Patient selectable joint arthroplasty devices and surgical tools

• US 8,337,501 B2
• Filed: 05/10/2010
• Issued: 12/25/2012
• Est. Priority Date: 05/25/2001
• Status: Expired due to Term

• Current Assignee: Conformis Incorporated
• Original Assignee: Conformis Incorporated
• Inventors: Fitz, Wolfgang, Lang, Philipp, Bojarski, Raymond A., Steines, Daniel
• Primary Examiner(s): Philogene, Pedro
• Application Number:
  US12/776,984
• Publication Number:
  US 20100305573A1
• Time in Patent Office: 960 Days
• Field of Search: 606/86.R, 606/87, 606/88, 606/89, 606/82, 606/80, 606/96, 606/98, 606/79, 606/102, 623/14.12, 623/16.11, 295/271, 295/57, 128/898
• 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 method of using a patient-specific surgical tool having at least one surface portion derived from image data of a joint of a patient, the method comprising:

aligning the at least one surface portion of the surgical tool on the joint of the patient against a corresponding surface portion of the joint of the patient; and

cutting or drilling a portion of the joint using a guide path of the surgical tool; and

implanting an orthopedic implant on the joint of the patient, wherein the implant has a predetermined position on the joint based at least in part on the cut or drilled portion of the joint, wherein the position includes at least one of a predetermined flexion, extension, abduction, adduction, internal rotation and external rotation angle of the implant relative to the joint of the patient based at least in part on the relative position of the guide path to the surface portion of the tool.

2. The method of claim 1, wherein the at least one surface portion of the surgical tool on the joint of the patient is, at least in part, derived by estimating cartilage loss for at least a portion of the joint.

3. The method of claim 1, further comprising estimating a thickness of cartilage associated with at least a portion of the joint.

4. The method of claim 1, wherein the implant is a first implant, and wherein the position of the first implant includes at least one of a predetermined flexion, and extension angle of the implant relative to the joint of the patient based at least in part on the relative position of the guide path to the surface portion of the tool.

5. The method of claim 4, further including implanting a second implant, wherein the position of the second implant includes at least one of a predetermined flexion and extension angle of the implant relative to the joint of the patient based at least in part on the relative position of the guide path to the surface portion of the tool.

6. The method of claim 1, wherein the implant is a first implant, and wherein the position of the first implant includes at least one of a predetermined internal rotation and external rotation of the implant relative to the joint of the patient based at least in part on the relative position of the guide path to the surface portion of the tool.

7. The method of claim 1, wherein the image data is CT image data.

8. The method of claim 1, wherein the image data is MRI image data.

9. The method of claim 1, wherein the image data is x-ray image data.

10. The method of claim 1, wherein the implant is a first implant, and wherein the first implant has a predetermined position relative to a second implant implanted in the patient.

11. The method of claim 10, wherein the predetermined position of the second implant is based at least in part on a predetermined flexion angle of the implant.

12. The method of claim 10, wherein the predetermined position of the second implant is based at least in part on a predetermined extension angle of the implant.

13. The method of claim 10, wherein the predetermined position of the second implant is based at least in part on a predetermined adduction angle of the implant.

14. The method of claim 10, wherein the predetermined position of the second implant is based at least in part on a predetermined abduction angle of the implant.

15. The method of claim 10, wherein the predetermined position of the second implant is based at least in part on a predetermined external rotation angle of the implant.

16. The method of claim 10, wherein the predetermined position of the second implant is based at least in part on a predetermined external rotation angle of the implant.

17. The method of claim 10, wherein the predetermined position of the second implant is based at least in part on a tibial slope of the implant.

18. The method of claim 1, wherein the corresponding surface portion of the joint includes at least one of normal or diseased cartilage.

19. The method of claim 1, wherein the corresponding surface portion of the joint includes subchondral bone.

20. The method of claim 1, wherein the corresponding surface portion of the joint includes at least a portion of a femoral condyle.

21. The method of claim 1, wherein the corresponding surface portion of the joint includes at least a portion of a tibial plateau.

22. The method of claim 1, wherein the corresponding surface portion of the joint includes at least a portion of an acetabulum or acetabular rim.

23. The method of claim 1, wherein the corresponding surface portion of the joint includes at least a portion of a femoral head or neck.

24. The method of claim 1, wherein the corresponding surface portion of the joint includes at least a portion of a glenoid or glenoid rim.

25. The method of claim 1, wherein the corresponding surface portion of the joint includes at least a portion of a humeral head or neck.

