Patient specific glenoid guide

A patient-specific guide tool for guiding an object toward a glenoid face of a scapula of a patient for implantation of a shoulder prosthetic device is disclosed. The guide tool includes a guide portion that includes a guide surface. The guide surface is configured to guide movement of the object toward the glenoid face. Furthermore, the guide tool includes a patient-specific portion that is operably coupled to the glenoid portion. The patient-specific portion includes at least one patient-specific surface that is three-dimensionally contoured and that is configured to nest and closely conform to a corresponding surface of the scapula to thereby position the guide surface at a predetermined position relative to the glenoid face.

FIELD

The present disclosure relates to a glenoid guide and, more particularly, relates to a patient-specific glenoid guide for use in establishing a reference on a glenoid.

BACKGROUND

This section provides background information related to the present disclosure that is not necessarily prior art.

Various guide tools have been proposed for assisting surgeons during surgical procedures. For instance, a cutting guide can be used during implantation of a prosthetic device.

In the case of a prosthetic knee, for example, a femoral cutting guide can be fixed at a known position relative to the femur. The cutting guide can include one or more surfaces that are consequently fixed at a known position relative to the femur. A cutting tool, such as a reciprocating blade can be operated while sliding along the guide surface of the cutting guide such that the femur can be cut (e.g., resected) at predetermined locations to predetermined dimensions. These anatomical cuts can form surfaces against which the femoral prosthetic device can seat.

Also, in some embodiments, the cutting guide can be used to guide the formation of holes or other features that can receive a referencing object (e.g., a pin, etc.) in a bone. Once the referencing object is fixed to the bone, another object (e.g., a cutting guide, etc.) can be attached to the referencing object for further use in a predetermined position.

SUMMARY

A patient-specific guide tool for guiding an object toward a glenoid face of a scapula of a patient for implantation of a shoulder prosthetic device is disclosed. The guide tool includes a guide portion that includes a guide surface. The guide surface is configured to guide movement of the object toward the glenoid face. Furthermore, the guide tool includes a patient-specific portion that is operably coupled to the glenoid portion. The patient-specific portion includes at least one patient-specific surface that is three-dimensionally contoured and that is configured to nest and closely conform to a corresponding surface of the scapula to thereby position the guide surface at a predetermined position relative to the glenoid face.

A method of guiding an object toward a glenoid face of a scapula of a patient for implantation of a shoulder prosthetic device is also disclosed. The method includes preoperatively imaging at least a portion of the scapula to produce an image of the portion of the scapula. The method also includes providing a patient-specific guide tool having a guide portion and a patient-specific portion. The guide portion includes a guide surface. The patient-specific portion is operably coupled to the glenoid portion. The patient-specific portion includes at least one patient-specific surface that is configured according to the image. Moreover, the method includes nesting the patient-specific surface of the guide tool to the at least a portion of the scapula to thereby position the guide surface at a predetermined position relative to the glenoid face.

Still further, a patient-specific glenoid guide tool for guiding an object toward a glenoid face of a scapula of a patient is disclosed for implantation of a shoulder prosthetic device. The guide tool includes a guide portion that includes an opening with a curved axis. The opening defines a guide surface, and the guide surface is configured to guide movement of the object toward the glenoid face. Moreover, the guide tool includes a patient-specific portion that is operably coupled to the glenoid portion. The patient-specific portion includes at least one patient-specific surface that is three-dimensionally contoured, and that is configured to nest and closely conform to a corresponding surface of the scapula to thereby position the guide surface at a predetermined position relative to the glenoid face. The patient-specific surface is configured to nest and closely conform to at least one of an anterior surface of an acromion of the scapula, an inferior surface of an acromion of the scapula, a posterior surface of an acromion of the scapula, a scapular spine, and the glenoid face.

Further areas of applicability of the present teachings will become apparent from the description provided hereinafter. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present teachings.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is in no way intended to limit the present teachings, applications, or uses.

