Patent Publication Number: US-2021169655-A1

Title: Interconnected implants and methods

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 16/442,429 filed on Jun. 14, 2019, entitled “INTERCONNECTED IMPLANTS AND METHODS”, which claims the benefit of U.S. Provisional Patent Application No. 62/750,781 filed on Oct. 25, 2018, entitled “INTERCONNECTED HIP IMPLANTS AND METHODS”, the disclosures of which are incorporated herein by reference in their entirety. 
    
    
     TECHNICAL FIELD 
     The present disclosure relates to surgical devices, systems, and methods. More specifically, the present disclosure relates to interconnected joint prosthesis implants and bone plates for replacing an articulating surface of a joint, as well as for repairing one or more bones associated with the joint. 
     BACKGROUND 
     Joint arthroplasty procedures are surgical procedures in which one or more articulating surfaces of a joint are replaced with prosthetic articulating surfaces. Such procedures are becoming increasingly commonplace. 
     Some joint replacements are necessitated by trauma. In such cases, it may be desirable to repair one of the bones associated with, or adjacent to, the joint as part of the same surgical procedure in which a partial or full joint replacement is carried out. Furthermore, in some cases, a previous joint arthroplasty procedure may need to be revised, for example, by removing one or more previously implanted components and inserting new components. Sometimes in the context of revision, repair of a bone fracture is needed, along with the partial or full joint replacement. 
     In one non-limiting example, the greater trochanter of a femur may receive significant loading, particularly after a hip replacement is carried out that replaces the ball of the femur with a prosthetic ball. Accordingly, in this example, there may be a need to repair a fracture of the greater trochanter at the time the joint is first replaced, or at the time of revision of the first joint replacement. Known joint replacement and fracture repair systems often lack sufficient implant stability and interoperability. 
     SUMMARY 
     A system may be used to replace a natural or artificial articular surface of a joint, and to repair a bone that is associated with the joint. The joint may be a hip or shoulder joint, and the bone may be a femur or humerus, as two non-limiting examples. 
     In one embodiment, the system may include a joint replacement prosthesis with a prosthetic articular surface, a support structure securable to the bone, and a first attachment interface. The system may also include a bone plate with a bone engagement surface securable to the bone on either side of a fracture formed in the bone, and a second attachment interface that is attachable to the first attachment interface of the joint replacement prosthesis in order to couple the bone plate to the joint replacement prosthesis. 
     In various embodiments of the system, the joint replacement prosthesis may include at least one of: a femoral joint replacement prosthesis; a tibial joint replacement prosthesis; a fibular joint replacement prosthesis; a humeral joint replacement prosthesis; a clavicle joint replacement prosthesis; a radial joint replacement prosthesis; an ulnar joint replacement prosthesis; a digital joint replacement prosthesis; and an intramedullary nail. 
     The system may also include a fastening system configured to engage the second attachment interface with the first attachment interface and couple the bone plate to the joint replacement prosthesis. In at least some embodiments, the fastening system may include a bolt and a washer. In at least some embodiments, the second attachment interface of the bone plate may be attachable to the first attachment interface of the joint replacement prosthesis at any of a first plurality of relative orientations about a first axis, and at any of a second plurality of relative orientations about a second axis, wherein the second axis is orthogonal to the first axis. The first attachment interface may include a dome having a first generally semispherical shape with a first radius. The second attachment interface may include a recess having a second generally semispherical shape with a second radius, wherein the second generally semispherical shape of the recess is complementary to the first generally semispherical shape of the dome. The first generally semispherical shape and the second generally semispherical shape may have substantially the same radius. 
     The bone plate of the system may further include at least one arm extending proximate the second attachment interface, at least one central expanse coupled to the at least one arm, and at least one bone engagement feature coupled to the at least one central expanse. One or more of the at least one arm, the at least one central expanse, and the at least one bone engagement feature may be bendable, such that the one or more of the at least one arm, the at least one central expanse, and the at least one bone engagement feature can be shaped to conform to at least one surface of the bone. 
     The at least one central expanse of the bone plate of the system may further include an aperture formed in the at least one central expanse in order to facilitate flexure of the at least one central expanse so that the at least one central expanse can be shaped to conform to the at least one surface of the bone. The at least one central expanse may be securable to the bone on a first side of the fracture that is formed in the bone, via a first bone engagement feature, and a second side of the fracture that is formed in the bone, via a second bone engagement feature. 
     In at least one embodiment of the system, the at least one arm may be further configured to allow the at least one central expanse to translate with respect to the at least one arm to in order to compress the at least one central expanse against the at least one surface of the bone. 
     In at least one embodiment of the system, the first attachment interface and the second attachment interface may be further configured to allow for rotational adjustment of the bone plate with respect to the joint replacement prosthesis. 
     In a particular embodiment, an apparatus for replacing a natural or artificial articular surface of a hip joint and for repairing a greater trochanter of a femur associated with the hip joint may include a hip prosthesis with a neck that is securable to the femur associated with the hip joint, an arm coupled to the neck, a prosthetic ball comprising an articular surface, wherein the prosthetic ball is couplable to the arm of the hip prosthesis, and a first attachment interface formed on a superior surface of the hip prosthesis. The apparatus may further include a bone plate with a bone engagement surface that is securable to the greater trochanter of the femur on either side of a fracture formed in the greater trochanter of the femur, and a second attachment interface that is attachable to the first attachment interface of the hip prosthesis in order to couple the bone plate to the hip prosthesis. 
