Surgical tools facilitating increased accuracy, speed and simplicity in performing joint arthroplasty

• US 8,122,582 B2
• Filed: 01/28/2009
• Issued: 02/28/2012
• Est. Priority Date: 05/25/2001
• Status: Expired due to Term

• Current Assignee: Conformis Incorporated
• Original Assignee: Conformis Incorporated
• Inventors: Burdulis, Albert G. Jr., Fitz, Wolfgang, Vargas-Voracek, Rene, Lang, Philipp, Steines, Daniel, Tsougarakis, Konstantinos
• Primary Examiner(s): Philogene, Pedro
• Application Number:
  US12/361,213
• Publication Number:
  US 20090307893A1
• Time in Patent Office: 1,126 Days
• Field of Search: 623/901, 623/14.12, 623/20.3, 623/20.31, 623/20.35, 623/20.32, 600/410, 600/427, 600/407, 606/96, 606/86.R, 606/86.A, 606/87, 606/88, 606/79, 295/271, 295/57
• US Class Current: 29/527.1
• 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 17/1677 for the patella
• CPC Class Codes: A61B 17/1767 for the patella
• CPC Class Codes: A61B 2017/0023 disposable
• CPC Class Codes: A61B 2017/568 produced with shape and dimensions specific for an individual patient
• 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: Y10T 29/49 Method of mechanical manufacture
• CPC Class Codes: Y10T 29/4998 Combined manufacture including applying or shaping of fluent material
• CPC Class Codes: Y10T 29/49995 Shaping one-piece blank by removing material

Abstract

Disclosed herein are tools for repairing articular surfaces repair materials and for repairing an articular surface. The surgical tools are designed to be customizable or highly selectable by patient to increase the speed, accuracy and simplicity of performing total or partial arthroplasty.

Claims

1. A patient-specific surgical tool for use in surgery on a knee joint of a patient, comprising:

a block having a patient-specific surface and a guide;

the patient-specific surface having at least a portion that is substantially a negative shape of a corresponding portion of a diseased or damaged articular surface of a tibial plateau of the knee joint of the patient; and

the guide having a shape to accommodate a cutting or drilling tool and having a predetermined position and orientation relative to the patient-specific surface such that, when the patient-specific surface is placed against and aligned with the corresponding portion of the diseased or damaged articular surface, the guide defines a cutting or drilling path extending through at least a portion of the proximal end of the tibia and having a predetermined alignment relative to a predetermined tibial slope of the patient in a sagittal plane.

2. The patient-specific surgical tool of claim 1, wherein the negative shape of the corresponding portion of the diseased or damaged articular surface follows at least a portion of a cartilage surface of the joint.

3. The patient-specific surgical tool of claim 1, wherein the negative shape of the corresponding portion of the diseased or damaged articular surface follows at least a portion of a surface of subchondral bone of the joint.

4. The patient-specific surgical tool of claim 1, wherein the negative shape of the corresponding portion of the diseased or damaged articular surface follows at least a portion of a cartilage surface portion and at least a portion of a subchondral bone surface portion of the joint.

5. The patient-specific surgical tool of claim 1, wherein the patient-specific surface further comprises a first reference portion that is substantially a negative shape of at least a portion of a medial tibial plateau of the joint and a second reference portion that is substantially a negative shape of a lateral tibial plateau of the joint.

6. The patient-specific surgical tool of claim 1, wherein the patient-specific surface is a first patient specific surface, the block further comprising a second patient specific surface, wherein the second patient-specific surface is substantially a negative surface of a non-articulating surface of the bone.

7. The patient-specific surgical tool of claim 1, wherein, when the patient-specific surface is aligned with the corresponding diseased or damaged articular surface of the joint, the guide is aligned along a plane through the tibia to provide a cutting or drilling path for the cutting or drilling tool at a predetermined distance from the tibial plateau.

8. The patient-specific surgical tool of claim 7, wherein the predetermined distance is relative to a cartilage surface of the tibial plateau.

9. The patient-specific surgical tool of claim 1, wherein the block further comprises an attachment mechanism.

10. The patient-specific surgical tool of claim 1, further comprising a surgical device for use with the block and connectable to the block by the attachment mechanism.