The present teachings generally provide patient-specific surgical instruments that include, for example, alignment guides, drill guides, templates, cutting/resection guides for use in shoulder joint replacement, shoulder resurfacing procedures and other procedures related to the shoulder joint or the various bones of the shoulder joint, including the glenoid and adjacent shoulder bones. The present teachings can be applied to anatomic shoulder replacement and reverse shoulder replacement. The patient-specific instruments can be used either with conventional implant components or with patient-specific implant components and/or bone grafts that are prepared using computer-assisted image methods according to the present teachings. Computer modeling for obtaining three dimensional images of the patient's anatomy using MRI or CT scans of the patient's anatomy, the patient-specific prosthesis components and the patient-specific guides, templates and other instruments, can be designed using various CAD programs and/or software available, for example, by Materialise USA, of Plymouth, Mich. The present teachings also provide algorithms for use with related CAD programs.

The patient-specific instruments and any associated patient-specific implants and bone grafts can be generally designed and formed using computer modeling based on 3-D anatomic image(s) generated from X-rays, MRI, CT, ultrasound or other medical scans. Specifically, an anatomical feature (e.g., a scapula with or without surrounding soft tissue) can be imaged to detect certain features of the anatomy (e.g., dimensions, curvature of surfaces, etc.). Then, patient-specific instruments can be formed according to these measurements.

The patient-specific instrument can have a three-dimensional engagement surface that is complementary and made to conformingly contact the anatomical surface. Thus, the patient-specific instruments can be configured to fit at only one position to the anatomical surface. The patient-specific instruments can include custom-made guiding formations, such as, for example, guiding bores or cannulated guiding posts or cannulated guiding extensions or receptacles that can be used for supporting or guiding other instruments, such as drill guides, reamers, cutters, cutting guides and cutting blocks or for inserting pins or other fasteners according to a surgeon-approved pre-operative plan.

In various embodiments, the patient-specific instruments can also include one or more patient-specific alignment guides for receiving and guiding a tool, such as a drill or pin or guide wire at corresponding patient-specific orientations relative to a selected anatomic axis for the specific patient. The patient-specific instruments can include guiding or orientation formations and features for guiding the implantation of patient-specific or off-the-shelf implants associated with the surgical procedure. The geometry, shape and orientation of the various features of the patient-specific instruments, as well as various patient-specific implants and bone grafts, if used, can be determined during the pre-operative planning stage of the procedure in connection with the computer-assisted modeling of the patient's anatomy. During the pre-operative planning stage, patient-specific instruments, custom, semi-custom or non custom implants and other non custom tools, can be selected and the patient-specific components can be manufactured for a specific-patient with input from a surgeon or other professional associated with the surgical procedure.

In the following discussion, the terms “patient-specific”, “custom-made” or “customized” are defined to apply to components, including tools, implants, portions or combinations thereof, which include certain geometric features, including surfaces, curves, or other lines, and which are made to closely conform as mirror-images or negatives or complementary surfaces of corresponding geometric features or anatomic landmarks of a patient's anatomy obtained or gathered during a pre-operative planning stage based on 3-D computer images of the corresponding anatomy reconstructed from image scans of the patient by computer imaging methods. Further, patient-specific guiding features, such as, guiding apertures, guiding slots, guiding members or other holes or openings that are included in alignment guides, drill guides, cutting guides, rasps or other instruments or in implants are defined as features that are made to have positions, orientations, dimensions, shapes and/or define cutting planes and axes specific to the particular patient's anatomy including various anatomic or mechanical axes based on the computer-assisted pre-operative plan associated with the patient.

The prepared patient-specific alignment guides can be configured to mate in alignment with natural anatomic landmarks by orienting and placing the corresponding alignment guide intra-operatively on top of the bone to mate with corresponding landmarks. The anatomic landmarks function as passive fiducial identifiers or fiducial markers for positioning of the various alignment guides, drill guides or other patient-specific instruments.

The various patient-specific alignment guides can be made of any biocompatible material, including, polymer, ceramic, metal or combinations thereof. The patient-specific alignment guides can be disposable and can be combined or used with reusable and non patient-specific cutting and guiding components.

More specifically, the present teachings provide various embodiments of patient-specific glenoid guides. The glenoid guides of the present teachings can have patient-specific engagement surfaces that reference various portions of the shoulder joint and include drill guides, guiding bores or sleeves or other guiding formations that can accurately position a guide wire for later glenoid preparation and implantation procedures and for alignment purposes, including implant position control, implant version control, implant inclination control.

