# Patent

## Title
Patient-modified implant

## Abstract

An orthopedic implant includes a first portion including at least one feature modified to be patient-specific and match the anatomy of a specific patient from a three-dimensional digital image of a patient's joint using computer modeling. The orthopedic implant includes a non-custom inner bone-engaging surface including a plurality of planar surfaces configured for engagement with non-custom bone cuts.

## Background
CROSS-REFERENCE TO RELATED APPLICATIONS
This application is a divisional of U.S. application Ser. No. 12/103,834, filed Apr. 16, 2008, which claims the benefit of U.S. Provisional Application No. 60/912,178, filed on Apr. 17, 2007, and which is related to U.S. application Ser. No. 11/756,057, filed on May 31, 2007, which claims the benefit of U.S. Provisional Application No. 60/812,694, filed on Jun. 9, 2006.
The disclosures of the above applications are incorporated herein by reference.


INTRODUCTION
Various custom made, patient-specific orthopedic implants and associated templates and guides are known in the art. Such implants and guides can be developed using commercially available software. Custom guides are used to accurately place pins, guide bone cuts, and insert implants during orthopedic procedures. The guides are made from a pre-operative plan formed from an MRI or CT scan of the patient and rely on matching an anatomic feature for correct positioning.
The present teachings provide semi-custom implants that can reduce inventory and allow more accurate placement and additional flexibility in addressing diverse patient-specific requirements.
SUMMARY
The present teachings provide an orthopedic implant. The implant has a first portion including at least one patient-adjustable feature, and a second portion including at least one standard feature.
The present teachings also provide an orthopedic implant manufacturing method. The method includes preparing a three-dimensional image of a patient's joint, selecting a standard size implant closely matching the joint, and modifying at least one feature of the implant to be patient-specific.
In another aspect, the implant is a femoral implant, and the method includes modifying a plurality of features of the femoral implant to be patient-specific.
The present teachings also provide an orthopedic implant that includes a first portion including at least one feature modified to be patient-specific and match the anatomy of a specific patient from a three-dimensional digital image of a patient's joint using computer modeling. The orthopedic implant includes a non-custom inner bone-engaging surface including a plurality of planar surfaces configured for engagement with non-custom bone cuts.
The present teachings provide an orthopedic implant that includes a non-custom inner bone-engaging surface including a plurality of planar surfaces configured for engagement with standard size femoral bone cuts prepared for a non-custom femoral implant. In some embodiments, the orthopedic implant includes a patient-specific feature, such as an anterior femoral flange of the orthopedic implant configured during a preoperative plan to have a patient-specific shape and closely match a corresponding portion of a femur of a specific patient from a three-dimensional digital image of a patient's joint using computer modeling. The patient-specific shape of the anterior femoral flange of the orthopedic implant is obtained by modifying a digital image of the non-custom femoral implant without modifying the plurality of planar surface of the inner bone-engaging surface. In some embodiments, the patient-specific feature is the orientation or the depth of a patella track.
The present teachings provide an orthopedic implant that includes a non-custom tibial bearing component, and a tibial tray including a non-custom locking mechanism couplable with the non-custom tibial bearing. The tibial tray has a patient-specific profile configured during a preoperative plan to be patient-specific and closely match a corresponding profile of a tibia of a specific patient from a three-dimensional digital image of a patient's joint using computer modeling, wherein the patient-specific profile of the tibial tray is obtained by modifying a digital image of a non-custom tibial implant without modifying the non-custom locking mechanism.
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 teachings.



BRIEF DESCRIPTION OF THE DRAWINGS
The present teachings will become more fully understood from the detailed description and the accompanying drawings, wherein:
FIG. 1 is a plan view of an exemplary femoral implant according to the present teachings;
FIG. 2 is a posterior elevated view of the femoral implant of FIG. 1;
FIG. 3 is an anterior-posterior sectional view of the femoral implant of FIG. 1;
FIG. 4 is an environmental view illustrating an exemplary femoral alignment guide according to the present teachings;
FIG. 5 is an environmental view illustrating an exemplary distal cutting block according to the present teachings;
FIG. 6 is an environmental view illustrating an exemplary four-in-one cutting block according to the present teachings;
FIG. 7 is a flowchart of an exemplary method according to the present teachings;
FIG. 8 is an anterior elevated view of a femoral implant according to the present teachings;
FIG. 9 is an anterior-posterior sectional view of the femoral implant of FIG. 8; and
FIG. 10 is a perspective view of a tibial component according to the present teachings.



