Abstract:
A bone void forming assembly includes a support member having a head portion and an elongate portion extending therefrom. A guide member is connected to the support member and has a guide body including a channel extending therethrough. The channel defines an axis offset and obliquely angled relative to an axis of the elongate portion. The assembly also includes reamer having a cutting head and a stop member. A bushing is slidably connected to the reamer between the stop member and cutting head and is slidably connectable to the guide body via the channel.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims the benefit of the filing date of U.S. Provisional Patent Application No. 62/102,260 filed Jan. 12, 2015, the disclosure of which is hereby incorporated herein by reference. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    Joint replacement surgery is a common orthopedic procedure to repair and replace a damaged, diseased, or otherwise unhealthy joint. These procedures generally fall into two categories: primary and revision. In a primary joint replacement, the operator replaces the native joint with prosthetic components typically by first resecting the native bone and/or cartilage and then affixing the prosthetic components to the resected bone. 
         [0003]    A revision procedure is performed to replace the primary prosthesis, or in some instances, a previously implanted revision prosthesis. Typically, during a revision procedure, the previously implanted prosthesis is extracted and the underlying bone resurfaced in preparation for receipt of the revision prosthesis. Bone defects in the form of bone loss or deterioration are frequently exposed upon extraction of the previously implanted prosthesis. These defects often reside within the epiphyseal and metaphyseal regions of the bone and extend radially outwardly from the center of the bone. Such defects may be caused by, inter alia, osteolysis, necrosis, infection, and bone incidentally removed along with the previously implanted prosthesis. In order to account for such defects, numerous void filling implants, such as that disclosed in Noiles U.S. Pat. No. 4,846,839, for example, have been developed to fill the voids formed by these defects and to provide structural support for the bone and prosthesis. 
         [0004]    Despite the benefits of these void filling implants, their use in complex revision procedures may further complicate the procedure. Prior to extraction of a previously implanted prosthesis, the joint must be exposed. In an example of a total knee replacement, exposure can be made difficult for a number of reasons, such as an exceptionally tight extensor mechanism, which may be due to an improperly fitted prosthesis. One technique for exposing difficult-to-expose knees is a tibial tubercle osteotomy in which the patella tendon is released from the tibia by resecting the bone surrounding the tibial tubercle, which is later resecured to the tibia by at least one fixation device, such as a bone screw or cerclage wire, for example. However, the presence of a void filler, or even an intramedullary stem, creates an obstacle for the fixation device that must be navigated, oftentimes blind, resulting in increased complication of the procedure. 
         [0005]    In another example, a patient may suffer an extensor mechanism complication, such as patellar tendon rupture, that must be repaired during the revision procedure. The ruptured tendon may be repaired by an allograft technique where a bone plug with an attached tendon is secured to the tibia also by a fixation device. Again the presence of a void filler or intramedullary stem may interfere with such a repair. 
         [0006]    Therefore there is a need for a void filling prosthesis that facilitates bone-to-bone fixation and tissue-to-bone fixation. 
       BRIEF SUMMARY OF THE INVENTION 
       [0007]    Generally, disclosed herein are devices and methods for filling bone voids and also providing means for soft tissue and/or bone-to-bone fixation. 
         [0008]    In one aspect of the disclosure, a void filling prosthesis, includes first and second ends defining a length therebetween and outer and inner surfaces defining a sidewall therebetween. The sidewall is at least partially curved about an axis that extends along the length. The void filling prosthesis also includes a fixation prominence extending from the outer surface and includes a first aperture extending in a direction toward the sidewall. 
         [0009]    Additionally, the first aperture may be threaded to receive a threaded fastener. A second aperture may define a passageway extending entirely through the fixation prominence. Furthermore, a third aperture may be disposed adjacent to the first aperture. The second aperture may extend through the fixation prominence between the first and third apertures. Also, the first and third apertures may extend parallel to each other and the second aperture may extend substantially perpendicular to the first and third apertures. 
         [0010]    Continuing with this aspect, the inner surface may include a solid material and the outer surface may include a porous material. The fixation prominence may be at least partially comprised of a porous metal material. Also, the void filler may include first and second portions and a channel extending therethrough. The channel may define the inner surface. Further, the first and second portions may each be substantially frustoconical. The void filler may also include at least one notch in the sidewall. The first portion may be configured to fit in a void formed in a metaphysis of a long bone and the second portion may be configured to fit in a void formed in a diaphysis of a long bone. The long bone may be a tibia. The fit of the first portion in the void may be a press-fit. 
