HUMERAL IMPLANT AND SYSTEMS AND METHODS FOR IMPLANTING THE SAME

Various embodiments disclosed herein relate to stemmed and stemless humeral anchors, and implanting tools for use in shoulder arthroplasty procedures. For example, the humeral anchor can include a distal shaft portion, a proximal portion, and a metaphyseal portion connecting the distal shaft portion and the proximal portion. The distal shaft portion can include multiple apertures configured to receive a screw or one or more plugs. The proximal portion can include a stem face configured to be removably attached to an implanting tool or to couple to an anatomic insert or a reverse insert.

BACKGROUND

Field

The present application relates to reverse and anatomic shoulder prostheses for fracture repair.

Description of the Related Art

Arthroplasty is the standard of care for the treatment of shoulder joint arthritis. A typical anatomical shoulder joint replacement attempts to mimic anatomic conditions. For example, a metallic humeral stem and a humeral head replacement are attached to the humerus of the arm and replace the humeral side of the arthritic shoulder joint. Such humeral head replacement can articulate with the native glenoid socket or with an opposing glenoid resurfacing device.

For more severe cases of shoulder arthritis, the standard treatment is a reverse reconstruction, which includes reversing the kinematics of the shoulder joint. A reverse shoulder prosthesis can be provided by securing a semi-spherical device (sometimes called a glenoid sphere) to the glenoid and implanting a humeral stem with a cavity capable of receiving the glenoid sphere.

As patient disease may progress after anatomic treatment, revision surgery may be necessary to perform a reverse reconstruction of the shoulder. In the known art, the change in the type of prosthesis is addressed either below the plane of resection or above the plane of resection. In prostheses that are converted from anatomic to reverse by a modularity below the plane of resection, removal of anatomic devices that have integrated into the patient's bony anatomy proves to be difficult for the surgeon, and could potentially cause excessive patient bone loss. One advantage of such conversion is that the reverse insert could partially reside below the resection plane and therefore reduce the distance between the cavity and the lateral contour of the humerus. Such position has proven to be beneficial to a reversed kinematics. In the contrary, in prostheses that are converted from anatomic to reversed above the plane of resection, using an adaptor, reverse kinematics are altered as the position of the cavity is further pushed out of the humerus by the addition of the adaptor above the resection plane. Such constructs are typically made of three components that present an extra modularity in comparison to two component constructs and could potentially cause disassembly or breakage of the construct. One possibility to limit the alteration of the kinematics and limit the modularity is to inverse the bearing surface material by having a harder cavity within the humerus and a softer semi-spherical device secured to the glenoid. But the proven clinical design and preferred embodiment is usually that the cavity is softer than the semi-spherical device.

In cases of displaced or dislocated 3- and 4-part proximal humeral fractures, the proximal humerus also needs to be reconstructed. Although hemi-arthroplasty procedures may be used for the treatment of such displaced fractures, the functional outcomes of these procedures are often reported as poor and unpredictable.

SUMMARY

A convertible prosthesis that can be converted from an anatomic replacement to a reverse reconstruction without removal of parts integrated into the patient's bony anatomy is highly desirable. For improved patient outcomes, such a convertible prosthesis should respect the biomechanics of a true anatomic replacement while also performing well when converted into a reverse reconstruction. In some cases, it may also be desirable for the convertible prosthesis to be configured for use in a humeral fracture repair procedure.

Improved humeral anchors, components, assemblies, and methods are needed to provide more flexibility in working with soft tissue around the shoulder joint. Such anchors may benefit from multiple apertures that can each receive a plug or a screw for securing the humeral anchor in the patient. Such anchors may benefit from having a V-shaped profile to reduce the amount of bone the clinician has to remove from the patient to implant the humeral anchor.

In some aspects of the disclosure, a stem for a shoulder prosthesis is disclosed. The stem can include a medial side, a lateral side opposite the medial side, and a plurality of apertures. Each aperture of the plurality of apertures can be adapted to receive a screw or one or more plugs. The plurality of apertures can include a first aperture and a second aperture. The first aperture can be positioned proximal to the second aperture. Each of the first and second apertures can include a first opening on the medial side, a second opening on the lateral side, and a length measured along a longitudinal centerline therebetween. The longitudinal centerline of at least one of the first and second apertures can be angled relative to a longitudinal plane extending in a medial-lateral direction of the stem. Alternatively, the longitudinal centerline of each of at least one of the first and second apertures can be angled relative to a longitudinal plane extending in an anterior-proximal direction of the stem or relative to any plane of the stem.

The stem of the preceding paragraphs or as described further herein can also include one or more of the following features. Each of the first and second apertures can be angled in an anterior-posterior direction relative to the medial-lateral longitudinal plane. Alternatively, each of the first and second apertures can be angled in medial-lateral direction relative to the anterior-posterior longitudinal plane. The first and second apertures can be angled in opposite directions relative to the longitudinal plane. Alternatively, the first and second apertures can be angled in the same direction relative to the longitudinal plane. The stem can further include a distal shaft portion, a proximal portion, and a metaphyseal portion. The distal shaft portion can be adapted to be anchored in a medullary canal of a humerus. The proximal portion can having a stem face. The metaphyseal portion can extend between and connect the distal shaft portion and the proximal portion. The metaphyseal portion can include a medial portion and first and second lateral arms. Alternatively, the metaphyseal portion can include only one lateral arm or more than two lateral arms. The distal shaft portion can include the plurality of apertures. The distal shaft portion can include a plurality of grooves. The plurality of grooves can extend in a longitudinal direction. The plurality of grooves can be circumferentially spaced apart. Each of the plurality of grooves can narrow toward a distal tip of the stem. The first aperture can be positioned proximal to the plurality of grooves. The second aperture can extend through at least one of the plurality of grooves. Alternatively, the first and second apertures can both be positioned proximal to the plurality of grooves or extend through at least one of the plurality of grooves. The plurality of apertures can further include a third aperture positioned distal to the second aperture. The longitudinal centerline of each of the first and second apertures can be angled about 30° relative to the longitudinal plane of the stem. Alternatively, the longitudinal centerline of each of the first and second apertures can be angled at less than or more than about 30° relative to the longitudinal plane of the stem. For example, the angle can be about 15° or about 45°. The longitudinal centerline of each of the first and second apertures can be angled at different angles. For example, the longitudinal centerline of the first aperture can be angled at about 15° and the longitudinal centerline of the second aperture can be angled at about 45°.

A system including the stem of any of the preceding paragraphs and/or any of the stem described herein is disclosed. Each aperture of the plurality of apertures can include a first opening, a second opening, and a length measured along a longitudinal centerline therebetween. The system can include at least one plug adapted to be received by one or more apertures of the plurality of apertures of the stem.

The system of the preceding paragraphs or as described further herein can also include one or more of the following features. The at least one plug can include at least one elongate plug. A width of the at least one elongate plug can be less than a length thereof. The length of the one or more apertures of the plurality of apertures can be less than the length of the at least one elongate plug. Alternatively, the length of the one or more apertures of the plurality of apertures can be equal to or greater than the length of the at least one elongate plug. The one or more apertures of the plurality of apertures can be adapted to receive the at least one elongate plug along the entire length of the one or more apertures. A width of the at least one plug can be greater than a length thereof. The length of the one or more apertures of the plurality of apertures can be greater than the length of the at least one plug. Two or more of the plugs can be adapted to be inserted into an aperture of the one or more apertures along the longitudinal centerline.

A kit including the stem of any of the preceding paragraphs and/or any of the stem described herein is disclosed. The kit can include a reverse insert, an anatomical articular component, and/or a spacer. The reverse insert can have a proximal portion and a distal portion. The proximal portion of the reverse insert can include a concave surface configured to receive a glenosphere. The distal portion can include a protrusion. The reverse insert can be adapted to directly couple to the stem. The anatomical articular component can have a proximal portion and a distal portion. The proximal portion of the anatomical articular component can include a convex surface. The distal portion of the anatomical articular component can include a protrusion. The anatomical articular component can be adapted to directly couple to the stem. The spacer can include a proximal portion and a distal portion. The spacer can be adapted to couple the reverse insert or the anatomical articular component to the stem. The proximal portion of the spacer can be symmetric or asymmetric.

In some aspects of the disclosure, a kit for a shoulder prosthesis is disclosed. The kit can include a stem, a reverse insert, an anatomical articular component, and/or a spacer. The stem can include a distal shaft portion, a proximal portion, and a metaphyseal portion. The distal shaft portion can be adapted to be anchored in a medullary canal of a humerus. The proximal portion can have a stem face. The metaphyseal portion can include a medial portion and first and second lateral arms. Alternatively, the metaphyseal portion can include only one lateral arm or more than two lateral arms. The first and second lateral arms can extend between and connect the distal shaft portion and the proximal portion. The reverse insert can have a proximal portion and a distal portion. The proximal portion of the reverse insert can include a concave surface adapted to receive a glenosphere. The distal portion of the reverse insert can include a protrusion. The reverse insert can be adapted to directly couple to the stem face. The anatomical articular component can have a proximal portion and a distal portion. The proximal portion of the anatomical articular component can include a convex surface. The distal portion of the anatomical articular component can include a protrusion. The anatomical articular component can be adapted to directly couple to the stem face. The spacer can include a proximal portion, a distal portion, and a protrusion. The protrusion of the spacer can extend from a distal facing surface of the spacer. The spacer can be adapted to couple the reverse insert or the anatomical articular component to the stem. The proximal portion of the spacer can be asymmetric. The protrusion can be adapted to provide rotational alignment between the spacer and the stem.

The kit of the preceding paragraphs or as described further herein can also include one or more of the following features. The proximal portion of the spacer can be symmetric. The stem face can include a central cavity. The central cavity of the stem face can be adapted to receive the reverse insert or the anatomical articular component. The distal shaft portion of the stem can include a plurality of apertures. The plurality of apertures of the distal shaft portion can be adapted to receive a screw or a plug. The spacer can include an engagement feature. The engagement feature can project from the distal facing surface of the spacer. The engagement feature can extend distally of the protrusion. The distal portion of the spacer can include first and second lateral cutouts. The first cutout can be positioned opposite the second cutout. Alternatively, the spacer can include a single lateral cutout or more than two lateral cutouts. The proximal portion of the spacer can include a proximal edge and a distal edge. The proximal edge can be angled relative to the distal edge. The proximal edge can be angled about 5° relative to the distal edge of the proximal portion of the spacer. Alternatively, the proximal edge can be angled less than or more than about 5° relative to the distal edge of the proximal portion of the spacer. For example, the proximal edge can be angled about 3° or about 10°. Alternatively, the distal edge can be angled relative to the proximal edge. The kit can further include a second stem. A distal shaft portion of the second stem can be longer than the distal shaft portion of the first stem. The kit can further include a plug or a plurality of plugs. The plug can be adapted to be received by one of the plurality of apertures. The plug can include a polyethylene material or any suitable material. For example, the plug can include a bone graft.

The kit of the preceding paragraphs or as described further herein can also include one or more of the following features. The kit can further include a second spacer. The second spacer can include a proximal portion and a distal portion. The second spacer can be adapted to couple the reverse insert or the anatomical articular component to the stem.

In some aspects of the disclosure, a stem for a shoulder prosthesis is disclosed. The stem can include a distal shaft portion, a proximal portion, a metaphyseal portion, and a suture groove. The distal shaft portion can be adapted to be anchored in a medullary canal of a humerus. The proximal portion can have a stem face. The stem face can be surrounded by a proximal rim. The metaphyseal portion can include a medial portion and first and second lateral arms. Alternatively, the metaphyseal portion can include only one lateral arm or more than two lateral arms. The first and second lateral arms can extend between and connect the distal shaft portion and the base portion of the proximal portion. The suture groove can be adapted to engage a suture. The suture groove can extend between the proximal rim and the metaphyseal portion along a medial side of the proximal portion. The suture groove can also extend around at least a portion of a circumference of the proximal portion. The suture groove can include a first concave curvature, a second concave curvature, and a convex portion. The second concave curvature can be distal to the first curvature. The convex portion can be positioned between the first concave curvature and the second concave curvature.

The stem of the preceding paragraphs or as described further herein can also include one or more of the following features. A height of the suture groove can be between about 0.5 cm and about 1.0 cm. The stem can further include a plurality of grooves. The plurality of grooves can be positioned on a lateral side of the proximal portion. The plurality of grooves can extend in an anterior-posterior direction. The stem can further include a plurality of grooves on lateral surfaces of the first and second lateral arms of the metaphyseal portion.

In some aspects of the disclosure, a stem for a shoulder prosthesis is disclosed. The stem can include a distal shaft portion, a proximal portion, a metaphyseal portion, and an aperture or a plurality of apertures. The distal shaft portion can be adapted to be anchored in a medullary canal of a humerus. The proximal portion can have a stem face. The stem face can include a central recess, a peripheral wall, and a base portion. The peripheral wall can be positioned along a periphery of the central recess. The base portion can be positioned distal to the peripheral wall. The metaphyseal portion can include a medial portion and first and second lateral arms. Alternatively, the metaphyseal portion can include one lateral arm or more than two lateral arms. The first and second lateral arms can extend between and connect the distal shaft portion and the base portion of the proximal portion. The medial portion can include an arm or a plurality of arms. The arm can have a lateral edge. The first and second lateral arms can have medial edges. A fenestration or a plurality of fenestrations can be defined between the lateral edge of the medial arm and the medial edges of the first and second lateral arms. The aperture can be adapted to receive a screw or a plug. The aperture can be positioned distal to the fenestration of the metaphyseal portion and extend in an anterior-posterior direction.

The stem of the preceding paragraphs or as described further herein can also include one or more of the following features. A longitudinal centerline of the aperture can be less than about 1.0 cm from a distal edge of the fenestration. The aperture can include a circular cross-section. The stem can further include additional apertures. The additional apertures can be positioned distal to the aperture. Each of the additional apertures can be adapted to receive a screw or a plug.

In some aspects of the disclosure, a kit for a shoulder prosthesis is disclosed. The kit can include a stem, a stem holder, and a jig. The stem can be adapted to be implanted into a shoulder of a patient. The stem can include a proximal portion and a plurality of apertures. The proximal portion can have a stem face. Each of the plurality of apertures can be adapted to receive cement or a screw to secure the stem within the shoulder of the patient. The stem holder can be adapted to implant the stem into the shoulder of the patient when the stem is being secured with the cement. The jig can be adapted to implant the stem into the shoulder of the patient when the stem is being secured with one or more screws.

