, the cross member having a cross member axis perpendicular to the support axis, the cross member axis and support axis defining a guide plane, the cross member having a slope reference oriented at a predetermined slope angle relative to the guide plane;
a cut guide having a cross member engaging end and a cutter guide, the cross member engaging end being mounted on the cross member in engagement with the slope reference, the cutter guide defining a cut plane that is oriented at a predetermined slope angle relative to the guide plane as determined by the slope reference. - View Dependent Claims (28, 29, 30, 31, 32, 33)
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34. A tibial cut guide assembly for cutting a proximal end of a tibia having a proximal end, a distal end, a tibial shaft, a tibial axis along the shaft, an anterior side parallel to a frontal plane, a medial side parallel to a sagittal plane, and a lateral side parallel to said sagittal plane, the tibial cut guide assembly comprising:
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a support having a support axis, the support being mountable on said tibia with the support axis parallel to said tibial axis;
a cut guide, the cut guide being mounted on the support with the cut guide oriented to guide a cutter obliquely toward said tibia between the anterior side and one of the medial and lateral sides of said tibia to cut the proximal end of said tibia when the support is mounted on said tibia. - View Dependent Claims (35, 36)
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37. A tibial cut guide assembly comprising:
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an alignment bar having a longitudinal alignment bar axis;
a boom mounted on the alignment bar, the boom having a boom axis perpendicular to the alignment bar axis, the boom axis and alignment bar axis defining a guide plane, the boom having a slope reference oriented at a predetermined slope angle relative to the guide plane;
a cut guide having a boom engaging end and a cutter guide, the boom engaging end being mounted on the boom in engagement with the boom slope reference, the cutter guide defining a cut plane that is oriented at a predetermined slope angle relative to the guide plane as determined by the boom slope reference. - View Dependent Claims (38, 39, 40, 41)
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42. A method for cutting a proximal end of a tibia having a proximal end, a distal end, a tibial shaft, a tibial axis along the shaft, an anterior side parallel to a frontal plane, a medial side parallel to a sagittal plane, and a lateral side parallel to said sagittal plane, the method comprising the steps of:
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mounting a cut guide on the tibia with the cut guide oriented to guide a cutter obliquely toward the tibia between the anterior side and one of the medial and lateral sides of the tibia; and
guiding a cutter obliquely toward the tibia with the cut guide to cut the proximal end of the tibia. - View Dependent Claims (43, 44, 45)
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46. A method for cutting a proximal end of a tibia having a proximal end, a distal end, a tibial shaft, a tibial axis along the shaft, an anterior side parallel to a frontal plane, a medial side parallel to a sagittal plane, and a lateral side parallel to said sagittal plane, the method comprising the steps of:
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providing a tibial alignment bar having an alignment bar axis and a tibial boom mounted on the alignment bar for translation along the alignment bar axis, the tibial boom having a boom axis perpendicular to the alignment bar axis, the alignment bar axis and boom axis together defining a guide plane, the boom further including a posterior slope reference defining a predetermined angle relative to the guide plane;
mounting the alignment bar on said tibia with the alignment bar axis parallel to the tibial axis;
providing a cut guide;
mounting the cut guide on the boom for translation along the boom axis and in engagement with the posterior slop reference such that the cut guide is oriented to guide a cutter obliquely toward the tibia between the anterior side and one of the medial and lateral sides of the tibia to cut a planar surface at the predetermined angle relative to the guide plane; and
guiding a cutter obliquely toward the tibia with the cut guide to cut the proximal end of the tibia. - View Dependent Claims (47, 48, 49, 50, 51)
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52. A guide for establishing a position reference on a distal portion of a femur having a distal end, an anterior surface, a medial side surface, a lateral side surface, posterior condyles, and anatomic landmarks, the guide comprising:
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a base having a reference surface for engaging said distal end; and
a pin guide mounted for rotation relative to the base, the pin guide including at least one pin guide hole for guiding a reference pin to engage one of said medial and lateral side surfaces of said distal femur. - View Dependent Claims (53, 54, 55, 56, 57, 58, 59, 60)
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61. A guide for establishing a position reference on a distal portion of a femur having a distal end, an anterior surface, a posterior surface, a medial side surface, a lateral side surface, posterior condyles, a femoral axis, and anatomic landmarks, the guide comprising:
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means for establishing a desired rotation angle relative to said femoral axis; and
means for establishing a desired A/P position between said anterior and posterior surfaces of said femur; and
means for establishing a datum on said distal femur that records the rotation angle and A/P position in such a way that the datum can be subsequently referenced by bone cutting guides to produce bone cuts relative to the rotation and position information. - View Dependent Claims (62, 63, 64)
