Source: https://patents.google.com/patent/US9597090B2/en
Timestamp: 2019-10-21 07:40:55
Document Index: 251260297

Matched Legal Cases: ['§119', '§119', '§119', '§119', 'art 1304', 'art 1580', 'art 1580', 'art 1580', 'art 1580', 'art 1580']

US9597090B2 - Cut guide attachment for use in tibial prosthesis systems - Google Patents
US9597090B2
US9597090B2 US14/304,009 US201414304009A US9597090B2 US 9597090 B2 US9597090 B2 US 9597090B2 US 201414304009 A US201414304009 A US 201414304009A US 9597090 B2 US9597090 B2 US 9597090B2
US14/304,009
US20140296859A1 (en
2014-06-13 Application filed by Zimmer Inc filed Critical Zimmer Inc
2014-10-02 Publication of US20140296859A1 publication Critical patent/US20140296859A1/en
2014-10-23 Priority claimed from EP14190180.1A external-priority patent/EP2918235B1/en
2015-05-13 Assigned to MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH reassignment MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: LEWALLEN, David
2015-05-13 Assigned to ZIMMER, INC. reassignment ZIMMER, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: CLAYPOOL, JODY L, STUMP, STEVEN E, PAPROSKY, WAYNE
2015-05-13 Assigned to ZIMMER, INC. reassignment ZIMMER, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: WHITE, STEPHEN E
2015-05-13 Assigned to ZIMMER, INC. reassignment ZIMMER, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH
2017-03-21 Publication of US9597090B2 publication Critical patent/US9597090B2/en
210000002303 Tibia Anatomy 0 abstract claims description 90
210000000629 knee joint Anatomy 0 abstract claims description 66
238000002271 resection Methods 0 abstract claims description 52
238000004513 sizing Methods 0 description 21
This application claims the benefit of priority under 35 U.S.C. §119(e) of U.S. Provisional Patent Application Ser. No. 61/895,825, entitled “CUT GUIDE ATTACHMENT FOR USE IN TIBIAL PROSTHESIS SYSTEMS,” filed on Oct. 25, 2013, which is herein incorporated by reference in its entirety. This application is a continuation-in-part of U.S. patent application Ser. No. 14/063,032, entitled “PROVISIONAL TIBIAL PROSTHESIS SYSTEM,” filed on Oct. 25, 2013, which is a continuation of U.S. patent application Ser. No. 13/087,610, entitled “PROVISIONAL TIBIAL PROSTHESIS SYTEM,” filed on Apr. 15, 2011, which claims the benefit of priority under 35 U.S.C. §119(e) of U.S. Provisional Patent Application Ser. No. 61/424,222, entitled “USER INTERFACE RELATED TO A SURGICAL PROVISIONAL,” filed on Dec. 17, 2010, each of which is herein incorporated by reference in its entirety. This application is a continuation-in-part of U.S. patent application Ser. No. 13/836,665, entitled “TIBIAL PROSTHESIS SYSTEMS, KITS, AND METHODS,” filed on Mar. 15, 2013, which claims the benefit of priority under 35 U.S.C. §119(e) of U.S. Provisional Patent Application Ser. No. 61/618,376, entitled “TIBIAL PROSTHESIS SYSTEMS, KITS, AND METHODS,” filed on Mar. 30, 2012, and also claims the benefit of priority under 35 U.S.C. §119(e) of U.S. Provisional Patent Application Ser. No. 61/740,268, entitled “TIBIAL PROSTHESIS SYSTEMS, KITS, AND METHODS,” filed on Dec. 20, 2012, each of which is herein incorporated by reference in its entirety.
This patent document pertains generally to provisional tibial prosthesis systems, kits, and methods, including one or more provisional tibial components that can collectively be used to replicate permanent (or final) tibial components or mimic bone cuts believed to be necessary during a surgical procedure. It is believed that the provisional tibial components can also be designed for, or find use as, permanent tibial components. Thus, while this disclosure relates to provisional uses of the present tibial prosthesis systems, kits, and methods, it should be appreciated that such subject matter can also find use in permanent applications. When used provisionally, the tibial prosthesis systems, kits, and methods disclosed herein can assist in determining a proper hone cut angle to be made (e.g., to a tibia or a femur) or a size, shape, or other configuration of a permanent tibial prosthesis system that is designed to replace all or a portion of a knee joint. The present tibial prosthesis systems, kits, and methods can be used in conjunction with one or both of a permanent tibial prosthesis system, as disclosed in U.S. Provisional Patent Application Ser. No. 61/381,800, filed on Sep. 10, 2010 and entitled “TIBIAL PROSTHESIS FACILITATING ROTATIONAL ALIGNMENT,” or a shim handling instrument and user-interface, as disclosed in U.S. Provisional Patent Application Ser. No. 61/424,222, filed on Dec. 17, 2010 and entitled “USER INTERFACE RELATED TO A SURGICAL PROVISIONAL,” the entire disclosures of each of which are hereby expressly incorporated by reference herein.