     The apparatus may further include a fastening system configured to engage the second attachment interface with the first attachment interface and couple the bone plate to the hip prosthesis. In at least one embodiment, the fastening system may include a bolt and a washer. In some embodiments, the second attachment interface of the bone plate may be attachable to the first attachment interface of the hip prosthesis at any of a first plurality of relative orientations about a first axis, and at any of a second plurality of relative orientations about a second axis, wherein the second axis is orthogonal to the first axis. The first attachment interface may include a dome having a first generally semispherical shape with a first radius. The second attachment interface may include a recess having a second generally semispherical shape with a second radius, wherein the second generally semispherical shape of the recess is complementary to the first generally semispherical shape of the dome. The first generally semispherical shape and the second generally semispherical shape may have substantially the same radius. 
     The bone plate of the apparatus may further include at least one arm extending proximate the second attachment interface, at least one central expanse coupled to the at least one arm, and at least one bone engagement feature coupled to the at least one central expanse. One or more of the at least one arm, the at least one central expanse, and the at least one bone engagement feature may be bendable, such that the one or more of the at least one arm, the at least one central expanse, and the at least one bone engagement feature can be shaped to conform to at least one surface of the greater trochanter of the femur. 
     The at least one central expanse of the bone plate of the apparatus may further include an aperture formed in the at least one central expanse in order to facilitate flexure of the at least one central expanse so that the at least one central expanse can be shaped to conform to the at least one surface of the greater trochanter of the femur. The at least one central expanse may be securable to the bone on a first side of the fracture that is formed in the greater trochanter of the femur, via a first bone engagement feature, and a second side of the fracture that is formed in the greater trochanter of the femur, via a second bone engagement feature. 
     In at least one embodiment of the apparatus, the at least one arm may be further configured to allow the at least one central expanse to translate with respect to the at least one arm to in order to compress the at least one central expanse against the at least one surface of the greater trochanter of the femur. 
     In at least one embodiment of the apparatus, the first attachment interface and the second attachment interface may be further configured to allow for rotational adjustment of the bone plate with respect to the hip prosthesis. In certain embodiments, the first attachment interface and the second attachment interface may be configured to allow for discrete rotational adjustments of the bone plate with respect to the hip prosthesis from among a plurality of different discrete rotational positions. In other embodiments, the first attachment interface and the second attachment interface may be configured to allow for an infinite number of rotational adjustment positions between the bone plate and the hip prosthesis. 
     According to another embodiment, a method of replacing a natural or artificial articular surface of a joint and repairing a bone associated with the joint may include coupling a joint replacement prosthesis to the bone associated with the joint, replacing an articular surface of the joint with a prosthetic articular surface of the joint replacement prosthesis that is coupled to the bone associated with the joint, coupling a bone plate to the joint replacement prosthesis, and securing the bone plate proximate a damaged area of the bone to facilitate repair of the damaged area of the bone associated with the joint. 
     The method may also include bending at least one of: an arm of the bone plate, a central expanse of the bone plate, and a bone engagement feature of the bone plate, in order to shape the bone plate to conform to at least one surface of the bone associated with the joint. 
     The method may also include translating the central expanse of the bone plate with respect to the arm of the bone plate and compressing the central expanse of the bone plate against at least one surface of the bone associated with the joint prior to securing the bone plate to the bone associated with the joint. 
     The method may also include rotating the bone plate to a desired position with respect to the joint replacement prosthesis prior to securing the bone plate to the bone associated with the joint. 
     In various embodiments of the method, the joint replacement prosthesis may include at least one of: a femoral joint replacement prosthesis; a tibial joint replacement prosthesis; a fibular joint replacement prosthesis; a humeral joint replacement prosthesis; a clavicle joint replacement prosthesis; a radial joint replacement prosthesis; an ulnar joint replacement prosthesis; a digital joint replacement prosthesis; and an intramedullary nail. 
     These and other features and advantages of the present disclosure will become more fully apparent from the following description and appended claims, or may be learned by the practice of the systems and methods set forth hereinafter. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Exemplary embodiments of the disclosure will become more fully apparent from the following description and appended claims, taken in conjunction with the accompanying drawings. Understanding that these drawings depict only exemplary embodiments and are, therefore, not to be considered limiting of the scope of the appended claims, the exemplary embodiments of the present disclosure will be described with additional specificity and detail through use of the accompanying drawings in which: 
         FIG. 1A  is a perspective view of a hip implant system  100  implanted in a femur, according to an embodiment of the present disclosure; 
         FIG. 1B  is a close up perspective view of the hip implant system  100  of  FIG. 1A ; 
         FIG. 2A  is a front elevation, section view of the hip implant system  100  shown in  FIG. 1A ; 
         FIG. 2B  is a close up view of the hip implant system  100  shown in  FIG. 2A ; 
         FIG. 3  shows the hip implant system  100  shown of  FIG. 2A  (without the femur), illustrating the fastening system  114  and first and second attachment interfaces  300 ,  310  of the hip implant system  100 ; 
         FIG. 4A  illustrates an exploded view of a hip implant system  500 , according to another embodiment of the present disclosure; 
         FIG. 4B  illustrates a side view of the hip implant system  500  of  FIG. 4A  in assembled form; 
         FIG. 5  illustrates a front elevation, section view of a hip implant system  400 , according to another embodiment of the present disclosure; 
         FIG. 6  illustrates a front elevation, section view of a hip implant system  600 , according to another embodiment of the present disclosure; 
         FIG. 7A  illustrates a top view of a hip prosthesis  710  with a keyed hole  720  formed therein, according to another embodiment of the present disclosure; 
         FIG. 7B  illustrates a top view of the hip prosthesis  710  of  FIG. 7A  coupled to a bone plate  712  via an offset arm  730 ; 
         FIG. 8A  illustrates an exploded top view of a hip implant system  800 , according to another embodiment of the present disclosure; 
         FIG. 8B  illustrates an exploded bottom view of the hip implant system  800  of  FIG. 8A ; 
         FIG. 9A  illustrates an exploded top view of a hip implant system  900 , according to another embodiment of the present disclosure; 
         FIG. 9B  illustrates an exploded bottom view of the hip implant system  900  of  FIG. 9A ; 
         FIG. 10  illustrates an exploded view of a hip implant system  1000 , according to another embodiment of the present disclosure; 
         FIG. 11  illustrates an exploded view of a hip implant system  2000 , according to another embodiment of the present disclosure; 
         FIG. 12  illustrates an exploded view of a hip implant system  3000 , according to another embodiment of the present disclosure; 
         FIG. 13  illustrates an exploded view of a humeral implant system  4000 , according to another embodiment of the present disclosure; and 
         FIG. 14  illustrates a flowchart of a method  5000  for replacing a natural or artificial articular surface of a joint and repairing a bone associated with the joint, according to an embodiment of the disclosure. 
