Changing relationship between bones

• US 6,423,063 B1
• Filed: 05/11/2000
• Issued: 07/23/2002
• Est. Priority Date: 08/20/1998
• Status: Expired due to Term

• Current Assignee: Bonutti Skeletal Innovations LLC (Acacia Research Corporation)
• Original Assignee: Peter M. Bonutti
• Inventors: Bonutti, Peter M.
• Primary Examiner(s): REIP, DAVID OWEN
• Application Number:
  US09/569,020
• Time in Patent Office: 803 Days
• Field of Search: 606/87, 606/88, 606/86, 606/75, 606/76, 606/77, 606/60, 606/61, 606/62, 606/90, 606/105, 623/416-420, 623/14.12, 623/16.11, 623/17.11, 623/17.16, 623/18.11, 623/23.63
• US Class Current: 606/60
• CPC Class Codes: A61B 17/562 Implants for placement in joint gaps without restricting joint motion, e.g. to reduce arthritic pain
• CPC Class Codes: A61B 17/8095 Wedge osteotomy devices
• CPC Class Codes: A61B 17/86 Pins or screws or threaded wires; nuts therefor A61B17/72 take precedence
• CPC Class Codes: A61F 2/0077 Special surfaces of prostheses, e.g. for improving ingrowth A61F2/30767 takes precedence
• CPC Class Codes: A61F 2/30734 Modular inserts, sleeves or augments, e.g. placed on proximal part of stem for fixation purposes or wedges for bridging a bone defect
• CPC Class Codes: A61F 2/38 for elbows or knees
• CPC Class Codes: A61F 2/442 Intervertebral or spinal discs, e.g. resilient non-disc-shaped intervertebral inflatable pockets A61F2/441; non-disc-shaped intervertebral fusion implants A61F2/4455
• CPC Class Codes: A61F 2/4455 for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages intervertebral discs A61F2/442
• CPC Class Codes: A61F 2002/0086 for preferentially controlling or promoting the growth of specific types of cells or tissues of bone tissue onto implantable joints A61F2002/3093
• CPC Class Codes: A61F 2002/30128 concentric ellipses
• CPC Class Codes: A61F 2002/30187 D-shaped or half-disc-shaped
• CPC Class Codes: A61F 2002/3023 wedge-shaped cylinders
• CPC Class Codes: A61F 2002/30232 Half-cylinders
• CPC Class Codes: A61F 2002/30518 with possibility of relative movement between the prosthetic parts
• CPC Class Codes: A61F 2002/30556 for adjusting thickness
• CPC Class Codes: A61F 2002/30578 having apertures, e.g. for receiving fixation screws
• CPC Class Codes: A61F 2002/30622 Implant for fusing a joint or bone material
• CPC Class Codes: A61F 2002/30736 Augments or augmentation pieces, e.g. wedges or blocks for bridging a bone defect
• CPC Class Codes: A61F 2002/30754 Implants for interposition between two natural articular surfaces
• CPC Class Codes: A61F 2002/30787 inclined obliquely with respect to each other
• CPC Class Codes: A61F 2220/0025 : Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
• CPC Class Codes: A61F 2230/0008 : elliptical or oval
• CPC Class Codes: A61F 2230/0034 : D-shaped
• CPC Class Codes: A61F 2230/0069 : cylindrical
• CPC Class Codes: A61F 2250/0009 : for adjusting thickness
• CPC Class Codes: A61F 2310/00976 : Coating or prosthesis-covering structure made of proteins or of polypeptides, e.g. of bone morphogenic proteins BMP or of transforming growth factors TGF
• CPC Class Codes: Y10S 606/907 : Composed of particular material or coated
• CPC Class Codes: Y10S 606/909 : Bone

Abstract

To change a spatial relationship between two or more bones in a patient'"'"'s body, a wedge member is moved into a joint between the bones. As the wedge member enters the joint, pivotal movement occurs between the bones to change the orientation of the bones relative to each other. The wedge member may have a circular cross sectional configuration and be moved into the joint by rotating the wedge member about an axis which extends between a thin leading edge portion and a thick trailing edge portion of the wedge member. Alternatively, the wedge member may have a cam-shaped configuration and be rotated through less than a revolution to apply force against the bones. The wedge member may have a porous construction which enables bone to grow through the wedge member and immobilize the joint. The wedge member may be coated with and/or contain bone growth promoting material. The wedge member may be connected to only one of the bones or may be connected to two adjacent bones. If the wedge member is connected to only one bone, the joint may be capable of being flexed after the wedge member is inserted into the joint.

