Abstract:
An implant for use in high tibial osteotomy can include a central implant portion, a first side implant portion and a second side implant portion. The first and second side implant portions can be selectively rotatable relative to each other. A method of performing high tibial osteotomy can include providing an implant having a superior surface and an inferior surface. The first superior surface and the second inferior surface can define an implant angle therebetween. A correction angle of the tibia can be determined. A first cut can be made in the tibia. An angle of a second cut relative to the first cut can be determined based on a difference between the implant angle and the correction angle. The second cut can be made in the tibia. The tibia can be opened creating an opening for receipt of the implant. The implant can be inserted into the opening.

Description:
FIELD 
       [0001]    The present disclosure relates generally to high tibial osteotomy. More particularly, the present disclosure relates to an implant and related technique for use in high tibial osteotomy. 
       BACKGROUND 
       [0002]    The background description provided herein is for the purpose of generally presenting the context of the disclosure. Work of the presently named inventors, to the extent it is described in this background section, as well as aspects of the description that may not otherwise qualify as prior art at the time of filing, are neither expressly nor impliedly admitted as prior art against the present disclosure. 
         [0003]    High tibial osteotomy is a surgical procedure used to correct a malalignment in a tibia. Malalignment in a tibia can accelerate wear in the lateral or medial compartments of the knee and lead to degeneration. Malalignment can include a varus deformation or a “bow-legged” knee condition and a valgus deformation or a “knock-knee” condition. In this regard, a varus knee can cause the protective tissues of the knee to wear more on a medial aspect of the knee. Similarly, a valgus knee can cause the protective tissues of the knee to wear more on the lateral aspect of the knee. In either scenario, it is desirable to perform a high tibial osteotomy to correct the malalignment and position the tibia in a more neutral orientation. 
         [0004]    In one procedure, a varus deformation can be corrected by making a single cut in the medial tibia. The tibia is opened and an implant is positioned within the opening. In another procedure, a valgus deformation can be corrected by making a pair of cuts in the medial tibia and removing a wedge of tibial bone. After the wedge of tibial bone is removed, the void is closed. 
         [0005]    When performing a procedure to correct a varus deformation, typically a surgeon would need to select an implant from a set of implants that has an implant angle suitable for the needs of a particular patient. A large inventory of implants are typically necessary to accommodate a wide range of patients. Furthermore, some implants may not match a profile of the patient&#39;s tibia in the transverse plane. In this regard, a need exists to provide a more universal implant suitable for use with a wide range of patients and related method for performing high tibial osteotomy. 
       SUMMARY 
       [0006]    This section provides a general summary of the disclosure, and is not a comprehensive disclosure of its full scope or all of its features. 
         [0007]    An implant for use in high tibial osteotomy can include a central implant portion, a first side implant portion and a second side implant portion. The first and second side implant portions can be selectively rotatable relative to each other. 
         [0008]    In one configuration, the first and second implant portions can be hingedly coupled relative to each other. The first side implant portion can include a first hinge arm that defines a first passage therein. The second side implant portion can include a second hinge arm that defines a second passage therein. The implant can further include a hinge post received by the first and second passages. The first and second implant portions can be configured to rotate about the hinge post. 
         [0009]    In additional configurations, the central implant portion can include an arcuate body having an outer arcuate portion and an inner arcuate portion. The central implant can comprise a central solid portion and a central porous portion. The central solid portion can be disposed on the outer arcuate portion. The central porous portion can be disposed on the inner arcuate portion. The first side implant portion can include a first outer solid portion and a first inner porous portion. The first hinge arm can be provided exclusively by the first outer solid portion. The second side implant portion can include a second outer solid portion and a second inner porous portion. The second hinge arm can be provided exclusively by the second outer solid portion. In one example, the first and second side implant portions can be rotatably coupled to each other at a living hinge. 
         [0010]    An implant for use in high tibial osteotomy can include a central implant portion, a first side implant portion and a second side implant portion. The central implant portion can have an arcuate body including a central solid portion and a central porous portion. The central solid portion can include a hinge post. The first side implant portion can have a first outer solid portion and a first inner porous portion. The first outer solid portion can include a first hinge arm that is rotatably coupled to the hinge post. The second side implant portion can have a second outer solid portion and a second inner porous portion. The second outer solid portion can include a second hinge arm that is rotatably coupled to the hinge post. The first and second side implant portions can be selectively rotatably coupled relative to each other. 