     
    
    
     It will be understood that the Figures are for purposes of illustrating the concepts of the present disclosure and may not be drawn to scale. Furthermore, the Figures illustrate exemplary embodiments and do not represent limitations to the scope of the present disclosure. 
     DETAILED DESCRIPTION 
     Exemplary embodiments of the present disclosure will be best understood by reference to the Figures, wherein like parts are designated by like numerals throughout. It will be readily understood that the components of the present disclosure, as generally described and illustrated in the Figures herein, could be arranged and designed in a wide variety of different configurations. Thus, the following more detailed description of the embodiments of the apparatus, systems, and methods, as represented in the Figures, is not intended to limit the scope of the present disclosure, as claimed in this or any other application claiming priority to this application, but is merely representative of exemplary embodiments of the present disclosure. 
     Standard medical directions, planes of reference, and descriptive terminology are employed in this specification. For example, anterior means toward the front of the body. Posterior means toward the back of the body. Superior means toward the head. Inferior means toward the feet. Medial means toward the midline of the body. Lateral means away from the midline of the body. Axial means toward a central axis of the body. Abaxial means away from a central axis of the body. Ipsilateral means on the same side of the body. Contralateral means on the opposite side of the body. A sagittal plane divides a body into right and left portions. A midsagittal plane divides the body into bilaterally symmetric right and left halves. A coronal plane divides a body into anterior and posterior portions. A transverse plane divides a body into superior and inferior portions. These descriptive terms may be applied to an animate or inanimate body. 
     The phrases “connected to,” “coupled to” and “in communication with” refer to any form of interaction between two or more entities, including mechanical, electrical, magnetic, electromagnetic, fluid, and thermal interaction. Two components may be functionally coupled to each other even though they are not in direct contact with each other. The term “abutting” refers to items that are in direct physical contact with each other, although the items may not necessarily be attached together. The phrase “fluid communication” refers to two features that are connected such that a fluid within one feature is able to pass into the other feature. 
     The word “exemplary” is used herein to mean “serving as an example, instance, or illustration.” Any embodiment described herein as “exemplary” is not necessarily to be construed as preferred or advantageous over other embodiments. While the various aspects of the embodiments are presented in drawings, the drawings are not necessarily drawn to scale unless specifically indicated. 
       FIGS. 1A-3  illustrate various views of a hip implant system  100 , according to one embodiment of the present disclosure. Specifically,  FIG. 1A  is a perspective view of the hip implant system  100  implanted in a femur  102 ;  FIG. 1B  is a close up perspective view of the hip implant system  100  of  FIG. 1A ;  FIG. 2A  is a front elevation, section view of the hip implant system  100  of  FIG. 1A ;  FIG. 2B  is a close up view of the hip implant system  100  shown in  FIG. 2A ; and  FIG. 3  shows the hip implant system  100  of  FIG. 2A  without the femur  102 , to illustrate a fastening system  114  and the first and second attachment interfaces  300 ,  310  of the hip implant system  100 . 
     As shown in  FIGS. 1A-2B , the femur  102  may have a body  104 , a ball  106 , and a greater trochanter  108 . The hip implant system  100  may be designed to replace one or more natural articulating surfaces of the ball  106 , and may also be designed to repair and/or strengthen the greater trochanter  108 . Thus, the hip implant system  100  may include a hip prosthesis  110  and a bone plate  112 , which may be secured together via a fastening system  114 . 
     The hip prosthesis  110  may have the configuration and components of any hip implant known in the art. The hip prosthesis  110  may be designed as a revision implant that replaces a prior hip prosthesis (not shown) that is no longer suitable due to wear, loosening, infection, and/or for other reasons. The hip prosthesis  110  may have a stem  120 , a neck  122 , and an arm  124 . The stem  120  may reside within the intramedullary canal of the femur  102 , specifically within the body  104  of the femur  102 , and may thus provide a support structure to support the hip prosthesis  110  relative to the femur  102 . The neck  122  may optionally also reside within the intramedullary canal of the femur  102 , proximal to the stem  120 . The stem  120  and the neck  122  may optionally be separate pieces, allowing for stems with different sizes and/or lengths to be used in combination with one or more necks. 
