Customized Patient-Specific Instrumentation for Use in Orthopaedic Surgical Procedures

• US 20090088753A1
• Filed: 09/29/2008
• Published: 04/02/2009
• Est. Priority Date: 09/30/2007
• Status: Active Grant

• Current Assignee: DePuy Synthes Products LLC (Johnson & Johnson)
• Original Assignee: DePuy Synthes Products LLC (Johnson & Johnson)
• Inventors: Cook, Laban, Smith, Matthew D., Ashby, Alan, Sokolov, Dimitri, Lester, Mark B., Rose, Bryan, Rhodes, Matt, Aram, Luke J., Roose, Jeffrey R.
• Granted Patent: US 8,425,523 B2
• Time in Patent Office: Days
• US Class Current: 606/79
• CPC Class Codes: A61B 17/155 Cutting femur
• CPC Class Codes: A61B 17/157 Cutting tibia
• CPC Class Codes: A61B 17/1764 for the knee
• CPC Class Codes: A61B 2017/00526 Methods of manufacturing
• CPC Class Codes: A61B 2017/568 produced with shape and dimensions specific for an individual patient
• CPC Class Codes: A61B 2034/108 Computer aided selection or customisation of medical implants or cutting guides
• CPC Class Codes: Y10T 409/30084 with regulation of operation by templet, card, or other replaceable information supply

Abstract

A number of orthopaedic surgical instruments are also disclosed. A method, apparatus, and system for fabricating such instruments are also disclosed.

Claims

1. A customized patient-specific orthopaedic instrument, comprising:

a customized patient-specific femoral cutting block that comprises;

(i) a body having a bone-facing surface having a customized patient-specific negative contour configured to receive a portion of an anterior side of a patient'"'"'s femur that has a corresponding positive contour;

(ii) at least one tab extending posteriorly from the body, the at least one tab having a bone-facing surface having a customized patient-specific negative contour configured to receive a portion of the distal side of the patient'"'"'s femur that has a corresponding positive contour; and

(iii) a lip extending superiorly from an end of the at least one tab, the lip having a bone-facing surface having a customized patient-specific negative contour configured to receive a portion of the posterior side of the patient'"'"'s femur that has a corresponding positive contour.

2. The customized patient-specific orthopaedic instrument of claim 1, wherein the customized patient-specific femoral cutting block comprises a first tab extending posteriorly from the body and a second tab extending posteriorly from the body, each of the first tab and the second tab having a customized patient-specific negative contour configured to receive a respective portion of the distal end of the patient'"'"'s femur that has a corresponding positive contour, and the first tab and the second tab defining an opening therebetween.

3. The customized patient-specific orthopaedic instrument of claim 2, wherein the customized patient-specific femoral cutting block comprises a first lip extending superiorly from an end of the first tab and a second lip extending superiorly from an end of the second tab, each of the first tab and the second tab having a customized patient-specific negative contour configured to receive a respective portion of the posterior side of the patient'"'"'s femur that has a corresponding positive contour.

4. The customized patient-specific orthopaedic instrument of claim 2, wherein the first tab extends posteriorly from the body a first distance and the second tab extends posteriorly form the body a second distance, the first and second distances being substantially different.

5. The customized patient-specific orthopaedic instrument of claim 2, wherein the body of the customized patient-specific femoral cutting block defines a vertical plane and the first tab and second tab extend obliquely from the body with respect to the vertical plane.

6. The customized patient-specific orthopaedic instrument of claim 1, wherein the body of the customized patient-specific femoral cutting block includes a cutting slot defined therein, the cutting slot being positioned to allow a surgeon to perform a distal cut on the patient'"'"'s femur using the cutting slot.

7. The customized patient-specific orthopaedic instrument of claim 1, wherein the customized patient-specific femoral cutting block comprises a cutting guide coupled to the body, the cutting guide having a cutting slot defined therein, the cutting guide being formed from a material different from the body and being positioned to allow a surgeon to perform a distal cut on the patient'"'"'s femur using the cutting slot.

8. The customized patient-specific orthopaedic instrument of claim 7, wherein the cutting guide is formed from a metallic material and is overmolded to the body of the customized patient-specific femoral cutting block.

9. The customized patient-specific orthopaedic instrument of claim 8, wherein the customized patient-specific femoral cutting block comprises a plurality of anterior guide pin bushings coupled to the body, each of the anterior guide pin bushings being formed from a material different from the body and having a passageway defined therethrough sized to receive a corresponding guide pin.