The kit of the preceding paragraphs or as described further herein can also include one or more of the following features. The kit can further include a second stem. The second stem can include a second length and a plurality of apertures. The stem can include a first length less than the second length. The jig can be adapted to implant the second stem into the shoulder of the patient when the second stem is being secured with the one or more screws. The jig can include a distal arm extension adapted to guide the one or more screws into one or more apertures of a plurality of apertures of the second stem. The distal arm extension of the jig can be adapted to be moveable between a first side of the jig and a second side of the jig. The distal arm extension can be positioned on the first side of the jig to implant the second stem into a left shoulder of the patient. The distal arm extension can be positioned on the second side of the jig to implant the second stem into a right shoulder of the patient. The jig can include an interfacing portion. The interfacing portion can be adapted to be removably coupled to the stem face of the second stem. The jig can include an impaction head. The impaction head of the jig can be adapted to receive impaction forces from a tool to implant the second stem into the shoulder of the patient. The impaction head of the jig can be located proximal to the interfacing portion. The jig can include a height gauge. The height gauge of the jig can be adapted to determine a height positioning of the second stem when implanting the second stem into the shoulder of the patient. The stem holder can include an impaction head. The impaction head of the stem holder can be adapted to receive impaction forces from a tool to implant the stem into the shoulder of the patient. The stem holder can include a height gauge. The height gauge of the stem holder can be adapted to determine a height positioning of the stem when implanting the stem into the shoulder of the patient.

In some aspects of the disclosure, a system for implanting a shoulder prosthesis is disclosed. The system can include a stem and a jig. The stem can be adapted to be implanted into a shoulder of a patient. The stem can include a plurality of apertures. The plurality of apertures can be adapted to receive one or more screws to secure the stem within the shoulder of the patient. The jig can be adapted to introduce the stem into the shoulder of the patient. The jig can include a distal arm extension. The distal arm extension can be adapted to guide the one or more screws into one or more apertures of the plurality of apertures of the stem. The distal arm extension of the jig can be adapted to be moveable between a first side of the jig and a second side of the jig. The distal arm extension can be positioned on the first side of the jig to implant the stem into a left shoulder of the patient. The distal arm extension can be positioned on the second side of the jig to implant the stem into a right shoulder of the patient. The distal arm extension can include a screw guide. The screw guide can be adapted to align the one or more screws with the one or more apertures of the stem. The screw guide can include a first aperture, a second aperture, and a sliding plate. Alternatively, the screw guide can include only a single aperture or more than two apertures. The sliding plate can be adapted to cover the first or second aperture of the screw guide. The first aperture of the screw guide can be adapted to align a screw of the one or more screws with a first aperture of the one or more apertures of the stem when the distal arm extension is on the first side of the jig. The second aperture of the screw guide can be adapted to align the screw of the one or more screws with a second aperture of the one or more apertures of the stem when the distal arm extension is on the second side of the jig. The sliding plate can cover the first aperture of the screw guide when the distal arm extension is on the second side of the jig. The sliding plate can cover the second aperture of the screw guide when the distal arm extension is on the first side of the jig.

The system of the preceding paragraphs or as described further herein can also include one or more of the following features. The jig can further include an inserter portion. The inserter portion can include an impaction head. The impaction head can be adapted to receive impaction forces from a tool. The inserter portion can further include an interfacing portion. The interfacing portion can be adapted to removably couple to a proximal portion of the stem. The jig can further include a height gauge. The height gauge can be adapted to determine a height positioning of the stem when implanting the stem into the shoulder of the patient. The jig can further include a vertical support structure. The vertical support structure can extend between the height gauge and the distal arm extension. The vertical support structure can include a proximal end and a distal end. The distal arm extension can be adapted to rotate about the distal end of the vertical support structure to move between the first and second sides of the jig. The distal arm extension can include a first portion and a second portion. The first portion of the distal arm extension can be coupled to the distal end of the vertical support structure and extend radially outward from a longitudinal axis of the jig. The second portion of the distal arm extension can include the screw guide and a second screw guide. The second screw guide can include an aperture. The aperture can be adapted to align a second screw of the one or more screws with a third aperture of the one or more apertures of the stem. The second screw guide can include an aperture adapted to align a second screw of the one or more screws with a third aperture of the one or more apertures of the stem. The first aperture of the one or more apertures of the stem can be adjacent a distal tip of the stem. The second aperture of the one or more apertures of the stem can be proximal to the first aperture of the one or more apertures of the stem. The third aperture of the one or more apertures of the stem can be proximal to the second aperture of the one or more apertures of the stem. The distal arm extension can include a curvature or a bend. The curvature or bend can extend between the first portion and the second portion to align the screw guide and the second screw guide with the one or more apertures of the stem. The sliding plate can move between a first position and a second position along a longitudinal axis of the screw guide. The sliding plate can be in the first position when the distal arm extension is on the first side of the jig. The sliding plate can be in the second position when the distal arm extension is on the second side of the jig. The sliding plate can be adapted to move between the first and second positions by gravitational forces. Alternatively, the sliding plate can be adapted to move between the first and second positions by other forces. For example, a user can manually move the sliding plate between the first and second positions.

In some aspects of the disclosure, a method for positioning a stem for a shoulder prosthesis into a medullary canal of a humerus of a patient is disclosed. The method can include: attaching a stem face of a stem to an interfacing portion of a stem holder; inserting the stem into the medullary canal of the humerus; and securing the stem in the medullary canal of the humerus. The stem can include a proximal portion and a distal shaft portion. The proximal portion can have the stem face. The distal shaft portion can have a plurality of apertures.

The method of the preceding paragraphs or as described further herein can also include one or more of the following features. The method can further include: inserting a plug into an aperture of the plurality of apertures of the stem and cutting the length of the plug. The aperture can include a first opening, a second opening, and a length measured along a longitudinal centerline therebetween. The plug can include a length and a width. The width can be less than the length of the plug. The length of the plug can be greater than the length of the aperture. The method can further include: inserting a first plug into one of the plurality of apertures of the stem; and inserting a second plug into said one of the plurality of apertures of the stem. The aperture can include a first opening, a second opening, and a length measured along a longitudinal centerline therebetween. Each of the first and second plugs can include a length and a width. The width can be greater than the length of each of the first and second plugs. The length of the aperture can be greater than the length of each of the first and second plugs. Securing the stem can include providing bone cement in the medullary canal of the humerus. The method can further include applying impaction forces to an impaction head of the stem holder. Securing the stem in the medullary canal can include inserting a screw into one of the plurality of apertures of the stem. The method can further include aligning a screw guide of the stem holder with the plurality of apertures. The screw guide can be carried by a distal arm extension of the stem holder. The method can further include: positioning the distal arm extension of the stem holder on a first side of the stem holder when the stem is inserted into the humerus of a left shoulder and positioning the distal arm extension of the stem holder on a second side of the stem holder when the stem is inserted into the humerus of a right shoulder. When the distal arm extension is on the second side of the stem holder, the distal arm extension can be inverted compared to when the distal arm extension is on the first side of the stem holder. When the distal arm extension is on the first side of the stem holder, the screw guide can cover a first aperture of the plurality of apertures. When the distal arm extension is on the second side of the stem holder, the screw guide can cover a second aperture of the plurality of apertures. The method can further include sliding a plate on the screw guide to a first position to cover the first aperture or a second position to cover the second aperture of the plurality of apertures. The plate can slide by gravitational forces. Alternatively, a user can manually move the sliding plate between the first and second positions.

Any feature, structure, or step disclosed herein can be replaced with or combined with any other feature, structure, or step disclosed herein, or omitted. Further, for purposes of summarizing the disclosure, certain aspects, advantages, and features of the inventions have been described herein. It is to be understood that not necessarily any or all such advantages are achieved in accordance with any particular embodiment of the inventions disclosed herein. No aspects of this disclosure are essential or indispensable.

DETAILED DESCRIPTION

While the present description sets forth specific details of various embodiments, it will be appreciated that the description is illustrative only and should not be construed in any way as limiting. Furthermore, various applications of such embodiments and modifications thereto, which may occur to those who are skilled in the art, are also encompassed by the general concepts described herein. Each and every feature described herein, and each and every combination of two or more of such features, is included within the scope of the present invention provided that the features included in such a combination are not mutually inconsistent.

FIGS.1A and1Bshow two conventional approaches to total shoulder arthroplasty.FIG.1Ashows an implant system10of an anatomic approach in which a natural humeral head of a natural human humerus H is replaced with an anatomical insert or articular component16that includes an articular body12having a convex articular surface14. In some configurations, the glenoid of the scapula can be modified with an implant providing a concave surface for articulation of the humeral articular body12. The humeral articular body12is secured to the humerus H using a humeral stem30. The humeral articular body12may be secured to the humeral stem30using an adaptor.

FIG.1Bshows an implant system20of a reverse approach in which the humerus H is fitted with a reverse insert or articular component40including an articular body44having a concave articular surface48. The glenoid region of the scapula is fitted with a spherical articular body, commonly called a glenosphere46. In this case, the concave articular surface48placed on the humerus H articulates the glenosphere46, which is fixed relative to the scapula. The reverse articular body44is mounted to a spacer42that is disposed between the reverse humeral articular body44and a humeral stem30that is surgically implanted in the humerus H. The humerus H is prepared by providing access to the medullary canal of the humerus H.

One can see that the anatomic and reverse approaches generally use different hardware to secure the articular components. For example, the presence of the spacer42may require more joint space. Thus, the reverse configuration may only be suitable for some patients with large joint space or following more invasive preparation of the humerus and/or the scapula.

With a standard shoulder prosthesis, when a surgeon desires to convert a primary anatomic shoulder prosthesis into a reverse shoulder prosthesis, the surgeon must typically remove the entire prosthesis, thereby risking further weakening the bone. However, using a modular system such as implant systems10and20illustrated inFIGS.1A and1B, the surgeon may leave the stem30implanted in the bone and simply replace the anatomic insert16with the reverse insert40. For example, the anatomic insert16may be removed using a wedge or similar instrument. The reverse insert40can be inserted into direct engagement with the stem face of the humeral stem30, for example, impacted into place using an impactor or similar tool.

I. Systems and Kits with Shared Implant Components

FIG.2is a schematic diagram of a total arthroplasty system comprising an arthroplasty kit100that can be used to perform anatomic or reverse arthroplasty, or to convert from one of anatomic to reverse or reverse to anatomic arthroplasty, according to various embodiments. The kit100can comprise one or a plurality of stemless humeral anchors103, one or a plurality of stemmed humeral anchors113, one or a plurality of articular components161, and/or one or more spacers and adapters150configured to couple a stemless humeral anchor103or a stemmed humeral anchor113with an anatomic insert or a reverse insert. The stemless humeral anchors103can have a distal portion105and a proximal portion107. The distal portion105of the anchors103shown inFIG.2can have one or a plurality of fins109extending distally. The fins109can be configured to secure the anchors103into the humerus. The stemless anchors103can have a tapered profile in which the anchors103narrow from the proximal portion107to the distal portion105.

As shown inFIG.2, the stemless anchors103can be provided in a plurality of sizes to accommodate patients of different sizes, different degrees of bone damage to the humerus, etc. In some embodiments, the lateral size of the stemless anchors103may vary so as to fit within different-sized resections of the humerus. For example, the kit100can comprise a plurality of stemless anchors103A,103B,103C,103D . . .103n, with n being the number of different sizes. Although four sizes are illustrated inFIG.2(e.g., n=4, with anchors103A-103D), in other embodiments, the kit can include any suitable number of anchors. In some embodiments, a length l1of the stemless anchors103A-103D may also vary so as to extend into the humerus by a depth that the clinician selects based on the particular patient being treated. Furthermore, the anchors103A-103D can have different fin lengths lfof the fins109to accommodate different sizes of the humerus.

In various embodiments, the fin lengths lfof the anchors103A-103D can differ substantially so as to beneficially provide a wide range of anchor strengths to the humerus and accommodate patients with different levels of bone damage. In the arrangement ofFIG.2, for example, the first anchor103A can have the shortest overall length l1and the shortest overall fin length lf. The fourth anchor103D can have the longest overall length l1and the longest overall fin length lf. In various embodiments, a ratio of an overall length l1of one anchor103(for example, the largest anchor103) to an overall length l1of another anchor103(for example, the smallest anchor103) in the kit100can be in a range of 1.15 to 2.5, in a range of 1.18 to 2.5, in a range of 1.2 to 2.5, in a range of 1.2 to 2, in a range of 1.2 to 1.8, in a range of 1.2 to 1.6, in a range of 1.3 to 1.6, or in a range of 1.25 to 1.4.

The kit100can also include one or a plurality of stemmed humeral anchors113. The kit100can include one or more humeral stem anchors112, each of which includes a proximal metaphysis portion120and an elongate diaphysis portion116extending therefrom. The diaphysis portion116is sometimes referred to herein as a stem or stem portion. The stemmed humeral anchors113may be used in patients in which stemless anchors103may not be adequately secured to the humerus, for example, in patients that have experienced severe bone loss. As with the stemless anchors103, the kit100can include humeral stem anchors113(sometimes referred to herein as a stemmed anchor) having a plurality of different sizes, e.g., different lateral sizes and/or different lengths l2. For example, as shown inFIG.2, the stemmed humeral anchors113can have respective lengths l2that are longer than the lengths l1of the stemless anchors103. Beneficially, the inclusion of differently-sized stemmed anchors113in the kit100can enable the clinician to select the appropriate size for a particular patient to ensure a secure implant of the anchor113into the patient, in view of the patient's bone size and health. In various embodiments, the lengths l2of the stemmed humeral anchors can be in a range of about 55 mm and about 175 mm. By contrast, the shorter lengths l1of the stemless humeral anchors103can be in a range of about 16 mm and about 28 mm. In various embodiments, stemmed humeral anchors113can be configured to reach into the intramedullary canal of the humerus H for additional anchorage.

In some embodiments, the stemmed humeral anchors113can include trauma or fracture stem anchors or humeral stems30,230, which can be used in patients that have experienced a fracture of the humerus H. The trauma or fracture stems30,230may be used where the humerus has fractured into one or more pieces. Moreover, the shaft portions of the fracture stems30,230may also have respective length l3, l4such that the length l4of the shaft portion of the longer fracture stem230can be longer than the length l3of the shaft portion of the shorter fracture stem30. In various embodiments, the lengths l4of the shaft portion of the longer fracture stem230can be in a range of about 125 mm and about 175 mm, in a range of about 150 mm and about 175 mm, or about 168 mm. By contrast, the shorter lengths l3of the shaft portion of the shorter fracture stem30can be in a range of about 50 mm and about 100 mm, a range of about 75 mm and about 100 mm, or about 88 mm.

