Patient selectable joint arthroplasty devices and surgical tools

• US 9,220,516 B2
• Filed: 01/20/2011
• Issued: 12/29/2015
• Est. Priority Date: 02/06/2006
• Status: Active Grant

• Current Assignee: Conformis Incorporated
• Original Assignee: Conformis Incorporated
• Inventors: Lang, Philipp, Fitz, Wolfgang
• Primary Examiner(s): Philogene, Pedro
• Application Number:
  US13/010,279
• Publication Number:
  US 20110319897A1
• Time in Patent Office: 1,804 Days
• Field of Search: 606/79, 606/80, 606/86.R, 606/87, 606/88, 606/89, 606/96, 623/22.2, 623/20.35, 623/23.42, 623/20.14, 600/429, 600/439, 600/424, 600/426, 600/407, 600/443
• US Class Current: 1/1
• 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 17/1666 for the acetabulum
• CPC Class Codes: A61B 17/1675 for the knee
• CPC Class Codes: A61B 17/1677 for the patella
• CPC Class Codes: A61B 17/1682 for the foot or ankle
• CPC Class Codes: A61B 17/1703 using imaging means, e.g. by X-rays
• 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 2034/105 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 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 5/4523 : Tendons
• CPC Class Codes: A61B 5/4528 : Joints A61B5/4533, A61B5/4538 take precedence
• CPC Class Codes: A61B 5/4533 : Ligaments
• CPC Class Codes: 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: B33Y 80/00 : Products made by additive manufacturing
• CPC Class Codes: G06F 30/00 : Computer-aided design [CAD]
• CPC Class Codes: G06F 30/10 : Geometric CAD
• CPC Class Codes: Y10T 29/49 : Method of mechanical manufacture

Abstract

Disclosed herein are methods, compositions and tools for repairing articular surfaces repair materials and for repairing an articular surface. The articular surface repairs are customizable or highly selectable by patient and geared toward providing optimal fit and function. 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 surgical instrument system for use in surgical procedures on a shoulder joint of a patient, comprising:

a first template having a patient-specific surface and a guide to direct or accommodate a surgical tool;

wherein the patient-specific surface is substantially a negative of a first surface of the shoulder joint; and

wherein the guide has a position or orientation relative to the patient-specific surface to define a predetermined path for the surgical tool that is aligned through a portion of tissue associated with the shoulder joint when the patient specific surface is placed against and aligned with the first surface; and

a linkage for cross-referencing at least one surgical instrument on a second joint surface opposing the first surface of the shoulder joint.

2. The surgical instrument system of claim 1, wherein the predetermined path for the surgical tool determines the resultant anteversion or retroversion of at least one glenoid or humeral implant component.

3. The surgical instrument system of claim 1, wherein the predetermined path for the surgical tool determines the resultant rotation of at least one glenoid or humeral implant component.

4. The surgical instrument system of claim 1, wherein the predetermined path for the surgical tool determines the resultant orientation of at least one glenoid or humeral implant component.

5. The surgical instrument system of claim 1, wherein the surgical tool is used for reaming a glenoid cup.

6. The surgical instrument system of claim 1, wherein the surgical tool is used for cutting a humeral neck.

7. The surgical instrument system of claim 1, wherein the surgical tool is used for reaming a humeral shaft.

8. The surgical instrument system of claim 1, wherein the patient-specific surface has at least a portion that is substantially a negative of a corresponding portion of a humeral neck of a proximal humerus of the shoulder joint.

9. The surgical instrument system of claim 1, wherein the portion of the patient-specific surface is a first portion and the patient-specific surface further comprises at least a second portion that is substantially a negative of a corresponding cortical bone surface of a proximal humerus of the shoulder joint, wherein the second portion is configured to align with the cortical bone surface when the first portion is placed against and aligned with the subchondral bone surface.

10. The surgical instrument system of claim 9, wherein the first surface is located near a humeral neck of the shoulder joint.

11. The surgical instrument system of claim 9, wherein the cortical bone surface is located on a humeral neck of the shoulder joint.

12. The surgical instrument system of claim 9, wherein the first surface is located adjacent to a humeral neck of the shoulder joint.

13. The surgical instrument system of claim 9, wherein the cortical bone surface is located adjacent to a humeral neck of the shoulder joint.

14. The surgical instrument system of claim 9, wherein the first surface is located on a humeral head of the shoulder joint.