         [0011]    In another aspect of the disclosure, a void filling prosthesis includes first and second ends and an inner surface disposed therebetween. The inner surface defines a channel that extends through the entirety of the prosthesis and is configured to receive an elongate portion of a joint prosthesis therein. The void filling prosthesis also includes a fixation prominence extending from an outer surface of the prosthesis and has at least one fixation aperture. 
         [0012]    Additionally, the at least one fixation aperture may a threaded opening. Also, the channel may extend along a longitudinal axis of the void filling prosthesis and the at least one fixation aperture may extend through the fixation prominence in a direction transverse to the longitudinal axis. 
         [0013]    Continuing with this aspect, the at least one fixation aperture may be a plurality of fixation apertures that include a first set of fixation apertures that each have a threaded inner surface and a second set of fixation apertures that are oriented in a direction transverse to the first set of fixation apertures. The first set of fixation apertures may extend partially into the fixation prominence and the second set of fixation apertures extend through the fixation prominence. 
         [0014]    In a further aspect of the disclosure, a prosthetic system for implantation into an end of bone includes a first prosthesis having a stem, and a second prosthesis having first and second ends and inner and outer surfaces extending between the first and second ends. The inner surface defines a channel for receipt of the stem. The outer surface has at least one fixation aperture extending therein. 
         [0015]    Additionally, the channel may be configured to receive the stem such that a gap sufficiently large to support a cement mantle is formed between the stem and the inner surface of the second prosthesis. The second prosthesis may include a first portion configured to be received within a metaphysis of the bone and a second portion configured to be received within a diaphysis of the bone. 
         [0016]    Continuing with this aspect, the second prosthesis may include a fixation prominence extending radially outwardly therefrom. The at least one fixation aperture may extend into the fixation prominence. The fixation prominence may extend along the first and second portions. The fixation prominence may include an intermediate segment that is at least partially cylindrical and the at least one fixation aperture may extend into the intermediate segment. The at least one fixation aperture may be threaded. The fixation prominence may include first and second flanking segments that flank the intermediate segment. The thickness of the void filler is may be greater at the intermediate segment than at the flanking segments. 
         [0017]    In a still further aspect of the disclosure, a method of implanting a void filling prosthesis into an end of bone includes inserting a void filling prosthesis into a void in the bone. The void filling prosthesis has first and second ends and a fixation prominence extending therefrom. The fixation prominence has at least one fixation aperture. The method also includes advancing a first fixation device through the bone and at least partially into the fixation aperture. 
         [0018]    Additionally, the inserting step may include inserting the void filling prosthesis so that the second end is disposed within the bone and the first end is flush with the end of the bone or disposed within the bone. The fixation aperture and fixation device may be correspondingly threaded. The method may also include reaming a first portion of the bone to receive a first frustoconical portion of the void filling prosthesis, and reaming a second portion of the bone to receive the fixation prominence. The method may also include inserting a body of an aiming device into the first end of the void filling prosthesis. The aiming device may include an aiming arm that has at least one guide aperture. The method may also include aligning the at least one guide aperture with at least one fixation aperture. 
         [0019]    In yet a further aspect of the disclosure, a method of implanting a void filling prosthesis into an end of bone includes inserting a void filling prosthesis into a void in the bone. The void filling prosthesis has first and second ends and inner and outer surfaces disposed therebetween. The inner surface defines a channel that extends through the entirety of the prosthesis and is configured to receive an elongate portion of a joint prosthesis. The outer surface includes at least one fixation aperture. The method also includes advancing a first fixation device through the bone and at least partially into the fixation aperture. 
         [0020]    Additionally, the method may also include inserting the elongate portion of a joint prosthesis into and through the channel such that at least a portion of the elongate portion extends from the second end of the void filling prosthesis. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0021]    These and other features, aspects, and advantages of the present invention will become better understood with regard to the following description, appended claims, and accompanying drawings where: 
           [0022]      FIG. 1  is a front view of one embodiment of a void filling prosthesis. 
           [0023]      FIG. 2  is a perspective view of the void filling prosthesis of  FIG. 1 . 
           [0024]      FIG. 3  is perspective view of one embodiment of a bone resection assembly. 
           [0025]      FIG. 4  is a perspective view of the void filling prosthesis of  FIG. 1  and an aiming device. 