Claims

1. A method comprising the steps of changing a spatial relationship between first and second bones which are ginter connected at a joint in a patient'"'"'s body, said step of changing a spatial relationship between the first and second bones includes moving a wedge member which is at least partially formed of biodegradable material into the joint between the first and second bones, said step of moving the wedge member into the joint between the first and second bones includes moving the second bone from a first orientation relative to the first bone to a second orientation relative to the first bone Under the influence of force applied against the second bone by the wedge member as the wedge member moves into the joint between the first and second bones, thereafter, transmitting force between the first and second bones through the wedge member while the second bone is in the second orientation relative to the first bone, and, thereafter, degrading biodegradable material of the wedge member.

2. A method as set forth in claim 1 further including the step of moving the second bone relative to the first bone under the influence of force applied against the second bone by the patient to change the orientation of the second bone relative to the first bone from the second orientation to a third orientation.

3. A method as set forth in claim 2 further including the steps of maintaining the wedge member stationary relative to one of said first and second bones during movement of said second bone.

4. A method as set forth in claim 1 wherein a first surface area on said first bone is adjacent to a first surface area on said second bone when the first and second bones are in the first orientation prior to performance of said step of moving the wedge member into the joint, said step of moving the wedge member into the joint includes sliding a first surface area on the wedge member along the first surface area on the first bone and sliding a second surface area on the wedge member along the first surface area on the second bone to move the first surface area on the second bone away from the first surface area on the first bone under the influence of force applied against the first surface area on the second bone by the wedge member.

5. A method as set forth in claim 1 wherein said step of moving a wedge member into a joint between the first and second bones includes rotating the wedge member about an axis which extends through the wedge member.

6. A method as set forth in claim 1 wherein said step of moving the wedge member into the joint between the first and second bones includes moving the wedge member along a path which extends between an end portion of the first bone and an end portion of the second bone without rotating the wedge member.

7. A method as set forth in claim 6 wherein said step of moving the wedge member along a path which extends between the end portions of the first and second bones includes increasing a distance between a surface area on the end portion of the first bone and a surface area on the second bone under the influence of force transmitted from the wedge member to the end portions of the first and second bones.

8. A method as set forth in claim 1 wherein said step of moving a wedge member into the joint between the first and second bones is performed with a thin end portion of the wedge member leading and a thick end portion of the wedge member trailing.

9. A method as set forth in claim 1 further including the steps of providing a plurality of wedge members at a location where an operation is to be performed on the patient, said step of providing a plurality of wedge members includes providing a plurality of wedge members having different acute angles between opposite side surfaces of the wedge members, and selecting one wedge member of the plurality of wedge members while the plurality of wedge members is at the location where an operation is to be performed on the patient, said step of transmitting force between the first and second bones through the wedge member includes transmitting force between the first and second bones through the selected one wedge member of the plurality of wedge members.

10. A method as set forth in claim 1 further including the steps of providing a plurality of wedge members at a location where an operation is to be performed on the patient, said step of providing a plurality of wedge members includes providing a plurality of wedge members of different sizes, and selecting one wedge member of the plurality of wedge members while the plurality of wedge members is at the location where an operation is| to be performed on the patient, said step of transmitting force between the first and second bones through the wedge member includes transmitting force between the first and second bones through the selected one wedge member of the plurality of wedge members.

