Source: https://patents.google.com/patent/US8764759B2/en
Timestamp: 2019-07-23 05:22:12
Document Index: 27889247

Matched Legal Cases: ['Application No. 05855250', 'Application No. 06836779', 'Application No. 2005319139', 'Application No. 2005319139', 'Application No. 2007', 'Application No. 2', 'Application No. 05855250']

US8764759B2 - Distal femoral trial with removable cutting guide - Google Patents
US8764759B2
US8764759B2 US13/101,609 US201113101609A US8764759B2 US 8764759 B2 US8764759 B2 US 8764759B2 US 201113101609 A US201113101609 A US 201113101609A US 8764759 B2 US8764759 B2 US 8764759B2
US13/101,609
US20110213378A1 (en
2011-05-05 Application filed by Smith and Nephew Inc filed Critical Smith and Nephew Inc
2011-09-01 Publication of US20110213378A1 publication Critical patent/US20110213378A1/en
2014-02-26 Assigned to SMITH & NEPHEW, INC. reassignment SMITH & NEPHEW, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: DEES, ROGER RYAN
2014-07-01 Publication of US8764759B2 publication Critical patent/US8764759B2/en
This application is a United States Divisional filing of U.S. application Ser. No. 11/316,255 filed on Dec. 21, 2005, now U.S. Pat. No. 7,963,968, which claims benefit of U.S. Patent Application Ser. No. 60/638,185 filed Dec. 21, 2004 titled Distal-Femoral Prosthetic Trial and Resection Guide, the entire contents of both of which are hereby incorporated by reference.
Typically, the posterior bone removed from the distal femur to accommodate the cam housing discussed above is removed using a cutting block and collet configuration. One example is shown and described by U.S. Pat. No. 5,810,829 to Elliott et al., entitled, “POSTERIOR STABILIZED/CONSTRAINED REAMER GUIDE”, the entire contents of which are hereby incorporated by reference. The cutting block is placed on the patient's femur with bone spikes and used to make anterior/posterior chamfer cuts. A rotary reamer is then inserted through a collet in the block to prepare the femur for the cam housing (to cut the central box geometry). A box chisel can then be used to complete the preparation. All of this preparation is done using the cutting block as the reference guide.
FIG. 4A shows a side perspective view of an alternate embodiment of a trial that may be used according to various embodiments of the invention.
FIG. 4B shows a side perspective view of an alternate cutting block that may be used according to various embodiments of the invention.
FIG. 1 shows a femoral trial component 12, a cutting guide 50, and retaining bolts 80, collectively referred to as assembly 10. FIG. 7 shows an alternate femoral trial component 112 and cutting guide 150, collectively referred to as assembly 100. In both embodiments, the trial 12, 112 is made with the same or similar proximal and anterior/posterior box geometry as the prosthesis that will be used so that it fits the geometry of the surface of the femur that has already been resected. It also has the same articulating surface as the prosthesis except that there is an opening to accommodate a cutting guide to prepare the central stabilizing/constraining box geometry. As shown in FIG. 7, the trial may also include various cutting slots 114, allowing the trial to also be used to prepare various resections on the femur. This feature is optional and although only shown with response to the embodiment shown in FIG. 7, may be used on any trial made according to various aspects of this invention.
In a specific embodiment, the trial 12 has two condylar regions 14 and an anterior patellar region 34 with an articulating surface 36. The condylar regions 14 define an opening 16. This opening 16 is where the distal femur is prepared to receive an implant having a cam that cooperates with a tibial post. An example of the cam portion 202 of an actual implant 200 is shown in FIGS. 3A and 3B. The bone of the femur must be prepared to make room to receive this cam 202, and the opening 16 in trial 12 allows the space for instruments to pass during preparation.
As best seen in FIGS. 4A and 4B, another embodiment of trial 12′ may have one or more slight indentations 21 at the posterior end of the trial that provide stopping points to allow a post 23 of cutting block 50′ to sit into as cutting block 50′ is moved into position. For example, the indentation could receive a movable securing pin of the cutting guide that secures the cutting guide in place with respect to trial 12 without the need to use bolts 80, the use of which are described in more detail below. Further connection mechanisms may be used also; the general concept is to provide a trial and a cutting block that are securable in a fixed position, but where that fixed position is adjustable before being secured.