15. The surgical instrument system of claim 9, wherein the cortical bone surface is located adjacent to a humeral head of the shoulder joint.

16. The surgical instrument system of claim 9, wherein the cortical bone surface is located adjacent to a humeral head of the shoulder joint.

17. The surgical instrument system of claim 9, wherein the first surface is located at a junction of the humeral head and humeral neck of the shoulder joint.

18. The surgical instrument system of claim 9, wherein the cortical bone surface is located at a junction of the humeral head and humeral neck of the shoulder joint.

19. The surgical instrument system of claim 9, wherein the first surface is located adjacent to a junction of the humeral head and humeral neck of the shoulder joint.

20. The surgical instrument system of claim 9, wherein the cortical bone surface is located adjacent to a junction of the humeral head and humeral neck of the shoulder joint.

21. The surgical instrument system of claim 9, wherein the first surface extends from a humeral neck to a humeral head of a proximal humerus associated with the shoulder joint.

22. The surgical instrument system of claim 1, wherein the first surface is located in an glenoid associated with the shoulder joint.

23. The surgical instrument system of claim 1, wherein the portion of the patient-specific surface is a first portion and the patient-specific surface further comprises at least a second portion that is substantially a negative of a corresponding cortical bone surface of an iliac bone of the shoulder joint, wherein the second portion is configured to align with the cortical bone surface when the first portion is placed against and aligned with the subchondral bone surface.

24. The surgical instrument system of claim 23, wherein the cortical bone surface is located on an glenoid rim associated with the shoulder joint.

25. The surgical instrument system of claim 1, wherein the portion of the patient-specific surface is a first portion and the patient-specific surface further comprises at least a second portion that is substantially a negative of a corresponding cartilage surface of a proximal humerus of the shoulder joint, wherein the second portion is configured to align with the cartilage surface when the first portion is placed against and aligned with the first surface.

26. The surgical instrument system of claim 1, wherein the portion of the patient-specific surface is a first portion and the patient-specific surface further comprises at least a second portion that is substantially a negative of a corresponding cartilage surface of an glenoid of the shoulder joint, wherein the second portion is configured to align with the cartilage surface when the first portion is placed against and aligned with the subchondral bone surface.

27. The surgical instrument system of claim 26, wherein the cartilage surface is located on a humeral head of the shoulder joint.

28. The surgical instrument system of claim 26, wherein the first surface is located on a humeral head of the shoulder joint.

29. The surgical instrument system of claim 26, wherein the cartilage surface is located on a humeral head of the shoulder joint.

30. The surgical instrument system of claim 26, wherein the first surface is located at a junction of the humeral head and humeral neck of the shoulder joint.

31. The surgical instrument system of claim 26, wherein the cartilage surface is located at a junction of the humeral head and humeral neck of the shoulder joint.

32. The surgical instrument system of claim 26, wherein the first surface is located adjacent a junction of the humeral head and humeral neck of the shoulder joint.

33. The surgical instrument system of claim 26, wherein the cartilage surface is located adjacent a junction of the humeral head and humeral neck of the shoulder joint.

34. The surgical instrument system of claim 26, wherein the first surface is located on an iliac bone associated with the shoulder joint.

35. The surgical instrument system of claim 26, wherein the first surface is located in an glenoid associated with the shoulder joint.

36. The surgical instrument system of claim 26, wherein the cartilage surface is located on an glenoid associated with the shoulder joint.

37. The surgical instrument system of claim 26, wherein the first surface is located on an iliac bone associated with the shoulder joint.

38. The surgical instrument system of claim 26, wherein the cartilage surface is located on an iliac bone associated with the shoulder joint.

39. The surgical instrument system of claim 1, wherein the portion of the patient-specific surface is a first portion and the patient-specific surface further comprises:

at least a second portion that is substantially a negative of a corresponding cortical bone surface of a proximal humerus of the shoulder joint; and

at least a third portion that is substantially a negative of a corresponding cartilage surface of a proximal humerus of the shoulder joint,

wherein the second portion is configured to align with the cortical bone surface and the third portion is configured to align with the cartilage surface when the first portion is placed against and aligned with the first surface.

40. The surgical instrument system of claim 1, wherein the portion of the patient-specific surface is a first portion and the patient-specific surface further comprises:

at least a second portion that is substantially a negative of a corresponding cortical bone surface of an glenoid of the shoulder joint; and

at least a third portion that is substantially a negative of a corresponding cartilage surface of an glenoid of the shoulder joint, wherein the second portion is configured to align with the cortical bone surface and the third portion is configured to align with the cartilage surface when the first portion is placed against and aligned with the first surface.