       
    
    
     DETAILED DESCRIPTION 
       [0026]    When referring to specific directions in the following discussion of certain implantable devices, it should be understood that such directions are described with regard to the implantable device&#39;s orientation and position during exemplary application to the human body. Thus, as used herein, the term “proximal” means close to the heart and the term “distal” means more distant from the heart. The term “anterior” means toward the front of the body or the face and the term “posterior” means toward the back of the body. The term “medial” means toward the midline of the body and the term “lateral” means away from the midline of the body. Also, as used herein, the terms “about,” “generally” and “substantially” are intended to mean that deviations from absolute are included within the scope of the term so modified. 
         [0027]      FIGS. 1 and 2  depict a void filler  10  or void filling prosthesis that is configured for placement within a void in a tibia and generally includes a metaphyseal portion or first portion  12 , a diaphyseal portion or second portion  14 , and a fixation prominence  16  that extends along portions of metaphyseal and diaphyseal portions  12  and  14 . It is noted that, while the following discussion refers to void filler  10  in relation to a tibia, the same principles apply for a void filler that may be utilized in a proximal humerus or distal or proximal femur. Of course, it is also envisioned that the present invention may have applicability elsewhere in the body. 
         [0028]    Metaphyseal portion  12 , as shown, is generally frustoconical. However, in some embodiments, metaphyseal portion  12  may be cylindrical. In other embodiments metaphyseal portion  12  may include lobed portions, asymmetrical geometries or other geometries that extend beyond the general frustoconical shape in order to help address asymmetric or lateral and/or medial defects in the bone. Examples of alternate geometrical shapes that can be employed are disclosed in U.S. Publication Nos. 2013/0150858; 2013/0172892; 2014/0276882; and 2014/0277567, the disclosures of which are hereby incorporated-by-reference herein in their entireties. 
         [0029]    A channel extends through metaphyseal portion  10  and defines an inner surface  26  and a sidewall  30 . Inner surface is preferably a stepped surface or otherwise textured surface to promote bone cement adhesion. Metaphyseal portion also includes notches  28  in sidewall  30  that form a clearance space for a baseplate keel of a tibial component. 
         [0030]    Diaphyseal portion  14  is generally cylindrical or frustoconical to substantially match the intramedullary canal of a long bone. In some embodiments, diaphyseal portion  14  may be frustoconical with a cylindrical distal end. Diaphyseal portion  14  extends distally from metaphyseal portion  12 , and the channel that extends through metaphyseal portion  12  also extends through diaphyseal portion  14  so that the channel extends through the length of the entirety of void filler  10 . The inner surface of diaphyseal portion  14  that is defined by this channel may also be stepped or textured to facilitate cement adhesion. The channel is preferably sized to receive a prosthesis stem and allow for sufficient space to receive and support a cement mantle such as a cement mantle that includes polymethyl methacrylate. 
         [0031]    Fixation prominence  16  extends radially outwardly from the outer surface of diaphyseal and metaphyseal portions and  14  and extends along these portions in a general proximal-distal direction. Fixation prominence  16  is preferably located in an area of void filler  10  that would be placed in an anterior or posterior position inside a tibial bone. However, fixation prominence  16  can be located in other locations, such as medial or lateral positions on void filler  10 . In some embodiments, fixation prominence  16  may only extend along the metaphyseal portion  12  or diaphyseal portion  14 . In other embodiments, there may be multiple fixation prominences  16  extending along void filler  10  in various locations. For example, a fixation prominence  16  may extend along void filler  10  in an anterior, posterior, lateral, and medial position. 
         [0032]    Fixation prominence  16  generally includes an intermediate elongate segment  18  and flanking elongate segments  20  (best shown in  FIG. 1 ). Intermediate segment  18  protrudes from the outer surface of void filler  10  further than at flanking segments  20  such that the thickness of void filler  10  at intermediate segment  18  is thicker than at flanking segments  20 . This helps maximize the depth of threaded openings  22  extending into intermediate segment  18 , while minimizing the amount of space taken up by void filler  10  in the bone. 
         [0033]    Intermediate and flanking segments  18  and  20  are generally curved to form cylindrical geometries, which may be complementary to a reaming tool. However, in some embodiments flanking segments  20  may blend into intermediate segment  18  to give the appearance of a single segment. In other, embodiments, segments  18  and  20  may have other geometries, such as square or triangular geometries. At the distal end of fixation prominence  16 , intermediate and flanking segments  18  and  20  are tapered to facilitate impaction into an end of bone. 