         [0011]    According to other features, the central implant portion can further comprise a first upper wing connected to a first lower wing by a first central wall. The first upper wing, the first lower wing and the first central wall can define a first recess. The central implant can further include a second upper wing connected to a second lower wing by a second central wall. The second upper wing, the second lower wing and the second central wall can define a second recess. 
         [0012]    According to additional features, the arcuate body of the central implant portion can include a convex central side and a concave central side. The first and second central walls can taper toward the convex central side. The first side implant portion can be at least partially received by the first recess. The second side implant portion can be at least partially received by the second recess. The implant can be formed as one unit by laser sintering. 
         [0013]    A method of performing high tibial osteotomy according to the present disclosure can include providing an implant having a first superior surface and a second inferior surface. The first superior surface and the second inferior surface can define an implant angle therebetween. A correction angle of the tibia can be determined. A first cut can be made in the tibia. An angle of a second cut relative to the first cut can be determined based on a difference between the implant angle and the correction angle. The second cut can be made in the tibia. The tibia can be opened creating an opening for receipt of the implant. The implant can be inserted into the opening. 
         [0014]    According to other features, a relief hole can be drilled into the tibia with a coring drill. A blade can be advanced through a slot in a guide arm. The blade can be advanced through a keyway defined in the coring drill. At least one of autograph and allograph bone matrix can be deposited into the opening prior to inserting the implant into the opening. The coring drill can remain at one position during the making of the first and second cuts. 
         [0015]    Further areas of applicability of the present disclosure will become apparent from the description provided hereinafter. The description and specific examples in this summary are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure. 
     
    
     
       DRAWINGS 
         [0016]    The present teachings will become more fully understood from the detailed description, the appended claims and the following drawings. The drawings are for illustrative purposes only and are not intended to limit the scope of the present disclosure. 
           [0017]      FIG. 1  is a front perspective view of an implant for use in high tibial osteotomy constructed in accordance to one example of the present disclosure; 
           [0018]      FIG. 2  is a front perspective view of the implant of  FIG. 1  and shown with a first and second side implant portions rotated relative to each other about a hinge; 
           [0019]      FIG. 3  is a front perspective view of a central implant portion of the implant shown in  FIG. 1 ; 
           [0020]      FIG. 4  is a front perspective view of the first side implant portion of the implant shown in  FIG. 1 ; 
           [0021]      FIG. 5  is a rear perspective view of the first side implant portion shown in  FIG. 4 ; 
           [0022]      FIG. 6  is a front perspective view of a second side implant portion of the implant shown in  FIG. 1 ; 
           [0023]      FIG. 7  is a rear perspective view of the second side implant portion of  FIG. 6 ; 
           [0024]      FIG. 8  is a front perspective view of an implant for use in high tibial osteotomy and constructed in accordance to additional features of the present disclosure; 
           [0025]      FIG. 9  is a front perspective view of an implant for use in high tibial osteotomy and constructed in accordance to other features of the present disclosure; 
           [0026]      FIG. 10  is a medial view of a left tibia shown with a guide arm in a first position and a blade making a first cut during a high tibial osteotomy procedure according to the present disclosure; 
           [0027]      FIG. 11  is a cross-sectional view of the tibia taken along lines  11 - 11  of  FIG. 10 ; 
           [0028]      FIG. 12  is a medial view of the left tibia of  FIG. 10  shown with the guide arm rotated to a second position and the blade making a second cut; 
           [0029]      FIG. 13  is an anterior view of the left tibia of  FIG. 10  shown with the implant positioned on a medial side ready for insertion into an opening of the tibia; and 
           [0030]      FIG. 14  is an anterior view of the left tibia of  FIG. 12  shown with the implant advanced into the opening of the tibia. 
       
    
    
     DETAILED DESCRIPTION 
       [0031]    The following description is merely exemplary in nature and is not intended to limit the present disclosure, its application, or uses. Although the following description is related generally to an implant for high tibial osteotomy, the implant and related technique is not so limited. In this regard, while the following discussion will be directed toward correcting a malalignment in a tibia, the same may be applied to correcting a malalignment in other long bones. 
