Joint replacement method

• US 8,425,522 B2
• Filed: 05/21/2010
• Issued: 04/23/2013
• Est. Priority Date: 01/14/2000
• Status: Expired due to Fees

• Current Assignee: Bonutti Skeletal Innovations LLC (Acacia Research Corporation)
• Original Assignee: Bonutti Skeletal Innovations LLC (Acacia Research Corporation)
• Inventors: Bonutti, Peter M.
• Primary Examiner(s): Philogene, Pedro
• Application Number:
  US12/784,724
• Publication Number:
  US 20100228257A1
• Time in Patent Office: 1,068 Days
• Field of Search: 606/80, 606/82, 606/86.A, 606/86.R, 606/87, 606/88, 606/89, 606/300, 128/898, 901/2, 901/30, 901/50, 623/16.11, 623/18.11
• US Class Current: 606/87
• 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 or resorptive
• 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

Imaging of a left or right joint is performed preoperatively, and an alignment guide and a custom cutting guide are formed based on the imaging. The alignment guide includes cannulations into which pins are placed. The cutting guide is then aligned using the pins, and bone of the joint is cut, using the guide, in preparation for an implant operative to replace a portion of the joint. The cutting guide is provided with one or more slots or surfaces to aid in aligning a cutting instrument. The alignment guide or cutting guide may be modified to correct for an existing joint problem, for example an incorrect alignment of the joint. The alignment guide or cutting guide may be formed with polymeric material.

Claims

1. A method for repairing or replacing at least a portion of a joint in a patient, comprising:

positioning an alignment guide on a diseased or damaged articular surface of a bone of the joint, wherein the alignment guide is custom fabricated for the patient based on imaging information of the joint and includes a cannulation configured and dimensioned to place a reference on the bone;

positioning a cutting guide having a guide surface, the positioning of the cutting guide with respect to at least two references; and

cutting at least a portion of the articular surface of the bone of the joint by moving a cutting tool along the guide surface of the cutting guide.

2. The method of claim 1, wherein the cutting guide includes a slot.

3. The method of claim 1, wherein the guide surface of the cutting guide forms a captured slot.

4. The method of claim 1, wherein the alignment guide is configured and dimensioned to correct a physical defect of the patient.

5. The method of claim 1, wherein the alignment guide corrects alignment of the joint based on mechanical axis alignment.

6. The method of claim 1, wherein the cutting guide is not custom fabricated based on imaging information of the joint.

7. The method of claim 1, wherein the alignment guide is custom fabricated for only one of either the left or right side of the patient'"'"'s body.

8. The method of claim 1, wherein the cutting guide is dimensioned for only one of either the left or right side of the patient'"'"'s body.

9. The method of claim 1, wherein the alignment guide is custom fabricated using a polymer.

10. The method of claim 1, wherein the alignment guide is custom fabricated for the patient based on imaging information of the patient'"'"'s joint, the imaging performed preoperatively.

11. The method of claim 1, wherein the articular surface of the bone cut contains holes formed by at least two pins.

12. The method of claim 1, wherein the cutting guide is offset from an axis of the joint.

13. The method of claim 1, wherein the imaging information of the joint includes preoperative imaging information.

14. The method of claim 2, wherein the cutting guide includes a plurality of slots.

15. A method for repairing or replacing at least a portion of a joint in a patient, comprising:

positioning an alignment guide on a diseased or damaged articular surface of a bone of the joint, wherein the alignment guide is custom fabricated for the patient based on imaging information of the joint and, the alignment guide having a cannulation configured for a cutting instrument;

guiding at least a portion of the cutting instrument through at least a portion of the cannulation and cutting a reference in the bone;

positioning a cutting guide with respect to the reference, the cutting guide configured to cut the articular surface; and

positioning an arthoplasty component on the cut surface.

16. The method of claim 15, wherein the cutting guide includes a slot.

17. The method of claim 15, wherein the cutting guide includes a captured slot.

18. The method of claim 15, wherein the alignment guide is configured and dimensioned to correct a physical defect of the patient.

