APPARATUS AND METHOD FOR SCULPTING THE SURFACE OF A JOINT

• US 20100145343A1
• Filed: 04/04/2008
• Published: 06/10/2010
• Est. Priority Date: 04/04/2007
• Status: Active Grant

• Current Assignee: Cayenne Medical Incorporated (Zimmer Biomet Holdings, Inc.)
• Original Assignee: Alexandria Research Technologies, LLC
• Inventors: Travanty, Micheal N., Swanson, Kevin D., Kremer, Anthony G., Staples, Kevin T., Engh, Gerard A., Johnson, Wesley D., Bisek, Aaron J., Pilarski, Daryl R., Kohler, Robert E.
• Granted Patent: US 8,425,516 B2
• Time in Patent Office: Days
• US Class Current: 606/85
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/1624 Drive mechanisms therefor
• CPC Class Codes: A61B 17/1659 Surgical rasps, files, planes, or scrapers
• CPC Class Codes: A61B 17/1662 for particular parts of the body
• CPC Class Codes: A61B 17/1675 for the knee
• CPC Class Codes: A61B 17/1735 for rasps or chisels
• CPC Class Codes: A61B 17/1764 for the knee
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/0268 for the knee
• CPC Class Codes: A61B 2017/1602 Mills
• CPC Class Codes: A61B 2017/320028 with reciprocating movements
• CPC Class Codes: A61B 2090/061 for measuring dimensions, e.g. length
• CPC Class Codes: A61B 2090/065 for measuring contact or contact pressure
• CPC Class Codes: A61F 2/389 Tibial components A61F2/3868 takes precedence
• CPC Class Codes: A61F 2/4684 Trial or dummy prostheses

Abstract

Methods and devices for sculpting bones, particularly in preparation for implanting prosthetic devices to replace articulating bone joint surfaces. Improved bone removal devices including burr mills driven by gears and loop drives are provided. Reciprocating cutters and belt cutters are also provided. Some devices have either integral or removable expandable portions to vary the force and bone resection depth. Devices can have irrigation ports and plenums to remove bone fragments. Some cutters are dual cutters, adapted to remove bone in two or more regions, such as the knee joint, simultaneously.

Claims

1. A method of sculpting the articular surface of a first bone that normally articulates in a predetermined manner with a second bone, the method comprising:

fixing a bone-sculpting tool to the second bone;

sculpting the articular surface of the first bone; and

applying a distracting force between the bone-sculpting tool and the second bone so as to force the bone-sculpting tool into the first bone, in which the force applying is operated at least in part under load control.

2. The method of claim 1, in which the applying the distracting force includes applying a fluid under pressure, and in which the load control includes controlling the fluid pressure.

3. The method of claim 1, in which the controlling the fluid pressure includes controlling a gaseous fluid pressure.

4. The method of claim 1, in which the controlling the fluid pressure includes controlling a liquid fluid pressure.

5. The method of claim 1, in which the load control includes measuring the load between the two bones and controlling the distracting force at least in part as a function of the measured load.

6. The method of claim 1, in which the force applying is controlled under load control, followed by displacement control after a displacement limit is reached.

7. The method of claim 6, in which the displacement control includes mechanically limiting the range of displacement.

8. The method of claim 1, in which the load control is at least in part performed by an automatic controller which automatically controls the distraction force at least in part as a function of the load.

9. The method of claim 1, in which the load control is at least in part performed under manual control, in which a human controls the distraction force at least in part in response to a load read-out value.

16. The apparatus of claim 10, referring to the barrel cutter of claim 1 as the first barrel cutter, further comprising a second barrel cutter coupled to the first barrel cutter so as to transfer applied torque between the first and second barrel cutters.

The apparatus of claim 10, in which the frame has a length of between about 10 mm and 90 mm, and a width of between about 10 mm and 50 mm.

49. The apparatus of claim 40, referring to the apparatus of claim 1 as the first belt cutter, further comprising a second belt cutter coupled to the first belt cutter so as to transfer applied torque between the first and second belt cutters.

10. An apparatus for cutting into mammalian bone, the apparatus comprising:

a frame having a space within and an outside region without;

a plurality of cutting cylinders rotatably disposed within the frame; and

a drive member externally accessible from outside of the frame, the drive member operably coupled to rotate the cutting cylinders.

11. The apparatus of claim 10, in which the housing has a posterior region for inserting into a mammalian body, an anterior region opposite the posterior region, a right side and a left side both extending between the posterior and anterior regions, in which the drive member is a shaft which protrudes outside of the housing through the right and/or left sides.

