Patent Publication Number: US-11642226-B2

Title: Implantable interpositional orthopedic pain management

Description:
FIELD 
     The present invention relates generally to implantable devices for medical and health-related purposes. More specifically, techniques for implantable interpositional orthopedic pain management are described. 
     BACKGROUND 
     Orthopedic pain is created by many different conditions including rheumatoid arthritis, traumatic arthritis, osteoarthritis, overuse, post-fracture deformation, bone loss (due to aging or use-related injuries) and others, all of which can result in substantial pain, loss of strength, or decreased ranges of motion. Pain can be caused due to severely weakened or degraded cartilage between bones, including those found in knee, hip, finger, metacarpal, carpometacarpal, and many other joints throughout the human body. Friction or physical contact between bones with missing, weakened, or degraded cartilage is a frequent source of pain, particularly in elderly persons. Consequently, orthopedic pain relief is a major field of research, endeavor, and investment. 
     Conventional techniques for relieving pain and restoring motion or improving a range of motion in some bodily joints typically require the removal of degraded cartilage and bones, fusing of joints, or other highly invasive surgical procedures that can often be counterproductive to biomechanical restoration of movement and future usefulness of degraded bodily joints. Fusion of bones in some bodily joints is also problematic because further use and range of motion are eliminated or severely limited. Also, conventional solutions are problematic and can lead to the transmission of pain from a joint through bones that are fused, which is typically a time (due to surgical operating time and post-surgical rehabilitation) less costly procedure than attempting joint repair or restoration. Further, conventional surgical techniques to alleviate pain in a joint often point away from removing bones or portions thereof, which limits effectiveness, minimizes pain relief and pain management, and restoration of joint stability and ranges of motion. Other conventional solutions often remove bone or parts thereof, such as ligament removal and tendon interpositioning (“LRTI”) remove bone or portions thereof such as removing a trapezium when attempting to surgically effect pain relief in joints such as the carpometacarpal (“CMC”) joint, which can leave gaps and undesirable large joint spaces. These conventional solutions do not typically achieve joint stability or restore range of motion or strength to a degree of normal articulation and use. 
     Other problematic conventional solutions rely upon the use of implantable devices. Due to large numbers of ligaments, connective tissue, and bone presence, conventional techniques for the placement of implantable devices can result in cutting connective and non-connective tissue, tendons, muscle, and ligaments that do not naturally restore easily post-surgery. Many implantable devices are made of materials that are problematic as long-term options for effecting orthopedic pain relief and range of motion restoration. For example, implantable devices such as ball-and-socket artificial joints made of cobalt chrome or other metals or alloys can erode surrounding bone or cause friction resulting in bone erosion over time. Further, conventional placement of implantable devices in bodily joints typically require substantial alterations to bones and bone structures by cutting off ends, portions, or removing bones entirely. Conventional techniques are hampered due to the sacrifice of function in exchange for pain relief and are limited in offerings to a user seeking to regain normal strength and range of motion. 
     Thus, what is needed is a solution for orthopedic pain management using implantable medical devices without the limitations of conventional techniques. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Various embodiments or examples (“examples”) of the invention are disclosed in the following detailed description and the accompanying drawings: 
         FIG.  1 A  illustrates a top view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  1 B  illustrates a bottom view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  1 C  illustrates an anterior view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  1 D  illustrates a posterior view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  1 E  illustrates a left view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  1 F  illustrates a right view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  1 G  illustrates a perspective view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  2 A  illustrates a top view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  2 B  illustrates a bottom view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  2 C  illustrates an anterior view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  2 D  illustrates a posterior view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  2 E  illustrates a left view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  2 F  illustrates a right view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  2 G  illustrates a perspective view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  3 A  illustrates a top view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  3 B  illustrates a bottom view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  3 C  illustrates an anterior view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  3 D  illustrates a posterior view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  3 E  illustrates a left view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  3 F  illustrates a right view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  3 G  illustrates a perspective view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  4 A  illustrates a top view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  4 B  illustrates a bottom view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  4 C  illustrates an anterior view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  4 D  illustrates a posterior view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  4 E  illustrates a left view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  4 F  illustrates a right view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  4 G  illustrates a perspective view of an exemplary implantable interpositional orthopedic pain management apparatus; 
         FIG.  5 A  illustrates a top view of an exemplary rasping instrument used for implantable interpositional orthopedic pain management; 
         FIG.  5 B  illustrates a bottom view of an exemplary rasping instrument used for implantable interpositional orthopedic pain management; 
         FIG.  5 C  illustrates an anterior view of an exemplary rasping instrument used for implantable interpositional orthopedic pain management; 
         FIG.  5 D  illustrates a posterior view of an exemplary rasping instrument used for implantable interpositional orthopedic pain management; 
         FIG.  5 E  illustrates a left view of an exemplary rasping instrument used for implantable interpositional orthopedic pain management; 
         FIG.  5 F  illustrates a right view of an exemplary rasping instrument used for implantable interpositional orthopedic pain management; 
         FIG.  5 G  illustrates a perspective view of an exemplary rasping instrument used for implantable interpositional orthopedic pain management; 
         FIG.  6 A  illustrates an exemplary rasping instrument used for implantable interpositional orthopedic pain management; 
         FIG.  6 B  illustrates an exemplary placement of an implantable interpositional orthopedic pain management device in a carpometacarpal joint; 
         FIG.  6 C  illustrates an exemplary placement of an implantable interpositional orthopedic pain management device in a carpometacarpal joint; 
         FIG.  7 A  illustrates another exemplary placement of an implantable interpositional orthopedic pain management device in a carpometacarpal joint; 
         FIG.  7 B  illustrates a further exemplary placement of an implantable interpositional orthopedic pain management device in a carpometacarpal joint; 
         FIG.  7 C  illustrates yet another exemplary placement of an implantable interpositional orthopedic pain management device in a bone joint; 
         FIG.  8    illustrates an exemplary surgical technique for implantable interpositional orthopedic pain management; 
         FIG.  9    illustrates another exemplary surgical technique for implantable interpositional orthopedic pain management; 
         FIG.  10    illustrates an exemplary surgical technique for implantable interpositional orthopedic pain management; and 
         FIG.  11    illustrates yet another exemplary surgical technique for implantable interpositional orthopedic pain management. 
     
    
    
     DETAILED DESCRIPTION 
     Various embodiments or examples may be implemented in numerous ways, including as a device, a system, a process, an apparatus, or an article of manufacture. Processes generally may be varied in individual operations, processes, or sub-processes may be performed in an arbitrary order, unless otherwise provided in the claims. 
     A detailed description of one or more examples is provided below along with accompanying figures. This detailed description is provided in connection with such examples, but is not limited to any particular example. The scope is limited only by the claims and numerous alternatives, modifications, and equivalents. Numerous specific details are set forth in the following description in order to provide a thorough understanding. These details are provided for the purpose of illustrating various examples and the described techniques may be practiced according to the claims without some or all of these specific details. For clarity, technical material that is known in the technical, medical, and industrial fields and related to the exemplary subject matter has not been described in detail to avoid unnecessarily obscuring the description or providing unnecessary details that may be already known to those of ordinary skill in the art. 
       FIG.  1 A  illustrates a top view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, a top view is shown of device  100 , which includes interpositional saddle surface  102 , saddle channel openings  104 - 110 , peripheral protrusions  112 - 118 , and periphery  120  (collectively “elements  102 - 120 ”). As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. As used herein, the term “saddle” may be used to refer to any implementation of device  100 , which is not limited to symmetrical, asymmetrical, off-centered, centered, aligned, or other specific geometric shapes or properties. A “saddle” may be implemented using various shapes that may be concave or convex and are not required to be aligned symmetrically around any dimensional axis (not shown) shown or described throughout, but can be axially aligned, anatomically aligned (i.e., aligned about a joint, bone, or other anatomical structure, without limitation or restriction), or aligned differently, without limitation or restriction. The term “saddle” may be used to refer, in some examples, to a body of device  100  that is configured to receive, fit, conform, or otherwise be positioned or placed on, over, under, or between one or more bones. Some of these shapes may be varied such that device is saddle-shaped or substantially saddle-shaped implementation. In some examples, device  100  may be an implantable medical device (as used herein, “implantable medical device,” “implantable device,” “implant device,” “implant,” and “device” are interchangeable terms that may be used to refer to, for example, device  100 , without limitation or restriction) configured for orthopedic pain relief in various types of joints such as the carpometacarpal joint, knee joint, elbow joint, or any other type of joint where two or more bones form a cartilaginous joint in which device  100  may be implanted or disposed (hereafter “implanted,” “inserted,” “surgically inserted,” “positioned,” “oriented,” or “placed,” may be used interchangeably with “disposed”). As shown, device  100  may be formed as a monolithic structure or as a composite of structures and/or sub-structures that, when combined, form an integrated implantable device that may be appropriately sized for a particular joint (or type of joints) to distract bones adjacent to a joint to prevent direct or indirect physical contact, thus alleviating pain and providing dynamic stability to the joint as well as restoring or maintaining a desired range of motion. Also, degraded (due to age-related wear or other biological deterioration) or damaged cartilage (e.g., resulting from a traumatic injury) may be replaced partially or fully using device  100 . 
     Here, device  100  is configured structurally to contour to bone ends (e.g., distal or proximal ends of bones that have various contoured surfaces that may be convex, concave, or otherwise). For example, in a carpometacarpal joint (hereafter referred to as the “CMC joint”), a trapezium bone (“trapezium”) and a metacarpal bone (“metacarpal”) form a joint surrounded by a synovial capsule in which there may be cartilage. When used to replace degraded, deteriorated, or missing cartilage in the CMC joint, device  100  may be structurally configured with a concave surface such as interpositional saddle surface  102 , which may be configured with a curvature attribute (e.g., one or more types of radii (e.g., spline, toroidal (e.g., elliptical, spline, donut, or other toroidal shapes), ellipse, or others, without limitation or restriction)) that is larger than that of, for example, a bone associated with a joint targeted for the implant within a given patient. In other examples, a curvature attribute (e.g., radius or radii of curvature) may be substituted with other units or attributes of measurement such as splines, As used herein, “larger” may refer to an attribute associated with the sizes and shapes of device  100  and interpositional saddle surface  102  (or other interpositional saddle surfaces or other features of device  100  and others such as those described herein) as determined by a range of size measurements of various bones forming different types of joints and standards of deviation. In some examples, the term “interpositional” as used herein may refer to an intended function and/or structure of device  100  as a “spacer” or intermediate implantable medical device that is designed to interpose between bones in a joint in order to alleviate pain, prevent distraction of bones from each other, and prevent or reduce loss of articulating motion and/or ranges of motion associated with a joint having missing and/or damaged cartilage. Here, device  100  may be configured for insertion into joints such as the CMC in order to relieve pain (e.g., due to injury, wounds, degradation, aging, arthritis, or other causes) while avoiding invasive and destructive procedures such as bone removal and/or joint fusion. 