FIGS. 22C-22D are perspective views of an example of a cut guide attachment and a tibial prosthesis system, as constructed in accordance with a least one embodiment.
The provisional tibial prosthesis system of the present disclosure may be used with a final tibial prosthesis in accordance with the tibial prosthesis described in U.S. patent application Ser. No. 61/381,800, filed Sep. 10, 2010 entitled “Tibial Prosthesis Facilitating Rotational Alignment,” the entire disclosure of which is hereby expressly incorporated herein by reference. Further, the provisional tibial prosthesis system of the present disclosure may be used with the method and apparatus described in U.S. patent application Ser. No. 61/424,222, filed Dec. 17, 2010, entitled “User Interface Related to a Surgical Provisional,” the entire disclosure of which was previously incorporated herein by reference.
FIG. 6 illustrates a natural knee comprising proximal tibial T and distal femur F. FIG. 6 depicts a coordinate system of the natural knee including anterior/posterior axis AA-P, medial/lateral axis AM-L, and proximal/distal axis AP,D. Anterior/posterior axis AA-P corresponds to anterior/posterior direction 20, medial/lateral axis AM-L corresponds to medial/lateral direction 22, and proximal/distal axis AP,D corresponds to proximal/distal direction 24. Anterior/posterior direction 20, medial/lateral direction 22, and proximal/distal direction 24 are each normal to one another. As used herein, “proximal” refers to a direction generally toward the heart of a patient, and “distal” refers to the opposite direction of proximal, away from the heart of the patient. Further, as used herein, “anterior” refers to a direction generally toward the front of a patient, and “posterior” refers to the opposite direction of anterior, i.e., toward the back of a patient. As used herein, “medial” refers to a direction generally toward the middle of a patient, and “lateral” refers to the opposite direction of medial, i.e., toward the side of a patient. For purposes of this disclosure, the above-mentioned anatomical references are used in the description of the components of the provisional tibial prosthesis system with reference to a desired operable use of the components in the body.
The common elements between the eleven described exemplary embodiments follow a similar reference number labeling scheme. For example, the first exemplary embodiment, as illustrated in FIGS. 2A-2D, includes tibial bearing component 32A generally including tibial bearing component inferior surface 42A, opposing tibial bearing component superior surface 44A, and tibial bearing component peripheral wall 46A extending from inferior surface 42A to superior surface 44A. Tibial bearing component 32A includes bearing anterior side 48A, bearing posterior side 50A, bearing lateral side 52A, and bearing medial side 54A. Superior surface 44A is adapted to articulate with condyles of a distal femur F (shown in FIGS. 6-8), or condyles of a femoral component (not shown) secured to a distal end of a femur. Superior surface 44A includes bearing lateral articular surface 56A in bearing lateral side 52A and bearing medial articular surface 58A in bearing medial side 54A, with central tibial eminence 60A disposed between bearing articular surfaces 56A, 58A. Referring to FIG. 2A, eminence 60A generally corresponds in shape and size with the natural tibial eminence of a proximal tibial T (shown in FIGS. 6-8) prior to resection. Tibial bearing component 32A further includes PCL cut-out 62A disposed at posterior side 50A between lateral articular surface 56A and medial articular surface 58A. PCL cut-out 62A is sized and positioned to correspond with a posterior cruciate retaining ligament of a knee joint.
FIG. 5 illustrates tibial base plate 38A according to an exemplary embodiment of the present disclosure. Tibial base plate 38A generally includes base plate superior surface 150A and opposing base plate bone contacting surface 152A. Tibial base plate 38A closely corresponds in size and shape with the resected proximal tibia surface, and includes base plate peripheral wall 156A extending from bone contacting surface 152A to superior surface 150A. Base plate peripheral wall 156A includes raised perimeter 158A and tibial base plate 38A includes base plate anterior side 166A, base plate posterior side 168A, base plate medial side 170A, and base plate lateral side 172A. Superior surface 150A includes medial condylar portion 160A and lateral condylar portion 162A. Base plate 38A further includes PCL cutout 164A disposed at posterior side 168A between medial condylar portion 160A and lateral condylar portion 162A to allow a posterior cruciate retaining ligament of a knee joint to pass therethrough. Further, tibial base plate 38A includes boss 174A having boss medial sides 176A and boss lateral sides 178A. Further, an interior recess is formed between inner medial side 176A and inner lateral side 178A.