10. The customized patient-specific orthopaedic instrument of claim 9, wherein the body of the customized patient-specific femoral cutting block includes a plurality of passageways extending therethrough, each of the plurality of anterior guide pin bushings being received in a corresponding passageway of the plurality of passageways and positioned such that a bone-facing end of each anterior guide pin bushing is recessed with respect to the bone-facing surface of the body.

11. The customized patient-specific orthopaedic instrument of claim 10, wherein one of the plurality of passageways is oblique with respect to the other plurality of passageways.

12. The customized patient-specific orthopaedic instrument of claim 10, wherein each of the passageways of the body of the customized patient-specific femoral cutting block are counterbored on the bone-facing surface.

13. The customized patient-specific orthopaedic instrument of claim 9, wherein the customized patient-specific femoral cutting block comprises a distal guide pin bushing coupled to the at least one tab, the distal guide pin bushing being formed from a material different from the at least one tab and having a passageway defined therethrough sized to receive a corresponding guide pin.

14. The customized patient-specific orthopaedic instrument of claim 9, wherein the body of the customized patient-specific femoral cutting block comprises an opening defined therein, the opening extending superiorly from the cutting guide to a point on the body that is more superior than the superior-most point of each of the plurality of anterior guide pin bushings.

15. The customized patient-specific orthopaedic instrument of claim 9, wherein the at least one tab includes a groove extending laterally across the bone-facing side of the at least one tab, the groove and the cutting guide defining a transverse plane.

16. The customized patient-specific orthopaedic instrument of claim 1, wherein the customized patient-specific femoral cutting block comprises a post extending anteriorly from the body, the post including a passageway defined therein, the passageway extending through the post to the bone-facing surface of the body and being sized to receive a corresponding guide pin.

17. The customized patient-specific orthopaedic instrument of claim 1, wherein the body of the customized patient-specific femoral cutting block comprises an outer surface opposite the bone-facing surface, the outer surface including a recessed area.

18. The customized patient-specific orthopaedic instrument of claim 1, wherein the customized patient-specific femoral cutting block comprises an arcuate bracket extending from the body, the arcuate bracket including a posterior bone-facing surface having a negative contour configured to receive a portion of the posterior side of the patient'"'"'s femur that has a corresponding positive contour.

19. The customized patient-specific orthopaedic instrument of claim 1, wherein the body includes an outer surface opposite the bone-facing surface, the outer surface having a recessed area sized to receive an end of a surgeon'"'"'s finger, the recessed area corresponding to a location on the body at which pressure is to be applied to couple the customized patient-specific femoral cutting block to the patient'"'"'s femur.

20. A customized patient-specific orthopaedic instrument, comprising:

a customized patient-specific tibial cutting block that comprises;

(i) a body having a bone-facing surface having a customized patient-specific negative contour configured to receive a portion of an anterior side of a patient'"'"'s tibia that has a corresponding positive contour and a portion of a medial side of the patient'"'"'s tibia that has a corresponding positive contour such that an angle greater than zero is defined between a vertically-extending, bisecting plane of the body and a bisecting saggital plane of the patient'"'"'s tibia when the portions of the patient'"'"'s tibia are received in the customized patient-specific negative contour of the body and (ii) at least one tab extending posteriorly from the body, the at least one tab having a bone-facing surface having a customized patient-specific negative contour configured to receive a portion of the proximal side of the patient'"'"'s tibia that has a corresponding positive contour.

21. The customized patient-specific orthopaedic instrument of claim 20, wherein the customized patient-specific tibial cutting block comprises a first tab extending posteriorly from the body and a second tab extending posteriorly from the body, each of the first tab and the second tab having a bone-facing surface having a customized patient-specific negative contour configured to receive a respective portion of the proximal end of the patient'"'"'s tibia that has a corresponding positive contour, the first tab and the second tab defining an opening therebetween.

22. The customized patient-specific orthopaedic instrument of claim 21, wherein each of the first tab and second tab include an enclosed elongated opening defined therein.

23. The customized patient-specific orthopaedic instrument of claim 21, wherein the body of the customized patient-specific tibial cutting bock includes a superior end and an outer surface opposite the bone-facing surface of the body, the superior end including a notch defined therein, the notch extending from the outer surface to the bone-facing surface of the body.

24. The customized patient-specific orthopaedic instrument of claim 21, wherein the first tab extends posteriorly from the body a first distance and the second tab extends posteriorly form the body a second distance, the first and second distances being substantially different.

25. The customized patient-specific orthopaedic instrument of claim 21, wherein the body of the customized patient-specific tibial cutting block defines a vertical plane and the first tab and second tab extend obliquely from the body with respect to the vertical plane.

