Patent Description:
Orthopedic procedures and prostheses are commonly utilized to repair and/or replace damaged bone and tissue in the human body. For example, a knee arthroplasty can be used to restore natural knee function by repairing damaged or diseased articular surfaces of the femur and/or tibia. An incision is made into the knee joint to expose the bones comprising the joint. Cut guides are used to guide the removal of the articular surfaces that are to be replaced. Prostheses are used to replicate the articular surfaces. Knee prostheses can include a femoral component implanted on the distal end of the femur, which articulates with a tibial bearing component and a tibial component implanted on the proximal end of a tibia to replicate the function of a healthy natural knee. Various types of arthroplasties are known including a total knee arthroplasty, where all of the articulating compartments of the joint are repaired with prosthetic components.

This disclosure pertains generally to knee prostheses, systems, and methods for a knee arthroplasty and/or as part of a knee revision surgery. The present inventors have recognized, among other things, that patients requiring knee arthroplasties can have femurs of varying qualities, such as size, density, and condition/health. Because of these variations, location and depth of cuts performed on the bones may vary relatively dramatically between patients. Because it may be expensive to match cutting guide specific to each patient, a system that is adjustable is desired to guide a bone cut for a variety of patients.

Thus, the present inventors propose a cutting block that can be quickly and easily adjusted (and readjusted) to select a cutting location as desired.

The present invention provides an adjustable cut guide, as defined in claim <NUM>. Further optional features of the invention are defined in the dependent claims. Methods are described herein but the methods are not claimed.

Optionally the insert may further comprise a rack including rack teeth; and the actuator further comprises teeth engageable with the rack teeth to secure the insert to the base when the actuator is in the extended position.

Optionally the teeth of the actuator may disengage the rack teeth when the actuator is in the retracted position such that the base is free to move relative to the insert.

Optionally the channel may further comprise: a track configured to receive the rack of the insert, wherein the actuator teeth extend into the track to engage the rack when the actuator is in the extended position.

Optionally a biasing element is included which engages the actuator and the base within the slot, the biasing element biasing the actuator to an extended position and the cam to the first position.

Optionally the actuator further comprises a leg extending away from the cam into an anti-rotation slot of the block, the leg translatable in the slot with the actuator and the slot limiting rotation of the leg about an axis of the actuator.

Optionally the cut guide may further comprise: a plurality of bores extending through the base substantially parallel to the intramedullary bore.

Optionally the channel is configured to accept a plurality of inserts including the insert, wherein each of the plurality of inserts comprises an intramedullary rod bore having a rod angle between <NUM> degree and <NUM> degrees.

Optionally the cut guide may be an anterior/posterior cutting block for resection of a distal portion of a femur.

Optionally translation of the base relative to the insert and the intramedullary rod provides an anterior to posterior adjustment of the base relative to the bone.

Optionally the body may further comprise: a plurality of pin apertures extending through the body configured to receive pins therethrough to fixate the base to the bone.

Further described herein but not claimed is a method of inserting an intramedullary guide rod into a bone, the method comprising: actuating a cam to retract an actuator; inserting an angle guide into a slot of the body of the guide; inserting an intramedullary rod through a bore of the angle guide and into an intramedullary cavity of the bone; and releasing the cam to extend the actuator to secure the angle guide relative to the body.

Optionally the method includes translating the body relative to the intramedullary rod and the angle guide to anteriorly to posteriorly adjust the body relative to the bone.

Optionally the method includes inserting one or more pins through pin apertures of the body to secure the body to the bone.

Optionally the method includes coupling a ligament tensioner to the body; and operating the tensioner to set a ligament tension of a joint of the bone.

Optionally the method includes coupling a cutting guide to the body; inserting a cutting blade through the guide to engage the bone; and operating the cutting blade to resect the bone.

Optionally the method includes spacing an anterior cutting guide on an anterior portion of the bone by coupling an outrigger to the anterior cutting guide and to the body.

