Patent Description:
The efficient functioning of the hip joints is important to the well-being and mobility of the human body. Each hip joint includes the upper portion of the femur, which terminates in an offset bony neck surmounted by a ball-headed portion known as the femoral head. The femoral head rotates within a socket, known as the acetabulum, in the pelvis to complete the hip joint. Diseases such as rheumatoid- and osteo-arthritis can cause erosion of the cartilage lining of the acetabulum so that the ball of the femur and the hip bone rub together, causing pain and further erosion. Bone erosion may cause the bones themselves to attempt to compensate for the erosion which may result in the bone becoming deformed. This misshapen joint may cause pain and may eventually cease to function altogether.

Operations to replace the hip joint with an artificial implant are well-known and widely practiced. Generally, the hip prosthesis will be formed of two components, namely: an acetabular, or socket, component which lines the acetabulum, and a femoral, or stem, component which includes a weight-bearing ball and replaces the femoral head. During the surgical procedure for implanting the hip prosthesis, the remaining cartilage or damaged tissue is removed from the acetabulum using a reamer such that the native acetabulum will accommodate the outer surface of the acetabular component of the hip prosthesis. The acetabular cup component of the prosthesis can then be inserted into the prepared acetabulum. In some arrangements, the acetabular cup component may simply be held in place by a tight fit with the bone. However, in other arrangements, additional fixing means such as screws and/or bone cement may be used. The use of additional fixing means helps to provide stability in the early stages after the prosthesis has been inserted. In some modern prosthesis, the acetabular cup component may be coated on its external surface with a bone growth promoting substance which will encourage bone ingrowth which helps to hold the acetabular component in place. The bone femoral head also is removed during the surgical procedure, and the femur shaft hollowed out using reamers and rasps to accept the femoral component of the prosthesis. The stem portion of the prosthesis is inserted into the femur and secured therein to complete the hip joint replacement.

In order to strive toward desired performance of the combined acetabular and femoral hip prosthesis components, the acetabular cup portion must be properly positioned in the acetabulum. This is particularly important since incorrect positioning of the acetabular cup component can lead to the prosthetic hip joint suffering from dislocations, a decreased range of motion, and possibly eventual loosening and/or failure of one or both components of the joint.

It is generally believed that there is a preferred orientation for the acetabular cup prosthesis component to provide a full range of motion and to minimize the risk of dislocation. Some example orientations of the acetabular cup prosthesis relative to the acetabular face are <NUM>° to <NUM>° from the vertical and rotated forward to <NUM>° to <NUM>° of anteversion. This broadly replicates the natural angle of the acetabulum. However, the specific angular orientation of the acetabular cup portion varies from patient to patient.

In hip replacement surgery, the acetabular cup portion of the prosthesis is usually oriented in the acetabulum by using an acetabulum positioning instrument. One example of such a positioner is a horizontal arm that is aligned parallel to a predetermined native tissue of the patient when the acetabular cup portion is oriented at a preferred abduction angle. This positioner is therefore sensitive to the position of the patient on the operating table for accuracy. The acetabular cup placement is typically done using an acetabular cup positioner and visual adjustment of the acetabular cup portion to ensure that the horizontal arm of the positioner is approximately parallel to the selected reference tissue (or axis) of the patient. The user of the positioner may also view the position of the acetabular cup portion relative to a second arm on the acetabular cup positioner which is positioned at a preset angle, to assist with positioning the acetabular cup at the correct abduction angle.

However, despite this known positioning procedure, the orientation of the acetabular cup portion in the replaced hip can deviate from the desired orientation. This may be due to one or more factors. First, the positioning of the acetabular cup is usually judged by eye. As the position to be judged by the user is a compound angle, it may be particularly difficult to visualize. Second, since the natural face of the acetabulum is not uniform and--where the hip is arthritic--may be distorted by osteophytes, the acetabulum is not generally a reliable guide for orientating the acetabular cup portion of the prosthetic joint. A third problem is that the prior art mechanical alignment guides usually rely on the pelvis being in a set position which may itself be difficult to judge, particularly in an obese patient. In view of these difficulties, the acetabular cup portion may sometimes be actually located via surgery as much as <NUM>° from the desired/planned position.

The above factors and issues encountered in surgical hip intervention have analogues in the shoulder surgery arena. For example, generally the normal glenoid retroversion of a given patient may fall within a range of approximately <NUM>° (<NUM>° of anteversion and <NUM>° of retroversion). (The version of the glenoid is defined as the angle between the plane of the glenoid fossa and the plane of the scapula body. ) In the pathologic state, glenoid bone loss may result in a much larger range of version angles.