DESCRIPTION OF VARIOUS EMBODIMENTS
The following description is merely exemplary in nature and is in no way intended to limit the teachings, its application, or uses. For example, although the present teachings are illustrated for specific implants and alignment guides in hip or knee surgery, the present teachings can be used with other implants and guides, templates, jigs, drills, rasps or other instruments used in various orthopedic procedures.
The present teachings generally provide a surgery system for use in orthopedic surgery for the knee, hip, or shoulder, for example. The surgery system can include various implant components 100, patient-specific alignment guides or templates 600, and cutting blocks or other conventional instruments 610, 620 that can be used in the specific orthopedic procedure. At least one implant component 100 can be semi-custom made. The semi-custom implant components are standard size components that have at least one feature modified to match a specific patient, as discussed below.
The alignment guides 600 can be used either with conventional (standard size) or patient-specific femoral and tibial prosthesis components prepared with computer-assisted image methods. The implant components 100 can be patient-specific (custom made) or semi-custom. Computer modeling for obtaining three dimensional images of the patient's anatomy using MRI or CT scans of the patient's anatomy, the semi-custom and/or custom made implant components 100, and the patient-specific alignment guides 600 can be provided by various CAD programs and/or software available, for example, by Materialise USA, Ann Arbor, Mich.
The alignment guides 600 can be generally formed using computer modeling for matching a three-dimensional image of the patient's bone surface (with or without the cartilage) by known methods. Further details of patient-specific alignment guides and associated methods are disclosed in U.S. application Ser. No. 11/756,057, filed on May 31, 2007, the disclosure of which is incorporated herein by reference.
Similarly, the implant components can be selected and modified to include patient-specific features by using computer modeling of the joint, as described above. A set of conventional femoral knee implants can be modeled and overlaid over the CAD image data to first determine the closest fit based on standard sizes. These standard sized overlays or templates can be based on commercially available implant systems, such as, for example, the Vanguard Knee System, commercially available from Biomet, Inc, of Warsaw, Ind., in size increments of 2.5 mm. Using standard sized implants as a base for semi-custom implant components can allow standard instrument sets to be used depending on the specific size selected. After the overlay is positioned on the digital representation of the femur, various adjustments can be made to this femoral implant.
Referring to FIGS. 1-3, various views of an exemplary semi-custom implant component 100 in the form of a femoral component for a knee replacement surgery system are illustrated. The semi-custom implant component 100 can include certain portions that are custom-made to match a particular patient using imaging techniques, and other portions that are provided in a series of standardized size increments to ensure a good fit. For example, the outside geometry of the femoral component 100 can be patient-specific or patient-matched. As an illustration, the width W and height H, and/or optionally the shape and dimensions of the entire articulating or outer surface 102, or portions thereof, can match/conform with that of the patient's corresponding joint surface. The inside geometry of the femoral component 100, such as the bone-engaging inner surface 104, can be selected from a standardized series of sizes, thereby allowing the use of standard instruments, such as cutting guides and resection instruments, to be used with the semi-custom implant components 100, and avoiding the need for specialized instruments and associated manufacturing and training costs.
With continued reference to FIGS. 1-3, to obtain a good match, the difference between consecutive sizes in the inner anterior-posterior distance D can be 3 mm or less to allow for as good a fit between the implant component 100 and the joint surface without the need to match or conform the inner surface 104 to the patient. In other words, the semi-custom implant component 100 is an implant component that can include certain portions, including shapes, dimensions, and/or sizes that are custom-made for a particular patient, while other portions including shapes and/or dimensions of the component are provided in a series of standardized sizes in increments that can provide a good fit without being fully custom-made to a particular patient.
In another aspect, and referring to the exemplary illustrations of FIGS. 8 and 9, five adjustments can be made to a standard size femoral component to obtain a semi-custom femoral implant component 100. These five adjustments can include the medial/lateral width W, the angle 8 of the patella track 106, the depth D1 of the patella track, the shape of the anterior flange 108, such as right or left-sided and a height of the anterior flange, such as the height H1 shown in FIG. 9, or overall height H, shown in FIG. 2. These five features or parameters can be adjusted to more closely match the knee of the patient without requiring changes in the standard cuts for the selected standard knee implant, because the bone engaging inner surface 104 does not substantially change allowing standard cutting guides and resections instruments corresponding to standard sizes to be used. This modified or patient matched digital model of the semi-custom implant can then be provided to the surgeon along with the image data for review. The surgeon can confirm whether the proposed design is acceptable, and the specific patient matched implant can be manufactured from the digital model.