11. The patient-specific surgical tool of claim 1, wherein the tool is comprised of multiple components.

12. The patient-specific surgical tool of claim 1, wherein the block containing the patient-specific surface and the guide are comprised of a single component.

13. The patient-specific surgical tool of claim 1, wherein the predetermined alignment includes a predetermined slope between 0 and 7 degrees.

14. The patient-specific surgical tool of claim 1, wherein the predetermined alignment includes a predetermined slope that substantially matches the normal slope of the tibial plateau.

15. The patient-specific surgical tool of claim 1, wherein the cutting or drilling path is substantially parallel to the slope of the tibial plateau of the joint.

16. The patient-specific surgical tool of claim 1, wherein the guide includes a stop to control the depth of the cutting or drilling tool.

17. The patient-specific surgical tool of claim 16, wherein the stop is a drill stop or a blade stop.

18. A surgical tool set for performing surgery on a knee joint of a patient, the set comprising the patient-specific surgical tool of claim 1 utilized to align and define a first cutting or drilling path, and

a second surgical tool comprising at least one of a spacer, a hinge and a ratchet-like device, the second surgical tool utilizing a surface of the first cutting or drilling path to align and define a second cutting or drilling path across a bone of the knee joint, the second cutting or drilling path optimized for ligament balancing of the knee joint.

19. The surgical tool set of claim 18, wherein the second surgical tool aligns and defines the second cutting or drilling path to optimize the second cutting or drilling path for addressing a flexion gap in the knee joint.

20. The surgical tool set of claim 18, wherein the second surgical tool aligns and defines the second cutting or drilling path to optimize the second cutting or drilling path for addressing an extension gap in the knee joint.

21. A surgical tool set for performing surgery on a knee joint of a patient, the set comprising the patient-specific surgical tool of claim 18 utilized to align and define a first cutting path, and

a second surgical tool comprising at least one of a spacer, a hinge and a ratchet-like device, the second surgical tool utilizing a surface of the first cutting path to align and define a second cutting or drilling path across a bone of the knee joint, the second cutting or drilling path optimized for ligament balancing of the knee joint.

22. The surgical tool set of claim 21, wherein the second surgical tool aligns and defines the second cutting or drilling path to optimize the second cutting or drilling path for addressing a flexion gap in the knee joint.

23. The surgical tool set of claim 21, wherein the second surgical tool aligns and defines the second cutting or drilling path to optimize the second cutting or drilling path for addressing an extension gap in the knee joint.

24. A patient-specific surgical tool for use in surgery on a knee joint of a patient, comprising:

a block having a patient-specific surface and a guide;

the patient-specific surface having at least a portion that is substantially a negative shape of a corresponding portion of a diseased or damaged articular surface of a tibial plateau of the knee joint of the patient,

wherein at least a portion of the corresponding portion includes a cartilage surface; and

the guide having a shape to accommodate a cutting or drilling tool and having a predetermined position and orientation relative to the patient-specific surface such that, when the patient-specific surface is placed against and aligned with the corresponding portion of the diseased or damaged articular surface, the guide defines a cutting or drilling path extending through at least a portion of the proximal end of the tibia and having a predetermined alignment relative to the patient-specific surface to define a predetermined tibial slope of the patient in a sagittal plane.

25. The patient-specific surgical tool of claim 24, wherein the negative shape of the corresponding portion of the diseased or damaged articular surface follows at least a portion of a surface of subchondral bone of the joint.

26. The patient-specific surgical tool of claim 24, wherein the patient-specific surface further comprises a first reference portion that is substantially a negative shape of at least a portion of a medial tibial plateau of the joint and a second reference portion that is substantially a negative shape of a lateral tibial plateau of the joint.

27. The patient-specific surgical tool of claim 24, wherein the patient-specific surface is a first patient specific surface, the block further comprising a second patient-specific surface, wherein the second patient-specific surface is substantially a negative surface of a non-articulating surface of the bone.

28. The patient-specific surgical tool of claim 24, wherein, when the patient-specific surface is aligned with the corresponding portion of the diseased or damaged articular surface of the joint, the guide is aligned along a plane through the tibia to provide a cutting or drilling path for the cutting or drilling tool at a predetermined distance from the tibial plateau.