In the following, when of portion of a glenoid guide is described as “referencing” a portion of the anatomy, it will be understood that the referencing portion of the glenoid guide is a patient-specific portion mirroring or negative to the corresponding referenced anatomic portion.

Referring initially toFIG. 1, a patient-specific glenoid guide10(i.e., patient-specific guide tool) is illustrated according to exemplary embodiments of the present disclosure. As will be discussed, the guide10can include one or more patient-specific surfaces that engage corresponding surfaces of a patient's scapula. For instance, in the embodiments ofFIGS. 3 and 4, patient-specific surfaces of the guide10can reference the glenoid face and can straddle the scapular spine. Once engaged with the scapular spine, guide surface(s) of the guide can be positioned, oriented, and located relative to the scapula. As such, the guide surface(s) can be used to guide a cutting tool (e.g., a drill bit) toward the scapula and/or the guide surface(s) can be used to guide a referencing object (e.g., a referencing pin) into the scapula. The guide10can also be shaped and dimensioned so as to avoid interference with surrounding soft tissue.

Generally, the guide10can include a guide portion12, a patient-specific portion14, and a shoulder16that is disposed therebetween. The guide portion12, the patient-specific portion14, and shoulder16can be integrally connected so as to be monolithic. Also, the guide10can be substantially L-shaped. Moreover, the guide10can be made from biocompatible metal and/or polymer.

The guide portion12can be generally frusto-conic in shape and can project partially from the shoulder16to have a length L3. The guide portion12can include a first axial end18(i.e., glenoid engaging surface) and a second axial end20. The guide portion12can also include a transverse (radial) surface24that extends between the first and second axial ends18,20. The transverse surface24can be tapered in the radial direction.

Moreover, the guide portion12can include an opening26that extends between and is defined through the first and second axial ends18,20. In the illustrated embodiments, the opening26can be a groove or slot that is also defined through and open on the transverse surface24. In additional embodiments, the opening26can be a through hole that is defined only through the first and second axial ends18,20. The opening26can have a substantially straight axis X. As will be discussed, an inner surface28of the opening26can be a guide surface that guides a cutting tool, such as a drill bit, or a referencing object, such as a referencing pin toward a glenoid of a patient.

Moreover, the patient-specific portion14can include a first member30and a second member32that extend from the shoulder16and that are spaced apart from each other at a distance D. In the embodiments illustrated, the members30,32are posts that are axially straight and substantially parallel to each other. In additional embodiments, the members30,32can be axially curved. The members30,32can each have a respective length L1. The members30,32can terminate at a respective end35,37.

The ends35,37can be tapered and, in some embodiments, sharpened so as to enable the ends35,37to penetrate through soft tissue. The members30,32can also include respective patient-specific surfaces34,36. The surfaces34,36can be recessed and can be three-dimensionally curved as will be described in greater detail below. The patient-specific surfaces34,36can face each other.

The shoulder16can curve between the guide portion12and the patient-specific portion14at any suitable radius. In additional embodiments, the shoulder16extends linearly between the guide portion12and patient-specific portion14. Also, the shoulder16can include an inner surface38. Furthermore, the shoulder16can extend along a length L2before the members30,32branch apart away from the shoulder16. Additionally, the shoulder16can be curved such that the members30,32are disposed at an angle8relative to the axis X of the opening26.

As shown inFIGS. 3 and 4, the guide10can be configured for engaging, mating, and nesting with a scapula42of a patient. Specifically, the members30,32can cooperatively straddle the scapular spine47such that the patient-specific surface34nests to a superior surface45of the spine47and the patient-specific surface36nests to an inferior surface49of the spine47. Positioned as such, the shoulder16can curve about and avoid interference with soft tissue (e.g., rotator cuff, etc.), and the first axial end18can abut against a glenoid face46of the patient to orient the opening26at a predetermined orientation and location relative to the glenoid face46. In some embodiments, the first axial end18can also have a patient-specific convex surface that also nests with the glenoid face46for further mating the guide10to the scapula42. Likewise, in some embodiments, the inner surface38of the shoulder portion16can include a patient-specific surface that is configured to nest against the rim of the glenoid face46and/or other surrounding tissue. Once nested against the scapula42, the guide10can be constrained against rotational and translation movement about three orthogonal axes.

