PATIENT SPECIFIC INSTRUMENTATION (PSI) FOR ORTHOPEDIC SURGERY

• US 20190209183A1
• Filed: 03/15/2019
• Published: 07/11/2019
• Est. Priority Date: 09/25/2013
• Status: Active Grant

• Current Assignee: Zimmer Incorporated (Zimmer Biomet Holdings, Inc.)
• Original Assignee: Zimmer Incorporated (Zimmer Biomet Holdings, Inc.)
• Inventors: COUTURE, Pierre, NGUYEN, Trong Tin, NEUROHR, Anselm Jakob, MERETTE, Jean-Sebastien
• Granted Patent: US 10,881,416 B2
• Time in Patent Office: Days
• 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 17/1764 for the knee
• CPC Class Codes: A61B 2017/568 produced with shape and dimensions specific for an individual patient
• 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: G16H 50/50 for simulation or modelling of medical disorders

Abstract

The patient specific instrument (PSI) assembly for guiding a surgical tool on a tibia during a knee replacement surgery includes an extra-medullary portion at a distal end, an elongated rod connected at a distal end to the extra-medullary portion and extending in a direction along a mechanical axis of the tibia, and an upper mounting portion at a proximal end. The extra-medullary portion has a pair of spaced apart malleoli clamping elements with a size and/or relative position that is patient-specific for engaging respective ones of the lateral and medial malleoli. The upper mounting portion including a base body connected to a proximal end of the elongated rod and a surgical guide having guide openings extending therethrough and anchor element(s) on the upper mounting portion in locations adapted to overlay a peripheral contour of the tibia. The peripheral contour of the tibia including an anterior surface of the proximal tibia.

Claims

1. A patient specific instrument assembly for guiding a surgical tool on a patient'"'"'s tibia during a knee replacement surgery, the patient specific instrument assembly comprising:

an extra-medullary portion at a distal end of the patient specific instrument assembly, the extra-medullary portion having a pair of spaced apart malleoli clamping elements for engaging respective ones of the lateral and medial malleoli of the patient, the malleoli clamping elements having a size and/or relative position that is patient-specific for engaging respective ones of the lateral and medial malleoli of the patient;

an elongated rod connected at a distal end to the extra-medullary portion, the elongated rod configured to extend in a direction along a mechanical axis of the patient'"'"'s tibia; and

an upper mounting portion at a proximal end of the patient specific instrument assembly, the upper mounting portion including a base body connected to a proximal end of the elongated rod and a surgical guide having guide openings extending therethrough, at least one of said guide openings adapted to receive the surgical tool, the surgical guide having one or more anchor elements disposed on the upper mounting portion in locations adapted to overlay a peripheral contour of the patient'"'"'s tibia, the peripheral contour of the patient'"'"'s tibia including an anterior surface of the patient'"'"'s proximal tibia.

2. The patient specific instrument assembly as defined in claim 1, wherein at least two of the guide openings are pin holes adapted for receiving locating pins and aligning said locating pins on the anterior surface of the patient'"'"'s proximal tibia, the locating pins being operable to mount the surgical guide to the patient'"'"'s tibia.

3. The patient specific instrument assembly as defined in claim 1, wherein at least one of the guide openings is a saw slot for receiving a saw of the surgical tool, the saw slot being operable to guide the saw along a resection plane transverse to the mechanical axis of the patient'"'"'s tibia.

4. The patient specific instrument assembly as defined in claim 1, wherein the malleoli clamping elements have a shape that is patient-specific and complementary to that of the patient'"'"'s lateral and medial malleoli.

5. The patient specific instrument assembly as defined in claim 1, wherein the surgical guide is removably attached to the base body.

6. The patient specific instrument assembly as defined in claim 2, wherein the surgical guide has a medially extending portion, the medially extending portion having said pin holes, the medially extending portion adapted to abut the anterior surface of the patient'"'"'s proximal tibia.

