Method and apparatus for less invasive knee resection

• US 20050113840A1
• Filed: 08/31/2004
• Published: 05/26/2005
• Est. Priority Date: 01/15/2003
• Status: Active Grant

• Current Assignee: Biomet Manufacturing, LLC (Zimmer Biomet Holdings, Inc.)
• Original Assignee: Biomet Manufacturing, LLC (Zimmer Biomet Holdings, Inc.)
• Inventors: Metzger, Robert, Brown, Stephen, Sheffer, Garrett A.
• Granted Patent: US 7,887,542 B2
• Time in Patent Office: Days
• US Class Current: 606/88
• CPC Class Codes: A61B 17/02 for holding wounds open; Tractors specula A61B1/32 ; drainage appliances for wounds A61M27/00
• CPC Class Codes: A61B 17/14 Surgical saws A61B17/1637 takes precedence; tooth saws A61C3/12 ; Accessories therefor
• CPC Class Codes: A61B 17/142 with reciprocating saw blades, e.g. with cutting edges at the distal end of the saw blades
• CPC Class Codes: A61B 17/155 Cutting femur
• CPC Class Codes: A61B 17/157 Cutting tibia

Abstract

Various method and apparatuses may be used to perform a procedure, such as a resection of a portion of the anatomy for preparation of the implants of a prosthetic. Various resecting member, including saw blades having selected geometries and shapes, can be used to assist in the resection of an anatomy to provide for implantation of a prosthetic. In addition, a cutting block assembly may be used to guide the resecting member. The cutting block assembly may be moveably mounted relative to the portion to be resected.

Claims

1. An instrument for guiding a tool relative to a portion of an anatomy, comprising:

a track member;

a translating member associated with said track member to translate relative to said track member; and

a positioning member operable to associate at least one of said track member or said translating member relative to the anatomy;

wherein said track member is operable to be fixed to the anatomy in an associated position.

2. The instrument of claim 1, wherein said track member includes a first portion operable to interconnect said track member with the anatomy and a second portion operable to engage said translating member.

3. The instrument of claim 2, wherein said second portion includes a track operable to engage said translating member wherein said translating member is operable to move relative to said track member along said second portion.

4. The instrument of claim 2, wherein said second portion includes a tenon portion of a dovetail interconnection operable to interconnect with said translating member.

5. The instrument of claim 2, wherein said second portion defines a generally T-shaped portion extending from said track member operable to be engaged by said translating member.

6. The instrument of claim 2, further comprising:

a member operable to interconnect said track member with the anatomy;

wherein said first portion defines a bore extending through said first portion and said second member is operable to pass through said bore.

7. The instrument of claim 1, wherein said translating member includes a first portion to engage said track member such that said translating member is operable to translate relative to said track member;

and

a guiding portion operable to guide the tool relative to the anatomy.

8. The instrument of claim 7, wherein said first portion includes a tenon of a dovetail connection operable to interconnect with a portion extending from said track member to hold said translating member relative to said track member and to allow said translating member to translate relative to said track member.

9. The instrument of claim 7, wherein said second portion defines a slot.

10. The instrument of claim 9, wherein said slot is operable to interact with a saw blade to guide a saw blade relative to the anatomy.

11. The instrument of claim 1, wherein said positioning member includes an intramedullary rod operable to be positioned in the anatomy.

12. The instrument of claim 11, wherein said positioning member includes a paddle instrument associated with said intramedullary rod to position said paddle instrument relative to the anatomy.

13. The instrument of claim 12, further comprising:

an interconnection portion;

wherein said interconnection portion interconnects said paddle instrument and at least one of said track member or said translating member.

14. The instrument of claim 1, wherein said positioning member includes a selectable portion to assist in achieving the selected position relative to the anatomy.

15. The instrument of claim 14, wherein said positioning portion selects at least one of a varus or valgus position of said at least one of said track member or said translating member relative to the anatomy.

16. The instrument of claim 1, wherein said translating member includes a guide surface operable to guide the tool relative to a femur.