         [0034]    Fixation prominence  16  includes fixation apertures that may be utilized to affix bone to bone and tissue to bone via various fixation means, such as threaded fasteners, cerclage wires, and sutures, for example. One such fixation aperture is a threaded opening  22  located in intermediate segment  18 . Intermediate segment  18  includes a plurality of these threaded openings, which extend in a direction transverse to a longitudinal axis of void filler  10  and toward the sidewall/channel of void filler  10 . The depth of threaded openings  22  is such that a threaded fastener, such as a bone screw, can be inserted through a segment of bone and into the threaded portion to create solid fixation. 
         [0035]    Another fixation aperture is a passageway  24  that extends through fixation prominence  16  in a direction transverse to threaded openings  22 . In some embodiments, the transverse direction may be substantially perpendicular with the extent of threaded openings  22 . These passageways may be smooth in order to safely house a fixation wire, suture, or other flexible fixation device. Passageways  24  are generally situated or positioned through fixation prominence  16  at locations that are between each of the plurality of threaded openings so that threaded openings  22  and passageways  24  do not intersect. 
         [0036]    While fixation prominence  16  is described and depicted as generally elongate and extending along and between diaphyseal and metaphyseal portions  12  and  14 , fixation prominence  16  may be another configuration, including, but not limited to, a plurality of bumps extending outwardly from the sidewall of void filler  10  at various locations about void filler  10 . Each of these bumps may be square or circular and may each include threaded opening  22  and/or passageway  24  as described above. 
         [0037]    Also, it is contemplated that void filler  10  may not include a fixation prominence, but rather threaded openings  22  extending into sidewall  30 . In such an embodiment, sidewall  30  may be thicker in order to accommodate a threaded fastener. 
         [0038]    In some embodiments, void filler  10  may be implanted into the bone such that fixation prominence  16  faces posteriorly. In such an embodiment, void filler  10  may include circumferential grooves (not shown) within metaphyseal and diaphyseal portions  12  and  14  that allow for a wire or suture to be retained therein, when the wire is wrapped around a portion of void filler  10  from a posterior to anterior direction. 
         [0039]    Void filler  10  can be made from any biocompatible material including stainless steel, titanium, cobalt-chromium, tantalum, niobium, or polymeric material such as PEEK. In addition, the void filler&#39;s bone contacting surfaces may be made from a porous metal such as titanium foam, and the void filler&#39;s non-bone contacting surfaces, such as inner surface  26 , may be made from solid or nonporous metal. The porosity of the bone contacting surfaces allows for bony ingrowth therein. In some embodiments, the entire thickness of void filler  10  may be porous, while in other embodiments, the entire thickness of void filler  10  may be solid. 
         [0040]    With particular regard to the construction of fixation prominence  16 , fixation prominence  16  may be entirely porous while the interior of threaded apertures  22  and passageways  24  may be coated with a solid material. In some embodiments, threaded openings  22  may be lined with a material softer than that of a threaded fastener, which deforms to conform to the threaded fastener upon insertion therein. In other embodiments, fixation prominence  16  may be primarily solid while the outer surface is treated to provide the requisite porosity. As an example, such treatment may be performed by high energy beam processing, such as Selective Laser Melting (“SLM”) and Electron Beam Melting (“EBM”), or other additive manufacturing processes. Examples of high energy beam processing are disclosed in U.S. Pat. Nos. 7,537,664 and 8,728,387 and U.S. Publication Nos. 2006/0147332 and 2013/0268085, the disclosures of which are hereby incorporated-by-reference herein in their entireties. 
         [0041]      FIG. 3  depicts a reamer assembly  100  for preparing a bone to receive void filler  10 , which includes a trial  130 , a reamer guide  120 , a bushing  140 , and a reamer  110 . When implanting void filler  10 , it is preferable to have the bone prepared to create a press-fit between void filler  10  and the bone such that compression of the bone promotes bony ingrowth into void filler  10 . Such bone preparation can be reproducibly performed by reamer assembly  100 . 
         [0042]    Trial  130  includes a head  136  and a shaft  132 . Head  136  is frustoconical to match the profile or shape of metaphyseal portion  12 . Head  136  includes indicia  138 , such as laser lines, to indicate the depth of head  136  in the bone. Head  136  also includes a groove  139  extending along its length to create space for cutting head  112  during the reaming process. 
