METHODS AND APPARATUS FOR CONFORMABLE PROSTHETIC IMPLANTS
A cutting tool is provided with an arcuate cutting blade that preferably engages a guide tool to create a curved resected surface during an arthroplasty procedure. In one embodiment, a depth of the cutting blade is sufficient to permit the simultaneous creation of resected surfaces on two bones that articulate, such as both the femur and the tibia for a given condyle, without the need to reposition the guide or the leg. In another embodiment, a cutting member has a generally rectangular cross-section along a longitudinal axis with a first and second surface having cutting teeth defined thereon and a third and fourth surface adapted to interface with a cutting guide positioned proximate the bone. In this embodiment, the cutting tool can resect the bone in two different directions without reorienting the cutting member.
This application is a continuation of U.S. patent application Ser. No. 11/075,840 filed Mar. 8, 2005, now U.S. Pat. No. 9,814,539 issued Nov. 14, 2017, which is a continuation-in-part of U.S. patent application Ser. No. 11/036,584 filed Jan. 14, 2005, now U.S. Pat. No. 7,815,645, which claims the benefit of U.S. Provisional Application No. 60/536,320 filed Jan. 14, 2004, and is a continuation-in-part of application Ser. No. 11/049,634 filed Feb. 2, 2005, now abandoned, which claims the benefit of U.S. Provisional Application No. 60/540,992 filed Feb. 2, 2004, and claims priority to U.S. Provisional Application No. 60/551,078 filed Mar. 8, 2004, and claims priority to U.S. Provisional Application No. 60/551,160 filed Mar. 8, 2004, and claims priority to U.S. Provisional Application No. 60/551,080 filed Mar. 8, 2004, and claims priority to U.S. Provisional Application No. 60/551,262 filed Mar. 8, 2004, and claims priority to U.S. Provisional Application No. 60/551,307 filed Mar. 8, 2004, and claims priority to U.S. Provisional Application No. 60/551,096 filed Mar. 8, 2004, and claims priority to U.S. Provisional Application No. 60/551,631 filed Mar. 8, 2004, the entire disclosures are hereby fully incorporated by reference.
BACKGROUND 1. Field of the InventionThis invention generally relates to methods and apparatus for bone resection to allow for the interconnection or attachment of various prosthetic devices with respect to the patient. More particularly, the present invention relates to methods and apparatus for improved cutting tools for resection and arthroplasty.
2. Background ArtDifferent methods and apparatus have been developed in the past to enable a surgeon to remove bony material to create specifically shaped surfaces in or on a bone for various reasons including to allow for attachment of various devices or objects to the bone. Keeping in mind that the ultimate goal of any surgical procedure is to restore the body to normal function, it is critical that the quality and orientation of the cut, as well as the quality of fixation, and the location and orientation of objects or devices attached to the bone, is sufficient to ensure proper healing of the body, as well as appropriate mechanical function of the musculoskeletal structure.
In total knee replacements, for example, a series of planar and/or curvilinear surfaces, or “resections,” are created to allow for the attachment of prosthetic or other devices to the femur, tibia, and/or patella. In the case of the femur, it is common to use the central axis of the femur, the posterior and distal femoral condyles, and/or the anterior distal femoral cortex as guides to determine the location and orientation of distal femoral resections. The location and orientation of these resections are critical in that they dictate the final location and orientation of the distal femoral implant. It is commonly thought that the location and orientation of the distal femoral implant are critical factors in the success or failure of the artificial knee joint. Additionally, with any surgical procedure, time is critical, and methods and apparatus that can save operating room time, are valuable. Past efforts have not been successful in consistently and/or properly locating and orienting distal femoral resections in a quick and efficient manner.
The use of oscillating sawblade based resection systems has been the standard in total knee replacement and other forms of bone resection for over 30 years. Other forms of arcuate and curvilinear sawblades and chisels have been proposed in the past as shown, for example, in U.S. Pat. Nos. 4,069,824 and 4,349,058 and PCT Publ. Appl. WO 97/05827, but these non-planar sawblade arrangement have not been widely accepted or adopted. Unfortunately, present approaches to using existing planar or non-planar saw blade instrumentation systems all possess certain limitations and liabilities.