17. The instrument of claim 16, wherein said translating member includes a dimension less than a dimension of the femur.

18. The instrument of claim 1, further comprising:

a prosthesis operable to replace at least a portion of the anatomy.

19. An instrumentation for guiding a tool relative to a selected portion of an anatomy, comprising:

a track member operable to be fixed to the anatomy having a first length between a first end and a second end;

a guide member including a second length between a first guide end and a second guide end; and

a guide surface defined by at least a portion of said guide member;

wherein said first length and said second length are less than a dimension to be affected by the tool.

20. The instrumentation of claim 19, wherein said track member includes a first track portion extending from said track member;

wherein said guide member includes a second track portion operable to engage said first track portion of said track member.

21. The instrumentation of claim 19, wherein said guide member includes a first track portion extending from said guide member;

wherein said track member includes a second track portion operable to receive said first track portion of said guide member.

22. The instrumentation of claim 19, wherein at least one of said first length or said second length is less than about 6 cm.

23. The instrumentation of claim 19, wherein said guide member is movable relative to said track member.

24. The instrumentation of claim 23, wherein said guide surface is operable to guide the tool relative to the anatomy through at least a movement of said guide member.

25. The instrumentation of claim 23, wherein said guide surface includes a slot defined by said guide member through which the tool is operable to pass.

26. The instrumentation of claim 25, wherein the tool is operable to move the guide member relative to the track member.

27. The instrumentation of claim 19, wherein said track member includes a fixable portion operable to interconnect said track member to the anatomy.

28. The instrumentation of claim 19, further comprising:

a positioning member operable to assist in positioning at least one of said track member or said guide member.

29. The instrumentation of claim 28, wherein said positioning member includes an paddle instrument for selecting at least one of a varus angle or a valgus angle relative to the anatomy.

30. The instrumentation of claim 28, wherein said positioning instrument includes an intramedullary rod positionable in an intramedullary canal of the anatomy.

31. The instrumentation of claim 19, further comprising:

at least one of a femoral prosthesis, a tibial prosthesis, a humeral prosthesis, or combinations thereof.

32. The instrumentation of claim 19, wherein the dimension to be affected is a transverse dimension.

33. A method of guiding a tool relative to a portion of an anatomy with a moving guide member, comprising:

positioning a track member relative to the anatomy;

positioning the guide member relative to the anatomy with the track member in a first position;

guiding the tool relative to the anatomy with the guide member in the first position;

moving the guide member to a second position; and

guiding the tool relative to the anatomy in the second position.

34. The method of claim 33, wherein moving the guide member to a second position includes:

moving the tool to move the guide member relative to the position track member.

35. The method of claim 33, further comprising:

resecting a selected portion of the anatomy; and

completing the resection of the anatomy with said guide member.

36. The method of claim 33, further comprising:

resecting the anatomy with the tool by guiding the tool relative to the anatomy in the first position and the second position in substantially one plane.

37. The method of claim 33, wherein positioning a track member includes pinning the track member to the anatomy to hold the track member in a position relative to the anatomy.

38. The method of claim 33, wherein positioning the guide member relative to the anatomy includes engaging the guide member to the track member wherein the guide member is movable relative to the track member.

39. The method of claim 38, wherein the guide member is movable relative to the anatomy only with the track member.

40. The method of claim 33, further comprising:

forming an incision in a soft tissue relative to the anatomy; and

wherein positioning a track member includes passing the track member through the incision.

41. The method of claim 40, wherein said incision is about 1 cm to about 13 cm.

42. The method of claim 33, further comprising:

implanting a prosthesis relative to the anatomy.

43. The method of claim 42, wherein implanting the prosthesis relative to the anatomy includes positioning at least one of a distal femoral implant, a proximal femoral implant, a tibial implant, a humeral implant, or a combination thereof relative to the anatomy.

44. The method of claim 33, further comprising:

resecting a portion of the anatomy with the tool.