With the guide10positioned as such, the surface28of the opening26can guide an object toward the glenoid face46. For instance, the surface28can guide a drill bit (not specifically shown) toward the glenoid face46to form a hole therein. Specifically, the drill bit can be inserted into the opening26at the second axial end20, moved toward the first axial end18, and cut (drill) into the glenoid face46while the surface28maintains the drill bit substantially coaxial with the opening26. Then, as shown inFIG. 5, a referencing object54(e.g., a pin, etc.) can be received in the newly-formed hole and fixed to the glenoid face46. The guide10can then be removed by the scapula42by sliding the members30,32off of the scapular spine47. In some embodiments, the guide10can move parallel to the axis X away from the glenoid face46. In additional embodiments, the guide10can move transverse to the axis X, for instance, such that the referencing object54moves through the portion of the opening26defined in the transverse surface24.

With the referencing object54in place in the glenoid face46, a cutting tool53(e.g., a bur, a rasp, a reamer, etc.) can be coupled to the glenoid face46. Specifically, a hole55of the cutting tool53can receive the referencing object54, and the referencing object54can guide the cutting tool53axially toward the glenoid face46. The cutting tool53can be actuated (e.g., rotated) via an actuator57(e.g., an electric motor, etc.) to remove tissue from the glenoid face46.

Referring now toFIGS. 2-5, surgical procedures employing the guide10will be described in greater detail. For purposes of discussion, it will be assumed that the surgical procedure relates to the implantation of a shoulder prosthetic device that is operable to restore and repair the shoulder joint. The prosthetic device can include a humeral portion, a scapular portion, and a bearing in some embodiments. It will be appreciated that the prosthetic can be either an anatomic or reverse shoulder prosthetic device. Also, the guide10can be used during open surgical procedures or during arthroscopic surgical procedures as will be discussed.

Initially, the patient's anatomy can be imaged and measured using one or more MRI scans, CT scans, etc. Specifically, the dimensions, shape, and other features of the patient's scapula42can be determined from these images. Also the prosthetic joint and the surgical procedure can be planned according to these measurements. More specifically, the amount of wear, damaged tissue, etc. on the patient's glenoid face46can be measured in this manner. Also, an appropriate size and orientation of the prosthetic shoulder joint (relative to the scapula42) can be selected for repairing the joint. Moreover, the surgeon can plan how much tissue should be removed, for example, from the glenoid face46for implantation of the prosthesis. The size, type, and other characteristics of the tool53(FIG. 5) necessary for removing the glenoid tissue can also be determined from this analysis. Moreover, the trajectory of the referencing object54relative to the glenoid face46for properly locating the tool53relative to the glenoid face46can be determined.

Additionally, the patient-specific guide10can be planned and constructed according to the data obtained from the images. The guide10can be constructed using known rapid-prototyping or other techniques. Specifically, the patient specific surfaces34,36can be constructed according to the measurements of the superior and inferior surfaces45,49of the scapula42such that the surfaces34,36can mate and nest with each other. Likewise, the guide10can be constructed such that the lengths L1, L2, L3, the distance D, the angle θ, and/or other dimensions of the guide10enable the members30,32to nest with the scapular spine47while the first axial end18abuts against the glenoid face46.

Once the guide10is constructed, the surgeon can make one or more incisions56(FIG. 2) adjacent the shoulder joint. Then, assuming that this is an open-shoulder procedure, the humerus40of the joint can be separated from the scapula42to thereby expose the glenoid face46. Then, the surgeon can mate the guide10to the scapula42by advancing the first and second members30,32in a medial direction over the scapular spine47as shown inFIGS. 3 and 4. The ends35,37of the members30,32can penetrate through soft tissue during advancement over the spine47. Moreover, in some embodiments, the members30,32can resiliently deflect away from each other slightly during advancement over the spine47, and the members30,32can recover to a neutral position (e.g., as shown inFIG. 1) when the patient-specific surfaces34,36reach the corresponding surfaces45,49of the scapular spine47.

