Source: https://patents.google.com/patent/US9913734B2/en
Timestamp: 2019-04-26 14:22:44+00:00

Document:
An acetabular device includes a patient-specific acetabular alignment guide including a bone engagement surface. The bone engagement surface has a first portion configured and shaped to be conforming and complementary to an acetabular rim surface and a second portion configured and shaped to be conforming and complementary to a periacetabular area of an acetabulum of a patient. The acetabular alignment guide includes a plurality of guiding formations extending through the second portion for guiding a plurality of alignment pins therethrough. The bone engagement surface and the plurality of guiding formations are prepared from a three-dimensional model of the acetabulum of the specific patient reconstructed pre-operatively from a scan of the patient.
This application is a continuation-in-part of U.S. application Ser. Nos. 13,041,469, 13/041,495, 13/041,665 and 13/041,883, each filed on Mar. 7, 2011, each of which is a continuation-in-part of U.S. application Ser. No. 12/978,069 filed Dec. 23, 2010, which is a continuation-in-part of U.S. application Ser. No. 12/973,214, filed Dec. 20, 2010, which is a continuation-in-part of U.S. application Ser. No. 12/955,361 filed Nov. 29, 2010, which is a continuation-in-part of U.S. application Ser. Nos. 12/938,913 and 12/938,905, both filed Nov. 3, 2010, each of which is a continuation-in-pan of U.S. application Ser. No. 12/893,306, filed Sep. 29, 2010, which is a continuation-in-part of U.S. application Ser. No. 12/888,005, filed Sep. 22, 2010, which is a continuation-in-part of U.S. application Ser. No. 12/714,023, filed Feb. 26, 2010, which is a continuation-in-part of U.S. application Ser. No. 12/571,969, filed Oct. 1, 2009, which is a continuation-in-part of U.S. application Ser. No. 12/486,992, filed Jun. 18, 2009, and is a continuation-in-part of U.S. application Ser. No. 12/389,901, filed Feb. 20, 2009, which is a continuation-in-part of U.S. application Ser. No. 12/211,407, filed Sep. 16, 2008, which is a continuation-in-part of U.S. application Ser. No. 12/039,849, filed Feb. 29, 2008, which: (1) claims the benefit of U.S. Provisional Application No. 60/953,620, filed on Aug. 2, 2007, U.S. Provisional Application No. 60/947,813, filed on Jul. 3, 2007, U.S. Provisional Application No. 60/911,297, filed on Apr. 12, 2007, and U.S. Provisional Application No. 60/892,349, filed on Mar. 1, 2007; (2) is a continuation-in-part U.S. application Ser. No. 11/756,057, filed on May 31, 2007, which claims the benefit of U.S. Provisional Application No. 60/812,694, filed on Jun. 9, 2006; (3) is a continuation-in-part of U.S. application Ser. No. 11/971,390, filed on Jan. 9, 2008, which is a continuation-in-part of U.S. application Ser. No. 11/363,548, filed on Feb. 27, 2006, now U.S. Pat. No. 7,780,672, issued on Aug. 24, 2010; and (4) is a continuation-in-part of U.S. application Ser. No. 12/025,414, filed on Feb. 4, 2008, which claims the benefit of U.S. Provisional Application No. 60/953,637, filed on Aug. 2, 2007.
The present teachings generally provide a patient-specific acetabular guide and associated inserter for use in orthopedic surgery, such as in joint replacement or revision surgery, for example. The patient-specific alignment guides can be used either with conventional or patient-specific implant components prepared with computer-assisted image methods. Computer modeling for obtaining three dimensional images of the patient's anatomy using MRI or CT scans of the patient's anatomy, the patient-specific prosthesis components, and the patient-specific guides and templates can be provided by various CAD programs and/or software available, for example, by Materialise U.S.A., Ann Arbor, Mich.
