Methods and compositions for articular repair

• US 7,468,075 B2
• Filed: 11/27/2002
• Issued: 12/23/2008
• Est. Priority Date: 05/25/2001
• Status: Expired due to Term

• Current Assignee: Conformis Incorporated
• Original Assignee: Conformis Incorporated
• Inventors: Lang, Philipp, Steines, Daniel, Tsougarakis, Konstantinos, Timsari, Bijan
• Primary Examiner(s): Philogene; Pedro
• Application Number:
  US10/305,652
• Publication Number:
  US 20030216669A1
• Time in Patent Office: 2,218 Days
• Field of Search: 623/20.14, 623/20.18, 623/23.61, 623/23.76, 623/20.19, 623/20.21, 623/20.31, 623/20.32, 623/20.38, 623/16.11, 623/20.2, 623/20.29, 623/17.16, 623/17.12, 623/18.11, 606/71, 606/88, 606/80, 606/86, 600/587, 128/898
• US Class Current: 623/16.11
• CPC Class Codes: A61B 17/15 Guides therefor arrangements for guiding straight saw blades in general B23D51/025
• 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 17/16 Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans arthroscopic bone cutters A61B17/320016; dental implant drills potentially for other surgical use A61C8/0089; bone grinders A61F2/4644, A22C17/06; A61B17/1662 takes precedence over all other subgroups except A61B17/17
• 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 17/1671 for the spine
• 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 17/1764 for the knee
• CPC Class Codes: A61B 17/7098 wherein the implant is permeable or has openings, e.g. fenestrated screw hollow surgical screws A61B17/864
• CPC Class Codes: A61B 17/8805 for introducing fluid filler into bone or extracting it A61B17/7097, A61B17/8833 take precedence
• 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 2034/256 having a database of accessory information, e.g. including context sensitive help or scientific articles
• CPC Class Codes: A61B 2090/061 for measuring dimensions, e.g. length
• 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 5/4504 : Bones A61B5/4547 takes precedence
• CPC Class Codes: A61B 5/4514 : Cartilage
• CPC Class Codes: A61B 5/4528 : Joints A61B5/4533, A61B5/4538 take precedence
• CPC Class Codes: A61B 6/508 : for non-human patients
• CPC Class Codes: A61F 2/30756 : Cartilage endoprostheses A61F2/3603 takes precedence
• CPC Class Codes: A61F 2/30767 : Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
• CPC Class Codes: A61F 2/30771 : applied in original prostheses, e.g. holes or grooves
• 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 2/36 : Femoral heads ; Femoral endoprostheses
• CPC Class Codes: A61F 2/3859 : Femoral components
• CPC Class Codes: A61F 2/4657 : Measuring instruments used for implanting artificial joints for surgical instruments A61B90/06
• CPC Class Codes: A61F 2002/30062 : (bio)absorbable, biodegradable, bioerodable, (bio)resorbable, resorptive
• CPC Class Codes: A61F 2002/30677 : Means for introducing or releasing pharmaceutical products, e.g. antibiotics, into the body
• CPC Class Codes: A61F 2002/30787 : inclined obliquely with respect to each other
• CPC Class Codes: A61F 2002/30841 : Sharp anchoring protrusions for impaction into the bone, e.g. sharp pins, spikes
• CPC Class Codes: A61F 2002/30894 : inclined obliquely with respect to each other
• CPC Class Codes: A61F 2002/3092 : having an open-celled or open-pored structure
• CPC Class Codes: A61F 2002/30948 : using computerized tomography, i.e. CT scans
• CPC Class Codes: A61F 2002/30957 : using a positive or a negative model, e.g. moulds
• CPC Class Codes: A61F 2002/30962 : using stereolithography
• CPC Class Codes: A61F 2002/3097 : using laser
• CPC Class Codes: A61F 2002/4631 : the prosthesis being specially adapted for being cemented
• CPC Class Codes: A61F 2210/0004 : bioabsorbable
• CPC Class Codes: A61F 2310/00011 : Metals or alloys
• CPC Class Codes: A61F 2310/00017 : Iron- or Fe-based alloys, e.g. stainless steel
• CPC Class Codes: A61F 2310/00023 : Titanium or titanium-based alloys, e.g. Ti-Ni alloys
• CPC Class Codes: A61F 2310/00029 : Cobalt-based alloys, e.g. Co-Cr alloys or Vitallium
• CPC Class Codes: A61F 2310/00047 : Aluminium or Al-based alloys
• CPC Class Codes: A61F 2310/00065 : Manganese or Mn-based alloys
• CPC Class Codes: A61F 2310/00071 : Nickel or Ni-based alloys
• CPC Class Codes: A61F 2310/00077 : Copper or Cu-based alloys
• CPC Class Codes: A61F 2310/00083 : Zinc or Zn-based alloys
• CPC Class Codes: A61F 2310/00107 : Palladium or Pd-based alloys
• CPC Class Codes: A61F 2310/00113 : Silver or Ag-based alloys
• CPC Class Codes: A61F 2310/00119 : Tin or Sn-based alloys
• CPC Class Codes: A61F 2310/00131 : Tantalum or Ta-based alloys
• CPC Class Codes: A61F 2310/00143 : Iridium or Ir-based alloys
• CPC Class Codes: A61F 2310/00149 : Platinum or Pt-based alloys
• CPC Class Codes: A61F 2310/00155 : Gold or Au-based alloys
• CPC Class Codes: A61F 2310/00293 : containing a phosphorus-containing compound, e.g. apatite
• CPC Class Codes: A61F 2310/00383 : Gelatin
• CPC Class Codes: A61F 2310/00395 : Coating or prosthesis-covering structure made of metals or of alloys
• CPC Class Codes: A61F 2310/00592 : Coating or prosthesis-covering structure made of ceramics or of ceramic-like compounds
• CPC Class Codes: B23Q 17/00 : Arrangements for observing, indicating or measuring on machine tools for automatic control or regulation of feed movement, cutting velocity or position of tool or work B23Q15/00
• CPC Class Codes: B33Y 80/00 : Products made by additive manufacturing
• CPC Class Codes: Y10T 29/49 : Method of mechanical manufacture
• CPC Class Codes: Y10T 29/49764 : with testing or indicating
• CPC Class Codes: Y10T 29/49778 : with aligning, guiding, or instruction