     As shown, the neck  122  may be formed as a single piece with the arm  124 . The arm  124  may have a Morse taper or other interface to which a prosthetic ball (not shown) may be attached. The prosthetic ball may replace the ball  106  of the femur  102 , which may be removed, or in the case of a revision surgery, may already have been removed and replaced with a previous prosthetic ball. Modularity between the prosthetic ball and the arm  124  may permit a variety of different prosthetic balls and arms to be used interchangeably with each other. Thus, the surgeon may, in some embodiments, make up the hip prosthesis  110  by selecting the stem  120  from a plurality of stems, selecting the neck  122  and the arm  124  from a plurality of neck and arm components, and selecting the prosthetic ball from a plurality of prosthetic balls. 
     The bone plate  112  may be designed to remedy a fracture or weakness (not shown) in the greater trochanter  108 . The bone plate  112  may have the shape and features of any bone plate known in the art. The bone plate  112  may have at least one bone engagement feature  132 , at least one central expanse  130 , and/or at least one arm  134 . 
     The central expanse  130  is shown with a shape that generally conforms to that of the greater trochanter  108 , with an oval aperture  136  that facilitates flexure of the central expanse  130  to enable the central expanse  130  to bend into greater conformity with the surface of the greater trochanter  108 , as the central expanse  130  is installed. The oval aperture  136  may also reduce the weight of the central expanse  130 . 
     The bone engagement features  132  may have any configuration known in the art. As embodied in  FIGS. 1A-3 , the bone engagement features  132  may be eyelets through which fasteners, such as bone screws (not shown), may be inserted to secure the periphery of the central expanse  130  to the greater trochanter  108 . In other embodiments, alternative bone fastening methods, such as pins or spikes (not shown), may be used to secure the bone plate  112  to the greater trochanter  108  in other ways. 
     The arm  134  may have a gooseneck shape that extends over the superior aspect of the greater trochanter  108 , and then distally toward the proximal end of the intramedullary canal of the femur  102 , where the proximal end of the neck  122  is located. The arm  134  may terminate in a ring  138  that may be used to secure the arm  134  of the bone plate  112  to the neck  122  of the hip prosthesis  110 . Like the central expanse  130 , the arm  134  may also be thin enough to be somewhat malleable, such that the arm  134  may be bent into closer conformity with the superior end of the femur  102  during implantation. 
     The bone plate  112  may also be a modular component of the hip implant system  100 . In some examples, the bone plate  112  may be selected from a number of differently-sized and/or differently-shaped bone plates. As a variety of fractures may occur in the greater trochanter  108 , such bone plates may have different configurations, each of which may address a specific fracture type and/or fracture severity. 
     The hip prosthesis  110  and the bone plate  112  may be secured together through use of the fastening system  114 . In some embodiments, the fastening system  114  may secure the bone plate  112  to the hip prosthesis  110  at any of a plurality of relative orientations. Thus, the fastening system  114  may be operable to secure the hip prosthesis  110  to the bone plate  112  with a variety of bone geometries. The fastening system  114  may further secure two or more components of the hip prosthesis  110  together. As embodied in  FIGS. 1A-3 , the fastening system  114  may secure the stem  120  to the neck  122 , in addition to securing the hip prosthesis  110  to the bone plate  112 . 
     As shown in  FIGS. 2B and 3 , the neck  122  of the hip prosthesis  110  may have a bore  240  that extends the entire length through the neck  122 . The stem  120  of the hip prosthesis  110  may have a tapered extension  242  that is inserted into a counterbore  244  of the bore  240 . The tapered extension  242  may have a threaded hole  246 . The neck  122  may also have a shoulder  248 , which may protrude from the intramedullary canal of the femur  102  after implantation of the hip prosthesis  110 . 
     The fastening system  114  may include a bolt  250  and a washer  252 . The bolt  250  may have a head  260 , a threaded distal end  262 , and a shank  264  extending from the head  260  to the threaded distal end  262 . The washer  252  may have a head engagement surface  270  and a ring engagement surface  272 . Prior to use of the fastening system  114 , the stem  120  and the neck  122  may be assembled as shown in  FIGS. 2A-3 , with the tapered extension  242  of the stem  120  residing in the counterbore  244  of the bore  240  of the neck  122 . Thus, the stem  120  and the neck  122  may be provisionally attached together, for example, via a press fit between the tapered extension  242  and the counterbore  244 . 
     The bolt  250  may be inserted through the ring  138  of the bone plate  112  and into the bore  240  of the neck  122  such that the threaded distal end  262  of the bolt  250  is inserted into the threaded hole  246  of the tapered extension  242 . The head  260  may then be rotated, for example, with a driver (not shown) that mates with a complementary shape formed in the head  260 , to cause the threaded distal end  262  of the bolt  250  to engage the threads of the threaded hole  246 . The bolt  250  may be tightened such that the head  260  is drawn to compress the ring  138  and the washer  252  between the head  260  and the shoulder  248  of the neck  122 . This tightening of the bolt  250  may secure the stem  120  to the neck  122 , and may also secure the bone plate  112  to the hip prosthesis  110 . 
     After the bolt  250  has been tightened, the bone plate  112  may be deformed as needed to cause the bone plate  112  to conform more closely to the shape of the greater trochanter  108  and the proximal surface of the femur  102 . In some embodiments, the bone plate  112  may not be secured to the femur  102  until after the bone plate  112  has been secured to the hip prosthesis  110 . A pair of pliers (not shown) or other instrumentation may be used to bend the bone plate  112  to the desired shape prior to attachment of the bone plate  112  to the femur  102 . 
     In some embodiments, it may be desirable for the bone plate  112  to have a polyaxially-adjustable attachment to the hip prosthesis  110 , so that the orientation of the bone plate  112 , relative to the hip prosthesis  110 , can be adjusted via rotation about at least two orthogonal axes. Further, in some embodiments, adjustability about three orthogonal axes may be provided. The hip implant system  100  may provide such adjustability, as will be shown and described in connection with  FIG. 3 . 