Next, a drill bit (not specifically shown) can be received in the opening26of the guide10, and the surface28can guide the drill bit axially toward the glenoid face46to form a hole for the referencing object54(FIG. 5). The referencing object54can be inserted into this hole of the glenoid face46to be fixed to the scapula42. Subsequently, the tool53can be positioned over the referencing object54, and the actuator57can drivingly rotate the tool53as it advances toward the glenoid face46. As such, the tool53can remove the predetermined amount of tissue from the glenoid face46to prepare the glenoid face for implantation of a prosthetic device (not specifically shown). After the glenoid face46is fully prepared, the scapular portion of a prosthetic device can be implanted on the scapula42in a known manner. Also, the humerus40can be resected in a known manner, and a humeral portion of the prosthetic device can be implanted thereon. Then, the artificial joint can be assembled, and the incision56(FIG. 2) can be repaired.

Thus, it will be appreciated that the guide10and its method of use can significantly aid the surgeon during these and/or other procedures. Because of the patient-specific surfaces34,36, the guide10can be tailored for the specific patient, thereby allowing the procedure to be tailored for the specific patient. Accordingly, the prosthetic joint can be very effective in repairing the patient's mobility, etc.

Referring now toFIGS. 6-8, additional embodiments of a glenoid guide110are illustrated according to the teachings of the present disclosure. Components that correspond with those ofFIGS. 1-5are indicated with corresponding reference numbers increased by 100.

In some embodiments, the guide110can be a monolithic body with integrally connected components. Also, the guide110can be made from biocompatible metal, polymer, etc.

The guide110can include a block-shaped guide portion112. The guide portion112can include a patient-specific surface170that is configured to engage and nest with the glenoid face146(FIGS. 7 and 8). For instance, the patient-specific surface170can engage and nest with an anterior rim of the glenoid face146. In additional embodiments, the patient-specific surface170can engage and nest with a superior, inferior, and/or posterior portion of the rim of the glenoid face146.

Also, the guide portion112can also include at least one tube164a,164bthat includes an opening126a,126b(FIG. 8) extending therethrough. The tubes164a,164bcan project from the guide portion112, opposite the patient-specific surface170. In the embodiments illustrated, there are two tubes164a,164b, and the openings126a,126bare holes that extend therethrough. The inner surfaces128a,128bcan act as guide surfaces for guiding a drill bit, a referencing object, etc. toward the glenoid face146. The tubes164a,164balso include respective slot-shaped windows165a,165bextending transversely therethrough. The windows165a,165bcan allow the user to view the drill bit, referencing object, etc. moving through the openings126a,126b.

The openings126a,126bcan be disposed at an angle α relative to each other. In some embodiments, the opening126acan be configured for use during implantation of a normal shoulder prosthetic device whereas the opening126bcan be configured for use during implantation of a reverse shoulder prosthetic device. Thus, the guide110can be versatile and usable for both procedures. Moreover, one or both tubes164a,164bcan include lettering or other symbols thereon that distinguish the tubes164a,164bfrom each other, that identify the patient associated with the guide110, etc.

The guide110can further include a handle168. In the embodiments illustrated, the handle168projects from one side of the guide portion112and the tubes164a,164band tapers so as to have a generally triangular shape. The handle164acan be used to grasp the guide110and to manipulate the guide110when mating the guide110against the scapula142. For instance, the surgeon can apply pressure to the handle168medially toward the glenoid face146when mating the guide110against the scapula142.

As shown inFIGS. 7 and 8, the guide110can further include a notch166that extends through the guide portion112. The notch166can extend in the lateral-medial direction and can be disposed inferiorly relative to the handle168when the guide110is mated to the scapula142. The notch166can provide exposure to the glenoid face146when the guide110is mated to the scapula142to ensure that the guide110is seated correctly against the scapula142.

Furthermore, the guide110can include an arm160that projects away from the tube164aor other portion of the guide110. The arm160can be curved. In additional embodiments, the arm160can be axially straight.