11. A method comprising the steps of changing a spatial relationship between first and second bones which are interconnected at a joint in a patient'"'"'s body, said step of changing a spatial relationship between the first and second bones includes providing a plurality of wedge members at a location where an operation is to be performed on the patient, said step of providing a plurality of wedge members includes providing a plurality of wedge members of different sizes, selecting one wedge member from the plurality of wedge members while the plurality of wedge members is at the location where an operation is to be performed on the patient, moving the selected one of the plurality of wedge members into the joint between the first and second bones to move the second bone from a first orientation relative to the first bone to a second orientation relative to the first bone under the influence of force applied against the second bone by the selected one of the plurality of wedge members as the selected one of the plurality of wedge members moves into the joint between the first and second bones, and transmitting force between the first and second bones through the selected one of the plurality of wedge members while the second bone is in the second orientation relative to the first bone.

12. A method as set forth in claim 11 wherein the selected one of the plurality of wedge members is at least partially formed of biodegradable material, said method further includes the step of degrading biodegradable material of the selected one of the plurality of wedge members.

13. A method as set forth in claim 11 further including the steps of abrading a surface on the first bone and abrading a surface on the second bone prior to performing said step of moving the selected one of the plurality of wedge members into the joint between the first and second bones, said step of moving the selected one of the plurality of wedge members into the joint between the first and second bones includes engaging the abraded surface on the first bone with a first surface on the selected one of the plurality of wedge members and engaging the abraded surface on the second bone with a second surface on the selected one of the plurality of wedge members.

14. A method as set forth in claim 11 wherein said step of providing a plurality of wedge members of different sizes includes providing a plurality of wedge members with each wedge member having small openings extending through the wedge member to enable body tissue to grow through the selected wedge member of the plurality of wedge members while the selected wedge member is disposed in the joint between the first and second bones.

15. A method as set forth in claim 11 wherein said step of providing a plurality of wedge members of different sizes includes providing a plurality of wedge members formed of human bone.

16. A method as set forth in claim 11 wherein said step of providing a plurality of wedge members of different sizes includes providing a plurality of wedge members formed of animal bone.

17. A method as set forth in claim 11 wherein said step of providing a plurality of wedge members of different sizes includes providing a plurality of wedge members formed of metal.

18. A method as set forth in claim 11 wherein said step of providing a plurality of wedge members of different sizes includes providing a plurality of wedge members formed of porous material.

19. A method as set forth in claim 11 wherein said step of providing a plurality of wedge members of different sizes includes providing a plurality of wedge members formed of biodegradable material.

20. A method as set forth in claim 11 wherein said step of providing a plurality of wedge members of different sizes includes providing a plurality of wedge members formed of polymeric material.

21. A method as set forth in claim 11 further including the steps of fixedly securing the selected one of the plurality of wedge members to the first bone and fixedly securing the selected one of the plurality of wedge members to the second bone to prevent movement between the selected one of the plurality of wedge members and the first and second bones.

22. A method as set forth in claim 11 wherein each of the wedge members of the plurality of wedge members tapers from a thick end portion to a thin end portion, said step of moving the selected one of the plurality of wedge members into the joint between the first and second bones includes moving the selected one of the wedge members into the joint between the first and second bones with the thin end portion of the selected one of the plurality of wedge members leading and the thick end portion of the selected one of the plurality of wedge members trailing.

23. A method as set forth in claim 22 further including the steps of connecting the selected one of the plurality of wedge members with the first bone with a first fastener which extends from the thick end portion of the selected one of the wedge members into the first bone at a location disposed between the first and second bones, and connecting the selected one of the plurality of wedge members with the second bone with a second fastener which extends from the thick end portion of the selected one of the wedge members into the second bone at a location disposed between the first and second bones.

24. A method as set forth in claim 11 wherein said step of moving the selected one of the plurality of wedge members into the joint between the first and second bones includes sliding a first side of the wedge member along a surface on the first bone and sliding a second side of the wedge member along a surface on the second bone, said method further includes moving a first fastener through the first side of wedge member and through the surface on the first bone to connect the wedge member with the first bone and moving a second fastener through the second side of the wedge member and through the surface on the second bone to connect the wedge member with the second bone.