       FIG. 3  shows the fastening system  114  and the first and second attachment interfaces  300 ,  310  of the hip implant system  100  of  FIGS. 1A-2B . Specifically, the portion of the hip prosthesis  110  that is secured to the bone plate  112 , i.e., the shoulder  248  of the neck  122 , may define a first attachment interface  300 . Similarly, the portion of the bone plate  112  that is secured to the hip prosthesis  110 , i.e., the ring  138 , may define a second attachment interface  310 . The first attachment interface  300  and the second attachment interface  310  may be shaped to allow the polyaxial adjustability mentioned previously. 
     Specifically, the first attachment interface  300  may be a dome with a generally semispherical shape with a first radius  320 . Similarly, the second attachment interface  310  on the bottom of the ring  138  may be a recess with a semispherical spherical shape that is complementary to that of the dome of the first attachment interface  300 . The recess may also be curved at the first radius  320 , or at a second radius that is substantially equal to the first radius  320 . Thus, before the bolt  250  is tightened, the position and orientation of the ring  138  on the shoulder  248  may be adjusted. Such adjustment may include rotation about any of three axes, for example, a longitudinal axis  350 , a lateral axis  360 , and a transverse axis  370 . Since the ring  138  may move along an arcuate pathway on the first attachment interface  300  of the shoulder  248 , such adjustment may further include some translation along the lateral axis  360  and/or the transverse axis  370 . Thus, the position and/or orientation of the bone plate  112  relative to the hip prosthesis  110  may be adjusted for optimal positioning of the bone plate  112  on the femur  102 . 
     In some embodiments, the first attachment interface  300  and the second attachment interface  310  may be textured so as to promote secure fixation together when the bolt  250  is tightened. For example, the first attachment interface  300  and the second attachment interface  310  may be knurled or otherwise roughened with any known pattern. In some embodiments, one or both of the first attachment interface  300  and the second attachment interface  310  may deform in response to tightening of the bolt  250  to provide additional secure fixation. 
     Further, any of the components of the hip implant system  100 , or any other implant system described herein, may have a coating or surface texturing that promotes bone in-growth. In some embodiment, nano-textured surfaces may be present. In some configurations, such surfaces may have protrusions and recesses that engage each other in a manner that may be termed “metal Velcro.” For example, the first attachment interface  300  and the second attachment interface  310  may each have such nano-texturing, with a matrix of protrusions and recesses on each of the first attachment interface  300  and the second attachment interface  310  such that the protrusions in each engage the recesses in the other. Thus, a very secure fixation may be obtained between the hip prosthesis  110  and the bone plate  112 . Such texturing may be used in other mating components of the any implant system described herein. 
       FIGS. 4A and 4B  illustrate two different views of a hip implant system  500  incorporating an alternative fastening system  515  configured to separately couple the bone plate  512  and the stem  520  to the hip prosthesis  510 . Specifically,  FIG. 4A  illustrates an exploded view of the hip implant system  500  and  FIG. 4B  illustrates a side view of the hip implant system  500  assembled together.  FIG. 4B  also illustrates the hip prosthesis  510  and the stem  520  as “see-through” parts, in order to better illustrate how the first and second fasteners  551 ,  553  may be utilized to couple the bone plate  512  and the stem  520  to the hip prosthesis  510 . 
     Specifically, the first fastener  551  and washer  552  may be utilized to couple the bone plate  512  to the hip prosthesis  510  via a threaded hole  555  formed in the proximal end of the hip prosthesis  510 . The stem  520  may also be separately coupled to the hip prosthesis  510  via the second fastener  553 . In the embodiment shown, the second fastener  553  may have a smaller diameter than the first fastener  551  to allow the second fastener  553  to pass through the threaded hole  555  formed in the proximal end of the hip prosthesis  510  and secure the stem  520  to the hip prosthesis  510 . The stem  520  may have a tapered extension  542  that may be inserted into a counterbore  544  formed in the distal end of the hip prosthesis  510 . The tapered extension  542  may also have a threaded hole  546  formed therein. In this manner, the stem  520  may be coupled to the hip prosthesis  510  via a press fit formed between the tapered extension  542  and the counterbore  544  as the second fastener  553  engages the threaded hole  546  formed in the tapered extension  542 . In this manner, both the bone plate  512  and the stem  520  may each be separately and independently couplable to the hip prosthesis  510 . It will also be understood that the first and second fasteners  551 ,  553  may be bolts, screws, or any other suitable fastener known in the art. 
     In at least some embodiments, the proximal end of the hip prosthesis  510  may additionally include a keyed hole and/or at least one surface configured to allow for rotational adjustment of the bone plate  512  with respect to the hip prosthesis  510 , as will be described below in more detail with respect to  FIGS. 7A-9B . 
       FIG. 5  illustrates a front elevation, section view of a hip implant system  400  coupled to an acetabular cup  420  via the hip prosthesis  110  which is also coupled to the bone plate  112 . The hip implant system  400  may be similar in construction to other hip implant systems described herein. However, the stem  401  of the hip implant system  400  may additionally include one or more transverse passages  405  formed in the distal end of the stem  401  which may be configured to receive one or more fasteners  410  therethrough in order to provide additional securement of the stem  401  to the femur  102 . 
