Source: http://www.google.fr/patents/US9486226
Timestamp: 2017-10-19 07:38:21
Document Index: 702947581

Matched Legal Cases: ['Application No. 09716738', 'Application No. 12170854', 'Application No. 10181149', 'Application No. 10181198', 'Application No. 10765271', 'Application No. 10181743', 'Application No. 04812187', 'art 1']

Brevet US9486226 - Tibial guides, tools, and techniques for resecting the tibial plateau - Google Brevets
Various patient-specific tibial guide housings, patient-specific tibial guide boxes, and methods of resecting the tibial plateau are disclosed herein....http://www.google.fr/patents/US9486226?utm_source=gb-gplus-shareBrevet US9486226 - Tibial guides, tools, and techniques for resecting the tibial plateau
Numéro de publication US9486226 B2
Numéro de demande US 13/865,958
Autre référence de publication US20130296874, US20170056024
Numéro de publication 13865958, 865958, US 9486226 B2, US 9486226B2, US-B2-9486226, US9486226 B2, US9486226B2
Inventeurs Nam T. Chao
Citations de brevets (530), Citations hors brevets (172), Référencé par (4), Classifications (2), Événements juridiques (1)
US 9486226 B2
1. A system for preparing a tibial plateau of a tibia of a patient, the system comprising: a tibial guide housing, the tibial guide housing comprising: a top side generally opposite a bottom side and a front side generally opposite a back side; a first reference arm having a patient-specific contact surface configured to conform to a first portion of a superior surface of the tibia; a second reference arm having a patient-specific contact surface configured to conform to a second portion of the superior surface of the tibia; and at least one pin hole configured to accommodate insertion of a pin through the tibial guide housing and into the tibia, wherein the back side includes a patient-specific contact surface configured to conform to a portion of the anterior surface of the tibia; one or more tibial cutting guide boxes, each of the one or more tibial cutting guide boxes comprising: a patient-specific contact surface configured to conform to a portion of an anterior surface of the tibia; a guide aperture configured to accommodate a surgical cutting tool and guide the cutting tool along a cutting plane having a predetermined cut depth and angle; and at least one pin hole configured to accommodate a pin passing into the tibia.
2. The system of claim 1, wherein the one or more tibial cutting guide boxes are each configured for releasable securement within the tibial guide housing.
3. The system of claim 1, including at least two tibial cutting guide boxes, wherein each of the at least two tibial cutting guide boxes has a different predetermined cut depth.
4. The system of claim 1, wherein the tibial guide housing further comprises a third reference arm having a patient-specific contact surface configured to conform to a third portion of the superior surface of the tibia.
5. A method of preparing a tibial plateau of a tibia of a knee joint of a patient for implantation of at least one prosthesis, the method comprising: providing a tibial guide housing, the tibial guide housing including: a first reference arm having a patient-specific contact surface configured to conform to a first portion of a superior surface of the tibia; a second reference arm having a patient-specific contact surface configured to conform to a second portion of the superior surface of the tibia; and a back side having a patient-specific contact surface configured to conform to a portion of an anterior surface of the tibia; providing a first tibial cutting guide box, the first tibial cutting guide box including: a patient-specific contact surface configured to conform to a portion of the anterior surface of the tibia; and a guide aperture configured to accommodate a surgical cutting tool and guide the cutting tool along a cutting plane having a predetermined cut depth and angle; positioning the tibial guide housing on the tibia such that each of the patient-specific contact surfaces of the tibial guide housing achieves a conforming fit with the tibia; positioning the first tibial cutting guide box such that the patient-specific contact surface of the first tibial cutting guide box achieves a conforming fit with the tibia; and inserting a cutting device through the guide aperture and cutting a portion of the tibia along the cutting plane.
6. The method of claim 5, further comprising inserting the first tibial cutting guide box into an opening of the tibial guide housing.
7. The method of claim 5, further comprising removing the first tibial cutting guide box from the tibial guide housing.
8. The method of claim 5, further comprising selecting the first tibial cutting guide box from a plurality of tibial cutting guide boxes, each including a guide aperture having a different predetermined cut depth.
9. The method of claim 5, further comprising: positioning a prosthesis component on a cut surface of the tibia; and checking a state of the knee joint, wherein the state of the knee joint is selected from the group consisting of ligament stability of the knee joint, range of motion of the knee joint, alignment of the knee joint, and combinations thereof.