Beneficially, the kit100can comprise one or a plurality of shared humeral components that be used with either the stemless humeral implants103or the stemmed humeral implants113, depending on which implant103or113would be more appropriate for a particular patient's humeral anatomy. For example, the shared humeral components of the kit100can comprise a plurality of articular components or assemblies161that can be used in conjunction with either the stemless implants103or the stemmed implants113. As explained herein, both the stemless humeral anchors103and the stemmed humeral anchors113can include shared engagement features that can be used with the same set of tools and/or articular components. For example, as described herein, the stemless anchors103and stemmed anchors113can include convex and concave locking features configured to engage with the same set of articular components.

For example, the kit100can include an anatomic articular component160configured to mechanically couple to both the stemless humeral implants103and the stemmed humeral implants113. The clinician may select the anatomic articular component160for procedures in which an anatomic reconstruction is suitable. The anatomic articular component160can comprise a coupler168and an articular body164(anatomical) configured to mechanically engage the coupler168. As shown inFIG.2, the articular body164for the anatomic articular component160can comprise a rounded, convex surface configured to engage a glenoid surface of the patient. The coupler168can serve to mechanically connect the anatomical articular body164(e.g., a rounded or essentially spherical surface) to either a stemless humeral implant103or a stemmed humeral implant113, depending on the patient's humeral bone structure. The articular body164and the coupler168can comprise a metal, such as cobalt, chrome, or titanium. In some embodiments, the articular body comprises a pyrocarbon layer on at least the articular surface. In various embodiments, the kit100can include anatomic articular components160having a plurality of sizes.

The kit100can also include a reverse articular component180configured to mechanically couple to both the stemless humeral implants103and the stemmed humeral implants113. The clinician may select the reverse articular component180for procedures in which a reverse anatomic reconstruction is suitable. The reverse articular component180can comprise a reverse articular body184and a locking device188configured to secure the reverse articular component180to a stemless humeral implant103or a stemmed humeral implant113, depending on the clinician's recommendation during the procedure. As shown, the reverse articular body184can comprise a rounded concave surface (e.g., essentially spherical) configured to engage with a glenosphere connected to the glenoid of the patient (not shown but in some cases combined with the kit into a larger surgical kit). In addition, in some embodiments, the kit100can include a wear resistant reverse articular component180A, which may be generally similar to the reverse articular component180but may further be formed to include vitamin E to promote long-term compatibility with the patient's bone structure. The reverse components180,180A can comprise a polymer, including, for example, ultra-high molecular weight polyethylene. In various embodiments, the kit100can include reverse articular components180,180A having a plurality of sizes.

The kit100can also include one or more spacers150that can mechanically couple the reverse articular component180or the anatomical articular component160to the stemless humeral implants103or the stemmed humeral implants113. As shown inFIG.2, the one or more spacers150can be provided in a plurality of sizes to accommodate patients of different sizes, different degrees of bone damage to the humerus, etc. For example, the kit100can comprise a plurality of spacers150A,150B,150C . . .150n, with n being the number of different sizes. Although four sizes are illustrated inFIG.2(e.g., n=4, with spacers150A-150C), in other embodiments, the kit can include any suitable number of spacers. Additionally, the one or more spacers150can be symmetric or asymmetric. The one or more spacers and adapters150are further described below in relation toFIGS.9A-12C.

During an arthroplasty procedure, the clinician may inspect the bone structure of the humerus and/or the scapula to determine whether the anatomy is suitable for a stemless or stemmed humeral anchor, and whether the anatomy is suitable for an anatomical or reverse anatomical reconstruction. Beneficially, the kit100shown inFIG.2can provide the clinician with a total arthroplasty system including components that are compatible with stemless or stemmed anchors, and with anatomical or reverse anatomical constructions. For example, during a procedure, the clinician may observe that the patient has sufficient humeral bone structure so that a stemless anchor103may be used to reduce the damage to the patient's anatomy. The clinician may also elect whether to proceed with an anatomical reconstruction or a reverse construction, and can accordingly select either the anatomical articular component160or the reverse articular component180,180A.

Similarly, if during a shoulder arthroplasty procedure, the clinician determines that the patient's bone structure is damaged or otherwise more suited to a stemmed anchor113, then the clinician can select an appropriately sized stemmed anchor113. The clinician can further select whether to proceed with an anatomical reconstruction or a reverse construction, and can accordingly select either the anatomical articular component160or the reverse articular component180,180A. Beneficially, the kit100ofFIG.2includes interchangeable or interoperable components that can be used in stemmed or stemless anchors, and with anatomical or reverse anatomical reconstructions. Because the shared humeral articular components161(e.g., anatomical or reverse anatomical articular bodies) can be used with either the stemless or stemmed anchors103,113, the clinician can make, or change, reconstruction decisions during surgery. The kit100can accordingly enable the clinician to quickly determine the reconstruction procedure most suitable for a patient and can provide the clinician with the components to be used for that reconstruction procedure.

As explained above, for humeral fractures, the kit100can also include one or more trauma stems30,230. Beneficially, the trauma stem(s)30,230can include engagement features generally similar to or the same as the engagement features in the stemless anchors103and humeral stem anchors113, such that the trauma stem(s)30,230can be used with a common set of shared articular components161and tools. Beneficially, therefore, the kit100can provide a shared set of implantation tools and a shared set of articular components161that can be used with either stemless or stemmed humeral anchors103,113, and that can be used for anatomical or reverse anatomical reconstructions.

In some embodiments, the coupler168can comprise a proximal extension163A configured to connect to the articular body164and a distal extension163B. The distal extension163B for can be received within a first recess52,252of a stem face50,250of the fracture stem30,230for anatomical reconstructions. In some embodiments, the recess52,252is can be recessed from (e.g., extends distally from) a distal end of a second recess54,254. In these embodiments, the disc or middle portion162can provide a spacer function in use in the trauma stem30,230. In some configurations, the recess52.252can be elevated toward the resection plane, and the disc or middle portion162disposed between the proximal extension163A and the distal extension163B can be eliminated. Additional details of trauma stems may be found throughout International Application No. PCT/US2015/065126, titled “CONVERTIBLE STEM/FRACTURE STEM,” filed Dec. 10, 2015, the entire contents of which are included in the Appendix.

The final implant can take any suitable configuration, such as any that are described in International Application No. PCT/US2019/054007, titled “SHOULDER PROSTHESIS COMPONENTS AND ASSEMBLIES,” and International Application No. PCT/US2019/054023, titled “MODULAR HUMERAL HEAD,” which were filed on Apr. 9, 2020. The final implant can take any configuration as disclosed in International Application No. PCT/US2020/053629, titled “SHOULDER PROSTHESIS COMPONENTS AND ASSEMBLIES,” filed on Sep. 30, 2020. The articular components can take any configuration as disclosed in International Application No. PCT/US2020/053625, titled “REVERSE SHOULDER SYSTEMS,” filed Sep. 30, 2020. The entire contents of each of the applications listed in this paragraph are included in the Appendix.

II. Examples of Fracture Stems

FIG.3illustrates a shoulder arthroplasty system for treating a patient with a fractured humerus. The arthroplasty system may include a fracture stem30, an anatomic articular component160, a reverse articular component180, a plurality of screws170configured to secure the fracture stem30within the humerus of the patient, and/or a plurality of plugs700A,700B configured to be received by a plurality of apertures of the stem30,230. As discussed above, a clinician may couple the anatomic articular component160to the fracture stem30when an anatomic reconstruction is suitable. The coupler168may mechanically couple the articular body164to the stem face50of the fracture stem30.

When a reverse reconstruction is suitable, the clinician may couple the reverse articular component180to the fracture stem30. The clinician may directly couple the reverse articular component180to the stem face50of the fracture stem30or the clinician may use a spacer150to couple the reverse articular component180to the stem face50of the fracture stem30. For example,FIG.4illustrates an assembled reverse shoulder prosthesis20with a spacer150A coupling the reverse articular component180to the fracture stem30.

FIGS.5A-7Billustrate an embodiment of a fracture stem30. The stem30ofFIGS.1A and2Ais a fracture stem configured to be used in humeral fracture repair procedures as described herein. The stem30is configured to be anchored in a medullary canal of a humerus of a patient. As shown inFIG.5A, the stem30includes a distal portion32, a proximal portion34, a medial side93and a lateral side91. In some embodiments, the stem30is a unitary body. Accordingly, the stem30can be monolithic, and the distal portion32and proximal portion34can be integrally formed. In some embodiments, the stem30and/or other humeral anchors herein can have a distal portion that includes a taper. For example, the distal portion32can have a gradually tapered overall shape to better fit the humerus bone into which it is implanted. A length of the distal portion32of the stem30can vary, as further described below in relation toFIGS.8A-8F.

In some embodiments, the proximal portion34includes a spherical portion. For example, as shown inFIG.5C, the outer surface35of the proximal portion34can be shaped generally as a half-sphere. A proximal end of the proximal portion34can include a stem face50, which is further described below in relation toFIG.7. The stem30can further include a metaphyseal portion90between the distal portion32and the proximal portion34, as shown inFIGS.5A and5C. The metaphyseal portion90can include three or more arms extending between and connecting the distal portion32and the proximal portion34. In the illustrated embodiment, the metaphyseal portion90includes three arms: a medial arm92, a first lateral arm94, and a second lateral arm96. The medial arm92can be positioned near the calcar. The medial arm92can be angled medially. Accordingly, a proximal end110of the medial arm92can be positioned medially relative to a distal end112of the medial arm92as shown inFIG.5C. For example, the proximal end110can be angled between about 10° and about 15°, or about 12° medially relative to the distal end112. The first lateral arm94and second later arm96can be configured and positioned to support the tuberosities. The first lateral arm94and second lateral arm96can be angled outwardly or laterally. Accordingly, a proximal end114of the first lateral arm94can be positioned laterally relative to a distal end116of the first lateral arm94, and a proximal end118of the second lateral arm96can be positioned laterally relative to a distal end120of the second lateral arm96as shown inFIG.5C. The angle and shape of each arm94,96can be selected based on virtual surgery and/or a numerical simulation of bone strain due to the prosthesis to adapt to the particular patient bony anatomy. For example, the proximal ends114,118of the first and second lateral arms94,96can be angled between about 5° and about 10°, or about 8° laterally relative to the distal ends116,120of the first and second lateral arms94,96. The use of the fracture stem30of the present disclosure in a fracture repair procedure advantageously helps promote tuberosity healing and inhibit or reduce tuberosity resorption.

As shown inFIGS.5B and5C, the stem30can include a notch108. The notch108can be at or near a location the medial side93of the metaphyseal portion90meets the proximal portion34. For example, the notch108can be at or near a location where the medial side93of the medial arm92meets the proximal portion34. The notch108can extend from this location along the medial side93of the proximal portion34to a peripheral rim38of the proximal portion34. For example, a height H1of the notch108can be between about 5 mm and about 10 mm, between about 7 mm and about 8 mm, or about 8.6 mm. In some configurations, the height H1of the notch108can be between about 20% and about 50% or about 30% and about 40% of a height of the metaphyseal portion90. The notch108can also extend along the outer surface35of the medial side93of the proximal portion34in an anterior to posterior direction. For example, the notch108can extend along at least a portion of a circumference of the proximal portion34. In some configurations, the notch108only extends along the medial side of the proximal portion34. In some configurations, the notch108can include a convex portion108bbetween two concave portions108a,108c. The notch108can be configured to engage a suture in a fracture repair procedure and can help inhibit the suture from sliding or slipping out of position.

The stem30can also include a fin102protruding from the lateral side91of the distal portion32. In the illustrated embodiment, the fin102extends from a proximal portion of the distal portion32distally along a portion of a length of the distal portion32. The fin102can help promote correct positioning of the stem30during stem placement. In some configurations, a length of the fin102can be between about 20 mm and about 40 mm, between about 25 mm and about 35 mm, or about 30.8 mm. In some configurations, the length of the fin102can be between about 10% and about 40% or about 20% and about 30% of a total length LT1(shown inFIG.5F) of the stem30.

In some configurations, a fenestration or window104can be defined between a lateral edge113of the medial arm92and medial edges115,119of the first94and second96lateral arms, respectively. In some embodiments of a fracture repair procedure, a bone graft can be placed in the fenestration104to help promote bone-to-stem fixation. A space or gap106, shown inFIGS.5E, can be defined or formed between an inner edge117of the first lateral arm94and an inner edge121of the second lateral arm96. In the illustrated embodiment, the gap106has an elongated, rounded rectangular shape, although other shapes or configurations are also possible. As shown, the gap106can extend from the proximal portion of the distal portion32to the proximal portion34. The space106may enable increased bone growth and fixation, for example enabling bone graft materials to be placed within the fenestration104, within the space106, and/or on a lateral side of the lateral arms94,96. For example, in some procedures, the stem30can be used in a tuberosity fixation procedure using a horseshoe graft. An example of such a procedure is described in Levy, Jonathan C. and Badman, Brian, Reverse Shoulder Prosthesis for Acute Four-Part Fracture: Tuberosity Fixation Using a Horseshoe Graft, J Orthop Trauma, Volume 25, Number 5, May 2011. In such a procedure, the horseshoe graft can be placed on the lateral surface of the metaphyseal portion90. The design of the metaphyseal portion can help provide stability to the horseshoe graft. The space106can allow the horseshoe graft to form or grow into or through the window106and improve fixation and tuberosity repair. In particular, resorption of the tuberosities can be reduced or prevented because more pathways for formation or growth of bone are provided to bridge between the fractured portions. The peripheral rim38of the stem face50can also help support and stabilize the tuberosities. The shape and size of the horseshoe graft can be selected based on a numerical simulation to accurately restore the tuberosities positions using virtual surgery.

The metaphyseal portion90can include one or more through holes98. For example, the one or more through holes98may be positioned below the fenestration104. The through holes98can be configured to receive one or more screws170or plugs700A,700B, which are further described below in relation toFIGS.13-16. The illustrated configuration shows only a single through hole98extending in the anterior-posterior direction. Advantageously, inserting a screw into the through hole98when implanting the stem30into the patient can improve stability and the mechanical strength of the stem30. For example, using this additional screw can decrease the stress exerted on a weak point of the stem30. The weak point may be located near or along the through hole98and the additional screw can decrease the stress exerted on this point by between about 30% and about 50%, or about 40% compared to the stress exerted on this point without the additional screw inserted in the through hole98.

In some configurations, the distal portion32can include a plurality of grooves130extending in a longitudinal direction and are circumferentially spaced apart. For example, the distal portion32can have only four grooves130. Each of the four grooves130can have a narrow distal end and a wider proximal end. In some configurations, the distal portion32of the stem30can include one or more apertures62,64configured to receive one or more screws170or plugs700A,700B, which are further described below in relation toFIGS.13-16. In the illustrated configuration, the distal portion32of the stem30includes only two apertures: a proximal aperture62and a distal aperture64. In some configurations, at least one of the apertures62,64can extend through at least one of the longitudinal grooves130. In some configurations, each aperture62,64may have a diameter of between about 2 mm and about 10 mm, about 4 mm and about 8 mm, or about 4.4 mm. In some configurations, each aperture62,64may have a length of between about 2 mm and about 10 mm, about 4 mm and about 8 mm, or about 5.4 mm.

