Surgical Tools for Arthroplasty

• US 20110066193A1
• Filed: 05/11/2010
• Published: 03/17/2011
• Est. Priority Date: 05/25/2001
• Status: Active Grant

• Current Assignee: Conformis Incorporated
• Original Assignee: Conformis Incorporated
• Inventors: Lang, Philipp, Steines, Daniel, Burdulis, Albert G. JR., Bojarski, Raymond A., Vargas-Voracek, Rene, Fitz, Wolfgang
• Granted Patent: US 9,023,050 B2
• Time in Patent Office: Days
• US Class Current: 606/86.R
• 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 surgical tool comprising:

a plurality of components including a first component engaging a second component via an interlock mechanism;

the plurality of components including;

a surface for engaging a joint surface, the surface being a mirror image of the joint surface; and

at least one guide aperture for directing movement of a surgical instrument.

2. The surgical tool according to claim 1, wherein the shape and/or position of the guide aperture is based, at least in part, on one or more axes related to said joint.

3. The surgical tool according to claim 1, wherein the interlock mechanism includes at least one of a screw, a pin, a thread, a ratchet-like mechanism, a hinge-like mechanism, and a press-fit mechanism.

4. The surgical tool according to claim 1, wherein one or more of the plurality of components is at least one of expandable and collapsible.

5. The surgical tool according to claim 4, wherein the one or more of the plurality of components includes a balloon.

6. The surgical tool according to claim 4, wherein the one or more of the plurality of components includes at least one of a hydraulic mechanism, an electronic mechanism, and a mechanical mechanism.

7. The surgical tool according to claim 1, wherein at least one of the plurality of components includes a passageway for inserting a guide wire.

8. The surgical tool according to claim 1, further including an arthroscopic instrument that includes a portal, the plurality of components capable of being deployed through the arthroscopic portal.

9. The surgical tool according to claim 1, wherein the plurality of components includes:

a first template having a first template surface for engaging a first joint surface, the first template surface being a mirror image of the first joint surface; and

a second template having a second template surface for engaging a second joint surface, the second template surface being a mirror image of the second joint surface; and

a linkage for cross-referencing the first template to the second template.

10. The surgical tool according to claim 9, wherein at least one of the first template and the second template includes one or more guide apertures for directing movement of a surgical instrument.

11. The surgical tool according to claim 9, wherein the linkage cross-references the first template to the second template relative to one of an anatomical and a biomechanical axis.

12. The surgical tool according to claim 1, configured to be used in at least one of hip, knee, ankle, shoulder, elbow and wrist.

13. A patellar 3-D guidance tool comprising:

a template, the template including;

at least one contact surface for engaging a surface of the patellar, the at least one contact surface substantially conforming with the surface associated with the patellar; and

at least one guide aperture for directing 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.

14. The tool according to claim 13, wherein the three or more anatomic reference surfaces include at least one of a medial osteochondral junction, a lateral osteochondral junction, an inferior tubercle of the patellar, and the attachment surface of the quadriceps tendon.

15. The tool according to claim 13, wherein the surface associated with the patellar is at least one of an articular cartilage surface and a bone surface.

16. The tool according to claim 13, wherein the template includes a mold.

17. The tool according to claim 13, wherein the template includes at least two components, the at least two pieces including a first component including one or more of the at least one contact surfaces, the second component including one or more of the at least one guide apertures.

18. The tool according to claim 13, wherein the at least one contact surface includes a plurality of discrete contact surfaces.

19. The tool according to claim 13, wherein the shape and/or position of the guide aperture is further based, at least in part, on one or more axes related to said joint.

20. The tool according to claim 13, wherein the guide aperture defines a cut plane that extends through the three or more anatomical reference points when the at least one contact surface engages the surface of the patellar.

21. The tool according to claim 13, wherein the shape and/or position of the guide aperture is further adapted, at least in part, to optimized tracking of the patellar with the femoral trochlea.

22. A patellar template comprising:

a plurality of discrete contact surfaces for engaging an articular surface of the patella, the plurality of contact surfaces substantially conforming with the articular surface of the patella; and

at least one guide for directing movement of a surgical instrument.

23. The template according to claim 22, wherein the template includes sidewalls defining an inner periphery that matches a circumference of the patella.

24. The template according to claim 23, wherein the inner periphery of the sidewall contacts the circumference of the patella and substantially prevents rotation of the patella.

25. The template according to claim 23, wherein the inner periphery of the sidewall contacts a non-articulating circumference of the patella.

26. The template according to claim 23, wherein the at least one guide is positioned on the sidewalls.

27. The template according to claim 23, wherein the sidewalls define a cup-shaped chamber having the inner periphery, an open end for inserting the patella, and a bottom surface that includes the discrete contact surfaces.

