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

• US 20180125509A1
• Filed: 12/19/2017
• Published: 05/10/2018
• Est. Priority Date: 10/29/2010
• Status: Active Application

• Current Assignee: Cleveland Clinic Foundation
• Original Assignee: Cleveland Clinic Foundation
• Inventors: IANNOTTI, Joseph P., BARSOUM, Wael K., BRYAN, Jason A.
• Granted Patent: US 10,258,352 B2
• Time in Patent Office: Days
• 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, 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, and two or more locating protrusions extending from the lower guide surface toward the upper implant surface for engaging the upper implant surface, the two or more locating protrusions being spaced apart from the at least one guiding aperture;

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

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

placing a chosen one of the at least one guiding aperture of the guide into a collinear relationship with a chosen one of the plurality of fastener apertures of the stock implant, and nesting the two or more locating protrusions of the guide into preselected ones of the plurality of fastener apertures of the stock prosthetic implant, wherein the guide and the guide and the stock prosthetic implant are engaged together in a fixed rotational orientation relationship when the two or more locating protrusions are nested with the preselected ones of the plurality of fastener apertures, such that relative rotation between the guide and the stock prosthetic implant is prevented in the fixed rotational relationship; and

at least one of guiding a surgical tool through the chosen guiding aperture and the chosen one of the plurality of fastener apertures 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 one of the plurality of fastener apertures 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.

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.

3. (canceled)

11-32. -32. (canceled)

33. A method of attaching a stock prosthetic implant to a patient tissue using a guide, the stock prosthetic implant including a lower implant surface, an upper implant surface, and a plurality of fastener apertures extending between the lower and upper implant surfaces, the guide including a lower guide surface contoured to at least partially mate with the 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, the method comprising the steps of:

providing the guide with two or more locating protrusions extending from the lower guide surface toward the upper implant surface for engaging the upper implant surface, the two or more locating protrusions being spaced apart from the at least one guiding aperture;

preselecting a target trajectory for a fastener though a chosen one of the plurality of fastener apertures of the stock prosthetic implant responsive to preoperative imaging of the patient tissue;

placing the lower implant surface of the stock prosthetic implant into contact with the patient tissue in a predetermined implant orientation, and placing the lower guide surface of the guide into mating contact with the upper implant surface of the stock prosthetic implant;

aligning the at least one guiding aperture of the guide into a collinear relationship with the chosen one of the plurality of fastener apertures of the stock prosthetic implant, the target trajectory extending through both the at least one guiding aperture and the chosen one of the plurality of fastener apertures;

engaging the guide and the stock prosthetic implant together in a fixed rotational orientation relationship by nesting the two or more locating protrusions of the guide into preselected ones of the plurality of fastener apertures of the stock prosthetic implant, wherein relative rotation between the guide and the stock prosthetic implant is prevented in said fixed rotational relationship; and

guiding a fastener along the target trajectory through the at least one guiding aperture and the chosen one of the plurality of fastener apertures, and into the patient tissue to attach the stock prosthetic implant to the patient tissue.

34. The method of claim 33, further comprising at least one of guiding a surgical tool through the chosen guiding aperture and the chosen one of the plurality of fastener apertures and inserting the surgical tool into the patient tissue along the target trajectory to create a fastener cavity in the patient tissue.

35. The method of claim 34, 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.

36. The method of claim 34, including the step of limiting a depth of insertion of at least one of the surgical tool and the fastener into the patient tissue.

37. The method of claim 33, further comprising:

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.

38. The method of claim 33, 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.

39. The method of claim 33, 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.

40. The method of claim 33, 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.

41. The method of claim 40, 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.

42. The method of claim 40, 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.