     For example, device  100  may be formed (i.e., made, manufactured, molded, synthesized, built, generated, or the like) to different sizes of joints using various types of materials. Materials such as alloys, ceramics, ceramic-like, or polymers (e.g., thermoplastics, polycarbonate, polycarbonate urethanes (“PCU”), carbon chrome, pyrolytic carbon, polycarbon, polyetheretherketone (“PEEK”), polyetherketone (“PEK”), polyetherketoneketone (“PEKK”), polyurethane, or others, without limitation or restriction) may be used to form device  100 . Also, materials may be organic, inorganic, synthetic, or natural when forming device  100 , elements  102 - 120 , and the other examples provided herein, regardless of manufacturing processes or techniques. In some examples, other attributes of device  100  may be varied before, during, or after formation. For example, device  100  may be implemented with attributes to determine the type of material to be used. In some examples, materials having an elastic modulus or moduli that is similar or substantially similar to that of bone may be used. In other words, some implementation examples of device  100  (and the other examples of devices similar or substantially similar to device  100  as described below) may be designed, formed, or otherwise implemented using materials that present attributes, characteristics, and properties (e.g., elastic modulus (i.e., elasticity), flexibility, permeability, porosity, strength, tensile strength, tensile/compressive moduli or others, without limitation or restriction) that are similar or substantially similar to those of cortical bone and bone matrix (e.g., materials that exhibit properties such as elastic moduli similar or substantially similar to cortical bone). In other examples, materials for forming device  100  may be selected based on attributes and properties of materials that are similar, substantially similar, or less than that of cortical bone and cortical bone matrix in order to prevent damage to surrounding bones during implantation. For example, material for forming device  100  may be selected with a low enough elastic moduli such that implantation may occur by folding or partially deforming device  100  for insertion through an incision in a synovial capsule and an enlarged opening into a joint. Once inserted, device  100  made of materials such as those described above, may have a sufficient low modulus (property of elastic moduli such that it recovers and restores into its originally formed shape once positioned within a joint. The above examples are provided solely for purposes of illustrating a variety of materials that may be used to implement device  100  and the other implementation examples provided herein, without limitation or restriction to any particular type of material, whether found in nature or synthesized in artificial manufacturing processes. As used herein, different types of materials may be used and are not limited to the examples above. 
     Sizes may be determined based on median measurements of bone structures and features such as radii of curvature of torii found at either the distal or proximal ends of the bone structures. To provide tolerance for sizing implants for various joint sizes, one or multiple standards of deviation of measurements may also be taken into account when forming device  100 . For a CMC joint of a given patient, in some examples, interpositional saddle surface  102  may be formed having a radius of curvature that is designed to fit over the proximal or distal end of a trapezium, metacarpal, tibia, femur, or other type of bone that couples to another bone over one or more joints. A “channel” or length of curvature traversing horizontally through interpositional saddle surface  102  may, in some examples, extend between saddle channel openings  106  and  110 . Thus, curved surfaces rising up the sides of a saddle channel between saddle channel openings  106 - 110  along interpositional saddle surface  102  may be formed with a radius of curvature that, when measured, may be one or two standard deviations apart from the measured radius of curvature of a bone end (i.e., distal or proximal end of a bone or bone structures such as those mentioned above) over which device  100  has been configured to “fit” when disposed within a joint. In other words, when device  100  is implanted within a synovial capsule (the term “synovial capsule” may be used interchangeably with “capsule” and may refer to an anatomical structure or feature surrounding a joint in which bone, cartilage, or other anatomical elements or features may be found), interpositional saddle surface  102  is designed (i.e., structured, formed, or configured) to contour to a corresponding surface of a bone. As an example, device  100  may be implanted into a CMC joint (not shown). When inserted, interpositional saddle surface  102  may be positioned over the end (e.g., proximal or distal) of the metacarpal or trapezium bones (not shown) adjacent to and forming the CMC joint. Formed having a radius of curvature that is one, two, or other standard deviations from a measured radius of curvature of a patient&#39;s metacarpal or trapezium, interpositional saddle surface  102  may be a concave channel traversing the distance between saddle channel openings  106  and  110  and configured to receive the end (e.g., distal or proximal) of a metacarpal, trapezium, or other bone of a joint. For example, anthropometric data may be used to determine a given radius of curvature and 1, 2, 3, or more standard deviations when forming device  100  in order to ensure interpositional saddle surface  102  has a radius of curvature that exceeds the radius of curvature of any bone adjacent to the joint. 
     In some examples, a channel (e.g., as formed by interpositional saddle surface  102  and saddle channel openings  106  and  110 ) may be disposed on one side of device  100  instead of having multiple channels on opposite sides. In other words, device  100  may be varied to have a single channel to receive the head or torus of a single bone of a joint as opposed to multiple channels configured to receive opposing bones. As shown in the present example,  FIG.  1 A  illustrates an example of device  100  having multiple channels, but there may be examples where cartilage is present within a synovial capsule and joint in such quantity as to require only a single channel implementation of device  100 . 
     Alternatively, another channel, an example of which is described below in connection with  FIG.  1 B , may be formed between saddle channel openings  104  and  108 . Saddle channel openings  104  and  108 , in some examples, may be disposed at either end of another saddle channel (not shown) that may be axially offset from the saddle channel formed by interpositional saddle surface  102  between saddle channel openings  106  and  110 . Another saddle channel (not shown) may be disposed on the opposite surface of interpositional saddle surface  102  and configured to receive the end of an opposing bone (e.g., trapezium or metacarpal) forming a joint (not shown) with the bone received by interpositional saddle surface  102 , as described in greater detail below in connection with  FIG.  1 B . 
     Referring back to  FIG.  1 A , an outer perimeter of device  102  (e.g., periphery  120 ) may have one or more peripheral protrusions  112 - 118  formed (e.g., molded, made, integrated, incorporated, included, or otherwise disposed) and disposed at different locations along periphery  120 . As shown from a top view, a cross section (not shown) of device  100  along a horizontal (i.e., x-axis) plane may, in some examples, be substantially rectangular in shape, particularly if a cross-sectional view is of a horizontal plane disposed between interpositional saddle surface  102  and interpositional saddle surface  132  ( FIG.  1 B )). Axes, as presented throughout this description, may be aligned along the length, width, cross-axially, anatomically aligned, or aligned otherwise, without limitation or restriction. In some examples, axes (as referred to herein) may refer to one or more axes that may run the length, width, diagonal, or in other directions aligned with one or more bones of a joint. For example, one axis may run lengthwise through a tibia, while another axis may also run lengthwise through a femur, and still another set of axes may be used for orientation associated with a joint or bone(s) (i.e., “anatomical alignment”). In other words, axes may or may not correspond to a set of three (3) dimensional axes that are orthogonal to each other, but are instead determined based on a joint and the bones that form said joint. An axis associated with a given bone may or may not necessarily also be aligned with another one of a joint. Axes may also be determined differently and are not limited to examples described. 
     In other examples, the positions of peripheral protrusions  112 - 118  may be varied, without limitation or restriction. For example, here, peripheral protrusions  112 - 118  are substantially positioned at the corner regions of device  100  along periphery  120 . Peripheral protrusions  112 - 118  may be configured (i.e., when device  100  is inserted into a synovial capsule of a joint) to be positioned at non-articulating regions of a joint (not shown), but may be shaped in various configurations to maintain and prevent expulsion of device  100  from within the joint. In other examples, the positioning, number, shape, configuration, design, material, or other aspects, without limitation or restriction to the examples described. In other examples, device  100  and elements  102 - 120  may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  1 B  illustrates a bottom view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, a bottom view is shown of device  100 , which includes saddle channel openings  104 - 110 , peripheral protrusions  112 - 118 , and periphery  120 , and interpositional saddle surface  132 , (collectively “elements  102 - 132 ”). As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In some examples, another saddle channel may be formed with interpositional saddle surface  132 , and saddle channel openings  104  and  108 . As described above, an interpositional saddle channel disposed between saddle channel openings  104  and  108  along interpositional saddle surface  132  may be a partially or entirely concave feature of device  100  that is configured to receive a bone (opposite to another bone received by interpositional saddle surface  102  (( FIG.  1 A )). In some examples, the heads (e.g., torus) of each bone, when received by interpositional saddle surfaces  102  and  132 , may be axially offset from or aligned with each other, without limitation or restriction. Interpositional saddle surface  102  and  132  may be orthogonal or substantially orthogonal to each other. In other examples, interpositional saddle surface  102  and  132  may be axially offset, along one or more different axes, by more or less than 90 degrees. 
     As shown, interpositional saddle surface  102 , in some examples, may have a cross sectional shape with a radius of curvature (which may be of various sizes) that is structured to receive a bone adjacent to a joint into which device  100  may be inserted. Also, as described above, a cross-section of a plane disposed substantially parallel to an axis of each interpositional saddle channel running between saddle channel openings  104  and  108  and  106  and  110 , respectively. A cross-section of a plane that is substantially orthogonal to a plane lying parallel to interpositional saddle surface  102  ( FIG.  1 A ) and interpositional saddle surface  132  ( FIG.  1 B ) may be substantially rectangular in shape. In other examples, the shape, cross-section, or other dimensional attributes of device  100  may be varied and is not limited to those shown and described. 