The cutting block, assembly, or method is optionally configured such that all elements or options recited are available to use or select from.

In the drawings, which are not necessarily drawn to scale, like numerals can describe similar components in different views. Like numerals having different letter suffixes can represent different instances of similar components. The drawings illustrate generally, by way of example, but not by way of limitation, various examples discussed in the present document.

The present application relates to devices and methods for a knee arthroplasty, where a tibia and/or a femur are resected to receive prostheses to replace damaged or nonfunctioning components of a patient.

As used herein, the terms "proximal" and "distal" should be given their generally understood anatomical interpretation. The term "proximal" refers to a direction generally toward the torso of a patient, and "distal" refers to the opposite direction of proximal, i.e., away from the torso of a patient. It should be understood that the use of the terms "proximal" and "distal" should be interpreted as though the patient were standing with the knee joint in extension despite the apparatuses described herein generally being used with the knee joint in flexion. The intent is to differentiate the terms "proximal" and "distal" from the terms "anterior" and "posterior". As used herein, the terms "anterior" and "posterior" should be given their generally understood anatomical interpretation. Thus, "posterior" refers to a rear of the patient, e.g., a back of the knee. Similarly, "anterior" refers to a front of the patient, e.g., a front of the knee. Thus, "posterior" refers to the opposite direction of "anterior".

<FIG> shows an isometric view of cutting guide assembly <NUM>, in accordance with at least one example of the present disclosure. Cutting guide assembly <NUM> includes base <NUM> and insert <NUM>. Base <NUM> includes channel <NUM>, cam <NUM>, and actuator <NUM>. Insert <NUM> can include anterior intramedullary (IM) bore <NUM>, posterior IM bore <NUM>, and rack <NUM>. Also shown in <FIG> are orientation indicators Anterior, Posterior, Medial, and Lateral.

Base <NUM> and insert <NUM> can be rigid members comprised of materials such as plastics, metals, and combinations thereof. For example, base <NUM> and insert <NUM> can be comprised of steel alloys. Insert <NUM> (or angle guide) can be insertable into base <NUM>, as described further below.

Channel <NUM> extends between an anterior portion and a posterior portion of base <NUM>. Channel <NUM> is sized to receive insert <NUM> such that insert <NUM> can translate therein. Channel <NUM> can include an undercut or track (discussed further below) configured to receive rack <NUM> of insert <NUM>.

Cam <NUM> can be a rigid member comprised of materials such as metals, plastics, and combinations thereof. Cam <NUM> can be pivotably coupled to base <NUM> and can engage actuator <NUM>. Actuator <NUM> can be a rigid member comprised of materials such as metals, plastics, and combinations thereof. Actuator <NUM> is disposed in a slot of base <NUM> (as discussed further below), where the slot intersects channel <NUM>, such that actuator <NUM> can extend into channel <NUM> when actuator <NUM> is in a first position, as shown in <FIG>. Actuator <NUM> can include teeth configured to engage teeth of rack <NUM>, as discussed further below.

Insert <NUM> includes anterior IM bore <NUM> and posterior IM bore <NUM>, where each bore can extend through the insert generally perpendicular to the anterior/posterior plane. Insert <NUM> can also include rack <NUM>, which can be a rack type gear including teeth configured to extend from a medial and a lateral portion of insert <NUM> (only medial teeth visible in <FIG>) to face medially and laterally, respectively.

In operation of some examples, cam <NUM> can be rotated clockwise (as shown further below) to retract actuator <NUM> into base <NUM>. Insert <NUM> can then be inserted into channel <NUM> such that rack <NUM> is disposed in the track of channel <NUM>. Cam <NUM> can then be released so that a biasing element within base <NUM> can force actuator <NUM> medially to enter the track of channel <NUM> to engage lateral teeth of insert <NUM>. This engagement can secure the position of insert <NUM> relative to base <NUM>.