One goal of shoulder surgery may be to modify the pathologic bone to correct pathologic version to be within the normal range or the normal version of the patient's native anatomy before the bone loss occurred. During surgery, and particularly minimally invasive procedures, the plane of the scapula may be difficult or impossible to determine by direct visual inspection, resulting in the need for assistive devices or methods to define both the pathologic version present at the time of surgery and the intended correction angle.

It is generally believed that there is a preferred orientation for the glenoid component to provide a full range of motion and to minimize the risk of dislocation. Some example orientations of the glenoid prosthesis relative to the glenoid face are about <NUM>° of anteversion to about <NUM>° of retroversion; average version is about <NUM>-<NUM>° of retroversion. This broadly replicates the natural angle of the glenoid. However, the specific angular orientation of the glenoid portion varies from patient to patient.

With a view to overcoming these disadvantages, some arrangements have been recently suggested in which a three-dimensional intraoperative computer imaging surgical navigation system is used to render a model of the patient's bone structure. This model is displayed on a computer screen and the user is provided with intraoperative three-dimensional information as to the desired positioning of the instruments and the glenoid component of the prosthetic implant. However, surgical navigation arrangements of this type are not wholly satisfactory since they generally use only a low number of measured landmark points to register the patient's anatomy and to specify the angle of the prosthetic implant component (e.g., a glenoid component), which may not provide the desired level of accuracy. Further, the information provided by such systems may be difficult to interpret and may even provide the user with a false sense of security. Moreover, these systems are generally expensive to install and operate and also have high user training costs. Various proposals for trial prosthetic joint components have been made in an attempt to overcome the problems associated with accurately locating the acetabular cup portion of the prosthetic implant. While these trial systems may help with checking whether the selected position is correct, they are not well-suited to specify the correct position initially, and thus there still is user desire for a system which may assist a user in placement of prosthetic implant component in a prepared native tissue site.

<CIT> shows a hip femoral resurfacing tooling including a distal sleeve interface, a guide for aligning the sleeve interface with femoral head axis, and handle.

<CIT> describes a patient-matched surgical guide for aligning, guiding, placing, orientating and fixing a prosthetic cup during a surgical procedure. The guide has an alignment structure including a contour formed from data indicative of patient anatomy.

Optional inventive embodiments are defined by the dependent claims.

In an embodiment of the present disclosure, a method of attaching a stock prosthetic implant to a patient tissue is described. The stock prosthetic implant includes a plurality of fastener apertures extending therethrough. A lower implant surface of the stock prosthetic implant is placed into contact with the patient tissue in a predetermined implant orientation. A guide having a lower guide surface contoured to substantially mate with at least a portion of an upper implant surface of the stock prosthetic implant, an upper guide surface spaced longitudinally apart from the lower guide surface by a guide body, and at least one guiding aperture extending through the guide body between the upper and lower guide surfaces at a predetermined aperture location with respect to the guide body is provided. A predetermined target trajectory is defined through the guide body with a chosen guiding aperture. At least one of the target trajectory and the aperture location of each guiding aperture is preselected responsive to preoperative imaging of the patient tissue. The lower guide surface is placed into mating contact with at least a portion of the upper implant surface in a predetermined relative guide/implant orientation. The chosen guiding aperture is placed into a collinear relationship with a chosen one of the fastener apertures. A surgical tool is guided through the chosen guiding aperture and the corresponding chosen fastener aperture and inserting the surgical tool into the patient tissue along the target trajectory to create a fastener cavity in the patient tissue, and/or a fastener is guided through the chosen fastener aperture and into the patient tissue along the target trajectory.

In an embodiment of the present disclosure, a guide for assisting with attachment of a stock prosthetic implant to a patient tissue is described. A lower guide surface is configured to contact an upper implant surface of the stock prosthetic implant when a lower implant surface of the stock prosthetic implant is in contact with the patient tissue. At least a portion of the lower guide surface is contoured to substantially mate with at least a portion of the upper implant surface. An upper guide surface is spaced longitudinally apart from the lower guide surface by a guide body. The upper guide surface is accessible to a user when the lower guide surface is in contact with the upper implant surface. At least one guiding aperture extends through the guide body between the upper and lower guide surfaces at a predetermined aperture location with respect to the guide body. The at least one guiding aperture defines a predetermined target trajectory through the guide body. The at least one guiding aperture is collinear with a corresponding at least one fastener aperture in the stock prosthetic implant when the lower guide surface is mated with the upper implant surface. At least one of the target trajectory and the aperture location of each guiding aperture is preselected responsive to preoperative imaging of the patient tissue.