In some configurations, the apertures62,64may be spaced apart from one another. For example, a distance between the two apertures62,64can be between about 10 mm and about 30 mm, or about 15 mm and about 25 mm. In some configurations, the distance between the two apertures62,64can be between about 10% and about 40% of a length of the distal shaft portion32or between about 20% and about 30% of the length of the distal shaft portion32. In some configurations, the distal aperture64can be positioned between about 25 mm and about 45 mm or about 30 mm and about 40 mm from a distal tip33of the stem30. In some configurations, the distance between the distal aperture64and the distal tip33can be between about 20% and about 50% of the length of the distal shaft portion32, or about 30% and about 40% of the length of the distal shaft portion32. In some configurations, the proximal aperture62can be positioned between about 45 mm and about 65 mm or about 50 mm and about 60 mm from the distal tip33of the stem30. In some configurations, the distance between the proximal aperture62and the distal tip33can be between about 40% and about 70% of the length of the distal shaft portion32, or about 50% and about 60% of the length of the distal shaft portion32.

As shown inFIG.5E, the aperture62,64may be angled relative to a longitudinal plane31of the stem30such that a longitudinal centerline that extends along the length of each aperture62,64is angled from the longitudinal plane31. The longitudinal plane31can extend in a medial-lateral direction of the stem30. In some configurations, the angle between the longitudinal centerline of the proximal aperture62and the longitudinal plane31may be between about 15° and about 75°, between about 30° and about 60°, or about 30°. In some configurations, the angle between the longitudinal centerline of the distal aperture64and the longitudinal plane31may be between about 15° and about 75°, between about 30° and about 60°, or about 30°. In some configurations, the proximal aperture62can be angled in the opposite direction from the distal aperture64.

As shown inFIG.5E, in some configurations, the lateral side91of the outer surface35of the proximal portion34may include a plurality of horizontal grooves111. The plurality of horizontal grooves111can be configured to increase tuberosities stability. In some configurations, each of the lateral arms94,98can include one or more horizontal grooves111. In some configurations, the horizontal grooves111can be displaced from the proximal ends114,118of the lateral arms94,98. For example, an area between the horizontal grooves111and the lateral arms95,98may include a smooth surface. A maximum length of the plurality of the horizontal grooves111can be between about 10 mm and about 20 mm, about 12 mm and about 18 mm, or about 14 mm and about 16 mm. A minimum length of the horizontal grooves111can be between about 1 mm and about 10 mm, about 3 mm and about 8 mm, or about 5 mm and about 6 mm.

FIGS.5F and5Gillustrate different dimensions of the stem30. For example, the stem30can have a total length LT1of between about 100 mm and about 150 mm, about 110 mm and about 140 mm, about 120 mm and about 130 mm, or about 136 mm. As shown in the illustrated configurations, the stem30may have varying widths. For example, the stem30may have a maximum width WT, a first width W1measured in the medial-lateral direction at a first length L1from a distal tip33of the stem30, a second width W2measured in the medial-lateral direction at a second length L2from the distal tip33, and a third width W3measured in the medial-lateral direction and a third length L3from the distal tip33. Additionally, the stem30may have a fourth width W4measured in the anterior-posterior direction at the first length L1from the distal tip33, a fifth width W5measured in the anterior-posterior direction at the third length L3from the distal tip33, and a sixth width W6measured in the anterior-posterior direction at a fourth length L4from the distal tip33.

In some configurations, the first length L1can be between about 30 mm and about 70 mm, about 40 mm and about 60 mm, or about 59 mm. In some configurations, the first length L1can be between about 30% and about 60% of the total length LT1, about 40% and about 50% of the total length LT1, or about 43% of the total length LT1. In some configurations, the second length L2can be between about 60 mm and about 100 mm, about mm and about 90 mm, or about 80 mm. In some configurations, the second length L2can be between about 40% and about 70% of the total length LT1, about 50% and about 60% of the total length LT1, or about 59% of the total length LT1. In some configurations, the third length L3can be between about 80 mm and about 120 mm, about 90 mm and about 110 mm, or about 96 mm. In some configurations, the third length L3can be between about 50% and about 80% of the total length LT1, about 60% and about 70% of the total length LT1, or about 71% of the total length LT1. In some configurations, the fourth length L4can be between about 90 mm and about 130 mm, about 100 mm and about 120 mm, or about 107 mm. In some configurations, the fourth length L4can be between about 60% and about 90% of the total length LT1, about 70% and about 80% of the total length LT1, or about 79% of the total length LT1.

In some configurations, the maximum width WTcan be less than the total length LT1. For example, the maximum width WTcan be between about 20 mm and about mm, about 30 mm and about 40 mm, or about 38 mm. In some configurations, the maximum width WTcan be between about 10% and about 40% of the total length LT1, about 20% and about 30% of the total length LT1, or about 28% of the total length LT1. In some configurations, the first width W1can be between about 5 mm and about 20 mm, or about 10 mm and about 15 mm. In some configurations, the first width W1can be between about 10% and about 60% of the maximum width WT, about 20% and about 50% of the maximum width WT, or about 30% and about 40% of the maximum width WT. In some configurations, the second width W2can be between about 7 mm and about 25 mm, or about 10 mm and about 20 mm. In some configurations, the second width W2can be between about 10% and about 70% of the maximum width WT, about 20% and about 60% of the maximum width WT, or about 30% and about 50% of the maximum width WT. In some configurations, the third width W3can be between about 10 mm and about 25 mm, or about 15 mm and about 20 mm. In some configurations, the third width W3can be between about 20% and about 70% of the maximum width WT, about 30% and about 60% of the maximum width WT, or about 40% and about 50% of the maximum width WT. In some configurations, the fourth width W4can be between about 5 mm and about 20 mm, or about 10 mm and about 15 mm. In some configurations, the fourth width W4can be between about 10% and about 60% of the maximum width WT, about 20% and about 50% of the maximum width WT, or about 30% and about 40% of the maximum width WT. In some configurations, the fifth width W5can be between about 8 mm and about 20 mm, or about 10 mm and about 15 mm. In some configurations, the fifth width W5can be between about 10% and about 60% of the maximum width WT, about 20% and about 50% of the maximum width WT, or about 30% and about 40% of the maximum width WT. In some configurations, the sixth width W6can be between about 10 mm and about 20 mm, or about mm and about 15 mm. In some configurations, the first width W1can be between about 20% and about 70% of the maximum width WT, about 30% and about 60% of the maximum width WT, or about 40% and about 50% of the maximum width WT. The table below provides example widths for different sizes of the stem30.

FIGS.7A and7Billustrates the stem face50of the stem30. As previously described, the stem face50can include a first recess52recessed from a distal end of a second recess54. As shown inFIGS.7A-7B, for example, the second recess54may be wider and larger than the first recess52. In some embodiments, the second recess54may be defined by generally cylindrical or only slightly tapered walls. Similarly, the first recess52may be defined by generally cylindrical or only slightly tapered walls. In some embodiments, the second recess54can be sized and shaped to receive an insert161. For example, the first recess52can be sized and shaped to receive a portion of the coupler168to convert the reverse anatomical reconstruction device ofFIG.4to the anatomical reconstruction device ofFIG.1A. Moreover, the first recess52can be sized and shaped to receive an engagement feature156A,156B,156C of the one or more spacers and adapters150.

As shown inFIGS.7A and7B, the stem face50can comprise one or more interfacing components such as one or more apertures51a,51b,53, a groove56, and one or more slots55a,55b,55c,55d,57a,57b. The one or more apertures51a,51b,53can include first and second aperture51a,51band an anti-rotation aperture53. In some configurations the one or more apertures51a,51b,53can be configured to engage with certain portions of the anatomic articular component160, the reverse articular component180, the one or more spacers150, and/or a tool configured to insert the stem30into the bone of patient (e.g., a stem holder900or a jig1000). For example, the anti-rotation aperture53may be configured to engage with a protrusion155A,155B of the one or more spacers and adapters150. When assembled, the protrusion155A,155B can extend into the anti-rotation aperture53to minimize or eliminate rotation of the spacer or adapter150in relation to the stem face50of the stem30. In some configurations, the one or more apertures51a,51b,53can be configured to engage with a tool, such as the stem holder900or the jig1000, which are further described below in relation toFIGS.18A-21E.

In some configurations, the one or more slots55a,55b,55c,55d,57a,57bcan be sized and configured to engage an insert161(such as the articular components160,180). For example, the slots55a,55b,55c,55d,57a,57bcan engage or receive corresponding ridges of an insert161. As explained herein, the slots55a,55b,55c,55d,57a,57bcan limit rotation of the insert161relative to the anchor30. The slots55a,55b,55d,57a,57bcan also guide the advancement of the insert161into an upper portion of the second recess54. The slots55a,55b,55c,55d,57a,57bcan be disposed vertically along the stem face50and can be circumferentially spaced from one another. For example, first and second slots55a,55bmay be positioned adjacent each other and opposite third and fourth slots55c,55d. Further, fifth and sixth slots57a,57bmay be positioned opposite one another. In some configurations, the fifth and sixth slots57a,57bmay have a greater width than the first, second, third, and fourth slots55a,55b,55c,55d. In the embodiment ofFIGS.7A and7B, the slots55a,55b,55c,55d,57a,57bcan extend from a location proximate the peripheral rim38towards the bottom of the second recess54. In some configurations, the stem face50may include one or more protrusions58a,58bbetween adjacent slots55a,55b,55c,55d. For example, the one or more protrusions58a,58bmay include a first protrusion58abetween adjacent slots55a,55band a second protrusion58bbetween adjacent slots55c,55d. The first and second protrusions58a,58bmay be configured to engage with a portion of the insert161(e.g., a distal portion152A,152B,152C of the one or more spacer and adapter150). Further, the stem face50can include the groove56extending circumferentially about the second recess54. The groove56can be sized and configured to receive a locking ring of an articular body assembly (e.g., any of the inserts161described herein).

FIGS.8A-8Fillustrate another embodiment of the stem230similar to the embodiments of the stem20illustrated in and described in relation toFIGS.3-7B. Reference numerals of the same or substantially the same features may share the same last two digits. As shown inFIG.8B, the stem230may have a total length LT2greater than the total length LT1of the stem30. For example, the total length LT2of the stem230can be between about 150 mm and about 250 mm, about 160 mm and about 240 mm, about 170 mm and about 230 mm, or about 215 mm. In some configurations, the total length LT2of the longer stem230can be between about 130% and about 180%, about 140% and about 170%, about 150% and about 160%, or about 158% of the total length LT1of the shorter stem30.

As shown inFIGS.8C-8F, the distal portion232of the stem230can comprise one or more apertures262,264,265,267,269configured to receive one or more screws170or plugs700A,700B, which are further described below in relation toFIGS.13-16. In the illustrated configuration, the distal portion232of the stem230can include only five apertures: a first aperture262, a second aperture264, a third aperture265, a fourth aperture267, and a fifth aperture269. The first and second apertures262,264can be the same as or similar to the proximal and distal apertures62,64of the stem30. For example, as shown inFIG.8E, the first and second apertures262,264may be angled relative to a longitudinal plane231of the stem230such that a longitudinal centerline that extends along the length of each aperture262,264is angled from the longitudinal plane231. The longitudinal plane231can extend in a medial-lateral direction of the stem230. In some configurations, the angle between the longitudinal centerline of the first aperture262and the longitudinal plane231may be between about 15° and about 75°, between about 30° and about 60°, or about 30°. In some configurations, the angle between the longitudinal centerline of the second aperture264and the longitudinal plane231may be between about and about 75°, between about 30° and about 60°, or about 30°. In some configurations, the first aperture262can be angled in the opposite direction from the second aperture264.

As shown inFIG.8E, the third, fourth, and fifth apertures265,267,269may be angled relative to a second longitudinal plane (not shown) that is substantially normal to the longitudinal plane231. For example, the longitudinal centerline of the third aperture265may extend in the same direction as the second longitudinal plane such that the third aperture265extends in an anterior-posterior direction. In some configurations, the angle between the longitudinal centerline of the fourth aperture267and the second longitudinal plane may be between about 10° and about 30°, between about 15° and about or about 20°. In some configurations, the angle between the longitudinal centerline of the fifth aperture269and the second longitudinal plane may be between about 10° and about 30°, between about 15° and about 25°, or about 20°. In some configurations, the fourth aperture267can be angled in the opposite direction from the fifth aperture269.

In some configurations, the first and second apertures262,264may be spaced apart from one another. For example, the distance between the two apertures62,64can be between about 4% and about 20% of the total length LT2of the stem230or about 10% and about 15% of the total length LT2of the stem230. In some configurations, the first aperture262can be positioned between about 130 mm and about 160 mm or about 140 mm and about 150 mm from a distal tip233of the stem230. In some configurations, the distance between the first aperture262and the distal tip233can be between about 45% and about 75% of the total length LT2of the stem230, or about 55% and about 65% of the total length LT2of the stem230. In some configurations, the second aperture262can be positioned between about 105 mm and about 135 mm or about 115 mm and about 125 mm from the distal tip233of the stem230. In some configurations, the distance between the second aperture264and the distal tip233can be between about 40% and about 80% of the total length LT2of the longer stem230, or about 50% and about 70% of the total length LT2of the longer stem230.

In some configurations, the first and second apertures262,264may be spaced apart from the third, fourth, and fifth apertures265,267,269. For example, a distance between the second aperture264and the third aperture265can be between about mm and about 100 mm, or about 70 mm and about 90 mm. In some configurations, the distance between the second aperture264and the third aperture265can be between about 20% and about 60% of the total length LT2of the stem230or about 30% and about 50% of the total length LT2of the stem230.

In some configurations, the third aperture265can be positioned between about 20 mm and about 60 mm or about 30 mm and about 50 mm from a distal tip233of the stem230. In some configurations, the distance between the third aperture265and the distal tip233can be between about 5% and about 40% of the total length LT2of the stem230, or about 10% and about 30% of the total length LT2of the stem230. In some configurations, the fourth aperture267can be positioned between about 10 mm and about mm or about 20 mm and about 40 mm from the distal tip233of the stem230. In some configurations, the distance between the fourth aperture267and the distal tip233can be between about 5% and about 30% of the total length LT2of the longer stem230, or about 10% and about 20% of the total length LT2of the longer stem230. In some configurations, the fifth aperture269can be positioned between about 5 mm and about 40 mm or about 10 mm and about 30 mm from the distal tip233of the stem230. In some configurations, the distance between the fifth aperture269and the distal tip233can be between about 5% and about 30% of the total length LT2of the longer stem230, or about 10% and about 20% of the total length LT2of the longer stem230.