Thereafter, (as shown further below) an intramedullary (IM) rod can be inserted through one of anterior IM bore <NUM> or posterior IM bore <NUM> to secure cutting guide assembly <NUM> to the IM rod and therefore the bone. By including two bores (<NUM> and <NUM>) in insert <NUM>, the IM rod can be aligned near posterior and anterior terminations of base <NUM>. In some examples, cutting guide assembly can be used for both left and right knees by rotating the insert about <NUM> degrees.

Then, cam <NUM> can be actuated again to allow base <NUM> to move relative to insert <NUM>. Base <NUM> can be aligned with the bone and cam <NUM> can be again released, allowing actuator <NUM> to secure base <NUM> to insert <NUM> and therefore secure base <NUM> relative to the IM rod and the bone. The details of the operations are discussed below in further detail.

By including cam <NUM> and actuator <NUM>, cut guide assembly <NUM> offers a base that is easily adjusted relative to insert <NUM> when insert <NUM> is secured to an IM rod. This can allow for simpler and easier adjustments of base <NUM> and insert <NUM> during arthroplasty procedures, which can save time and cost.

<FIG> shows a plan view from a slightly anterior perspective of cutting guide assembly <NUM>, in accordance with at least one example of the present disclosure. Cutting guide assembly <NUM> includes base <NUM>, which can include channel <NUM>, cam <NUM>, actuator <NUM>, cam pin <NUM>, biasing element <NUM>, and slot <NUM>. Actuator <NUM> can include teeth <NUM>. Also shown in <FIG> are orientation indicators Anterior, Posterior, Medial, and Lateral.

Cutting guide assembly <NUM> can be consistent with the description of <FIG> above; however, <FIG> shows additional details of cutting guide assembly <NUM>. For example, cam <NUM> is shown as being coupled to base <NUM> by cam pin <NUM>. Cam pin <NUM> can be a generally cylindrical rigid member comprised of materials such as metals, plastics, and combinations thereof. Cam pin <NUM> can be secured to base <NUM> at two respective ends and can pass through a bore of cam <NUM> to form a journal bearing about which cam <NUM> can rotate, in some examples.

Also shown in <FIG> is slot <NUM>, which can house cam <NUM>, actuator <NUM> and biasing element <NUM>. In some examples, slot <NUM> can be of multiple sizes where a larger portion can support actuator <NUM> and a smaller portion can support actuator <NUM> and biasing element <NUM>. Slot <NUM> intersects with channel <NUM>, as shown below in further detail.

Biasing element <NUM> can be a resilient member configured to bias actuator <NUM> medially from slot <NUM> to extend partially into channel <NUM>. In some examples, biasing element <NUM> can be a compression spring, such as a coil compression spring or a wave spring. In some other examples, biasing element <NUM> can be other types of resilient members, such as a resilient plastic or rubber elements.

Also shown in <FIG> is actuator <NUM>, which can be a rigid member extending most of the lateral to medial length of slot <NUM>. Actuator <NUM> can also include teeth <NUM>, which can be disposed at a medial termination of actuator <NUM> facing medially outward from actuator <NUM>, such that teeth <NUM> can extend into channel <NUM> when actuator <NUM> is in the first position (as shown in <FIG>) and can be retracted into slot <NUM> when actuator <NUM> is in the second position (as shown in <FIG>).

<FIG> shows an isometric view of cutting guide assembly <NUM> in a first condition, in accordance with at least one example of the present disclosure. <FIG> shows a cross-section view of cutting guide assembly <NUM> across section 3B-3B of <FIG> in a first condition, in accordance with at least one example of the present disclosure. <FIG> are discussed below concurrently.