26. A method of using patient-specific surgical tools each having at least one surface portion derived from image data of a joint of a patient, the method comprising:

placing at least one surface portion of a first patient-specific surgical tool on the joint of the patient to a corresponding articular surface portion of the joint of the patient;

cutting or drilling a portion of the joint using a guide path of the first surgical tool;

implanting a first orthopedic implant on the joint of the patient, wherein the first implant has a predetermined position on the joint based at least in part on the cut or drilled portion of the joint;

placing at least one surface portion of a second patient-specific surgical tool on the joint of the patient to a corresponding second articular surface portion of the joint of the patient;

cutting or drilling a portion of the joint using a guide path of the second surgical tool; and

implanting a second orthopedic implant on the joint of the patient, wherein the second implant has a predetermined rotation on the joint based at least in part on the cut or drilled portion of the joint.

27. The method of claim 26, wherein the position of the first implant includes at least one of a predetermined flexion, and extension angle of the first implant relative to the joint of the patient based at least in part on the relative position of the guide path to the surface portion of the tool.

28. The method of claim 26, wherein the position of the second implant includes at least one of a predetermined flexion and extension angle of the second implant relative to the joint of the patient based at least in part on the relative position of the guide path to the surface portion of the tool.

29. The method of claim 26, wherein the position of the first implant includes at least one of a predetermined internal rotation and external rotation of the first implant relative to the joint of the patient based at least in part on the relative position of the guide path to the surface portion of the tool.

30. The method of claim 26, wherein the position or orientation of at least one of the first or second implants is optimized relative to the other implant to account for ligament tension or balancing.

31. The method of claim 30, wherein position or orientation of the first or second implant is optimized using one of a spacer, ratchet, hinge-like device or tensiometer.

32. The method of claim 26, wherein the image data is CT image data.

33. The method of claim 26, wherein the image data is MRI image data.

34. The method of claim 26, wherein the image data is x-ray image data.

35. The method of claim 26, wherein the first implant has a predetermined position relative to the second implant.

36. The method of claim 26, wherein the predetermined position of the first implant is based at least in part on a predetermined flexion angle of the first implant.

37. The method of claim 26, wherein the predetermined position of the first implant is based at least in part on a predetermined extension angle of the first implant.

38. The method of claim 26, wherein the predetermined position of the first implant is based at least in part on a predetermined adduction angle of the first implant.

39. The method of claim 26, wherein the predetermined position of the first implant is based at least in part on a predetermined abduction angle of the first implant.

40. The method of claim 26, wherein the predetermined position of the first implant is based at least in part on a predetermined external rotation angle of the first implant.

41. The method of claim 26, wherein the predetermined position of the first implant is based at least in part on a predetermined external rotation angle of the first implant.

42. The method of claim 26, wherein the predetermined position of the first implant is based at least in part on a tibial slope of the first implant.

43. The method of claim 26, further comprising estimating a thickness of cartilage associated with at least a portion of the joint.

44. The method of claim 26, further comprising estimating cartilage loss for at least a portion of the joint.

45. A method of using a patient-specific surgical tool having at least one patient-specific portion derived from image data of a joint of a patient, the method comprising:

registering the at least one patient-specific portion of the surgical tool on the joint of the patient against a corresponding surface portion of the joint of the patient; and

cutting or drilling a portion of the joint using a guide path of the surgical tool while the patient-specific portion is registered to the corresponding portion of the joint; and

implanting a femoral implant on the joint of the patient, wherein the implant has a predetermined position on the joint based at least in part on the cut or drilled portion of the joint, wherein the position of the femoral implant includes an internal or external rotation angle of the femoral implant relative to the joint of the patient that is at least partially based on a predetermined position of the guide path relative the patient-specific portion of the tool.

46. A method of using a patient-specific surgical tool having at least one patient-specific portion derived from image data of a joint of a patient, the method comprising:

registering the at least one patient-specific portion of the surgical tool on the joint of the patient against a corresponding surface portion of the joint of the patient; and

cutting or drilling a portion of the joint using a guide path of the surgical tool while the patient-specific portion is registered to the corresponding portion of the joint; and

implanting a femoral implant on the joint of the patient, wherein the femoral implant has a predetermined position on the joint based at least in part on the cut or drilled portion of the joint, wherein the position of the femoral implant includes a flexion angle of the femoral implant relative to the joint of the patient that is at least partially based on a predetermined position of the guide path relative the patient-specific portion of the tool.

47. A method of using a patient-specific surgical tool having at least one patient-specific portion derived from image data of a joint of a patient, the method comprising:

registering the at least one patient-specific portion of the surgical tool on the joint of the patient against a corresponding surface portion of the joint of the patient; and

cutting or drilling a portion of the joint using a guide path of the surgical tool while the patient-specific portion is registered to the corresponding portion of the joint; and

implanting an orthopedic implant on the joint of the patient, wherein the implant has a predetermined position on the joint based at least in part on the cut or drilled portion of the joint, wherein the position includes at least one of a predetermined flexion, extension, abduction, adduction, internal rotation and external rotation angle of the implant relative to the joint of the patient based at least in part on the relative position of the guide path to the surface portion of the tool.