Referring to FIG. 2, the inserter 300 with the acetabular implant 200 mounted thereon eon can be directed toward the acetabular guide 100. The outer surface 312 of the guide engaging portion 310 of the inserter 300 can be brought into contact with the inner surface 102 of the acetabular guide 100, guiding the acetabular implant 200 toward the selected anteversion and abduction orientation through the acetabular guide 100. The outer surface 312 of the guide engaging portion 310 can also provide an impaction-depth feedback by alignment with the inner surface 102 of the acetabular guide. Full impaction of the acetabular implant 200 into the acetabulum 82 can be indicated when planar portion 320 and/or outer surface 312 of the guide-engaging portion 310 of the inserter 300 are flush with and do not protrude over and above the second surface 110 of the acetabular guide 100. Depth indicia 322 can also be provided on the inserter shaft 302 or on the guide-engaging portion 310 of the inserter 300, as shown in FIG. 2.
Referring to FIG. 7, after the alignment pins 420 have been inserted into the bone, the acetabular alignment guide 400 can be removed. An acetabular positioner or inserter or inserter/impactor 450 can be guided by the alignment pins 420 for inserting the acetabular implant 200 in the acetabulum. The inserter 450 can include a handle 451 with a knob 453 and a shaft 452 coupled to a patient-specific alignment adapter 470. The patient-specific alignment adapter 470 can include an arm 474 defining a plurality of alignment apertures 478 complementary to the alignment pins 420, such that the alignment adapter 470 can removably slide over the alignment pins 420. In this respect, the shape and size of the arm 474 and the placement, arrangement and configuration of the alignment apertures 478 can be determined during the pre-operative operative plan to correspond to the guiding formations 406 of the acetabular alignment guide 400. The alignment adapter 470 can include a coupling opening 472 for removably receiving the shaft 452 of the inserter 450 or can be integrally coupled to the shaft 452 of the inserter 450. The coupling opening 472 can be, for example, an interference fitting or snap-on side slot. Alternatively, the coupling opening 472 can be an enclosed hole, which receives the shaft 452 of the inserter 450, when the shaft is modularly coupled to the inserter 450. The inserter 450 can be connected to and disconnected from the acetabular implant 200 with a coupler 480 at the distal end of the shaft 452 by rotating the knob 453. The coupler 480 can also be modularly connected to the shaft 452. During insertion of the acetabular implant 200, the alignment pins 420 help stabilize, guide and secure the orientation of the inserter/impactor 450 and acetabular implant 200 and place the acetabular implant 220 in the desired position and orientation relative to the acetabulum 82 as determined during the pre-operative plan using imaging scans of the patient.
Referring to FIGS. 11A to 12, another patient-specific acetabular guide 400′ is illustrated for use with a reamer 331′. As discussed above in connection with acetabular guides 100 and 400, the acetabular guide 400′, can include a first portion 402′ configured and adapted to be positioned around the rim surface 84 of the acetabulum 82 and a second portion 404′ configured and adapted to be positioned around the periacetabular area of the pelvis 80 of a specific patient. The acetabular alignment guide 400′ can include a three-dimensional curved patient-specific bone engagement surface 408′, which is the underside surface of the first and second portions 402′, 404′ that nestingly mates with the specific patients anatomy. In the exemplary embodiment illustrated in FIG. 11A, the first portion 402′ can extend around the entire inner rim surface 84 of the acetabulum and at least a portion of the acetabulum 82. Similarly, the second portion 404′ can extend around the entire periacetabular area around the acetabulum 84 when additional stability and attachment area is desired for the particular patient or preferred by the surgeon. The bone engagement surface 408′ can be designed to match complementarily to portions of the acetabular rim surface 84, of the acetabulum 82 and of an adjacent periacetabular area of the pelvis 80 of the patient for close contact/nesting thereon in only one position and orientation. The second portion 404′ of the acetabular alignment guide 400 is also designed during the pre-operative plan to define a plurality of elongated through-slots, apertures or other guiding formations or holes 406′ directed toward the periacetabular area for guiding a plurality of alignment pins 420 parallel to the pre-determined acetabular centering axis CC, as discussed above in connection with FIGS. 5-7. After the alignment pins 620 are secured to the bone, the acetabular guide 400′ can be removed leaving the alignment pins 420 for use with a reamer, as discussed below.
