Open wedge osteotomy system and surgical method

• US 20050273114A1
• Filed: 01/31/2005
• Published: 12/08/2005
• Est. Priority Date: 05/07/2004
• Status: Active Grant

• Current Assignee: Arthrex Incorporated
• Original Assignee: Arthrex Incorporated
• Inventors: Novak, Vincent P.
• Granted Patent: US 8,083,746 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 17/15 Guides therefor arrangements for guiding straight saw blades in general B23D51/025
• CPC Class Codes: A61B 17/152 for removing a wedge-shaped piece of bone
• CPC Class Codes: A61B 17/1732 for bone breaking devices
• CPC Class Codes: A61B 17/1764 for the knee
• CPC Class Codes: A61B 17/8095 Wedge osteotomy devices
• CPC Class Codes: A61B 17/8858 laterally or radially expansible inflatable A61B17/8855
• CPC Class Codes: A61B 17/8866 for gripping or pushing bones, e.g. approximators joint distractors A61B17/025
• CPC Class Codes: A61B 2090/067 for measuring angles

Abstract

A system and method for performing an opening wedge osteotomy in a tibia, the system and method comprising (i) a positioning guide configured for aligning a portion of the positioning guide with a joint line of the tibia and for fixing the positioning guide to the tibia; (ii) a cutting guide configured to direct a cutting blade into the tibia so as to form a bone cut therein; (iii) a mechanical jack configured for placement into the bone cut in the tibia so as to distract the tibia at the bone cut; and (iv) a multi-part implant for supporting the open wedge osteotomy in the tibia, with a first component for disposition in a posterior portion of the open wedge osteotomy, a second component for disposition in an anterior portion of the open wedge osteotomy, and a connection device for selectively connecting the components to one another.

Claims

1. A positioning guide for performing an opening wedge osteotomy in a tibia, the positioning guide comprising an alignment component for aligning a portion of the positioning guide with a joint line of the tibia, a fixation component for fixing the positioning guide to the tibia, and a connection component for connecting the positioning guide to a cutting guide.

2. A positioning guide body according to claim 1 wherein the alignment component comprises a top surface configured for alignment with the joint line of the tibia.

3. A positioning guide according to claim 1 wherein the positioning guide forms a pair of fixation holes therein, and the fixation component comprises a pair of fixation screws configured for placement through the pair of fixation holes so as fix the positioning guide to the tibia.

4. A positioning guide according to claim 1 wherein the connection component comprises a connection screw threadably engaging the positioning guide.

5. A cutting guide for performing an opening wedge osteotomy in a tibia, the cutting guide having a guide attachment component for selective attachment of the cutting guide to the tibia, the cutting guide forming an angled cutting slot therein configured to direct a cutting blade into the tibia so as to form a bone cut therein.

6. A cutting guide according to claim 5 wherein the cutting guide forms a passageway therethrough, and the guide attachment component comprises a connection screw selectively disposed through the passageway so as to anchor the cutting guide to the tibia.

7. A cutting guide according to claim 6 wherein the guide attachment component is configured to selectively anchor the connection screw directly to the tibia.

8. A cutting guide according to claim 6 wherein the guide attachment component is configured to selectively anchor the connection screw to a positioning guide in attachment to the tibia.

9. A cutting guide according to claim 5 wherein the angled cutting slot is substantially parallel to a joint line of the tibia.

10. A cutting guide according to claim 5 wherein the angled cutting slot is disposed at a given angle to a joint line of the tibia so as to form a bone cut at the given angle to the joint line of the tibia.

11. An anterior protector member and a posterior protector member for performing an opening wedge osteotomy, each of the anterior protector member and the posterior protector member having a first end, a second end and a given length between the first end and the second end, the first end of the anterior protector member and the posterior protector member each having a connector portion configured for anchoring to the tibia, the anterior protector member and the posterior protector member each having a contoured shape to closely approximate an anterior aspect and a posterior aspect of the tibia,

respectively, wherein the second end of the anterior protector member and the second end of the posterior protector member are each inserted around the tibia from the medial aspect toward the anterior aspect and the posterior aspect, respectively, and the first end of the anterior protector member and the first end of the posterior protector member are each anchored to the tibia.

12. An anterior protector member and a posterior protector member according to claim 11 wherein the connector portion of the anterior protector member and the connector portion of the posterior protector member are configured to selectively attach to a cutting guide in attachment to the tibia so as to anchor the anterior protector member and the posterior protector member to the tibia.

13. An anterior protector member and a posterior protector member according to claim 11 wherein the connector portion of the anterior protector member and the connector portion of the posterior protector member are configured to selectively attach directly to the tibia using fixation screws so as to anchor the anterior protector member and the posterior protector member to the tibia.

14. A mechanical jack for performing an opening wedge osteotomy in a tibia, the mechanical jack comprising a jack attachment component for selective attachment of the jack to the tibia, the mechanical jack having a pair of plates with a first end and a second end in opposition to one another, the first end of the pair of plates configured to remain substantially together with one another and configured for placement into the bone cut in the tibia, and the second end of the pair of plates configured for selective positioning (i) from a first position with the second ends of the pair of plates substantially together with one another, (ii) to a second position with the second ends of the pair of plates apart from one another so as to distract the tibia at the bone cut.

