SYSTEM AND METHOD FOR ASSISTING WITH ATTACHMENT OF A STOCK IMPLANT TO A PATIENT TISSUE

• US 20120109137A1
• Filed: 10/27/2011
• Published: 05/03/2012
• Est. Priority Date: 10/29/2010
• Status: Active Grant

• Current Assignee: Cleveland Clinic Foundation
• Original Assignee: Cleveland Clinic Foundation
• Inventors: Iannotti, Joseph P., Barsoum, Wael K., Bryan, Jason A.
• Granted Patent: US 9,877,735 B2
• Time in Patent Office: Days
• US Class Current: 606/87
• CPC Class Codes: A61B 17/1728 for holes for bone plates or plate screws
• CPC Class Codes: A61B 17/1746 for the acetabulum
• CPC Class Codes: A61B 17/1753 for fixing pins through femoral hip prostheses
• CPC Class Codes: A61B 17/1778 for the shoulder
• CPC Class Codes: A61B 17/8061 specially adapted for particular bones A61B17/70 and A61B17/74 take precedence
• CPC Class Codes: A61B 17/8897 Guide wires or guide pins
• CPC Class Codes: A61B 17/90 Guides therefor
• CPC Class Codes: A61B 2017/00526 Methods of manufacturing
• CPC Class Codes: A61B 2017/568 produced with shape and dimensions specific for an individual patient
• CPC Class Codes: A61B 34/10 Computer-aided planning, simulation or modelling of surgical operations
• CPC Class Codes: A61F 2/34 Acetabular cups
• CPC Class Codes: A61F 2/4609 of acetabular cups
• 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 2002/3408 Shells having at least two sets of different apertures, e.g. one set located in the equatorial zone and another set located in the polar zone
• CPC Class Codes: A61F 2002/4687 Mechanical guides for implantation instruments

Abstract

A guide for assisting with attachment of a stock prosthetic implant to a patient tissue includes a lower guide surface configured to contact an upper implant surface of the stock prosthetic implant when a lower implant surface of the stock prosthetic implant contacts the patient tissue. An upper guide surface is accessible to a user when the lower guide surface is in contact with the upper implant surface. At least one guiding aperture extends through the guide body between the upper and lower guide surfaces at a predetermined aperture location with respect to the guide body and defines a predetermined target trajectory through the guide body. At least one of the target trajectory and the aperture location of each guiding aperture is preselected responsive to preoperative imaging of the patient tissue. A method of assisting with attachment of a stock prosthetic implant to a patient tissue is also provided.

Claims

1. A method of attaching a stock prosthetic implant to a patient tissue, the stock prosthetic implant including a plurality of fastener apertures extending therethrough, the method comprising the steps of:

placing a lower implant surface of the stock prosthetic implant into contact with the patient tissue in a predetermined implant orientation;

providing a guide having a lower guide surface contoured to substantially mate with at least a portion of an upper implant surface of the stock prosthetic implant, an upper guide surface spaced longitudinally apart from the lower guide surface by a guide body, and at least one guiding aperture extending through the guide body between the upper and lower guide surfaces at a predetermined aperture location with respect to the guide body;

defining a predetermined target trajectory through the guide body with a chosen guiding aperture, at least one of the target trajectory and the aperture location of each guiding aperture being preselected responsive to preoperative imaging of the patient tissue;

placing the lower guide surface into mating contact with at least a portion of the upper implant surface in a predetermined relative guide/implant orientation;

placing the chosen guiding aperture into a collinear relationship with a chosen one of the fastener apertures; and

at least one of guiding a surgical tool through the chosen guiding aperture and the corresponding chosen fastener aperture and inserting the surgical tool into the patient tissue along the target trajectory to create a fastener cavity in the patient tissue; and

guiding a fastener through the chosen fastener aperture and into the patient tissue along the target trajectory.

2. The method of claim 1, including the steps of:

removing the surgical tool from the guide;

removing the guide from the stock prosthetic implant;

placing at least one fastener through the chosen fastener aperture and inserting the fastener into the corresponding fastener cavity without placing the at least one fastener through the guiding aperture; and

securing the fastener within the fastener cavity to maintain the stock prosthetic implant in the predetermined implant orientation.