       FIG. 6  illustrates a front elevation, section view of a hip implant system  600 , according to another embodiment of the present disclosure. The hip implant system  600  may be similar in construction to other hip implant systems described herein. However, the hip implant system  600  may additionally include an adjustable arm mechanism  634  that may be configured to adjustably couple the bone plate  612  to the hip prosthesis  110  at a plurality of different distances with respect to the hip prosthesis  110 . The adjustable arm mechanism  634  may be coupled to the hip prosthesis  110  via a first fastener  251 . The bone plate  612  may be coupled to the adjustable arm mechanism  634  via a second fastener  254 . The second fastener  254  may be configured to move the bone plate  612  toward the hip prosthesis  110  in order to compress the bone plate  612  against a greater trochanter of a femur (not shown in  FIG. 6 ), as the second fastener  254  is threadably engaged with the adjustable arm mechanism  634 . Conversely, the second fastener  254  may be configured to move the bone plate  612  away from the hip prosthesis  110  in order to decompress the bone plate  612  away from the greater trochanter of the femur, as the second fastener  254  is threadably disengaged with the adjustable arm mechanism  634 . In this manner, the adjustable arm mechanism  634  may provide for additional conformity of the bone plate  612  with respect to the greater trochanter of the femur. Moreover, in at least some embodiments, the adjustable arm mechanism  634  may be further configured to rotate about the hip prosthesis  110  via a keyed or toothed mechanism/connection (not shown in  FIG. 6 ) formed between the adjustable arm mechanism  634  and the hip prosthesis  110 , as will be discussed below in more detail with respect to  FIGS. 7A and 7B . 
       FIGS. 7A and 7B  illustrate two top views of a hip prosthesis  710 , according to another embodiment of the present disclosure. Specifically,  FIG. 7A  shows a top view of the hip prosthesis  710  illustrating a keyed hole  720  formed in the proximal end of the hip prosthesis  710  and  FIG. 7B  shows a top view of the hip prosthesis  710  coupled to a bone plate  712  via an offset arm  730 . The keyed hole  720  may include one or more recesses  740  which may be shaped and/or configured to receive one or more complementarily shaped teeth (not shown) formed on the offset arm  730  at the point where the offset arm  730  connects to the hip prosthesis  710  via insertion into the keyed hole  720 . In this manner, the bone plate  712  may be selectively rotated relative to the hip prosthesis  710  in order to adjust an angular position of the bone plate  712  with respect to the hip prosthesis  710  in order to achieve a better conformity of the bone plate  712  with a surface of the femur  102 . Moreover, the offset arm  730  may also help facilitate better positioning of the bone plate  712  with respect to the femur  102  and/or the hip prosthesis  710 , as the bone plate  712  is selectively rotated and positioned relative to the hip prosthesis  710 . Once the bone plate  712  has been selectively rotated and positioned relative to the hip prosthesis  710 , the bone plate  712  may be secured to the hip prosthesis  710  via a suitable fastener (not shown) which may be inserted through the offset arm  730  and into the keyed hole  720 . 
       FIGS. 8A and 8B  illustrate exploded views of another example hip implant system  800  including a hip prosthesis  810  and a bone plate  812  that may rotate relative to the hip prosthesis  810 . The hip implant system  800  may also include a hip stem (not shown) which may be coupled to the distal end of the hip prosthesis  810 . 
     The bone plate  812  may be coupled to the proximal end of the hip prosthesis  810  via the fastener  850  and washer  852 . The fastener  850  and washer  852  may be configured to apply a compression force to the ring  838  of the bone plate  812  in order to couple the bone plate  812  to the hip prosthesis  810 . The bone plate  812  may be rotated to any number of different discrete angular positions relative to the hip prosthesis  810  prior to securing the bone plate  812  to the hip prosthesis  810 . The distal surface  802  of the ring  838  may include one or more teeth  804  formed thereon and the proximal surface  801  of the hip prosthesis  810  may include one or more recesses  803  formed therein. The one or more teeth  804  formed on the distal surface  802  of the ring  838  may be configured to fit within the one or more recesses  803  formed in the proximal surface  801  of the hip prosthesis  810 , in order to prevent the bone plate  812  from further rotation with respect to the hip prosthesis  810  after the bone plate  812  has been secured to the hip prosthesis  810 . In this manner, the attachment interfaces between the bone plate  812  and the hip prosthesis  810  may be configured to allow for rotational adjustment of the bone plate  812  with respect to the hip prosthesis  810  to any number of different selectable discrete angular or rotational positions. 
       FIGS. 9A and 9B  illustrate exploded views of another example hip implant system  900  including an intramedullary nail  910  and a bone plate  912  that may rotate relative to the intramedullary nail  910 . The bone plate  912  may be coupled to the proximal end of the intramedullary nail  910  via the fastener  950  and washer  952 . The fastener  950  and washer  952  may be configured to apply a compression force to the ring  938  of the bone plate  912  in order to couple the bone plate  912  to the intramedullary nail  910 . The bone plate  912  may be rotated to any number of different discrete angular positions relative to the intramedullary nail  910  prior to securing the bone plate  912  to the intramedullary nail  910 . The distal surface  902  of the ring  938  may include one or more teeth  904  formed thereon and the proximal surface  901  of the intramedullary nail  910  may include one or more recesses  903  formed therein. The one or more teeth  904  formed on the distal surface  902  of the ring  938  may be configured to fit within the one or more recesses  903  formed in the proximal surface  901  of the intramedullary nail  910 , in order to prevent the bone plate  912  from further rotation with respect to the intramedullary nail  910  after the bone plate  912  has been secured to the intramedullary nail  910 . In this manner, the attachment interfaces between the bone plate  912  and the intramedullary nail  910  may be configured to allow for rotational adjustment of the bone plate  912  with respect to the intramedullary nail  910  to any number of different selectable discrete angular or rotational positions. 