29. The patient-specific surgical tool of claim 28, wherein the predetermined distance is relative to a cartilage surface of the tibial plateau.

30. The patient-specific surgical tool of claim 24, wherein the block further comprises an attachment mechanism.

31. The patient-specific surgical tool of claim 30, further comprising a surgical device for use with the block and connectable to the block by the attachment mechanism.

32. The patient-specific surgical tool of claim 24, wherein the tool is comprised of multiple components.

33. The patient-specific surgical tool of claim 24, wherein the block containing the patient-specific surface and the guide are comprised of a single component.

34. The patient-specific surgical tool of claim 24, wherein the predetermined alignment includes a predetermined slope between 0 and 7 degrees.

35. The patient-specific surgical tool of claim 24, wherein the predetermined alignment includes a predetermined slope that substantially matches the normal slope of the tibial plateau.

36. The patient-specific surgical tool of claim 24, wherein the cutting or drilling path is substantially parallel to the slope of the tibial plateau of the joint.

37. The patient-specific surgical tool of claim 24, wherein the guide includes a stop to control the depth of the cutting or drilling tool.

38. The patient-specific surgical tool of claim 37, wherein the stop is a drill stop or a blade stop.

39. A surgical tool set for performing surgery on a knee joint of a patient, the set comprising the patient-specific surgical tool of claim 24 utilized to align and define a first cutting or drilling path, and

a second surgical tool comprising at least one of a spacer, a hinge and a ratchet-like device, the second surgical tool utilizing a surface of the first cutting or drilling path to align and define a second cutting or drilling path across a bone of the knee joint, the second cutting or drilling path optimized for ligament balancing of the knee joint.

40. The surgical tool set of claim 39, wherein the second surgical tool aligns and defines the second cutting or drilling path to optimize the second cutting or drilling path for addressing a flexion gap in the knee joint.

41. The surgical tool set of claim 39, wherein the second surgical tool aligns and defines the second cutting or drilling path to optimize the second cutting or drilling path for addressing an extension gap in the knee joint.

42. A patient-specific surgical tool for surgery on a tibia of a patient, comprising:

a block having a patient-specific surface and a guide;

the patient-specific surface having at least a portion that is substantially a negative shape of a bone surface proximate to a knee joint of the patient and a second portion that is substantially a negative shape of a corresponding portion of a diseased or damaged articular surface; and

the guide being sized to accommodate a cutting or drilling tool and having a predetermined position and orientation relative to the patient-specific surface such that, when the patient-specific surface is placed against and aligned with the bone surface, the guide defines a cutting or drilling path having a predetermined alignment relative to a predetermined tibial slope of the patient in at least one of a sagittal plane and a coronal plane.

43. The patient-specific surgical tool of claim 42, wherein the negative shape of at least a portion of the bone surface follows at least a portion of a cartilage surface of the joint.

44. The patient-specific surgical tool of claim 42, wherein the negative shape of at least a portion of the bone surface follows at least a portion of a surface of subchondral bone of the joint.

45. The patient-specific surgical tool of claim 42, wherein the negative shape of at least a portion of the bone surface follows at least a portion of a cartilage surface portion and at least a portion of a subchondral bone surface portion of the joint.

46. The patient-specific surgical tool of claim 42, wherein the patient-specific surface further comprises a first reference portion that is substantially a negative shape of at least a portion of a medial tibial plateau of the joint and a second reference portion that is substantially a negative shape of a lateral tibial plateau of the joint.

47. The patient-specific surgical tool of claim 42, wherein the patient-specific surface is a first patient specific surface, the block further comprising a second patient- specific surface, wherein the second patient-specific surface is substantially a negative surface of a non-articulating surface of the bone.

48. patient-specific surgical tool of claim 42, wherein, when the patient-specific surface is aligned with the corresponding bone surface of the joint, the guide is aligned along a plane through the tibia to provide a cutting or drilling path for the cutting or drilling tool at a predetermined distance from a tibial plateau of the tibia.

49. The patient-specific surgical tool of claim 48, wherein the predetermined distance is relative to a cartilage surface of the tibial plateau.

