Patent Publication Number: US-9408616-B2

Title: Humeral cut guide

Description:
FIELD 
     The present disclosure relates to humeral cut guide members. 
     BACKGROUND 
     This section provides background information related to the present disclosure which is not necessarily prior art. 
     During shoulder arthroplasty, the humeral bone may require resurfacing to resectioning for receipt of a shoulder implant. Prior to surgery, it is common for the surgeon to take various images via X-ray, CT, ultrasound, MRI, or PET of the surgical area including the humeral bone. Based on these images, the surgeon can determine the best course of action for resurfacing or resectioning the humeral bone, as well as determine whether the primary procedure for shoulder repair is an anatomical or reverse arthroplasty. During the surgery, however, it is not uncommon for the surgeon to determine that the preselected courses of action are not suitable for the patient. If the course of action changes during surgery, new instruments may be required to properly complete the resurfacing or resectioning of the humeral bone before completing the arthroplasty procedure. 
     SUMMARY 
     This section provides a general summary of the disclosure, and is not a comprehensive disclosure of its full scope or all of its features. 
     The present disclosure provides a humeral cut guide system for resectioning or resurfacing a humeral head. The cut guide system includes a primary cut guide member configured to be removably coupled to the humeral head. The primary cut guide member includes a patient-specific bone-engaging surface, a primary elongate slot that defines a primary cutting plane, and a pair of cylindrical apertures configured to receive a pair of guide pins. The cut guide system also includes a secondary cut guide member that includes a pair of through-holes configured to mate with the pair of guide pins, wherein the secondary cut guide member includes a secondary elongate slot that defines a secondary cutting plane. 
     The present disclosure also provides a method of resectioning or resurfacing a humeral head. The method includes affixing a primary cut guide member to a humeral head. The primary cut guide member includes a patient-specific bone-engaging surface, a primary elongate slot that defines a primary cutting plane, and a pair of cylindrical apertures. The method also includes determining whether the primary cutting plane is sufficient for the resectioning or the resurfacing of the humeral head. If the primary cutting plane is sufficient, the resectioning or the resurfacing of the humeral head is conducted. If the primary cutting plane is not sufficient for the resectioning or the resurfacing of the humeral head, a pair of guide pins are coupled to the humeral head through the cylindrical apertures, the primary cut guide slot is removed, and a secondary cut guide member including a secondary elongate slot that defines a secondary cutting plane is attached to the pins. 
     Further areas of applicability will become apparent from the description provided herein. The description and specific examples in this summary are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure. 
    
    
     
       DRAWINGS 
       The drawings described herein are for illustrative purposes only of selected embodiments and not all possible implementations, and are not intended to limit the scope of the present disclosure. 
         FIG. 1  is an exploded view of a prior art implant for reverse shoulder arthroplasty; 
         FIG. 2  is an environmental view of the prior art implant of  FIG. 1 ; 
         FIG. 3  is a perspective environmental view of a humeral cut guide system according to a principle of the present disclosure; 
         FIG. 4  is a perspective environmental view of a humeral cut guide member according to a principle of the present disclosure; 
         FIG. 5  is a perspective view of an exterior of the humeral cut guide illustrated in  FIG. 3 ; 
         FIG. 6  is another perspective view of an interior of the humeral cut guide illustrated in  FIG. 3 ; 
         FIG. 7  is a perspective view of a secondary cut guide according to a principle of the present disclosure; 
         FIG. 8  is a perspective environmental view of the pins illustrated in  FIG. 4 , with the humeral cut guide in  FIG. 4  removed; 
         FIG. 9  is a perspective environmental view of the secondary cut guide illustrated in  FIG. 7  mounted to the pins illustrated in  FIG. 8 ; 
         FIG. 10  is a perspective environmental view of a humeral cut guide system according to a principle of the present disclosure; 
         FIG. 11  is another perspective environmental view of the humeral cut guide system illustrated in  FIG. 10 ; 
         FIG. 12  is a perspective environmental view of a humeral mating member that forms part of the humeral cut guide system illustrated in  FIG. 10 ; 
         FIG. 13  is a perspective view of a humeral cut guide member that forms part of the humeral cut guide system illustrated in  FIG. 10 ; 
         FIG. 14  is a perspective view of the humeral mating member illustrated in  FIG. 12 ; 
         FIG. 15  is a perspective environmental view of another humeral cut guide system according to a principle of the present disclosure; 
         FIG. 16  is another perspective environmental view of the humeral cut guide system illustrated in  FIG. 15 ; 
         FIG. 17  is a perspective view of a humeral cut guide member illustrated in  FIG. 15 ; and 
         FIG. 18  is another perspective view of the humeral cut guide member illustrated in  FIG. 15 . 
