Patient Selectable Joint Arthroplasty Devices and Surgical Tools

• US 20080281426A1
• Filed: 06/09/2008
• Published: 11/13/2008
• Est. Priority Date: 05/25/2001
• Status: Active Grant

• Current Assignee: Conformis Incorporated
• Original Assignee: Conformis Incorporated
• Inventors: Steines, Daniel, Bojarski, Raymond A., Fitz, Wolfgang, Lang, Phillip
• Granted Patent: US 7,981,158 B2
• Time in Patent Office: Days
• US Class Current: 623/17.16
• 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 17/158 Cutting patella
• CPC Class Codes: A61B 17/1666 for the acetabulum
• CPC Class Codes: A61B 17/1668 for the upper femur A61B17/164 takes precedence
• CPC Class Codes: A61B 17/1675 for the knee
• CPC Class Codes: A61B 17/1739 specially adapted for particular parts of the body
• CPC Class Codes: A61B 17/1746 for the acetabulum
• CPC Class Codes: A61B 17/1767 for the patella
• CPC Class Codes: A61B 2017/568 produced with shape and dimensions specific for an individual patient
• CPC Class Codes: A61B 2034/102 Modelling of surgical devices, implants or prosthesis
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/108 Computer aided selection or customisation of medical implants or cutting guides
• CPC Class Codes: A61B 2034/2055 Optical tracking systems
• CPC Class Codes: A61B 2090/063 for measuring volume
• CPC Class Codes: A61B 34/10 Computer-aided planning, simulation or modelling of surgical operations
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 5/103 Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes A61B5/08 takes precedence; measuring aids for tailors A41H1/00; measuring instruments specially adapted for dentistry A61C19/04
• CPC Class Codes: A61B 5/4504 Bones A61B5/4547 takes precedence
• CPC Class Codes: A61B 5/4514 : Cartilage
• CPC Class Codes: A61B 5/4523 : Tendons
• CPC Class Codes: A61B 5/4528 : Joints A61B5/4533, A61B5/4538 take precedence
• CPC Class Codes: A61B 5/4533 : Ligaments
• CPC Class Codes: A61B 90/06 : Measuring instruments not otherwise provided for
• CPC Class Codes: A61F 2/30756 : Cartilage endoprostheses A61F2/3603 takes precedence
• CPC Class Codes: A61F 2/30942 : for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques
• CPC Class Codes: A61F 2/38 : for elbows or knees
• CPC Class Codes: A61F 2/3877 : Patellae or trochleae
• CPC Class Codes: A61F 2002/3895 : unicompartimental
• CPC Class Codes: B33Y 80/00 : Products made by additive manufacturing

Abstract

A patellar 3-D guidance tool includes a template. The template includes at least one contact surface for engaging a surface of the patella. The at least one contact surface substantially conforms with the surface associated with the patellar. At least one guide aperture directs movement of a surgical instrument, wherein the shape and/or position of the guide aperture is based, at least in part, on three or more anatomic reference points associated with the patellar.

Claims

1. A method for joint arthroplasty, the method comprising:

mating a contact surface of a surgical tool onto an uncut surface of a joint, wherein the contact surface is substantially a mirror image of the uncut surface of the joint onto which the surgical tool is to be mated, the tool including a guide for directing movement of a surgical instrument; and

determining intraoperatively a desired position of the guide relative to the contact surface.

2. The method according to claim 1, wherein determining the position of the guide includes optimizing joint motion for at least one of flexion, extension, abduction, adduction, internal rotation, and external rotation.

3. The method according to claim 1, wherein determining the position of the guide includes optimizing for at least one of flexion gap and extension gap.

4. The method according to claim 1, wherein determining the position of the guide includes optimizing for ligament balancing.

5. The method according to claim 1, wherein determining the position of the guide includes using at least one of a spacer, a shim, a trial implant, a linkage, a ratchet, a hinge, a jack and a tensiometer.

6. The method according to claim 1, wherein the tool further comprises a plurality of guides, the method further comprising:

selecting a guide from the plurality of guides based on the intraoperatively-determined position; and

directing movement of the surgical instrument based on the guide selected.

7. The method according to claim 6, wherein directing movement of the surgical instrument includes making at least one of a cut, a drill hole, and a reaming.

8. The method according to claim 1, further comprising:

adjusting the guide to the desired position.

9. The method according to claim 8, wherein adjusting the guide includes adjusting at least one of the tool and the guide on a first surface relative to a second surface.

10. The method according to claim 8, wherein adjusting the guide includes adjusting for at least one of flexion, extension, abduction, adduction, internal rotation, external rotation, flexion gap, extension gap, and ligament balancing.

11. The method according to claim 8, wherein the tool includes a second component that interfaces with the surgical tool, and wherein the second component includes the guide, wherein adjusting the guide to the desired position includes:

placing one of a spacer, a shim, ratchet, a trial implant, a linkage, a hinge, a tensiometer and a jack between the contact surface and the joint surface and at least one component of the surgical tool.

12. The method according to claim 8, wherein adjusting the guide to the desired position includes using at least one of a spacer, a shim, ratchet, a trial implant, a linkage, a hinge, a tensiometer and a jack.

13. The method according to claim 8, further comprising directing movement of the surgical instrument based on the guide to make at least one of a cut, a drill hole, and a reaming.

14. The method according to claim 1, further comprising obtaining electronic image data of the joint;

and determining a shape of the contact surface based, at least in part, on electronic image data.

15. The method according to claim 1, wherein the surface of the joint is one of cortical bone, subchondral bone, and cartilage.

16. A surgical tool for joint arthroplasty, the tool comprising:

a contact surface for engaging a first uncut surface of a joint, the contact surface being substantially a mirror image of the uncut first surface of a joint;

a guide for directing movement of a surgical instrument; and

an adjustment mechanism for adjusting the position of the tool and/or the guide to a desired position relative to the contact surface.

17. The tool according to claim 16, further comprising a second component that interfaces with the surgical tool, and wherein the second component includes the guide for directing movement of a surgical instrument, and the adjustment mechanism comprises at least one of a spacer, a shim, a trial implant, a linkage, a hinge, a jack and a tensiometer for placing between the contact surface and the joint surface, and at least one component of the surgical tool.

18. The tool according to claim 16, wherein the adjustment mechanism includes at least one of a spacer, a trial implant, a shim, a linkage, a ratchet, a hinge, a tensiometer and a jack.

19. The tool according to claim 16, wherein the first surface of a joint includes at least one of cortical bone, subchondral bone, and cartilage.

20. The tool according to claim 16, further comprising at least one of a spacer, a shim, trial implant, a linkage, a ratchet, a hinge, a jack and a tensiometer for communicating with the contact surface intraoperatively to assist in determining the desired position of the guide for directing movement of a surgical instrument relative to at least one of cortical bone, subchondral bone, and cartilage so as to optimize at least one of ligament balancing, flexion gap, extension gap, flexion, extension, abduction, adduction, internal rotation, and external rotation.