Also, the guide110can include a patient-specific portion114(i.e., an acromion engaging portion) that is configured to engage and mate to the patient's acromion148. The acromion-engaging portion114can include a head162that is fixed to the arm160, on an end that is opposite the tube164a. The head162can include a recessed patient-specific surface134that is the negative of the patient's acromion148. Thus, the head162can be generally saddle-shaped, and the patient-specific surface134can mesh with the anterior, inferior, and posterior surfaces of the acromion148(FIGS. 7 and 8). Thus, the patient-specific surface134and the patient-specific surface170of the guide portion112can cooperate to closely mesh with the scapula142and constrain the guide110against relative movement.

In additional embodiments, the patient-specific surface134can engage only the anterior surface of the acromion148. In still additional embodiments, the patient-specific surface134can be configured to nest with the inferior surface of the acromion148only. In further embodiments, the patient-specific surface134can be configured to nest with the posterior surface of the acromion148only.

It will be appreciated that the guide110can be designed, structured, shaped, dimensioned, and otherwise configured to nest with a particular patient's scapula142in order to locate at least one of the openings126a,162bin a predetermined manner relative to the glenoid face146. Thus, the guide110can be used similarly to the guide10discussed above in relation toFIGS. 1-5. However, as mentioned above, the surgeon can choose to use only one of the tubes164a,164bfor guiding a drill bit, a referencing object, etc., depending on whether a normal or a reverse shoulder prosthetic device is being implanted.

Referring now toFIGS. 9 and 10, additional embodiments of the guide210are illustrated according to exemplary embodiments. In some embodiments, the guide210can be used during arthroscopic procedures. The guide210can, however, also be used during open shoulder surgical procedures. Also, the guide210can nest against both the acromion248and the glenoid face246, similar to the embodiments ofFIGS. 6-8. Components that correspond to those of the embodiments ofFIGS. 6-8are indicated by corresponding reference numbers increased by 100.

As shown inFIG. 9, the guide210can include a first rod276. The rod276can be elongate, axially straight, and can have a relatively small diameter in cross section. Accordingly, the rod276can extend through a small incision256in the patient's skin (e.g., during arthroscopic surgery). In some embodiments, a cannulated instrument (not specifically shown) can extend through the incision256, and the rod276can extend through the cannulated instrument toward the acromion248.

The rod276can also include the head262on one end. Like the embodiments ofFIGS. 6-8, the head262can be generally saddle-shaped and can include patient specific surfaces that are configured to nest with anterior, inferior, and posterior surfaces of the acromion248. Moreover, the rod276can be coupled to a handle278on an end opposite the head262. The handle278can remain outside the patient's body while the head262is nested to the acromion248.

The guide210can further include a second rod280. On one end, the rod280can be coupled to the handle278such that the first and second rods276,280are spaced apart at a distance. In some embodiments, the rod280can be removably coupled to the handle278(e.g., via a threaded attachment, etc.). The second rod280can extend through a separate incision256in the patient's body.

As best shown inFIG. 10, the second rod280can further include a patient-specific pad284on an end opposite the handle278. The patient-specific pad284can be relatively small and disc-shaped and can include a patient-specific surface285thereon, which is configured to nest with the glenoid face246(e.g., at the superior portion of the glenoid face246).

Moreover, the guide210can include a branch290that is substantially T-shaped and that is moveably (e.g., pivotally) attached to the second rod280. In some embodiments, the branch290can include a patient-specific pad286on one end. The patient-specific pad286can be relatively small and disc-shaped and can include a patient-specific surface287thereon, which is configured to nest with the glenoid face246(e.g., at the inferior portion of the glenoid face246). The branch290can further include a tab286with a guide tube292extending therethrough. The guide tube292can guide a drill bit253, a referencing pin, or other object toward the glenoid face246, similar to the embodiments discussed above. A scope274can extend toward the joint to allow the surgeon to view this procedure.

The guide tube292can be axially curved in some embodiments. This curvature can enable the surgeon to manipulate the drill bit253around surrounding tissue (e.g., during an arthroscopic procedure), where the drill bit253is flexible to follow the curvature. In other embodiments, the guide tube292can be axially straight.