In an embodiment of the present disclosure, a guide for assisting with attachment of a stock prosthetic implant to a patient tissue is provided. A lower guide surface is configured to contact an upper implant surface of the stock prosthetic implant when a lower implant surface of the stock prosthetic implant is in contact with the patient tissue. The lower guide surface is contoured to substantially mate with at least a portion of the upper implant surface. An upper guide surface is spaced longitudinally apart from the lower guide surface by a guide body. The upper guide surface is accessible to a user when the lower guide surface is in contact with the upper implant surface. An orienting feature is configured to enter a predetermined orienting relationship with a previously placed landmark while the lower guide surface is in mating contact with at least a portion of the upper implant surface in a predetermined relative guide/implant orientation.

For a better understanding of the invention, reference may be made to the accompanying drawings, in which:.

<FIG> depicts a portion of the external surface of a (left) hip bone <NUM>, which is an example of a possible patient tissue use environment for the described systems, apparatuses, and methods. Directional arrow <NUM> indicates the superior/inferior and anterior/posterior directions. The body of ischium, body of ilium, and body of pubis are shown generally at <NUM>, <NUM>, and <NUM>, respectively. The acetabulum <NUM>, which is formed in part by these three bodies <NUM>, <NUM>, and <NUM>, has a recessed acetabular fossa <NUM> and is surrounded by an acetabular margin <NUM> (shown approximately in <FIG> via dashed line).

The patient tissue is shown and described herein at least as a hip bone and the implant component is shown and described herein at least as an acetabular prosthetic hip component, but the patient tissue and corresponding implant component could be any desired types such as, but not limited to, hip joints, shoulder joints, knee joints, ankle joints, phalangeal joints, metatarsal joints, spinal structures, long bones (e.g., fracture sites), or any other suitable patient tissue use environment.

For example, the implant component could be an internal fixation device (e.g., a bone plate), a structure of a replacement/prosthetic joint, or any other suitable artificial device to replace or augment a missing or impaired part of the body. The implant component will be described herein as a prosthetic implant component.

The term "lateral" is used herein to refer to a direction indicated by directional arrow <NUM> in <FIG>; the lateral direction in <FIG> lies substantially within the plane of the drawing and includes all of the superior, inferior, anterior, and posterior directions. The term "longitudinal" is used herein to refer to a direction defined perpendicular to the plane created by directional arrow <NUM>, with the longitudinal direction being substantially into and out of the plane of the drawing in <FIG> and representing the proximal (toward the medial line of the body) and distal (out from the body) directions, respectively.

<FIG> are side and top views, respectively, of a prior art stock prosthetic implant, and, more specifically, of a stock acetabular cup implant <NUM> of a stock hip prosthesis. The term "stock" is used herein to indicate that the prosthetic component indicated is not custom-manufactured or -configured for the patient, but is instead provided as a standard inventory item by the prosthetic manufacturer. A particular stock component may be selected by the user from a product line range of available components, with the user specifying a desired configuration, general size (e.g., small, medium, large), material, or any other characteristic of the component. Indeed, the stock component may be manufactured only after the user has selected the desired options from the range of choices available. However, the stock component is differentiated from a custom-manufactured or bespoke component in that the stock component is agnostic and indifferent regarding a particular patient anatomy during the design and manufacturing processes for a prosthetic implant intended for that patient, while the patient anatomy is an input into at least one design and/or manufacturing process for a custom-manufactured component. The following description presumes the use of a stock prosthetic component, though one of ordinary skill in the art will be able to provide for the use of the present disclosure with a custom-manufactured component, instead.