15. A mechanical jack according to claim 14 wherein the jack attachment component comprises a housing portion forming a throughbore configured to allow an attachment screw therethrough for threadable engagement with a positioning guide in attachment to the tibia.

16. A mechanical jack according to claim 14 further comprising a worm gear having a first portion and a second portion disposed substantially perpendicular to one another, wherein a line from the first end of the pair of plates to the second end of the pair of plates defines a plate longitudinal axis, wherein the first portion is disposed in a first orientation substantially perpendicular to the plate longitudinal axis so as to drive the plates between the first position and the second position, and the second portion is disposed in a second orientation substantially parallel to the plate longitudinal axis so as to allow engagement of a driver tool at an angle substantially parallel to the plate longitudinal axis.

17. A system for performing an opening wedge osteotomy in a tibia, the system comprising:

a positioning guide having an alignment component for aligning a portion of the positioning guide with a joint line of the tibia, and a fixation component for fixing the positioning guide to the tibia;

a cutting guide having a guide attachment component for selectively attaching the cutting guide to the positioning guide, the cutting guide forming an angled cutting slot therein configured to direct a cutting blade into the tibia so as to form a bone cut therein;

a mechanical jack having a jack attachment component for selectively attaching the jack to the positioning guide, the mechanical jack having a pair of plates with a first end and a second end in opposition to one another, the first end of the pair of plates configured to remain substantially together with one another and configured for placement into the bone cut in the tibia, and the second end of the pair of plates configured for selective positioning (i) from a first position with the second ends of the pairs of plates substantially together with one another, (ii) to a second position with the second ends of the pair of plates apart from one another so as to distract the tibia at the bone cut; and

a multi-part implant for supporting the open wedge osteotomy in the tibia, the multi-part implant having a first component for disposition in a posterior portion of the open wedge osteotomy, a second component for disposition in an anterior portion of the open wedge osteotomy, and a connection device for selectively connecting the first component and the second component to one another.

18. A system according to claim 17 wherein the multi-part implant forms a fixation hole therein, and further comprising a fixation device configured for placement through the fixation hole in the multi-part implant and disposition in the tibia so as to anchor the multi-part implant to the tibia.

19. A system according to claim 17 wherein the connection device of the multi-part implant comprises a slotted fitting formed between the first component and the second component.

20. A system according to claim 17 wherein the connection device of the multi-part implant comprises a base portion for disposition between the first portion and the second portion, the base portion has a first side and a second side in opposition to one another, and the base portion is configured for selectively connecting the first component and the second component to the first side and the second side thereof, respectively, so as to selectively connect the first component and the second component to one another with the base portion.

21. A method for performing an opening wedge osteotomy in a tibia, the method comprising:

providing a system for performing the opening wedge osteotomy in the tibia, the system comprising;

a positioning guide having an alignment component for aligning a portion of the positioning guide with a joint line of the tibia, and a fixation component for fixing the positioning guide body to the tibia;

a cutting guide having a guide attachment component for selectively attaching the cutting guide to the positioning guide, the cutting guide forming an angled cutting slot therein configured to direct a cutting blade into the tibia so as to form a bone cut therein;

a mechanical jack having a jack attachment component for selectively attaching the jack to the positioning guide, the mechanical jack having a pair of plates with a first end and a second end in opposition to one another, the first end of the pair of plates configured to remain substantially together with one another and configured for placement into the bone cut in the tibia, and the second end of the pair of plates configured for selective positioning (i) from a first position with the second ends of the pair of plates substantially together with one another, to (ii) a second position with the second ends of the pair of plates apart from one another so as to distract the tibia at the bone cut; and

a multi-part implant for supporting the open wedge osteotomy in the tibia, the multi-part implant having a first component for disposition in a posterior portion of the open wedge osteotomy, a second component for disposition in an anterior portion of the open wedge osteotomy, and a connection device for selectively connecting the first component and the second component to one another;

aligning the positioning guide to the joint line of the tibia using the alignment component;

fixing the positioning guide to the tibia using the fixation component;

attaching the guide attachment component of the cutting guide to the positioning guide so as to position the angled cutting slot in a predetermined orientation with the joint line of the tibia;

moving the cutting blade through the angled cutting slot of the cutting guide so as to form the bone cut therein;

positioning the first end of the pair of plates of the mechanical jack into the bone cut, the pair of plates having their second ends in the first position with the second ends of the pair of plates substantially together;

actuating the mechanical jack to move the second ends of the pair of plates from the first position to the second position with the second ends of the pair of plates apart from one another so as to distract the tibia at the bone cut; and

inserting the multi-part implant into the tibia.

22. A method for performing an opening wedge osteotomy in a tibia according to claim 21 wherein the alignment component comprises a top surface of the positioning guide, and further wherein the step of aligning the positioning guide to the joint line of the tibia comprises aligning the top surface of the positioning guide to the joint line of the tibia.