12. The apparatus of claim 10, in which the drive member is operably coupled to the cutting cylinders through gears.

13. The apparatus of claim 10, in which the drive member is operably coupled to the cutting cylinders through a flexible drive loop.

14. The apparatus of claim 10, further comprising a fluid inlet port and outlet port in fluid communication with the housing interior for providing irrigation.

15. The apparatus of claim 10, further comprising a plurality of nested telescoping platforms, the platforms having an interior, an extended configuration and a collapsed configuration, in which the platforms can be urged from the collapsed configuration to the extended configuration through direct or indirect application of fluid pressure to the platforms interior.

18. The apparatus of claim 10, in which the frame has a length of between about 10 mm and 90 mm, and a width of between about 40 mm and 100 mm.

19. The apparatus of claim 10, in which the frame has a length of less than about 10 cm and a width of less than 10 cm.

20. A method of removing bone comprising applying the apparatus of claim 10 to bone.

21. An apparatus for cutting into mammalian bone, the apparatus comprising:

a frame having a posterior region for inserting into a mammalian body and an anterior region opposite the posterior region;

at least one upper cutting element having a cutting surface; and

an extendable body operably coupled to the bottom portion, the extendable body having a first configuration, and a second configuration, in which the apparatus has a greater height in the second configuration than in the first configuration, in which the extendable body is mechanically restricted with respect to side-to-side movement.

22. The apparatus of claim 21, in which the extendable body is directly coupled to the housing.

23. The apparatus of claim 21, in which the extendable body is at least partially received within the housing.

26. The apparatus of claim 21, in which the extendable body includes at least one leg received into the housing.

27. The apparatus of claim 21, in which the extendable body includes an expandable envelope.

28. The apparatus of claim 21, in which the extendable body includes at least two nested structures, one at least partially nested within the other.

29. The apparatus of claim 21, further comprising a drive member operably coupled to the cutter element so as to move the cutting element, in which the drive member is accessible from outside of the frame.

30. The of apparatus of claim 21, in which the cutting element includes a cutting element selected from the group consisting of cutting cylinders, cutting belts, and reciprocating cutting planar surfaces.

31. The apparatus of claim 21, in which the frame has a length of between about 10 mm and 90 mm, and a width of between about 10 mm and 50 mm.

32. The apparatus of claim 21, in which the frame has a length of between about 10 mm and 90 mm, and a width of between about 40 mm and 100 mm.

33. The apparatus of claim 21, in which the frame has a length of less than about 10 cm and a width of less than 10 cm.

34. A method of removing bone comprising applying the apparatus of claim 21 to bone.

35. The apparatus of claim 21, further comprising an irrigation inlet port, an irrigation outlet port, and an irrigation flow path therebetween adapted to flush bone and tissue pieces from the apparatus.

24. The apparatus of claim 24, in which the extendable body includes a bellows.

25. The apparatus of claim 24, in which the bellows includes inward and outward folds.

36. An apparatus for simultaneously cutting into two distinct regions of mammalian bone, the apparatus comprising:

a first frame having a posterior region for inserting into a mammalian body and an anterior region opposite the posterior region;

a second frame having a posterior region for inserting into a mammalian body and an anterior region opposite the posterior region;

the first frame having a first moveable cutting body including a first upper cutting surface capable of cutting into tissue and bone;

the second frame having a second moveable cutting body including a second upper cutting surface capable of cutting into tissue and bone;

a first drive member operably coupled to the first cutting body;

a second drive member operably coupled to the second cutting body; and

at least one connecting member for maintaining the first and second frames in spaced apart relation to each other.

37. The apparatus of claim 36, in which the first and second moveable cutting bodies are each a rotating cylinder having cutting surfaces.

38. The apparatus of claim 36, in which the first and second moveable cutting bodies are reciprocating cutting surfaces each bearing cutting elements.

39. The apparatus of claim 36, in which the first and second moveable cutting bodies are each closed loop belts bearing cutting elements, wherein the belts are driven by the drive members to move in a longitudinal direction.

40. An apparatus for cutting into mammalian bone, the apparatus comprising:

a frame having a posterior region for inserting into a mammalian body and an anterior region opposite the posterior region;

a posterior roller rotatably coupled to the frame posterior region;

a anterior roller rotatably coupled to the frame anterior region;

a cutting belt looped around both the posterior and anterior rollers; and

a drive member operably coupled to the anterior roller to rotatably drive the anterior roller and cutting belt.

