Knee arthroplasty method

• US 7,806,896 B1
• Filed: 11/25/2003
• Issued: 10/05/2010
• Est. Priority Date: 01/14/2000
• Status: Expired due to Fees

• Current Assignee: Bonutti Skeletal Innovations LLC (Acacia Research Corporation)
• Original Assignee: MarcTec LLC
• Inventors: Bonutti, Peter M.
• Primary Examiner(s): Philogene, Pedro
• Application Number:
  US10/722,102
• Time in Patent Office: 2,506 Days
• Field of Search: 606/80, 606/82, 606/86, 606/87, 606/88, 606/89, 606/86.R, 623/20.14, 623/16.11, 623/18.11
• US Class Current: 606/86.00R
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• 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 17/1604 Chisels; Rongeurs; Punches; Stamps
• 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 17/1703 using imaging means, e.g. by X-rays
• CPC Class Codes: A61B 17/1717 for applying intramedullary nails or pins
• CPC Class Codes: A61B 17/1721 for applying pins along or parallel to the axis of the femoral neck
• CPC Class Codes: A61B 17/1746 for the acetabulum
• CPC Class Codes: A61B 17/1764 for the knee
• CPC Class Codes: A61B 17/809 with bone-penetrating elements, e.g. blades or prongs bone staples A61B17/0642; intramedullary nails with a plate at an end A61B17/7233
• CPC Class Codes: A61B 17/8095 Wedge osteotomy devices
• CPC Class Codes: A61B 2017/00004 (bio)absorbable, (bio)resorbable, resorptive for implantable prostheses A61F2210/0004
• 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 2017/564 : Methods for bone or joint treatment
• 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 2034/107 : Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/2055 : Optical tracking systems
• CPC Class Codes: A61B 2046/201 : for extremities, e.g. having collection pouch
• CPC Class Codes: A61B 2046/205 : Adhesive drapes
• CPC Class Codes: A61B 2046/236 : with means for collecting drain fluid, e.g. drain tubes
• CPC Class Codes: A61B 2090/064 : for measuring force, pressure or mechanical tension
• CPC Class Codes: A61B 2090/366 : using projection of images directly onto the body
• CPC Class Codes: A61B 2090/376 : using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2217/005 : with suction drainage system
• CPC Class Codes: A61B 2217/007 : with irrigation system
• 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 34/30 : Surgical robots
• CPC Class Codes: A61B 42/00 : Surgical gloves; Finger-stalls specially adapted for surgery; Devices for handling or treatment thereof
• CPC Class Codes: A61B 46/00 : Surgical drapes
• CPC Class Codes: A61B 90/13 : guided by light, e.g. laser pointers
• CPC Class Codes: A61B 90/30 : Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
• CPC Class Codes: A61B 90/361 : Image-producing devices, e.g. surgical cameras
• CPC Class Codes: A61B 90/37 : Surgical systems with images on a monitor during operation
• CPC Class Codes: A61F 2/0077 : Special surfaces of prostheses, e.g. for improving ingrowth A61F2/30767 takes precedence
• CPC Class Codes: A61F 2/30721 : Accessories
• CPC Class Codes: A61F 2/30724 : Spacers for centering an implant in a bone cavity, e.g. in a cement-receiving cavity
• 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 2/34 : Acetabular cups
• CPC Class Codes: A61F 2/38 : for elbows or knees
• CPC Class Codes: A61F 2/3836 : Special connection between upper and lower leg, e.g. constrained
• CPC Class Codes: A61F 2/3859 : Femoral components
• CPC Class Codes: A61F 2/3868 : with sliding tibial bearing
• CPC Class Codes: A61F 2/3872 : Meniscus for implantation between the natural bone surfaces
• CPC Class Codes: A61F 2/3877 : Patellae or trochleae
• CPC Class Codes: A61F 2/389 : Tibial components A61F2/3868 takes precedence
• CPC Class Codes: A61F 2/4609 : of acetabular cups
• CPC Class Codes: A61F 2/461 : of knees
• CPC Class Codes: A61F 2/4684 : Trial or dummy prostheses
• CPC Class Codes: A61F 2002/2817 : Bone stimulation by chemical reactions or by osteogenic or biological products for enhancing ossification, e.g. by bone morphogenetic or morphogenic proteins [BMP] or by transforming growth factors [TGF]
• CPC Class Codes: A61F 2002/2825 : Femur
• CPC Class Codes: A61F 2002/2835 : Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
• CPC Class Codes: A61F 2002/30079 : magnetic
• CPC Class Codes: A61F 2002/30326 : differing in height or in length
• CPC Class Codes: A61F 2002/30331 : made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
• CPC Class Codes: A61F 2002/30364 : Rotation about the common longitudinal axis
• CPC Class Codes: A61F 2002/30387 : Dovetail connection
• CPC Class Codes: A61F 2002/30398 : Sliding
• CPC Class Codes: A61F 2002/30433 : using additional screws, bolts, dowels, rivets or washers e.g. connecting screws
• CPC Class Codes: A61F 2002/30507 : using a threaded locking member, e.g. a locking screw or a set screw
• CPC Class Codes: A61F 2002/30761 : Support means for artificial cartilage, e.g. cartilage defect covering membranes
• CPC Class Codes: A61F 2002/30883 : dovetail-shaped
• CPC Class Codes: A61F 2002/30892 : parallel
• CPC Class Codes: A61F 2002/3092 : having an open-celled or open-pored structure
• CPC Class Codes: A61F 2002/30934 : Special articulating surfaces
• CPC Class Codes: A61F 2002/30975 : made of two halves
• CPC Class Codes: A61F 2002/3401 : with radial apertures, e.g. radial bores for receiving fixation screws
• CPC Class Codes: A61F 2002/3403 : Polar aperture
• CPC Class Codes: A61F 2002/3895 : unicompartimental
• CPC Class Codes: A61F 2002/4631 : the prosthesis being specially adapted for being cemented
• CPC Class Codes: A61F 2002/4635 : using minimally invasive surgery
• CPC Class Codes: A61F 2002/4677 : using a guide wire
• CPC Class Codes: A61F 2210/009 : magnetic
• CPC Class Codes: A61F 2220/0025 : Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
• CPC Class Codes: A61F 2220/0033 : made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
• CPC Class Codes: A61F 2220/0041 : using additional screws, bolts, dowels or rivets, e.g. connecting screws
• CPC Class Codes: A61F 2250/0037 : differing in height or in length
• 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 2310/00131 : Tantalum or Ta-based alloys
• CPC Class Codes: A61F 2310/00365 : Proteins; Polypeptides; Degradation products thereof
• CPC Class Codes: A61G 13/0045 : specially adapted for hand or wrist surgeries
• CPC Class Codes: A61G 13/0054 : specially adapted for back or spinal surgeries
• CPC Class Codes: A61G 13/0063 : specially adapted for knee surgeries
• CPC Class Codes: A61G 13/0072 : specially adapted for shoulder surgeries
• CPC Class Codes: A61G 13/0081 : specially adapted for hip surgeries
• CPC Class Codes: A61G 13/1245 : Knees, upper or lower legs
• CPC Class Codes: A61G 13/125 : Ankles or feet