The reamer used typically is side cutting, so anterior/posterior resection is carried out until the cutter reaches both A/P stops. If the stops are positioned so that NP freedom is not allowed, then side cutting or resecting in an A/P direction is not needed. This depends on the size and design of the trial.
Another way that the A/P distance that block is allowed to travel with respect to trial can be controlled is to insert bone spikes or screws directly into the distal bone, through the directional limit slots without the use of bolts 80 or through any other area of the trial, which would secure the assembly and eliminate the need to use bolts as A/P translation stops. An alternate embodiment would be to insert bone spikes or screw through cannulated bolts 80.
1. A method for preparing a distal femur to receive a posterior stabilized prosthesis, comprising:
(a) resecting and preparing a patient's distal femur with anterior and posterior cuts;
(b) positioning a femoral trial component on the distal femur, the trial component comprising (i) condylar regions separated by an opening, the opening defining a central portion with an anterior-most portion and opening side edges and (ii) a removable cutting guide adapted to be received by the opening and secured in the opening in a fixed relationship with the anterior-most portion of the opening;
(c) securing the removable cutting guide in a fixed relationship relative to the opening prior to the step of preparing the patient's distal femur;
(d) preparing the patient's distal femur to receive a posterior stabilized prosthesis using the removable cutting guide to guide at least one cutting instrument; and
(e) controlling the at least one cutting instrument in an anterior/posterior direction wherein the step of controlling the at least one cutting instrument in an anterior/posterior direction is controlled by a length of the cutting guide.
2. The method of claim 1, further comprising the step of pinning the femoral trial component in place.
3. The method of claim 1, further comprising the step of threading at least one retaining bolt into a receiving portion of the femoral trial component.
4. The method of claim 1, further comprising the step of placing at least one bone spike through the femoral trial component.
5. A method for preparing a distal femur to receive a posterior stabilized prosthesis, comprising:
(b) positioning a femoral trial component on the distal femur, the trial component comprising condylar regions separated by an opening, the opening defining a central portion with an anterior-most portion and opening side edges;
(c) receiving a removable cutting guide by the opening;
(d) adjusting the removable cutting guide in an anterior/posterior direction and within a pre-defined space; and
(e) securing the removable cutting guide in the opening in a fixed relationship relative to the opening after adjusting the removable cutting guide in an anterior/posterior direction and prior to cutting using the cutting guide.
6. The method of claim 5, further comprising the step of preparing the patient's distal femur to receive a posterior stabilized prosthesis using the removable cutting guide to guide cutting instruments and moving a reamer between an anterior stop and a posterior stop within an internal box geometry.
7. The method of claim 5, wherein the step of adjusting the removable cutting guide in an anterior/posterior direction comprises positioning the cutting guide using directional limit slots to achieve a desired anterior/posterior position on the femoral trial component.
8. The method of claim 1, further comprising the steps of removing the cutting guide from the femoral trial component, verifying additional preparation is needed without removing the femoral trial component, and replacing the cutting guide in substantially the same prior position.
9. A method for preparing a distal femur to receive a posterior stabilized prosthesis, comprising:
(b) positioning a femoral trial component on the distal femur, the trial component comprising (i) condylar regions separated by an opening, the opening defining a central portion with an anterior-most portion and opening side edges and (ii) a removable cutting guide adapted to be received by the opening and secured in the opening in adjustable relation to the anterior-most portion of the opening, the removable cutting guide having a rectangular box shape and an internal rectangular box that accepts at least one cutting instrument;
(c) securing the removable cutting guide in a fixed relationship relative to the opening prior to the step of preparing a box geometry of the patient's distal femur;
(d) preparing a box geometry of the patient's distal femur to receive a posterior stabilized prosthesis using the internal rectangular box of the removable cutting guide to guide the at least one cutting instrument; and
(e) controlling a depth of the box geometry in an anterior/posterior direction.
10. The method of claim 9, wherein the step of controlling the depth of the box geometry in an anterior/posterior direction is controlled by a length of the cutting guide.
11. The method of claim 9, further comprising the step of pinning the femoral trial component in place.
12. The method of claim 9, further comprising the step of threading at least one retaining bolt into a receiving portion of femoral trial component.
