Abstract:
Systems, devices, and methods are provided for orthopedic implants. The implants may include a base member, such as an acetabular shell or an augment, that is configured to couple with an augment, flange cup, mounting member, or any other suitable orthopedic attachment. An implant may include a base member that has at least two projections with a gap between the projections. The gap between the projections allows the implant to be implanted around another implanted component, such as around a bone screw of an acetabular shell. The implant may include a fixation element, such as a screw or a cement trough, on one or more projections to couple the implant to an implanted acetabular shell. The implant may also include timing marks to facilitate alignment with corresponding marks on another implanted component.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims the benefit of U.S. Provisional Patent Application No. 61/352,705, filed Jun. 8, 2010, U.S. Provisional Application No. 61/352,722, filed Jun. 8, 2010, U.S. Provisional Application No. 61/422,903, filed Dec. 14, 2010, and U.S. Provisional Application No. 61/466,817, filed Mar. 23, 2011, which are hereby incorporated by reference herein in their entireties. 
     
    
     BACKGROUND 
       [0002]    Joints often undergo degenerative changes due to a variety of reasons. When joint degeneration becomes advanced or irreversible, it may become necessary to replace the natural joint with a prosthetic joint. Artificial implants, including hip joints, shoulder joints, and knee joints are widely used in orthopedic surgery. Specifically, hip joint prostheses are common. The human hip joint acts mechanically as a ball and socket joint, wherein the ball-shaped head of the femur is positioned within the socket-shaped acetabulum of the pelvis. Various degenerative diseases and injuries may require replacement of all or a portion of a hip using synthetic materials, typically metals, ceramics, or plastics. 
         [0003]    More particularly, natural hips often undergo degenerative changes, requiring replacement of the hip joint with a prosthetic joint. Often, the hip is replaced with two bearing surfaces between the femoral head and the acetabulum. The first bearing surface is typically a prosthesis shell or acetabular cup, which may be formed of metal, ceramic material, or as otherwise desired. A liner (conventionally formed of polyethylene material such as ultra high molecular weight polyethylene, a ceramic material, or in some cases, even a metal liner) is then fit tightly within the shell to provide an inner bearing surface that receives and cooperates with an artificial femoral head in an articulating relationship to track and accommodate the relative movement between the femur and the acetabulum. 
         [0004]    The cup (or a cup and liner assembly) is typically fixed either by placing screws through apertures in the cup or by securing the cup with cement. In some cases, only a liner is cemented in a patient due to poor bone stock. In other cases, a cup having a porous surface may be press fit into the reamed acetabular surface. 
         [0005]    It may become necessary to conduct a second or subsequent surgery in order to replace a prosthetic joint with a (often larger) replacement joint. Such surgeries often become necessary due to further degeneration of bone or advancement of a degenerative disease, requiring removal of further bone and replacement of the removed, diseased bone with a larger or enhanced prosthetic joint, often referred to as a revision prosthesis. For example, bone is often lost around the rim of the acetabulum, and this may provide less rim coverage to securely place a press-fit cup. Such surgeries may thus be referred to as revision surgeries. 
         [0006]    In acetabular revision surgery, an acetabular prosthesis generally includes additional mounting elements, such as augments, flanges, hooks, plates, or any other attachment or mounting points or members that provide additional support and/or stability for the replacement prosthesis once positioned. These additional mounting or attachment members are often required due to bone degeneration, bone loss, or bone defects in the affected area (in this instance, the hip joint). 
         [0007]    Various types of these mounting members (which term is intended to include but not be limited to flanges, blades, plates and/or hooks) may be provided in conjunction with a prosthesis system in order to help the surgeon achieve optimal fixation, non-limiting examples of which include iliac flanges (providing securement and fixation in and against the ilium region of the pelvis), ischial blades (providing securement and fixation in and against the ischium), and obturator hooks (providing securement and inferior fixation by engaging the obturator foramen). Although there have been attempts to provide such mounting attachments with modularity, the solutions to date have generally fallen short of providing true modularity. Instead, they typically provide a few discrete positions at which the mounting members may be positioned, without providing the surgeon a fuller range of decision options. 
         [0008]    Additionally, in some primary surgeries and more often in revision surgeries, the acetabulum may have a bone defect or void that the surgeon must fill with bone grafts before inserting a new shell. This can be time consuming and expensive, and may subject the patient to additional health risks. Some techniques use an augment in connection with the acetabular shell, which can be coupled to or otherwise attached to the outer surface of the shell. 