         [0032]    With initial reference to  FIGS. 1 and 2 , an implant for high tibial osteotomy constructed in accordance to the present disclosure is shown and generally identified as implant  10 . As will become appreciated by the following discussion, the implant  10  may be used during a high tibial osteotomy procedure to correct a malalignment in a tibia. The implant  10  can generally include a central implant portion  12 , a first side implant portion  14  and a second side implant portion  16 . The implant  10  can further include a hinge  20  that can allow the first side implant portion  14  and the second side implant portion  16  to selectively rotate relative to each other. While the first and second side implant portions  14  and  16  are shown rotated outwardly an exemplary amount in  FIG. 2 , it will be appreciated that the first and second side implant portions  14  and  16  may be rotated outwardly any given amount to specifically match a profile of a patient&#39;s tibia  22  ( FIG. 13 ) in a transverse plane. In this regard, the implant  10  can be adjustable to accommodate a tibial profile of a specific patient intraoperatively. 
         [0033]    While the central implant portion  12 , the first side implant portion  14  and the second side implant portion  16  are shown separately in  FIGS. 3-7 , they may be formed as a single unit such as during a laser sintering process. In this regard, as described herein, each of the central implant portion  12 , the first side implant portion  14  and the second side implant portion  16  include both solid portions and porous portions. The respective solid and porous portions can be integrally formed during laser sintering. Explained further, the respective solid and porous portions need not be specifically coupled together from distinctly formed pieces. Moreover, the central implant portion  12 , the first side implant portion  14  and the second side implant portion  16  can be formed as a hinged unit. In this regard, the central implant portion  12 , the first side implant portion  14  and the second side implant portion  16  are not required to be specifically assembled together. In one example, the implant can be formed of biocompatible metal such as titanium, titanium alloys, cobalt, cobalt alloys, chromium, chromium alloys, tantalum, tantalum alloys, and stainless steel. Other materials are contemplated. 
         [0034]    With additional reference now to  FIG. 3 , the central implant portion  12  will be further described. The central implant portion  12  generally includes an arcuate body  24  that generally includes a central solid portion  26  and a central porous portion  28 . The arcuate body  24  can have an upper portion  30 , a lower portion  32  and a connecting portion  34 . The upper portion  30 , the lower portion  32  and the connecting portion  34  of the arcuate body  24  can collectively provide an outer arcuate portion  40  and an inner arcuate portion  42 . The outer arcuate portion  40  and the inner arcuate portion  42  can generally provide a convex central side  46  and a concave central side  48 , respectively. 
         [0035]    The upper portion  30  can include a first upper wing  50  and a second upper wing  52 . The lower portion  32  can include a first lower wing  54  and a second lower wing  56 . As shown in  FIG. 3 , the first and second upper wings  50  and  52  form a continuous sweeping geometry. Similarly, the first and second lower wings  54  and  56  form a continuous sweeping geometry. 
         [0036]    The connecting portion  34  can include a first central wall  60  and a second central wall  62 . The first and second central walls  60  and  62  can generally taper toward the convex central side  46 . The first upper wing  50 , the first lower wing  54  and the first central wall  60  can cooperate to form a first recess  66 . The second upper wing  52 , the second lower wing  56  and the second central wall  62  can cooperate to form a second recess  68 . A hinge post  70  can generally extend between the upper portion  30  and the lower portion  32  near the outer arcuate portion  40 . The hinge post  70  can be formed exclusively of solid material by the central solid portion  26 . 
         [0037]    Turning now to  FIGS. 4 and 5 , the first side implant portion  14  will be further described. The first side implant portion  14  generally includes a first arcuate body  74  that generally includes a first solid portion  76  and a first porous portion  78 . The first solid portion  76  can include a first outer solid portion  80  and a first hinge portion  82 . The first hinge portion  82  can include a first hinge arm  86  that defines a first passage  88 . The first porous portion  78  can include a first inner porous portion  90  and a first wall  92 . 
         [0038]    Turning now to  FIGS. 6 and 7 , the second side implant portion  16  will be further described. The second side implant portion  16  generally includes a second arcuate body  94  that generally includes a second solid portion  96  and a second porous portion  98 . The second solid portion  96  can include a second outer solid portion  100  and a second hinge portion  102 . The second hinge portion  102  can include a pair of second hinge arms  106  that collectively define a second passage  108 . The second porous portion  98  can include a second inner porous portion  110  and a first wall  112 . 