In some configurations, the third aperture265can be configured to receive a screw170when securing the stem230in a left or right shoulder of a patient. In some configurations, the fourth aperture257can be configured to receive the screw170when securing the stem230in the right shoulder of the patient. In some configurations, the fifth aperture259can be configured to receive the screw170when securing the stem230in the left shoulder of the patient. In other configurations the fourth aperture257can be configured to receive the screw170when securing the stem230in the left shoulder of the patient and the fifth aperture259can be configured to receive the screw170when securing the stem230in the left shoulder of the patient.

III. Examples of Components of the Humeral Assembly

As explained above in relation toFIG.3, the shoulder arthroplasty system or humeral assembly can include a number of components, such as an adapter168, a spacer150, a plurality of screws170, and/or a plurality of plugs700A,700B.

FIGS.9A-11Cillustrate different embodiments of the spacer150.FIGS.9A-9Cillustrate an embodiment of a spacer150A that is asymmetric. The spacer150A can include a proximal portion151A and a distal portion152A. The proximal portion151A may have a diameter greater than the diameter of the distal portion152A such that the proximal portion151A extends radially outward from the distal portion152A. In some configurations, the distal portion152A extends from a distal facing surface153A of the proximal portion151A.

As shown inFIGS.9A and9B, the distal portion152A can include a distal facing surface154A. The distal facing surface154A can include a protrusion155A and an engagement feature156A. In some configurations, the protrusion155A and the engagement feature156A can extend distally from the distal facing surface154A. As described above, the protrusion155A can be configured to engage with the anti-rotation aperture53,253of the stem30,230. When the spacer150A is coupled to the stem30,230, the protrusion155A can extend into the anti-rotation aperture53,253to minimize or eliminate rotation of the spacer150A in relation to the stem face50,250of the stem30,230. The engagement feature156A can be configured to engage with the first recess52,252of the stem face50,250of the stem30,230. When the spacer150A is coupled to the stem30,230, the engagement feature156A can extend into the first recess52,252. In some configurations, the engagement feature156A can have a substantially cylindrical shape or any other suitable shape. In some configurations, the engagement feature156A can be positioned at or near the center of the distal facing surface154A. In some configurations, the protrusion155A may be positioned medially or laterally from the engagement feature156A.

As shown inFIGS.9A and9B, the distal portion152A can include a curved outer surface with one or more cutouts157A. The one or more cutouts157A can be positioned on opposite sides of the distal portion152A. The one or more cutouts157A can be configured to align with the one or more slots55a,55b,55c,55d,255a,255b,255c,255dand the first and second protrusions58a,58b,258a,258bof the stem face50,250. For example, the one or more cutouts157A can engage with the one or more slots55a,55b,55d,255a,255b,255c,255dand the first and second protrusions58a,58b,258a,258bto minimize or eliminate rotation of the spacer150A in relation to the stem face50,250of the stem30,230.

As shown inFIG.9B, the proximal portion151A of the asymmetric spacer150A has a distal surface1515that is generally parallel to the stem face50,250of the stem230that the spacer150A is engaging with when the spacer150A is used with the stem230. When the spacer150A is used with the stemless humeral anchor103, the distal surface1515is generally parallel to the engaging face of the stemless humeral anchor103. A longitudinal axis L of the spacer150A is defined that is orthogonal to the distal surface1515. The proximal portion151A of the asymmetric spacer150A is asymmetric with respect to the longitudinal axis L.

The asymmetry of the asymmetric spacer150A is defined as follows. As shown inFIG.9B, a distal edge158A of the proximal portion151A on a medial side93A of the spacer150A extends farther medially than a proximal edge159A of the proximal portion151A on the medial side93A of the spacer150A and the distal edge158A on the lateral side91A of the spacer150A can extend medially relative to the proximal edge159A on the lateral side91A of the spacer150A.

Compared to the symmetric cylindrical spacer150C shown inFIGS.11A-11C, the asymmetric configuration of the spacer150A enables selective distalization of the humerus while minimizing lateralization of the humerus. In other words, the use of the asymmetric configuration of the spacer150A selectively extends or lengthens the humerus by locating the articulating assembly of reverse prosthetic shoulder joint farther in the proximal direction away from the stem face50,250at the proximal end of the humerus while minimizing the amount of lateralization of the humerus with respect to the shoulder joint. This feature can be useful in treating conditions where the pre-existing humeral stem was healed or cemented too low in the humerus, for example. In such situation, the asymmetric spacer150A can be used to effectively increase the height of the humeral component of the prosthetic joint without revising the humeral stem. The asymmetric feature can also be useful in allowing tuberosity fixation using the fracture stems30,230without or minimal lateralization.

This beneficial effect of the asymmetric spacer150A is now described with reference toFIGS.4B and4C.FIG.4Bis an illustration of a reverse shoulder prosthesis assembly of a fracture stem30,230, a symmetric spacer150C, a reverse articular component180,180A, with an articular body164(a glenosphere) engaging the reverse articular component180,180A.FIG.4Cfor comparison is an illustration of a reverse shoulder prosthesis assembly shown inFIG.4Bexcept that the spacer150A is an asymmetric spacer.

FIGS.4B and4Cshow that in the prosthetic assembly ofFIG.4C, the asymmetric shape of the asymmetric spacer150A has shifted the whole prosthetic assembly generally in the superior direction. This is illustrated by the relative position of the center of the glenosphere164marked by “X” with respect to the most proximal point A of the stem30,230. InFIG.4B, the center “X” of the glenosphere164is below the most proximal point A of the stem30,230by a distance D. InFIG.4C, the center “X” of the glenosphere164has been moved in the superior direction and is almost at the same level with the most proximal point A of the stem30,230. However, the overall width W′ of the prosthetic assembly is reduced because of the angle of the stem face50,250of the stem230. The width W′ of the asymmetric spacer150A assembly inFIG.4Cis smaller than the width W of the symmetric spacer150C assembly inFIG.4C. The asymmetric spacer150A can also be used in combination with the stemless humeral anchors103or humeral stem113in assembling a reverse prosthetic shoulder joint arrangement for the same beneficial reasoning described.

The stem implants30and230are examples of fracture stem implants. However, the asymmetric spacer150A can also be used with standard humeral stem implants to achieve the similar beneficial effect of selectively distalizing the humerus while iminizing lateralization of the humerus.

As shown inFIG.9C, the proximal portion151A can include a proximal face400. The proximal face400can be the same as or substantially similar to the stem face50of the stem30illustrated in and described in relation toFIGS.7A and7B. Reference numerals of the same or substantially the same features may share the same last two digits. For example, the proximal face400can be configured to couple the stem face230to the reverse articular component180, the adapter or coupler168, or the articular body164. The proximal face400can include a first recess452, a second recess454, a peripheral rim438, a groove456, one or more slots455a,455b,455c,455d,457a,457b, and first and second protrusions457a,457b. As shown in the illustrated configurations, the proximal face400may include only the aforementioned features. In other configurations, the proximal face400can also include one or more apertures similar to or the same as the one or more apertures51a,51b,53of the stem30.

With the asymmetric spacer150A in the arthroplasty kit100, a surgeon can use the asymmetric spacer150A to adjust the position of the reverse shoulder prosthetic joint. In the case of an initial arthroplasty procedure assembling a reverse prosthetic shoulder joint, after a stemless humeral anchor103or a stemmed humeral anchor113is positioned in the proximal end of the prepared humerus, the reverse articular component180or180A can be attached to the anchor103,113with an asymmetric spacer150A in between to position the articulating assembly (comprising the reverse articular component180or180A and a glenosphere164) to selectively distalize the humerus while minimizing any lateralization of the humerus. An asymmetric spacer150A having the appropriate thickness and appropriate amount of asymmetry would be selected for a given patient. In the case of a revision arthroplasty, if the position of the originally placed stemless humeral anchor103or the originally placed stemmed humeral anchor113is too low in the humerus, an appropriately dimensioned asymmetric spacer150A can be positioned between the humeral anchor103or113and the reverse articular component180,180A.

In some embodiments, a protrusion similar to the protrusion155A can be placed at a different location on the distal facing surface154A to function as a locating key for keying the asymmetric spacer to a different rotational position. This can be used to vary the direction of the distalization. In some embodiments, the protrusion155A on the distal facing surface154A of the spacer can be omitted to allow arbitrary rotation of the asymmetric spacer. Either way, some examples of benefits from having the ability to dial in the direction of the asymmetry are (but now limited to these): a) pure distalization would allow to tension more deltoid and get additional construct stability of the shoulder without adding tension on fractured tuberosity (in a fracture cases, surgeons generally do not want to tighten too much on the tuberosity to enhance healing without tuberosity migration); b) anterior or posterior offset to accommodate internal rotation/external rotation balance; c) anterior or posterior offset to accommodate bone distortion (Fracture sequalae for instance); d) anterior or posterior offset to accommodate joint subluxation in a tight shoulder. and e) optimizing impingement free range of motion by the ability to place the tray offset in any direction.

FIGS.10A-10Billustrate another embodiment of the spacer150B similar to the embodiments of the spacer150A illustrated in and described in relation toFIGS.9A-9B. Reference numerals of the same or substantially the same features may share the same first three digits. As shown inFIG.10B, the proximal portion151B may be angled. For example, the proximal edge159B of the proximal portion151B may be angled relative to the distal edge158B of the proximal portion151B such that the proximal edge159B on the medial side93B of the spacer150B extends farther proximally than the proximal edge159B on the lateral side91B of the spacer150B. For example, the proximal edge159B can be angled between about 1° and about 20°, or about 5° and about 15° about 5° relative to the distal edge158B. In some configurations, the proximal edge159B on the medial side93B of the spacer150B can extend farther distally than the proximal edge159B on the lateral side91B of the spacer150B.

FIG.10Cillustrates the proximal face500of the spacer150B, which can be similar to the proximal face400of the spacer150A and the stem face50of the stem30illustrated in and described in relation toFIGS.7A-7B and9C. Reference numerals of the same or substantially the same features may share the same last three digits.

FIGS.11A-11Billustrate another embodiment of the spacer150C similar to the embodiments of the spacer150A illustrated in and described in relation toFIGS.9A-9B. Reference numerals of the same or substantially the same features may share the same first three digits. As shown inFIGS.11A and11B, the distal portion152C can include only the engagement feature156C and the one or more cutouts157C on the curved outer surface of the distal portion152C. In some configurations, the distal portion152C can include a protrusion similar to or the same as the protrusion155A of the spacer150C. As shown inFIG.11B, the spacer150C may be symmetrical about the longitudinal axis and/or non-angled. For example, the distal edge158C of the proximal portion151C on both sides91C,93C of the spacer150C aligns with the proximal edge159C of the proximal portion151C on the both sides91C,93C of the spacer150C.

FIG.11Cillustrates the proximal face600of the spacer150B, which can be similar to the proximal face400of the spacer150A and the stem face50of the stem30illustrated in and described in relation toFIGS.7A-7B and9C. Reference numerals of the same or substantially the same features may share the same last three digits.

FIGS.12A-12Cillustrate an embodiment of an adapter or coupler168. As described above, the coupler168can include the proximal extension163A configured to connect to the articular body164and the distal extension163B. In some configurations, the distal extension163B can include a first distal portion163C and a second distal portion163D. The second distal portion163D can extend distally from the first distal portion163C. In some configurations, the first distal portion163C may have a greater diameter than the second distal portion163D. The first distal portion163C can be configured to engage within the second recess54,254,454,554,564of the fracture stem30,230or the spacer150A,150B,150C. The second distal portion163D can be configured to engage within the first recess52,252,452,552,562of the fracture stem30,230or the spacer150A,150B,150C. The disc or middle portion162can be disposed between the proximal extension163A and the distal extension163B. The disc or middle portion162can contact the peripheral rim38,238,438,538,638of the fracture stem30,230or the spacer150A,150B,150C. In some configurations, the disc or middle portion162can provide a spacer function in use when the adapter or coupler168is coupled to the stem30,230. In some configurations, the disc or middle portion162may include a window165. The window165can uncover an indicium on a corresponding stem that is indicative of an orientation or a configuration of the articular body164relative to the other member of the joint prosthesis (e.g., the anchor103,113or to a glenoid component) or a native glenoid in the case of a hemi-arthroplasty. The adapter or coupler168may also include a channel165extending between a proximal end165A and a distal end165B.

FIGS.13A and13Billustrates an embodiment of a screw170that can be received by the plurality of apertures62,64,98,262,264,265,267,269,298of the stem230. The screw170may have a length greater than a width of the screw170. The length of the screw170may be greater the length of the plurality of apertures62,64,98,262,264,265,267,269,298. For example, when the screw170is inserted into an aperture of the plurality of apertures62,64,98,262,264,265,267,269,298, a portion of screw170may be inserted into the bone of the patient. The screw170can be configured to secure the stem30,230to the bone of the patient. In some configurations, the screw170can have a continuous thread176between a proximal head172of the screw170and a distal end174of the screw170. In some configurations, the screw170can include one or more cutouts178at the distal end of the screw170. The one or more cutouts178can extend from the distal end174of screw170to at least a portion of the thread176. Advantageously, the screw170can be configured to screw into, for example, the bone of the patient faster due to the one or more cutouts178compared to a screw170without the one or more cutouts178.

FIGS.14-16illustrate various embodiments of a plug700A,700B.FIG.14illustrates the stem30with one or more plugs700in each aperture62,64,98. The one or more plugs700can include an elongate plug700A and/or a plug700B, shown in Figures and16, respectively. When the stem30is being used in cemented applications, the one or more plugs700can prevent cement from bridging across an aperture of the plurality of apertures62,64,98. The one or more plugs700can comprise a polyethylene material, a bone graft, or a combination thereof. For example, the clinician can use a graft tool800, which is further described below in relation toFIGS.17A-17C, to create one or more plugs700.

As shown inFIG.15, the elongate plug700A can include a length greater than a width of the elongate plug700A. For example, the length and the width of the elongate plug700A can be similar to or the same as the length and width of an aperture of the plurality of apertures62,64,98such that a single elongate plug700A can be received by the aperture. In some configurations, the length of the elongate plug700A can be between about 10 mm and about 40 mm, about 20 mm and about 30 mm, or about 25 mm. In some configurations, the width of the elongate plug700A can be between about 2 and about 10 mm, or about 4.4 mm. In some configurations, the width of the elongate plug700A can be between about 5% and about 30%, about 10% and about 20%, or about 18% of the length of the elongate plug700A. The elongate plug700A may also include a plurality of slots702A that extend along the length of the elongate plug700A and are circumferentially spaced apart. A length of each of the plurality of slots702A may be less than or equal to the length of the elongate plug700A. A width of each of the plurality of slots702A can be between about 0.1 mm and about 1.0 mm, or about 0.5 mm.