     In some examples, peripheral protrusions  112 - 118  may be disposed at substantially corner positions of periphery  120  to provide sub-structures molded into periphery  120  that are configured to maintain a given position and/or orientation of device  100  within a joint. Although shown disposed at substantially corner positions of periphery  120 , peripheral protrusions  112 - 118  may be formed at different positions, angles, attitudes, or other varying attributes along periphery  120 . Here, device  100  includes peripheral protrusions  112 - 118  that are configured for disposition within non-articulating regions when device  100  is inserted and oriented within a synovial capsule and joint. Peripheral protrusions  112 - 118 , in some examples, are configured to maintain device  100  within one or more tolerances of fit within a joint to prevent physical contact (i.e., relieving or lessening pain by doing so) between one or more bones of a joint, but also to maintain position within a joint and prevent expulsion, partially or fully, of device  100 . In other examples, device  100  and elements  102 - 132  may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  1 C  illustrates an anterior view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, an anterior or frontal view of device  100  includes interpositional saddle channel surface  102  (showing a substantially concave contour), channel openings  104 ,  108  and  110  (peripheral protrusions  104  and  108  being used to form a saddle channel (i.e., a channel or contoured surface, concave or convex, configured to receive the end, head, torus, or other portion of a bone adjacent to a joint into which device  100  is surgically implanted, inserted, or otherwise disposed, regardless of surgical technique) with surface  132  (as described in connection with  FIG.  1 B  above)), and peripheral protrusions  116 - 118  disposed along periphery  120 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In some examples, when device  100  is inserted into a synovial capsule or into a joint, a bone adjacent to the joint may be received by interpositional saddle surface  102 . As an example, saddle surface  102  may be disposed on one side or another of device  100  in order to provide a channel (i.e., a regularly, irregularly, symmetrical, asymmetrical, or other contoured surface that may or may not be substantially concave, convex, or shaped differently) configured to receive a torus or other portion of a bone in order to provide an intermediate structure designed to prevent one bone of a joint from contact another bone in the same joint in order to prevent or alleviate pain (i.e., pain management). 
     Once inserted and positioned within a joint, device  100  may be configured to remain in place by disposing peripheral protrusions  116 - 118  in non-articulating regions of a joint (i.e., between two or more bones). As a joint is articulated (not shown), device  100 , as shown in  FIG.  1 C , may be used to receive the end of a bone in direct or indirect or “floating” (i.e., intermittent) contact with interpositional saddle surface  102 . Periphery  120 , which forms an integrate perimeter of device  100 , including peripheral protrusions  116 - 118 , which may be substantially smooth or shaped with structures (as shown in  FIGS.  2 - 4    below) configured to maintain device  100  within a joint (i.e., prevent expulsion of device  100  by providing structures (e.g., peripheral protrusion  116 - 118 ) that are configured to maintain the position of device  100  between two or more articulating bones. Saddle channel opening  110  may be shaped (e.g., configured with a radius of curvature that is larger than that of a bone intended to be received within interpositional saddle surface  102 ) to receive the end, head, torus, or other portion of a bone when surgically implanted into a joint (e.g., inserting through a surgically-created opening in a synovial capsule surrounding a joint). Likewise, saddle channel openings  104  and  108  may be implemented similarly or differently. 
     Also shown in  FIG.  1 C  are saddle channel openings  104  and  108 , which may be axially (e.g., symmetrically) or not axially (e.g., asymmetrically) aligned to provide another saddle channel (as described below in connection with  FIG.  1 D ) to receive the head, end, torus or other portion of an opposing or another bone when device  100  is surgically implanted. For example, when device  100  is surgically implanted in a CMC joint, interpositional saddle surface  102  and saddle channel opening  110  may be configured to receive a torus of a metacarpal bone. In some examples, saddle channel openings  104  (not shown) and  108  may be configured to receive an opposing end, head, torus, or portion of a trapezium bone and, once implanted, device  100  may be configured in function and shape to provide an intermediate implantable device (e.g., device  100 ) to manage, relieve, or prevent pain by preventing a trapezium and metacarpal bones from direct or indirect contact. As described herein, device  100  may be used to replace deteriorated, damaged, injured, worn, partially or wholly lost cartilage in a CMC or other joint, without restriction or limitation. 
     In other examples, device  100  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  1 D  illustrates a posterior or rear view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, a posterior or rear view of device  100  includes interpositional saddle channel surface  102  (showing a substantially concave contour substantially opposite to that shown in  FIG.  1 C ), channel openings  104 - 108  (channel openings  106 - 108  may be used to implement a saddle channel with interpositional saddle channel surface  102  (as described above in connection with  FIG.  1 A )), and peripheral protrusions  112 - 114  disposed along periphery  120 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. For example, although interpositional saddle surface  102  is shown as substantially concave, in other examples, different shapes, contours, structures, or features may instead be implemented. As an example, interpositional saddle surfaces  102  and  132  ( FIG.  1 B ) may be convex and/or concave, in entirety or partially. In other examples, interpositional saddle surfaces  102  and  132  ( FIG.  1 B ) may also be substantially flat or planar or the degree of concavity or convex curvature (i.e., radii of curvature) may be altered to varying degrees. Still further, concave, convex, flat, planar, or other surface contouring may be symmetrically or asymmetrically oriented around a vertical axis (not shown) of device  100 . 
     As shown and described, the posterior or rear view of device  100  also illustrates interpositional saddle surface  102 , saddle channel openings  104 - 108  (for interpositional saddle surface  132  (not shown)), and peripheral protrusions  112 - 114  disposed along periphery  120 . As described above, device  100  and the elements shown may be implemented in structure and function similarly to device  100  as shown and described above in connection with  FIGS.  1 A- 1 C . In other examples, device  100  may include variations in function and/or structure such as having a saddle channel (i.e., interpositional saddle surface  102  extending between saddle channel openings  106  and  110  ( FIG.  1 C )) on a single side of device  100 . In other examples, device  100  may be implemented such that saddle channels may be disposed on adjacent sides or surfaces instead of being disposed on substantially opposite sides of device  100 . In still other examples, device  100  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  1 E  illustrates a left view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, a left view is shown of device  100  (i.e., an example of an implantable interpositional orthopedic pain management apparatus), which includes saddle channel openings  104 - 106  and  110 , peripheral protrusions  112  and  118  disposed along and formed with periphery  120 , interpositional saddle surface  132 , and outer surface  134  (collectively “elements  102 - 132 ”). As described herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In some examples, outer surface  134  may be shaped, curved, contoured, or otherwise formed to have a radius of curvature that is configured to receive a bone adjacent to a joint in which device  100  is surgically implanted. As shown, interpositional saddle surface  132  may be configured substantially orthogonal and opposing to interpositional saddle surface  102  ( FIG.  1 A ) and used to receive a bone other than that received by a channel formed by interpositional saddle surface  102  and saddle channel openings  106  and  110 . If implanted in a CMC joint, for example, interpositional saddle surface  132  may be configured with outer surface  134  having a radius of curvature that is one, two, or more standard deviations of width, depth, or other dimensions in order to receive a trapezium bone. A trapezium, when inserted into a channel formed by interpositional saddle surface  132  and saddle channel openings  104  and  108 , may be configured to receive a trapezium bone. Further, another channel on substantially an opposing side of device  100  may be formed with interpositional saddle surface  102  and saddle channel openings  106  and  110  and configured to receive a metacarpal bone. In other examples, device  100  and elements  102 - 134  may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  1 F  illustrates a right view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, a right view is shown of device  100 , which includes saddle channel openings  106 - 110 , peripheral protrusions  114 - 116  formed in periphery  120 , and interpositional saddle surface  132  with outer surface  134  (collectively “elements  102 - 132 ”). As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In some examples, the above-described elements are similar to those previously described and device  100  is shown from a right-side view illustrating interpositional saddle surface  132  with saddle channel opening  108  being configured to receive a bone (e.g., trapezium, metacarpal, tibia, ulna, or others, without limitation or restriction). As described above in connection with  FIG.  1 E , outer surface  134  may be formed as part of interpositional saddle surface  132  with a radius of curvature configured to receive another bone. In other examples, the radius of curvature of outer surface  134  and interpositional saddle surface  132  may have a different or no curvature of radius. In other words, device  100  may be implemented with a channel on a single side and used to instead have a substantially flat surface for outer surface  134  when inserted into a joint. In other examples, device  100  and elements  102 - 134  may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  1 G  illustrates a perspective view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, a perspective view of device  100  is shown including interpositional saddle surface  102 , saddle channel openings  104 - 110 , peripheral protrusions  112 - 118 , periphery  120 , interpositional saddle surface  132 , and outer surface  134  of interpositional saddle surface  132 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In some examples, saddle channel openings  104 - 110  may refer to those portions or regions of device  100  that have substantially concave surfaces and are designed to act as openings for receiving, for example, heads, portion, torus, or other parts of bones into interpositional saddle surfaces  102  and  132 . In other examples, as described above, the radius of curvature of interpositional saddle surfaces  102  and/or  132  may be varied and alternatively have a flat or substantially flat surface on one side. In some examples, when device  100  is formed, interpositional saddle surfaces  102  and  132  may be configured to have flat, curved, concave, convex, or multi-faceted (i.e., having concave and convex surfaces disposed over interpositional saddle surfaces  102  or  132 ) structures or sub-structures. As described in greater detail below, peripheral protrusions  112 - 118  may be configured for placement within a joint to receive adjacent bones (and prevent them from contact). Device  100 , in some examples, is substantially maintained in position and prevented from expulsion due to peripheral protrusions  112 - 118  disposed at various points along periphery  120 . Thus, regardless of how a joint or bones are manipulated along various axes (e.g., abduction-adduction, flexion-extension, supination-pronation, and others) whether due to active manipulation of a joint (e.g., active motion) or passive motion (i.e., motion that may occur when the joint or bones adjacent thereto are not being directly manipulated, but instead have motion imparted to them due to other proximal or distal anatomical motion or activity), device  100  may be prevent from expulsion by one or more of peripheral protrusions  112 - 118  coming into contact with an articulating or non-articulating structure that keeps device  100  in position. In other examples, device  100  and elements  102 - 134  may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  2 A  illustrates a top view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, device  200  includes interpositional saddle surface  202 , saddle channel openings  204 - 210 , peripheral protrusions  212 - 218 , and periphery  220 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may also be described separately without limitation, restriction, or regard to a specific feature previously described. For example, interpositional saddle surface  202  may be designed and implemented in function and structure similarly or substantially similarly to interpositional saddle surface  102  ( FIGS.  1 A,  1 C- 1 G ). In some examples, interpositional saddle surface  202  may be, with saddle channel openings  206  and  210 , configured to be substantially concave in shape and receive a bone (e.g., metacarpal, trapezium, tibia, femur, or others, without limitation or restriction) and function similarly to the examples shown and described above in connection with  FIGS.  1 A- 1 G . Alternatively, peripheral protrusions  212 - 218  may be formed and integrated with periphery  220  to provide pronounced structures that, when device  202  is surgically implanted in a joint, may be configured to interact within articulating or non-articulating regions (or, in some examples, in a combination of articulating and non-articulating regions) of a joint. 