     
    
    
     Corresponding reference numerals indicate corresponding parts throughout the several views of the drawings. 
     DETAILED DESCRIPTION 
     Example embodiments will now be described more fully with reference to the accompanying drawings. 
     The present disclosure generally provide patient-specific surgical instruments that include, for example, alignment guides, drill guides, and other tools for use in shoulder joint replacement, shoulder resurfacing procedures and other procedures related to the shoulder joint or the various bones of the shoulder joint, including the humeral head. The present disclosure can be applied to anatomic shoulder replacement and reverse shoulder replacement or resurfacing. The patient-specific instruments can be used either with conventional implant components or with patient-specific implant components and/or bone grafts that are prepared using computer-assisted image methods according to the present disclosure. Computer modeling for obtaining three-dimensional images of the patient&#39;s anatomy using medical scans of the patient&#39;s anatomy (such as MRI, CT, ultrasound, X-rays, PET, etc.), the patient-specific prosthesis components and the patient-specific guides, templates and other instruments, can be prepared using various commercially available CAD programs and/or software available, for example, by Object Research Systems or ORS, Montreal, Canada. 
     The patient-specific instruments and any associated patient-specific implants and bone grafts can be generally designed and manufactured based on computer modeling of the patient&#39;s 3-D anatomic image generated from medical image scans including, for example, X-rays, MRI, CT, PET, ultrasound or other medical scans. The patient-specific instruments can have a three-dimensional engagement surface that is complementary and made to substantially mate and match in only one position (i.e., as a substantially negative or mirror or inverse surface) with a three-dimensional bone surface with or without associated soft tissues, which is reconstructed as a 3-D image via the aforementioned CAD or software. Very small irregularities need not be incorporated in the three-dimensional engagement surface. The patient-specific instruments can include custom-made guiding formations, such as, for example, guiding bores or cannulated guiding posts or cannulated guiding extensions or receptacles that can be used for supporting or guiding other instruments, such as drill guides, reamers, cutters, cutting guides and cutting blocks or for inserting guiding pins, K-wire, or other fasteners according to a surgeon-approved pre-operative plan. 
     In various embodiments, the patient-specific instruments of the present disclosure can also include one or more patient-specific guide members for receiving and guiding a tool, such as a drill or saw or guidewire at corresponding patient-specific insertion points and orientations relative to a selected anatomic or reverse axis for the specific patient. The patient-specific instruments can include guiding or orientation formations and features for guiding the implantation of patient-specific or off-the-shelf implants associated with the surgical procedure. The geometry, shape and orientation of the various features of the patient-specific instruments, as well as various patient-specific implants and bone grafts, if used, can be determined during the pre-operative planning stage of the procedure in connection with the computer-assisted modeling of the patient&#39;s anatomy. During the pre-operative planning stage, patient-specific instruments, custom, semi-custom or non-custom implants and other non-custom tools, can be selected and the patient-specific components can be manufactured for a specific-patient with input from a surgeon or other professional associated with the surgical procedure. 
     In the following discussion, the terms “patient-specific”, “custom-made” or “customized” are defined to apply to components, including tools, implants, portions or combinations thereof, which include certain geometric features, including surfaces, curves, or other lines, and which are made to closely conform substantially as mirror-images or negatives or complementary surfaces of corresponding geometric features or anatomic landmarks of a patient&#39;s anatomy obtained or gathered during a pre-operative planning stage based on 3-D computer images of the corresponding anatomy reconstructed from image scans of the patient by computer imaging methods. Further, patient-specific guiding features, such as, guiding apertures, guiding slots, guiding members or other holes or openings that are included in alignment guides, drill guides, cutting guides, rasps or other instruments or in implants are defined as features that are made to have positions, orientations, dimensions, shapes and/or define cutting planes and axes specific to the particular patient&#39;s anatomy including various anatomic or mechanical axes based on the computer-assisted pre-operative plan associated with the patient. 