3. The method of claim 1, wherein the step of placing the lower guide surface into mating contact with at least a portion of the upper implant surface includes the steps of:

providing at least one locating protrusion extending from the lower guide surface toward the upper implant surface; and

nesting the locating protrusion into at least one of a preselected one of the fastener apertures and a location aperture of the upper implant surface.

4. The method of claim 1, including the step of limiting a depth of insertion of at least one of the surgical tool and the fastener into the patient tissue.

5. The method of claim 1, wherein the step of providing a guide includes at least one of the steps of:

custom-manufacturing the guide responsive to at least one of preoperative imaging of the patient tissue and preoperative selection of the stock prosthetic implant; and

modifying a stock guide responsive to at least one of preoperative imaging of the patient tissue and preoperative selection of the stock prosthetic implant.

6. The method of claim 1, including the step of preselecting each target trajectory and each aperture location to facilitate placement of the fastener into the stock prosthetic implant and the underlying patient tissue at a preselected fastener location and a preselected fastener trajectory after removal of the guide from the stock prosthetic implant.

7. The method of claim 1, including the steps of:

affixing at least one landmark to the patient tissue at a predetermined landmark location chosen responsive to preoperative imaging of the patient tissue; and

using the at least one landmark to assist with at least one of the steps of placing a lower implant surface of the stock prosthetic implant into contact with the patient tissue, placing the lower guide surface into mating contact with at least a portion of the upper implant surface, and placing the chosen guiding aperture into a collinear relationship with a chosen one of the fastener apertures.

8. The method of claim 1, wherein the step of placing a lower implant surface of the stock prosthetic implant into contact with the patient tissue in a predetermined implant orientation includes the steps of:

providing an orienting feature on the guide;

affixing at least one landmark to the patient tissue at a location spaced from a location of implantation of the stock prosthetic implant;

placing the lower guide surface into mating contact with at least a portion of the upper implant surface; and

repositioning the guide and mated implant to bring the orienting feature into a predetermined orienting relationship with the landmark.

9. The method of claim 8, wherein the orienting feature includes an orienting indicator, and the step of repositioning the guide and mated implant to bring the orienting feature into a predetermined orienting relationship with the landmark includes the step of repositioning the guide and mated implant to achieve a predetermined signaling relationship between the landmark and the orienting indicator.

10. The method of claim 8, wherein the step of repositioning the guide and mated implant to bring the orienting feature into a predetermined orienting relationship with the landmark includes the step of moving the stock prosthetic implant and the guide concurrently to move both the stock prosthetic implant into the predetermined implant orientation and the guide into the predetermined guide orientation.

11. A guide for assisting with attachment of a stock prosthetic implant to a patient tissue, the guide comprising:

a lower guide surface configured to contact an upper implant surface of the stock prosthetic implant when a lower implant surface of the stock prosthetic implant is in contact with the patient tissue, at least a portion of the lower guide surface being contoured to substantially mate with at least a portion of the upper implant surface;

an upper guide surface spaced longitudinally apart from the lower guide surface by a guide body, the upper guide surface being accessible to a user when the lower guide surface is in contact with the upper implant surface; and

at least one guiding aperture extending through the guide body between the upper and lower guide surfaces at a predetermined aperture location with respect to the guide body, the at least one guiding aperture defining a predetermined target trajectory through the guide body, and the at least one guiding aperture being collinear with a corresponding at least one fastener aperture in the stock prosthetic implant when the lower guide surface is mated with the upper implant surface;

wherein at least one of the target trajectory and the aperture location of each guiding aperture is preselected responsive to preoperative imaging of the patient tissue.

12. The guide of claim 11, wherein both the lower guide surface and the upper implant surface are concave in profile.

13. The guide of claim 11, wherein both the lower guide surface and the upper implant surface are convex in profile.

14. The guide of claim 11, wherein the stock prosthetic implant includes a predetermined number of fastener apertures, and the guide includes a predetermined number of guiding apertures which is no more than the predetermined number of fastener apertures, each guiding aperture being collinear with a predetermined one of the fastener apertures when the lower guide surface is mated with the upper implant surface.