26. The customized patient-specific orthopaedic instrument of claim 21, wherein the first tab has a maximum thickness and the second tab has a maximum thickness, the maximum thickness of the first tab being greater than the maximum thickness of the second tab.

27. The customized patient-specific orthopaedic instrument of claim 20, wherein the body of the customized patient-specific tibial cutting block includes a cutting slot defined therein, the cutting slot being positioned to allow a surgeon to perform a proximal cut on the patient'"'"'s femur using the cutting slot.

28. The customized patient-specific orthopaedic instrument of claim 20, wherein the customized patient-specific tibial cutting block comprises a cutting guide coupled to the body, the cutting guide having a cutting slot defined therein, the cutting guide being formed from a material different from the body and being positioned to allow a surgeon to perform a distal cut on the patient'"'"'s femur using the cutting slot.

29. The customized patient-specific orthopaedic instrument of claim 28, wherein the cutting guide is formed from a metallic material and is overmolded to the body of the customized patient-specific tibial cutting block.

30. The customized patient-specific orthopaedic instrument of claim 28, wherein the customized patient-specific tibial cutting block includes an outer surface opposite the bone-facing surface and a ledge extending outwardly from the outer surface, the ledge having a top surface coplanar with a bottom surface of the cutting slot of the cutting guide.

31. The customized patient-specific orthopaedic instrument of claim 28, wherein the customized patient-specific tibial cutting block comprises a plurality of anterior guide pin bushings coupled to the body, each of the anterior guide pin bushings being formed from a material different from the body and having a passageway defined therethrough sized to receive a corresponding guide pin.

32. The customized patient-specific orthopaedic instrument of claim 31, wherein the body of the customized patient-specific tibial cutting block includes a plurality of passageways extending therethrough, each of the plurality of anterior guide pin bushings being received in a corresponding passageway of the plurality of passageways and positioned such that a bone-facing end of each anterior guide pin bushing is recessed with respect to the bone-facing surface of the body.

33. The customized patient-specific orthopaedic instrument of claim 32, wherein one of the plurality of passageways is oblique with respect to the other plurality of passageways.

34. The customized patient-specific orthopaedic instrument of claim 33, wherein each of the passageways of the body of the customized patient-specific tibial cutting block are counterbored on the bone-facing surface.

35. The customized patient-specific orthopaedic instrument of claim 31, wherein the customized patient-specific tibial cutting block comprises a proximal guide pin bushing coupled to the at least one tab, the proximal guide pin bushing being formed from a material different from the at least one tab and having a passageway defined therethrough sized to receive a corresponding guide pin.

36. The customized patient-specific orthopaedic instrument of claim 20, wherein the body includes an outer surface opposite the bone-facing surface, the outer surface having a recessed area sized to receive an end of a surgeon'"'"'s finger, the recessed area corresponding to a location on the body at which pressure is to be applied to couple the customized patient-specific tibial cutting block to the patient'"'"'s tibia.

37. The customized patient-specific orthopaedic instrument of claim 20, wherein the angle defined between the vertically-extending, bisecting plane of the body and the bisecting sagittal plane of the patient'"'"'s tibia is between ten degrees and thirty degrees.

38. The customized patient-specific orthopaedic instrument of claim 37, wherein the angle defined between the vertically-extending, bisecting plane of the body and the bisecting sagittal plane of the patient'"'"'s tibia is about twenty degrees.

39. The customized patient-specific orthopaedic instrument of claim 20, wherein the tab has a decreasing thickness in the anterior-to-posterior direction.

40. The customized patient-specific orthopaedic instrument of claim 20, wherein the at least one tab has a top surface that has a concave cross-section in the sagittal plane.

41. The customized patient-specific orthopaedic instrument of claim 20, wherein a portion of the customized patient-specific negative contour of the bone-facing surface of the body substantially defines a compound angle.

42. The customized patient-specific orthopaedic instrument of claim 20, wherein the bone-facing surface of the at least one tab includes a central recess to define a rim therearound, the customized patient-specific negative contour of the bone facing surface of the at least one tab being defined on the rim.

43. A customized patient-specific orthopaedic instrument, comprising:

a customized patient-specific cutting block having a bone-facing surface including a negative contour configured to receive a portion of a patient'"'"'s bone having a corresponding contour, the negative contour being scaled with respect to the positive contour of the patient'"'"'s bone by a predetermined amount based on the thickness of the cartilage present on the patient'"'"'s bone.