The manner in which tibial base plate 38A is attached to a proximal tibia will now be discussed. The proximal portion of a patient's tibia is resected to provide a substantially flat surface for receipt of bone contacting surface 152A of tibial base plate 38A. Once the proximal tibia is resected, tibial base plate 38A is implanted and secured to the resected proximal tibia using standard surgical techniques. For example, conventional features such as a stem and fins may be located on bone contacting surface 152. to affect securement of tibial base plate 38A to a proximal tibia. While tibial base plate 38A is part of the provisional prosthesis system disclosed herein, tibial base plate 38A may also be part of a final prosthesis system, i.e., tibial base plate 38A is the final base plate implanted to a resected proximal tibia. Tibial base plate 38A may also be part of any other tibia contacting implement utilized in knee arthroplasty. For example, tibial base plate 38A could be part of a tibial sizing plate system in accordance with the tibial sizing plate described in U.S. Pat. No. 7,850,698, issued Dec. 14, 2010, entitled “Tibial Trialing Assembly and Method of Trialing a Tibial Implant,” the entire disclosure of which is hereby expressly incorporated herein by reference. Tibial base plate 38A may also be part of a tibial sizing plate system in accordance with the tibial sizing plate described in two brochures published by Zimmer, Inc., namely the “Zimmer® Patient Specific Instruments, Surgical Techniques for NexGen® Complete Knee Solution” brochure, copyright 2010, and the “Zimmer® NexGen Trabecular Metal Tibial Tray, Surgical Technique” brochure, copyright 2007 and 2009, the entire disclosures of which are hereby expressly incorporated herein by reference.
During insertion of shim 36A, as best shown in FIGS. 6 and 7, lead-in walls 146A of shim 36A are placed between bearing component 32A and base component 34A and are used to affect separation of bearing component 32A from base component 34A by a distance along proximal/distal axis AP-D equal to a height of shim 36A. In this manner, lead-in walls 146A act as a ramp to separate bearing component 32A from base component 34A. Advantageously, the provisional tibial prosthesis system of the present disclosure can be adjusted in a manner requiring the knee joint to only be distracted by a distance equal to the height of shim 36A. In another embodiment, to further help separation of bearing component 32A from base component 34A, bearing component inferior surface 42A (shown in FIG. 2C) at bearing anterior side 48A (shown in FIGS. 2A-2C) can include a beveled edge corresponding to lead-in walls 146A of shim 36A.
The manner in which shim 36A locks tibial bearing component 32A to base component 34A in proximal/distal direction 24 will now be discussed. Referring to FIGS. 6-8, shim 36A is inserted between tibial bearing component 32A and base component 34A in anterior/posterior direction 20. Referring to FIGS. 2A-2D and 4A-4C, and 6, shim rails 136A are aligned with respective tibial bearing component slots 64A. Referring to FIG. 4A, rails 136A each include lead-in edge 140A to guide insertion of rails 136A in slots 64A. The rail/slot connection between shim 36A and tibial bearing component 32A is important because it prevents lift-off of tibial bearing component 32A from shim 36A, i.e., prevents significant relative movement between tibial bearing component 32A and shim 36A in proximal/distal direction 24. In one exemplary embodiment, as shown in FIGS. 2A-2D and 4A-4C, slots 64A of tibial bearing component 32A and rails 136A of shim 36A each have a dovetail cross-sectional shape. Slots 64A including tapering walls 66A of bearing component 32A cooperate with rails 136A having tapering walls 138A of shim 36A to act as a physical barrier to prevent Liftoff of the tibial bearing component 32A from shim 36A. In an alternate embodiment, slots 64A of tibial bearing component 32A and rails 136A of shim 36A can each have a T-shaped cross-sectional shape or other various shapes that would provide a physical barrier that would prevent lift-off, i.e., prevent significant relative movement between tibial bearing component 32A and base component 34A in proximal/distal direction 24, or any movement of tibial bearing component 32A in any direction that is perpendicular to base component 34A.
Referring to FIGS. 6-8, the use of surgical instrument 180 to insert shim 36A will now be described. FIGS. 6-8 illustrate surgical instrument 180 for insertion or removal of shim 36A. Surgical instrument 180 generally includes handle body 182, handle end 184, opposing attachment end 186, alignment pins 188, tooth 190, button 192, and handle pegs 194. Surgical instrument 180 has one alignment pin 18$ on each side of tooth 190. Alignment pins 188 fit in respective exterior circular recesses in rails 142A (shown in FIG. 4B) of shim 36A to properly align surgical instrument 180 to shim 36A. Once properly aligned tooth 190 of surgical instrument 180 slides along shim ramp 148A (shown in FIGS. 4A and 4B) and, when tooth 190 slides past shim ramp 148A, a biasing force on tooth 190 causes tooth 190 to travel downward and engage the backside of shim ramp 148A to lock surgical instrument 180 to shim 36A. In one embodiment, a biasing force is exerted on tooth 190 by a tension spring. When surgical instrument 180 is properly locked to shim 36A, a surgeon holding handle end 184 of surgical instrument 180 can insert shim 36A in anterior/posterior direction 20 between tibial bearing component 32A and tibial base plate 38A to space tibial bearing component 32A from tibial base plate 38A along proximal/distal axis AP,D a distance equal to the shim height. Once shim 36A is properly inserted between tibial bearing component 32A and tibial base plate 38A, release button 192 of surgical instrument 180 can be depressed to overcome the biasing force of the spring to release and disengage tooth 190 from the backside of shim ramp 148A. Thereafter, surgical instrument 180 can be removed. In another embodiment, surgical instrument 180 can be used in the manner described above to insert shim 36A in anterior/posterior direction 20 between tibial bearing component 32A and base component 34A. Also, surgical instrument 180 may be used to remove shim 36A from between tibial bearing component 32A and base component 34A.