         [0043]    Reamer  110  includes a cutting head  112 , a bushing  140 , and a depth stop  114 . Cutting head  112  is slidable within and guided by bushing  140 . Depth stop  114  is located proximal to bushing  140  and during use contacts bushing  140  to indicate that cutting head  112  has reached the appropriate depth. 
         [0044]    Reamer guide  120  includes a retaining sleeve  124  that is configured to slide over shaft  132  of trial  130 . Reamer guide  120  also includes a guide collar  126  attached to retaining sleeve  124  by a flange  122  such that guide collar  126  has a longitudinal axis that is angled with respect to a longitudinal axis of retaining sleeve  124 . 
         [0045]    Guide collar  126  generally includes a slot  127  extending through a sidewall in guide collar  126 . Slot  127  is in communication with a retaining channel that extends through guide collar  126 . The retaining channel is sized to slidingly receive and retain bushing  140 , and slot  127  is sized to allow reamer head  112 , but not bushing  140 , to be passed there through. 
         [0046]    Reamer  100  is mounted to guide collar  126  by holding bushing  140  against depth stop  114  and passing cutting head  112  though slot  127  and into the retaining channel. Once cutting head  112  is in the retaining channel, bushing  140  is slid into the retaining channel where it is retained during the reaming process in which cutting head  112  is guided by bushing  140  into bone. 
         [0047]      FIG. 4  depicts an aiming device  200  that can be used when securing a threaded fastener to void filler  10  through bone and/or tissue. Once void filler  10  is implanted, bone and tissue may obscure the operator&#39;s view of fixation apertures  22  and  24 . Aiming device  200  allows the operator to locate threaded openings  22  through such bone and tissue. Aiming device  200  generally includes a body  210  and aiming arm  220 . 
         [0048]    Body  210  may be cylindrical or frustoconical such that it fits within the channel of the metaphyseal portion. Alignment tabs  212  extend radially outwardly from body  210  so that they can engage with or slide within notches  28  within void filler  10 . This engagement aligns aiming arm  220  with fixation prominence  16 . 
         [0049]    Aiming arm  220  can be connected to body  210  or in some embodiments may be integral with body  210 , and generally includes a first guide portion  222  and a second guide portion  224 . First guide  222  portion extends from body  210  and curves or turns in a distal direction. In one embodiment, first guide portion  222  may include an offset segment (not shown) that would be located adjacent to the aiming arm&#39;s connection to body  210 . The offset segment may be offset laterally or medially to provide a clearance space for the patella and patella tendon during fixation. 
         [0050]    First guide portion  222  also includes a plurality of guide apertures  226  that are aligned with threaded openings  22  when aiming device  200  is engaged with void filler  10 . The second guide portion  224  is offset anteriorly from first guide portion  222  and also includes a plurality of guide apertures  226  that are also aligned with threaded openings  22  of void filler  10 . This offset relationship helps stabilize a driving device when driving a threaded fastener into threaded opening  22 . 
         [0051]    In a wire fixation embodiment (not shown), an aiming arm may extend from body  210  in a lateral or medial direction when engaged to void filler  10  and align with passageways  24 . In this embodiment, the wires may be passed through guide apertures in the aiming arm and punched or passed through the bone and through passageways  24 . 
         [0052]    In one embodiment of a method of use, void filler  10  may be utilized to reattach a bone fragment resected during a tibial tubercle osteotomy. Such attachment may be achieved by wire fixation, suture fixation, screw fixation, or the like. In a tibial tubercle osteotomy, a bone fragment underlying the tibial tubercle and patella tendon is at least partially resected so that the extensor mechanism can be moved aside to expose the primary or previously implanted prosthesis. The prosthesis is removed from the tibia, and the bone is assessed for defects. An appropriate void filler is selected based on the size and shape of the defect, and a single reamer or a series of reamers are used to prepare the void for void filler  10 . After a generally frustoconical void is formed in the metaphysis with a frustoconical reamer (not shown) that corresponds with head  136  and metaphyseal portion  12 , head  136  of trial  130  may be placed into the void. If the proper depth of the head, as indicated by indicia  138 , cannot be reached, the bone is successively reamed until the proper depth is achieved. 