15. The guide of claim 14, including at least one locating protrusion extending from the lower guide surface toward the upper implant surface, the locating protrusion being configured to nest into a preselected one of the fastener apertures.

16. The guide of claim 11, wherein at least one guiding aperture is configured to guide a surgical tool through a corresponding fastener aperture and into the patient tissue along the target trajectory to create a fastener cavity in the patient tissue.

17. The guide of claim 16, including at least one depth limiting feature configured to prevent further motion of at least one of a fastener and the surgical tool along the target trajectory and into the patient tissue past a predetermined depth.

18. The guide of claim 11, wherein the upper guide surface includes at least one orienting feature, the orienting feature being configured to guide the user in placing the guide in a predetermined relative guide/implant orientation with the stock prosthetic implant.

19. The guide of claim 11, being at least one of custom-manufactured and modified from a stock guide, responsive to at least one of preoperative imaging of the patient tissue and preoperative selection of the stock prosthetic implant.

20. The guide of claim 11, wherein each target trajectory and each aperture location is preselected responsive to preoperative imaging of the patient tissue, with each target trajectory and each aperture location being preselected to facilitate placement of a fastener into the stock prosthetic implant and the underlying patient tissue at a preselected fastener location and a preselected fastener trajectory after removal of the guide from the stock prosthetic implant.

21. The guide of claim 11, including an orienting feature, the orienting feature entering a predetermined orienting relationship with a previously placed landmark while the lower guide surface is in mating contact with at least a portion of the upper implant surface in a predetermined relative guide/implant orientation.

22. The guide of claim 21, wherein the orienting feature includes an orienting indicator, and the orienting indicator achieves a predetermined signaling relationship with the landmark while the guide and stock prosthetic implant are in the predetermined relative guide/implant orientation.

23. The guide of claim 21, wherein the stock prosthetic implant and the guide are moved concurrently to move both the guide and stock prosthetic implant into predetermined guide and implant orientations with respect to the patient tissue.

24. The guide of claim 11, wherein at least one locating protrusion extends from the lower guide surface and is configured to nest into a location aperture of the upper implant surface to assist with mating of the lower guide surface with at least a portion of the upper implant surface.

25. A guide for assisting with attachment of a stock prosthetic implant to a patient tissue, the guide comprising:

a lower guide surface configured to contact an upper implant surface of the stock prosthetic implant when a lower implant surface of the stock prosthetic implant is in contact with the patient tissue, the lower guide surface being contoured to substantially mate with at least a portion of the upper implant surface;

an upper guide surface spaced longitudinally apart from the lower guide surface by a guide body, the upper guide surface being accessible to a user when the lower guide surface is in contact with the upper implant surface; and

an orienting feature;

wherein

the orienting feature is configured to enter a predetermined orienting relationship with a previously placed landmark while the lower guide surface is in mating contact with at least a portion of the upper implant surface in a predetermined relative guide/implant orientation.

26. The guide of claim 25, wherein both the lower guide surface and the upper implant surface are concave in profile.

27. The guide of claim 25, wherein both the lower guide surface and the upper implant surface are convex in profile.

28. The guide of claim 25, wherein the stock prosthetic implant includes a predetermined number of fastener apertures, and the guide includes at least one locating protrusion extending from the lower guide surface toward the upper implant surface, the locating protrusion being configured to nest into a preselected one of the fastener apertures.

29. The guide of claim 25, being at least one of custom-manufactured and modified from a stock guide, responsive to at least one of preoperative imaging of the patient tissue and preoperative selection of the stock prosthetic implant.

30. The guide of claim 25, wherein the orienting feature includes an orienting indicator, and the orienting indicator achieves a predetermined signaling relationship with the landmark while the guide and stock prosthetic implant are in the predetermined relative guide/implant orientation.

31. The guide of claim 25, wherein the stock prosthetic implant and the guide are moved concurrently to move both the guide and stock prosthetic implant into predetermined guide and implant orientations with respect to the patient tissue.

32. The guide of claim 25, including at least one guide aperture extending through the guide body between the upper and lower guide surfaces, the guide aperture being configured to accept a landmark placed in a predetermined relationship with the patient tissue.