Perhaps the most critical factor in the clinical success of any bone resection for the purpose of creating an implant surface on the bone is the accuracy of the implant's placement. This can be described by the degrees of freedom associated with each implant. In the case of a total knee arthroplasty (TKA), for example, for the femoral component these include location and orientation that may be described as Varus-Valgus Alignment, Rotational Alignment, Flexion-Extension Alignment, A-P location, Distal Resection Depth Location, and Mediolateral Location. Conventional instrumentation very often relies on the placement of ⅛ or 3/16 inch diameter pin or drill placement in the anterior or distal faces of the femur for placement of cutting guides. In the case of posterior referencing systems for TKA, the distal resection cutting guide is positioned by drilling two long drill bits into the anterior cortex across the longitudinal axis of the bone. As these long drills contact the oblique surface of the femur they very often deflect, following the path of least resistance into the bone. As the alignment guides are disconnected from these cutting guides, the drill pins will “spring” to whatever position was dictated by their deflected course thus changing their designated, desired alignment to something less predictable and/or desirable. This kind of error is further compounded by the “tolerance stacking” inherent in the use of multiple alignment guides and cutting guides.
Another error inherent in these systems further adding to mal-alignment is deflection of the oscillating sawblade during the cutting process. The use of an oscillating sawblade is very skill intensive as the blade will also follow the path of least resistance through the bone and deflect in a manner creating variations in the cut surfaces which further contribute to prosthesis mal-alignment as well as poor fit between the prosthesis and the resection surfaces. Despite the fact that the oscillating saw has been used in TKA and other bone resection procedures for more than 30 years, there are still reports of incidences where poor cuts result in significant gaps in the fit between the implant and the bone.
Improvements in the alignment and operation of cutting tools for resecting bone surfaces are desired in order to increase the consistency and repeatability of bone resection procedures as is the improvement of prosthetic stability in attachment to bone.
SUMMARYThe present invention provides for embodiments of cutting tools and soft tissue management techniques facilitating intraoperative and postoperative efficacy and ease of use. In one embodiment, the cutting tool is a side cutting tool that has only a portion of the arc of the cutting profile exposed for cutting and is preferably used in a dynamic cutting mode where the leg is moved in flexion to engage the exposed portion of the cutting profile. In another embodiment, a cutting tool having dual planar cutting profile, preferably orthogonal to each other, permits the cutting tool to be utilized to create multiple resected surfaces at different orientations without the need to disengage the cutting tool from the guide surfaces. In still another embodiment, the cutting tool is provided with an arcuate cutting blade that preferably engages a guide tool with spaced apart guide surfaces that permit the creation of resected surfaces on both the femur and the tibia for a given condyle without the need to reposition the guide or the leg.
The present invention utilizes a number of embodiments of cutting tools to remove bony material to create cut surfaces for prosthetic implant attachment and fixation. The overriding objects of the embodiments are to provide the ability to perform resection in very small incisions, the creation of precise and accurate cut(s), and to provide for soft tissue protection characteristics and features preventing the tool from accidentally harming soft tissue. Specifically, many of the cutting tool embodiments disclosed are either incapable or highly resistant to damaging soft tissue, or are by means disclosed prevented from coming into contact with soft tissue in the first place.
The present invention utilizes a number of embodiments of cutting guide technologies loosely or directly based on Profile Based Resection (PBR). The overriding objects of PBR technologies are to provide for significantly improved reproducibility of implant fit and alignment in a manner largely independent of the individual surgeon's manual skills, while providing for outstanding ease of use, economic, safety, and work flow performance.
The present invention utilizes a number of embodiments of alignment or drill guides to precisely and accurately determine the desired cutting guide location/orientation, thus cut surface location(s)/orientation(s), thus prosthetic implant location and orientation. The overriding objects of the embodiments are to precisely and accurately dictate the aforementioned locations and orientations while optionally enabling ease of use in conjunction with manually or Computer Assisted techniques, and while optionally enabling ease of use in minimally invasive procedures where surgical exposure and trauma are minimized.
The present invention utilizes a number of methods and apparatus embodiments of soft tissue management techniques and the devices supporting said techniques. The overriding object of these embodiments is to take advantage of the anatomy, physiology, and kinematics of the human body in facilitating clinical efficacy of orthopedic procedures.
It is an often repeated rule of thumb for orthopedic surgeons that a “Well placed, but poorly designed implant will perform well clinically, while a poorly placed, well designed implant will perform poorly clinically.” The present invention provides a method and apparatus for reducing implant placement errors in order to create more reproducible, consistently excellent clinical results in a manner that decreases risk to soft tissue, incision or exposure size requirements, manual skill requirements, and/or visualization of cutting action.
It should be clear that applications of the present invention is not limited to Total Knee Arthroplasty or the other specific applications cited herein, but are rather universally applicable to any form of surgical intervention where the resection of bone is required. These possible applications include, but are not limited to Unicondylar Knee Replacement, Hip Arthroplasty, Ankle Arthroplasty, Spinal Fusion, Osteotomy Procedures (such as High Tibial Osteotomy), ACL or PCL reconstruction, and many others. In essence, any application where an expense, accuracy, precision, soft tissue protection or preservation, minimal incision size or exposure are required or desired for a bone resection and/or prosthetic implantation is a potential application for this technology. In addition, many of the embodiments shown have unique applicability to minimally invasive surgical (MIS) procedures and/or for use in conjunction with Surgical Navigation, Image Guided Surgery, or Computer Aided Surgery systems.