     In some examples, peripheral protrusions  212 - 218  may be implemented as spherical or substantially spherical (or other shapes) structures that are integrated (i.e., formed) with or along periphery  220  of device  202 . When device  202  is surgically implanted, peripheral protrusions  212 - 218  may be positioned (i.e., disposed) within a joint so as to contact or provide structures that are configured to interact with bones or portions thereof adjacent or joining within a joint. Here, a channel may be formed as a concave or substantially concave surface of interpositional saddle surface  202  and saddle channel openings  206  and  210  that are configured to receive, as an example, a metacarpal bone in a CMC joint. As the CMC joint (not shown) is articulated, spherically-shaped (as shown in this example, but in others, different shapes, sizes, and quantities may be used and are not restricted or limited to the examples presented herein) peripheral protrusions  212 - 218  formed as part of periphery  220  are configured to prevent expulsion of device  200  from the joint. In other examples, the size, dimensions, and shape of device  200  may be configured for placement in different types of joints, including wrist, elbow, shoulder, knee, ankle, or others, without limitation or restriction. Further, peripheral protrusions may be extended to an opposing surface (i.e., an opposing interpositional saddle surface, as described in greater detail below) of interposition saddle surface  202 . 
     As described herein, including in connection with  FIGS.  1 A- 1 G , device  200  may be surgically implanted to achieve stability and regain hand strength in a carpometacarpal (“CMC”), basal, or other type of joint and is not limited to any particular joint. When implanted, device  200  using peripheral protrusions  212 - 218  disposed about periphery  220  may be used to prevent expulsion of device  200  from a joint while also providing dynamic stability and pain relief in cases where cartilage has been worn away, destroyed, damaged, or is otherwise missing from a joint. Further, peripheral protrusions  212 - 218  are configured to not interfere with motion of joint in order to provide maximum range of extension and motion associated with individual bones forming a joint. Prevents migration of implantable device (i.e., implant or device) from joint. As described herein, device  200  may be surgically implanted (i.e., placed) in a joint at a point, position, and/or orientation where device  202  is least likely to be expulsed when the joint is articulated. As described above, device  200  is configured to permit motion or articulation of a joint without dislocation or expulsion of device  200  from the joint. In other words, when bones in a given joint are articulated, device  200  when implanted may be configured and implemented to prevent one or more bones from dislocation or expulsing device  200  from the joint. 
     In some examples, device  200  with peripheral protrusions  212 - 218  is configured to permit motion such as pivoting about one or more axes (e.g., abduction-adduction, flexion-extension, supination-pronation, and others) without dislocation of bones or displacement of device  200  from a joint. In some examples, surgical clamps or any type of implant holder may be configured for surgical insertion of implantable devices such as device  200  in human or animal joints, which may include carpometacarpal, trapeziometacarpal, or others, without limitation or restriction. In other examples, device  200  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  2 B  illustrates a bottom view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, device  200  includes saddle channel openings  204 - 210 , peripheral protrusions  212 - 218 , periphery  220 , and interpositional saddle surface  230 . In some examples, interpositional saddle surface  230  may be contoured substantially opposite to that of interpositional saddle surface  202  ( FIG.  2 A ). For example, interpositional saddle surface  202  ( FIG.  2 A ) may be concave or substantially concave while interpositional saddle surface  230  may be formed to provide a convex or substantially convex channel for receiving an opposing bone in a joint. As an example, interpositional saddle surface  202  ( FIG.  2 A ) may be formed as a substantially concave surface configured to receive a portion (e.g., central ridge, radial facet volar tubercle, or other structure disposed toward the proximal end of a metacarpal) of a bone while interpositional saddle surface  230  may be configured to fit a concave feature formed at the distal end of a trapezium bone. In other examples, interpositional saddle surfaces  202  ( FIG.  2 A ) and  230  may be implemented differently and are not limited to the examples shown and described. 
     As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In other examples, device  200  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  2 C  illustrates an anterior view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, an anterior or front view of device  200  is shown, including interpositional saddle surface  202 , saddle channel opening  206 , peripheral protrusions  212 - 214 , and periphery  220 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. Here, a directional arrow points toward saddle channel opening  206 , which is an opening into a saddle channel formed with interpositional saddle surface  202  and saddle channel opening  206  and saddle channel opening  210  (not shown) in which a bone (e.g., metacarpal, trapezium, femur, tibia, or the like) may be received. In some examples, peripheral protrusions  212 - 214  may be formed as substantially spherical structures that are integrated with periphery  220 . In some examples, peripheral protrusions  212 - 214  may be configured to provide structures on one side (not shown) of device  200  or on multiple sides (as shown and described). In other examples, peripheral protrusions  212 - 214  may be formed differently and are not limited to the substantially spherical examples shown and described. Alternatively, peripheral protrusions  212 - 214  may be implemented using non-spherical or partially-spherical shapes. In other examples, device  200  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  2 D  illustrates a posterior view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, a posterior or rear view of device  200  is shown, including interpositional saddle surface  202 , saddle channel opening  210 , peripheral protrusions  216 - 218 , and periphery  220 . In some examples, saddle channel opening  210  is configured to form, with interpositional saddle surface  202  and saddle channel opening  206  ( FIG.  2 C ) a saddle-shaped channel configured to receive a bone in interpositional saddle surface  202  when device  200  is surgically implanted into a synovial capsule and joint. Disposed at an opposite end of a saddle channel formed with interpositional saddle surface  202  and saddle channel opening  206 , saddle channel opening  210  is configured to receive a bone or a portion thereof (e.g., metacarpal) onto interpositional saddle surface  202 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. 
     In other examples, device  200  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  2 E  illustrates a left view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, device  200  is shown from a left view, including saddle channel openings  204 - 210 , peripheral protrusions  212 - 218 , periphery  220 , and interpositional saddle surface  230 . From a side view, interpositional saddle surface  230  is visible substantially underneath device  200  with saddle channel openings  204  and  208  at either end. In some examples, interpositional saddle surface  230  is configured, with saddle channel openings  204  and  208 , to receive a bone or a portion thereof when device  200  is surgically implanted. For example, if device  200  is surgically implanted into a CMC joint, interpositional saddle surface  230  may be configured, with saddle channel openings  204  and  208 , to receive (i.e., interpositional saddle surface  230  may have a radius of curvature that is larger than that of a trapezium bone) a trapezium bone, or other bone adjacent to the joint. As described above, a saddle channel consisting of interpositional saddle surface  202  (not shown;  FIG.  2 A ) is also disposed between saddle channel openings  206  and  210 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In other examples, device  200  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  2 F  illustrates a right view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, a right view of device  200  is shown including saddle channel openings  204 - 210 , peripheral protrusions  212 - 218 , periphery  220 , and interpositional saddle surface  230 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In other examples, device  200  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  2 G  illustrates a perspective view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, device  200  includes interpositional saddle surface  202 , saddle channel openings  206 - 210 , peripheral protrusions  212 - 218 , and periphery  220 . In some examples, a channel configured to receive a bone (e.g., a metacarpal bone in a CMC joint or a bone adjacent to another joint) may be implemented using interpositional saddle surface  202 , saddle channel openings  206  and  210 . As described above, when device  200  is surgically implanted in a joint (e.g., through an incision or opening in a synovial capsule), peripheral protrusions  212 - 218  may be oriented by positioning device  200  in a joint to provide dynamic stability to a joint with weakened, degraded, or missing cartilage while preventing dislocation of bones from a joint and expulsion of device  200  when a given joint is articulated. As shown, another saddle channel may be implemented on the opposite side of device  200  by using interpositional saddle surface  230  ( FIG.  2 B ; not shown) and saddle channel openings  204  ( FIG.  2 B ; not shown) and  208 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In other examples, device  200  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  3 A  illustrates a top view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, device  300  includes interpositional saddle surface  302 , saddle channel openings  304 - 310 , peripheral protrusions  312 - 318 , and periphery  320 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. As shown in this drawing and others above and below, dotted lines are presented for purposes of illustrating contours and features that may include convex or concave ridges, structural or ornamental features, or other attributes as described herein. 
     In some examples, interpositional saddle surface  302  is configured to provide a concave surface of device  300  that is contoured and integrated with peripheral protrusions  312 - 318 , which may be configured to “rise” from the channel formed between saddle channel openings  304  and  308 . As used throughout the description of this drawing and others described above and below, the term “channel” may refer to a concave or convex feature using interpositional saddle surfaces such as interpositional saddle surface  302  or  330  (see  FIG.  3 B  below), which functions to provide a structural feature that is configured to fit within a joint as described herein. 
     Here, dotted lines are presented to illustrate contouring of peripheral protrusions  312 - 318  as corner features of periphery  320 , the latter of which may describe a perimeter portion of device  300 . While formed as part or integrated with device  300 , periphery  300  may be an outermost perimeter of device  300  into which features are shaped such as peripheral protrusions  312 - 318 . As shown, periphery  320  can be found on the outer edges (i.e., perimeter) of device  300  and, disposed at various points are peripheral protrusions  312 - 318 . In other examples, as in the previously and following described figures, the number, shape, type, quantity, and disposition of peripheral protrusions  312 - 318  may be varied and are not limited to those shown and described. 