As mentioned, the branch290can be moveably coupled to the second rod280. The guide210can also include a lever282that is mounted to the handle278and a linkage281that operably couples the lever282and the branch290. The linkage281can be a rigid rod that is attached at one end to the lever282and that is attached at the opposite end to the branch290. By manipulating the lever282, the surgeon can selectively move the branch290relative to the second rod280. In some embodiments, the lever282can include a clamp or other retaining device that is operable to selectively fix the branch290relative to the second rod280.

Thus, to use the guide210, the surgeon can make the incisions256and can insert the first rod276into the patient to mate the head262to the acromion248. Then, the surgeon can insert the second rod280into the patient. The second rod280and branch290can be inserted in a collapsed state (e.g., where the branch290is positioned substantially parallel to the second rod280). Once inserted, the surgeon can use the lever282to move the second rod280and branch290to an expanded state (e.g., where the branch290is angled away from the second rod280). This movement can allow both patient specific surfaces285,287to nest against the glenoid face246, thereby securing the guide tube292into the predetermined position relative to the glenoid face246. Then, the drill bit253can be used to form the hole for the referencing pin, and the procedure can be carried out as discussed above. Next, the surgeon can use the lever282to collapse the branch290against the second rod280, and the guide210can be removed from the patient's body.

Referring now toFIG. 11, additional embodiments of the guide310are illustrated. As will be disclosed, the guide310can be a patient-specific guide that nests against the glenoid346and the acromion348. Thus, the guide310can include components that especially correspond to the embodiments ofFIGS. 6-8. Corresponding components are identified with corresponding reference numbers increased by 200.

As shown, the guide310can include a guide portion312that can include one or more patient-specific surfaces for nesting against the glenoid face346. The guide portion312can include a guide tube326, which can guide a drill bit, a referencing pin, or other object toward a center of the glenoid face346.

The guide310can further include an arm360that extends away from the guide portion312and a head362that is fixed to an end of the arm360opposite the guide portion312. The head362can include patient-specific surfaces334that are configured to nest against the acromion348, similar to the embodiments ofFIGS. 6-8.

In some embodiments, the guide portion312and the arm360and/or the guide portion312and the head362can be moveably attached. For instance, in some embodiments, the guide310can include a movable coupling394, such as a pivoting joint, that moveably couples the guide portion312and the arm360. The coupling394can be substantially coaxial with the guide tube326. The coupling394can be a ring bearing with an outer race fixed to the guide portion312, an inner race fixed to the arm360, and one or more bearings between the races. The coupling394could also be of a different type, such as a hinge, etc.

Because of the coupling394, the guide310can move between a collapsed position and an extended position. In the extended position, the guide310can mate against both the glenoid face346and the acromion348as shown inFIG. 11. In the collapsed position, the arm360can rotate toward the guide portion312such that the guide310is more compact. Accordingly, during use, the surgeon can introduce the guide310into the patient's body while the guide310is collapsed. After the guide310is introduced, the surgeon can selectively and manually move the arm360away from the guide portion312and nest the head362to the acromion348and the guide portion312to the glenoid face346. Then, the guide310can be used as detailed above. In some embodiments, the guide310can further include a retaining device, such as a clamp, etc., which can be used to selectively secure the guide310in its extended position.

Thus, because the guide310can selectively move between a collapsed and extended position, the guide310can be useful during arthroscopic surgical procedures. For instance, the guide310can be configured to collapse to a relatively small size so that the guide310can fit into a relatively small cannula to be introduced into the body and can move within the body without interfering with surrounding patient anatomy.

Referring now toFIG. 12, additional embodiments of a guide410are illustrated. Components that correspond to the embodiments ofFIGS. 1-5are indicated with corresponding reference numbers increased by 400.