41. The surgical instrument system of claim 1, wherein the patient-specific surface has at least a portion that is substantially a negative of a corresponding portion of a glenoid of a shoulder joint.

42. The surgical instrument system of claim 1, wherein the patient-specific surface has at least a portion that is substantially a negative of a corresponding portion of a glenoid rim of a shoulder joint.

43. The surgical instrument system of claim 1, wherein the patient-specific surface has at least a portion that is substantially a negative of a corresponding portion of subchondral bone of a glenoid of the shoulder joint.

44. The surgical instrument system of claim 1, wherein the patient-specific surface has at least a portion that is substantially a negative of a corresponding portion of a humeral head of a proximal humerus of the associated shoulder joint.

45. The surgical instrument system of claim 1, wherein the patient-specific surface has at least a portion that is substantially a negative of a corresponding portion of subchondral bone of a humeral head of a proximal humerus of the shoulder joint.

46. The surgical instrument system of claim 1, wherein the patient-specific surface has at least a portion that is substantially a negative of a corresponding portion of a humeral neck of a proximal humerus of the shoulder joint.

47. The surgical instrument system of claim 1, wherein the patient-specific surface has at least a portion that is substantially a negative of a corresponding portion of a junction of a humeral head and humeral neck of a proximal humerus of the shoulder joint.

48. The surgical instrument system of claim 1, wherein the patient-specific surface is part of a component, wherein the component and the guide are formed in two separate pieces that can be linked to each other.

49. The surgical instrument system of claim 1, wherein the patient-specific surface has at least a portion that is substantially a negative of a corresponding portion of an iliac bone of the shoulder joint.

50. The surgical instrument system of claim 1, wherein the patient-specific surface has at least a portion that is substantially a negative of a corresponding portion of subchondral bone of the shoulder joint.

51. The surgical instrument system of claim 1, wherein the surgical instrument is stabilized against at least one of an iliac bone, an glenoid, an glenoid rim, a humeral head, neck or shaft using at least one of a wire, a screw, an anchor, or a drill bit.

52. The surgical instrument system of claim 1, wherein the template is stabilized against at least one of an iliac bone, an glenoid, an glenoid rim, a humeral head, neck or shaft using at least one or more convexities and one or more concavities on said subchondral bone surface.

53. The surgical instrument system of claim 1, wherein the template is stabilized against at least one of an iliac bone, an glenoid, an glenoid rim, a humeral head, neck or shaft using at least one or more convexities and one or more concavities on a cortical surface.

54. The surgical instrument system of claim 1, wherein the surgical instrument is stabilized against at least one of an iliac bone, an glenoid, an glenoid rim, a humeral head, neck or shaft using at least one or more convexities and one or more concavities on a cartilage surface.

55. The surgical instrument system of claim 1, wherein the first surface includes normal subchondral bone.

56. The surgical instrument system of claim 1, wherein the first surface includes diseased subchondral bone.

57. The surgical instrument system of claim 1, wherein the first surface includes normal and diseased subchondral bone.

58. The surgical instrument system of claim 1, wherein the template is stabilized against at least one of an iliac bone, an glenoid or a humeral head by positioning it on or over an interface between normal and diseased subchondral bone.

59. The surgical instrument system of claim 1, wherein the template surgical instrument-is stabilized against at least one of an iliac bone, an glenoid or a humeral head by positioning it on or over an anatomic feature.

60. The surgical instrument system of claim 59, wherein said anatomic features is at least one of a fovea capities, a tri-radiate subchondral bone, an glenoid fossa, an glenoid wall or an glenoid rim.

61. The surgical instrument system of claim 1, further including an adjustment mechanism configured to adjust the position of the guide intraoperatively.

62. The surgical instrument system of claim 61, wherein the position of the guide can be adjusted using at least one or more of a spacer like device, a ratchet like device or a pin like device.

63. The surgical instrument system of claim 1, wherein the position of the guide can be adjusted intraoperatively in order to optimize placement of one or more implant components of the system.

64. The surgical instrument system of claim 63, wherein the position of the guide can be adjusted using at least one or more of a spacer like device, a ratchet like device or a pin like device.