         [0053]    Thereafter, with head  136  securely placed within the void such that groove  139  generally faces anteriorly, reamer guide  120  is slid over shaft  132  of trial  130  until retaining sleeve  124  abuts abutment surface  134 . Cutting head  112  is passed through slot  127  while bushing  140  is in a proximal position about cutting head  112  such that bushing  140  is proximal of guide collar  126  as cutting head  112  is passed through slot  127 . Once cutting head  112  is within the retaining channel of guide collar  126 , bushing  140  is advanced distally until it is fully seated within guide collar  126 . Reamer  110  is then advanced into the bone to form a resected geometry to receive fixation prominence  16 . 
         [0054]    Depending on the condition of the bone and/or the extent of the bone defect, the tibial tubercle osteotomy may remove so much anterior bone that a slot in the anterior bone extending into the bone canal is exposed. Where this occurs, anterior reaming for fixation prominence  16  may not be warranted since there may be no anterior bone to resect. If this is the case, a rongeur may be used to shape the resected bone fragment to matingly engage fixation prominence  16  when reaffixing the fragment to the tibia. 
         [0055]    Once the void has been sufficiently shaped, void filler  10  is inserted into the bone to achieve a press-fit relationship with the bone via impaction or some other means. This impaction or other means may occur until the proximal end of void filler  10  is either flush with or below the proximal end of the tibia. 
         [0056]    Aiming device  200  is then attached to void filler  10  by inserting body  210  into metaphyseal portion  12  and by inserting the alignment tabs  212  into the notches  28  of metaphyseal portion  12 . At this point aiming arm  220  is oriented in an anterior position external to the bone and aligned with fixation prominence  16 . The fragment of bone that was removed by the tibial tubercle osteotomy is placed into a mating position against the tibia and a threaded fastener is advanced through guide apertures  226  of aiming device  200 , through the bone, and into threaded openings  22  of void filler  10 , thereby affixing the bone fragment to the tibia and void filler  10 . 
         [0057]    Once the bone fragment and patella tendon are secured, the tibial prosthesis, which preferably includes a baseplate and a stem, is affixed to the tibia. This may be performed by placing cement or some other adhesive into the channel of void filler  10  and or around the stem, and then inserting the stem into and through the channel such that at least a portion of the stem extends from the distal end of void filler  10 . 
         [0058]    As an alternative to a threaded fastener, cerclage wires may be utilized to fix the bone fragment to the tibia. In this embodiment method of fixation, an aiming device specific to wire or suture fixation is engaged to the implanted void filler  10 . Wires are advanced through the guide apertures, through the bone, through passageways  24 , and back out through the bone. The free ends of the wires extending from the bone are then used to affix the bone fragment to the tibia in the usual way. 
         [0059]    In another method of wire fixation utilizing void filler  10 , void filler  10  can be inserted such that fixation prominence  16  faces posteriorly. In this embodiment, wires can be passed through the bone and passageways  24  at a posterior region of the tibia and then wrapped around the tibia to secure the bone fragment. Alternatively, the wires may be wrapped around void filler  10  prior to implantation. This may be achieved by selecting a void filler  10  that is sized to be cemented into the bone, rather than press-fit, or a void filler  10  with channels to house the wires as void filler  10  is impacted into the bone. 
         [0060]    Turning to another method embodiment, void filler  10  may be utilized to make other repairs such as the repair of a ruptured patella tendon. In this embodiment void filler  10  is utilized in a similar fashion as with a tibial tubercle osteotomy. For example, where the patella tendon is ruptured, a bone plug and tendon allograft may be harvested and implanted into the tibia. In this embodiment, void filler  10  is implanted into the bone, aiming device  200  engaged to void filler  10 , and the bone plug either fixed to void filler  10  and bone via threaded fastener or via wire fixation, as previously described. 
         [0061]    Still other types of procedures are possible utilizing void filler  10  described herein. For example, void filler  10  may be used in procedures involving uncontained defects or other bone defects or repairs that require the use of morselized bone graft and metal mesh to contain the bone graft material. In such a procedure, void filler  10  and fixation apertures extending therein may be used to help fix the mesh to void filler  10 . In this scenario, fixation prominence  16  may be a plurality of bumps each containing threaded opening  22  or passageway  24  wherein the bumps and fixation apertures may be utilized to help secure the wire mesh to the bone to facilitate a solid containment unit for the morselized bone graft, particularly as the graft material is being impacted into the bone. 
         [0062]    Although the invention herein has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the present invention. It is therefore to be understood that numerous modifications may be made to the illustrative embodiments and that other arrangements may be devised without departing from the spirit and scope of the present invention as defined by the appended claims.