Cutting guide assembly <NUM> includes base <NUM> and insert <NUM> (only shown in <FIG>). Base <NUM> includes channel <NUM>, cam <NUM>, actuator <NUM> (only shown in <FIG>), cam pin <NUM> (only visible in <FIG>), biasing element <NUM> (only visible in <FIG>), slot <NUM>, actuator bore <NUM> (only visible in <FIG>), and actuator plug <NUM> (only visible in <FIG>). Channel <NUM> can include track <NUM>. Cam <NUM> can include bores <NUM> and notch <NUM>. Actuator <NUM> can include teeth <NUM>, cam arm <NUM> and alignment arm <NUM>. Insert <NUM> can include rack <NUM>. Also shown in <FIG> are orientation indicators Anterior, Posterior, Medial, and Lateral.

Cutting guide assembly <NUM> includes slot <NUM>, which can extend through base <NUM> substantially perpendicular to the anterior-posterior plane. Slot <NUM> can be sized to support cam <NUM> and actuator <NUM>. Actuator bore <NUM> can be a bore extending from a lateral termination of base <NUM>, intersecting slot <NUM> and intersecting with and terminating at channel <NUM>. In some examples, actuator bore <NUM> can be sized to support actuator <NUM>, biasing element <NUM>, and actuator plug <NUM>.

Actuator plug <NUM> can be a rigid member disposed proximate a lateral termination of actuator bore <NUM>. Actuator plug <NUM> can be configured to engage biasing element <NUM> and can be configured to retain biasing element <NUM> and therefore actuator <NUM> within actuator bore <NUM>. In some examples, actuator plug <NUM> can be secured to base <NUM> in a threaded configuration, and can be pinned, compression fit, welded, and snap fit into actuator bore <NUM> in other examples.

<FIG> also show track <NUM> of channel <NUM>, which can be an undercut extending medially and laterally into base <NUM>. Track <NUM> can be sized to receive rack <NUM> of insert <NUM> (of <FIG>) while allowing track <NUM>, and therefore insert <NUM>, to translate within channel <NUM> and track <NUM> when actuator <NUM> does not engage track <NUM>.

Cam <NUM> can include bores <NUM>, which can extend through cam <NUM> providing cleaning and sterilization access to internal components of base <NUM>, such as actuator plug <NUM>, biasing element <NUM>, slot <NUM>, and actuator <NUM>. Notch <NUM> can be a notch in cam <NUM> substantially facing actuator <NUM> and sized to receive cam arm <NUM> of actuator <NUM>.

Cam arm <NUM> can be a rigid protrusion extending towards cam <NUM> from actuator <NUM> and can be configured to engage notch <NUM> of cam <NUM>. Alignment arm <NUM> can extend opposite of cam arm <NUM> from actuator <NUM> and can terminate prior to extending past base <NUM>. Alignment arm <NUM> can be sized to fit within slot <NUM> but sized to engage the walls of channel <NUM> to reduce rotation of actuator <NUM> relative to actuator bore <NUM>, helping to ensure that teeth <NUM> of actuator <NUM> remain aligned with teeth of track <NUM>.

In operation of some examples, teeth <NUM> can be disposed at a medial termination of actuator <NUM>, as described above, and can extend into track <NUM> to engage teeth of rack <NUM> when actuator <NUM> is in a first position, as shown in <FIG>. Because biasing element <NUM> applies a force to plug <NUM> and actuator <NUM>, biasing element <NUM> biases teeth <NUM> to extend into track <NUM>. Also, because cam arm <NUM> engages cam <NUM> at notch <NUM> of cam <NUM>, biasing element <NUM> biases cam <NUM> into the first position as shown in <FIG>.

While teeth <NUM> of actuator <NUM> help prevent translation of insert <NUM> within slot <NUM>, engagement of rack <NUM> with surfaces of track <NUM> and engagement of other portion of insert <NUM> with surfaces of channel <NUM> reduce translation or rotation of insert <NUM> relative to base <NUM> in any other direction.

<FIG> shows an isometric view of cutting block assembly <NUM> in a second condition, in accordance with at least one example of the present disclosure. <FIG> shows a cross-section view of cutting guide assembly <NUM> across section 4B-4B of <FIG> in a second condition, in accordance with at least one example of the present disclosure. <FIG> are discussed below concurrently. The components of <FIG> can be consistent with <FIG>, described above, but can show cutting guide assembly <NUM> in a second state or condition. <FIG> also show force F.