65. The surgical instrument system of claim 48, wherein the component and the guide are integrally formed.

66. The surgical instrument system of claim 1, wherein the guide is located at a position relative to said template, the position configured to provide a cut at a predetermined position and orientation.

67. The surgical instrument system of claim 1, further comprising an adjustment mechanism configured to adjust the guide relative to the template.

68. The surgical instrument system of claim 67, wherein said adjustment mechanism is configured to achieve a desired humeral component anteversion or retroversion.

69. The surgical instrument system of claim 67, wherein said adjustment mechanism is configured to achieve a desired humeral component rotation.

70. The surgical instrument system of claim 67, wherein said adjustment mechanism is configured can be performed in order to achieve a desired glenoid component anteversion or retroversion.

71. The surgical instrument system of claim 67, wherein said adjustment mechanism is configured to achieve a desired glenoid component rotation.

72. The surgical instrument system of claim of claim 1, wherein the surgical tool is at least one of a drill, reamer, k-wire, pin, screw and saw.

73. The surgical instrument system of claim of claim 1, further comprising a first third portion having a second guide to direct or accommodate a surgical tool, wherein the third portion includes a linkage mechanism to the second portion.

74. A surgical instrument for use in surgically replacing or resurfacing portions of or an entire shoulder joint of a patient, comprising:

a first component having a patient-specific surface and a guide to direct or accommodate a surgical tool;

wherein the patient-specific surface has at least a portion that is substantially a negative of a first surface of the shoulder joint; and

wherein the guide has a position or orientation relative to the patient-specific surface to define a predetermined path for the surgical tool that is aligned through a portion of tissue associated with the shoulder joint when the patient specific surface is placed against and aligned with the first surface;

a second component including a second contact surface substantially conforming to and for engaging a second surface of the shoulder joint and a second guide for directing movement of a second surgical tool;

and a linkage for cross-referencing the second component to the first component to align a position of orientation of the second component on the second joint surface.

75. The surgical instrument of claim 74, wherein the predetermined path for the surgical tool determines the resultant anteversion or retroversion of at least one glenoid or humeral implant component.

76. The surgical instrument of claim 74, wherein the predetermined path for the surgical tool determines the resultant rotation of at least one glenoid or humeral implant component.

77. The surgical instrument of claim 74, wherein the predetermined path for the surgical tool determines the resultant orientation of at least one glenoid or humeral implant component.

78. The surgical instrument of claim 74, wherein the surgical tool is used for reaming a glenoid cup.

79. The surgical instrument of claim 74, wherein the surgical tool is used for cutting a humeral neck.

80. The surgical instrument of claim 74, wherein the surgical tool is used for reaming a humeral shaft.

81. The surgical instrument of claim 74, wherein the patient-specific surface has at least a portion that is substantially a negative of a corresponding portion of a humeral neck of a proximal humerus of the shoulder joint.

82. The surgical instrument of claim 74, wherein the portion of the patient-specific surface is a first portion and the patient-specific surface further comprises at least a second portion that is substantially a negative of a corresponding cortical bone surface of a proximal humerus of the shoulder joint, wherein the second portion is configured to align with the cortical bone surface when the first portion is placed against and aligned with the first surface.

83. The surgical instrument of claim 82, wherein the first surface is located near a humeral neck of the shoulder joint.

84. The surgical instrument of claim 82, wherein the cortical bone surface is located on a humeral neck of the shoulder joint.

85. The surgical instrument of claim 82, wherein the first surface is located adjacent to a humeral neck of the shoulder joint.

86. The surgical instrument of claim 82, wherein the cortical bone surface is located adjacent to a humeral neck of the shoulder joint.

87. The surgical instrument of claim 82, wherein the first surface is located on a humeral head of the shoulder joint.

88. The surgical instrument of claim 82, wherein the cortical bone surface is located adjacent to a humeral head of the shoulder joint.

89. The surgical instrument of claim 82, wherein the cortical bone surface is located adjacent to a humeral head of the shoulder joint.

90. The surgical instrument of claim 82, wherein the first surface is located at a junction of the humeral head and humeral neck of the shoulder joint.

91. The surgical instrument of claim 82, wherein the cortical bone surface is located at a junction of the humeral head and humeral neck of the shoulder joint.

92. The surgical instrument of claim 82, wherein the first surface is located adjacent to a junction of the humeral head and humeral neck of the shoulder joint.