     The patient-specific guide members can be configured to mate in alignment with natural anatomic landmarks by orienting and placing the corresponding alignment guide intra-operatively on top of the bone to mate with corresponding landmarks. The anatomic landmarks function as passive fiducial identifiers or fiducial markers for positioning of the various alignment guide members, drill guides or other patient-specific instruments. 
     The various patient-specific alignment guide members can be made of any biocompatible material, including, polymer, ceramic, metal or combinations thereof. The patient-specific alignment guide members can be disposable and can be combined or used with reusable and non-patient-specific cutting and guiding components. 
     More specifically, the present disclosure provides various embodiments of patient-specific humeral cut guide members for anatomic and reverse arthroplasty. The humeral cut guides of the present disclosure can have patient-specific engagement surfaces that reference various portions of the shoulder joint and include tubular drill guides, guiding bores or sleeves or other guiding formations that can accurately position guide pins for later humeral preparation and implantation procedures and for alignment purposes, including implant position control, implant version control, implant inclination control for both anatomic and reverse arthroplasty. 
     In the following, when a portion of a humeral guide member is described as “referencing” a portion of the anatomy, it will be understood that the referencing portion of the humeral guide member is a patient-specific portion that mirrors or is a negative of the corresponding referenced anatomic portion. 
     In some embodiments the humeral guide member can have built-in holes, openings or windows that allow the surgeon to mark the humeral bone or a model of the humeral bone with a marking pen, burr, scalpel, or any other device that can create markings to be used as landmarks on or in the humeral bone or humeral model. These landmarks can be used for the orientation of a secondary guide. 
     Referring to  FIGS. 1 and 2 , a prior art reverse shoulder implant  10  is illustrated. The reverse shoulder implant  100  includes a humeral stem  12 , a humeral tray  14 , a humeral bearing  16 , a glenosphere  18  and a baseplate  20  having a plate portion  22  and a central boss  24 . The humeral stem  12  is implanted in the humeral bone  26  and has a proximal end  28  coupled via a Morse taper connection to a male taper  30  extending from a plate  32  of the humeral tray  14 . The glenosphere  18  can be modular and include a head  34  articulating with the bearing  16  and an offset double-taper component  36 . The double-taper component  36  has a first tapered portion  38  coupled to a corresponding tapered opening  40  of the head  34  and a second tapered portion  42  coupled to the central boss  24  of the glenoid baseplate  20 . A central screw  44  passes through the baseplate  20  into the glenoid face  46  of the patient&#39;s scapula. Peripheral screws  48  are used to lock the baseplate  20  in the glenoid face  46 . 
     As best illustrated in  FIG. 2 , humeral bone  26  must include a planar surface  50  for abutment with plate  32  of humeral tray  14 . To provide planar surface  50 , humeral bone  26  must first be cut using a tool such as a bone saw (not shown). To properly orient the saw at the correct angle relative to humeral bone  26 , the present disclosure provides a humeral cut guide system  52 . 
     Referring to  FIGS. 3-9 , an exemplary humeral cut guide system  52  according to an aspect of the present disclosure is illustrated. Humeral cut guide system  52  includes a patient-specific primary cut guide member  54  and a secondary cut guide member  56 . Primary cut guide member  54  is configured to be patient-specific such that primary guide member  54  mates with humeral bone  26 . In this regard, primary cut guide member  54  includes an interior or bone-engagement surface  58  that is complementary and made to substantially mate and match in only one position (i.e., as a substantially negative or mirror or inverse surface) with a three-dimensional bone surface  60  of humeral bone  26  with or without associated soft tissues, which is reconstructed as a 3-D image via the aforementioned CAD or software. 