As shown inFIG.16, the plug700B can include a width greater than a length of the plug700B. For example, the length of the plug700B can be less than the length of an aperture of the plurality of apertures62,64,98and the width of the plug700B can be similar to or the width of the aperture of the plurality of apertures62,64,98such that multiple plugs700B (e.g., two, three, four or more) can be received by the aperture. In some configurations, the length of the plug700B can be between about 1.0 mm and about 4.0 mm, about 2.0 mm and about 3.0 mm, or about 2.5 mm. In some configurations, the width of the plug700B can be between about 2 and about 10 mm, or about 4.4 mm. In some configurations, the length of the plug700B can be between about 30% and about 70%, about 40% and about 60%, or about 56% of the width of the plug700B. The plug700B may also include a plurality of slots702B that extend along the length of the plug700B and are circumferentially spaced apart. A length of each of the plurality of slots702B may be less than or equal to the length of the plug700B. A width of each of the plurality of slots702B can be between about 0.1 mm and about 1.0 mm, or about 0.5 mm.

It may be desirable, for example, to use the elongate plug700A for ease of handling and inserting into one or more of the plurality of apertures62,64,98. On the other hand, it may be desirable to use one or more of the plugs700B (e.g., two, three, four, five or more plugs700B) to fill the aperture(s)62,64,98without needing to cut the length of the plug700B. Methods of using the plugs700A,700B are further described below in relation toFIGS.18E-18H,19F,20E, and21E.

FIGS.17A-17Fillustrates a graft tool800that can be used to create the one or more plugs700out of bone. The graft tool800can include an impactor810and a tip850. The impactor810can include a distal end820, a proximal end830, and a middle portion840extending between the two ends820,830. The distal end820can include an impaction head822having a larger diameter than the middle portion840and/or the proximal end830. The impaction head822can be configured to receive impaction forces from a tool (e.g., a mallet). The proximal end830can include a first portion832and a second portion834proximal to the first portion832. A perimeter of the first portion832can extend beyond a perimeter of the middle portion840. A diameter or perimeter of the second portion834can be similar to or greater than the diameter or perimeter of the middle portion840. The impactor810can also include a channel842that extend from the distal end820to the proximal end830.

FIGS.17C-17Fillustrate different views of the tip850. As shown inFIG.17C, the tip850can include a distal portion852with a distal end854and a proximal portion856with a proximal end858. The distal portion852can have a greater diameter than the proximal portion856. In some configurations, the distal portion852may have a varying diameter. For example, a diameter of the distal end854of the distal portion852can be greater than a diameter of a proximal end of the distal portion852. As shown inFIG.17D, in some configurations, a maximum diameter Dmax1of the distal portion852can be between about 5 mm and about 30 mm, about 10 mm and about 20 mm, or about 15.9 mm, or about 16.9 mm. In some configurations, the distal portion852can have a funnel-like shape. The distal portion852of the tip850can be configured to couple to the proximal end830of the impactor810. For example, as shown inFIG.17B, the distal portion852of the tip850can include a recess851that can be threaded and the second portion834of the proximal end830of the impactor810can have corresponding threads to engage with the threaded opening of the tip850. The recess851can extend from the distal end854of the tip850toward the proximal end858of the tip850. In some configurations, a length of the recess851can be less than or equal to the length of the distal portion852. In some configurations, when the impactor810is coupled to the tip850, a proximal facing surface of the first portion832of the proximal end830of the impactor810can abut a distal facing surface of the distal end854of the tip850.

FIG.17Fillustrates a cross sectional view of the tip850along the line17F-17F inFIG.17D.FIG.17Fillustrates example dimensions of the tip850. The proximal portion856of the tip850may have a diameter less than the diameter of the distal portion852. In some configurations, the proximal portion856may have a varying diameter. For example, a diameter of a distal end of the proximal portion856can be greater than a diameter of the proximal end858of the proximal portion856. In some configurations, a maximum diameter Dmax2of the proximal portion can be between about 2 mm and about 20 mm, about 5 mm and about 10 mm, or about 6.4 mm. In some configurations, a minimum diameter Dminof the proximal portion can be between about 2 mm and about 20 mm, about 5 mm and about 10 mm, or about 4.4 mm. The diameter of the distal end of the proximal portion856can be the same as or similar to the diameter of the proximal end of the distal portion852. The proximal portion856can have a channel853that extends from the proximal end858toward the distal end854. A length of the channel853can be greater than or equal to the length of the proximal portion850. In some configurations, the channel853can at least partially extend into the distal portion852.

In use, the clinician can thread the impactor810into the tip850. The clinician can position the proximal end858of the tip850against the bone of a patient. The clinician can use a mallet to apply impacting forces to the impaction head822, which causes portions of the bone to fill the channel853of the tip850. Once a sufficient amount of bone is in the channel853, the clinician can remove the bone graft from the tip850. As shown inFIG.17G, the clinician can remove the tip850from the impactor810and use a tool860, such as a screwdriver or a rod with a flat end, to remove the bone graft from the tip850by pushing the tool860against one end of the bone graft until the bone graft exits the proximal end858of the tip850. The clinician can remove the bone graft from the tip850by inserting a tool, such as a pin or a rod with a flat end, into the channel842of the impactor810and push the bone graft until the bone graft exits the proximal end858of the tip850. Advantageously, using the rod with the flat end can reduce or prevent breaking in the bone graft. Once the bone graft is removed, the clinician can insert the bone graft into one or more of the apertures62,64,98,262,264,265,267,269of the stem30,230.

IV. Shoulder Arthroplasty Methods and Instrumentation

The humeral anchors described above can be implanted using certain tools and instruments that are described below in connection withFIGS.18A-21E.

A. Dual Use Surgical Instruments

One advantage of various kits and systems disclosed herein is that multiple different types of humeral anchors can be implanted using shared instrumentation. Examples of shared instrumentation are discussed below.

As discussed above, a stem30,230may include one or more interfacing features, such as the one or more apertures51a,51b,53,251a,251b,253, configured to engage a tool and enable insertion of the stem30,230into the bone.FIGS.18A-18Iillustrate a stem holder900configured to position a stem30,230into the bone (e.g., the humerus H). As discussed in more detail below, the stem holder900can be configured to receive impaction forces, for example from a mallet, to properly insert the stem30,230into the bone. For example, the proximal surface of the stem30,230(e.g., the stem face250) can take most of the impaction force via direct contact with a distal surface903of the stem holder900.

The stem holder900may include an elongate body905. The elongate body905may generally extend from a first or proximal end902of the stem holder900to a second or distal end904of the stem holder900. As shown inFIG.18B, the elongate body905may include a stem interfacing portion910at the second end904of the stem holder900. The stem interfacing portion910may be configured engage the stem face50,250of a stem30,230. For example, the stem interfacing portion910can include one or more interfacing features911,912,913,914. The plurality of interfacing features can include a first interfacing feature911, a second interfacing feature913, a third interfacing feature912, and/or a fourth interfacing feature914, which is further described below in relation toFIG.18C. The third interfacing feature912can extend distally from a distal surface903of the stem holder900and be configured to engage with the second recess54,254of the stem30,230. For example, the second recess54,254can receive the third interfacing feature912. In some configurations, the third interfacing feature912can be spaced from the perimeter of the distal surface903such that a portion of the distal surface903can contact the peripheral rim38,238of the stem face50,250when the stem30,230is coupled to the stem holder900. In some configurations, the third interfacing feature912can include two portions that are connected on one end and otherwise spaced apart. The gap between the two portions of the third interfacing feature912can have a width corresponding with a width of the fourth interfacing feature914such that the fourth interfacing feature914can be received by the gap between the two portions. The first and second interfacing features911,913can extend distally from a distal surface of the third interfacing feature912. For example, the first interfacing feature911can extend from the distal surface of one of the two portions of the third interfacing feature912and the second interfacing feature913can extend from the distal surface of the other one of the two portions of the third interfacing feature912. The first and second interfacing features911,913can be configured to engage with the one or more apertures51a,51b,53,251a,251b,253of the stem30,230. For example, the first interfacing feature911can be received by the second aperture51bof the stem face50,250and the second interfacing feature913can be received by the first aperture51aof the stem face50,250.

The stem holder900may also include a moveable assembly906(seeFIGS.18C and18D) coupled with the elongate body905.FIG.18Dillustrates the stem holder900with the elongate body905partially transparent such that the internal components (e.g., the moveable assembly906) are visible. The moveable assembly906may include a handle908disposed between the first end902and the second end904of the stem holder900. The handle908may be coupled, for example pivotably coupled, with the elongate body905at pivot location918.

As shown inFIGS.18C and18D, the moveable assembly906may also include the fourth interfacing feature914disposed at the second end904of the stem holder900. The fourth interfacing feature914may be coupled, for example pivotably coupled, with the elongate body905at pivot location919. In some configurations, the fourth interfacing feature914may be a stationary peg that is fixed with respect to the remainder of the stem holder900and does not move. The fourth interfacing feature914may be configured to engage with one of the one or more apertures51a,51b,53,251a,251b,253of the stem30,230. For example, the fourth interfacing feature914may be a peg configured to interface with the anti-rotation aperture53,253.

The handle908may be directly or indirectly coupled to the fourth interfacing feature914. For example, the handle908may be indirectly coupled to the fourth interfacing feature914by a spring linkage916. The spring linkage916may have an arcuate portion and a spring gap920. The spring linkage916may be indirectly coupled to the elongate body905by the handle908and/or the fourth interfacing feature914without a direct connection between the spring linkage916and the elongate body905.

The handle908can be configured to move the fourth interfacing feature914between a first configuration and a second configuration. A proximal end of the handle908can be free to move relative to the elongate body905. The transition between the first configuration and the second configuration may include rotation and/or translation of the fourth interfacing feature914with respect to elongate body905. For example, actuating (e.g., pivoting) the handle908away from the elongate body905may move the fourth interfacing feature914from the first configuration to the second configuration, while releasing the handle908may move the fourth interfacing feature914back to the first configuration. In the second configuration, the fourth interfacing feature914can be rotated and at least partially retracted with respect to a distal surface903of the stem holder900. In this position, the surgeon may engage the stem face50,250of the stem30,230. While the fourth interfacing feature914engages the stem face50,250of the stem30,230, the handle908may be released (e.g., toward the elongate body905) so as to apply a gripping force to the stem30,230. In the first configuration, the spring linkage916can be compressed (e.g. the spring gap920has been slightly closed), and provide a spring force which can help to hold the fourth interfacing feature914closed against the stem30,230.

In some configurations, the fourth interfacing feature914may be angled relative to the first and second interfacing features911,913. For example, longitudinal axes of the first and second interfacing features911,913may extend substantially perpendicularly from the distal surfaces of the third interfacing feature912. Accordingly, a longitudinal axis of the fourth interfacing feature914may be angled relative to the longitudinal axes of the first and second interfacing features911,913. When the fourth interfacing feature914is moved from the first configuration to the second configuration, the angle between the fourth interfacing feature914and the first and second interfacing features911,913can decrease. In some configuration, the angle between the fourth interfacing feature914and the first and second features911,913may increase when moving the fourth interfacing feature914from the first configuration to the second configuration.

Stem holder900may include at least one impaction head924configured to receive impaction forces from a tool (e.g., a mallet). For example, the stem holder900may include a single impaction head924that may be disposed at the first end902of the stem holder900. In some configurations, the at least one impaction head can include two impaction heads with the impaction head924and a second impaction head being positioned closer to the second end904of the stem holder900. The impaction head924may be coupled with the elongate body905. In some configurations, the impaction head924may be aligned with the longitudinal axis of the elongate body905. In some configurations, the impaction head924may be disposed at an angle relative to the longitudinal axis of the elongate body905. When a force is applied to the impaction head924, the impacting force can be directed to the stem30,230in a direction aligned with a longitudinal axis of the stem30,230to embed the stem30,230in the bone.

The stem holder900may also be configured to receive a retroversion rod. For example, the retroversion rod may be inserted into one of the openings926. Each opening may position the retroversion rod at a different angle, corresponding to the desired angle of resection, and allow the surgeon to evaluate the version. If the proximal bone resection was not accurate or for other reasons dictated by surgeon judgment, the surgeon can modify the resection plane.

The stem holder900may also include a height gauge930configured to determine a height of the stem30,230relative to the humerus or a depth of the stem30,230within the humerus. For example, prior to implanting the stem30,230into the humerus, a clinician can determine the appropriate stem height of the stem30,230relative to the humerus based on x-rays of the humerus, a trial stem, or other suitable methods. The height gauge930can include a ruler932, a connector rod934, a connector hub940, and a marker950. The ruler932can include a plurality of markings (not shown) associated with a measurement (e.g., millimeters (mm), centimeters (cm)). In some configurations, the ruler932can have an elongate shape (e.g., a cylinder). In some configurations, a longitudinal axis of the ruler932can be substantially parallel to the longitudinal axis of the elongate body905. The connector rod934can be configured to couple the height gauge930to the elongate body905. In some configurations, the elongate body905can include a connector portion928configured to receive the connector rod934. The elongate body905can include the connector portion928on one or both sides of the elongate body905. When the elongate body905has connector portion928on both sides, the clinician can position the connector rod934in either of the connector portions928. The connector rod934can have an elongate shape (e.g., a cylindrical shape). In some configurations, a longitudinal axis of the connector rod934can be substantially perpendicular to the longitudinal axis of the ruler932and/or the elongate body905.

The marker950can extend perpendicularly from a distal end of the ruler932. A distal facing surface of the marker950can be configured to be positioned on the humerus after the humeral head is removed. The connector hub940may be configured to couple the ruler932and the connector rod934. The connector hub940can include an adjustment portion942and a connector portion944. The adjustment portion942can be configured to move the ruler932relative to the connector rod934. In some configurations, the adjustment portion942can be a wheel942. In use, after the clinician has determined the appropriate stem height and connected the stem30,230to the stem holder900, the clinician can turn the wheel942to move the ruler932until the ruler932reaches the appropriate stem height. The clinician can apply impaction forces to the impaction head924to insert the stem30,230into the humerus until the marker950contacts the resected portion of the humerus.

The stem holder900may form part of a kit including a stemless bone anchor and/or a stemmed bone anchor. The stemless and/or stemmed bone anchor may include any of the features of the implants described above. The stem interfacing portion910may be configured to engage the stem holder interface of the stemless bone anchor and/or the stem face of the stemmed bone anchor.

