Method of performing total knee arthroplasty

• US 9,192,459 B2
• Filed: 04/22/2014
• Issued: 11/24/2015
• Est. Priority Date: 01/14/2000
• Status: Expired due to Term

• Current Assignee: Bonutti Skeletal Innovations LLC (Acacia Research Corporation)
• Original Assignee: Bonutti Skeletal Innovations LLC (Acacia Research Corporation)
• Inventors: Bonutti, Peter M.
• Primary Examiner(s): Philogene, Pedro
• Application Number:
  US14/258,852
• Publication Number:
  US 20140228963A1
• Time in Patent Office: 581 Days
• Field of Search: 606 79- 85, 606/86.R, 606 87- 89, 606/96, 606/91, 128/898, 623/16.11, 623/20.32, 623/20.35, 623/14.12, 623/20.14, 623/20.15
• US Class Current: 1/1
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• 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 17/1604 Chisels; Rongeurs; Punches; Stamps
• CPC Class Codes: A61B 17/1666 for the acetabulum
• CPC Class Codes: A61B 17/1668 for the upper femur A61B17/164 takes precedence
• 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 17/1717 for applying intramedullary nails or pins
• CPC Class Codes: A61B 17/1721 for applying pins along or parallel to the axis of the femoral neck
• CPC Class Codes: A61B 17/1746 for the acetabulum
• CPC Class Codes: A61B 17/1764 for the knee
• CPC Class Codes: A61B 17/809 with bone-penetrating elements, e.g. blades or prongs bone staples A61B17/0642; intramedullary nails with a plate at an end A61B17/7233
• CPC Class Codes: A61B 17/8095 Wedge osteotomy devices
• CPC Class Codes: A61B 2017/00004 (bio)absorbable, (bio)resorbable, resorptive for implantable prostheses A61F2210/0004
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/0268 for the knee
• CPC Class Codes: A61B 2017/1602 Mills
• CPC Class Codes: A61B 2017/564 : Methods for bone or joint treatment
• CPC Class Codes: A61B 2034/102 : Modelling of surgical devices, implants or prosthesis
• CPC Class Codes: A61B 2034/105 : Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/107 : Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/2055 : Optical tracking systems
• CPC Class Codes: A61B 2046/201 : for extremities, e.g. having collection pouch
• CPC Class Codes: A61B 2046/205 : Adhesive drapes
• CPC Class Codes: A61B 2046/236 : with means for collecting drain fluid, e.g. drain tubes
• CPC Class Codes: A61B 2090/064 : for measuring force, pressure or mechanical tension
• CPC Class Codes: A61B 2090/366 : using projection of images directly onto the body
• CPC Class Codes: A61B 2090/376 : using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2217/005 : with suction drainage system
• CPC Class Codes: A61B 2217/007 : with irrigation system
• 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 34/30 : Surgical robots
• CPC Class Codes: A61B 42/00 : Surgical gloves; Finger-stalls specially adapted for surgery; Devices for handling or treatment thereof
• CPC Class Codes: A61B 46/00 : Surgical drapes
• CPC Class Codes: A61B 90/13 : guided by light, e.g. laser pointers
• CPC Class Codes: A61B 90/30 : Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
• CPC Class Codes: A61B 90/361 : Image-producing devices, e.g. surgical cameras
• CPC Class Codes: A61B 90/37 : Surgical systems with images on a monitor during operation
• CPC Class Codes: A61F 2/0077 : Special surfaces of prostheses, e.g. for improving ingrowth A61F2/30767 takes precedence
• CPC Class Codes: A61F 2/30721 : Accessories
• CPC Class Codes: A61F 2/30724 : Spacers for centering an implant in a bone cavity, e.g. in a cement-receiving cavity
• CPC Class Codes: A61F 2/30767 : Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
• CPC Class Codes: A61F 2/30771 : applied in original prostheses, e.g. holes or grooves
• CPC Class Codes: A61F 2/34 : Acetabular cups
• CPC Class Codes: A61F 2/38 : for elbows or knees
• CPC Class Codes: A61F 2/3836 : Special connection between upper and lower leg, e.g. constrained
• CPC Class Codes: A61F 2/3859 : Femoral components
• CPC Class Codes: A61F 2/3868 : with sliding tibial bearing
• CPC Class Codes: A61F 2/3872 : Meniscus for implantation between the natural bone surfaces
• CPC Class Codes: A61F 2/3877 : Patellae or trochleae
• CPC Class Codes: A61F 2/389 : Tibial components A61F2/3868 takes precedence
• CPC Class Codes: A61F 2/4609 : of acetabular cups
• CPC Class Codes: A61F 2/461 : of knees
• CPC Class Codes: A61F 2/4684 : Trial or dummy prostheses
• CPC Class Codes: A61F 2002/2817 : Bone stimulation by chemical reactions or by osteogenic or biological products for enhancing ossification, e.g. by bone morphogenetic or morphogenic proteins [BMP] or by transforming growth factors [TGF]
• CPC Class Codes: A61F 2002/2825 : Femur
• CPC Class Codes: A61F 2002/2835 : Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
• CPC Class Codes: A61F 2002/30079 : magnetic
• CPC Class Codes: A61F 2002/30326 : differing in height or in length
• CPC Class Codes: A61F 2002/30331 : made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
• CPC Class Codes: A61F 2002/30364 : Rotation about the common longitudinal axis
• CPC Class Codes: A61F 2002/30387 : Dovetail connection
• CPC Class Codes: A61F 2002/30398 : Sliding
• CPC Class Codes: A61F 2002/30433 : using additional screws, bolts, dowels, rivets or washers e.g. connecting screws
• CPC Class Codes: A61F 2002/30507 : using a threaded locking member, e.g. a locking screw or a set screw
• CPC Class Codes: A61F 2002/30761 : Support means for artificial cartilage, e.g. cartilage defect covering membranes
• CPC Class Codes: A61F 2002/30883 : dovetail-shaped
• CPC Class Codes: A61F 2002/30892 : parallel
• CPC Class Codes: A61F 2002/3092 : having an open-celled or open-pored structure
• CPC Class Codes: A61F 2002/30934 : Special articulating surfaces
• CPC Class Codes: A61F 2002/30975 : made of two halves
• 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 2002/3895 : unicompartimental
• CPC Class Codes: A61F 2002/4631 : the prosthesis being specially adapted for being cemented
• CPC Class Codes: A61F 2002/4635 : using minimally invasive surgery
• CPC Class Codes: A61F 2002/4677 : using a guide wire
• CPC Class Codes: A61F 2210/009 : magnetic
• CPC Class Codes: A61F 2220/0025 : Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
• CPC Class Codes: A61F 2220/0033 : made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
• CPC Class Codes: A61F 2220/0041 : using additional screws, bolts, dowels or rivets, e.g. connecting screws
• CPC Class Codes: A61F 2250/0037 : differing in height or in length
• CPC Class Codes: A61F 2310/00011 : Metals or alloys
• CPC Class Codes: A61F 2310/00017 : Iron- or Fe-based alloys, e.g. stainless steel
• CPC Class Codes: A61F 2310/00023 : Titanium or titanium-based alloys, e.g. Ti-Ni alloys
• CPC Class Codes: A61F 2310/00029 : Cobalt-based alloys, e.g. Co-Cr alloys or Vitallium
• CPC Class Codes: A61F 2310/00131 : Tantalum or Ta-based alloys
• CPC Class Codes: A61F 2310/00365 : Proteins; Polypeptides; Degradation products thereof
• CPC Class Codes: A61G 13/0045 : specially adapted for hand or wrist surgeries
• CPC Class Codes: A61G 13/0054 : specially adapted for back or spinal surgeries
• CPC Class Codes: A61G 13/0063 : specially adapted for knee surgeries
• CPC Class Codes: A61G 13/0072 : specially adapted for shoulder surgeries
• CPC Class Codes: A61G 13/0081 : specially adapted for hip surgeries
• CPC Class Codes: A61G 13/1245 : Knees, upper or lower legs
• CPC Class Codes: A61G 13/125 : Ankles or feet