A joint line 1122, about which the knee joint 1114 flexes, is approximately parallel to a line through medial and lateral femoral condyles 1124 and to a tibial plateau 1126. Although illustrated as perpendicular in FIG. 9, the joint line 1122 can extend at a yarns or valgus angle relative to the mechanical axes 1110 and 1118 of the femur 1104 and tibia 1106, respectively. Normally, during a partial or total knee replacement procedure, portions of a distal end of the femur 1104 or a proximal end of the tibia 1106 are resected to be parallel or approximately parallel to the joint line 1122, and thus perpendicular to the mechanical axes 1110 and 1118, as indicated at 1128 and 1130, respectively.
FIG. 10 illustrates a closer view of the knee joint 1114 and its coordinate system, in which a medial/lateral axis 1202 corresponds approximately to the joint line 1122 (FIG. 9), a proximal/distal axis 204 corresponds approximately to the mechanical axes 1110 and 1118 (FIG. 9), and an anterior/posterior axis 1206 is approximately normal to the other two axes. Position along each of these axes can be depicted by arrows, which can represent the medial/lateral 1208, anterior/posterior 1210, and proximal/distal 1212 positioning of inserted prosthesis components. Rotation about each of these axes can also be depicted by arrows. Rotation about the proximal/distal axis 1204 can correspond anatomically to external rotation of a femoral component, while rotation about the anterior/posterior axis 1206 and medial/lateral axis 1202 can correspond to extension plane slope and varus/valgus angle of a component, respectively. Depending on a position of the proximal tibial cut 1130 (FIG. 9) made, a varus/valgus angle 1214, extension plane angle 1216, external rotation 1218, or joint extension gap can be affected. Similarly, a position of the distal femoral cut 1128 FIG. 9) can affect the location of the joint line 1122, the extension gap, the varus/valgus angle 1214, or the extension plane angle 1216.
Each component of the provisional tibial prosthesis system 340 includes an associated height. A shim component height 347 can be combined with a bearing component height 343 and abuse component height 345, for example, to represent a desired height of a permanent tibial prosthesis system. A plurality of different or varying sized shims 346 can be slidably inserted between the bearing component 342 and a bearing support component, such as the base component 344, in an anterior/posterior 210 direction, Advantageously, the different or varying sized shims 346 can be inserted and removed without removing the bearing component 342 or the bearing support component from within a knee joint 314 (FIG. 11). Instead, all that is needed is a distraction of the knee joint 314 in an amount equal or approximately equal to the height profile of a particular shim component 346. In one example, the shim handling instrument 354 can be used to engage one or more handling alignment voids of a shim component 346 to assist in inserting and removing the shim component 346 between the bearing component 342 and the bearing support component 344. The one or more handling alignment voids of the shim component 346 can be consistent over the broad range of different sized shim components for universal compatibility with the shim handling instrument 354.
Each component of the provisional tibial prosthesis system 340 can include a structure defined by various surfaces, voids, or cavities. As shown in FIG. 12B, the bearing component 342, for example, can include an inferior surface 348, an opposing superior surface 460, and a peripheral wall 462 extending from the inferior surface 348 to the superior surface 460. The bearing component 342 can further include an anterior side 464, a posterior side 466, a lateral side 468, and a medial side 470. The superior surface 460 can be configured to articulate with natural or prosthetic condyles of a distal femur and can include a bearing lateral articular surface portion and a bearing medial articular surface portion, with a central tibial eminence 472 disposed between the articular surface portions. The inferior surface 348 can include a bearing cavity and one or more bearing nub cavities. The bearing cavity can extend from the inferior surface 348 toward the superior surface 460 and can be sized and shaped to accept a projection of the base component 344. The bearing nub cavities can extend on opposing sides of the bearing cavity and can each be sized and shaped to receive a nub located on the projection of the base component 344.
A posterior cruciate ligament (PCL) cutout 474 can be disposed at the posterior side 466 between the articular surfaces. The PCL cutout 474 can be sized and positioned to correspond with a PCL of the knee joint 314. In the example of FIG. 12B, the bearing component 342 is illustrated as a cruciate retaining bearing component, although it is contemplated that other tibial bearing components can be used. Bearing components that cooperate to form a posterior stabilized prosthesis, as shown in the example of FIG. 12A, or a knee prosthesis having an intermediate level of constraint between a posterior stabilized and cruciate retaining prosthesis are within the scope of the present disclosure. The bearing component 342 can also be made available in a variety of shapes and sizes to accommodate a variety of patient knee joints.