Abstract

An improved method of performing surgery on a joint in a patient'"'"'s body, such as a knee, includes making an incision in a knee portion of one leg while a lower portion of the one leg is extending downward from an upper portion of the one leg and while a foot connected with the lower portion of the one leg is below a support surface on which the patient is disposed. The incision is relatively short, for example, between seven and thirteen centimeters. A patella may be offset from its normal position with an inner side of the patella facing inward during cutting of a bone with a cutting tool. During cutting of the bone, one or more guide members having opposite ends which are spaced apart by a distance less than the width of an implant may be utilized to guide movement of a cutting tool.

Claims

1. A method of replacing at least a portion of a patient'"'"'s knee, the method comprising the steps of:

making an incision in a knee portion of a leg of the patient;

determining a position of a cutting guide using references derived independently from an intramedullary device;

positioning a cutting guide using the determined position, passing the cutting guide through the incision and on a surface of a distal end portion of an unresected femur, the cutting guide secured to the bone free of an extramedullary or intramedullary alignment rod;

moving a cutting tool through the incision into engagement with a guide surface on the cutting guide; and

forming at least an initial cut on the femur by moving the cutting tool along the guide surface;

attaching a replacement portion of the knee to the cut surface, the replacement portion having a transverse dimension that is larger than a transverse dimension of the guide surface.

2. The method of claim 1 wherein the surface is a medial or lateral side of the distal end portion of the femur.

3. The method of claim 1 wherein a computer navigation system is used in the determining step.

4. The method of claim 1 wherein the positioning step includes removably attaching the cutting guide to the side surface of the distal end portion of the femur.