     Here, peripheral protrusions  312 - 318  are illustrated in contrast to spherical or substantially spherical (e.g., peripheral protrusions  212 - 218  ( FIGS.  2 A- 2 G )), flat or substantially flat (e.g.,  112 - 118  ( FIGS.  1 A- 1 G )) shapes such as those previously shown and described. In some examples, peripheral protrusions  212 - 218  are shaped to provide additional features and contours to improve placement, positioning, and expulsion resistance when device  300  is surgically implanted. Cavities formed within the proximal or distal ends of bones may have structures that device  300  is configured to contour to fit. The dotted lines shown in device  300  may represent contours of peripheral protrusions  212 - 218  that are configured to be disposed within non-articulating portions of a synovial capsule and/or joint and, when motion occurs that articulates a given joint, device  300  alleviates pain by preventing distal and proximal ends of bones in a joint from contact while peripheral protrusions also prevent dislocation (i.e., one or more bones distracting or dislocating from a joint) and expulsion of device  300 . In other examples, device  300  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  3 B  illustrates a bottom view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, device  300  includes saddle channel openings  304 - 310 , peripheral protrusions  312 - 318 , periphery  320 , and interpositional saddle surface  330 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. As shown herein, an “underside” view of device  300  is shown with interpositional saddle surface  330  forming a channel or contour that is configured to be disposed over or fit within a cavity formed with or within a bone, bone structure, bone joint, or portion(s) thereof, functioning similar or substantially similar to the other examples shown and described above and below in connection with various drawings throughout. In some examples, interpositional saddle surface  330  may be convex, concave, or having a radius of curvature that is substantially opposing to that of interpositional saddle surface  302 . For example, interpositional saddle surface  302  ( FIG.  3 A ) may be concave or substantially concave while interpositional saddle surface  330  may be convex or substantially convex. 
     Here, the radius of curvature of each of interpositional saddle surfaces  302  and  330  are configured such that a layer of material such as those described above is disposed between interpositional saddle surfaces  302  and  330  in such a manner that a cross sectional area that is coplanar between the two is substantially rectangular in shape or configuration. While the various examples shown herein may exhibit symmetry around various axes, in other examples device  300  and others described above and below may be asymmetrically formed or off-axially aligned, including when surgically implanted within a joint. In still other examples, device  300  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  3 C  illustrates an anterior view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, an anterior or frontal view of device  300  includes interpositional saddle surface  302 , saddle channel openings  304 - 310 , peripheral protrusions  312 - 318  disposed in periphery  320 , and contours  340 - 342 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In some examples, an interpositional saddle (i.e., “channel”) is provided by interpositional surface  302  and saddle channel openings  304  and  308 , which is configured to receive a bone (e.g., metacarpal) when surgically implanted into a joint (e.g., CMC joint). Disposition within a joint (not shown) may include peripheral protrusions  312 - 318  being positioned to prevent expulsion of device  300  when the joint is articulated. Specifically, one or more of peripheral protrusions  312 - 318  (which are shown extending both to the upper and lower surfaces of device  300 ) may be configured to interact with one or more bones, bone structures, heads, ends, or portions thereof when surgically implanted. Further, contours  340 - 342  may be configured to provide additional surface features or contours that are also shaped or formed to interact with other portions of one or more bones, bone structures, heads, ends, or portions thereof when device  300  is surgically implanted within a joint. In other words, when surgically implanted, peripheral protrusions  312 - 318  and contours  340 - 342  may be configured for different types of joints or those that are specific to a given individual based on input or attributes determined or defined from techniques such as x-rays, magnetic resonance imaging (MRI), computed tomography (CAT), fluoroscopy, or other types of imaging techniques, without limitation or restriction. Device  300 , as shown and described herein, provides peripheral or corner features that may be tailored to provide customization features for individual joints, bones, or other anatomical structures. Additionally, another channel may be provided, as partially indicated by saddle channel openings  306  and  310 , which may be used with interpositional saddle channel  330  ( FIG.  3 B ) to provide an opposing or substantially opposing channel on the underside of device  300  that is shaped to receive mutually reciprocal or substantially mutually reciprocal bones, bone structures, or portions thereof in a joint (e.g., trapezium, metacarpal, radial facet of a metacarpal, or others, without restriction or limitation). In other examples, device  300  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  3 D  illustrates a posterior view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, a posterior or rear view of device  300  includes interpositional saddle surface  302 , saddle channel openings  304 - 310 , peripheral protrusions  312 - 318  disposed in periphery  320 , and contours  344 - 346 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. 
     Here, peripheral protrusions  312 - 318  are shown, including contours  344 - 346 , which are configured in structure and function similarly to contours  340 - 342  ( FIG.  3 C ). Peripheral protrusions  312 - 318  and contours  344 - 346  may be configured to reside in non-articulating regions of a joint (not shown) when device  300  is surgically implanted. In some examples, like contours  340 - 342  ( FIG.  3 C ), contours  344 - 346  may be formed with various types of shapes and features (e.g., convex, concave, partially or wholly, or a combination thereof). If one or more bones of the joint (in which device  300  is surgically implanted) are articulated, then peripheral protrusions  312 - 318  and contours  344 - 346  are configured to prevent the bones from coming into contact with each other, maintaining dynamic stability, and restoring an ability for the joint to be manipulated while preventing expulsion of device  300  from the joint or dislocation of bones from the joint. In other words, peripheral protrusions  312 - 318  and contours  344 - 346  may be formed to provide structures that function to interact with anatomical structures of a joint, including the bones or portions thereof within the joint, to prevent device  300  from expulsion and dislocation. In other examples, device  300  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  3 E  illustrates a left view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, a left side view of device  300  includes saddle channel openings  304 - 310 , peripheral protrusions  312 - 318  disposed along and within periphery  320 , interpositional saddle surface  330 , and contours  342 - 344 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. As shown, a left side view reveals interpositional saddle surface  330  on the underside of device  300  forming a channel between saddle channel openings  306  and  310  in a substantially orthogonal or substantially mutually reciprocal orientation to the channel described above in connection with  FIG.  3 C . In other examples, the channel formed by interpositional saddle surface  330  and saddle channel openings  306  and  310  may be oriented differently (i.e., set at an angle other than orthorgonal to a given axis) and implementation of the techniques described herein do not require an axially orthogonal position. Alternatively, a channel may be found on only a single side of device  300  and is not required to be on mutually reciprocal or substantially reciprocal sides of device  300 . 
     In other examples, device  300  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  3 F  illustrates a right view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, a right side view of device  300  includes saddle channel openings  304 - 310 , peripheral protrusions  312 - 318  disposed along and integrated with periphery  320 , interpositional saddle surface  330 , and contours  344  and  346 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. 
     In some examples, peripheral protrusions  312 - 318  may be coupled directly or indirectly with periphery  320  or formed as surface or structural features or components thereof. As shown and described, peripheral protrusions  312 - 318  may have various sizes, shapes, dimensions, and other attributes, without limitation or restriction. As shown and described, peripheral protrusions  312 - 318  may have features integrated or formed within them as well, including, but not limited to, contours  340  and  346 . Like contours  342 - 344  ( FIG.  3 E ), contours  344  and  346  may be implemented as concave features, “dimple-like” in appearance, but are configured to provide contouring for peripheral protrusions  312 - 318  to engage and fit within a joint when device  300  is surgically implanted. 
     As shown, an “opening” into a saddle-shaped channel formed by interpositional saddle surface  330  and extending between saddle channel openings  310  (from the right side of device  300 ) and  306  (not shown, but disposed as a saddle-shaped opening from the left side of device ( FIG.  3 E )). In some examples, interpositional saddle surface  330  may be a mutually reciprocal surface to interpositional saddle surface  302 , both of which provides engaging surfaces of device  300  to fit within a joint having, for example, opposing bones, bone structures, or portions thereof. In other examples, peripheral protrusions  312 - 318  may be implemented with multiple or no contours (e.g., contours  340 - 346 ), or varied beyond those examples shown and/or described, without limitation or restriction. In still other examples, device  300  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  3 G  illustrates a perspective view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, a perspective view of device  300  includes interpositional saddle surface  302 , saddle channel openings  304 - 310 , peripheral protrusions  312 - 318  in periphery  320 , interpositional saddle surface  330 , and contours  340 - 344  (contour  346  ( FIG.  3 F ) formed as part of peripheral protrusion  318  is not shown). As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. 
     As shown, in some examples, device  300  has multiple channel configured to receive the proximal or distal ends of bones within a joint (not shown). Interpositional saddle surfaces  302  and  330  are shown, which are formed and integrated with peripheral protrusions  312 - 318  from a top and bottom surfaces of device  300 . Here, dotted lines are provided to show outlines of peripheral protrusions  312 - 318 , which provide corner structures that “rise” from the corners of interpositional saddle surface  302  to provide structures that, when placed within non-articulating regions of a joint, prevent device  300  from being expulsed, partially or wholly, when the joint is articulated. Further, peripheral protrusions  312 - 318  may be implemented with additional structures configured to further prevent expulsion of device  300  from a joint or to aid in maintaining position and/or orientation of device  300  when surgically implanted. For example, contours  340 - 344  may be implemented as substantially concave features that can be configured to “fit” or receive bones, bone structures, or portions thereof in addition to interpositional saddle surfaces  302  and  330  when device  300  is surgically implanted. In other examples, contours  340 - 344  may also be configured to provide surfaces that are shaped to fit and/or fill with other materials within a synovial capsule such as cartilage, blood, bodily fluids, or other synthetic or organic materials that are injected or otherwise implanted to aid device  300  in maintaining dynamic stability and position within a joint after surgical implantation. In still other examples, device  300  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  4 A  illustrates a top view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, device  400  includes interpositional saddle surface  402 , saddle channel openings  404 - 410 , and peripheral protrusions  412 - 418  disposed along periphery  420 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In some examples, device  400  may be designed, formed, and implemented as described above. Broken (i.e., dotted) lines are provided for purposes illustrating contours of peripheral protrusions  412 - 418 , which are formed as part of periphery  420  and interpositional saddle surface  402 . In some examples, peripheral protrusions  412 - 418  may be built up as structures that rise in the “corners” of device  400  from a concave recess or cavity (or convex feature) formed from interpositional saddle surface  402  that is configured to maintain dynamic stability of device  400  once surgically implanted in a joint. Peripheral protrusions  412 - 418  may also be configured in some examples without contours or other features, such as those described above in connection with  FIGS.  3 A- 3 G . In other examples, device  400  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  4 B  illustrates a bottom view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, a bottom view of device  400  is shown, including saddle channel openings  404 - 410 , peripheral protrusions  412 - 418  disposed in periphery  420 , and interpositional saddle surface  430 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. For example, peripheral protrusions  412 - 418  may be designed, formed, implemented, and function substantially similar or similar to peripheral protrusions  312 - 318  ( FIG.  3 A ) or as other examples shown or described. 