The surgery system can include patient-specific and/or conventional (standard size) implants for the remaining components of the knee replacement system, such as the tibial component, bearing component and patella component. For example, and referring to FIG. 10, a tibial component 300 can be designed with a profile 302 that matches and conforms to the patient's anatomy based on the 3-D image data of the patient's bone. The resulting tibial component 300 can still have standard features, including a standard locking mechanism for bearings, such as, for example, slots 304 for coupling with a standard bearing component 310. The standard locking mechanism allows existing inventory of bearings to be used. In another aspect, the bearing components 310 can be similarly customized.
In another aspect, the tibial component 300 can also be designed in closely packed tibial sizes that very in increments of less that 2 mm in width and are available for manufacture on as-needed basis. When used with patient-specific alignment guides made from digital images of the joint, the closely packed sizes need not be stocked in inventory, but manufactured only in the size determined from the digital image from planned molds or other just-in-time manufacturing methods.
In another aspect, disease-specific off-the shelf implants can be provided and included in a surgery kit. Each disease-specific implant can be designed to address a specific deformity, by making angle or size adjustment related to the deformity, such as different lengths or thickness or angles of certain portions of the implant component, such as the size and shape of femoral condyles, the patella track angle, etc. Each disease-specific implant can be used for multiple patients with the same deformity/disease, such as valgus, varus or flexion deformities. In this regard, for each patient with the same deformity, one or more off-the-shelf disease-specific implants can be selected to address the patient's needs without using patient-specific implants.
The surgery system can also include patient-specific alignment guides 600, as illustrated in FIG. 4 for a joint surface 82 of the distal femur 80. The patient specific alignment guide 600 can define openings 606 for guide elements 604 that pass through corresponding holes 606a drilled in the femur, and openings 602 for drilling holes 602a on the femur 80, as shown in FIGS. 4, and 6. The surgery system can also include a set of cutting blocks for the femoral joint surface 82, such as the distal cutting block 610 illustrated in FIG. 5 and mounted on the femur 80 with various guide or fixation elements 604, 605, and the four-in-one cutting block 620 illustrated in FIG. 6. The four-in-one cutting block 620 can be supported on the femur with pins 622 received in openings 602a. Other cutting blocks, drill guides or other instruments can also be used. The joint surface 82 can be a bone surface with or without soft tissue, such as articular cartilage for the knee or other joint soft tissue. It will be appreciated that other instruments, such as drill guides, guide pins, attachment pins or pegs or others can be included in the surgery system.
The surgery system can be used for surgical pre-planning as illustrated in FIG. 7. The patient's knee, or other joint, can be scanned using an imaging technique, such as MRI or CT, at 400. A three-dimensional (3D) model of the joint surfaces can be reconstructed at 410 using known computer imaging methods. The implant components 100 can be designed, sized and positioned using the 3D reconstruction, at 420. As discussed above, the implant components 100 can include conventional, custom made, or semi-custom implant components 100. The semi-custom implant components can include some portions that are of standard sizes, such as a bone-engaging inner surface 104 (shown with five planar surfaces in FIG. 9), and other portions that are customized for the patient, including portions of the articulating surface or other outer dimensions and orientations of the articulating surface 102 of the implant 100. Customized alignment guides 600 for the joint surfaces, such as femoral and tibial alignment guides 600 for a total knee replacement, can be designed and prepared based on the 3D reconstruction and the implants 100, at 430. A surgery system or kit can be assembled for the surgeon at the time of surgery, at 450. The surgery system can include at least one semi-custom implant component 100, at least one patient specific alignment guide 600, and at least one cutting block 610.
It will be appreciated that surgery kits as described above can be constructed for various joints, including the knee, the hip, the shoulder, etc. The present teachings provide the ability to customize implant and alignment guide components and their position using patient-specific data. Further, the amount of inventory required in the operating room can be reduced because the sizes of the various semi-custom implant components 100 are known prior to surgery and only the required size is sent to the surgeon for the surgical procedure. In another aspect, when close-packed sizes are planned, the small difference between individual sizes of the implant components 100, such as 3 mm or 2.5 mm or less, can allow optimal anterior-posterior fit to the joint surface 80 without adverse impact on inventory requirements, because only the required size can be manufactured and shipped for a specific patient based on the patient's image data. Additionally, the use of semi-custom implant components based on anterior-posterior sizing, as contrasted to fully patient-specific components, allows use and re-use of standard cutting blocks. Disposable cutting blocks can also be mass produced in high volumes at less cost because of the standardization.
The foregoing discussion discloses and describes merely exemplary arrangements of the present teachings. One skilled in the art will readily recognize from such discussion, and from the accompanying drawings that various changes, modifications and variations can be made therein without departing from the spirit and scope of the teachings as described herein.