93. The surgical instrument of claim 82, wherein the cortical bone surface is located adjacent to a junction of the humeral head and humeral neck of the shoulder joint.

94. The surgical instrument of claim 82, wherein the first surface extends from a humeral neck to a humeral head of a proximal humerus associated with the shoulder joint.

95. The surgical instrument of claim 74, wherein the first surface is located in an glenoid associated with the shoulder joint.

96. The surgical instrument of claim 74, wherein the portion of the patient-specific surface is a first portion and the patient-specific surface further comprises at least a second portion that is substantially a negative of a corresponding cortical bone surface of an iliac bone of the shoulder joint, wherein the second portion is configured to align with the cortical bone surface when the first portion is placed against and aligned with the first cartilage surface.

97. The surgical instrument of claim 96, wherein the cortical bone surface is located on an glenoid rim associated with the shoulder joint.

98. The surgical instrument of claim 74, wherein the portion of the patient-specific surface is a first portion and the patient-specific surface further comprises at least a second portion that is substantially a negative of a corresponding subchondral bone surface of a proximal humerus of the shoulder joint, wherein the second portion is configured to align with the subchondral bone surface when the first portion is placed against and aligned with the first surface.

99. The surgical instrument of claim 74, wherein the portion of the patient-specific surface is a first portion and the patient-specific surface further comprises at least a second portion that is substantially a negative of a corresponding subchondral bone surface of an glenoid of the shoulder joint, wherein the second portion is configured to align with the subchondral bone surface when the first portion is placed against and aligned with the first surface.

100. The surgical instrument of claim 99, wherein the subchondral bone surface is located on a humeral head of the shoulder joint.

101. The surgical instrument of claim 99, wherein the first surface is located on a humeral head of the shoulder joint.

102. The surgical instrument of claim 99, wherein the subchondral bone surface is located on a humeral head of the shoulder joint.

103. The surgical instrument of claim 99, wherein the first surface is located at a junction of the humeral head and humeral neck of the shoulder joint.

104. The surgical instrument of claim 99, wherein the subchondral bone surface is located at a junction of the humeral head and humeral neck of the shoulder joint.

105. The surgical instrument of claim 99, wherein the first surface is located adjacent a junction of the humeral head and humeral neck of the shoulder joint.

106. The surgical instrument of claim 99, wherein the subchondral bone surface is located adjacent a junction of the humeral head and humeral neck of the shoulder joint.

107. The surgical instrument of claim 99, wherein the first surface is located on an iliac bone associated with the shoulder joint.

108. The surgical instrument of claim 99, wherein the first surface is located in an glenoid associated with the shoulder joint.

109. The surgical instrument of claim 99, wherein the subchondral bone surface is located on an glenoid associated with the shoulder joint.

110. The surgical instrument of claim 99, wherein the first surface is located on an iliac bone associated with the shoulder joint.

111. The surgical instrument of claim 99, wherein the subchondral bone surface is located on an iliac bone associated with the shoulder joint.

112. The surgical instrument of claim 74, wherein the portion of the patient-specific surface is a first portion and the patient-specific surface further comprises:

at least a second portion that is substantially a negative of a corresponding cortical bone surface of a proximal humerus of the shoulder joint; and

at least a third portion that is substantially a negative of a corresponding subchondral bone surface of a proximal humerus of the shoulder joint,

wherein the second portion is configured to align with the cortical bone surface and the third portion is configured to align with the subchondral bone surface when the first portion is placed against and aligned with the first surface.

113. The surgical instrument of claim 74, wherein the portion of the patient-specific surface is a first portion and the patient-specific surface further comprises:

at least a second portion that is substantially a negative of a corresponding cortical bone surface of an glenoid of the shoulder joint; and

at least a third portion that is substantially a negative of a corresponding subchondral bone surface of an glenoid of the shoulder joint,

wherein the second portion is configured to align with the cortical bone surface and the third portion is configured to align with the subchondral bone surface when the first portion is placed against and aligned with the first surface.

114. The surgical instrument of claim 74, wherein the patient-specific surface has at least a portion that is substantially a negative of a corresponding portion of a glenoid of a shoulder joint.

115. The surgical instrument of claim 74, wherein the patient-specific surface has at least a portion that is substantially a negative of a corresponding portion of a glenoid rim of a shoulder joint.

116. The surgical instrument of claim 74, wherein the patient-specific surface has at least a portion that is substantially a negative of a corresponding portion of cartilage of a glenoid of the shoulder joint.