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65. A method for establishing a position reference datum on a distal portion of a femur having an anterior surface, a posterior surface, posterior condyles, a femoral axis, medial and lateral epicondyles, and an A/P axis, the method comprising the steps of:
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determining a desired rotation angle relative to the femoral axis;
determining a desired A/P position between the anterior and posterior surfaces of the femur;
creating a datum on the distal femur that records the rotation angle and A/P position in such a way that the datum can be subsequently referenced by bone cutting guides to produce bone cuts relative to the rotation and position information. - View Dependent Claims (66, 67, 68, 69, 70, 71, 72)
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73. A method for establishing a position reference datum on a distal portion of a femur having a distal end, an anterior surface, a posterior surface, a medial side surface, a lateral side surface, posterior condyles, a femoral axis, and anatomic landmarks, the method comprising the steps of:
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providing a guide having a base and a pin guide mounted for rotation and translation relative to the base;
placing the base against the distal end of said femur;
rotating the pin guide relative to the base to a desired rotation angle;
translating the pin guide relative to the base to a desired A/P position; and
inserting at least one pin into said femur with the pin guide, the at least on pin fixing the rotation angle and A/P position for future reference. - View Dependent Claims (74, 75, 76)
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77. An apparatus for guiding a cutter to cut a femur having a datum established on it, the datum fixing a desired external rotation and A/P position, the apparatus comprising:
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a cut guide for guiding a cutter to cut said femur; and
means for engaging said datum to orient the cut guide to guide a cutter to cut said femur at said desired external rotation and A/P position. - View Dependent Claims (78, 79, 80, 81)
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82. A guide for guiding a cutter to cut a profile on a distal femur, the femur having at least one pin inserted into the side of the femur fixing a desired external rotation and A/P position, the guide comprising:
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a distal portion having inner and outer distal surfaces;
a side portion having inner and outer side surfaces with at least one hole extending through the side from the inner to the outer side surface for receiving said at least one pin to set the guide at said desired external rotation and A/P position; and
a cut guide for guiding a cutter to cut said femur at said desired external rotation and A/P position. - View Dependent Claims (83, 84, 85, 86, 87)
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88. A method for cutting a distal portion of a femur having an anterior surface, a posterior surface, and a femoral axis, the method comprising the steps of:
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determining a desired rotation angle relative to the femoral axis;
determining a desired A/P position between the anterior and posterior surfaces of the femur;
creating a datum on the distal femur that records the rotation angle and A/P position;
referencing the datum with a cut guide to orient the cut guide relative to the rotation angle and A/P position; and
guiding a cutter with the cut guide to cut the femur. - View Dependent Claims (89, 90, 91, 92, 93, 94, 95)
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96. A cut guide for a femur having an anterior side, a posterior side, a proximal end, and a distal end, the cut guide comprising:
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an anterior body portion having an outer anterior surface, an inner anterior surface, and an anterior cut guide surface;
a distal body portion having an outer distal surface, an inner distal surface, and a distal cut guide surface, the distal body portion extending from the anterior body portion at an angle, the distal cut guide surface being aligned with the anterior cut guide surface; and
a cutter guidable from the distal cut guide surface to the anterior cut guide surface to cut the anterodistal aspect of said femur along an angle from posterior and distal to anterior and proximal. - View Dependent Claims (97, 98, 99, 100, 101, 102, 103)
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104. A method for cutting the anterodistal aspect of a femur having an anterior side, a posterior side, a proximal end, and a distal end, the method comprising the steps of:
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mounting a cut guide on the femur, the cut guide having a chisel guide; and
guiding a chisel with the chisel guide to cut the anterodistal aspect of the femur along an angle from posterior and distal to anterior and proximal. - View Dependent Claims (105, 106, 107, 108, 109, 110, 111)
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112. A method of total knee arthroplasty comprising the steps of:
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making an incision on at least one of the medial and lateral sides of a knee to expose the knee joint from the side;
placing a patella cut guide adjacent the patella;
guiding a cutter with the patella cut guide through the incision to cut the patella from the side of the knee;
placing a femoral cut guide adjacent the femur;
guiding a cutter with the femoral cut guide through the incision to cut the femur from the side of the knee;
placing a tibial cut guide adjacent the tibia; and
guiding a cutter with the tibial cut guide through the incision to cut the tibia from the side of the knee. - View Dependent Claims (113, 114)
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Specification