     It will be understood that any other suitable features may also be implemented to achieve discrete angular or rotational adjustment of the bone plate with respect to the joint replacement prosthesis including, but not limited to: Torx shaped features, hex shaped features, or any multi-side polygon shaped features, etc. 
     In other embodiments (not shown), the attachment interfaces between the bone plate and the joint replacement prosthesis may be configured to allow for an infinite number of rotational adjustment positions between the bone plate and the joint replacement prosthesis via a friction locking mechanism. For example, each of the attachment interfaces may be textured so as to promote secure fixation when the attachment interfaces are coupled together via a compression force. For example, the attachment interfaces may be knurled, bead-blasted, sprayed with metal plasma, shot-peened, acid-etched, or otherwise roughened with any known pattern that may form interlocking positive and negative features on opposing surfaces to resist rotation and/or shear and form surfaces that are a friction-locked together. In some embodiments, one or both of the attachment interfaces may deform in response to a compression force to provide additional secure fixation. In some configurations, the attachment interfaces may have protrusions and recesses that engage each other in a manner that may be termed “metal Velcro.” For example, the attachment interfaces may each have nano-texturing, with a matrix of protrusions and recesses on each of the attachment interfaces such that the protrusions in each engage the recesses in the other. Examples of such surface texturing may be found in at least PCT Application No. PCT/US19/16697 entitled “MEDICAL IMPLANT SURFACE TREATMENT AND METHOD” filed on Feb. 5, 2019 and claiming priority to U.S. Provisional Patent Application Ser. No. 62/626,479, which was filed on Feb. 5, 2018. Both of these references are incorporated herein by reference in their entirety. 
       FIGS. 10-13  illustrate various examples of implant systems that may be configured to utilize a bone plate coupled to an implant. Specifically,  FIG. 10  illustrates an exploded view of an example hip implant system  1000  configured to utilize a bone plate that may be coupled to the implant shown in  FIG. 10 ;  FIG. 11  illustrates an exploded view of another example hip implant system  2000  configured to utilize a bone plate that may be coupled to the implant shown in  FIG. 11 ;  FIG. 12  illustrates an exploded view of another hip implant system  3000  configured to utilize a bone plate that may be coupled to the implant shown in  FIG. 12 ; and  FIG. 13  illustrates an exploded view of a humeral implant system  4000  configured to utilize a bone plate that may be coupled to the implant shown in  FIG. 13 . 
     However, it will also be understood that the implants, systems, and methods presented herein are merely exemplary. Those of skill in the art will recognize that the principles set forth herein could be applied to a wide variety of surgical procedures and implants. In particular, the implants, systems, and methods set forth herein are not limited to femoral hip implants or femoral greater trochanter plates, but may be used for a wide variety of joint arthroplasties, joint hemi-arthroplasties, and/or bone fractures. For example, such joint replacement prostheses may include, but are not limited to, femoral joint replacement prostheses, tibial joint replacement prostheses, fibular joint replacement prostheses, humeral joint replacement prostheses, clavicle joint replacement prostheses, radial joint replacement prostheses, ulnar joint replacement prostheses, digital joint replacement prostheses, intramedullary nails, etc. Moreover, each of these replacement prostheses may be combined with any bone plate system described herein. 
       FIG. 10  illustrates an exploded view of an example hip implant system  1000  configured to utilize the bone plate  112 . The hip implant system  1000  may include an intramedullary nail  1010  inserted within an intramedullary canal of the femur  102 , a first hip prosthesis member  1100  providing support to the femoral head  103  via the intramedullary nail  1010 , and a second hip prosthesis member  1200  providing additional support to the femoral head  103  via the intramedullary nail  1010 . The hip implant system  1000  may also be coupled to the bone plate  112  via the bolt  250  and washer  252 , in a similar fashion to other hip implant systems described herein. In at least one embodiment, the hip implant system  1000  may also be polyaxially-adjustable relative to the bone plate  112 , such that the bone plate  112  can be adjusted via rotation about at least two orthogonal axes. In other embodiments, the hip implant system  1000  may be polyaxially-adjustable relative to the bone plate  112  about three orthogonal axes. 
       FIG. 11  illustrates an exploded view of another example hip implant system  2000  configured to utilize the bone plate  112 . The hip implant system  2000  may include an intramedullary nail  2010  inserted within an intramedullary canal of the femur  102 , and a hip prosthesis member  2100  providing support to the femoral head  103  via the intramedullary nail  2010 . The hip implant system  2000  may also be coupled to the bone plate  112  via the bolt  250  and washer  252 , in a similar fashion to other hip implant systems described herein. In at least one embodiment, the hip implant system  2000  may be polyaxially-adjustable relative to the bone plate  112 , such that the bone plate  112  can be adjusted via rotation about at least two orthogonal axes. In other embodiments, the hip implant system  2000  may be polyaxially-adjustable relative to the bone plate  112  about three orthogonal axes. 
       FIG. 12  illustrates an exploded view of another example hip implant system  3000  configured to utilize the bone plate  112 . The hip implant system  3000  may include an intramedullary nail  3010  inserted within an intramedullary canal of the femur  102 , a first hip prosthesis member  3100  providing support to the femoral head  103  via the intramedullary nail  3010 , and a second hip prosthesis member  3200  providing additional support to the femoral head  103  via the intramedullary nail  3010 . The hip implant system  3000  may also be coupled to the bone plate  112  via the bolt  250  and washer  252 , in a similar fashion to other hip implant systems described herein. In at least one embodiment, the hip implant system  3000  may be polyaxially-adjustable relative to the bone plate  112 , such that the bone plate  112  can be adjusted via rotation about at least two orthogonal axes. In other embodiments, the hip implant system  3000  may be polyaxially-adjustable relative to the bone plate  112  about three orthogonal axes. 