50. The patient-specific surgical tool of claim 42, wherein the block further comprises an attachment mechanism.

51. The patient-specific surgical tool of claim 50, further comprising a surgical device for use with the block and connectable to the block by the attachment mechanism.

52. The patient-specific surgical tool of claim 42, wherein the tool is comprised of multiple components.

53. The patient-specific surgical tool of claim 42, wherein the block containing the patient-specific surface and the guide a single component.

54. The patient-specific surgical tool of claim 42, wherein the guide defines a planar cutting path having a predetermined slope relative to the tibial plateau of the joint.

55. The patient-specific surgical tool of claim 42, wherein the predetermined alignment includes a predetermined slope between 0 and 7 degrees.

56. The patient-specific surgical tool of claim 42, wherein the predetermined alignment includes a predetermined slope that substantially matches the normal slope of the tibial plateau.

57. The patient-specific surgical tool of claim 54, wherein the planar cutting path is substantially parallel to the slope of the tibial plateau of the joint.

58. The patient-specific surgical tool of claim 42, wherein the guide includes a stop to control the depth of the cutting or drilling tool.

59. The patient-specific surgical tool of claim 58, wherein the stop is a drill stop or a blade stop.

60. A patient-specific surgical alignment guide for surgery on a tibia of a patient, comprising:

a block having a patient-specific surfaces and a guide;

the patient-specific surface having at least a portion that is substantially a negative shape of a bone surface proximate to a knee joint of the patient and a second portion that is substantially a negative shape of at least a portion of a diseased or damaged cartilage surface of the knee joint; and

the guide having a shape to accommodate a cutting or drilling tool and having a position and orientation relative to the patient-specific surface such that, when the patient-specific surface is placed against and aligned with the bone surface, the guide has a predetermined alignment relative to a predetermined tibial slope of the patient in at least one of a sagittal plane and a coronal plane.

61. A patient-specific surgical tool for use in surgery on a knee joint of a patient, comprising:

a tibial cutting or drilling guide having a patient-specific surface and a guide;

the patient-specific surface having at least a portion that is substantially a negative shape of a corresponding portion of a diseased or damaged articular surface of a tibial plateau of the knee joint of the patient;

the guide having a shape to accommodate a cutting or drilling tool and having a position and orientation relative to the patient-specific surface such that, when the patient-specific surface is placed against and aligned with the corresponding portion of the diseased or damaged articular surface, the guide has a predetermined alignment relative to the tibial plateau of the joint and defines a cutting or drilling path extending through at least a portion of the proximal end of the tibia at a predetermined distance from a surface of the tibial plateau and at a predetermined slope relative to the tibial plateau of the patient in at least one plane.

62. The patient-specific surgical tool of claim 61, wherein the negative shape of the corresponding portion of the diseased or damaged articular surface follows at least a portion of a cartilage surface of the joint.

63. The patient-specific surgical tool of claim 61, wherein the negative shape of the corresponding portion of the diseased or damaged articular surface follows at least a portion of a surface of subchondral bone of the joint.

64. The patient-specific surgical tool of claim 61, wherein the negative shape of the corresponding portion of the diseased or damaged articular surface follows at least a portion of a cartilage surface portion and at least a portion of a subchondral bone surface portion of the joint.

65. The patient-specific surgical tool of claim 61, wherein the patient-specific surface further comprises a first reference portion that is substantially a negative shape of at least a portion of a medial tibial plateau of the joint and a second reference portion that is substantially a negative shape of a lateral tibial plateau of the joint.

66. The patient-specific surgical tool of claim 61, wherein the patient-specific surface is a first patient specific surface, the block further comprising a second patient specific surface, wherein the second patient-specific surface is substantially a negative surface of a non-articulating surface of the-bone.

67. The patient-specific surgical tool of claim 61, wherein, when the patient-specific surface is aligned with the corresponding portion of the diseased or damaged articular surface of the joint, the guide is aligned along a plane through the tibia to provide a cutting or drilling path for the cutting or drilling tool at a predetermined distance from a tibial plateau of the tibia.

68. The patient-specific surgical tool of claim 61, wherein the predetermined distance is relative to a cartilage surface of the tibial plateau.

69. The patient-specific surgical tool of claim 61, wherein the alignment guide further comprises an attachment mechanism.