     An exterior surface  62  of primary cut guide member  54  is substantially pie-shaped and includes a pair of apertures  64 . Apertures  64  provide lines of sight for the surgeon to see through to humeral bone  26 . In addition, apertures  64  reduce the amount of material needed to form primary cut guide  54 . It should be understood, however, that primary cut guide member  54  may be formed without apertures  64  without departing from the scope of the present disclosure. Regardless, if primary cut guide member  54  is provided with apertures  64 , a rib  65  extends between apertures  64  and includes a protrusion  66  that extends therefrom. Protrusion  66  provides a curved contact surface  68  that allows humeral guide member  54  to be manipulated by the surgeon into correct alignment on humeral bone  26 . In other words, the surgeon may place a finger-tip upon contact surface  68 , which allows the surgeon to more easily orient primary cut guide member  54  in a manner that bone-engagement surface  58  properly aligns with bone surface  60  of humeral bone  26 . Primary cut guide member  54  may include protrusion  66  regardless whether primary cut guide member  54  includes apertures  64 . 
     Primary cut guide member  54  may include a distal end  70  that defines a patient-specific pin guide aperture  72 . Pin guide aperture  72  is aligned per the specific patient and allows for passage of a drill, Steinmann pin, or guidewire (not shown), that allows humeral bone  26  to be reamed at the appropriate location for any desired resurfacing of humeral bone  26 . In addition, pin guide aperture  72  allows humeral bone  26  to be reamed with a reaming device (not shown) for stemless prosthetic resections, if desired. 
     A proximal end  74  of primary cut guide member  54  defines a patient-specific primary elongate slot  76 . Primary elongate slot  76  is for receipt of a blade from a cutting tool such as a bone saw (not shown) that allows humeral bone  26  to be resurfaced or resected to provide planar surface  50 . Primary elongate slot  76  is formed in a shelf  78  that extends outward from exterior surface  62 . Shelf  78  includes an upper surface  80  and an opposing lower surface  82 . Shelf  78  extends along substantially an entire length of proximal end  74 . By providing primary elongate slot  76  in shelf  78  rather than simply forming primary elongate slot  76  in exterior surface  62 , the tool blade is substantially prevented from being improperly angled during resurfacing of humeral bone  26  to form planar surface  50 . 
     Primary cut guide member  54  may include a tab  83  ( FIG. 6 ) extending outward from shelf  78 . Tab  83  includes an outer surface  84  facing away from humeral bone  26 , and an inner surface  85  that faces humeral bone  26 . Similar to bone-engagement surface  58 , inner surface  85  of tab  83  is configured to be patient-specific such that inner surface  85  mates with humeral bone  26 . In particular, tab  83  including inner surface  85  is configured to sit within and mate with a groove bicipital groove in the humeral bone  26 . Accordingly, tab  83  may serve as an alignment device for primary cut guide member  54  when primary cut guide member  54  is mated with humeral bone  26 . 
     Once the surgeon has correctly affixed primary guide member  54  to humeral bone  26 , the surgeon can decide whether to resect humeral bone  26 . That is, before performing shoulder arthroplasty, the surgeon will plan for a primary procedure and a secondary procedure. For example, the primary procedure may be to resect humeral bone  26  for reverse shoulder implant  10 . Alternatively, the secondary procedure may be to resect humeral bone  26  for an anatomic shoulder implant (not shown), which requires resecting a different section of humeral bone  26 . Regardless, once the surgeon has affixed primary cut guide member  54  for conducting the primary procedure, the surgeon may decide that the primary procedure is not satisfactory for the patient. In contrast, the surgeon may decide that the secondary procedure would be more beneficial for the patient. Regardless which procedure is selected, primary cut guide member  54  allows for practicing the primary and secondary procedures, as desired. 
     More specifically, in addition to including elongate slot  76 , primary cut guide member  54  includes a pair of patient-specific tubular guide apertures  86 . Tubular guide apertures  86  may be positioned proximate opposing ends of shelf  78 , and allow for passage of a drill for reaming humeral bone  26 . After reaming of humeral bone  26 , a pair of pins  88  may be implanted in humeral bone  26 . Pins  88  may be, for example, Steinman pins or K-wires. Any type of pin known to one skilled in the art, however, may be implanted. 
     After implantation of pins  88 , primary cut guide member  54  may be removed from humeral bone  26  with pins  88  remaining in place. Secondary cut guide member  56  may then be mated with pins  88 . Secondary cut guide member  56  is a substantially parallel piped-shaped member including a first, second, third, and fourth major surfaces  90 ,  92 ,  94 , and  96 . Side surfaces  98  may be formed on opposing ends of cut guide member  56 . Corners that connect each major surface  90 - 96 , as well as connect major surfaces  90 - 96  to side surfaces  98 , may be curved or chamfered as best illustrated in  FIG. 7 . 