         [0039]    With reference now to  FIGS. 1-7 , the geometries of the central implant portion  12 , the first side implant portion  14  and the second side implant portion  16  will be described. In general, the first wall  92  ( FIG. 4 ) of the first side implant portion  14  can be nestingly received by the first recess  66  ( FIG. 3 ) of the central implant portion  12 . The hinge post  70  can be received by the first passage  88  of the first hinge arm  86 . The second wall  112  ( FIG. 7 ) of the second side implant portion  16  can be nestingly received by the second recess  68  ( FIG. 3 ) of the central implant portion  12 . The hinge post  70  can be received by the pair of second passages  108  of the respective second hinge arms  106 . The first hinge arm  86  can be received between the pair of second hinge arms  106  ( FIG. 1 ). It will be appreciated that the configuration of the hinge  20  is merely exemplary. In this regard, while the first side implant portion  14  is shown having one hinge arm  86  and the second side implant portion  16  is shown having two hinge arms  106 , the configuration may be reversed. Alternatively, each of the first and second hinge arms  86  and  106  may be formed of one or more hinge arms. Moreover, while the hinge post  70  has been described as part of the central implant  12 , the hinge post  70  may additionally or alternatively be incorporated on the first or second implant portion  14  or  16 . 
         [0040]    With reference now to  FIG. 8  an implant constructed in accordance to additional features of the present disclosure is shown and generally identified at reference  210 . The implant  210  can generally include a central implant portion  212 , a first side implant portion  214  and a second side implant portion  216 . The implant  210  can further include a hinge  220  that allows the first side implant portion  214  and the second side implant portion  216  to selectively rotate relative to each other. The hinge  220  of the implant  210  can include a living hinge. In this regard, the hinge  220  can deform to allow the first and second side implant portions  214  and  216  to rotate relative to each other. 
         [0041]    The first side implant portion  214  generally includes a first arcuate body portion  230  that includes a first solid portion  232  and a first porous portion  234 . The second side implant portion  216  generally includes a second arcuate body portion  240  that includes a second solid portion  242  and a second porous portion  244 . The first solid portion  232 , the second solid portion  242  and the living hinge  212  can be formed of biocompatible metal. In this regard, the living hinge  212  can be a metal living hinge. Again, as with the implant  10  described above, the first and second side implant portions  214  and  216  can rotate about the living hinge  212  to any given position to specifically match a profile of a patient&#39;s tibia  22  ( FIG. 13 ) in the transverse plane. 
         [0042]    With reference now to  FIG. 9  an implant constructed in accordance to additional features of the present disclosure is shown and generally identified at reference  310 . The implant  310  can generally include a central implant portion  312 , a first side implant portion  314  and a second side implant portion  316 . The implant  310  can further include a hinge  320  that allows the first side implant portion  314  and the second side implant portion  316  to selectively rotate relative to each other. The hinge  320  of the implant  310  can include a living hinge. In this regard, the hinge  320  can deform to allow the first and second side implant portions  314  and  316  to rotate relative to each other. 
         [0043]    The first side implant portion  314  generally includes a first arcuate body portion  330  that includes a first solid portion  332  and a first porous portion  334 . The second side implant portion  316  generally includes a second arcuate body portion  340  that includes a second solid portion  342  and a second porous portion  344 . The first solid portion  332 , the second solid portion  342  and the living hinge  312  can be formed of polymeric material such as ultra high molecular weight polyethylene. In this regard, the living hinge  312  can be a polymeric or plastic living hinge. Again, as with the implant  10  described above, the first and second side implant portions  314  and  316  can rotate about the living hinge  312  to any given position to specifically match a profile of a patient&#39;s tibia  22  ( FIG. 13 ) in the transverse plane. 
         [0044]    With additional reference now to  FIGS. 10-14 , an exemplary technique for high tibial osteotomy will be described. In general, the femoral-tibial alignment angle is desirable between 7 and 13 degrees. In the example shown, the tibia is a left tibia having a varus deformation. In this regard, the high tibial osteotomy discussed below will be performed to correct a “bow-legged” malformation. It will be appreciated that the implants and techniques described herein can be also applied for a valgus deformation to correct a “knock-kneed” malformation. To correct the varus deformation, the implant  10  can be advanced into an opening created on the medial side of the tibia  22  ( FIGS. 13 and 14 ). 