The bearing component 342 and the base component 344 can be coupled to or engaged with each other. In an example, the bearing component 342 can be positioned atop of the base component 344 and the projection 488, including the one or more nubs 490, of the base component 344 can be positioned within the bearing and bearing nub cavities of the bearing component 342. The base component 344 can be secured to the bearing component 342 in a medial/lateral direction 1208 (FIG. 10) when the projection 488 is received with the bearing cavity and can be secured in an anterior/posterior direction 1210 (FIG. 10) when the one or more nubs 490 are received with respective nub cavities. The walls of the bearing cavity can provide a physical barrier to inhibit significant relative movement between the base component 344 and the bearing component 342 in the medial/lateral direction 208. Similarly, the wails of the bearing nub cavities can provide a physical barrier to inhibit significant relative movement between the base component 344 and the bearing component 342 in the anterior/posterior direction 1210. When the bearing component 342 is positioned atop the base component 344, and before insertion of the shim component 346, the bearing component can 342 be movable relative to the base component 344 in a proximal/distal direction 1212 (FIG. 10).
In some examples, the shim components 346C and 346D can include an entry ramp 709, which can be similar to the entry ramp 614 described above and shown in FIG. 14B. A ratio R from a start of the ramp 709 to a beginning of a
dovetail of each of the shim components 346C and 346D can be used to maintain engagement of the dovetails during a shim insertion procedure.
FIG. 19 illustrates an example of a cut guide attachment 1300 for use with a provisional tibial prosthesis system. In an example, the cut guide attachment 1300 can include a first body portion 1302, a second body portion 1304, and a slotted portion 1306. The first body portion 1302 or connector portion can include one or more alignment pins 1308. The second body portion 1304 can also be referred to as a main body portion. The slotted portion 1306 can include an elongated groove or slot 1310 extending through a first side 1312 to a second side 1314 of the slotted 1306. The elongated groove or slot 1310 can be configured to receive a cutting tool that can extend through the slot 1310. As described further below, the cut guide attachment 1300 can be used for further resecting the tibia after a provisional tibial prosthesis system has been implanted on the resected tibia. The cut guide attachment 1300 can be used to create one or more additional resection surfaces on the tibia and the additional resection surface(s) can be at an angle relative to the original resection surface.
In an example, the slot 1310 can have a downward slope (moving from the first side 1312 to the second side 1314). In another example, the elongated slot can have an upward slope. The slot 1310 can be configured such that the cutting tool can create a resection having an anterior/posterior slope. In an example, the slope of the slot 1310 can be between +2 degrees and −2 degrees, inclusive. In an example, the slope of the slot 1310 can be between +3 degrees and −3 degrees, inclusive. In other examples, the slope can be between −10 degrees and −10 degrees, inclusive. Different slotted portions 1306 and/or different cut guide attachments 1300 can be configured to have varying slopes within any given range. In an example, multiple cut guide attachments 1300 can be available in 1 degree increments, ranging between +2 degrees and −2 degrees.
The cut guide attachments 1300 and 1400 can be designed such that a distance of a second resection from the original resection (in a (proximal-distal direction) can be used to determine the particular portions selected for the cut guide attachments 1300 and 1400. In an example, the first 1302 and/or second 1304 body portions of the cut guide attachment 1300 can have varying heights in order to adjust the proximal-distal distance of the slot 1310 from the original resection. The second body portion 1304 can be removably attached to the first body portion 1302 such that the second body portion 1304 and the slotted portion 1306 can be easily removed and substituted with other portions 1304 and 1306 after the cut guide attachment 1300 is attached to the provisional tibial prosthesis system 340. The cut guide attachment 1300 can include a measurement marker on a component of the attachment 1300, for example, the second part 1304, such that the user would be able to measure and/or monitor relative distances in determining one or more additional resection surfaces on the tibia.
In an example, the adjustment mechanism of the out guide attachment 1500 can be part of the middle portion 1503 and can include a ball 1507, a first clamp 1509, a second clamp 1511 and an adjuster 1513. The ball 1507 can sit at least partially inside the first 1509 and second 1511 clamps; the first and second 1511 clamps can be adjustable, as described below, and can create friction on the ball 1507. The ball 1507 can be attached to the top portion 1501 using, for example, a shaft 1515 extending from the top portion 1501.
FIGS. 22C and 22D show an example of a cut guide attachment 1500′ and the provisional tibial prosthesis system 340. The cut guide attachment 1500′ can be similar to the cut guide attachment 1500 of FIGS. 22A and 22B, but can also include a readout feature 1550′ which can be part of a top portion 1501′ the cut guide attachment 1500′. The readout feature 1550′ can include multiple reference markers, described further below, for indicating a slope angle of the slot 1510′ at a given position. The readout feature 1550′, along with a slotted portion 1506′, can be movable through the inclusion of rails 1552′ formed in the top portion 1501′. The rails 1552′ can allow for adjustment of the slotted portion 1506′ in an anterior/posterior direction during alignment of the slotted portion 1506′ with the femur.
A dart 1580′ on the directional readout feature 1550′ can be connected to the pin 1554′such that the dart 1580′ can move on a surface 1582′ of the readout 1550′ as the pin 1554′ moves. The dart 1580′ can thus represent the particular slope angle in the medial/lateral and anterior/posterior directions based on a position of the dart 1580′ relative to the markers 1560′ and 1570′. The position of the dart 1580′ shown in FIG. 22C represents a slope angle of zero degrees in an anterior/posterior direction and zero degrees in a medial/lateral direction.