     A pair of though-holes  99  extend between second and fourth major surfaces  92  and  96  for receipt of pins  88 . In addition, a secondary elongate slot  100  may extend between second and fourth major surfaces  92  and  96 . Although only a single secondary slot  100  is illustrated, it should be understood that secondary cut guide member  56  may include a plurality of secondary elongate slots  100 . Providing a plurality of secondary elongate slots  100  allows cut guide member  56  to be reusable, and allows the surgeon to select the appropriate secondary elongate slot  100  for resecting humeral bone  26 . Secondary elongate slots  100  may be formed on either side of through holes  99 , without limitation. Once secondary cut guide member  56  is mated with pins  88 , humeral bone  26  may be resurfaced as desired using the selected secondary elongate slot  100  as a guide for the cutting tool such as a bone saw. It should be understood that secondary elongate slot  100  may be used if the surgeon determines intra-operatively that a different cut height should be used instead of the cut height provided by primary elongate slot  76 . It should also be understood that pins  88  are not necessarily oriented relative to humeral bone  26  to provide a different cut height. In contrast, guide apertures  86  may include an orientation that provides a different (i.e., non-parallel) cutting plane once pins  88  are mated with humeral bone  26  and secondary cut guide member  56  is coupled to pins  88 . 
     According to the above-described embodiment, humeral cut guide system  52  allows for a plurality of cutting heights and planes to be selected by the surgeon performing humeral resurfacing. Because primary cut guide member  54  is patient-specific and includes primary elongate slot  76  as well as tubular guide apertures  86 , primary cut guide member  54  can be used to prepare the patient for each of the primary and secondary procedures that are determined before surgery. 
     Now referring to  FIGS. 10 to 14 , another exemplary humeral cut guide system  200  is illustrated. Humeral cut guide system  200  includes a primary cut guide member that includes humeral mating member  202  and a humeral cut guide member  204 . Humeral mating member  202  includes a plurality of grasping members  206 . In the illustrated embodiment, humeral mating member  202  includes three grasping members  208 ,  210  and  212  that extend outward from a central hub  214 . It should be understood, however, that any number of grasping members  206  may be used without departing from the scope of the present disclosure. 
     Each grasping member  206  includes a proximal end  216  fixed to central hub  214  and a distal end  218  positioned away from central hub  214 . Central hub  214  and grasping members  206  each include an interior or bone-engagement surface  217  and an exterior surface  219  that faces away from humeral bone  26 . Similar to humeral cut guide system  52 , bone-engagement surface  217  is complementary and made to substantially mate and match in only one position (i.e., as a substantially negative or mirror or inverse surface) with a three-dimensional bone surface  60  of humeral bone  26  with or without associated soft tissues, which is reconstructed as a 3-D image via the aforementioned CAD or software. 
     Grasping members  206  may be differently sized. In the illustrated embodiment, for example, grasping members  208  and  210  are substantially the same size, while grasping member  212  is wider than grasping members  208  and  210 . Grasping member  212 , however, has a length that is less than that of grasping members  208  and  210 . Regardless, grasping member  212  provides a greater amount of contact with humeral bone  26  that assists in locating humeral mating member  202  on humeral bone  26 . Due to grasping members  208  and  210  having a greater length than grasping member  212 , grasping members  208  and  210  can include patient-specific hooks  215  that mate with various protrusions of humeral bone  26 . 
     Central hub  214  may be oval shaped, and include a planar exterior surface  220 . Central hub  214  can include a pair of recesses  222  and  224  having different depths and trajectories. For example, recess  222  may have a greater depth than recess  224 . The different depths of recesses  222  and  224  are so that humeral mating member  202  can be used in each of an anatomical shoulder replacement or reverse shoulder replacement procedure. That is, recess  222  having the greater depth may be used for anatomical shoulder replacement, and recess  224  having the shallower depth may used for reverse shoulder replacement. It should be understood, however, that the recess  222  having the greater depth may be used for reverse shoulder replacement, that recess  224  having the lesser depth may be used for anatomical shoulder replacement as determined by the surgeon pre-operatively. Moreover, it should be understood that recesses  222  and  224  are not necessarily arranged in parallel. That is, recess  222  can be angled relative to recess  224 , or vice versa. Regardless, recesses  222  and  224  can be oriented in the desired manner according to patient-specific pre-operative planning. 