23. A method for performing an opening wedge osteotomy in a tibia according to claim 21 wherein the fixation component comprises two fixation screws and the positioning guide forms two fixation screw holes therein configured to receive each of the two fixation screws therethrough, respectively, and further wherein the step of fixing the positioning guide to the tibia comprises attaching each of the two fixation screws through the positioning guide into the tibia.

24. A method for performing an opening wedge osteotomy in a tibia according to claim 21 wherein the cutting guide forms a passageway therethrough, wherein the guide attachment component comprises a connection screw selectively disposed through the passageway so as to anchor the cutting guide to the tibia, and wherein the step of attaching the cutting guide to the positioning guide comprises positioning the cutting guide adjacent the positioning guide, positioning the connection screw through the passageway of the cutting guide, and threadably engaging the connection screw with the positioning guide.

25. A method for performing an opening wedge osteotomy in a tibia according to claim 21 wherein the step of actuating the mechanical jack to move the second ends of the pair of plates from the first position to the second position with the second ends of the pair of plates apart from one another further comprises the step of reading calibrations disposed on the mechanical jack so as to distract the tibia at the bone cut to a given distance as indicated by the calibrations.

26. A method for performing an opening wedge osteotomy in a tibia according to claim 21 wherein the step of inserting the multi-part implant into the tibia further comprises the step of assembling the implant in-situ so as to provide a minimally invasive surgical procedure.

27. A method for performing an opening wedge osteotomy in a tibia according to claim 21 wherein the step of inserting the multi-part implant into the tibia further comprises the step of assembling the implant outside of the opening wedge osteotomy.

28. A system for performing an opening wedge osteotomy in a tibia, the system comprising:

a cutting guide having a guide attachment component for selectively attaching the cutting guide to the tibia, the cutting guide forming an angled cutting slot therein configured to direct a cutting blade into the tibia so as to form a bone cut therein;

a mechanical jack having a pair of plates with a first end and a second end in opposition to one another, the first end of the pair of plates configured to remain substantially together with one another and configured for placement into the bone cut in the tibia, and the second end of the pair of plates configured for selective positioning (i) from a first position with the second ends of the pair of plates substantially together with one another, to (ii) a second position with the second ends of the pair of plates apart from one another so as to distract the tibia at the bone cut; and

a multi-part implant for supporting the open wedge osteotomy in the tibia, the multi-part implant having a first component for disposition in a posterior portion of the open wedge osteotomy, a second component for disposition in an anterior portion of the open wedge osteotomy, and a connection device for selectively connecting the first component and the second component to one another.

29. A method for performing an opening wedge osteotomy in a tibia, the method comprising:

providing a system for performing an opening wedge osteotomy in a tibia, the system comprising;

a cutting guide having a guide attachment component for selectively attaching the cutting guide to the tibia, the cutting guide forming an angled cutting slot therein configured to direct a cutting blade into the tibia so as to form a bone cut therein;

a mechanical jack having a pair of plates with a first end and a second end in opposition to one another, the first end of the pair of plates configured to remain substantially together with one another and configured for placement into the bone cut in the tibia, and the second end of the pair of plates configured for selective positioning from (i) a first position with the second end of the pair of plates substantially together with one another, to (ii) a second position with the second end of the pair of plates apart from one another so as to distract the tibia at the bone cut; and

a multi-part implant for supporting the open wedge osteotomy in the tibia, the multi-part implant having a first component for disposition in a posterior portion of the open wedge osteotomy, a second component for disposition in an anterior portion of the open wedge osteotomy, and a connection device for selectively connecting the first component and the second component to one another;

aligning the cutting guide to joint line of the tibia;

attaching the cutting guide to the tibia so as to position the angled cutting slot in a predetermined orientation with the joint line of the tibia;

positioning the cutting blade through the angled cutting slot of the cutting guide so as to form the bone cut therein;

positioning the first ends of the pair of plates of the mechanical jack into the bone cut, the pair of plates having their second ends in the first position with the second end of the pair of plates substantially together;

actuating the mechanical jack to move the second ends of the pair of plates from the first position to the second position with the second ends of the pair of plates apart from one another so as to distract the tibia at the bone cut; and

inserting the multi-part implant into the tibia.

30. A method for performing an opening wedge osteotomy in a tibia according to claim 29 further comprising an anterior protector member and a posterior protector member, wherein a connector portion of the anterior protector member and a connector portion of the posterior protector member are configured to selectively attach directly to the tibia using fixation screws so as to anchor the anterior protector member and the posterior protector member to the tibia, respectively, wherein a first alignment reference on the anterior protector member and a second alignment reference on the posterior protector member allow alignment of the anterior protector member and the posterior protector member to a joint line of the tibia, wherein the step of aligning the cutting guide to the joint line of the tibia comprises the steps of aligning the anterior protector member and the posterior protector member to the joint line of the tibia, and attaching the anterior protector member and the posterior protector member to the tibia so as to provide a first attachment site defined by the anterior protector member and a second attachment site defined by the posterior protector member, and the step of attaching the cutting guide to the tibia comprises attaching the cutting guide based on the location of the first attachment site and the second attachment site.