In use, the same stem holder900may engage the stem holder interface of a first, stemless bone anchor or the stem face of a second, stemmed bone anchor. The stemless and/or stemmed bone anchor may include any of the features of the implants described above. For example, the stem holder900may engage the stem holder interface of the stemless bone anchor and advance the stemless bone anchor into bone matter exposed at a resection of a bone. When advancing the stemless bone anchor, a force may be applied to the impaction head924of the stem holder900to apply a force perpendicular to the resection plane of the bone.

The same stem holder900may engage the stem face of the stemmed bone anchor and advance the stemmed bone anchor to position the stem of the bone anchor in a medullary canal of the bone. When advancing the stemmed bone anchor, a force may be applied to the impaction head924of the stem holder900to apply a force aligned with a longitudinal axis of the stemmed bone anchor to embed the stem in the bone.

FIGS.19A-21Eillustrate different configurations of a jig1000,1100,1200configured to position a stem30,230into the bone (e.g., the humerus H). As discussed in more detail below, the jig1000,1100,1200can be configured to receive impaction forces, for example from a mallet, to properly insert the stem30,230into the bone. For example, the proximal surface of the stem30,230(e.g., the stem face50,250) can take most of the impaction force via direct contact with a distal surface1003,1103,1203of the jig1000,1100,1200.

FIGS.19A-19Fillustrates an embodiment of the jig1000. The jig1000may extend between a first or proximal end1002and a second or distal end1004. At or near the proximal end1002, the jig can include a proximal portion1006. The proximal portion1006can include an inserter portion1008and a connecting bridge1010. The inserter portion1008can include at least one impaction head1012and an elongate body1016.

The elongate body1016may generally extend from the impaction head1012toward the second end1004of the jig1000. A longitudinal axis of the elongate body1016can be substantially perpendicular to a longitudinal axis of the connecting bridge1010. The elongate body1016may include an interfacing portion1014at a distal end of the elongate body1016. The interfacing portion1014may be configured engage the stem face50,250of a stem30,230. The interfacing portion1014can be the same as or similar to the stem interfacing feature910described in relation toFIG.18B. For example, as shown inFIG.19C, the interfacing portion1014can include a plurality of interfacing features1020,1022,1024,1026extending from a distal facing surface1018of the interfacing portion1014. The plurality of interfacing features can include a first interfacing feature1022, a second interfacing feature1024, a third interfacing feature1020, and a fourth interfacing feature1026.

The jig1000may also include a moveable assembly1030(seeFIGS.19D and19E) coupled with the elongate body1016.FIG.19Eillustrates the jig1000with the elongate body1016and the connecting bridge1010partially transparent such that the internal components (e.g., the moveable assembly1030) are visible. The moveable assembly1030may include a handle1032disposed along the connecting bridge1010. The handle1032may be coupled, for example pivotably coupled, with the elongate body1016at pivot location1034.

As shown inFIGS.19D and19E, the moveable assembly1030may also include the fourth interfacing feature1026disposed at the distal end of the elongate body1026. The fourth interfacing feature1026may be coupled, for example pivotably coupled, with the elongate body1026at pivot location1036. In some configurations, the fourth interfacing feature1026may be a stationary peg that is fixed with respect to the remainder of the stem holder1000and does not move. The fourth interfacing feature1026may be configured to engage with one of the one or more apertures51a,51b,53,251a,251b,253of the stem30,230. For example, the fourth interfacing feature1026may be a peg configured to interface with the anti-rotation aperture53,253.

The handle1032may be directly or indirectly coupled to the fourth interfacing feature1026. For example, the handle1032may be indirectly coupled to the fourth interfacing feature1026by a spring linkage1038. The spring linkage1038may have an arcuate portion and a spring gap1040. The spring linkage1038may be indirectly coupled to the elongate body1016by the handle1032and/or the fourth interfacing feature1026without a direct connection between the spring linkage1038and the elongate body1016.

The handle1032can be configured to move the fourth interfacing feature1026between a first configuration and a second configuration. A free end1033of the handle1032can be free to move relative to the elongate body1016. The transition between the first configuration and the second configuration may include rotation and/or translation of the fourth interfacing feature1026with respect to elongate body1016. For example, actuating (e.g., pivoting) the free end1033of the handle1032away from connecting bridge1010may move the fourth interfacing feature1026from the first configuration to the second configuration, while releasing the free end1033of the handle1032may move the fourth interfacing feature1026back to the first configuration. In the second configuration, the fourth interfacing feature1026can be rotated and at least partially retracted with respect to the distal surface1018of the interfacing portion1014. In this position, the surgeon may engage the stem face50,250of the stem30,230. While the fourth interfacing feature1026engages the stem face50,250of the stem30,230, the free end1033of the handle1032may be released (e.g., toward the connecting bridge1010) so as to apply a gripping force to the stem30,230. In the first configuration, the spring linkage1038can be compressed (e.g. the spring gap1040has been slightly closed), and provide a spring force which can help to hold the fourth interfacing feature1026closed against the stem30,230.

As show inFIGS.19A and19B, the handle1032may also include an elongate gap1031. The elongate gap1031may be configured to receive a distal portion of the impaction head1012so that the distal portion of the impaction head1012can couple to the elongate body1016and/or the connecting bridge1010.

The at least one impaction head1012can be configured to receive impaction forces from a tool (e.g., a mallet). For example, the jig1000may include a single impaction head1012that may be disposed at the first end1002of the jig1000. In some configurations, the at least one impaction head can include two impaction heads with the impaction head1012and a second impaction head being positioned closer to the second end1004of the jig1000. The impaction head1012may be coupled with the elongate body1016. In some configurations, the impaction head1012may be parallel to or aligned with a longitudinal axis of the elongate body1016. In some configurations, the impaction head1012may be disposed at an angle relative to the longitudinal axis of the elongate body1016. When a force is applied to the impaction head1012, the impacting force can be directed to the stem30,230in a direction aligned with a longitudinal axis of the stem30,230to embed the stem30,230in the bone.

The jig1000may also be configured to receive a retroversion rod. For example, the retroversion rod may be inserted into one of the openings1042. Each opening may position the retroversion rod at a different angle, corresponding to the desired angle of resection, and allow the surgeon to evaluate the version. If the proximal bone resection was not accurate or for other reasons dictated by surgeon judgment, the surgeon can modify the resection plane.

As shown inFIGS.19A-19C, the jig1000may also include a height gauge1050configured to determine a height of the stem30,230relative to the humerus or a depth of the stem30,230within the humerus. The height gauge1050can be similar to or the same as the height gauge930of the stem holder900. For example, the height gauge1050can include a ruler1052and a marker1054. The ruler1052can include a plurality of markings (not shown) associated with a measurement (e.g., millimeters (mm), centimeters (cm)). In some configurations, the ruler1052can have an elongate shape. The ruler1052can have a substantially square cross-sectional shape. In some configurations, a longitudinal axis of the ruler1052can be substantially parallel to the longitudinal axis of the elongate body1016. In some configurations, the longitudinal axis of the ruler1052can be substantially perpendicular to the longitudinal axis of the connecting bridge1010. A proximal end of the ruler1052can be directly or indirectly coupled to the connecting bridge1010.

The marker1054can extend perpendicularly from the ruler1052. A distal facing surface of the marker1054can be configured to be positioned on the humerus after the humeral head is removed. In some configurations, the height gauge1050can include a marker connector1056. The marker connector1056can include an aperture configured to receive the ruler1052. The marker connector1056can be configured to couple the marker1054to the ruler1052. The marker connector1056can include an adjustment portion1058configured to allow the marker1054and marker connector1056relative to the ruler1052. In some configurations, the adjustment portion can be a release button1058. In use, after the clinician has determined the appropriate stem height and connected the stem30,230to the jig1000, the clinician can turn the push the release button1058and move the marker connector1056until the marker connector1056and the marker1054reaches the appropriate stem height. The clinician can release the release button1058to secure a positon of the marker connector1058and marker1054relative to the ruler1052. The clinician can apply impaction forces to the impaction head1012to insert the stem30,230into the humerus until the marker1054contacts the resected portion of the humerus.

The jig1000may further include a vertical support structure1060and one or more screw guides1064. The vertical support structure1060can extend from the height gauge1050to the distal end1004of the jig1000. The vertical support structure1060can couple to the height gauge1050at a proximal end of the vertical support structure1060. For example, the vertical support structure1060can be coupled to the height gauge1050by one or more fastening screws1062. The vertical support structure1060can be configured to couple the jig1000with a distal arm extension1102, which is further described belowFIGS.20A-21E.

The one or more screw guides1064can be configured to align one or more screws170with the one or more apertures62,64in the distal shaft portion32of the stem30. For example, as shown inFIGS.19A-19C, each of the one or more screw guides1064can be configured to receive a drill sleeve1070. The drill sleeve1070can include a channel1072that extends from a distal end (i.e., the end of the drill sleeve1070facing away from the screw30) to a proximal end (i.e., the end of the drill sleeve1070facing the stem30) of the drill sleeve1070. The channel1072can be sized and shaped to receive a screw170. For example, a surgeon can insert the screw170through the channel1072and drill the screw170through the one or more aperture62,64in the distal shaft portion32of the stem to secure the stem30to the humerus of the patient. In some configurations, the drill sleeve1070can include a plurality of drill sleeves. The plurality of drill sleeves can be configured to nest inside one another.

FIGS.20A-21Eillustrate a first configuration (FIGS.20A-20E) and a second configuration (FIGS.21A-21E) of another embodiment of a jig1100. The jig1100can include the jig1000described above in addition to a distal arm extension1102. The distal arm extension1102can be configured to align one or more screws170with the one or more apertures265,267,269of the distal shaft232of the stem230. The distal arm extension1102can include a first portion1104that includes a first end of the distal arm extension1102and a second portion1106that includes a second end of the distal arm extension1102. The distal arm extension1102can include a curvature between the first and second ends. The first portion1104of the distal arm extension1102can be coupled to the distal end of the vertical support structure1060. For example, the first end of the first portion1104can be secured to the distal end of the vertical support structure1060by a fastening screw1062. In some configurations, the distal arm extension1102extend radially outward from the first end of the first portion1104to the second end of the second portion1106.

The distal arm extension1102can be configured to be moveable between a first side of the jig1100(FIGS.20A-20E) and a second side of the jig1100(FIGS.21A-21E). For example, the clinician can loosen the fastening screw1062connecting the distal arm extension1102with the vertical support structure1060and rotate the distal arm extension1102about the distal end of the vertical support structure1060. When the distal arm extension1102is on the appropriate side of the jig1100, the clinician can tighten the fastening screw1062to secure the distal arm extension1102on the appropriate side of the jig1100. The jig1100can be configured to implant a stem230into a left arm of a patient when the jig1100is on the first side of the jig1110. The jig1100can be configured to implant the stem230into a right arm of the patient when the jig1100is on the second side of the jig1110.

The distal arm extension1102can include one or more screw guides1108,1110. For example, the one or more guides1108,1110can include a first screw guide1108and a second screw guide1112. The first and second screw guides1108,1110can be positioned on the second portion1106of the distal arm extension1102. The first screw guide1108can be positioned at the second end of the second portion1106. The second screw guide1110can be positioned between the second end of the second portion1104of the distal arm extension1102and the first portion1104of the distal arm extension1102. For example, the second screw guide1110can be adjacent the first screw guide1108. The first and second screw guides1108,1110can be configured to align a screw170with one or more of the apertures265,267,269of the stem240. For example, the first screw guide1108can align a screw170with the fourth or fifth aperture267,259and the second screw guide1110can be configured to align the screw170with the third aperture265. In some configurations, as shown inFIGS.20A-21E, each of the first and second screw guides1108,1110can be configured to receive a drill sleeve1070.

The first screw guide1108can include one or more apertures1112,1114configured to align a screw170with one or more apertures265,267,269of the stem230. For example, the one or more apertures can include a first aperture1112and a second aperture1114. The first aperture1112can align the screw170and/or the drill sleeve1070with the fifth aperture269. The second aperture1114can align the screw170and/or the drill sleeve1070with the fourth aperture269.

The first screw guide1108can include a sliding plate1116that can move between a first position and a second position. The sliding plate1116can be configured to cover the first or second aperture1112,1114of the first screw guide1108. For example, the sliding plate1116can include corresponding first and second apertures that align with the first and second apertures1112,1114of the first screw guide1108, respectively. When the distal arm extension1102is on the first side of the jig1100, as shown inFIGS.20A-20E, the sliding plate1116can be in the first position. When the sliding plate1116is in the first position, the sliding plate1116can cover the second aperture1114and the first aperture of the sliding plate1116can align with the first aperture1112of the first screw guide1108such that the first screw guide1108can align the screw170and/or the drill sleeve1070with the fifth aperture269. When the distal arm extension1102is on the second side of the jig1100, as shown inFIGS.21A-21E, the sliding plate1116can be in the second position. When the sliding plate1116is in the second position, the sliding plate1116can cover the first aperture1112and the second aperture of the sliding plate1116can align with the second aperture11124of the first screw guide1108such that the first screw guide1108can align the screw170and/or the drill sleeve1070with the fourth aperture267.

The sliding plate1116can be configured to move along a longitudinal axis of the first screw guide1108to move between the first and second positions. The sliding plate1116can be configured to move between the first and second positions by gravitational forces and/or the user manually moving the sliding plate1116. In some configurations, the sliding plate1116can include a sliding mechanism that can move the sliding plate1116between the first and second positions. For example, when the distal arm extension1102is moved to the first side of the jig1100, gravitational forces, the user, and/or the sliding mechanism can move the sliding plate1116distally relative to the body of the first screw guide1108to the first position such that the top aperture (e.g., the second aperture1114) is covered and the bottom aperture (e.g., the first aperture1112) is uncovered. As a further example, when the distal arm extension1102is moved to the second side of the jig1100, gravitational forces. the user, and/or the sliding mechanism can move the sliding plate1116distally relative to the body of the first screw guide1108to the second position such that the top aperture (e.g., the first aperture1112) is covered and the bottom aperture (e.g., the second aperture1114) is uncovered. Advantageously, whether the surgeon is implanting the stem230in the left or right arm of the patient, the sliding plate1116can prevent the surgeon from inserting the screw170and/or the drill sleeve1070into the incorrect aperture of the first and second apertures1112,1116for the procedure.

The jig1000,1100may form part of a kit including a stemless bone anchor and/or a stemmed bone anchor. The stemless and/or stemmed bone anchor may include any of the features of the implants described above. The interfacing portion1014may be configured to engage the jig interface of the stemless bone anchor, which is the same as or similar to the stem holder interface described above, and/or the stem face of the stemmed bone anchor.