FIGS. 22C and 22D provide one example of a system that includes a readout indicating a position of the slot 1510′, and such system can be used with an adjustment mechanism providing multiple degrees of freedom for adjusting a
position of a slot similar to slots 1510 and 1510′. It is recognized that other types of readouts or marking systems can be used to provide the user with an indication of a changing position of the slot 1510′.
The cu guide attachment 1600 can include a first adjustment mechanism 1620 between the second body portion 1604 and the slotted portion 1606, and a second adjustment mechanism 1622 between the first body portion 1602 and the second body portion 1604. The first adjustment mechanism 1620 can be configured to adjust a slope of the slot 1610 in an anterior/posterior direction, as described further below, by configuring the slotted portion 1606 to be movable, relative to the second body portion 1604, in first and second directions indicated by an arrow A1. The second adjustment mechanism 1622, as described further below in reference to FIGS. 25 and 26, can be configured to adjust a slope of the slot 1610 in a medial/lateral direction by configuring the second body portion 1604 to be movable, relative to the first body portion 1602, in third and fourth directions indicated by an arrow A2.
The above Detailed Description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more elements thereof) can be used in combination with each other. Other embodiments can be used, such as by one of ordinary skill in the art upon reviewing the above description. Also, various features or elements can be grouped together to streamline the disclosure, This should not be interpreted as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter can lie in less than all features of a particular disclosed embodiment. Thus, the following claims are hereby incorporated into the Detailed Description, with each claim standing on its own as a separate embodiment. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.
a provisional tibial prosthesis system implantable on a first resected surface of a proximal tibia and comprising a tibial base plate, a tibial bearing component attachable to the tibial base plate, and at least one shim slidably receivable between the tibial base plate and the tibial bearing component; and
2. The system of claim 1, wherein the cut guide is configured to create a second resected surface of the proximal tibia that is at an angle relative to the first resected surface.
4. The system of claim 1, wherein the cut guide is removably attachable to the at least one shim.
5. The system of claim 4, wherein the at least one shim includes one or more alignment voids on an end of the at least one shim, and the cut guide includes one or more alignment pins configured to fit into the one or more alignment voids on the at least one shim.
6. The system of claim 1, wherein the cut guide includes an elongated slot configured to receive a cutting tool for creating the second resected surface of the proximal tibia.
7. The system of claim 6, wherein the cut guide includes at least one adjustment mechanism for adjusting an angle of the elongated slot in at least one direction, relative to the first resected surface.
8. The system of claim 7, wherein the at least one adjustment mechanism includes a ball and at least one clamp, the at least one clamp adjustable and configured to releasably engage the ball, and adjustment of the at least one clamp relative to the ball adjusts an angle of the elongated slot, in at least one direction, relative to the first resected surface.
9. The system of claim 7, wherein the cut guide includes a slotted portion and a main body portion, the elongated slot formed in the slotted portion.
10. The system of claim 9, wherein the at least one adjustment mechanism includes first teeth formed on an end of the slotted portion and second teeth formed on an end of the main body portion, the first and second teeth configured to releasably mate with one another at different positions corresponding to different angles of the elongated slot relative to the first resected surface.
11. The system of claim 9, wherein the cut guide includes a connector portion having at least one feature for releasable attachment of the cut guide to the at least one shim, and the least one adjustment mechanism includes a shaft extending from the main body portion and a recess formed in the connector portion, the shaft and recess configured to releasably engage with one another at different positions corresponding to different angles of the elongated slot relative to the first resected surface.
12. The system of claim 1, wherein the at least one shim includes a first shim having a first shim height, and the tibial bearing component and the tibial base plate are separated by a first distance equal to the first shim height.
13. The system of claim 12, wherein the at least one shim includes a second shim having a second shim height, and the second shim replaces the first shim for placement between the tibial base plate and the tibial bearing component or the second shim is used in combination with the first shim.
14. The system of claim 1, wherein the at least one shim includes a first shim including one or both of a medial edge having a different height than a lateral edge or an anterior edge having a different height than a posterior edge.
15. The system of claim 14, wherein an inferior surface of the first shim includes a medial to lateral angle of between +3 degrees and −3 degrees, inclusive, or an anterior to posterior angle of between +3 degrees and −3 degrees, inclusive.
16. A system for performing a surgical procedure on a portion of a knee joint, the system comprising:
a provisional tibial prosthesis system implantable on a first resected surface of a proximal tibia and comprising a tibial base plate, a tibial bearing component, and at least one shim positionable between the tibial base plate and the tibial hearing component; and
a plurality of cut guides, each cut guide removably attachable to the prosthesis system and having an elongated slot configured to receive a cutting tool for further resecting the proximal tibia at an angle relative to the first resected surface.
17. The system of claim 16, wherein each cut guide has an elongated slot configured such that each cut guide is configured to create an angled resection, relative to the first resected surface that is different from an angled resection created by another cut guide included in the plurality of cut guides.
18. The system of claim 17, wherein the angled resection includes one or both of a slope in an anterior-posterior direction or a slope in a medial-lateral direction, relative to the first resected surface.