41. The apparatus of claim 40, in which the cutting belt includes a plurality of apertures therethrough.

42. The apparatus of claim 41, in which the cutting belt apertures have a raised trailing edge.

43. The apparatus of claim 40, further comprising a posterior tissue protector coupled to the frame to protect tissue from the cutting belt posterior region.

44. The apparatus of claim 40, further comprising an anterior frame member coupled to the frame anterior portion.

45. The apparatus of claim 40, in which the drive member is externally accessible from outside the frame, and in which the drive member is disposed along an anterior-posterior axis.

46. The apparatus of claim 40, in which the drive member is externally accessible from outside the frame, and in which the drive member is disposed perpendicular to an anterior-posterior axis.

47. The apparatus of claim 40, further comprising a housing base operably coupled to the frame for protecting tissue from a bottom portion of the cutting belt.

48. The apparatus of claim 40, further comprising a tensioning arm operably coupled to the anterior and posterior roller for adjusting belt tension.

50. The apparatus of claim 40, in which the frame has a length of between about 10 mm and 90 mm, and a width of between about 10 mm and 50 mm.

51. The apparatus of claim 40, in which the frame has a length of between about 10 mm and 90 mm, and a width of between about 40 mm and 100 mm.

52. The apparatus of claim 40, in which the frame has a length of less than about 10 cm and a width of less than 10 cm.

53. A method of removing bone comprising applying the apparatus of claim 40 to bone.

54. The apparatus of claim 40, further comprising an irrigation inlet port, an irrigation outlet port, and an irrigation flow path therebetween adapted to flush bone and tissue pieces from the apparatus.

55. The apparatus of claim 40, in which the cutting belt has a longitudinal axis, a substantially planar surface, and a plurality of outer cutting ridges disposed on the belt outer surface.

56. The apparatus of claim 55, further comprising a plurality of inner ridges disposed on the belt inner surface.

57. The apparatus of claim 55, in which the ridges are oriented substantially perpendicular to the belt longitudinal axis.

58. The apparatus of claim 55, in which the ridges are oriented at between about a 20 and a 70 degree angle with respect to the longitudinal axis.

59. The apparatus of claim 40, in which the belt has a first set of substantially parallel cutting ridges on the belt outer surface, and in which the belt has a second set of substantially parallel cutting ridges on the belt outer surface, in which the first and second set of ridges cross each other to form a diamond shape pattern.

60. The apparatus of claim 55, in which the belt has a first set of substantially parallel ridges on the belt outer surface, and in which the belt has a second set of substantially parallel ridges on the belt outer surface, in which the first and second set of ridges are disposed at least a 20 degree angle with respect to each other.

61. The apparatus of claim 40, in which the cutting belt includes an abrasive cutting surface.

62. An apparatus for cutting into mammalian bone, the apparatus comprising:

a frame having a posterior region for inserting into a mammalian body and an anterior region opposite the posterior region;

a substantially planar upper cutting element having a cutting surface; and

a drive member operably coupled to the cutter element so as to drive the cutting element to move substantially within a plane, in which the drive member is accessible from outside of the frame.

63. The apparatus of claim 62, in which the drive member operable coupling is through an offset or eccentric cam.

64. The apparatus of claim 62, in which the drive member is disposed along an anterior-posterior axis.

65. The apparatus of claim 62, in which the drive member is disposed orthogonal to an anterior-posterior axis.

66. The apparatus of claim 62, comprising at least 2 upper cutting elements, each configured to operate in substantially the same plane.

67. The apparatus of claim 62 in which the upper cutting element cuts primarily only when moved in one direction, but not the opposite direction.

68. The apparatus of claim 62 in which the upper cutting element cuts when moved in one direction and also in the opposite direction.

69. The apparatus of claim 62, in which the frame has a length of between about 10 mm and 90 mm, and a width of between about 10 mm and 50 mm.

70. The apparatus of claim 62, in which the frame has a length of between about 10 mm and 90 mm, and a width of between about 40 mm and 100 mm.

71. The apparatus of claim 62, in which the frame has a length of less than about 10 cm and a width of less than 10 cm.

72. A method of removing bone comprising applying the apparatus of claim 62 to bone.

73. The apparatus of claim 62, further comprising an irrigation inlet port, an irrigation outlet port, and an irrigation flow path therebetween adapted to flush bone and tissue pieces from the apparatus.