The above summary is not intended to describe each illustrated embodiment or every implementation of the subject matter hereof. The figures and the detailed description that follow more particularly exemplify various embodiments.
Other important objects and features of the invention will be apparent from the following detailed description of the invention taken in connection with the accompanying drawings in which:
It should be noted that, in many of the figures, the cut surface created by the cutting tool in accordance with the techniques of the present invention are shown as having already been completed for the sake of clarity. Similarly, the bones may be shown as being transparent or translucent for the sake of clarity. The guides/pins, cutting tool, bones, and other items disclosed are may be similarly represented for the sake of clarity or brevity
FIGS. 1 Through 4The embodiments of the present invention are shown for femoral resection. For the sake of clarity, it should be noted that any combination of the forms of the present invention disclosed herein may be modified or combined to form constructs not specifically disclosed herein, but still within the scope of the present invention. The embodiments represented in
Looking at
It is of particular interest to note that what is described as the Inner cutting radius and the outer cutting radius in
It should also be noted that the methods described herein are applicable to the methods demonstrated in Provisional Patent Application Ser. No. 60/536,320 “Methods and Apparatus for Pinplasty Bone Resection”, and Provisional Patent Application Ser. No. 60/540,992, entitled “Methods and Apparatus for Wireplasty Bone Resection.”
It should also be noted that another embodiment of the present invention, represented in
This embodiment of the present invention is especially useful in determining the proper location, orientation, and implant size for modular tricompartment components, non-modular implants, and standard implants where the appropriate size, location, and orientation would be determined by that which best mimics existing articular bone surfaces thus resulting in optimal postoperative kinematic function. Alternatively, surgical navigation methods could be implemented in registering these articular surfaces and determining the resulting idealized implant location(s) and orientation(s) as reflected by the geometry and/or kinematics of the joint.
The following patents and patent applications describing various surgical navigation system and alignment and cutting guide systems that are beneficially utilized in whole or in part with the embodiments of the present invention are herein incorporated by reference: U.S. Pat. Nos. 2004/0122436, 2003/0069591, 2004/0039396, 2004/0153083, 5,810,827, 6,595,997, 2003/0069585, 2003/0028196, JP74214-2002, U.S. Pat. Nos. 2003/0208122, 6,725,080, 2004/0122305, 6,685,711, 2004/0153085, 2004/0152970, 6,694,168, WO04100758, WO04070580, WO04069036, U.S. Pat. Nos. 5,799,055, 6,236,875, 6,285,902, 6,340,363, 6,348,058, 6,430,434, 6,470,207, 6,477,400, 6,491,699, 6,697,664, 6,701,174, 6,711,432, 6,725,080, 6,796,988, and 6,827,723. Image guidance techniques typically involve acquiring preoperative images of the relevant anatomical structures and generating a data base which represents a three dimensional model of the anatomical structures. The relevant surgical instruments typically have a known and fixed geometry which is also defined preoperatively. During the surgical procedure, the position of the instrument being used is registered with the anatomical coordinate system and a graphical display showing the relative positions of the tool and anatomical structure may be computed in real time and displayed for the surgeon to assist the surgeon in properly positioning and manipulating the surgical instrument with respect to the relevant anatomical structure.
As is known in the art, the relevant dimensional data concerning an anatomical structure of interest, e.g., a femur, may be determined using data acquired from images of the anatomical structure to generate a data base representing a model of the anatomical structure. The model of the anatomical structure may be a three dimensional model which is developed by acquiring a series of two dimensional images of the anatomical structure. Alternatively, the model of the anatomical structure may be a set of two dimensional images having known spatial relationships or other data structure which can be used to convey information concerning the three dimensional form of the anatomical structure. The model of the anatomical structure may then be used to generate displays of the anatomical structure from various perspectives for preoperative planning purposes and intraoperative navigational purposes. A variety of technologies which may be employed to generate such a model of an anatomical structure are well known in the art and include computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), ultrasound scanning and fluoroscopic imaging technologies.
In one embodiment, the present invention contemplates a computer-based method of generating a surgical plan comprising reading digital data associated with a 3D (three-dimensional) model of a patient's bone, wherein the digital data resides in a memory in a computer; and generating a surgical plan for the patient's bone based on an analysis of the digital data associated with the 3D model. A surgical planner/simulator module in the computer assisted orthopedic surgery planner software makes a detailed surgical plan using realistic 3D computer graphics and animation. The simulated surgical plan may be viewed on a display seen of a personal computer. The planner module may also generate a pre-surgery report documenting various aspects of the bone surgery.