13. The method of claim 9, further comprising the step of placing at least one bone spike through the femoral trial component.
14. The method of claim 9, further comprising the steps of removing the cutting guide from the femoral trial component, verifying additional preparation is needed without removing the femoral trial component, and replacing the cutting guide in substantially the same prior position.
15. The method of claim 5, wherein the step of receiving a removable cutting guide by the opening includes the step of sliding the cutting guide into place along orientation slots.
16. The method of claim 5, further comprising the step of preparing the patient's distal femur to receive a posterior stabilized prosthesis using the removable cutting guide to guide cutting instruments.
17. The method of claim 5, wherein the step of adjusting the removable cutting guide in an anterior/posterior direction comprises making an adjustment relative to the anterior-most portion of the opening.
18. A method for preparing a distal femur to receive a posterior stabilized prosthesis, comprising:
(e) securing the removable cutting guide in the opening after adjusting the removable cutting guide in an anterior/posterior direction, wherein the femoral trial component has a plurality of stopping points and wherein the steps of adjusting the removable cutting guide in an anterior/posterior direction and securing the removable cutting guide in the opening comprises moving the cutting guide relative to the femoral trial component and moving a securing pin into a portion of at least one of the plurality of stopping points.
19. The method of claim 18, further comprising the step of preparing the patient's distal femur to receive a posterior stabilized prosthesis using the removable cutting guide to guide cutting instruments and moving a reamer between an anterior stop and a posterior stop within an internal box geometry.
20. The method of claim 18, wherein the step of adjusting the removable cutting guide in an anterior/posterior direction comprises positioning the cutting guide using directional limit slots to achieve a desired anterior/posterior position on the femoral trial component.
21. The method of claim 18, further comprising the steps of removing the cutting guide from the femoral trial component, verifying additional preparation is needed without removing the femoral trial component, and replacing the cutting guide in substantially the same prior position.
22. A method for preparing a distal femur to receive a posterior stabilized prosthesis, comprising:
(e) securing the removable cutting guide in the opening after adjusting the removable cutting guide in an anterior/posterior direction, wherein the femoral trial component opening has an anterior abutment portion and further comprising the step of releasing an anterior abutment pin of the cutting guide such that the pin engages the anterior abutment portion.
23. The method of claim 22, further comprising the step of preparing the patient's distal femur to receive a posterior stabilized prosthesis using the removable cutting guide to guide cutting instruments and moving a reamer between an anterior stop and a posterior stop within an internal box geometry.
24. The method of claim 22, wherein the step of adjusting the removable cutting guide in an anterior/posterior direction comprises positioning the cutting guide using directional limit slots to achieve a desired anterior/posterior position on the femoral trial component.
25. The method of claim 22, further comprising the steps of removing the cutting guide from the femoral trial component, verifying additional preparation is needed without removing the femoral trial component, and replacing the cutting guide in substantially the same prior position.
26. A method for preparing a distal femur to receive a posterior stabilized prosthesis, comprising:
(c) selecting at least one of a plurality of removable cutting guides, each of the plurality of removable cutting guides having a different length;
(d) receiving the at least one removable cutting guides by the opening; and
(e) securing the at least one removable cutting guide in the opening in a fixed relationship relative to the opening after adjusting the removable cutting guide in an anterior/posterior direction and prior to cutting using at least one of a plurality of removable cutting guides.
27. The method of claim 26, further comprising the step of pinning the femoral trial component in place.
28. The method of claim 26, further comprising the step of placing at least one bone spike through the femoral trial component.
29. The method of claim 26, further comprising the steps of removing the cutting guide from the femoral trial component, verifying additional preparation is needed without removing the femoral trial component, and replacing the cutting guide in substantially the same prior position.
US13/101,609 2004-12-21 2011-05-05 Distal femoral trial with removable cutting guide Active US8764759B2 (en)
US11/316,255 Division US7963968B2 (en) 2004-12-21 2005-12-21 Distal femoral trial with removable cutting guide
US14/317,048 Continuation US9044249B2 (en) 2004-12-21 2014-06-27 Distal femoral trial with removable cutting guide
US20110213378A1 US20110213378A1 (en) 2011-09-01
US8764759B2 true US8764759B2 (en) 2014-07-01
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Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:DEES, ROGER RYAN;REEL/FRAME:032301/0607