     Here, broken (i.e., dotted) lines are shown for purposes of illustrating the outline of peripheral protrusions  412 - 418  as shown integrated with device  400  and interpositional saddle surface  430 . In other examples, device  400  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  4 C  illustrates an anterior view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, an anterior or front view of device  400  includes interpositional saddle surface  402 , saddle channel openings  404 - 410 , peripheral protrusions  412 - 418  disposed along periphery  420 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In some examples, peripheral protrusions  412 - 418  may be implemented without contours (e.g., contours  340 - 346  ( FIGS.  3 A- 3 G )) and instead provide substantially vertical walls rising from the bottom to the top of device  300  (i.e., from the bottom to the top of peripheral protrusions  412 - 418 ). Device  400 , as shown and described here, is an example of another type of implementation that may be used to provide dynamic stability and range of motion while providing pain relief and prevent expulsion due to joint articulation (i.e., one or more bones, bone structures, or portions thereof being manipulated within a joint) after surgical implantation. As shown and described, interpositional saddle surface  402  forms a channel between saddle channel openings  404  and  408  while saddle channel openings  406  and  410  provide another channel with interpositional saddle surface  430  ( FIG.  4 B ). Directional arrows associated with saddle channel openings  404 - 410  are intended to indicate openings for each of channel formed using interpositional saddle surfaces  402  and  430 . For example, saddle channel opening  404  indicates an opening between peripheral protrusions  412  and  414  that is directed into a substantially concave recess formed by interpositional saddle surface  402 , which then exits through saddle channel opening  408 . Likewise, another channel is indicated at either end by saddle channel openings  406  and  410  that, together with interpositional saddle channel  430 , create another channel on the bottom surface of device  400 . In other examples, device  400  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  4 D  illustrates a posterior view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, posterior or rear view of device  400  includes interpositional saddle surface  402 , saddle channel openings  404 - 410 , peripheral protrusions  412 - 418  disposed along periphery  420 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In some examples, a rear view of device  400  further illustrates peripheral protrusions  416 - 418  may be implemented with or without contours (e.g., contours  340 - 346  ( FIGS.  3 A- 3 G )), such as those shown and described above. Peripheral protrusions  412 - 418  may be varied and are not limited to examples shown and described and may be varied in number, placement, position, shape, configuration, shape, and may be varied in other attributes, without limitation or restriction. In other examples, device  400  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  4 E  illustrates a left view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, a left view of device  400  includes saddle channel openings  404 - 410 , peripheral protrusions  412 - 418  disposed in periphery  420 , and interpositional saddle surface  430 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In some examples, interpositional saddle surface  430  may be implemented on the bottom (i.e., underside, underneath, or the like) of device  400 . A channel may be formed with interpositional saddle surface  430  and saddle channel openings  406  and  410 . As shown, a channel disposed in device  400  using interpositional saddle surface  430  may be configured to receive a bone, bone structure, or portion thereof when surgical implantation occurs. 
     In some examples, when device  400  is surgically implanted, peripheral protrusions  412 - 418  provide structures along periphery  420  that are configured to maintain device  400  in a given joint (i.e., prevent expulsion of device  400 ), provide dynamic stability in the given joint, and alleviate pain by preventing bones, bone structures, or portions thereof from contacting each other as a replacement for missing, damaged, worn, or otherwise degraded cartilage within a joint or synovial capsule. As shown and described, peripheral protrusions  412 - 418  may be configured to provide outer perimeter walls that are devoid of contours such as those discussed above in connection with  FIGS.  3 A- 3 G . In other examples, peripheral protrusions  412 - 418  may be implemented with different structures (e.g., contours) apart from those shown and described. For example, peripheral protrusions  412 - 418  may alternatively have convex or concave structures formed within them to provide features to maintain device  400  within a joint, provide dynamic stability, maintain positioning of device  400  within a synovial capsule and/or joint, increase or protect ranges of motion, alleviate or prevent pain due to bone contact, or others. Still further, peripheral protrusions  412 - 418  may be varied in quantity, placement, location, position, or other attributes relative to periphery  420 . As another example, peripheral protrusions  412 - 418  may be varied in the number of protrusions disposed and formed with periphery  420 . In still other examples, device  400  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  4 F  illustrates a right view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, a right view of device  400  includes saddle channel openings  404 - 410 , peripheral protrusions  412 - 418  disposed in periphery  420 , and interpositional saddle surface  430 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. As shown, saddle channel opening  410  indicates an opening to a channel formed with interpositional saddle surface  430  and saddle channel opening  406 , the latter of which being indicated by a directional arrow pointed to the rear of device  400 . As shown herein (as well as other drawings above and below), a directional arrow for saddle channel opening is directed at an opening having a radius of curvature implemented with interpositional saddle surface  430 , which is configured to receive a bone, bone structure, or portion thereof such as a trapezium bone in a CMC joint. As with the other examples throughout this description, various radii of curvature may be used and are not limited to the examples shown and described. For example, an orthopedic surgeon (not shown) may receive a kit having one or more devices similar or substantially similar to device  400 . Various devices may be formed using different radii of curvature in order to provide a range of options for a surgeon to determine which device (e.g., device  400 ) would be suited or appropriately sized for a given joint. Further, as discussed in greater detail below, trial devices (hereafter referred to as “trials”) may be implemented examples of device  400  of different sizes (e.g., having varied or different dimensions), but also have a stem that may be manipulated for testing the placement and position of a device within a given joint. In some examples, a trial may also be used to probe a synovial capsule or joint in order to determine one or more attributes (e.g., size, dimensions, depth, width, tension, resistance, presence or lack of cartilage, and others, without limitation or restriction). 
     Referring back to  FIG.  4 F , device  400  may be implemented without contours or other features on the outer most perimeter of periphery  420 . In alternative examples, contours or other features may be used and are not limited to those shown and described. In still other examples, device  400  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  4 G  illustrates a perspective view of an exemplary implantable interpositional orthopedic pain management apparatus. Here, device  400  includes interpositional saddle surface  402 , saddle channel openings  404 - 410 , peripheral protrusions  412 - 418  disposed in periphery  420 , and interpositional saddle surface  430 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In some examples, device  400  includes peripheral protrusions  412 - 418 , which may be formed with or without features such as contours (e.g., contours  340 - 346  ( FIGS.  3 A- 3 G )). As shown and described herein, peripheral protrusions  412 - 416  are illustrated with upper and lower portions (peripheral protrusion  418  is shown with an upper portion based on the perspective view angle) that are intended to convey the integration of peripheral protrusions  412 - 418  with interpositional saddle surfaces  402  and  430  in device  400 . Further, broken lines are provided to illustrate exemplary contouring and shaping of peripheral protrusions  412 - 418  as each is formed shape-wise into interpositional saddle surface  402 . While periphery  420  is identified as a separate element, one, some, or all of peripheral protrusions  412 - 418  may be integrated portions that are part of periphery  420 . In other examples, periphery  420  may be formed by directly or indirectly coupling peripheral protrusions  412 - 418 , which may be formed with or apart from device  400 . In other examples, device  400  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  5 A  illustrates a top view of an exemplary rasping instrument used for implantable interpositional orthopedic pain management. Here, instrument  500  includes handle  502 , neck  504 , rasp  506 , and teeth  508 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In some examples, instrument  500  may be used to prepare a path for surgical insertion (i.e., implantation) of device  100  ( FIGS.  1 A- 1 G ),  200  ( FIGS.  2 A- 2 G ),  300  ( FIGS.  3 A- 3 G ),  400  ( FIGS.  4 A- 4 G ), or others. Using handle  502 , which is coupled to rasp  506 , a user (e.g., orthopedic surgeon, or others) may prepare a joint for insertion of an implantable device, examples of which are provided and discussed herein. As an example, rasp  506  may be implemented (i.e., formed, manufactured, shaped, or otherwise formed) to have a larger radius of curvature than a device (hereafter “device” may refer to any of the exemplary implantable devices shown and described herein). Rasp  506  may be implemented with teeth  508 , which may be rasping ridges, cutting ridges, cutting teeth, saw teeth, cutting rows, or the like. As an example, rasp  506  with teeth  508  may be used to “rasp” or modify a joint prior to insertion and implanting of a device. Instrument  500  and the elements may be constructed of various types of materials, such as those described above. In other examples, device  500  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  5 B  illustrates a bottom view of an exemplary rasping instrument used for implantable interpositional orthopedic pain management. Here, instrument  500  includes handle  502 , neck  504 , rasp  506 , and teeth  508 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. As shown and described, instrument  500  may be configured with rasp  506 , which may have a radius of curvature that is slightly larger than a device to be implanted and may be substantially similar in shape to a device. In other words, rasp  506  may be formed in size, shape, and configuration similar to a device intended for implantation. When instrument  500  is used to modify or rasp a joint, the substantial similarity in size, shape, and configuration aids implantation of a device. In other examples, instrument  500  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  5 C  illustrates an anterior view of an exemplary rasping instrument used for implantable interpositional orthopedic pain management. Here, instrument  500  includes handle  502 , neck  504 , rasp  506 , and teeth  508 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In other examples, instrument  500  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  5 D  illustrates a posterior view of an exemplary rasping instrument used for implantable interpositional orthopedic pain management. Here, instrument  500  includes handle  502 , neck  504 , rasp  506 , and teeth  508 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In other examples, instrument  500  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  5 E  illustrates a left view of an exemplary rasping instrument used for implantable interpositional orthopedic pain