7. The patient specific instrument assembly as defined in claim 1, wherein the one or more anchor elements include an abutting surface on a bone abutting side of the surgical guide, the abutting surface forming one of said anchor elements, the abutting surface adapted to abut the anterior surface of the patient'"'"'s proximal tibia.

8. The patient specific instrument assembly as defined in claim 7, wherein the abutting surface has a shape that is patient-specific and complementary to that of the anterior surface of the patient'"'"'s proximal tibia.

9. The patient specific instrument assembly as defined in claim 1, wherein the surgical guide includes a posteriorly extending finger having a visual guide, for aligning the surgical guide with the mechanical axis of the patient'"'"'s tibia in a Varus-Valgus orientation.

10. The patient specific instrument assembly as defined in claim 1, wherein the one or more anchor elements include an anteriorly extending blade, the anteriorly extending blade forming one of said anchor elements.

11. The patient specific instrument assembly as defined in claim 1, further comprising a pair of arms extending posteriorly from the upper mounting portion, each of the arms having one of the anchor elements disposed near a remote end thereof, said one of the anchor elements forming a posterior anchor of the patient specific instrument assembly.

12. The patient specific instrument assembly as defined in claim 1, wherein the patient specific instrument assembly has at least three of said anchor elements thereon.

13. The patient specific instrument assembly as defined in claim 12, wherein the at least three anchor elements include two bone spikes spaced apart in a medial-lateral direction.

14. The patient specific instrument assembly as defined in claim 1, wherein the surgical guide is a first surgical guide, the first surgical guide being a tibial pin guide, the upper mounting portion including a second surgical guide, the second surgical guide being a resection cutting guide, at least one of the guide openings is a saw slot on the resection cutting guide for receiving a saw of the surgical tool, the saw slot being operable to guide the saw along a resection plane transverse to the mechanical axis of the patient'"'"'s tibia.

15. The patient specific instrument assembly as defined in claim 1, wherein the surgical guide is a resection cutting guide.

16. The patient specific instrument assembly as defined in claim 1, wherein the surgical guide and the base body are integrally formed.

17. The patient specific instrument assembly as defined in claim 1, wherein the patient specific instrument assembly is integrally formed of a material produced by additive manufacturing.

18. The patient specific instrument assembly as defined in claim 1, wherein the patient specific instrument assembly is formed based on a digital bone model.

19. A patient specific instrument assembly for guiding a surgical tool on a patient'"'"'s tibia during a knee replacement surgery, the patient specific instrument assembly comprising:

an extra-medullary portion at a distal end of the patient specific instrument assembly, the extra-medullary portion having a pair of spaced apart malleoli clamping elements for engaging respective ones of the lateral and medial malleoli of the patient, the malleoli clamping elements having a size and/or relative position that is patient-specific for engaging respective ones of the lateral and medial malleoli of the patient,

an elongated rod connected at a distal end to the extra-medullary portion, the elongated rod configured to extend in a direction along a mechanical axis of the patient'"'"'s tibia,

an upper mounting portion at a proximal end of the patient specific instrument assembly, the upper mounting portion including a base body connected to a proximal end of the elongated rod and a resection cutting guide, the resection cutting guide having;

a saw slot for receiving a saw of the surgical tool, the saw slot being operable to guide the saw along a resection plane transverse to the mechanical axis of the patient'"'"'s tibia;

and

an abutting surface on a bone abutting side of the resection cutting guide, the abutting surface adapted to abut the anterior surface of the patient'"'"'s proximal tibia;

wherein the resection cutting guide is made of a plastic or metallic material produced by additive manufacturing.

20. The patient specific instrument assembly as defined in claim 19, wherein the resection cutting guide has a pair of pin holes extending through the resection cutting guide, adapted for receiving locating pins and aligning said locating pins on an anterior surface of the patient'"'"'s proximal tibia, the locating pins being operable to mount the resection cutting guide to the patient'"'"'s tibia.