5. The method of claim 4 wherein the cutting guide is removably attached with first and second pins extending through holes in the cutting guide and into the femur.

6. The method of claim 1 wherein the guide surface comprises a plurality of straight guide segments.

7. The method of claim 6 wherein the plurality of straight guide segments comprises:

a distal guide segment disposed in a plane which extends perpendicular to a longitudinal central axis of the femur and extends through lateral and medial condyles of the femur;

an anterior chamfer guide segment disposed in a plane which extends at an acute angle to a plane containing the distal guide surface;

a posterior chamfer guide segment disposed in a plane which extends at an acute angle to a plane containing the distal guide surface, the plane containing the posterior chamfer guide surface extending perpendicular to the plane containing the anterior chamfer guide surface;

an anterior guide segment disposed in a plane which extends perpendicular to a plane containing the distal guide surface and extends generally parallel to a longitudinal central axis of the femur; and

a posterior guide surface disposed in a plane which extends parallel to a plane containing the anterior guide surface and perpendicular to a plane containing the distal guide surface.

8. The method of claim 1 wherein said step of cutting the femur includes utilizing the guide surface on the cutting guide to guide the cutting tool during making of an initial portion of a cut in the femur, and completing the cut in the femur while guiding the cutting tool with a surface formed during making of the initial portion of the cut in the femur.

9. The method of claim 8 wherein the cutting guide is removed from a side surface of the distal end portion of the femur after making the initial portion of the cut and before completion of the cut.

10. The method of claim 1, wherein in said step of making an incision, said incision is offset from the center of said knee area.

11. The method of claim 1, wherein the determining step includes adjusting the determined position to correct a deformity of the joint.

12. The method of claim 1, wherein the portion of a patient'"'"'s knee replaced is at least a portion of an articulating surface of the joint.

13. A method of replacing at least a portion of a joint in a patient, the method comprising the steps of:

obtaining a customized cutting guide fabricated for the patient based on preoperative information, the cutting guide positionable in a pre-determined position on a bone of the joint using references derived independently from an intramedullary device;

making an incision adjacent to the joint in the patient;

positioning the cutting guide in the pre-determined position by passing the cutting guide through the incision and on a surface of an end portion of an unresected bone of the joint;

moving a cutting tool through the incision into engagement with a guide surface on the positioned cutting guide;

cutting the unresected bone of the joint for the first time, by moving the cutting tool along the guide surface;

attaching a replacement portion of the knee to the cut surface, the replacement portion having a transverse dimension that is larger than a transverse dimension of the guide surface; and

disposing of the cutting guide, as it is no longer safely usable the bone for which it was custom fabricated having been cut and therefore changed.

14. The method of claim 13 wherein the side surface is a medial or lateral side of the end portion of the first bone.

15. The method of claim 13 wherein the positioning step includes removably attaching the cutting guide to the side surface of the end portion of the first bone.

16. The method of claim 15 wherein the cutting guide is removably attached with first and second pins extending through holes in the cutting guide and into the first bone.

17. The method of claim 13 wherein the guide surface comprises a plurality of straight guide segments.

18. The method of claim 17 wherein the plurality of straight guide segments comprises:

a distal guide segment disposed in a plane which extends perpendicular to a longitudinal central axis of the first bone;

an anterior chamfer guide segment disposed in a plane which extends at an acute angle to a plane containing the distal guide surface;

a posterior chamfer guide segment disposed in a plane which extends at an acute angle to a plane containing the distal guide surface, the plane containing the posterior chamfer guide surface extending perpendicular to the plane containing the anterior chamfer guide surface;

an anterior guide segment disposed in a plane which extends perpendicular to a plane containing the distal guide surface and extends generally parallel to a longitudinal central axis of the first bone; and

a posterior guide surface disposed in a plane which extends parallel to a plane containing the anterior guide surface and perpendicular to a plane containing the distal guide surface.

19. The method of claim 13 wherein said step of cutting the first bone includes utilizing the guide surface on the cutting guide to guide the cutting tool during making of an initial portion of a cut in the first bone, and completing the cut in the first bone while guiding the cutting tool with a surface formed during making of the initial portion of the cut in the first bone.

20. The method of claim 19 wherein the cutting guide is positioned on the side surface of the end portion of the first bone during completion of the cut.

21. The method of claim 20 wherein the cutting guide is removed from the side surface of the end portion of the first bone after making the initial portion of the cut and before completion of the cut.