Abstract

An improved method of performing total knee arthroplasty. The method including making an incision having a length of less than eleven (11) centimeters proximate a knee joint of a leg of a patient. Performing all of the following through the incision: moving a femoral cutting guide through the incision; positioning the femoral cutting guide against a femur of the leg; cutting a medial condyle, a lateral condyle, and a trochlear groove of the femur of the leg to create at least one femoral cut surface; moving a unitary femoral component of a knee implant through the incision to replace articulating surfaces of the medial and lateral condyles and the trochlear groove; and positioning the unitary femoral component with respect to the at least one femoral cut surface.

Claims

1. A method of performing total knee arthroplasty, the method comprising:

making an incision having a length of less than eleven (11) centimeters proximate a knee joint of a leg of a patient, and performing the following through the incision;

subluxing a patella of the leg without everting the patella so that an inner side surface of the patella remains in a position facing a femur;

moving a femoral cutting guide through the incision;

positioning the femoral cutting guide against the femur of the leg;

securing the femoral cutting guide to the femur of the leg;

positioning a cutting tool in association with a guide surface of the femoral cutting guide;

cutting a medial condyle, a lateral condyle, and a trochlear groove of the femur of the leg with the cutting tool to create at least one femoral cut surface;

moving a single unitary femoral component of a knee implant through the incision to replace all three of the articulating surfaces of the medial and lateral condyles and the trochlear groove; and

positioning the single unitary femoral component with respect to the at least one femoral cut surface.

2. The method of claim 1, wherein the incision is located adjacent a medial edge of the patella of the leg.

3. The method of claim 1, further comprising:

moving a tibial cutting guide through the incision;

positioning the tibial cutting guide against a tibia of the leg;

cutting the tibia of the leg to create at least one tibial cut surface;

moving a tibial component of the knee implant through the incision; and

positioning the tibial component with respect to the at least one tibial cut surface.