10. The method of claim 9, further comprising: selecting a second tibial cutting guide box from a plurality of tibial cutting guide boxes, each including a guide aperture having a different predetermined cut depth, based, at least in part, on the checking a state of the knee joint; and positioning the second tibial cutting guide box such that a patient-specific contact surface of the second tibial cutting guide box achieves a conforming fit with a portion of the anterior surface the tibia.
11. The method of claim 5, including cutting a medial portion of the tibia or a lateral portion of the tibia.
FIGS. 12A and 12B depict a human knee with exemplary varus, neutral and valgus orientations, and various exemplary angles that a cut guided slot 30 or other tool may incorporate to accommodate and/or correct such orientations. In a varus knee, this line passes medial to the knee and a moment arm is created, which increases force across the medial compartment of the knee. In a valgus knee, the load-bearing axis (LBA) passes lateral to the knee, and the resulting moment arm increases force across the lateral compartment of the knee. In various embodiments, specifically designed tibial guide boxes that incorporate patient specific varus/valgus angles could be employed to reduce and/or correct such deformities, desirably reducing abnormal forces in the artificial knee joint, and returning the LBA to a normal functioning knee at its neutral position. FIG. 13A depicts various cut guide slot angulations that, when used in conjunction with a tibial guide box as described herein, can generally be employed to alter the resulting varus or valgus angles of one or more tibial cut planes. FIG. 13B depicts one alternative embodiment of a guide tool that incorporates an adjustment mechanism 322 that can be employed and adjusted to alter the cut angle. The adjustment mechanism could include a screw thread or other mechanism that allows a wide variation in the cut plane angle, which could include larger wedges to accommodate more severe varus/valgus angles. In various embodiment, the guide tool with the adjustable mechanism could be sized and configured to fit into the standard guided slots 1301-1304 as shown in FIG. 13A.
In at least one alternative embodiment, various features of guide tools and surgical methods described herein can be used in conjunction with a wide variety of tibial trays, wedges and/or tibial inserts to accommodate the correction and/or reduction of extremely high varus and/or valgus angles in a given patient's anatomy. In such embodiments, a surgeon may choose to resect the medial and lateral portions of the tibia to differing levels and/or depths, as shown in FIG. 24, in which a medial tibial section has been resected using a substantially horizontal cut 2401, and a lateral tibial section has been resected at a relatively steep angle 2402, desirably removing a minimal amount of bone from the lateral side (see FIG. 25). After resection and creation of the respective tibial cut planes, the surgeon can choose to employ various combinations of tibial trays (e.g., separate medial and lateral trays) and/or inserts (e.g., dual inserts) to desirably create and/or replicate medial and lateral tibial condylar surfaces that improve and/or correct the varus and/or valgus angles of one or both of the patient's knee joints. In the embodiment shown in FIG. 26, a substantially thicker lateral insert 2601 (as compared to the thickness of the medial insert 2602) has been employed to create a desired resulting angulation for the knee implant. In one alternative embodiment, a single tibial tray may be used with a single or multiple tibial cuts, with a one or two piece insert having differing thickness on each of the medial/lateral portions in a similar manner.
FIG. 27 illustrates a coronal plane of the knee with exemplary resection cuts that can be used to correct lower limb alignment in a knee replacement. As shown in the figure, the selected and/or designed resection cuts can include different cuts on different portions of a patient's biological structure. For example, resection cut facets on medial and lateral femoral condyles can be non-coplanar and parallel 1602, 1602′, angled 1604, 1604′, or non-coplanar and non-parallel, for example, cuts 1602 and 1604′ or cuts 1602′ and 1604. Similar, resection cut facets on medial and lateral portions of the tibia can be non-coplanar and parallel 1606, 1606′, angled and parallel 1608, 1608′, or non-coplanar and non-parallel, for example, cuts 1606 and 1608′ or cuts 1606′ and 1608. Non-coplanar facets of resection cuts can include a step-cut 1610 to connect the non-coplanar resection facet surfaces. Selected and/or designed resection dimensions can be achieved using one or more selected and/or designed guide tools (e.g., cutting jigs) that guide resectioning (e.g., guide cutting tools) of the patient's biological structure to yield the predetermined resection surface dimensions (e.g., resection surface(s), angles, and/or orientation(s)). In certain embodiments, the bone-facing surfaces of the implant components can be designed to include one or more features (e.g., bone cut surface areas, perimeters, angles, and/or orientations) that substantially match one or more of the resection cut or cut facets that were predetermined to enhance the patient's alignment. As shown in FIG. 27, certain combinations of resection cuts can aid in bringing the femoral mechanical axis 1612 and tibial mechanical axis 1614 into alignment 1616.
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