28. The template according to claim 22, wherein the plurality of discrete contact points includes at least three spikes.

29. The template according to claim 22, wherein the plurality of contact surfaces are hollow so as to allow passage of at least one of a drill a pin, a marking instrument.

30. The template according to claim 22, wherein at least one of the contact surfaces references subchondral bone.

31. The template according to claim 22, wherein at least one of the contact surfaces references cartilage.

32. The template according to claim 22, wherein the articular surface is at least one of an articular cartilage surface and a bone surface.

33. The template according to claim 22, wherein the at least one guide is positioned relative to the plurality of contact surfaces so as to guide a cut plane through one or more anatomical landmarks on the patella.

35. The template according to claim 22, wherein the guide defines a cut plane that extends through three or more anatomical reference points when the at least one contact surface engages the surface of the patellar.

37. The template according to claim 22, wherein the template includes at least two components, the at least two components including a first component including the plurality of contact surfaces, the second component including one or more of the at least one guides.

38. The template according to claim 22, wherein the shape and/or position of the guide is further based, at least in part, on one or more axes related to said joint.

39. The tool according to claim 22, wherein the shape and/or position of the guide aperture is further adapted, at least in part, to optimized tracking of the patellar with the femoral trochlea.

40. The tool according to claim 22, wherein the guide includes at least one of an aperture and an outer cutting surface.

34. The template according to claim 34, wherein the anatomical landmarks include at least one of a medial junction, a medial osteochondral junction, a lateral junction, a lateral osteochondral junction, an inferior tubercle of the patellar, and the attachment surface of the quadriceps tendon.

36. The template according to claim 34, wherein the anatomical landmarks include at least one of a medial junction, a lateral junction, a medial osteochondral junction, a lateral osteochondral junction, an inferior tubercle of the patellar, and the attachment surface of the quadriceps tendon.

41. A method of preparing a patella using a template, the template including a plurality of discrete contact surfaces for engaging an articular surface of the patella, the plurality of contact surfaces substantially conforming with the articular surface of the patella, the template further comprising at least one guide for directing movement of a surgical instrument, the method comprising:

positioning the template such that the plurality of discrete contact surfaces contact the articular surface of the patella; and

guiding a surgical instrument via the at least one guide so as to modify the patella.

42. The method according to claim 41, wherein the template includes sidewalls that define an inner periphery, the method further comprising:

inserting the patella into the inner periphery such that at least a portion of the inner periphery of the chamber contacts an outer circumference of the patella, and the discrete contact surfaces contact the articulating side of the patella;

marking locations on the patella which engage the contact surfaces;

removing the patella from the inner periphery; and

excising cartilage at the marked locations so as to leave subchondral bone,

wherein positioning the template includes placing the plurality of discrete contacts surfaces in contact with the subchondral bone at the excised locations.

43. The method according to claim 42, wherein the discrete contact surfaces are spikes, and wherein marking locations on the patella includes pushing the spikes into cartilage on the patella.

44. The method according to claim 42, wherein the discrete contact surfaces are hollow spikes, and wherein marking locations on the patella includes:

placing one of a drill and a pin through the hollow spikes to mark locations on the patella.

45. The method according to claim 42, wherein the template is a cup-shaped chamber having the sidewalls that define the inner periphery, an open end for inserting the patella, and a bottom surface that includes the discrete contact surfaces.

46. The method according to claim 41, wherein guiding a surgical instrument via the at least one guide includes performing a cut on the patella.

47. The method according to claim 46, wherein the cut extends through three or more anatomical reference points.

48. The method according to claim 47, wherein the anatomical landmarks include at least one of a medial junction, a lateral junction, a medial osteochondral junction, a lateral osteochondral junction, an inferior tubercle of the patellar, and the attachment surface of the quadriceps tendon.

49. The method according to claim 41, wherein the template includes sidewalls that define an inner periphery, wherein positioning the template includes inserting the patella into the inner periphery such that at least a portion of the inner periphery of the chamber contacts an outer circumference of the patella, and the discrete contact surfaces contact the cartilage on the patella.

50. The method according to claim 49, wherein the template is a cup-shaped chamber having the sidewalls that define the inner periphery, an open end for inserting the patella, and a bottom surface that includes the discrete contact surfaces.

51. The method according to claim 41, further comprising:

obtaining an image of the patella; and

determining the shape, orientation and/or position of at least one of the guides and the plurality of contact surfaces based, at least in part, on the image.

52. The method according to claim 51, wherein obtaining an image includes performing a CT, the method further comprising segmenting bony margins of the patella from the image.

53. The method according to claim 51, wherein obtaining an image includes at least one of MRI, CT, ultrasound, x-ray technology, digital tomosynthesis, and optical coherence tomography.