management. Here, instrument  500  includes handle  502 , neck  504 , rasp  506 , and teeth  508 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In other examples, instrument  500  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  5 F  illustrates a right view of an exemplary rasping instrument used for implantable interpositional orthopedic pain management. Here, instrument  500  includes handle  502 , neck  504 , rasp  506 , and teeth  508 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In other examples, instrument  500  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  5 G  illustrates a perspective view of an exemplary rasping instrument used for implantable interpositional orthopedic pain management. Here, instrument  500  includes handle  502 , neck  504 , rasp  506 , and teeth  508 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In other examples, instrument  500  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  6    illustrates an exemplary rasping instrument used for implantable interpositional orthopedic pain management. Here, diagram  600  illustrates a basic skeletal structure of a human hand (in other examples, the skeletal structure of an animal other than  Homo sapiens  may be used) having metacarpal bone  602 , trapezium bone  604 , and joint  606 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. As described above in connection with  FIGS.  5 A- 5 G , rasping instrument  500  with rasp  506  is shown disposed between metacarpal  602  and trapezium  604  forming joint  606 . As shown here, rasping instrument  500  may be used to clear, abrade, rasp, or otherwise modify the CMC joint between metacarpal  602  and trapezium  604  for the purpose of path preparation into joint  606  prior to surgical implantation of a device (e.g., device  100  ( FIGS.  1 A- 1 G ), device  200  ( FIGS.  2 A- 2 G ), device  300  ( FIGS.  3 A- 3 G ), device  400  ( FIGS.  4 A- 4 G ); not shown here). In other examples, rasping instrument  500  may be used to modify joints other than a CMC joint (e.g., joint  606 ) and is not limited to those shown and described. As presented herein, a joint (e.g., joint  606 ) targeted for surgical implantation of a device such as those described herein may be prepared (i.e., have a path prepared) by rasping out a path in joint  606  into which a trial or device may be inserted. Surgeons (i.e., users) of rasping instrument  500  may prepare a path for surgical implantation of an interpositional orthopedic pain management device such as those described herein, regardless of the type of joint targeted for modification. In other examples, path preparation may also be performed using more or different tools other than rasping instrument  500  (and rasp  506 ) and are not limited to the examples shown and described. In other examples, rasping instrument  500  as depicted in diagram  600  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  6 B  illustrates an exemplary placement of an implantable interpositional orthopedic pain management device in a carpometacarpal joint. Here, diagram  610  depicts metacarpal bone (i.e., “metacarpal”)  602 , trapezium bone (i.e., “trapezium”)  604 , joint  606 , trial  612 , and trial device  614 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In some examples, after path preparation (as described above in connection with  FIG.  6 A ) has been performed, trial  612  (i.e., a stem coupled to trial device  614 , which may be used for purposes of identifying a size of an implantable device targeted for surgical implantation into joint  606 , such as those described above) may be inserted into joint  606  to determine whether additional path preparation is desired and, once completed, a size for an implantable device. As shown and described, trial  612  may be formed with trial device  614 . In some examples, trial  614  may be welded, integrated with, incorporated into, or otherwise attached to a stem of trial  612 . Here, when trial  612  is manipulated by a surgeon or other user, a stem may be provided to formed of various types of materials, such as those described above, and is not limited to the type, manner of formation or manufacturing, or shape. For example, a stem of trial  612  may be an elongated handle having a rounded, circular, oval, square, rectangular, or other type of cross section. Further, a stem of trial  612  may be rigid, flexible, malleable, or have other attributes intended to provide ease of manipulation of trial device  614  during path preparation and fitting (i.e., “sizing” or determining a size for an implantable device based on joint  606 ). As described herein, trial  612  may be manipulated in various directions to test ranges of motion for trial  614 , as indicated by the various arrows provided for generally indicating directional manipulation of device  612 , without limitation or restriction to degree, angle, or direction. 
     As used herein, trial  612  may be one of several trials included in a surgical kit having one or more implantable devices (e.g., device  100  ( FIGS.  1 A- 1 G ), device  200  ( FIGS.  2 A- 2 G ), device  300  ( FIGS.  3 A- 3 G ), device  400  ( FIGS.  4 A- 4 G ); not shown here). Trial  612  and other trials not shown may be included in a kit intended for reuse or disposal, but after being used to identify a suitable size of an implantable device (not shown) for insertion into joint  606 . As shown, trial device  614  may be shaped, configured, or otherwise formed similarly or substantially similarly to a device (not shown) intended for surgical implantation. Trial  612  and other trials used provide the ability to determine a suitable size for an implantable device without requiring excessive trial and error (i.e., attempting to surgically implant disparate implantable devices), which can not only be time and cost-consuming, but also incur risks associated with unnecessary tissue, ligament and ligature, and tendon stress or damage. In other examples, trial  612  as depicted in diagram  610  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  6 C  illustrates an exemplary placement of an implantable interpositional orthopedic pain management device in a carpometacarpal joint. Here, diagram  620  depicts metacarpal bone (i.e., “metacarpal”)  602 , trapezium bone (i.e., “trapezium”)  604 , joint  606 , trial  612 , and device  622 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In some examples, device  622  may be surgically implanted in joint  606  between metacarpal  602  and trapezium  606 . However, in other examples, device  622  and others as described above (e.g., device  100  ( FIGS.  1 A- 1 G ), device  200  ( FIGS.  2 A- 2 G ), device  300  ( FIGS.  3 A- 3 G ), device  400  ( FIGS.  4 A- 4 G ); not shown here) may be used for surgical implantation in other human or animal joints, without limitation or restriction, using the techniques and tools described herein. In other examples, device  622  as depicted in diagram  610  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  7 A  illustrates another exemplary placement of an implantable interpositional orthopedic pain management device in a bone joint. Here, diagram  700  illustrates a general illustration of device  702  being configured for insertion into joint  704  between bones  706 - 708 . As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. In some examples, device  702  may be of varying dimensions, shapes, sizes, or other attributes, including modification for joints other than a CMC joint. Here, joint  704  is provided as a basic illustration of a joint in which multiple bones (e.g., bones  706 - 708 ) are positioned against each other, but without any intervening material (e.g., cartilage or other bone structures). Device  702  may be formed of varying size and shape to be used, as described herein, for insertion between bones  706 - 708  to provide the functions provided and described elsewhere. Although bones  706 - 708  are shown, joint  704  may include other bones or bone structures beyond those shown and described. 
     As shown, joint  704  between bones  706 - 708  may lack cartilage, in which case, device  702  may be surgically implanted to prevent contact resulting in pain (i.e., pain relief and management). In other examples, device  702  may be surgically implanted into joint  704  between bones  706 - 708  to prevent dislocation and, once inserted, features such as those described above in connection with various implementations of an implantable device may be used to prevent expulsion of device  702  from joint  704 . In other examples, device  702  as depicted in diagram  700  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  7 B  illustrates a further exemplary placement of an implantable interpositional orthopedic pain management device in a bone joint. Here, diagram  720  provides a three-dimensional oriented view (i.e., perspective view) of surgically implanting device  702  into joint  722  between bones  724  and  726 , which are not limited or restrictive to only those of the CMC joint. As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. For example, bones  724  and  726  may be representative of those found in a knee joint (e.g., femur and tibia) and device  722  may be used to replace worn, damaged, aged, missing, or otherwise incapacitated cartilage that is no longer sufficiently structured or functionally able to provide dynamic stability to joint  722 , enable range of motion, or alleviate pain when bones  724 - 726  physically contact each other. In other examples, device  702  as depicted in diagram  720  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  7 C  illustrates yet another exemplary placement of an implantable interpositional orthopedic pain management device in a bone joint. Here, diagram  730  provides a three-dimensional oriented view (i.e., perspective view) of surgically implanting device  732  into joint  722  between bones  724  and  726 , anchor structure  734  and anchor recess  736 . As described above, joint  722  is not limited to a specific joint or type of joints, examples of which are provided for purposes of illustration and explanation. As used herein, like numbered and/or like named elements are assumed to be referencing the same or a substantially similar element having the same or substantially similar function or structure. Differences in function or structure may be described separately with regard to a specific feature described. 
     As described above, device  732  may be implemented similar to other devices (e.g., device  100  ( FIGS.  1 A- 1 G ), device  200  ( FIGS.  2 A- 2 G ), device  300  ( FIGS.  3 A- 3 G ), device  400  ( FIGS.  4 A- 4 G )). In some examples, device  732  may also be varied to include elements other than those described herein (e.g., peripheral protrusions, periphery, opposing interpositional saddle surfaces, or others). As shown here, device  732  may be implemented with anchor structure  734 , which may be an extra or different element configured to be placed, positioned, or otherwise inserted into anchor recess  736  to provide, among other uses, a point of fixation to bone  724  within joint  722 . In some examples, when inserted into anchor recess  736 , anchor structure  734  may be used to prevent device  732  from a loss or degradation of position or orientation, dislodgement, or expulsion from joint  722 . Further, anchor structure  734  may also be used to prevent one or both of bones  724 - 726  (which may be any type of bone surrounding any type of joint, as used herein) from becoming dislocated from joint  722 . In other examples, anchor structure  734  may be designed, configured, or implemented differently and is not limited to the shape, structure, or function as described herein. For example, anchor structure  734  may have different shapes or other structures, such as protrusions, corners, recesses, or other elements that are configured to fit within anchor recess  736 . In still other examples, anchor recess  736  may not be present and bone  724  may instead be configured to receive anchor structure  734  (e.g., which may be implemented as a bump, protrusion, nub, or other type of raised surface or structure (which may or may not be coupled directly or indirectly or formed with device  73 )), which have a penetrating or sharp edge that may be pressed into bone  724  without a pre-configured or pre-cut recess or receptacle such as anchor recess  736 . In still other examples, device  732  and/or anchor structure  734  may be configured differently and is not limited to the examples shown or described herein. 