22. The method of claim 13, wherein after said step of cutting, further including the steps of:

removing said cutting guide; and

,

guiding said cutting tool using cuts formed in said cutting step to complete said cuts.

23. The method of claim 13, wherein in said step of positioning, said cutting guide is sized smaller than said side surface.

24. The method of claim 13, wherein after said step of positioning, further including the step of:

aligning said cutting guide using markings on said side surface.

25. A method of replacing at least a portion of a patient'"'"'s knee, the method comprising the steps of:

making an incision in a knee portion of a leg of the patient;

expanding the incision from an unexpanded configuration to an expanded configuration by applying force against opposite edge portions of the incision;

determining a position of a cutting guide using references derived independently from an intramedullary device;

positioning a cutting guide using the determined position, passing the cutting guide through the expanded incision and on a surface of a distal end portion of an unresected bone, the cutting guide secured to the bone free of an extramedullary or intramedullary alignment rod, the cutting guide sized to be received in the expanded configuration;

moving a cutting tool through the incision into engagement with a guide surface on the cutting guide; and

forming at least an initial cut on the bone by moving the cutting tool along the guide surface;

attaching a replacement portion of the knee to the cut surface, the replacement portion having a transverse dimension that is larger than a transverse dimension of the guide surface.

26. The method of claim 25, wherein the cutting guide is customized to a patient'"'"'s bone, and further including the step of disposing of the cutting guide, as the cutting guide is no longer useful as the bone for which it has been customized has been cut and thereby changed.

27. The method of claim 25, wherein the cutting guide is fabricated from a plurality of cutting guide parts, and further including the step of disposing of at least one of said plurality of cutting guide parts.

28. The method of claim 25, wherein the replacement portion of the knee is attached without dislocating the knee joint.

29. The method of claim 25, wherein the bone is cut with a mill.

30. The method of claim 25, wherein the bone is cut using a robotic arm.

31. The method of claim 25, wherein in said forming step, a recess is formed in the bone, and in said attaching step, at least a part of the replacement portion is inlaid into the recess.

32. The method of claim 25, wherein the replacement portion of the knee includes a plurality of segments having an articulating surface.

33. The method of claim 25, further including the step of inserting a guide wire in bone of the knee, and wherein the replacement portion of the knee is provided with an opening through which the guide wire is passed.

34. The method of claim 25, wherein the guide surface operates to capture the cutting tool within a slot.

35. The method of claim 25, wherein at least a portion of the cutting guide is polymeric.

36. The method of claim 25, wherein in carrying out the method, the quadriceps mechanism is not cut.

37. The method of claim 25, wherein in carrying out the method, the articulating surface of the patella is maintained facing the femur.

38. The method of claim 25, further including the step of unpacking a sterile package containing only one cutting guide.

39. The method of claim 25, further including the step of unpacking a sterile package containing only one each of a cutting guide and a replacement portion of the knee.

40. A method of replacing at least a portion of a joint in a patient, the method comprising the steps of:

obtaining an alignment guide positionable on a bone using references derived independently of an intramedullary device, wherein the alignment guide is custom fabricated for the patient based on patient imaging information;

positioning the alignment guide in relation to the surface of an unresected bone of the joint;

referencing a cutting guide with respect to the alignment guide; and

cutting the unresected bone of the joint for the first time, by moving a cutting tool along a guide surface of the cutting guide.

41. The method of claim 40, wherein the joint is a knee joint and a total knee replacement is performed.

42. The method of claim 40, wherein referencing the cutting guide includes positioning a pin into the bone to secure the cutting guide to the bone and wherein the pin position is determined by the alignment guide.

43. The method of claim 40, wherein the guide surface has a width less than the width of the cut portion of the bone.

44. The method of claim 40, wherein the joint is selected from the group consisting of:

finger, wrist, elbow, shoulder, spine, hip, knee, ankle, toe.

45. The method of claim 40, wherein at least a portion of the articulating surface of the joint is replaced within the cut bone.

46. The method of claim 45, wherein the at least a portion of the articulating surface is replaced with a material selected from the group consisting of:

biological, metal, composite, polymeric, ceramic, metal/ceramic, metal/polymer, polymer/ceramic, polymer/polymer, ceramic/ceramic, and ceramic/composite.

47. The method of claim 40, wherein the joint has a plurality of articulating surface compartments, and at least a portion of the articulating surface is not replaced in all articulating surface compartments.

48. The method of claim 40, wherein the cutting guide or the alignment guide is passed into the body through a cannula.