       FIG. 13  illustrates an exploded view of an example humeral implant system  4000  configured to utilize the bone plate  112 . The humeral implant system  4000  may include an intramedullary nail  4010  inserted within an intramedullary canal of the humerus  105 , a first fastener  4100  and a second fastener  4200  to couple the intramedullary nail  4010  to the humerus  105 , and one or more fasteners  4300  to provide support for the humeral head  107  via the intramedullary nail  4010 . The humeral implant system  4000  may also be coupled to a bone plate  112  via the bolt  250  and washer  252  in similar fashion to other implant systems described herein. In at least one embodiment, the humeral implant system  4000  may be polyaxially-adjustable relative to the bone plate  112 , such that the bone plate  112  can be adjusted via rotation about at least two orthogonal axes. In other embodiments, the humeral implant system  4000  may be polyaxially-adjustable relative to the bone plate  112  about three orthogonal axes. 
       FIG. 14  illustrates a flowchart of a method  5000  for replacing a natural or artificial articular surface of a joint and repairing a bone associated with the joint, according to an embodiment of the disclosure. 
     The method  5000  may begin with a step  5100  in which a joint replacement prosthesis may be coupled to a bone that is associated with a joint. The joint replacement prosthesis may include any type of joint replacement prosthesis including, but not limited to, femoral joint replacement prostheses, tibial joint replacement prostheses, fibular joint replacement prostheses, humeral joint replacement prostheses, clavicle joint replacement prostheses, radial joint replacement prostheses, ulnar joint replacement prostheses, digital joint replacement prostheses, intramedullary nails, etc. 
     Once the joint replacement prosthesis has been coupled to the bone associated with a joint, the method  5000  may proceed to a step  5200  in which an articular surface of the joint may be replaced with a prosthetic articular surface of the joint replacement prosthesis. However, it will also be understood that in other embodiments, an articular surface of the joint may not be replaced with a prosthetic articular surface of the joint replacement prosthesis. For example, a hip joint replacement prosthesis that comprises an intramedullary nail may not include any additional structures that may replace an articular surface of the hip joint with a prosthetic articular surface. 
     Once the articular surface of the joint may have been replaced with a prosthetic articular surface of the joint replacement prosthesis, the method  5000  may proceed to a step  5300  in which a bone plate may be coupled to the joint replacement prosthesis. The bone plate may be coupled to the joint replacement prosthesis via any method described herein, or via any other suitable method known in the art. 
     Once the bone plate has been coupled to the joint replacement prosthesis, the method  5000  may proceed to a step  5400  in which the bone plate may be secured proximate a damaged area of the bone, in order to facilitate repair of the damaged area of the bone associated with the joint. In at least one embodiment, the damaged area of the bone may include a fracture that is formed in the bone associated with the joint. 
     Alternatively, or in addition thereto, the method  5000  may proceed to a step  5500  in which at least a portion of the bone plate may be bent in order to shape the bone plate to conform to at least one surface of the bone associated with the joint. The bone plate may be bent prior to being secured proximate the damaged area of the bone. 
     Alternatively, or in addition thereto, the method  5000  may proceed to a step  5600  in which the bone plate may be translated with respect to an arm of the bone plate. The bone plate may also be compressed against the at least one surface of the bone associated with the joint, prior to securing the bone plate to the bone associated with the joint. 
     Alternatively, or in addition thereto, the method  5000  may proceed to a step  5700  in which the bone plate may be rotated to a desired position with respect to the joint replacement prosthesis, prior to securing the bone plate to the bone associated with the joint. The bone plate may be rotated with respect to the joint replacement prosthesis according to discrete or infinite rotational positions, as described herein, and the method  5000  may end. 
     Any methods disclosed herein comprise one or more steps or actions for performing the described method. One or more of the method steps and/or actions may be omitted from any of the methods disclosed herein. Moreover, any of the method steps and/or actions may be interchanged with one another. In other words, unless a specific order of steps or actions is required for proper operation of the embodiment, the order and/or use of specific steps and/or actions may be modified. 
     Reference throughout this specification to “an embodiment” or “the embodiment” means that a particular feature, structure or characteristic described in connection with that embodiment is included in at least one embodiment. Thus, the quoted phrases, or variations thereof, as recited throughout this specification are not necessarily all referring to the same embodiment. 
     Similarly, it should be appreciated that in the above description of embodiments, various features are sometimes grouped together in a single embodiment, Figure, or description thereof for the purpose of streamlining the disclosure. This method of disclosure, however, is not to be interpreted as reflecting an intention that any claim require more features than those expressly recited in that claim. Rather, as the following claims reflect, inventive aspects lie in a combination of fewer than all features of any single foregoing disclosed embodiment. Thus, the claims following this Detailed Description are hereby expressly incorporated into this Detailed Description, with each claim standing on its own as a separate embodiment. This disclosure includes all permutations of the independent claims with their dependent claims. 
     Recitation in the claims of the term “first” with respect to a feature or element does not necessarily imply the existence of a second or additional such feature or element. Elements recited in means-plus-function format are intended to be construed in accordance with 35 U.S.C. § 112 Para. 6. It will be apparent to those having skill in the art that changes may be made to the details of the above-described embodiments without departing from the underlying principles set forth herein. 
     While specific embodiments and applications of the present disclosure have been illustrated and described, it is to be understood that the scope of the appended claims is not limited to the precise configuration and components disclosed herein. Various modifications, changes, and variations which will be apparent to those skilled in the art may be made in the arrangement, operation, and details of the methods and systems disclosed herein.