         [0009]    With current augments, the surgeon can attach the augment to the bone and then implant the cup. However, many acetabular shells rely on bone screws to achieve proper fixation and the augment often gets in the way of a screw. In short, surgeons need the freedom to place screws in the best location, but this compromises their ability to use augments. With current systems, it also takes an increased amount of time surgical time to trial the component orientation and then try to find good bone fixation for the cup. The surgeon will often have to free-hand the amount of bone removed while estimating the size of augment needed. In the cases where bone is often deficient, surgeons are hesitant to take away any more bone than necessary. 
         [0010]    Various additional features and improved features intended for use and application with various types of joint implants are also described herein, such as improved bone screws, improved coatings, and various augment removal and insertion options. 
       SUMMARY 
       [0011]    Disclosed herein are systems, devices, and methods for providing modular orthopedic implants. The implants may include a base member, such as an acetabular shell or an augment, that is configured to couple with an augment, flange cup, mounting member, any other suitable orthopedic attachment, or any combinations thereof. Mounting members include, for example, flanges, blades, hooks, and plates. In some embodiments, the orthopedic attachments may be adjustably positionable about the base member or other attachments thereby providing modularity for assembling and implanting the device. Various securing and/or locking mechanisms may be used between the components of the implant. In certain embodiments, the orthopedic attachments are removably coupled to the base member or other components. In certain embodiments, the orthopedic attachments are integrally provided on the base member or other components, yet may still be adjustably positionable thereabout. In some embodiments, expandable augments, base members, or other bone filling devices are provided. In some embodiments, surface features are provided that create friction and allow for surrounding bone ingrowth at the interface of the implants and a patient&#39;s bone. 
         [0012]    Systems, devices, and methods described herein provide implants having a plurality of projections and optional fixation elements. In certain embodiments, an orthopedic augment includes a base member to which at least two projections are coupled, the at least two projections having a gap therebetween, and a fixation element provided on one or more of the at least two projections. The fixation element may be a cement trough. In certain embodiments, the base member is shaped to couple with an implant. For example, a first surface of the base member that contacts the implant may be substantially arcuate. The at least two projections may be disposed in substantially the same direction. The length of the at least two projections may be substantially the same, or the length of one of the at least two projections may be different than the respective length of another of the at least two projections. In some embodiments, the base member includes one or more fixation elements such as screw holes configured to receive a fastener. In some embodiments, the base member includes a connection element configured to receive a driver handle for placing the orthopedic augment into a patient&#39;s joint. In some embodiments, the base member includes timing marks configured to align with corresponding timing marks on an implant. In some embodiments, the augment may further include flanges, blades, plates, or hooks attached thereto. 
         [0013]    In certain embodiments, a method of implanting an orthopedic device in a patient&#39;s joint may include placing an implant within the patient&#39;s joint, the implant secured to the joint via a fixation device, preparing a space in the patient&#39;s bone proximate the implant and the fixation device, providing an augment that includes at least two projections having a gap therebetween, and inserting the augment into the prepared space by positioning the augment around the fixation member such that the fixation member extends through the gap between the at least two projections of the augment. The method may further include forming a cement trough on one or more of the at least two projections, and setting the augment by pouring cement into the cement trough. In some embodiments, the method includes setting the augment using screws. The preparing may include rasping or reaming the patient&#39;s bone with a broach. The broach may have approximately the same cross-sectional profile as the augment. In some embodiments, the amount of bone removed may be limited by using a depth stop disposed on the broach. The inserting may include attaching the augment to a driver handle for positioning the augment into the prepared space. The method may further include aligning timing marks disposed on the augment with timing marks disposed on the implant. In some embodiments, the augment further comprises flanges, blades, plates, or hooks attached thereto. In some embodiments, the placing including mounting an acetabular shell or cage within the patient&#39;s acetabulum. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0014]    The foregoing and other objects and advantages will be apparent upon consideration of the following detailed description, taken in conjunction with the accompanying drawings, in which like reference characters refer to like parts throughout, and in which: 
           [0015]      FIGS. 1 and 2  show a front perspective view and a back view, respectively, of an illustrative augment; 
           [0016]      FIG. 3  shows a top plan view of an augment illustratively installed on an acetabular shell; 
           [0017]      FIGS. 4-7  illustrate exemplary methods for installing an augment into a patient&#39;s joint; 
           [0018]      FIG. 8  shows a front perspective view of an illustrative augment having three projections; 
           [0019]      FIG. 9  shows a top plan view of an augment having an illustrative flange; and 
           [0020]      FIG. 10  shows a partial cross-section elevation view of an illustrative augment with a flange installed in an acetabulum. 
       
    
    
     DETAILED DESCRIPTION 
       [0021]    To provide an overall understanding of the systems, devices, and methods described herein, certain illustrative embodiments will be described. Although the embodiments and features described herein are specifically described for use in connection with acetabular systems, it will be understood that all the components, connection mechanisms, adjustable systems, fixation methods, manufacturing methods, coatings, and other features outlined below may be combined with one another in any suitable manner and may be adapted and applied to medical devices and implants to be used in other surgical procedures, including, but not limited to: spine arthroplasty, cranio-maxillofacial surgical procedures, knee arthroplasty, shoulder arthroplasty, as well as foot, ankle, hand, and other extremity procedures. 