19. The system of claim 18, wherein the slope in the anterior-posterior direction is between +3 degrees and −3 degrees, inclusive, relative to the first resected surface, and the slope in the medial-lateral direction is between +2 degrees and −2 degrees, inclusive, relative to the first resected surface.
20. The system of claim 16, wherein the at least one shim includes a first shim including one or both of a medial edge having a different height than a. lateral edge or an anterior edge having a different height than a posterior edge.
21. A method of performing a surgical procedure on a portion of a knee joint, the method comprising:
implanting a provisional tibial prosthesis system on the resected proximal tibia surface, the prosthesis system comprising a tibial base plate, a tibial bearing component attachable to the tibial base plate, and a first shim receivable between the tibial base plate and the tibial bearing component;
performing a second resection of the proximal tibia to form a second resected proximal tibia surface, wherein the second resected proximal tibia surface is at an angle relative to the first resected proximal tibia surface, and the second resection is performed using a cut guide removably attachable to the prosthesis system.
22. method of claim 21, wherein the cut guide used in performing the second resection is removably attachable to the first shim.
23. The method of claim 21, wherein the cut guide used in performing the second resection is selected from a plurality of cut guides configured to create different resection angles relative to one another.
24. The method of claim 21, wherein the cut guide comprises:
an elongated slot configured to receive a cutting tool for performing the second resection; and
at least one adjustment mechanism for adjusting an angle of the elongated slot n at least one direction, relative to the first resected proximal tibia surface.
25. The method of claim 24, wherein the at least one adjustment mechanism includes a ball and at least one clamp, the at least one clamp adjustable and configured to releasably engage the ball, and adjustment of the at least one clamp relative to the ball adjusts an angle of the elongated slot, in at least one direction, relative to the first resected proximal tibia surface.
26. The method of claim 21, wherein performing a second resection of the proximal tibia includes creating a second resection having one or both of a slope in an anterior-posterior direction or a slope in a medial-lateral direction, relative to the first resected proximal tibia surface.
prior to performing the second resection, when the force balance is not satisfactory, removing the first shim;
inserting a second shim between the tibial base plate and the tibial bearing component, wherein the second shim has a height different than a height of the first shim; and
retesting the force balance on at least a portion of the knee joint.
US14/304,009 2010-12-17 2014-06-13 Cut guide attachment for use in tibial prosthesis systems Active 2032-07-19 US9597090B2 (en)
EP14190180.1A EP2918235B1 (en) 2013-10-25 2014-10-23 Cut guide attachment for use in tibial prosthesis systems
US13/836,665 Continuation-In-Part US9149206B2 (en) 2012-03-30 2013-03-15 Tibial prosthesis systems, kits, and methods
US14/063,032 Continuation-In-Part US9011459B2 (en) 2010-12-17 2013-10-25 Provisional tibial prosthesis system
US14/063,032 Continuation US9011459B2 (en) 2010-12-17 2013-10-25 Provisional tibial prosthesis system
US15/435,620 Continuation US10010330B2 (en) 2010-12-17 2017-02-17 Cut guide attachment for use in tibial prosthesis systems
US20140296859A1 US20140296859A1 (en) 2014-10-02
US9597090B2 true US9597090B2 (en) 2017-03-21
WO2012148960A3 (en) 2011-04-25 2012-12-20 University Of Notre Dame Du Lac Systems and methods for detecting and quantifying a sequence of nucleotides
EP2824260A2 (en) 2013-07-12 2015-01-14 ASTRA Gesellschaft für Asset Management mbH & Co. KG Door handle fitting with a digital door fitting with adjustable inclination of the handle
JP2014508554A (en) 2010-12-17 2014-04-10 ジンマー，インコーポレイティド Tibial prosthesis device
JP2014505517A (en) 2010-12-17 2014-03-06 ジンマー，インコーポレイティド User interface related to surgical temporary instruments
JP2015513966A (en) 2012-03-30 2015-05-18 ジンマー，インコーポレイティド Tibial prosthesis system, kit, and method
JP2015512307A (en) 2012-03-30 2015-04-27 ジンマー，インコーポレイティド Tibial prosthesis system, kit, and method
"Chinese Application Serial No. 201180067430.X, Office Action mailed Aug. 28, 2014", (W/ English Translation), 8 pgs.
"Chinese Application Serial No. 201180067757.7, Response filed Jan. 27, 2016 to Office Action mailed Nov. 16, 2015", (W/ English Translation of Claims), 12 pgs.
"Chinese Application Serial No. 201180067757.7, Response filed Jul. 10, 2015 to Office Action mailed Mar. 2, 2015", (W/ English Translation), 13 pgs.
"Chinese Application Serial No. 201380028683.5, Office Action mailed Nov. 4, 2015", (W/ English Translation), 16 pgs.
"Chinese Application Serial No. 201380028683.5, Response filed Mar. 18, 2016 to Office Action mailed Nov. 4, 2015", (W/ English Translation of Claims), 11 pgs.