25. A method comprising the steps of providing a plurality of wedge members formed of bone at a location where an operation is to be performed on the patient, selecting one wedge member formed of bone from the plurality of wedge members formed of bone while the plurality of wedge members formed of bone is at the location where an operation is to be performed on the patient, moving the selected one of the plurality of wedge members formed of bone into the joint between the first and second bones, and transmitting force between the first and second bones through the selected one of the plurality of wedge members formed of bone.

26. A method as set forth in claim 25 further including the step of moving the second bone relative to the first bone under the influence of force applied against the second bone by the patient to change the orientation of the second bone relative to the first bone from the second orientation to a third orientation.

27. A method as set forth in claim 26 further including the steps of maintaining the selected one of the plurality of wedge members formed of bone stationary relative to one of said first and second bones during movement of said second bone.

28. A method as set forth in claim 25 wherein a first surface area on said first bone is adjacent to a first surface area on said second bone when the first and second bones are in a first orientation prior to performance of said step of moving the selected one of the plurality of wedge members formed of bone into the joint, said step of moving the selected one of the plurality of wedge members formed of bone into the joint includes sliding a first surface area on the selected one of the plurality of wedge members formed of bone along the first surface area on the first bone and sliding a second surface area on the selected one of the plurality of selected one of the plurality of wedge members formed of bone formed of bone along the first surface area on the second bone to move the first surface area on the second bone away from the first surface area on the first bone under the influence of force applied against the first surface area on the second bone by the selected one of the plurality of wedge members formed of bone.

29. A method as set forth in claim 25 wherein said step of moving the selected one of the plurality of wedge members formed of bone into a joint between the first and second bones includes rotating the selected one of the plurality of wedge members formed of bone about an axis which extends through the selected one of the plurality of wedge members formed of bone.

30. A method as set forth in claim 25 wherein said step of moving the selected one of the plurality of wedge members formed of bone into the joint between the first and second bones includes moving the selected one of the plurality of wedge members formed of bone along a path which extends between an end portion of the first bone and an end portion of the second bone without rotating the selected one of the plurality of wedge members formed of bone.

31. A method as set forth in claim 30 wherein said step of moving the selected one of the plurality of wedge members formed of bone along a path which extends between the end portions of the first and second bones includes increasing a distance between a surface area on the end portion of the first bone and a surface area on the second bone under the influence of force transmitted from the selected one of the plurality of wedge members formed of bone to the end portions of the first and second bones.

32. A method as set forth in claim 25 wherein said step of moving the selected one of the plurality of wedge members formed of bone into the joint between the first and second bones is performed with a thin end portion of the selected one of the plurality of wedge members formed of bone leading and a thick end portion of the selected one of the plurality of wedge members formed of bone trailing.

33. A method as set forth in claim 25 wherein said step of providing a plurality of wedge members formed of bone includes providing a plurality of wedge members formed of bone having different acute angles between opposite side surfaces of the wedge members.

34. A method comprising the steps of changing a spatial relationship between first and second bones which are interconnected at a joint in a patient'"'"'s body, said step of changing the spatial relationship between the first and second bones includes abrading a portion of the first bone at the joint between the first and second bones, abrading a portion of the second bone at the joint between the first and second bones, providing a wedge member which is at least partially formed of biodegradable material, and moving the wedge member which is at least partially formed of biodegradable material into the joint between the first and second bones, said step of moving the wedge member which is at least partially formed of biodegradable material into the joint between the first and second bones includes engaging the abraded portion of the first bone with the wedge member and engaging the abraded portion of the second bone with the wedge member.

35. A method as set forth in claim 34 further including the steps of providing a plurality of porous wedge members at a location where an operation is to be performed on the patient, said step of providing a plurality of porous wedge members includes providing a plurality of wedge members of different sizes, and selecting one wedge member from the plurality of wedge members for movement into the joint between the first and second bones while the plurality of wedge members is at the location where the operation is to be performed on the patient.