In operation of some examples, force F can be applied to cam <NUM>, rotating cam <NUM> about cam pin <NUM> in a counter-clockwise direction (as orientated in <FIG>), which can cause cam <NUM> to move to a second position. Rotation of cam <NUM> can also cause cam arm <NUM> and therefore actuator <NUM> to translate medially, compressing biasing element <NUM>. Medial translation of actuator <NUM> can cause teeth <NUM> to translate in actuator bore <NUM> out of track <NUM> of channel <NUM> such that teeth <NUM> will disengage rack <NUM> of insert <NUM>. This can allow insert <NUM> to be translated anteriorly to posteriorly within channel <NUM> (or base <NUM> to translate relative to insert <NUM>).

In some examples, when force F is removed from cam <NUM>, or when force F is reduced so that a biasing force of biasing element <NUM> overcomes force F, biasing element <NUM> can motivate actuator <NUM> to translate laterally, which can cause cam <NUM> to rotate about cam pin <NUM> in a clockwise direction (as orientated in <FIG>) toward the first position of cam <NUM> (as shown in <FIG>). Because actuator <NUM> is biased to the first position, base <NUM> and insert <NUM> can be secured to each other without continued application of a force external to cutting guide assembly <NUM> (such as force F).

<FIG> shows a cross-section view of cutting guide assembly <NUM> across section <NUM>-<NUM> of <FIG> in a second condition, in accordance with at least one example of the present disclosure. Cutting guide assembly <NUM> can include base <NUM>, actuator <NUM>, track <NUM>, biasing element <NUM>, actuator bore <NUM>, and plug <NUM>. Actuator <NUM> can include teeth <NUM>. Base <NUM> can include central opening <NUM> and pin bores <NUM>.

Cutting guide assembly <NUM> as shown in <FIG> can be consistent with the description of the FIGS. However, <FIG> more clearly shows that biasing element <NUM> can be disposed around a posterior portion of actuator <NUM> and a medial portion of plug <NUM>. <FIG> also shows how teeth <NUM> of actuator <NUM> are retracted out of track <NUM> and into actuator bore <NUM> when actuator <NUM> is in the second position.

Central opening <NUM> can be an opening extending through an approximately central portion of base <NUM>. Central opening <NUM> can have a geometric shape that is substantially rectangular, in some examples, but can include non-regular aspects, such as rounded corners and notches. In some examples, central opening <NUM> can be placed to align with IM bores of the insert when the insert is inserted into channel <NUM> of base <NUM>.

Pin bores <NUM> can also extend through base <NUM>. Pin bores <NUM> can be sized to receive and guide drill bits through base <NUM>. Pine bores <NUM> can also be sized to receive pins, such as Steinmann pins, in some examples, to temporarily secure base <NUM> to a bone, such as a femur, as discussed further below.

<FIG> shows an isometric view of femur <NUM> and tibia <NUM> where a drilling operation is being performed, in accordance with at least one example of the present disclosure. <FIG> shows an isometric view of femur <NUM> and tibia <NUM> with intramedullary rod <NUM> installed, in accordance with at least one example of the present disclosure. <FIG> and <FIG> are discussed below concurrently.

Femur <NUM> and tibia <NUM> can be a femur and tibia, respectfully, of a human leg. Femur <NUM> can include condyles <NUM> and intramedullary cavity <NUM>. Tibia <NUM> can include resected portion <NUM>, which can be resected by operations performed prior to those operations described herein. Also shown in <FIG> is drill bit <NUM>, intramedullary (IM) rod <NUM>, and orientation indicators Anterior, Posterior, Medial, and Lateral.