     For example, device  732  may be designed, configured, or implemented differently. In some examples, a stem or substrate, which may be disposed on one or more sides of a joint, may be implemented with one or more peripheral protrusions to be used with or without anchor structure  734  or anchor recess  736 . A stem (not shown) may be a substantially flat, smooth, sharp, shortened, elongated, or other shape apart from those shown and described, but when coupled (directly or indirectly) to one or more peripheral protrusions (e.g., peripheral protrusions  112 - 118  ( FIGS.  1 A- 1 G ),  212 - 218  ( FIGS.  2 A- 2 G ),  312 - 318  ( FIGS.  3 A- 3 G ),  412 - 418  ( FIGS.  4 A- 4 G ), or others, without limitation or restriction) or other structures (e.g., anchor structure  734 ) may be used to provide the functions as described herein, including, but not limited to pain relief, pain management, cartilaginous replacement/supplement/augmentation, prevention of dislocation, and others. In other examples, device  732  as depicted in diagram  730  and the elements shown and described may be designed, configured, formed, modified, or implemented apart from the examples shown or described and are not limited to those provided. 
       FIG.  8    illustrates an exemplary surgical technique for implantable interpositional orthopedic pain management. Here, process  800  begins by incising (i.e., making an incision) into a synovial capsule surrounding a joint ( 802 ). Once an incision (i.e., an opening) has been made, the opening into a synovial capsule may be enlarged using, for example, a trocar or other cutting tool designed for surgically enlarging an incision ( 804 ). A determination is then made to determine whether the joint require modification due to obstructions or restrictions such as an osteophyte, abnormal bone growth, or other skeletal structure or sub-structure that may obstruct the articulation of an implantable device (e.g., device  100  ( FIGS.  1 A- 1 G ), device  200  ( FIGS.  2 A- 2 G ), device  300  ( FIGS.  3 A- 3 G ), device  400  ( FIGS.  4 A- 4 G ), or any other implementation of said devices having one or more peripheral protrusions and other features as described herein) once positioned within a joint ( 806 ). If modification is desired, a rasping instrument (e.g., rasping instrument  500  ( FIGS.  5 A- 5 G )) may be used to rasp or remove/cut away obstructions within a joint in order to permit insertion, articulation, and non-obstruction of a device once surgically implanted ( 808 ). 
     After rasping or modifying a joint, a trial (e.g., trial  612  ( FIG.  6 B )) may be inserted into the joint through the enlarged opening to determine if further modification (e.g., additional modification using, for example, rasping instrument  500  ( FIGS.  5 A- 5 G )) is desired ( 810 ). A determination is then made using a trial as to whether further modification of the joint is required ( 812 ). In some examples, if further modification is desired, then rasping instrument  500  ( FIGS.  5 A- 5 G ) may be used ( 808 ) and trial  612  ( FIG.  6 B ) is again inserted to determine if various attributes are within tolerances and/or thresholds for surgical implantation of a device (e.g., device  100  ( FIGS.  1 A- 1 G ), device  200  ( FIGS.  2 A- 2 G ), device  300  ( FIGS.  3 A- 3 G ), device  400  ( FIGS.  4 A- 4 G )) ( 810 ). However, if modification of a joint is not required, then a device may be surgically implanted and the process ends ( 814 ). In other examples, process  800  and the sub-processes or processes shown and described may be designed, configured, performed, ordered, reordered, or otherwise implemented differently than the examples shown or described and are not limited to those provided. 
       FIG.  9    illustrates another exemplary surgical technique for implantable interpositional orthopedic pain management. Here, alternate process  900  begins by identifying a joint for implantation using a device (e.g., device  100  ( FIGS.  1 A- 1 G ), device  200  ( FIGS.  2 A- 2 G ), device  300  ( FIGS.  3 A- 3 G ), device  400  ( FIGS.  4 A- 4 G )) ( 902 ). After identifying a joint for implantation, an opening is made into a synovial capsule surrounding the joint (e.g., CMC joint) ( 904 ). Next, a tool may be introduced into the opening (e.g., scalpel, trocar, or other cutting tools) to enlarge the initial incision ( 906 ). Once the opening/incision has been enlarged, a trial (e.g., trial  612  ( FIG.  6 B )) is inserted into the joint to determine one or more attributes (e.g., size, position, orientation, and others, without limitation or restriction) ( 908 ). In order to aid determination of the one or more factors, the trial device is articulated. In some examples, trial  612  may be articulated using, for example, a stem molded, adhered, attached, or otherwise coupled, directly or indirectly, to a trial device (e.g., trial device  614  ( FIG.  6 B )) ( 910 ). By articulating trial  612 , a determination may be made to identify whether any obstructions, restrictions, or limitations are present in the joint ( 912 ). For example, osteophytes (i.e., abnormal bone growth or bone structures within a joint) may form into a joint that could prohibit an implantable device (e.g., device  100  ( FIGS.  1 A- 1 G ), device  200  ( FIGS.  2 A- 2 G ), device  300  ( FIGS.  3 A- 3 G ), device  400  ( FIGS.  4 A- 4 G )) from articulating fully within a given range of motion, or prohibit articulation of bones adjacent to the joint once surgical implantation has occurred. 
     In some examples, if a determination is made that a joint is restricted in its ability to articulate, then modification of the joint may be desired and performed using, for example, surgical instruments such as rasping instrument  500  ( FIGS.  5 A- 5 G ) ( 916 ). Once modified or, in the alternative, if no obstruction, restriction, or limitation to articulation of a target joint was detected in step  912 , then a device may be surgically implanted into the joint ( 918 ) and process  900  ends. In other examples, process  900  and the sub-processes or processes shown and described may be designed, configured, performed, ordered, reordered, or otherwise implemented differently than the examples shown or described and are not limited to those provided. 
       FIG.  10    illustrates an exemplary surgical technique for implantable interpositional orthopedic pain management. Here, process  1000  begins by incising an opening into a joint ( 1002 ). Once incised, the opening is modified (i.e., enlarged) ( 1004 ). As described herein, various surgical tools and techniques may be used to enlarge the incision, without limitation or restriction, to any particular technique. In some examples, a determination is made as to whether a joint or bones forming the joint need to be modified in order to permit implantation, positioning, and unimpeded (i.e., unobstructed, unrestricted) articulation of a device (e.g., device  100  ( FIGS.  1 A- 1 G ), device  200  ( FIGS.  2 A- 2 G ), device  300  ( FIGS.  3 A- 3 G ), device  400  ( FIGS.  4 A- 4 G )) once surgically implanted in a joint ( 1006 ). If modification of a joint is required, then a rasping instrument (e.g., rasping instrument  500  ( FIGS.  5 A- 5 G )) may be used to modify the joint by removing obstructions, rasping or cutting down osteophytes or other bone growth or bone structures ( 1008 ). Once modified or if no modification is required, a device may be surgically implanted ( 1010 ). Once inserted, a device may be positioned in order to position peripheral protrusions, such as those described above, to permit articulation of the joint, demonstration of dynamic stability, and restoration (either immediately or a gradual restoration) of strength and range of motion, among other benefits ( 1012 ). In other examples, process  1000  and the sub-processes or processes shown and described may be designed, configured, performed, ordered, reordered, or otherwise implemented differently than the examples shown or described and are not limited to those provided. 
       FIG.  11    illustrates yet another exemplary surgical technique for implantable interpositional orthopedic pain management. Here, process  1100  begins by inserting a needle into a joint to confirm placement of a device ( 1102 ). After determining the intended position of a surgically implanted device (e.g., device  100  ( FIGS.  1 A- 1 G ), device  200  ( FIGS.  2 A- 2 G ), device  300  ( FIGS.  3 A- 3 G ), device  400  ( FIGS.  4 A- 4 G )), a location for an initial incision is marked ( 1104 ). In some examples, an incision performed for purposes of inserting a device (e.g., device  100  ( FIGS.  1 A- 1 G ), device  200  ( FIGS.  2 A- 2 G ), device  300  ( FIGS.  3 A- 3 G ), device  400  ( FIGS.  4 A- 4 G )) into a CMC joint may be marked as running between the radial nerve and the abductor pollicis longus tendon (“APLT”), to avoid cutting, slicing, incising, or otherwise damaging either the radial nerve or the APLT. Generally, an incision should lie or fall between the radial nerve and the APLT. In other words, the radial nerve and the APLT may bracket either side of an incision as marked in this step. Once marked, one or more radial sensory nerve branches are dorsally retracted ( 1106 ). Next, a joint capsule (e.g., synovial capsule) surround a joint is opened ( 1108 ). A determination is then made as to whether a loose body (e.g., bone shard, loose cartilage, or other undesired tissue or bone remnants) or osteophytes are detected within a joint ( 1110 ). If detected, then rasping instrument  500  ( FIGS.  5 A- 5 G ) may be used to rasp or cut osteophytes or remove loose objects within the joint ( 1112 ). In other examples, different types of surgical tools may be used and are not limited to the examples presented and discussed herein. If no loose bodies (i.e., objects) or osteophytes are detected within a joint, then a trial device may be used to determine a size of an implantable device ( 1114 ). Once inserted into a joint through an enlarged opening incised into a joint capsule, trial  612  ( FIG.  6 B ) may be articulated to determine a size of a device (e.g., device  100  ( FIGS.  1 A- 1 G ), device  200  ( FIGS.  2 A- 2 G ), device  300  ( FIGS.  3 A- 3 G ), device  400  ( FIGS.  4 A- 4 G )) ultimately intended for surgical implantation in a joint ( 1114 ). 
     After determining a size of a device to be surgically implanted into a joint, articulation may be performed with a trial inserted into the joint in order to reconfirm one or more attributes of implantation ( 1116 ). In some examples, attributes of implantation may include size, scale, orientation, position, or other factors for consideration when surgically implanting a device (e.g., device  100  ( FIGS.  1 A- 1 G ), device  200  ( FIGS.  2 A- 2 G ), device  300  ( FIGS.  3 A- 3 G ), device  400  ( FIGS.  4 A- 4 G )). After reconfirming attributes associated with the surgically implanted device (i.e., “device”), the joint capsule may be closed and one or more ligaments reefed ( 1118 ). Radial sensory nerve branches may then be repositioned prior to closure ( 1120 ) and the initial incision is closed ( 1122 ). In other examples, process  1000  and the sub-processes or processes shown and described may be designed, configured, performed, ordered, reordered, or otherwise implemented differently than the examples shown or described and are not limited to those provided. 
     Although the foregoing examples have been described in various detail for purposes of clarity of understanding, the above-described inventive techniques and subject matter are not limited to the details provided. There are many alternative ways of implementing the above-described invention techniques. The disclosed examples are illustrative and not restrictive.