     Recesses  222  and  224  are designed to mate with humeral cut guide member  204 . As best shown in  FIG. 13 , humeral cut guide member  204  includes a guide arm  226  and an attachment arm  228 . Guide arm  226  and attachment arm  228  are illustrated as being unitary, but may be separately formed and attached without departing from the scope of the present disclosure. Guide arm  226  includes an outer face  228  and an opposing inner face  230  that are connected by side faces  232 . A patient-specific primary elongate slot  234  extends between outer face  228  and inner face  230  for receipt of a cutting blade of, for example, a bone saw for resurfacing humeral bone  26 . Although only a single primary elongate slot  234  is illustrated, it should be understood that a plurality of elongate slots  234  may be provided that provide the surgeon with different cutting planes to select for the patient to adjust for the cutting height intraoperatively. Guide arm  226  may include a through-hole  236 . Through-hole  236  provides a line of sight for the surgeon to ensure that humeral cut guide member  204  is properly aligned relative to humeral bone  26 . 
     Attachment arm  228  extends substantially orthogonally outward from guide arm  226 , and includes a proximal end  238  that is attached to guide arm  226  and a distal free end  240 . Attachment arm  228  includes a planar upper surface  242  and a planar lower surface  244 , with the planar upper and lower surfaces  242  and  244  being connected by side surfaces  246 . An elongate aperture  248  extends between the planar upper and lower surfaces  242  and  244 . Similar to through-hole  236 , elongate aperture  248  provides a line of sight for the surgeon to ensure that humeral cut guide member  204  is properly aligned relative to humeral bone  26 . 
     A projection  250  extends outward from planar lower surface  244  at distal free end  240 . Projection  250  is sized to mate with either recess  222  or recess  224  depending on whether an anatomical or reverse shoulder arthroplasty is being performed. Because these procedures are conducted at different cutting planes, the different depths of recesses  222  and  224  allow for primary elongate slot  234  of guide arm  226  to be arranged at different cutting planes dependent on the recess  222  or  224  selected. Projection  250  also allows cut guide member  204  to pivot relative to humeral bone  26 . This allows the surgeon to position cut guide member  204  at the appropriate position of humeral bone  26  before beginning resurfacing or resecting of humeral bone  26 . Alternatively, it should be understood that projection  250  and recesses  222  and  224  can be shaped to not allow cut guide member  204  to pivot relative to humeral bone  26 . Rather, because cut guide system  200  is patient-specific, the correct orientation of cut guide member  204  relative to humeral bone  26  can be selected before attachment of humeral cut guide system  200  to humeral bone  26 . 
     Cut guide member  204  can be configured similar to humeral guide member  54 . That is, cut guide member  204  additionally includes a pair of patient-specific cylindrical apertures  252  that allow for passage of a drill for reaming humeral bone  26 . After reaming of humeral bone  26 , a pair of pins  88  may be implanted in humeral bone  26 . Pins  88  may be, for example, Steinman pins or K-wires. Any type of pin known to one skilled in the art, however, may be implanted. After implantation of pins  88 , humeral mating member  202  and cut guide member  204  may be removed from humeral bone  26  with pins  88  remaining in place. Secondary cut guide member  56  may then be mated with pins  88  to provide yet another cutting plane for the surgeon to select. Similar to previously described embodiments, it should also be understood that pins  88  are not necessarily oriented relative to humeral bone  26  to provide a different cut height. In contrast, cylindrical apertures  252  may include an orientation that provides a different (i.e., non-parallel) cutting plane once pins  88  are mated with humeral bone  26  and secondary cut guide member  56  is coupled to pins  88 . 
     According to the above-described embodiment, humeral cut guide system  200  allows for a plurality of cutting heights and planes to be selected by the surgeon performing humeral arthroplasty. Because humeral mating member  202  is patient-specific and includes recesses  222  and  224  for different procedures that are designed to mate with cut guide member  204 , humeral cut guide system  200  can be used to prepare the patient for each of the primary and secondary procedures (e.g., anatomical or reverse shoulder arthroplasty) that are determined before surgery. 