In one embodiment, cutting tools may be plunged across, along, or through the pin guides of the present invention in any direction desirable. The directions of tool movement with respect to the pins include those generally oblique, normal, or parallel to the long axis of any pin, guide, or guide surface of this invention. Furthermore, the cutting tools may move linearly with respect to the bone and/or guide, or may be manipulated to move in circular, nonlinear, or ‘sweeping motions.
Furthermore, although the pins can have the upper surface of the guide pins having been used to guide the cutting tool to create the cut surface, the pins could easily be located in a more anterior location allowing their ‘underside’ to act as the guide surface. This concept could be referred to as ‘undercutting.’ The technique of cutting while engaged to the ‘upper side’ of the pins could be referred to as ‘overcutting’ (a term not to be confused with removing too much bone).
Tibial resection in TKA can be somewhat frustrating to a certain percentage of orthopedic surgeons. This frustration appears to stem from the high demands upon the surgeon's manual skills or craftsmanship. The forms of the present invention may help alleviate this issue by providing positive guidance of the cutting tool throughout all or most of the cutting process. Also, it should be noted that these concepts allow for implementation with very small incisions.
Preferably, pin guide members are made of materials that are more durable than bone material and also at least as durable, if not more durable, than the materials of the planar saw blade of the cutting tool. Materials could be harder or softer than the material comprising the cutting tool, and in some cases the cutting tool and the pins could be the same material—this is especially viable for ceramics which have very nice bearing characteristics. Certain surface treatments for metal may also be advantageous (titanium nitride, ceramic or non-metallic coating). Preferably, the cutting tool is prevented from cutting or abrading the cutting guide to avoid debris generation. Although pulsating lavage will normally clean any debris from the cut surfaces, the possibility of a foreign body, allergic, or other adverse reaction should be avoided. In certain situations, however, it may be desirable to construct the pin member guides of allograft or autograft bone tissue, such as when used in cortical bone tissue where it may be acceptable to cut the pin member guides. Diamond, or other carbon-based materials, could also be utilized, cost permitting. Also, the pin guides could be constructed of plastics, liquid metal, or some other form of injection moldable material thereby reducing cost levels to an extent enabling the pins to be offered on a disposable or semi-disposable basis.
An example of the fiddle factor problem in existing alignment and guide systems is shown, for example, in the device by Grimm described in U.S. Patent Publ. No. 2004/0122436 (herein incorporated by reference). The actuation of the locking mechanism to fix the carriage with respect to the sphere will actually cause the carriage to rotate with respect to sphere. Thus in use, the surgeon would attain the correct location and orientation of the cutting tool guide of Grimm, as indicated on the computer display, and then attempt to lock varus valgus, flexion extension, and internal/external rotational alignment by way of the actuation of locking mechanism, but in doing so, the carriage, and thereby the cutting tool guide would shift from the desired orientation. This dynamic will force the surgeon to iteratively tighten the lock, adjust the carriage, tighten the lock a little more, adjust the carriage a little more, tighten the lock even more, adjust the carriage a little more, etc., until intraoperative time constraints would compel the surgeon to move forward with the procedure with alignment that is suboptimal. These problems can be compounded by several additional adjustments and locking mechanisms to similarly fiddle that need to be made prior to making the first cut.
Simply put, the major problem with the majority of surgically navigated “anchor-cutting guide linkage” type devices is that the act of locking the orientation and location of the cutting guide in place with respect to the anchor and/or the desired implant location and orientation actually causes the location and orientation of the cutting guides to change, in some cases radically. As the ultimate objectives of surgical navigation are to improve accuracy and promote and facilitate minimally invasive implantation, the fiddle factor problem clearly runs counter to these objectives.
This embodiment of the present invention solves the fiddle factor problem by providing for an elegant locking mechanism that secures a plurality of translation and rotational degrees of freedom in a manner which fails to shift the location and orientation of the cutting tool guide while it is being secured. More precisely, the sum of the force moment couples acting about the center of mass of the cutting tool guide(s) by the actuation of the locking mechanism are governed by the following equation: .SIGMA.M.sub.(x,y,z)+.SIGMA.F.sub.(x,y,z)=0 (1), where M=moments about three mutually orthogonal axes and F=forces about three mutually orthogonal axes.
The primary components of this embodiment of the present invention are shown in
The anchor possesses four primary features, either alone or in combination with the primary components of this embodiment of the present invention. Those features include a bone penetrating and anchor stabilizing feature (indicated as the anchor thread in
The locking sleeve possesses three primary features alone or in combination with the primary components of the embodiment of the present invention including a drag feature, a locking feature, and a surgeon grasping surface. These features coact to enable rapid and effective locking and quick release of the cutting tool guide with respect to the anchor. The drag feature coacts with the anchor, split sphere, and cutting tool guide to affect frictionally resisted movement of the cutting tool guide with respect to the anchor about 3, 4, 5, 6, 7, or 8 degrees of freedom.