         [0022]    Various implants and other devices described herein in their various embodiments may be used in conjunction with any appropriate reinforcement material, non-limiting examples of which include bone cement, appropriate polymers, resorbable polyurethane, and/or any materials provided by PolyNovo Biomaterials Limited, or any suitable combinations thereof. Further non-limiting examples of potential materials that may be used are described in the following references: U.S. Patent Application Publication No. 2006/0051394, entitled “Biodegradable Polyurethane and Polyurethane Ureas,” U.S. Patent Application Publication No. 2005/0197422, entitled “Biocompatible Polymer Compositions for Dual or Multi Staged Curing,” U.S. Patent Application Publication No. 2005/0238683, entitled “Biodegradable Polyurethane/Urea Compositions,” U.S. Patent Application Publication No. 2007/0225387, entitled “Polymer Compositions for Dual or Multi Staged Curing,” U.S. Patent Application Publication No. 2009/0324675, entitled “Biocompatible Polymer Compositions,” U.S. Patent Application Publication No. 2009/0175921, entitled “Chain Extenders,” and U.S. Patent Application Publication No. 2009/0099600, entitled “High Modulus Polyurethane and Polyurethane/Urea Compositions.” Each of the prior references is incorporated by reference herein in its entirety. 
         [0023]      FIGS. 1 and 2  are a front perspective view and a back view, respectively, of an augment according to certain embodiments. In  FIGS. 1 and 2 , augment  910  is in the shape of a staple and is provided with a number of projections and optional fixation elements. For example, augment  910  includes two projections  920  extending from a base portion or member  970 , although it is possible that the augment  910  may have three or more projections that extend from a base member as described below. As shown, the projections  920  may be disposed in substantially the same direction from the augment  910  defined by the respective axis of each projection, with a gap  925  between the two projections  920 . In certain embodiments the projections  920  may be angled or otherwise offset such that the projections  920  are not disposed in the same direction from the augment  910 ; however, there may still preferably be a gap disposed between the two projections  920 . Furthermore, although the length of the projections  920  is shown as being substantially the same, it will be understood that the length of one of the projections  920  may be different than the respective length of the other projection. The base member  970 , or the projections  920 , or both, may have a surface that is substantially arcuate, for example, in order to complement an outer curved surface of an acetabular shell or other implant. 
         [0024]    Optional fixation elements include screw holes  930  and cement troughs  960 . The fixation elements fix the augment  910  in place when implanted. Each fixation element may connect the augment  910  to a patient&#39;s bone, an acetabular shell, or both. The augment  910  may also include a connection element  940  on base member  970 , for example, at the center top of the augment  910 . In certain embodiments, connection element  940  is a threaded opening that may be attached to the end of a driver handle (e.g., driver handle  1060  of  FIG. 7 ) for assisting with the implantation of the augment  910 . However, the connection element  940  may be a tapered connection, a quick-connect, or any other type of fitting. The augment  910  may further include timing marks  950  to allow the augment  910  to be properly placed within the hip bone. Installation of the augment  910  is described in further detail below. 
         [0025]      FIG. 3  is a top view of an augment installed on an acetabular shell. Augment  860  may be similar to augment  910 . As shown, augment  860  is positioned next to acetabular shell  862  such that timing marks  864  disposed on the augment  860  are aligned with timing marks  866  disposed on the acetabular shell  862 . The base member of augment  860  has an arcuate surface that contacts the complementary curved outer surface of the acetabular shell  862 . As described above, an augment such as augment  860  may be fixed to the acetabular shell  862 , a patient&#39;s bone, or both, via optional fixation elements such as screw holes and cement troughs. 
         [0026]      FIGS. 4-7  illustrate exemplary methods for installing an augment  910  into a patient&#39;s joint according to certain embodiments. 
         [0027]      FIG. 4  is a cross-sectional elevation drawing of an acetabulum  990  and an acetabular shell  1010 . The acetabulum  990  would have been prepared to receive the shell  1010  by reaming, rasping or the like. Bone screws  1020  or other appropriate fixation devices have also been installed to secure shell  1010 . Also shown is bone deficient area  1000 . This area  1000  is a void space extending from the outer wall of the acetabular shell  1010  to the acetabulum  990 . 