74. An apparatus for cutting into mammalian bone, the apparatus comprising:

a frame having a posterior region for inserting into a mammalian body and an anterior region opposite the posterior region;

a removable cartridge having an upper surface bearing a plurality of cutting elements, the cartridge slidably coupled to the frame to allow for movement of the cutting elements with respect to the frame; and

a drive member operably coupled to the cartridge so as to reciprocatingly drive the cartridge, in which the drive member is accessible from outside of the frame.

75. The apparatus of claim 74, in which the drive member is rotatably coupled to an off-center cam and the off-center cam reciprocatingly drives the removable cartridge.

76. The apparatus of claim 74, in which the apparatus has a protected, non-cutting posterior end region for protecting tissue.

77. A distraction element comprising:

a. an elongate body having first and second ends, a top face and a bottom face, a platform slidingly receivable in the top face, the second end including a proximal receiving chamber;

b. an adapator including a first end received into the proximal receiving chamber, a second threaded end, and an adaptor receiving channel disposed therewithin,

wherein the adaptor receiving channel is structured to receive bone sculpting instruments.

78. The distraction element of claim 77 wherein the platform includes a support face having a longitudinal groove for supporting an instrument.

79. The distraction element of claim 77 wherein said platform is spring-loaded, hydraulically powered, or comprises a scissors mechanism.

80. The distraction element of claim 79 in combination with a scribing instrument, the scribing instrument receivable within said cylindrical body receiving channel, the scribe instrument comprising:

a rasp;

a scribe body having an opening for receiving and securing the rasp; and

a cap engageable with said adaptor second threaded end for securing said scribing instrument to said distraction element.

81. The scribing instrument of claim 80 wherein said rasp is operably received in the longitudinal groove.

82. The scribing instrument of claim 80 wherein at least one side of said rasp is serrated.

83. The scribing instrument of claim 82 wherein said rasp is forced against a first bone when said handle is in the second position.

84. The distraction element of claim 79 in combination with a primary bone sculpting tool receivable within said adaptor receiving channel, said primary bone sculpting tool comprising:

a. a motor including a drive shaft;

b. a drive tube engageable with the drive shaft;

c. a collett slidably received in said drive tube; and

d. a sculpting element engageable with said collett.

85. The primary bone sculpting tool of claim 84 wherein said sculpting element is rotatably receivable in said longitudinal groove.

86. The distraction element of claim 79 in combination with a secondary bone sculpting tool receivable within said adaptor receiving channel, said secondary bone sculpting tool comprising:

a. a base;

b. a drive shaft operably connected to said base;

c. a plurality of spline gears operably connected to said drive shaft for receiving torque from said drive shaft; and

d. a plurality of cutting elements connected to said spline gears and rotatable by said spline gears when torque is applied.

87. The secondary bone sculpting tool of claim 86 wherein said plurality of cutting elements are position on opposite sides of a guide element.

88. The secondary bone sculpting tool of claim 87 wherein said guide element is received in a guide surface on a first bone prepared by a primary sculpting tool.

94. The distraction element of claim 79 in combination with a secondary bone sculpting tool receivable within said adaptor receiving channel, said secondary bone sculpting tool comprising:

a. a base;

b. a cam shaft operably connected to said base;

c. a plurality of connecting arms operably connected to said cam shaft for receiving torque from said cam shaft; and

d. a plurality of cutting elements connected to said connecting arms and rotatable by said connecting arms when torque is applied.

95. The distraction element of claim 77 further including a closed-loop control system.

96. The distraction element of claim 95 wherein the closed-loop control system operates under displacement control, load control or combinations thereof.

89. An apparatus for sculpting the articular surface of a first bone in a joint having first and second bones, the apparatus comprising a primary bone-sculpting tool including at least one sculpting element and a base in contact with the second bone, the primary bone-sculpting tool including a parallel distractor for distracting the first bone away from the second bone, said primary bone sculpting tool positioning said at least one sculpting element at a predetermined distance from said base.

90. The primary bone sculpting tool of claim 89 wherein the predetermined distance of sculpting element from base is adjustable.

91. A distraction element comprising:

a. an elongate body having first and second ends, a top face and a bottom face, a spring-loaded platform slidingly receivable in the bottom face, the second end including a proximal receiving chamber;

b. an adapator including a first end received into the proximal receiving chamber, a second threaded end, and an adaptor receiving channel disposed therewithin,

wherein the adaptor receiving channel is structured to receive bone sculpting instruments.

92. The distraction element of claim 91 wherein the top face includes a longitudinal groove for supporting an instrument.

93. The distraction element of claim 91 further comprising a handle in operable engagement with the platform, said handle positionable between a first position in which the platform is in a collapsed position and a second position in which the platform is in a released position.