The split sphere, in this embodiment of the invention, possesses three primary features alone or in combination with the primary components of the embodiment of the present invention including an articulation aperture feature, a spherical articulation feature, and a relief feature. As may be seen in
The spherical articulation feature of the split sphere enables both tri-axial rotational and single axial translational manipulation of the split sphere with respect to the anchor and along its long axis, as well as simultaneous locking of those degrees of freedom, and an additional axial translational degree of freedom of the articulation post of the cutting tool guide with respect to the articulation aperture feature of the split sphere. Locking is attained by compression of the locking channel feature (see
In the context of tibial resection for the embodiment of the present invention, the sphere articulates with respect to the anchor in 4 degrees of freedom (anterior to posterior, varus-valgus, internal external rotation, and flexion-extension) while the articulation post, and thereby the cutting tool guide, articulate with respect to the split sphere, and thereby the anchor and bone, in at least one additional degree of freedom (proximal-distal). The second function of the relief feature is to optionally allow the articulation post of the cutting tool guide to be rotationally keyed to the split sphere to enable the split sphere and cutting tool guide to be rotated in tandem with respect to the locking channel of the anchor.
In another embodiment of the present invention (not shown), the articulation post of the cutting tool guide could be split along its long axis and coact with an articulation feature on the cutting tool guide to enable mediolateral translation and locking of the cutting tool guide with respect to the bone wherein effective locking of the mediolateral degree of freedom would also be affected by actuation of the cone lock feature in addition to the aforementioned 5 degrees of freedom.
The complete disclosures of the patents, patent applications and publications cited herein are incorporated by reference in their entirety as if each were individually incorporated. Various modifications and alterations to this invention will become apparent to those skilled in the art without departing from the scope and spirit of this invention. It should be understood that this invention is not intended to be unduly limited by the illustrative embodiments and examples set forth herein and that such examples and embodiments are presented by way of example only with the scope of the invention intended to be limited only by the claims set forth herein.
Various embodiments of systems, devices, and methods have been described herein. These embodiments are given only by way of example and are not intended to limit the scope of the claimed inventions. It should be appreciated, moreover, that the various features of the embodiments that have been described may be combined in various ways to produce numerous additional embodiments. Moreover, while various materials, dimensions, shapes, configurations and locations, etc. have been described for use with disclosed embodiments, others besides those disclosed may be utilized without exceeding the scope of the claimed inventions.
Persons of ordinary skill in the relevant arts will recognize that the subject matter hereof may comprise fewer features than illustrated in any individual embodiment described above. The embodiments described herein are not meant to be an exhaustive presentation of the ways in which the various features of the subject matter hereof may be combined. Accordingly, the embodiments are not mutually exclusive combinations of features; rather, the various embodiments can comprise a combination of different individual features selected from different individual embodiments, as understood by persons of ordinary skill in the art. Moreover, elements described with respect to one embodiment can be implemented in other embodiments even when not described in such embodiments unless otherwise noted.
Although a dependent claim may refer in the claims to a specific combination with one or more other claims, other embodiments can also include a combination of the dependent claim with the subject matter of each other dependent claim or a combination of one or more features with other dependent or independent claims. Such combinations are proposed herein unless it is stated that a specific combination is not intended.
Any incorporation by reference of documents above is limited such that no subject matter is incorporated that is contrary to the explicit disclosure herein. Any incorporation by reference of documents above is further limited such that no claims included in the documents are incorporated by reference herein. Any incorporation by reference of documents above is yet further limited such that any definitions provided in the documents are not incorporated by reference herein unless expressly included herein.
For purposes of interpreting the claims, it is expressly intended that the provisions of 35 U.S.C. § 112(f) are not to be invoked unless the specific terms “means for” or “step for” are recited in a claim.