45. The method of claim 44, wherein resecting a portion of the anatomy with the tool includes resecting at least one of a proximal portion of a femur, a distal portion of a femur, an inferior portion of a femur, a posterior portion of a femur, a proximal portion of a tibia, a portion of a humerus, or combinations thereof.

46. An instrument system for guiding a resection of a selected dimension of a selected portion of an anatomy, comprising:

a first member fixed relative to the selected portion of the anatomy; and

a second member moveable relative to said first portion of the anatomy;

wherein said second member defines a guide surface having a dimension less than a dimension to be resected on the selected portion of the anatomy;

wherein said second member is operable to constructively define a guide surface greater than a dimension of either of said first member or said second member.

47. The instrument system of claim 46, wherein the guide surface defined by said second member includes a slot extending from a first side to a second side of said second member.

48. The instrument system of claim 46, wherein said second member includes a first side and a second side;

wherein said first side is spaced from said second side at a distance of less than about 6 cm.

49. The instrument system of claim 46, wherein said first member defines a rail;

wherein said second member defines a channel to operably interact with said rail to allow movement of said second member relative to said first member.

50. The instrument system of claim 49, wherein said rail includes a tenon of a dovetail and said channel includes a mortis of a dovetail.

51. The instrument system of claim 46, further comprising:

a resecting instrument operable to be guided with said guide surface relative to said the selected portion of the anatomy;

wherein the resection of the selected portion of the anatomy is completed substantially while guiding the resection instrument with the guide surface relative to the selected portion of the anatomy.

52. The instrument system of claim 46, wherein said second member includes a cutting block operable to form at least one cut relative to a distal portion of a femur.

53. The instrument system of claim 46, wherein said second member is operable to at least one of rotate, slide, distract, or combinations thereof relative to said first member.

54. The instrument system of claim 53, wherein said second member is operable to be moved substantially freely by a user with a resection instrument.

55. The instrument system of claim 46, wherein said first member includes a groove;

wherein said second member includes a peg receivable in the groove, such that the second member can slide along the groove and rotate about the peg relative to the first member.

56. The instrument system of claim 46, wherein the first member is attached medially to the tibia.

57. The tibial resection apparatus of claim 56, further comprising a stylus operable to assist in positioning the support block relative to the tibia.

58. The tibial resection apparatus of claim 46, wherein said first member includes a first side and a second side separated by a distance of less than about 2 cm.

59. A method of performing a surgical procedure relative to a boney portion through an incision in the soft tissue, comprising:

forming an incision in the soft tissue;

positioning a first member relative to the boney portion;

associating a second member with the first member;

guiding a tool relative to the boney portion with the second member; and

forming a complete cut by moving the second member relative to the boney portion to form a constructive guide surface.

60. The method of claim 59, wherein forming an incision in the soft tissue includes forming an incision of at least about 5 cm.

61. The method of claim 60, wherein forming an incision includes forming an incision of about 13 cm to about 25 cm.

62. The method of claim 59, wherein associating the second member with the first member includes movably interconnecting the second member with the first member.

63. The method of claim 59, further comprising:

moving the second member relative to the first member.

64. The method of claim 63, wherein guiding a tool relative to the boney portion includes moving the second member relative to the first member.

65. The method of claim 59, further comprising:

positioning a tool relative to the second member;

moving the tool relative to the bony portion to resect a selected portion of the bony portion; and

guiding the tool with the second member during the entire resection of the bony portion.

66. The method of claim 59, wherein the second member includes a dimension less than a selected dimension of the resection relative to the bony portion.

67. The method of claim 59, wherein forming the constructive guide surface includes at least one of sliding the second member, rotating the second member, distracting the second member, or combinations thereof relative to the first member.

68. The method of claim 59, further comprising:

resecting a femoral portion for implantation of a distal femoral implant.

69. The method of claim 59, further comprising:

resecting a proximal portion of a tibia for a tibial implant.

70. The method of claim 59, further comprising:

fixing the first member relative to the tibia;

guiding the tool relative to the tibia to resect a selected portion of the tibia; and

forming a constructive guide surface with the second member relative to the tibia.