Drill bit <NUM> can be a component engageable with a rotary device, such as a drill. In some examples, the rotary device can rotate drill bit <NUM> at speeds sufficiently high to remove material (such as bone) in contact with drill bit <NUM>. In this way, drill bit <NUM> can create a bore. Drill bit <NUM> can be comprised of metal alloys and other rigid materials (such as diamond) and combinations thereof.

IM rod <NUM> can be a rigid member comprised of materials such as metals, plastics, and combinations thereof. IM rod <NUM> can be configured to be inserted into a bore created by drill bit <NUM>. IM rod <NUM> can be further inserted into the bore and into intramedullary cavity <NUM> of femur <NUM>.

In operation of some examples, a drill or other rotary tool (not shown) can be used to create a bore between condyles <NUM> of femur <NUM> to expose intramedullary cavity <NUM>, as shown in <FIG>. Once intramedullary cavity <NUM> is exposed, IM rod <NUM> can be inserted into intramedullary cavity <NUM>, as shown in <FIG>. Further operations are detailed in the figures below.

<FIG> shows an isometric view of cutting guide assembly <NUM>, in accordance with at least one example of the present disclosure. <FIG> shows arrow A and orientation indicators Anterior, Posterior, Medial, and Lateral. Cutting guide assembly <NUM> can be consistent with the above description of cutting guide assembly <NUM> in <FIG>. However, <FIG> also shows inserts 104A and 104B, which can both be consistent with the description of insert <NUM> discussed above. Insert 104A can include angle θ<NUM> and angle θ<NUM> and insert 104B can include angle θ<NUM>. Angle θ<NUM> can represent a first valgus angle, or an angle between a mechanical axis and an anatomical axis of the femur. Angle θ<NUM> can represent a second valgus angle and angle θ<NUM> can represent a third valgus angle. In some examples, angle θ<NUM> and angle θ<NUM> can be the same angle. In some other examples, angle θ<NUM> and angle θ<NUM> can be different angles. In some examples, angle θ<NUM> and angle θ<NUM> can be different than angle θ<NUM>.

In operation of some examples, an insert with a desired valgus angle can be selected. The insert, such as insert 104A, can then be inserted into channel <NUM> in the direction of arrow A, in some examples. In other examples, insert 104A can be inserted into the posterior opening of channel <NUM> in a direction substantially opposite arrow A. That is, insert 104A can be inserted into channel <NUM> from either direction.

Once insert 104A is inserted, or during or prior to insert 104A being inserted, cam <NUM> can be actuated, retracting actuator <NUM> (not shown in <FIG>) out of channel <NUM>, so that insert 104A can be placed as desired into channel <NUM>. Once a location has been selected, cam <NUM> can be released, allowing actuator <NUM> to engage insert 104A. The rest of the operations are discussed with respect to the FIGS.

<FIG> shows an isometric view of femur <NUM> and tibia <NUM> with cutting guide assembly <NUM> secured to the intramedullary rod <NUM>, in accordance with at least one example of the present disclosure. Cutting guide assembly <NUM> can be consistent with the above description of cutting guide assembly <NUM>.

In operation of some examples, IM rod <NUM> can be guided through a central opening of base <NUM> and through an IM bore (such as bore <NUM> or <NUM>) of insert <NUM> to secure cutting guide <NUM> to IM rod <NUM>.

<FIG> shows an isometric view of femur <NUM> and tibia <NUM> with cutting guide assembly <NUM> secured to the intramedullary rod <NUM> and anterior femoral feeler <NUM> secured to cutting guide assembly <NUM>, in accordance with at least one example of the present disclosure. Cutting guide assembly <NUM> can be consistent with the above description of cutting guide assembly <NUM>.