Claims
1-25. (canceled)
26. A method for performing a total knee arthroplasty procedure comprising:
- positioning a distal femoral cutting guide against a femur immediately adjacent an anterior periphery of a distal cut to be made on a distal end of the femur, the distal femoral cutting guide having a planar femoral guide surface adapted to guide an oscillating sawblade to create the distal cut, the anterior periphery of the distal cut having a curvilinear shape, and the planar femoral guide surface having a posterior periphery having a curvilinear shape mimicking the shape of the anterior periphery of the distal cut, wherein the shape of the posterior periphery of the planar femoral guide surface is based upon preoperatively acquired three-dimensional digital patient image data;
- engaging the sawblade with the planar femoral guide surface and creating the distal cut on the femur using the planar femoral guide surface to guide the sawblade with the planar femoral guide surface coplanar with the distal cut on the femur;
- prior to creating the distal cut, creating markings in the distal end of the femur using a marking element;
- removing the distal femoral cutting guide after creating the distal cut on the femur and disposing of the distal femoral cutting guide so that it is not used as a part of another total knee arthroplasty procedure;
- following removal of the distal femoral cutting guide, attaching a second femoral cutting guide to the femur, wherein the second cutting guide operably references the markings on the femur;
- using the second femoral cutting guide to create at least two of an anterior cut, an anterior chamfer cut, a posterior chamfer cut, and a posterior cut on the femur;
- positioning a tibial alignment guide on a proximal end of a tibia of the patient, the tibial alignment guide configured based on preoperatively acquired three-dimensional digital patient image data such that the tibial alignment guide simultaneously contacts the tibia at least at nine points that include at least three points on a non-resected medial tibial condyle, at least three points on a non-resected lateral tibial condyle and at least three points on a non-resected anterocentral surface of the tibia located medially of the points of contact with the lateral tibial condyle;
- positioning a proximal tibial cutting guide against a medial half of the proximal end of the tibia immediately adjacent an anterior periphery of a planar proximal cut to be made on a proximal end of the tibia with a location and orientation of the proximal tibial cutting guide being dictated by the tibial alignment guide, the proximal tibial cutting guide having only one planar tibial guide surface which is coplanar with the planar proximal cut and adapted to guide an oscillating sawblade to create the planar proximal cut, the anterior periphery of the planar proximal cut having a curvilinear shape, and the one planar tibial guide surface having a posterior periphery having a curvilinear shape mimicking the shape of at least a portion of a medial half of the anterior periphery of the planar proximal cut, wherein the shape of the posterior periphery of the one planar tibial guide surface is based upon preoperatively acquired three-dimensional digital patient image data, and wherein a lateral-most point of the posterior periphery of the planar tibial guide surface is located medially of a lateral-most of the points of contact between the tibial alignment guide and the lateral tibial condyle;
- engaging the sawblade with the one planar tibial guide surface of the proximal tibial cutting guide and creating the planar proximal cut on the tibia underlying both a medial condyle and a lateral condyle of the tibia using the one planar tibial guide surface to guide the sawblade with the one planar tibial guide surface positioned coplanar with the planar proximal cut;
- removing the proximal tibial cutting guide after creating the planar proximal cut on the tibia and disposing of the proximal tibial cutting guide so that it is not used as a part of another total knee arthroplasty procedure;
- implanting a total knee arthroplasty femoral implant on the distal end of the femur; and
- implanting a total knee arthroplasty tibial implant on the proximal end of the tibia.
27. The method of claim 26, where positioning a distal femoral cutting guide against the femur immediately adjacent an anterior periphery of a distal cut to be made on the distal end of the femur includes positioning the distal femoral cutting guide such that a portion of the distal femoral cutting guide wraps around an anteromedial corner of the distal end of the femur and extends at least partially posteriorly along a medial side of the distal end of the femur.
28. The method of claim 26, further comprising utilizing the proximal tibial cutting guide to create a second planar proximal cut on the tibia with the proximal tibial cutting guide, the second planar proximal cut being deeper on the tibia that the planar proximal cut.
29. The method of claim 26, wherein creating the distal cut on the femur using the planar femoral guide surface includes creating the distal cut across all of the distal end of the femur.
30. The method of claim 26, wherein the distal femoral cutting guide includes a second planar femoral guide surface that is not coplanar with the planar femoral guide surface and further comprising engaging the sawblade with the second planar femoral guide surface to create a second cut on the femur using the second planar femoral guide surface to guide the sawblade.
31. The method of claim 26, wherein the tibial implant has a periphery mimicking a periphery of the planar proximal cut, and wherein the periphery of the tibial implant is based on preoperatively acquired three-dimensional digital patient image data.
32. The method of claim 26, wherein the femoral implant has a periphery mimicking a periphery of cut bone surfaces on the femur, and wherein the periphery of the femoral implant is based on preoperatively acquired three-dimensional digital patient image data.
33. The method of claim 31, wherein the femoral implant has a periphery mimicking a periphery of cut bone surfaces on the femur, and wherein the periphery of the femoral implant is based on preoperatively acquired three-dimensional digital patient image data.