Abstract

Disclosed herein are methods and compositions for producing articular repair materials and for repairing an articular surface. In particular, methods for providing articular repair systems. Also provided are articular surface repair systems designed to replace a selected area cartilage, for example, and surgical tools for repairing articular surfaces.

Claims

1. A method of selecting an articular implant for repairing an articular surface having diseased articular cartilage, the articular implant having an inner surface for facing bone and an outer surface for facing a cavity of a joint, the method comprising:

obtaining an image of a joint, wherein the image includes subchondral bone;

deriving a shape of the subchondral bone from the image;

determining a desired shape for the outer surface of the articular implant from, at least in part, the derived shape of the subchondral bone;

selecting the articular implant from a library of implants, such that the outer surface of the articular implant substantially matches the desired shape, and the inner surface of the articular implant substantially fits to the derived shape of the subchondral bone, wherein the articular implant includes an attachment mechanism for fixing the articular implant to the joint.

2. The method according to claim 1, further comprising preparing an implantation site such that there is substantially no subchondral bone loss except to accommodate the attachment mechanism.

3. The method according to claim 2, further comprising implanting the articular implant at the implantation site.

4. The method according to claim 1, wherein the image is selected from the group consisting of MRI, CT, ultrasound, digital tomosynthesis, optical coherence tomography and combinations thereof.

5. The method according to claim 1, wherein the imaging is non-intrusive.

6. The method according to claim 1, wherein the reconstruction comprises obtaining a parametric surface that follows the contour of the normal cartilage, the parametric surface comprising control points that extend the contour of the normal cartilage to the diseased cartilage.

7. The method according to claim 6, wherein the parametric surface comprises a B-spline surface.

8. The method according to claim 1, wherein the reconstruction comprises obtaining a binary image of cartilage by extracting cartilage from the image, wherein diseased cartilage appears as indentations in the binary image;

and performing a morphological closing operation to determine the shape of an implant to fill the areas of diseased cartilage.

9. The method according to claim 8, wherein the morphological closing operation is performed in two or three-dimensions using a structuring element.

10. The method according to claim 8, wherein the morphological closing operation comprises a dilation followed by an erosion.

11. The method of claim 1, wherein the shape of the subchondral bone derived from the image is located underneath the diseased articular cartilage.

12. The method of claim 1, further comprising:

deriving a shape of articular tissue surrounding or adjacent the diseased articular cartilage, wherein determining the desired shape of the outer surface of the implant is further based, at least in part, on the derived shape of the surrounding or adjacent articular tissue.

13. The method of claim 1, wherein the outer surface of the articular implant is derived, at least in part, based on subchondral bone underlying the diseased cartilage and surrounding or adjacent articular tissue.