Referring to FIG. 12, a non-custom reamer 331″ can be coupled with a patient-specific adapter 470″ designed to slide over the alignment pins 420, after the alignment pins 420 are secured on the patient's pelvis 80 in a patient-specific configuration, position and orientation, which also determines the acetabular centering axis CC, as discussed above in connection with FIGS. 5-7. In the embodiment illustrated in FIG. 12, the adapter 470″ can be monolithic and include two arms 474″ for receiving respectively two alignment pins 420 through corresponding openings 478″, although different number of arms 474″ can be used and each arm 474″ can include more than one opening 478″ for receiving more than one pin 420. The adapter 470″ can by coupled to the reamer 331″ with a quick-connect to the shaft of the reamer 331″, as described above in relation to FIGS. 4A-4G, or with another type of connection 335″, such as snap-fit or threadable socket or bayonet coupling. The reamer 331″ can be of the blade type, including reaming blades 333. In one embodiment, the blades 333″ can be removable, replaceable and/or disposable. Each blade 333″ can be semicircular or quarter-circular and can be attached to a chuck or other support 337″ of the reamer 331″ with set screws or grooves or jaws.
wherein the first arm and the second arm are parallel to each other.
3. The device of claim 2, in combination with the acetabular instrument.
4. The device of claim 3, wherein the acetabular instrument comprises an acetabular reamer and a shaft comprising the first and second components of the acetabular instrument, respectively, wherein the acetabular reamer and the shaft are configured to be connected at the quick-connection component.
5. The acetabular device of claim 2, wherein the first and second arms are integral to each other.
6. The acetabular device of claim 2, wherein the first and second arms are independently rotatable relative to the quick-connection component about a common axis of rotation.
7. The acetabular device of claim 6, wherein the acetabular guide includes a third guide formation.
8. The acetabular device of claim 2, wherein the quick-connection component comprises a quick-coupling opening through the first arm and the second arm.
9. The acetabular device of claim 8, wherein the acetabular instrument comprises a reamer having a shaft extending through the quick-coupling opening.
10. The acetabular device of claim 2, wherein the quick-connection component comprises one of a snap-fit, a threadable socket and a bayonet coupling.
11. The acetabular device of claim 10, wherein the acetabular instrument comprises a hemispherical reamer.
the first and second guide formations are configured to be co-axial with the first and second guiding openings, respectively.
13. The acetabular device of claim 1, wherein the plurality of guiding formations are arranged and configured parallel to a patient-specific acetabular centering axis extending through a center of the acetabulum based on a pre-operative plan for the patient.
14. The acetabular device of claim 1, wherein the patient-specific alignment adapter includes a quick-connection component for receiving the acetabular instrument.
15. The acetabular device of claim 14, wherein the quick-connection component comprises a through-bore for receiving a shaft of a patient-specific reamer.
16. The acetabular device of claim 14, wherein the quick-connection component comprises one of a snap-fit, a threadable socket and a bayonet coupling for receiving a non-custom reamer.
wherein the first arm and the second arm are parallel to each other and perpendicular to the patient-specific centering axis.
the second portion is configured and shaped to be conforming and complementary to the periacetabular area of the acetabulum of the specific patient in accordance with the three-dimensional model of the acetabulum of the specific patient reconstructed pre-operatively from the image scan of the patient.
19. The acetabular device of claim 17, wherein the patient-specific alignment adapter is couplable to the acetabular instrument via a quick-connection component located on the patient-specific alignment adapter.

References: Application No. 60
 Application No. 60
 Application No. 60
 Application No. 60
 Application No. 60
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