70. The patient-specific surgical tool of claim 69, further comprising a surgical device for use with the alignment guide and connectable to the alignment guide by the attachment mechanism.

71. The patient-specific surgical tool of claim 61, wherein the tool is comprised of multiple components.

72. The patient-specific surgical tool of claim 61, wherein the alignment guide containing the patient-specific surface and the guide are comprised of a single component.

73. The patient-specific surgical tool of claim 61, wherein the guide defines a planar cutting path having a predetermined slope relative to the tibial plateau of the joint.

74. The patient-specific surgical tool of claim 61, wherein the predetermined slope is between 0 and 7 degrees.

75. The patient-specific surgical tool of claim 61, wherein the predetermined slope substantially matches the normal slope of the tibial plateau.

76. The patient-specific surgical tool of claim 73, wherein the planar cutting path is substantially parallel to the slope of the tibial plateau of the joint.

77. The patient-specific surgical tool of claim 61, wherein the guide includes a stop to control the depth of the cutting or drilling tool.

78. The patient-specific surgical tool of claim 77, wherein the stop is a drill stop or a blade stop.

79. A surgical tool set for performing surgery on a knee joint of a patient, the set comprising the patient-specific surgical tool of claim 61 utilized to align and define a first cutting or drilling path, and

a second surgical tool comprising at least one of a spacer, a hinge and a ratchet-like device, the second surgical tool utilizing a surface of the first cutting or drilling path to align and define a second cutting or drilling path across a bone of the knee joint, the second cutting or drilling path optimized for ligament balancing of the knee joint.

80. The surgical tool set of claim 79, wherein the second surgical tool aligns and defines the second cutting or drilling path to optimize the second cutting or drilling path for addressing a flexion gap in the knee joint.

81. The surgical tool set of claim 79, wherein the second surgical tool aligns and defines the second cutting or drilling path to optimize the second cutting or drilling path for addressing an extension gap in the knee joint.

82. A patient-specific surgical tool for use in surgery on a knee joint of a patient, comprising:

a tibial cutting guide having a patient-specific surface and a guide;

the patient-specific surface having at least a portion that is substantially a negative shape of a corresponding portion of a diseased or damaged articular surface of a tibial plateau of the knee joint of the patient; and

the guide having a shape to accommodate a surgical instrument and having a position and orientation relative to the patient-specific surface such that, when the patient-specific surface is placed against and aligned with the corresponding portion of the diseased or damaged articular surface, the guide has a predetermined alignment relative to the tibial plateau and defines a planar cutting path extending through at least a portion of the proximal end of the tibia at a predetermined distance from a surface of the tibial plateau and having a predetermined orientation relative to a predetermined tibial slope of the patient.

83. A surgical tool set for performing surgery on a knee joint of a patient, the set comprising the patient-specific surgical tool of claim 82 utilized to align and define a first planar cutting path, and

a second surgical tool comprising at least one of a spacer, a hinge and a ratchet-like device, the second surgical tool utilizing a surface of the first planar cutting path to align and define a second cutting or drilling path across a bone of the knee joint, the second cutting or drilling path optimized for ligament balancing of the knee joint.

84. The surgical tool set of claim 83, wherein the second surgical tool aligns and defines the second cutting or drilling path to optimize the second cutting or drilling path for addressing a flexion gap in the knee joint.

85. The surgical tool set of claim 83, wherein the second surgical tool aligns and defines the second cutting or drilling path to optimize the second cutting or drilling path for addressing an extension gap in the knee joint.

86. A patient-specific surgical tool for surgery on a tibia of a patient, comprising:

a mold having a patient-specific surface, wherein at least a portion of the patient-specific surface is substantially a negative shape of an articular surface of a knee joint of the patient;

a block having a guide having a shape to accommodate a cutting or drilling tool; and

an attachment mechanism, wherein the block is attachable to the mold in a predetermined position relative to the patient-specific surface such that, when the patient-specific surface is placed against and aligned with the bone surface, the guide aperture is aligned along a plane through the tibia to provide a cutting path for the cutting tool at a predetermined distance from a surface of the tibia at a predetermined orientation relative to a predetermined tibial slope of the patient.