As shown, the guide410can include an arm414with a head462attached. The head462can include one or more patient-specific surfaces434that are configured to nest with the patient's acromion (not specifically shown). The guide410can further include a guide portion412. The guide portion412can include a cutting surface496. The cutting surface496can be similar to those of known burr-type devices, rasps, or other cutting tools. Also, the cutting surface496can be patient-specific and can be configured according to the shape of the patient's glenoid surface and/or according to the amount of tissue that the surgeon aims to remove from the glenoid surface as will be discussed in greater detail below. The guide410can be operably coupled to an actuator497via a coupling498. The actuator497can be of any type, such as a vibrating motor, etc., and the coupling498can be a rigid rod or other type that extends between the actuator497and the guide portion412. Moreover, the guide410can include one or more fluid conduits499that pump fluids toward the cutting surfaces496for facilitating cutting of the glenoid face. In the embodiments illustrated, the fluid conduit499can extend toward the actuator497and through the coupling498.

To use the guide410, the patient's shoulder joint can be imaged using a CT scan, MRI, etc., and a treatment can be planned therefrom. Specifically, the surgeon can plan out how much tissue to remove from the glenoid face, locations on the glenoid face from which to remove tissue, etc. Then, the guide410can be planned and constructed accordingly to enable such tissue removal. Specifically, the size, shape, and relative locations of the head462, patient-specific surfaces434, arm460, and cutting surfaces496of the guide412can be planned so as to enable tissue removal according to the surgical plan.

Thus, the guide410can allow the surgeon to provide patient-specific cutting of the glenoid face. Also, the guide410could be used to prepare the glenoid face for implantation of a patient-specific prosthetic implant. For instance, a bearing (not shown) could include a glenoid-engaging surface that is configured to mate against the glenoid face after the cutting surfaces496have prepared the glenoid face. The bearing can include a plurality of small posts with anchoring formations for anchoring into the glenoid face without the need for cement. Also, a patient-specific impacting guide can be employed for implanting such a bearing. The impacting guide could include a bearing engaging end that engages the bearing, an impacting head that the surgeon can impact to drive the bearing into engagement with the glenoid face, and a patient-specific surface that nests to the acromion or other portion of the scapula. Thus, the impacting guide could reference the patient's anatomy to ensure that the impacting guide is in its desired position relative to the anatomy during implantation of the bearing.

Referring now toFIG. 13, additional embodiments of a guide510are illustrated according to exemplary embodiments. Components that are similar to those ofFIGS. 1-5are indicated with corresponding reference numbers increased by 500.

In the embodiments illustrated, the guide510can include a guide portion512that is configured to engage the glenoid face. A guide tube526can extend from the guide portion512and an inner surface of the guide tube526can extend continuously through the guide portion512. The guide portion512can be made out of transparent material (e.g., a transparent polymeric material). The guide portion512can also include cross hairs or other similar indicia thereon that are visible through the guide portion512. The cross hairs can intersect the central axis of the guide tube526.

In some embodiments, the guide510can include three-dimensionally curved, patient-specific surfaces that are configured to nest to the glenoid of the patient. Thus, the guide510can be used similar to the embodiments discussed above. The cross hairs on the guide portion512can help the surgeon center the guide portion510on the glenoid face.

In additional embodiments, the guide510can have standardized surfaces such that the guide510can be used for multiple patients. The guide510can also be part of a set of similar guides510of different sizes, and the surgeon can select an appropriately-sized guide510according to the particular size of the glenoid face. Again, the cross hairs on the guide portion512can help the surgeon center the guide portion510on the glenoid face.

In summary, the guides10,110,210,310,410,510discussed above can facilitate implantation of a shoulder prosthesis. The guides10,110,210,310,410,510can include one or more patient-specific features such that the guide10,110,210,310,410,510can be tailored for a specific patient, and the associated shoulder prosthesis and/or implantation procedure can be similarly tailored. Thus, the patient's shoulder can be repaired and shoulder joint function can be restored in an effective manner.

The foregoing discussion discloses and describes merely exemplary arrangements of the present teachings. Furthermore, the mixing and matching of features, elements and/or functions between various embodiments is expressly contemplated herein, so that one of ordinary skill in the art would appreciate from this disclosure that features, elements and/or functions of one embodiment may be incorporated into another embodiment as appropriate, unless described otherwise above. Moreover, many modifications may be made to adapt a particular situation or material to the present teachings without departing from the essential scope thereof. One skilled in the art will readily recognize from such discussion, and from the accompanying drawings and claims, that various changes, modifications and variations can be made therein without departing from the spirit and scope of the present teachings as defined in the following claims.