Anterior femoral feeler <NUM> can be secured to cutting guide assembly and knob <NUM> can be adjusted to position the feeler relative to femur <NUM> and condyles <NUM>. Cam <NUM> can be actuated to retracted actuator <NUM> (not shown in <FIG>), allowing base <NUM> to translate in the anterior-posterior plane. In some examples, base <NUM> can be translated anteriorly to reduce an amount of femur <NUM> that is to be resected from a distal portion of femur <NUM>, whereby anterior femoral feeler <NUM> can provide an indication of the correct position based on contact between anterior femoral feeler <NUM> and/or its position relative to femur <NUM> and condyles <NUM> thereof. In some other examples, base <NUM> can be translated posteriorly to increase an amount of femur <NUM> that is to be resected from a distal portion of femur <NUM>. Once a desired position is selected, cam <NUM> can be released, allowing the actuator to secure insert <NUM> to base <NUM>. In some examples, it can be determined that the relative position of insert <NUM> to base <NUM> is not desirable and the process of actuating cam <NUM>, translating base <NUM>, and releasing cam <NUM> can be repeated. In this way, cutting guide assembly <NUM> allows for a quick and easy selection (and reselection) of a position of base <NUM> to insert <NUM>. This can increase procedural efficiency, saving time and cost.

<FIG> shows an isometric view of femur <NUM> and tibia <NUM> with a tibia rotation block and cutting guide assembly <NUM> secured to the intramedullary rod <NUM>, in accordance with at least one example of the present disclosure. Cutting guide assembly <NUM> can be consistent with the above description of cutting guide assembly <NUM>.

In operation of some examples, ligament balancing can be achieved through rotation of cutting guide assembly <NUM> by securing tibia rotation block <NUM> to base <NUM> of cutting guide assembly <NUM>. A desired external rotation of cutting guide assembly <NUM> of about <NUM>° can be obtained automatically through correct balance and tension of the ligament system, in some examples. In some other examples, rotation can also be checked via the epicondylar axis using medial and lateral pins secured to base <NUM>.

<FIG> shows an isometric view of a femur and a tibia with ligament tensioner <NUM>, in accordance with at least one example of the present disclosure. Ligament tensioner <NUM> can be a tensioner or balancer insertable between femur <NUM> and tibia14. In operation of some examples, tensioner <NUM> can be actuated at tool interface <NUM> to increase or decrease tension of soft tissues of the knee joint. After a desired tension in achieved, tensioner <NUM> can be disengaged from the knee joint.

<FIG> shows an isometric view of a femur and a tibia with pins <NUM> securing cutting guide assembly <NUM> to femur <NUM>, in accordance with at least one example of the present disclosure. In operation of some examples, a drill can be used to drill into a distal portion of femur <NUM> through pin bores <NUM> to create a bore in a distal portion of femur <NUM>. Thereafter, pins <NUM>, which can be Steinmann pins in some examples, can be inserted through pin bores <NUM> and into bores of the bone to temporarily secure base <NUM> to femur <NUM>. Together with IM rod <NUM>, pins <NUM> can reduce rotation of base <NUM> and insert <NUM> relative to femur <NUM> and can reduce translation of base <NUM> and insert <NUM> along an axis of IM rod <NUM>.

<FIG> shows an isometric view of femur <NUM> and tibia <NUM> with cutting tool <NUM> performing a cut of femur <NUM>, in accordance with at least one example of the present disclosure.

In some examples, posterior blade guide <NUM> can be secured to a posterior portion of base <NUM>. Posterior blade guide <NUM> can include a blade slot sized to receive cutting tool <NUM>. The blade slot can limit movement of cutting tool <NUM> to translation substantially perpendicular to the anterior-posterior plane, so that only a substantially planar cut of the posterior portion of femur <NUM> can be made with cutting tool <NUM>.

<FIG> shows an isometric view of femur <NUM> and tibia <NUM> with cutting tool <NUM> performing cut <NUM> of femur <NUM>, in accordance with at least one example of the present disclosure.