         [0028]    In  FIG. 5 , the acetabulum  990  is prepared for the augment  910  by use of broach  1030 . The broach  1030  can be of any kind useful for rasping or reaming bone. For use with the augments described herein, the broach  1030  is typically provided with a depth stop  1040 . Depth stop  1040  prevents the broach  1030  from removing too much bone by catching, for example, on the rim of acetabular shell  1010 . The broach  1030  may have roughly the same cross-sectional profile and overall shape as the augment  910  and is typically sized to allow the augment  910  to be wedge-fitted into bone deficient area  1000 . The broach  1030  may also have a slot provided therein to allow the broach  1030  to slide on either side of the installed screw  1020  to clear away bone on both sides of the screw  1020 . 
         [0029]    In  FIG. 6 , the acetabulum  990  has been prepared for the augment  910 . Bone deficient area  1000  has been replaced with prepared space  1050  between the acetabulum  990  and the acetabular shell  1010 , the prepared space including screw  1020 . 
         [0030]    The next step in the procedure is illustrated in  FIG. 7 . The augment  910  is attached to driver handle  1060  and inserted into prepared space  1050 . During insertion, the surgeon matches the timing marks  950  on the top of the augment  910  to timing marks (e.g., timing marks  886 ) on the acetabular shell  1010  to ensure that bone screw  1020  is avoided. The augment  910  is inserted into the prepared space by positioning the augment around the screw  1020  (or any other fixation member) such that the screw  1020  extends through the gap  925  between projections  920  of augment  910 . Once the augment  910  has been pushed into place by hand, it may be tapped into its final position with a hammer. If the surgeon desires, the surgeon may then fix the augment  910  even further by using augment screws placed into screw holes  930  and then into the patient&#39;s bone. Alternatively or additionally, the surgeon can pour bone cement down the troughs  960  illustrated in  FIG. 1 . The cement may bind the augment  910  to the acetabular shell  1010 , the patient&#39;s bone, or both. 
         [0031]    In some embodiments, the augment  910  is held in place solely by a friction fit. In some embodiments, fixation devices like bone screws or cement may be used to secure augment  910  in place, for example, via screw holes  930  or cement troughs  960 , respectively. Any kind of bone screw or cement familiar to one of ordinary skill in the art may be used. 
         [0032]      FIG. 8  shows a front perspective view of an augment having three projections extending from a top or base member according to certain embodiments. For example, augment  910 ′ may be similar to augment  910  of  FIG. 1 , but augment  910 ′ includes three projections  920 ′ extending from the top member  970 ′. It will be understood that in certain embodiments an augment may include more than three projections. 
         [0033]    In some embodiments, the augments described above may be provided with flanges, blades, plates, hooks, any other suitable mounting members, or any combinations thereof. For example,  FIG. 9  shows a top plan view of an augment  1080  with flange  1090 . Flange  1090  may provide additional support for the augment  1080  on the outside of the acetabulum (e.g., acetabulum  1092  of  FIG. 10 ).  FIG. 10  illustrates a partial cross-section elevation view of an augment  1080  installed in acetabulum  1092  with flange  1090  having bone screw  1094  provided therethrough. 
         [0034]    The augments described herein may be made of a number of materials, including Titanium, Cobalt-Chromium, Zirconium oxide, any other biocompatible materials or alloys that have the appropriate strength, resistance to wear, etc., or any combinations thereof. The augments may also be made fully porous or partially porous to allow for greater bone in-growth, for example, and the augments may be coated with hydroxyapatite or any other bone-promoting agents or combinations thereof. 
         [0035]    The embodiments described preferably above allow a surgeon to implant the acetabular shell or cup first and gain desired screw fixation and then prepare the bone minimally to fit a desired augment. This enables the surgeon to get the desired fixation for the acetabular shell without compromising the surgeon&#39;s ability to use an augment. An additional advantage is that the surgeon removes no more bone than is necessary. 
         [0036]    The foregoing is merely illustrative of the principles of the disclosure, and the systems, devices, and methods can be practiced by other than the described embodiments, which are presented for purposes of illustration and not of limitation. It is to be understood that the systems, devices, and methods disclosed herein, while shown for use in acetabular systems, may be applied to medical devices to be used in other surgical procedures including, but not limited to, spine arthroplasty, cranio-maxillofacial surgical procedures, knee arthroplasty, shoulder arthroplasty, as well as foot, ankle, hand, and extremities procedures. 
         [0037]    Variations and modifications will occur to those of skill in the art after reviewing this disclosure. The disclosed features may be implemented, in any combination and subcombinations (including multiple dependent combinations and subcombinations), with one or more other features described herein. The various features described or illustrated above, including any components thereof, may be combined or integrated in other systems. Moreover, certain features may be omitted or not implemented. 
         [0038]    Examples of changes, substitutions, and alterations are ascertainable by one skilled in the art and could be made without departing from the scope of the information disclosed herein. All references cited herein are incorporated by reference in their entirety and made part of this application.