117. The surgical instrument of claim 74, wherein the patient-specific surface has at least a portion that is substantially a negative of a corresponding portion of a humeral head of a proximal humerus of the associated shoulder joint.

118. The surgical instrument of claim 74, wherein the patient-specific surface has at least a portion that is substantially a negative of a corresponding portion of cartilage of a humeral head of a proximal humerus of the shoulder joint.

119. The surgical instrument of claim 74, wherein the patient-specific surface has at least a portion that is substantially a negative of a corresponding portion of a humeral neck of a proximal humerus of the shoulder joint.

120. The surgical instrument of claim 74, wherein the patient-specific surface has at least a portion that is substantially a negative of a corresponding portion of a junction of a humeral head and humeral neck of a proximal humerus of the shoulder joint.

121. The surgical instrument of claim 74, wherein the components and the guides are formed in two separate pieces that can be linked to each other.

122. The surgical instrument of claim 74, wherein the patient-specific surface has at least a portion that is substantially a negative of a corresponding portion of an iliac bone of the shoulder joint.

123. The surgical instrument of claim 74, wherein the patient-specific surface has at least a portion that is substantially a negative of a corresponding portion of cartilage of an iliac bone of the shoulder joint.

124. The surgical instrument of claim 74, wherein the surgical instrument is stabilized against at least one of an iliac bone, an glenoid, an glenoid rim, a humeral head, neck or shaft using at least one of a wire, a screw, an anchor, or a drill bit.

125. The surgical instrument of claim 74, wherein the surgical instrument is stabilized against at least one of an iliac bone, an glenoid, an glenoid rim, a humeral head, neck or shaft using at least one or more convexities and one or more concavities on said cartilage surface.

126. The surgical instrument of claim 74, wherein the surgical instrument is stabilized against at least one of an iliac bone, an glenoid, an glenoid rim, a humeral head, neck or shaft using at least one or more convexities and one or more concavities on a cortical surface.

127. The surgical instrument of claim 74, wherein the surgical instrument is stabilized against at least one of an iliac bone, an glenoid, an glenoid rim, a humeral head, neck or shaft using at least one or more convexities and one or more concavities on a subchondral bone surface.

128. The surgical instrument of claim 74, wherein the first surface includes normal cartilage.

129. The surgical instrument of claim 74, wherein the first surface includes diseased cartilage.

130. The surgical instrument of claim 74, wherein the first surface includes normal and diseased cartilage.

131. The surgical instrument of claim 74, wherein the surgical instrument is stabilized against at least one of an iliac bone, an glenoid or a humeral head by positioning it on or over an interface between normal and diseased cartilage.

132. The surgical instrument of claim 74, wherein the surgical instrument is stabilized against at least one of an iliac bone, an glenoid or a humeral head by positioning it on or over an anatomic feature.

133. The surgical instrument of claim 132, wherein said anatomic features is at least one of a fovea capities, a tri-radiate cartilage, an glenoid fossa, an glenoid wall or an glenoid rim.

134. The surgical instrument of claim 74, wherein the position of the guide can be adjusted intraoperatively.

135. The surgical instrument sy claim 134, wherein the position of the guide can be adjusted using at least one or more of a spacer like device, a ratchet like device or a pin like device.

136. The surgical instrument of claim 74, wherein the first and second components are each integrally formed.

137. The surgical instrument of claim 74, further comprising an adjustment mechanism configured to adjust the first or second guide relative to the first or second component, respectively.

138. The surgical instrument of claim 137, wherein said adjustment mechanism is configured to achieve a desired humeral component anteversion or retroversion.

139. The surgical instrument of claim 137, wherein said adjustment mechanism is configured to achieve a desired humeral component rotation.

140. The surgical instrument of claim 137, wherein said adjustment mechanism is configured can be performed in order to achieve a desired glenoid component anteversion or retroversion.

141. The surgical instrument of claim 137, wherein said adjustment mechanism is configured to achieve a desired glenoid component rotation.

142. The surgical instrument of claim 74, wherein the first or second surgical tool is a drill, reamer, k-wire, pin, screw or saw.

143. The surgical instrument of claim 74, further comprising a first third portion having a second guide to direct or accommodate a surgical tool, wherein the third portion includes a linkage mechanism to the second portion.

144. The surgical instrument of claim 74, wherein the first and second components form a single component.