In some examples, anterior blade guide <NUM> can be secured to an anterior portion of base <NUM>. Anterior blade guide <NUM> can include a blade slot sized to receive cutting tool <NUM>. The blade slot can limit movement of cutting tool <NUM> to translation perpendicular to the anterior-posterior plane, so that a substantially planar cut of the posterior portion of femur <NUM> can be made with cutting tool <NUM>. In some examples, cutting tool <NUM> can be operated to create anterior femoral cuts <NUM> in femur <NUM>.

<FIG> shows an isometric view of femur <NUM> and tibia <NUM> with secondary cutting guide <NUM> secured to cutting guide assembly <NUM>, in accordance with at least one example of the present disclosure.

Secondary cutting guide <NUM> can be a distal cutting guide configured to guide a cutting tool for making a distal femoral cut. In operation of some examples, outrigger <NUM> can be securable to base <NUM>. Outrigger <NUM> can then be used to position distal cutting guide <NUM> relative to base <NUM> and therefore relative to femur <NUM>. Once distal cutting guide <NUM> has been placed as desired and secured to femur <NUM>, removal tool <NUM> can be secured to base <NUM> and can be used to remove cutting guide assembly <NUM> and outrigger 1010from femur <NUM> so that a distal femoral cut can be performed using distal cutting guide <NUM>.

<FIG> shows a flow chart using the devices and systems described above, in accordance with at least one example of this disclosure. The steps or operations of the method of <FIG> are illustrated in a particular order for convenience and clarity. Many of the discussed operations can be performed in a different sequence or in parallel, and some operations may be excluded, without materially impacting other operations. The method of <FIG>, as discussed, includes operations that may be performed by multiple different actors, devices, and/or systems. It is understood that subsets of the operations discussed in the method of <FIG> that are attributable to a single actor, device, or system could be considered a separate standalone process or method.

In operation of one example, method <NUM> can begin with step <NUM>, where a femur (such as femur <NUM> of <FIG>) can be bored or drilled using a tool (such as drill bit <NUM> of <FIG>). At step <NUM> IM rod <NUM> can be inserted into the bore and an intramedullary cavity of the femur. Then, at step <NUM>, cam <NUM> can be actuated to retract actuator <NUM> of cutting guide assembly <NUM>, so that an angle guide (or insert <NUM>) can be inserted into channel <NUM> of base <NUM> at step <NUM> and also positioned relative to base <NUM>. Once a desired position has been selected, cam <NUM> can be released, allowing actuator <NUM> to secure the position of insert <NUM> relative to base <NUM> at step <NUM>.

At step <NUM>, a bore of insert <NUM> (such as bore <NUM> or <NUM>) and a central bore of base <NUM> can receive IM rod <NUM> therethrough. Cam <NUM> can then be actuated again at step <NUM> to release the engagement between block <NUM> and insert <NUM>. Base <NUM> can then be translated relative to insert <NUM> and IM rod <NUM> to position base <NUM> as desired relative to femur <NUM>. Thereafter, cam <NUM> can be released to secure insert <NUM> relative to base <NUM>.

In operation of some examples, steps <NUM> through <NUM> can be repeated in any order to position base <NUM> and insert <NUM>, as desired. In operation of some examples, cam <NUM> can be actuated to remove base <NUM> and insert <NUM> from IM rod <NUM>.

Claim 1:
An adjustable cut guide (<NUM>) for resecting a bone, the cut guide comprising:
a base (<NUM>) defining:
a channel (<NUM>) extending between a first end of the base and a second end of the base; and
a slot (<NUM>) intersecting the channel;
a cam (<NUM>) connected to the base and operable to move within the slot;
an actuator (<NUM>) located at least partially within the slot, the actuator operable to translate by movement of the cam between an extended position and a retracted position; and
an insert (<NUM>) located within the channel of the base, the insert secured relative to the base by the actuator when the actuator is in the extended position, and the base translatable relative to the insert when the actuator is in the retracted position, characterised in that the insert includes a first intramedullary bore (<NUM>) located near an anterior portion of the insert and a second intramedullary bore (<NUM>) located near a posterior portion of the insert.