Patient selectable joint arthroplasty devices and surgical tools incorporating anatomical relief

• US 8,623,026 B2
• Filed: 08/10/2011
• Issued: 01/07/2014
• Est. Priority Date: 02/06/2006
• Status: Active Grant

• Current Assignee: Conformis Incorporated
• Original Assignee: Conformis Incorporated
• Inventors: Wong, Terrance, Bojarski, Raymond A., Steines, Daniel, Lang, Philipp
• Primary Examiner(s): Philogene, Pedro
• Application Number:
  US13/207,396
• Publication Number:
  US 20120041446A1
• Time in Patent Office: 881 Days
• Field of Search: 606/96, 606/99, 606/85, 606/86.R, 606/87, 606/88, 606/89, 295/92
• US Class Current: 606/96
• 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 17/1703 using imaging means, e.g. by X-rays
• CPC Class Codes: A61B 17/1746 for the acetabulum
• CPC Class Codes: A61B 17/175 for preparing the femur for hip prosthesis insertion
• CPC Class Codes: A61B 17/1778 for the shoulder
• CPC Class Codes: A61B 2017/568 produced with shape and dimensions specific for an individual patient
• CPC Class Codes: A61B 2034/102 Modelling of surgical devices, implants or prosthesis
• CPC Class Codes: A61B 2034/104 Modelling the effect of the tool, e.g. the effect of an implanted prosthesis or for predicting the effect of ablation or burring
• 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 2034/2065 Tracking using image or pattern recognition
• 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 5/4514 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: A61F 2/3859 : Femoral components
• CPC Class Codes: A61F 2/389 : Tibial components A61F2/3868 takes precedence
• CPC Class Codes: A61F 2/46 : Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
• CPC Class Codes: A61F 2002/3069 : Revision endoprostheses
• CPC Class Codes: B33Y 70/00 : Materials specially adapted for additive manufacturing
• CPC Class Codes: B33Y 80/00 : Products made by additive manufacturing
• 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 assistance tool for joint arthroplasty, the surgical assistance tool comprising:

a first template, the first template including;

at least one surface for engaging at least a portion of a trochlear region of a knee joint of a patient, the at least one surface being substantially a negative of one or more portions of the trochlear region;

at least one relieved portion of the surface, the at least one relieved portion being relieved relative to a corresponding sub-portion of the trochlear region such that the at least one relieved portion does not engage the corresponding sub-portion of the trochlear region when the at least one surface is engaged with the portion of the trochlear region; and

at least one guide for directing movement of a surgical instrument; and

wherein said guide has a predetermined orientation relative to an anatomical or a biomechanical axis associated with the knee joint of the patient.

2. The surgical assistance tool of claim 1, wherein said at least one relieved portion corresponds to one or more portions of a trochlear groove.

3. The surgical assistance tool of claim 1, wherein the at least one guide includes at least one of the features selected from the group of features consisting of a guide aperture, a reaming aperture, a drill aperture, a cutting slot, and a cutting plane.

4. The surgical assistance tool of claim 1, further comprising an adjustment mechanism for adjusting a position of the at least one guide relative to the at least one surface.

5. The surgical assistance tool of claim 1, further comprising an adjustment mechanism for adjusting an orientation of the at least one guide relative to the at least one surface.

6. The surgical assistance tool of claim 1, wherein the at least one surface is substantially a negative of a portion of an articular cartilage surface of the trochlear region.

7. The surgical assistance tool of claim 1, wherein the at least one surface is substantially a negative of a portion of a subchondral bone surface of the trochlear region.

8. The surgical assistance tool of claim 1, wherein the at least one surface comprises a plurality of anatomical relief surfaces.

9. The surgical assistance tool of claim 1, wherein the at least one surface comprises a plurality of surfaces for engaging at least a portion of the trochlear region of the knee joint.

10. The surgical assistance tool of claim 1, wherein said at least one relieved portion accommodates one or more osteophytes on the trochlear region of the knee joint.

11. The surgical assistance tool of claim 1, wherein said at least one relieved portion accommodates an area of normal cartilage on the trochlear region of the knee joint.

12. The surgical assistance tool of claim 1, wherein said at least one relieved portion accommodates an area of diseased cartilage on the trochlear region of the knee joint.

13. The surgical assistance tool of claim 1, wherein said at least one relieved portion accommodates an area of normal and diseased cartilage on the trochlear region of the knee joint.

14. The surgical assistance tool of claim 1, wherein said at least one relieved portion accommodates an area of subchondral bone on the trochlear region of the knee joint.

15. A system for joint arthroplasty, the system comprising:

a first template, the first template including;

at least one surface for engaging a first articular surface of a joint, the at least one surface being substantially a negative of portions or all of the first articular surface;

at least a portion of the at least one surface further including an anatomical relief; and

at least one guide for directing movement of a surgical instrument; and

wherein said at least one guide has a predetermined orientation relative to an anatomical or a biomechanical axis associated with the joint.

16. The system of claim 15, wherein the at least one guide includes at least one of the features selected from the group of features consisting of a guide aperture, a reaming aperture, a drill aperture, a cutting slot, and a cutting plane.

17. The system of claim 15, further comprising an adjustment mechanism for adjusting a position of the at least one guide relative to the at least one surface.

18. The system of claim 15, further comprising an adjustment mechanism for adjusting an orientation of the at least one guide relative to the at least one surface.

19. The system of claim 15, wherein said anatomic relief accommodates one or more osteophytes on the first articular surface of the joint.

20. The system of claim 15, wherein said anatomic relief accommodates an area of normal cartilage on the first articular surface of the joint.