## Claims

1. A method for manufacturing an orthopedic implant, comprising:
constructing a three-dimensional digital image of a patient's joint using computer modeling;
obtaining a digital image of a femoral implant having a non-custom inner bone-engaging surface including a plurality of planar surfaces configured for engagement with standard size femoral bone cuts prepared for a non-custom femoral implant;
modifying the digital image of the femoral implant by configuring an anterior femoral flange of the femoral implant to have a patient-specific shape and size and to closely match a corresponding portion of a femur of a specific patient based on the three-dimensional image of the patient's joint; and
manufacturing the femoral implant based on the digital image.

2. The method of claim 1, further comprising modifying the digital image of the femoral implant by configuring the anterior flange of the femoral implant to have a patient-specific height that is based on the three-dimensional image of the patient's joint.

3. The method of claim 1, wherein obtaining the digital image of the femoral implant includes creating the digital image.

4. The method of claim 1, wherein obtaining the digital image of the femoral implant includes selecting the femoral implant from a plurality of femoral implants having different non-custom sizes based on a size of the patient's joint.

5. The method of claim 1, further comprising overlaying the digital image of the femoral implant on the three-dimensional image of the patient's joint.

6. A method for manufacturing an orthopedic implant, comprising:
constructing a three-dimensional digital image of a patient's joint using computer modeling;
obtaining a digital image of a femoral implant having a non-custom inner bone-engaging surface including a plurality of planar surfaces configured for engagement with standard size femoral bone cuts prepared for a non-custom femoral implant;
modifying the digital image of the femoral implant by configuring an orientation of a patella track of the femoral implant to have a patient-specific shape and size and to closely match a corresponding portion of a femur of a specific patient based on the three-dimensional image of the patient's joint; and
manufacturing the femoral implant based on the digital image.

7. The method of claim 6, further comprising modifying the digital image of the femoral implant by configuring the patella track of the femoral implant to be oriented at a patient-specific angle with respect to a medial/lateral centerline of the orthopedic implant based on the three-dimensional image of the patient's joint.

8. The method of claim 6, wherein obtaining the digital image of the femoral implant includes creating the digital image.

9. The method of claim 6, wherein obtaining the digital image of the femoral implant includes selecting the femoral implant from a plurality of femoral implants having different non-custom sizes based on a size of the patient's joint.

10. The method of claim 6, further comprising overlaying the digital image of the femoral implant on the three-dimensional image of the patient's joint.

11. A method for manufacturing an orthopedic implant, comprising:
constructing a three-dimensional digital image of a patient's joint using computer modeling;
obtaining a digital image of a femoral implant having a non-custom inner bone-engaging surface including a plurality of planar surfaces configured for engagement with standard size femoral bone cuts prepared for a non-custom femoral implant;
modifying the digital image of the femoral implant by configuring a depth of a patella track of the femoral implant to have a patient-specific shape and size and to closely match a corresponding portion of a femur of a specific patient based on the three-dimensional image of the patient's joint; and
manufacturing the femoral implant based on the digital image.

12. The method of claim 11, wherein obtaining the digital image of the femoral implant includes creating the digital image.

13. The method of claim 11, wherein obtaining the digital image of the femoral implant includes selecting the femoral implant from a plurality of femoral implants having different non-custom sizes based on a size of the patient's joint.

14. The method of claim 11, further comprising overlaying the digital image of the femoral implant on the three-dimensional image of the patient's joint.

15. A method for manufacturing an orthopedic implant, comprising:
constructing a three-dimensional digital image of a patient's joint using computer modeling;
obtaining a digital image of a tibial tray including a non-custom locking mechanism couplable with a non-custom tibial bearing;
modifying the digital image of the tibial tray by configuring a peripheral surface of the tibial tray to be patient-specific and to closely match a corresponding peripheral surface of a tibia of a specific patient based on the three-dimensional digital image of the patient's joint; and
manufacturing the tibial tray based on the digital image.

16. The method of claim 15, wherein obtaining the digital image of the tibial tray includes creating the digital image.

17. The method of claim 15, wherein obtaining the digital image of the tibial tray includes selecting the tibial tray from a plurality of tibial trays having different non-custom sizes based on a size of the patient's joint.

18. The method of claim 15, further comprising overlaying the digital image of the tibial tray on the three-dimensional image of the patient's joint.

19. The method of claim 15, wherein the non-custom locking mechanism includes a plurality of recesses on the tibial tray.

20. The method of claim 15, further comprising:
obtaining a digital image of a tibial bearing couplable with the locking mechanism of the tibial tray;
modifying the digital image of the tibial bearing by configuring a peripheral surface of the tibial bearing to be patient-specific and to closely match a corresponding peripheral surface of the tibia of the specific patient based on the three-dimensional digital image of the patient's joint; and
manufacturing the tibial bearing based on the digital image of the tibial bearing.