"European Application Serial No. 13716636.9, Communication Pursuant to Article 94(3) EPC mailed Jun. 6, 2016", 5 pgs.
"International Application Serial No, PCT/US2013/034286, International Preliminary Report on Patentability mailed Oct. 9, 2014", 8 pgs.
"International Application Serial No. PCT/US2013/034293, International Preliminary Report on Patentability mailed Oct. 9, 14", 9 pgs.
"International Application Serial No. PCT/US2013/034293, Written Opinion mailed Jun. 25, 2013", 6 pgs.
"Japanese Application Serial No. 2013-544655, Office Action mailed Mar. 8, 2016", (W/ English Translation), 8 pgs.
"Japanese Application Serial No. 2014-121515, Response filed Aug. 20, 2015 to Office Action mailed Jun. 2, 2015", W/ English Translation of Claims, 6 pgs.
"Japanese Application Serial No. 2014-121515, Response filed May 11, 2016 to Notice of Reasons for Rejection mailed Jan. 5, 2016", (W/ English Translation of Claims, 11 pgs.
"U.S. Appl. No. 13/087,610, Notice or Allowance mailed Jun. 28, 2013", 6 pgs.
"U.S. Appl. No. 13/819,116, Advisory Action mailed Jan. 5, 2016", 3 pgs.
"U.S. Appl. No. 13/819,116, Examiner Interview Summary Mailed Apr. 18, 2016", 11 pgs.
"U.S. Appl. No. 13/819,116, Final Office Action mailed Oct. 21, 2015", 15 pgs.
"U.S. Appl. No. 13/819,116, Non Final Office Action mailed Feb. 17, 2016", 15 pgs.
"U.S. Appl. No. 13/819,116, Response filed Apr. 29, 2016 to Non Final Office Action mailed Feb. 17, 2016", 17 pgs.
"U.S. Appl. No. 13/819,116, Response filed Dec. 15, 2015 to Final Office Action mailed Oct. 21, 2015", 16 pgs.
"U.S. Appl. No. 13/819,116, Response filed Jul. 16, 2015 to Non Final Office Action mailed Jul. 2, 2015", 22 pgs.
"U.S. Appl. No. 13/837,294, Final Office Action mailed Apr. 25, 2016", 7 pgs.
"U.S. Appl. No. 13/837,294, Final Office Action mailed Jun. 2, 2016", 7 pgs.
"U.S. Appl. No. 13/837,294, Non Final Office Action mailed Dec. 10, 2015", 8 pgs.
"U.S. Appl. No. 13/837,294, Response filed Mar. 4, 2016 to Non Final Office Action mailed Dec. 10, 2015", 16 pgs.
"U.S. Appl. No. 13/837,294, Response filed Oct. 12, 2015 to Restriction Requirement mailed Aug. 24, 2015", 9 pgs.
"U.S. Appl. No. 13/837,294, Restriction Requirement mailed Aug. 24, 2015", 6 pgs.
"U.S. Appl. No. 13/837,774, Final Office Action mailed Mar. 17, 2016", 14 pgs.
"U.S. Appl. No. 13/837,774, Response filed Dec. 16, 2015 to Non Final Office Action mailed Sep. 18, 2015", 17 pgs.
"U.S. Appl. No. 14/063,032, Non Final Office Action mailed Jun. 20, 2014", 6 pages.
"U.S. Appl. No. 14/660,217, Corrected Notice of Allowance mailed May 26, 2016", 3 pgs.
"U.S. Appl. No. 14/660,217, Non Final Office Action mailed Dec. 17, 2015", 8 pgs.
"U.S. Appl. No. 14/660,217, Notice of Allowance mailed Apr. 26, 2016", 5 pgs.
"U.S. Appl. No. 14/660,217, Response filed Mar. 23, 2016 to Non Final Office Action mailed Dec. 17, 2015", 14 pgs.
U.S. Appl. No. 13/087,610, filed Apr. 15, 2011, Provisional Tibial Prosthesis System.
U.S. Appl. No. 13/819,116, filed May 9, 2013, User Interface Related to a Surgical Provisional.
U.S. Appl. No. 13/836,665, filed Mar. 15, 2013, Tibial Prosthesis Systems, Kits, and Methods.
U.S. Appl. No. 13/837,294, filed Mar. 15, 2013, Tibial Prosthesis Systems, Kits, and Methods.
U.S. Appl. No. 13/837,774, filed Mar. 15, 2013, Tibial Prosthesis Systems, Kits, and Methods.
U.S. Appl. No. 14/063,032, filed Oct. 25, 2013, Provisional Tibial Prosthesis Systems.
US10010330B2 (en) 2018-07-03
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:WHITE, STEPHEN E;REEL/FRAME:035624/0290
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH;REEL/FRAME:035624/0421
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:LEWALLEN, DAVID;REEL/FRAME:035624/0353
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:CLAYPOOL, JODY L;STUMP, STEVEN E;PAPROSKY, WAYNE;SIGNING DATES FROM 20140708 TO 20150120;REEL/FRAME:035624/0227