34. A method for performing a total knee arthroplasty procedure comprising:
- positioning a distal femoral cutting guide against a femur immediately adjacent an anterior periphery of a distal cut to be made on a distal end of the femur, the distal femoral cutting guide having a planar femoral guide surface adapted to guide an oscillating sawblade to create the distal cut, the anterior periphery of the distal cut having a curvilinear shape, and the planar femoral guide surface having a posterior periphery having a curvilinear shape mimicking the shape of the anterior periphery of the distal cut, wherein the shape of the posterior periphery of the planar femoral guide surface is based upon preoperatively acquired three-dimensional digital patient image data;
- engaging the sawblade with the planar femoral guide surface and creating the distal cut on the femur using the planar femoral guide surface to guide the sawblade with the planar femoral guide surface coplanar with the distal cut on the femur;
- prior to creating the distal cut, creating markings in the distal end of the femur using a marking element;
- removing the distal femoral cutting guide after creating the distal cut on the femur and disposing of the distal femoral cutting guide so that it is not used as a part of another total knee arthroplasty procedure;
- following removal of the distal femoral cutting guide, attaching a second femoral cutting guide to the femur, wherein the second cutting guide operably references the markings on the femur;
- using the second femoral cutting guide to create at least two of an anterior cut, an anterior chamfer cut, a posterior chamfer cut, and a posterior cut on the femur;
- positioning a tibial alignment guide on a proximal end of a tibia of the patient, the tibial alignment guide configured based on preoperatively acquired three-dimensional digital patient image data such that the tibial alignment guide simultaneously contacts the tibia at least at nine points that include at least three points on a non-resected medial tibial condyle, at least three points on a non-resected lateral tibial condyle and at least three points on a non-resected anterocentral surface of the tibia located medially of the points of contact with the lateral tibial condyle;
- positioning a proximal tibial cutting guide against a medial half of the proximal end of the tibia immediately adjacent an anterior periphery of a planar proximal cut to be made on a proximal end of the tibia with a location and orientation of the proximal tibial cutting guide being dictated by the tibial alignment guide, the proximal tibial cutting guide having only one planar tibial guide surface which is coplanar with the planar proximal cut and adapted to guide an oscillating sawblade to create the planar proximal cut, the anterior periphery of the planar proximal cut having a curvilinear shape, and the one planar tibial guide surface having a posterior periphery having a curvilinear shape mimicking the shape of at least a portion of a medial half of the anterior periphery of the planar proximal cut, wherein the shape of the posterior periphery of the one planar tibial guide surface is based upon preoperatively acquired three-dimensional digital patient image data, and wherein a lateral-most point of the posterior periphery of the planar tibial guide surface is located medially of a lateral-most of the points of contact between the tibial alignment guide and the lateral tibial condyle;
- engaging the sawblade with the one planar tibial guide surface of the proximal tibial cutting guide and creating the planar proximal cut on the tibia underlying both a medial condyle and a lateral condyle of the tibia using the one planar tibial guide surface to guide the sawblade with the one planar tibial guide surface positioned coplanar with the planar proximal cut;
- removing the proximal tibial cutting guide after creating the planar proximal cut on the tibia and disposing of the proximal tibial cutting guide so that it is not used as a part of another total knee arthroplasty procedure;
- implanting a total knee arthroplasty femoral implant on the distal end of the femur, and
- implanting a total knee arthroplasty tibial implant on the proximal end of the tibia, wherein the tibial implant has a periphery mimicking a periphery of the planar proximal cut, and wherein the periphery of the tibial implant is based on preoperatively acquired three-dimensional digital patient image data.
35. The method of claim 34, where positioning a distal femoral cutting guide against the femur immediately adjacent an anterior periphery of a distal cut to be made on the distal end of the femur includes positioning the distal femoral cutting guide such that a portion of the distal femoral cutting guide wraps around an anteromedial corner of the distal end of the femur and extends at least partially posteriorly along a medial side of the distal end of the femur.
36. The method of claim 34, further comprising utilizing the proximal tibial cutting guide to create a second planar proximal cut on the tibia with the proximal tibial cutting guide, the second planar proximal cut being deeper on the tibia that the planar proximal cut.
37. The method of claim 34, wherein creating the distal cut on the femur using the planar femoral guide surface includes creating the distal cut across all of the distal end of the femur.
38. The method of claim 34, wherein the distal femoral cutting guide includes a second planar femoral guide surface that is not coplanar with the planar femoral guide surface and further comprising engaging the sawblade with the second planar femoral guide surface to create a second cut on the femur using the second planar femoral guide surface to guide the sawblade.
39. The method of claim 34, wherein the femoral implant has a periphery mimicking a periphery of cut bone surfaces on the femur, and wherein the periphery of the femoral implant is based on preoperatively acquired three-dimensional digital patient image data.