19. The method of claim 15, wherein the alignment guide corrects alignment of the joint based on mechanical axis alignment.

20. The method of claim 15, wherein the alignment guide is custom fabricated for only one of either the left or right side of the patient'"'"'s body.

21. The method of claim 15, wherein the alignment guide is custom fabricated using a polymer.

22. The method of claim 15, wherein the alignment guide is custom fabricated for the patient based on imaging information of the patient'"'"'s joint, the imaging performed preoperatively.

23. The method of claim 15, wherein the alignment guide includes at least two cannulations configured for cutting at least two references in the bone.

24. A method for repairing or replacing at least a portion of a joint in a patient, comprising:

positioning an alignment guide on an articular surface of a bone of the joint, wherein the alignment guide is custom fabricated for the patient based on imaging information of the joint, the alignment guide having at least two cannulations;

forming apertures in bone, using the at least two cannulations;

removing the alignment guide from the articular surface;

aligning a cutting guide using the formed apertures; and

cutting the articular surface of the bone of the joint by moving a cutting tool along a guide surface of the cutting guide.

25. The method of claim 24, wherein the guide surface forms a slot.

26. The method of claim 24, wherein the guide surface forms a captured slot.

27. The method of claim 24, wherein the alignment guide is configured and dimensioned to correct a physical defect of the patient.

28. The method of claim 24, wherein the alignment guide is dimensioned and configured to align a joint dimension selected from the group consisting of:

mechanical axis alignment, rotational alignment, implant size, slope, and combinations thereof.

29. The method of claim 24, wherein the cutting guide is not custom fabricated based on imaging information of the joint.

30. The method of claim 24, wherein the alignment guide is custom fabricated for only one of either the left or right side of the patient'"'"'s body.

31. The method of claim 24, wherein the cutting guide is dimensioned for only one of either the left or right side of the patient'"'"'s body.

32. The method of claim 24, wherein the alignment guide is custom fabricated using a polymer.

33. The method of claim 24, wherein the alignment guide is custom fabricated for the patient based on imaging information of the patient'"'"'s joint, the imaging performed preoperatively.

34. The method of claim 24, wherein pins are inserted in the apertures in the bone.

35. The method of claim 24, wherein the cutting guide is offset from an axis of joint.

36. A method for repairing or replacing at least a portion of a joint in a patient, comprising:

positioning an alignment guide with respect to a bone of the joint, wherein the alignment guide is custom fabricated for the patient based on imaging information of a cut bone surface and includes a cannulation configured and dimensioned to place a reference on the bone;

positioning a cutting guide having a guide surface, the positioning of the cutting guide with respect to at least two references; and

cutting at least a portion of the bone of the joint by moving a cutting tool along a guide surface of the cutting guide.

37. The method of claim 36, wherein the cutting guide includes a slot.

38. The method of claim 36, wherein the alignment guide includes polymer material.

39. A method for repairing or replacing at least a portion of a joint in a patient, comprising:

positioning an alignment guide on a diseased or damaged articular surface of a bone of the joint, wherein the alignment guide is custom fabricated for the patient based on imaging information of the joint and, the alignment guide being configured to receive a cutting instrument;

guiding at least a portion of the cutting instrument through at least a portion of the alignment guide;

forming a reference in the bone with the cutting instrument;

positioning a cutting guide with respect to the reference, the cutting guide configured to cut the articular surface; and

positioning an arthoplasty component on the cut surface.

40. The method of claim 39, wherein the cutting guide includes a slot.

41. The method of claim 39, wherein the alignment guide is custom fabricated using a polymer.

42. The method of claim 39, wherein the alignment guide is custom fabricated for the patient based on imaging information of the diseased or damaged joint.

43. A method of performing surgery on a patient'"'"'s knee including a femur and a tibia, the method comprising the steps of:

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

positioning a cutting guide through the incision and on a side surface of a distal end portion of the femur;

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

cutting the femur by moving the cutting tool along the guide surface, wherein the cutting guide is positioned free of an extramedullary or intramedullary alignment rod.