14. A method of designing an articular implant for attaching to a joint, the articular implant for repairing an articular surface having diseased articular cartilage, the articular implant having an inner surface for facing bone and an outer surface for facing a cavity of a joint, the method comprising:

non-invasively obtaining an image of a joint, wherein the image includes subchondral bone;

deriving a shape of the subchondral bone from the image;

determining a desired shape of the outer surface of the articular implant from, at least in part, the derived shape of the subchondral bone; and

designing the articular implant such that the outer surface of the articular implant substantially matches the desired shape, and the inner surface of the articular implant substantially fits to the derived shape of the subchondral bone, wherein the articular implant includes an attachment mechanism for fixing the articular implant to the joint.

15. The method according to claim 14, wherein the image is selected from the group consisting of MRI, CT, ultrasound, digital tomosynthesis, optical coherence tomography and combinations thereof.

16. The method of claim 14, wherein the shape of the subchondral bone derived from the image is located underneath the diseased articular cartilage.

17. The method of claim 14, further comprising:

deriving a shape of articular tissue surrounding or adjacent the diseased articular cartilage age, wherein determining the desired shape of the outer surface of the implant is further based, at least in part, on the derived shape of the surrounding or adjacent articular tissue.

18. The method of claim 14, wherein the outer surface of the articular implant is derived, at least in part, based on subchondral bone underlying the diseased cartilage and surrounding or adjacent articular tissue.

19. A method of designing or selecting an articular implant for repairing articular cartilage of a joint, the articular implant having an inner surface for facing bone and an outer surface for facing a cavity of a joint, the method including:

obtaining an image of a joint, the image including shape information of the subchondral bone;

deriving the shape of the subchondral bone from the image;

designing or selecting the articular implant with both the inner and the outer surface of the implant based, at least in part, on the derived shape, wherein the articular implant includes an attachment mechanism for fixing the articular implant to the joint.

20. The method according to claim 19, wherein obtaining an image of the joint imaging is non-invasive.

21. The method according to claim 19, further comprising preparing an implantation site.

22. The method according to claim 21, wherein preparing the implantation site includes substantially no subchondral bone loss.

23. The method according to claim 21, wherein preparing the implantation site includes substantially no subchondral bone loss except to accommodate the attachment mechanism.

24. The method according to claim 23, wherein the attachment mechanism is at least one of a peg, a stem, and an anchor for extending into the subchondral bone.

25. The method according to claim 21, wherein the implantation site is located in one of a femoral condyle, a tibial plateau, a femoral head, an acetabulum, a shoulder, elbow, wrist, hand, ankle and foot joint.

26. The method according to claim 19, wherein the shape information includes curvature of the subchondral bone.

27. A method of selecting an articular implant for resurfacing articular cartilage attached to underlying subchondral bone in a joint, the articular implant having an inner surface for facing bone and an outer surface for facing a cavity of a joint, the method comprising:

determining shape information of subchondral bone associated with the joint;

deriving a desired shape of the outer surface of the articular implant from, at least in part, the determined shape of the subchondral bone;

selecting the articular implant from a library of implants with the outer surface of the implant based, at least in part, on the desired shape and the inner surface of the articular implant substantially fitting to the determined shape of the subchondral bone, wherein the articular implant includes an attachment mechanism for fixing the articular implant to the joint.

28. The method according to claim 27, further comprising preparing an implantation site such that there is substantially no subchondral bone loss except to accommodate the attachment mechanism.

29. The method according to claim 28, further comprising implanting the articular implant at the implantation site, such that the articular implant rests on subchondral bone.

30. The method according to claim 28, wherein the implantation site is located in one of a femoral condyle, a tibial plateau, a femoral head, an acetabulum, a shoulder, elbow, wrist, hand, ankle and foot joint.

31. A method of designing an articular implant for resurfacing articular cartilage attached to underlying subchondral bone in a joint, the articular cartilage including a diseased articular cartilage surface, the articular implant having an inner surface for facing bone and an outer surface for facing a cavity of a joint, the method comprising:

determining shape information of subchondral bone associated with the joint;

deriving a desired shape of the outer surface surface of the articular implant from, at least in part, the determined shape of the subchondral bone; and

designing the articular implant with the outer surface of the implant based, at least in part, on the desired shape and the inner surface of the articular implant substantially fitting to the determined shape of the subchondral bone, wherein the articular implant includes an attachment mechanism for fixing the articular implant to the joint.

32. The method according to claim 31, further comprising preparing an implantation site such that there is substantially no subchondral bone loss except to accommodate the attachment mechanism.

33. The method according to claim 32, further comprising implanting the articular implant at the implantation site, such that the articular implant rests on subchondral bone.

34. The method according to claim 32, wherein the implantation site is located in one of a femoral condyle, a tibial plateau, a femoral head, an acetabulum, a shoulder, elbow, wrist, hand, ankle and foot joint.