     Now referring to  FIGS. 15 to 18 , another exemplary humeral cut guide system  300  is illustrated. Cut guide system  300  is similar to humeral cut guide system  200  in that cut guide system  300  includes a primary cut guide member including a humeral mating member  302  and a humeral cut guide member  304 . In the present embodiment, however, humeral mating member  302  and humeral cut guide member  304  are unitary. Humeral mating member  302  includes a plurality of grasping members  306 . In the illustrated embodiment, humeral mating member  302  includes two grasping members  308  and  310  that extend outward from a central hub  314 . It should be understood, however, that any number of grasping members  306  may be used without departing from the scope of the present disclosure. 
     Each grasping member  306  includes a proximal end  316  fixed to central hub  314  and a distal end  318  positioned away from central hub  314 . Central hub  314  and grasping members  306  each include an interior or bone-engagement surface  315  and an exterior surface  317  that faces away from humeral bone  26 . Similar to humeral cut guide system  52 , bone-engagement surface  315  is complementary and made to substantially mate and match in only one position (i.e., as a substantially negative or mirror or inverse surface) with a three-dimensional bone surface  60  of humeral bone  26  with or without associated soft tissues, which is reconstructed as a 3-D image via the aforementioned CAD or software. In the illustrated embodiment, grasping members  308  and  310  are substantially the same size. It should be understood, however, that grasping members  306  may be differently sized without departing from the scope of the present disclosure. 
     Central hub  314  may include cylindrical base portion  320 . A tubular shaft  322  may extend outward from base portion  320  that defines a patient-specific pin guide aperture  324 . Pin guide aperture  324  allows for passage of a drill (not shown), that allows humeral bone  26  to be reamed at the appropriate location for any desired resurfacing of humeral bone  26 . In addition, pin guide aperture  324  allows humeral bone  26  to be reamed for stemless prosthetic resections, if desired. 
     As best shown in  FIGS. 16-18 , humeral cut guide member  304  includes outer face  328  and an opposing inner face  330  that are connected by side faces  332 . A patient-specific primary elongate slot  334  extends between outer face  328  and inner face  330  for receipt of a cutting blade of, for example, a bone saw for resurfacing humeral bone  26 . Although only a single primary elongate slot  334  is illustrated, it should be understood that a plurality of elongate slots  334  may be provided that provide the surgeon with different cutting planes to select for the patient. 
     Cut guide member  304  is configured similar to humeral guide member  54 . That is, cut guide member  304  additionally includes a pair of patient-specific cylindrical apertures  352  that allow for passage of a drill for reaming humeral bone  26 . After reaming of humeral bone  26 , a pair of pins  88  may be implanted in humeral bone  26 . Pins  88  may be, for example, Steinman pins or K-wires. Any type of pin known to one skilled in the art, however, may be implanted. After implantation of pins  88 , humeral mating member  302  and cut guide member  304  may be removed from humeral bone  26  with pins  88  remaining in place. Secondary cut guide member  56  may then be mated with pins  88  to provide yet another cutting plane for the surgeon to select. Again, it should be understood that pins  88  are not necessarily oriented relative to humeral bone  26  to provide a different cut height. In contrast, cylindrical apertures  352  may include an orientation that provides a different (i.e., non-parallel) cutting plane once pins  88  are mated with humeral bone  26  and secondary cut guide member  56  is coupled to pins  88 . 
     According to the above-described embodiment, humeral cut guide system  300  allows for a plurality of cutting heights and planes to be selected by the surgeon performing humeral resurfacing. Because humeral mating member  302  and humeral cut guide member  304  are patient-specific and include patient-specific elongate slot  322  and patient-specific cylindrical apertures  352 , humeral cut guide system  300  can be used to prepare the patient for each of the primary and secondary procedures (e.g., anatomical or reverse shoulder arthroplasty) that are determined before surgery. 
     The foregoing description of the embodiments has been provided for purposes of illustration and description. It is not intended to be exhaustive or to limit the disclosure. Individual elements or features of a particular embodiment are generally not limited to that particular embodiment, but, where applicable, are interchangeable and can be used in a selected embodiment, even if not specifically shown or described. The same may also be varied in many ways. Such variations are not to be regarded as a departure from the disclosure, and all such modifications are intended to be included within the scope of the disclosure.