In use, the same jig1000,1100may engage the jig interface of a first, stemless bone anchor or the stem face of a second, stemmed bone anchor. The stemless and/or stemmed bone anchor may include any of the features of the implants described above. For example, the jig1000,1100may engage the jig interface of the stemless bone anchor and advance the stemless bone anchor into bone matter exposed at a resection of a bone. When advancing the stemless bone anchor, a force may be applied to the impaction head1012of the jig1000,1100to apply a force perpendicular to the resection plane of the bone.

The same jig1000,1100may engage the stem face of the stemmed bone anchor and advance the stemmed bone anchor to position the stem of the bone anchor in a medullary canal of the bone. When advancing the stemmed bone anchor, a force may be applied to the impaction head1012of the jig1000,1100to apply a force aligned with a longitudinal axis of the stemmed bone anchor to embed the stem in the bone.

B. Methods of Implanting Humeral Anchors

The humeral anchors described above can be implanted following methods discussed below in connection withFIGS.18A-21E. These methods can advantageously employ certain tools and instruments, such as the ones described above, that can be shared among the stemless anchors103and the stemmed anchors30,230. This provides advantages in reducing the training required to complete a surgical procedure.

1. Methods of Using the Stem Holder

FIGS.18E-18Hillustrate the stem holder900coupled to a stem30andFIG.18Iillustrates the stem holder900coupled to the stem30with the stem30being implanted in a humerus H.

Before implanting the stem30into the humerus H, the surgeon can prepare the humerus H. The surgeon can resect the humerus H at the anatomic neck to separate the articular surface of the humerus H from the rest of the humerus H. The separation of the articular surface from the rest of the humerus H creates a resection surface. Optionally, the surgeon can apply a protect tool, such as a plate, to the resected surface to cover the newly exposed cancellous bone. It is important to protect the newly exposed cancellous bone because this bone is to be formed in later parts of the method to have a recess having an inner profile that matches the outer or exterior and distal surface of any of the anchors (e.g., the stemless anchor or the metaphysis portion of the stemmed anchors). The surgeon can optionally remove the protect tool and size the resected humerus H to determine which size of the stem30,230(or other anchors as disclosed herein) should be used for the particular patient. Following the resection step, or the optional protection and/or sizing steps, the surgeon can ream the humerus H to form a recess or cavity in the exposed cancellous bone. The reaming step can produce a stepped internal recess or cavity in the metaphysis of the humerus H shaped to receive a humeral anchor portion, e.g., the stemless anchor103or a metaphysis potion of a stemmed anchor30,230.

After the humerus H has been prepared, the surgeon can use the stem holder900to employ trial anchors, which can have more easily disengaged connections with a trial head assembly or trial insert assembly than would be the case in a final implant. The trial step can enable the surgeon to choose or confirm a size to be used in the final implant. During this step, the surgeon may also use the height gauge930to determine an appropriate stem height for the particular patient. The surgeon may couple the stem holder900to the trail anchor and move the wheel942until the marker is950contacts the exposed cancellous bone. Also, the surgeon may use the graft tool800to create any plugs700from the removed humeral head.

FIGS.18E-18Hshow the stem holder900coupled with the stem30. The stem holder900can be coupled with the other stem230or any of the stemless anchors103. The use of common instrumentation enables the surgeon to determine during the procedure that the stemless anchor103is not appropriate and then to quickly switch to the humeral stem30,230following any additional preparation of the humerus H that would make the humerus H ready for the humeral stem30,230.

In the case of the stem30, the stem holder900can grip the stem30in the recess thereof by engaging the tooling interfaces, e.g., the one or more apertures51a,51b,53. Optionally, the surgeon can insert one or more plugs700into the one or more apertures62,64,98of the humeral stem30. In the case of an elongate plug700A, the surgeon may cut the elongate plug700A so that the elongate plug700A is the same length as the aperture52,54,98. In the case of a plug700B, the surgeon may insert a first plug700B in one end of the aperture52,54,98and a second plug700B in the other end of the aperture52,54,98.

Thereafter, the distal shaft portion32of humeral stem30can be inserted through the formed recess in the resection surface and further inserted into the intramedullary canal. Once the distal shaft portion32is in the diaphysis of the humerus H and the metaphyseal portion90is in the metaphysis of the humerus H, an impaction load can be applied to the stem holder900. In particular, an impactor, e.g., a mallet, can strike the impaction head924that is disposed at the proximal end902of the stem holder900driving the humeral stem30into firm engagement with the humerus H generally along the axis of the distal shaft portion32of the humeral stem30. For example, the surgeon can apply impaction forces to the stem holder900until the marker950contacts the humerus H.

In the case of a stemless anchor103, the stem holder900can grip the anchor in the recess thereof by engaging the tooling interfaces. Thereafter, the anchor103can be moved into the recess formed in the humerus H and pressed against the prepared surface. Thereafter, an impactor, e.g., a mallet, can be used to apply a load to the impaction head924at the proximal end904of the stem holder900and along the longitudinal axis thereof. The load can thus be directed transverse to, e.g., generally perpendicular to the plane of the resection surface that is formed in the resection step. Thus the inserting step can be achieved for a stemless implant103and for a stemmed implant such as the humeral stem30,230using the same impactor instrument, e.g., the stem holder900.

An impacting step can follow the previously described inserting step. The impacting step involves impacting an anatomic assembly160, reverse articular body180, and/or a spacer150into the stemmed anchor30(or another stemmed anchor230). As discussed above, the kit100includes shared implant components. As such, the impacting step can be the same for the humeral stem30,230as for the stemless anchors103.

2. Methods of Using the Jig

FIGS.19F,20E, and21Eillustrate the jig1000,1100coupled to a stem30or a stem230with the stem30,230being implanted in a humerus H. Before implanting the stem30,230, the surgeon can prepare the humerus H with the same or similar methods as described above in relation to the method(s) of using the stem holder900.

FIG.19Fillustrates the jig1000coupled with the stem30. The jig1000can be coupled with the other stem230or any of the stemless anchors103. The use of common instrumentation enables the surgeon to determine during the procedure that the humeral stem30is not appropriate and then to quickly switch to the other humeral stem230following any additional preparation of the humerus H that would make the humerus H ready for the humeral stem230.

In the case of the stem30, the jig1000can grip the stem30in the stem face by engaging the tooling interfaces, e.g., the one or more apertures51a,51b,53. Optionally, the surgeon can insert one or more plugs700into the one or more apertures62,64,98of the humeral stem30. In the case of an elongate plug700A, the surgeon may cut the elongate plug700A so that the elongate plug700A is the same length as the aperture52,54,98. In the case of a plug700B, the surgeon may insert a first plug700B in one end of the aperture52,54,98and a second plug700B in the other end of the aperture52,54,98.

Thereafter, the distal shaft portion32of humeral stem30can be inserted through the formed recess in the resection surface and further inserted into the intramedullary canal. Once the distal shaft portion32is in the diaphysis of the humerus H and the metaphyseal portion90is in the metaphysis of the humerus H, an impaction load can be applied to the jig1000. In particular, an impactor, e.g., a mallet, can strike the impaction head1012that is disposed at the proximal end1002of the jig1000driving the humeral stem30into firm engagement with the humerus H generally along the axis of the distal shaft portion32of the humeral stem30. For example, the surgeon can apply impaction forces to the jig1000until the marker1053contacts the humerus H.

An impacting step can follow the previously described inserting step. The impacting step involves impacting an anatomic assembly160, reverse articular body180, and/or a spacer150into the stemmed anchor30(or another stemmed anchor230). As discussed above, the kit100includes shared implant components. As such, the impacting step can be the same for the humeral stem30,230as for the stemless anchors103.

After the impacting step, in the case of the stem30, a securing step can be performed. A minimal skin incision may be performed at a planned entry point of the screw170. The drill sleeve1070can be inserted into one of the screw guides1064. The drill sleeve1070can be advanced through the incised entry point to the humerus H. A tool can be inserted through the channel1072of the drill sleeve1070to create a hole in the humerus H and through one of the apertures62,64. For example, a drill can be used to create the hole. The same or another tool can be sued to insert a screw170into the channel1072of the drill sleeve1070and into the previously created hole. These steps can be repeated to insert a screw170into the other one of the apertures62,64.

FIGS.20E and21Eillustrate the jig1100coupled with the stem230. The jig1100can be coupled with the other stem30or any of the stemless anchors103. In the case of the stem230, the jig1100can grip the stem230in the stem face250by engaging the tooling interfaces, e.g., the one or more apertures251a,251b,253. Optionally, one or more plugs700can be inserted into the one or more apertures262,264,265,267,269,298of the humeral stem230. For example, the one or more plugs700can be inserted into the fourth aperture267of the stem230when implanting the stem230in the left arm of the patient (FIG.20E). Alternatively, the one or more plugs700can be inserted into the fifth aperture269of the stem230when implanting the stem230in the right arm of the patient (FIG.21E). In the case of an elongate plug700A, the surgeon may cut the elongate plug700A so that the elongate plug700A is the same length as the aperture267,269. In the case of a plug700B, the surgeon may insert a first plug700B in one end of the aperture267,269and a second plug700B in the other end of the aperture267,269.

Thereafter, the distal arm extension1102can be moved to the first side of the jig1100(FIG.20E) or the second side of the jig1100(FIG.21E) depending on which arm of the patient is being operated on. The distal arm extension1102can be secured in this position by tightening the distal-most fastening screw1062. The distal shaft232of humeral stem230can be inserted through the formed recess in the resection surface and further inserted into the intramedullary canal. Once the distal shaft232is in the diaphysis of the humerus H and the metaphyseal portion290is in the metaphysis of the humerus H, an impaction load can be applied to the jig1100. In particular, an impactor, e.g., a mallet, can strike the impaction head1012that is disposed at the proximal end1002of the jig1100driving the humeral stem230into firm engagement with the humerus H generally along the axis of the distal shaft232of the humeral stem230. For example, the surgeon can apply impaction forces to the jig1100until the marker1053contacts the humerus H.

An impacting step can follow the previously described inserting step. The impacting step involves impacting an anatomic assembly160, reverse articular body180, and/or a spacer150into the stemmed anchor230(or another stemmed anchor30). As discussed above, the kit100includes shared implant components. As such, the impacting step can be the same for the humeral stem30,230as for the stemless anchors103.

After the impacting step, in the case of the stem230, a securing step can be performed. A minimal skin incision may be performed at a planned entry point of the screw170. The drill sleeve1070can be inserted into one of the screw guides1064,1108,1110. The drill sleeve1070can be advanced through the incised entry point to the humerus H. A tool can be inserted through the channel1072of the drill sleeve1070to create a hole in the humerus H and through one of the apertures262,264,265,267,269. For example, a drill can be used to create the hole. The same or another tool can be used to insert a screw170into the channel1072of the drill sleeve1070and into the previously created hole. These steps can be repeated to insert a screw170into the other ones of the apertures262,264,265,267,269, as needed.

Other Variations and Terminology

Although certain embodiments have been described herein, the implants and methods described herein can interchangeably use any articular component, as the context may dictate.

As used herein, the relative terms “proximal” and “distal” shall be defined from the perspective of the implant. Thus, proximal refers to the direction of the articular component and distal refers to the direction of an anchor component, such as a stem of a humeral anchor or a thread or porous surface or other anchoring structure of a stemless anchor when the implant is assembled.

Conditional language, such as “can,” “could,” “might,” or “may,” unless specifically stated otherwise, or otherwise understood within the context as used, is generally intended to convey that certain embodiments include, while other embodiments do not include, certain features, elements, and/or steps. Thus, such conditional language is not generally intended to imply that features, elements, and/or steps are in any way required for one or more embodiments.

The terms “comprising,” “including,” “having,” and the like are synonymous and are used inclusively, in an open-ended fashion, and do not exclude additional elements, features, acts, operations, and so forth. Also, the term “or” is used in its inclusive sense (and not in its exclusive sense) so that when used, for example, to connect a list of elements, the term “or” means one, some, or all of the elements in the list. In addition, the articles “a,” “an,” and “the” as used in this application and the appended claims are to be construed to mean “one or more” or “at least one” unless specified otherwise.

The ranges disclosed herein also encompass any and all overlap, sub-ranges, and combinations thereof. Language such as “up to,” “at least,” “greater than,” “less than,” “between,” and the like includes the number recited. Numbers preceded by a term such as “about” or “approximately” include the recited numbers and should be interpreted based on the circumstances (e.g., as accurate as reasonably possible under the circumstances, for example ±5%, ±10%, ±15%, etc.). For example, “about 1” includes “1.” Phrases preceded by a term such as “substantially,” “generally,” and the like include the recited phrase and should be interpreted based on the circumstances (e.g., as much as reasonably possible under the circumstances). For example, “substantially spherical” includes “spherical.” Unless stated otherwise, all measurements are at standard conditions including temperature and pressure.

Although certain embodiments and examples have been described herein, it should be emphasized that many variations and modifications may be made to the humeral head assembly shown and described in the present disclosure, the elements of which are to be understood as being differently combined and/or modified to form still further embodiments or acceptable examples. All such modifications and variations are intended to be included herein within the scope of this disclosure. A wide variety of designs and approaches are possible. No feature, structure, or step disclosed herein is essential or indispensable.

Although these inventions have been disclosed in the context of certain preferred embodiments and examples, it will be understood by those skilled in the art that the present inventions extend beyond the specifically disclosed embodiments to other alternative embodiments and/or uses of the inventions and obvious modifications and equivalents thereof. In addition, while several variations of the inventions have been shown and described in detail, other modifications, which are within the scope of these inventions, will be readily apparent to those of skill in the art based upon this disclosure. It is also contemplated that various combination or sub-combinations of the specific features and aspects of the embodiments may be made and still fall within the scope of the inventions. It should be understood that various features and aspects of the disclosed embodiments can be combined with or substituted for one another in order to form varying modes of the disclosed inventions. Further, the actions of the disclosed processes and methods may be modified in any manner, including by reordering actions and/or inserting additional actions and/or deleting actions. Thus, it is intended that the scope of at least some of the present inventions herein disclosed should not be limited by the particular disclosed embodiments described above. The limitations are to be interpreted broadly based on the language employed and not limited to the examples described in the present specification or during the prosecution of the application, which examples are to be construed as non-exclusive.

Any methods disclosed herein need not be performed in the order recited. The methods disclosed herein include certain actions taken by a practitioner; however, they can also include any third-party instruction of those actions, either expressly or by implication. For example, actions such as “coupling a glenoid guide with the glenoid rim” include “instructing coupling of a glenoid guide with a glenoid rim.”