         [0045]    At the outset, a surgeon can determine a correction angle  400  of the tibia  22 . In the example shown, the correction angle  400  ( FIG. 14 ) of the tibia  22  will be 10 degrees. In this regard, the medial side of the tibia will be raised 10 degrees. Next, an implant angle  402  ( FIG. 13 ) of the implant  10  can be determined. The implant angle  402  can be an angle between a superior surface  412  of the implant  10  and an inferior surface  414  of the implant. In the example provided, the implant angle  402  is 15 degrees. As will become appreciated, a modular implant  10  having an implant angle  402  of 15 degrees can be used in a variety of examples to correct various valgus and varus deformations. In this way, a modular implant  10  can be used for correcting malalignments on tibias for a wide range of patients. 
         [0046]    Next, a cannulated coring drill  418  can be used to create a relief or datum hole  420  in the tibia  22 . The coring drill  418  can have a coring drill collar  422  that defines a keyway  430 . A blade  434  can then be used to make a first cut  440  ( FIG. 13 ) in the tibia  22 . In one example, the blade  434  can be guided through a slot  450  defined in a guide arm  452  pivotally coupled to the coring drill  418 . The datum hole  420  acts as a datum axis, which can constrain the guide arm and blade  434  across all degrees of freedom except rotation on the coronal plane. 
         [0047]    Notably, the depth of cut in the lateral direction is limited by the coring drill collar  422 . Explained further, the blade  434  can be received by the keyway  430  ( FIG. 11 ) and inhibited from advancing further into the tibia  22  by the collar  422 . Other geometries of the keyway  430  are contemplated for inhibiting further lateral advancement of the blade  434 . The keyway  430  on the coring drill collar  422  can also catch debris created while advancing the blade  434  toward the coring drill collar  422 . 
         [0048]    After the first cut  440  has been made, an angle  458  of a second cut  460  (relative to the first cut  440 ) can be determined. The angle of the second cut  460  will be the implant angle  400  (in this example 15 degrees) minus the angle of correction (in this example 10 degrees). The angle of the second cut  460  (relative to the first cut  440 ) in this example is 5 degrees. 
         [0049]    The guide arm  452  can then be rotated about the drill  418  to the angle  458  of the second cut. In one example indicia can be provided on the guide arm and/or the coring drill collar  422  to assist in attaining the angle  458 . The second cut  460  can then be made using the blade  434 . Again, as with the first cut  440 , the blade  434  can be received by the keyway  430  to inhibit further advancing of the blade  434  into the tibia. 
         [0050]    After the second cut  460  has been made, the blade  434 , guide arm  452  and coring drill  418  can be removed from the tibia. The tibia can then be “opened” to receive the implant  10 . The implant  10  can then be advanced into the opening. In some examples, the first and second side implant portions  14  and  16  can be rotated to substantially match an outer profile of the tibia in the transverse plane. As such, the implant  10  can address patient variability in the anterior-posterior direction. Bone filler  470  such as allograft, autograft or xenograft material can be optionally disposed inboard of the implant  10 . 
         [0051]    As can be appreciated, the present teachings provide a single implant  10 ,  210  or  310  that can be applicable for all tibial correction angles. In this way, the tibia  22  can be cut in any manner suitable to accommodate the implant  10  while still attaining any correction angle. 
         [0052]    Exemplary embodiments are provided so that this disclosure will be thorough, and will fully convey the scope to those who are skilled in the art. Numerous specific details are set forth such as examples of specific components, devices, systems and/or methods, to provide a thorough understanding of exemplary embodiments of the present disclosure. It will be apparent to those skilled in the art that specific details need not be employed, that exemplary embodiments may be embodied in many different forms and that neither should be construed to limit the scope of the disclosure. In some exemplary embodiments, well-known processes, well-known device structures, and well-known technologies are not described in detail. 
         [0053]    The terminology used herein is for the purpose of describing particular example implementations only and is not intended to be limiting. As used herein, the singular forms “a,” “an,” and “the” may be intended to include the plural forms as well, unless the context clearly indicates otherwise. The term “and/or” includes any and all combinations of one or more of the associated listed items. The terms “comprises,” “comprising,” “including,” and “having,” are inclusive and therefore specify the presence of stated features, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and/or groups thereof. The method steps, processes, and operations described herein are not to be construed as necessarily requiring their performance in the particular order discussed or illustrated, unless specifically identified as an order of performance. It is also to be understood that additional or alternative steps may be employed.