4. The method of claim 3, further comprising utilizing an extramedullary alignment guide for the positioning the tibial cutting guide.

5. The method of claim 1, wherein the incision is made when the knee joint of the leg is flexed.

6. The method of claim 1, wherein the incision is made when the knee joint of the leg is extended.

7. The method of claim 6, wherein a length of the guide surface of the femoral cutting guide is less than a distance between the medial and lateral condyles of the femur.

8. The method of claim 1, further comprising utilizing an intramedullary alignment guide for the positioning the femoral cutting guide.

9. The method of claim 1, wherein the length of the incision is less than ten (10) centimeters.

10. The method of claim 1, wherein the incision is stretched with at least one mechanical or pneumatic retractor.

11. The method of claim 1, wherein at least a portion of the incision is at an acute angle to a central longitudinal axis of the patella of the leg.

12. A method of performing total knee arthroplasty, the method comprising:

making an incision having a length of less than eleven (11) centimeters proximate a knee joint of a leg of a patient, and performing the following through the incision;

moving a femoral cutting guide through the incision;

positioning the femoral cutting guide against a femur of the leg;

securing the femoral cutting guide to the femur of the leg;

positioning a cutting tool in association with a guide surface of the femoral cutting guide;

cutting a medial condyle, a lateral condyle, and a trochlear groove of the femur of the leg with the cutting tool to create at least one femoral cut surface;

moving a single unitary femoral component of a knee implant through the incision to replace all three of the articulating surfaces of the medial and lateral condyles and the trochlear groove;

positioning the signal unitary femoral component with respect to the at least one femoral cut surface

cutting a portion of a patella of the leg to create a patellar cut surface;

moving a patellar component of the knee implant through the incision; and

positioning the patellar component with respect to the patellar cut surface.

13. A method of performing total knee arthroplasty, the method comprising:

making an incision having a length between nine (9) and twelve (12) centimeters proximate a knee joint of a leg of a patient, and performing the following through the incision;

moving a femoral cutting guide through the incision;

positioning the femoral cutting guide against a femur of the leg;

securing the femoral cutting guide to the femur of the leg;

positioning a cutting tool in association with a guide surface of the femoral cutting guide;

cutting a medial condyle, a lateral condyle, and a trochlear groove of the femur of the leg with the cutting tool to create at least one femoral cut surface;

moving a single unitary femoral component of a knee implant through the incision to replace all three of the articulating surfaces of the medial and lateral condyles and the trochlear groove;

positioning the single unitary femoral component with respect to the at least one femoral cut surface

cutting a portion of a patella to create a patellar cut surface;

moving a patellar component of the knee implant through the incision; and

positioning the patellar component with respect to the patellar cut surface.

14. The method of claim 13, wherein the incision is located adjacent a medial edge of the patella of the leg.

15. The method of claim 14, further comprising:

moving a tibial cutting guide through the incision;

positioning the tibial cutting guide against a tibia of the leg;

cutting the tibia of the leg to create at least one tibial cut surface;

moving a tibial component of the knee implant through the incision; and

positioning the tibial component with respect to the at least one tibial cut surface.

16. The method of claim 15, further comprising utilizing an extramedullary alignment guide for the positioning the tibial cutting guide.

17. The method of claim 13, wherein the incision is made when the knee joint of the leg is flexed.

18. The method of claim 13, wherein the incision is made when the knee joint of the leg is extended.

19. The method of claim 18, wherein a length of the guide surface of the femoral cutting guide is less than a distance between the medial and lateral condyles of the femur.

20. The method of claim 13, further comprising utilizing an intramedullary alignment guide for the positioning the femoral cutting guide.

21. The method of claim 13, wherein the length of the incision is between ten (10) and eleven (11) centimeters.

22. The method of claim 13, wherein the incision is stretched with at least one mechanical or pneumatic retractor.

23. The method of claim 13, wherein at least a portion of the incision is at an acute angle to a central longitudinal axis of the patella of the leg.

24. A method of performing total knee arthroplasty, the method comprising:

making an incision having a length between nine (9) and twelve (12) centimeters proximate a knee joint of a leg of a patient, and performing the following through the incision;

subluxing a patella of the leg without everting the patella so that an inner side of the patella remains in a position facing the femur;

moving a femoral cutting guide through the incision;

positioning the femoral cutting guide against a femur of the leg;

securing the femoral cutting guide to the femur of the leg;

positioning a cutting tool in association with a guide surface of the femoral cutting guide;

cutting a medial condyle, a lateral condyle, and a trochlear groove of the femur of the leg with the cutting tool to create at least one femoral cut surface;

moving a single unitary femoral component of a knee implant through the incision to replace all three of the articulating surfaces of the medial and lateral condyles and the trochlear groove; and

positioning the single unitary femoral component with respect to the at least one femoral cut surface.