40. A method for performing a total knee arthroplasty procedure comprising:
- positioning a distal femoral cutting guide against a femur immediately adjacent an anterior periphery of a distal cut to be made on a distal end of the femur, the distal femoral cutting guide having a planar femoral guide surface adapted to guide an oscillating sawblade to create the distal cut, the anterior periphery of the distal cut having a curvilinear shape, and the planar femoral guide surface having a posterior periphery having a curvilinear shape mimicking the shape of the anterior periphery of the distal cut, wherein the shape of the posterior periphery of the planar femoral guide surface is based upon preoperatively acquired three-dimensional digital patient image data;
- engaging the sawblade with the planar femoral guide surface and creating the distal cut on the femur using the planar femoral guide surface to guide the sawblade with the planar femoral guide surface coplanar with the distal cut on the femur;
- prior to creating the distal cut, creating markings in the distal end of the femur using a marking element;
- removing the distal femoral cutting guide after creating the distal cut on the femur and disposing of the distal femoral cutting guide so that it is not used as a part of another total knee arthroplasty procedure;
- following removal of the distal femoral cutting guide, attaching a second femoral cutting guide to the femur, wherein the second cutting guide operably references the markings on the femur;
- using the second femoral cutting guide to create at least two of an anterior cut, an anterior chamfer cut, a posterior chamfer cut, and a posterior cut on the femur;
- positioning a tibial alignment guide on a proximal end of a tibia of the patient, the tibial alignment guide configured based on preoperatively acquired three-dimensional digital patient image data such that the tibial alignment guide simultaneously contacts the tibia at least at nine points that include at least three points on a non-resected medial tibial condyle, at least three points on a non-resected lateral tibial condyle and at least three points on a non-resected anterocentral surface of the tibia located medially of the points of contact with the lateral tibial condyle;
- positioning a proximal tibial cutting guide against a medial half of the proximal end of the tibia immediately adjacent an anterior periphery of a planar proximal cut to be made on a proximal end of the tibia with a location and orientation of the proximal tibial cutting guide being dictated by the tibial alignment guide, the proximal tibial cutting guide having only one planar tibial guide surface which is coplanar with the planar proximal cut and adapted to guide an oscillating sawblade to create the planar proximal cut, the anterior periphery of the planar proximal cut having a curvilinear shape, and the one planar tibial guide surface having a posterior periphery having a curvilinear shape mimicking the shape of at least a portion of a medial half of the anterior periphery of the planar proximal cut, wherein the shape of the posterior periphery of the one planar tibial guide surface is based upon preoperatively acquired three-dimensional digital patient image data, and wherein a lateral-most point of the posterior periphery of the planar tibial guide surface is located medially of a lateral-most of the points of contact between the tibial alignment guide and the lateral tibial condyle;
- engaging the sawblade with the one planar tibial guide surface of the proximal tibial cutting guide and creating the planar proximal cut on the tibia underlying both a medial condyle and a lateral condyle of the tibia using the one planar tibial guide surface to guide the sawblade with the one planar tibial guide surface positioned coplanar with the planar proximal cut;
- removing the proximal tibial cutting guide after creating the planar proximal cut on the tibia and disposing of the proximal tibial cutting guide so that it is not used as a part of another total knee arthroplasty procedure;
- implanting a total knee arthroplasty femoral implant on the distal end of the femur, wherein the femoral implant has a periphery mimicking a periphery of cut bone surfaces on the femur, and wherein the periphery of the femoral implant is based on preoperatively acquired three-dimensional digital patient image data; and
- implanting a total knee arthroplasty tibial implant on the proximal end of the tibia, wherein the tibial implant has a periphery mimicking a periphery of the planar proximal cut, and wherein the periphery of the tibial implant is based on preoperatively acquired three-dimensional digital patient image data.
41. The method of claim 40, where positioning a distal femoral cutting guide against the femur immediately adjacent an anterior periphery of a distal cut to be made on the distal end of the femur includes positioning the distal femoral cutting guide such that a portion of the distal femoral cutting guide wraps around an anteromedial corner of the distal end of the femur and extends at least partially posteriorly along a medial side of the distal end of the femur.
42. The method of claim 40, further comprising utilizing the proximal tibial cutting guide to create a second planar proximal cut on the tibia with the proximal tibial cutting guide, the second planar proximal cut being deeper on the tibia that the planar proximal cut.
43. The method of claim 40, wherein creating the distal cut on the femur using the planar femoral guide surface includes creating the distal cut across all of the distal end of the femur.
44. The method of claim 40, wherein the distal femoral cutting guide includes a second planar femoral guide surface that is not coplanar with the planar femoral guide surface and further comprising engaging the sawblade with the second planar femoral guide surface to create a second cut on the femur using the second planar femoral guide surface to guide the sawblade.
Type: Application
Filed: Nov 13, 2017
Publication Date: May 10, 2018
Inventor: Timothy G. Haines (Saratoga Springs, NY)
Application Number: 15/810,726