21. The system of claim 15, wherein said anatomic relief accommodates an area of diseased cartilage on the first articular surface of the joint.

22. The system of claim 15, wherein said anatomic relief accommodates an area of normal and diseased cartilage on the first articular surface of the joint.

23. The system of claim 15, wherein said anatomic relief accommodates an area of subchondral bone on the first articular surface of the joint.

24. A method of making a surgical tool, the method comprising:

obtaining image data associated with at least a portion of a joint;

deriving joint surface information from the image data;

determining at least a portion of the joint surface to be engaged by a contact surface;

determining an anatomical structure to be disengaged from a corresponding anatomical relief surface, and

providing a surgical tool that includes a guide, the contact surface and the anatomical relief surface, the contact surface for engaging at least a portion of the joint surface, the anatomical relief surface being substantially disengaged from the anatomical structure when the contact surface is engaged with the at least a portion of the joint surface, the guide being configured to direct movement of a surgical instrument.

25. The method according to claim 24, wherein the anatomical relief surface is adjacent to the contact surface.

26. The method according to claim 24, wherein an entirety of a perimeter of the anatomical relief surface is adjacent to the contact surface.

27. The method according to claim 24, wherein a portion of a perimeter of the anatomical relief surface is adjacent to the contact surface.

28. The method according to claim 24, wherein the anatomical relief surface is not adjacent to the contact surface.

29. The method according to claim 24, wherein the guide includes at least one of the features selected from the group of features consisting of a guide aperture, a reaming aperture, a drill aperture, a cutting slot, and a cutting plane.

30. The method according to claim 24, wherein the guide directs the surgical instrument in making a bone cut at a predetermined distance from a surface of the joint.

31. The method according to claim 24, wherein the guide directs the surgical instrument in making a planar bone cut in the joint.

32. The method according to claim 24, further comprising determining, from said image data, a desired orientation of an implant in relation to at least one reference selected from the group of references consisting of an anatomic landmark, an anatomic axis, and a biomechanical axis associated with the joint.

33. The method according to claim 24, wherein the derived joint surface comprises subchondral bone of the joint.

34. The method according to claim 24, wherein the derived joint surface comprises articular cartilage of the joint.

35. The method according to claim 24, wherein the surgical tool further comprises a plurality of anatomical relief surfaces.

36. The method according to claim 24, wherein said anatomic relief surface accommodates one or more osteophytes on the at least a portion of the joint surface.

37. The method according to claim 24, wherein said anatomic relief surface accommodates an area of normal cartilage on the at least a portion of the joint surface.

38. The method according to claim 24, wherein said anatomic relief surface accommodates an area of diseased cartilage on the at least a portion of the joint surface.

39. The method according to claim 24, wherein said anatomic relief surface accommodates an area of normal and diseased cartilage on the at least a portion of the joint surface.

40. The method according to claim 24, wherein said anatomic relief surface accommodates an area of subchondral bone on the at least a portion of the joint surface.

41. The method according to claim 24, wherein providing the surgical tool includes:

shaping the contact surface based on the derived joint surface information such that the contact surface is substantially a negative of the derived joint surface; and

determining position, shape and/or orientation of the at least one guide from the image data, such that changes induced on the implant site by the surgical instrument ensures a desired orientation of an implant.

42. The method according to claim 24, wherein the anatomical structure is an uncut surface portion of the joint.

43. The method according to claim 24, wherein the anatomical structure is a cut surface portion of the joint.

44. The method according to claim 24, wherein the anatomical structure is a trochlear groove.

45. The method according to claim 24, wherein the anatomical structure is an osteophyte.

46. A surgical assistance tool for joint arthroplasty, the surgical assistance tool comprising:

a first template, the first template including;

at least one surface for engaging at least a portion of a trochlear region of a knee joint, the at least one surface being substantially a negative of one or more portions of the trochlear cartilage;

at least a portion of the at least one surface further including an anatomical relief; and

at least one guide for directing movement of a surgical instrument.

47. The surgical assistance tool of claim 46, wherein said anatomic relief accommodates one or more osteophytes on the trochlear region of the knee joint.

48. The surgical assistance tool of claim 46, wherein said anatomic relief accommodates an area of normal cartilage on the trochlear region of the knee joint.

49. The surgical assistance tool of claim 46, wherein said anatomic relief accommodates an area of diseased cartilage on the trochlear region of the knee joint.

50. The surgical assistance tool of claim 46, wherein said anatomic relief accommodates an area of normal and diseased cartilage on the trochlear region of the knee joint.

51. The surgical assistance tool of claim 46, wherein said anatomic relief accommodates an area of subchondral bone on the trochlear region of the knee joint.

52. A system for joint arthroplasty, the system comprising:

a first template, the first template including;

at least one surface for engaging a first cartilage surface of a joint, the at least one surface being substantially a negative of portions of the first cartilage surface;

at least a portion of the surface further including an anatomical relief; and

at least one guide for directing movement of a surgical instrument; and

wherein said guide has a predetermined orientation relative to one of an anatomical and a biomechanical axis.

53. The system of claim 52, wherein said anatomic relief accommodates one or more osteophytes of the joint.

54. The system of claim 52, wherein said anatomic relief accommodates an area of normal cartilage of the joint.

55. The system of claim 52, wherein said anatomic relief accommodates an area of diseased cartilage of the joint.

56. The system of claim 52, wherein said anatomic relief accommodates an area of normal and diseased cartilage of the joint.

57. The system of claim 52, wherein said anatomic relief accommodates an area of subchondral bone of the joint.