The acetabular cup implant <NUM> comprises a parti-spherical acetabular shell <NUM> and a plurality of prosthetic apertures, described herein as fastener apertures <NUM>, extending through the thickness of the acetabular shell between an upper implant surface <NUM> and a lower implant surface <NUM>. The below description of "fastener apertures" <NUM> does not presume that each of such are configured and/or intended to actually receive a fastener, but is done solely for ease of description herein. The acetabular cup implant <NUM> is generally made from metal or another durable, biocompatible material and is fastened securely into an acetabulum <NUM> during a hip replacement procedure. An acetabular liner (not shown), generally made of a polymer or another material having desirable lubricity and durability properties, is then attached within the acetabular shell <NUM> and the acetabular liner cradles the femoral ball component (not shown) in the finished prosthetic hip joint. The fastener apertures <NUM> are configured to accept fasteners (not shown), and the acetabular shell <NUM> usually includes more fastener cavities than the number of fasteners expected to be used, to provide flexibility for the user in selecting fastener placement for a particular patient. The multiplicity of fastener apertures <NUM>, beyond the number intended to receive fasteners, also may provide advantages in weight savings and increased flexibility of the acetabular cup implant <NUM>.

Much of the success of a prosthetic joint replacement arises from secure affixation of the acetabular cup implant <NUM> to the hip bone <NUM>, and anchoring of the fasteners into robust bony matter contributes to a suitably snug fit between the acetabular cup implant and the hip bone. However, pathological anatomy of the hip bone <NUM> may affect where the fasteners can be securely placed. The native and pathological anatomies differ from patient to patient, so preoperative patient imaging scans may be used to preoperatively plan desired locations and trajectories for the fasteners to be inserted through the emplaced acetabular cup implant <NUM> into the hip bone <NUM>. However, and particularly during minimally invasive surgeries, very little of the hip bone <NUM> is visible to the user, and the visible portion of the hip bone may be located at the distal end of a "tunnel" of surrounding soft tissue temporarily cleared out of the way by the user; accordingly, available maneuvering space at the surgical site may be severely restricted. In addition, the patient's hip joint may be actually canted slightly differently during the surgical procedure than planned preoperatively. These are among the factors which may result in a preoperative location/trajectory plan for a particular fastener being very difficult and time-consuming for a user to actually perform in an operative environment.

To aid with carrying out a preoperative plan for attaching a stock prosthetic implant to a patient tissue, a guide <NUM> may be provided, according to a first embodiment of the present disclosure.

The guide <NUM>, shown in various optional configurations in <FIG>, is at least partially custom-manufactured for a particular patient responsive to preoperative imaging of the patient tissue. For example, the guide <NUM> may be wholly custom-made (e.g., using rapid prototyping techniques) or may be modified from a stock guide or guide blank (not shown). It is contemplated that at least a part of the guide <NUM> is a patient-specific, single-use, bespoke feature suited only for use at the indicated surgical site, though one of ordinary skill in the art could create a guide (not shown) which uses a patient-specific "disposable" structure connected to a stock, generic "reusable" carrier.

Regardless of the whole/partial custom manufacture status, the guide <NUM> may be configured responsive to at least one of preoperative imaging of the patient tissue and preoperative selection of the stock prosthetic implant. The location and target trajectory of each fastener of the implant are predetermined by a user before the guide <NUM> is associated with the patient tissue. This predetermination may occur intraoperatively, as the user is able to directly see the condition of the surgical site. However, it is contemplated that a predetermination of the desired insertion location and target trajectory of each fastener could be accomplished preoperatively, with reference to preoperative imaging of the patient tissue. For example, a system similar to that of co-pending U. Patent Application No. to be determined, filed October <NUM>, <NUM>, titled "System of Preoperative Planning and Provision of Patient-Specific Surgical Aids" and claiming priority to <CIT> and titled "System of Preoperative Planning and Provision of Patient-Specific Surgical Aids", or any suitable preoperative planning system, could be used. In this manner, a user can create a patient tissue model for observation, manipulation, rehearsal, or any other pre-operative tasks.

The term "model" is used herein to indicate a replica or copy of a physical item, at any relative scale and represented in any medium, physical or virtual. The patient tissue model may be a total or partial model of a subject patient tissue, and may be created in any suitable manner. For example, and as presumed in the below description, the patient tissue model may be based upon computer tomography ("CT") data imported into a computer aided drafting ("CAD") system. Additionally or alternatively, the patient tissue model may be based upon digital or analog radiography, magnetic resonance imaging, or any other suitable imaging means. The patient tissue model will generally be displayed for the user to review and manipulate preoperatively, such as through the use of a computer or other graphical workstation interface.

During preoperative planning, the user can view the patient tissue model and, based upon knowledge of other patient characteristics (such as, but not limited to, height, weight, age, and activity level), then choose a desired stock prosthetic implant. Because three-dimensional image models are available of many stock prosthetic implants, the user may be able to "install" the stock prosthetic implant virtually in the patient tissue model via a preoperative computer simulation. During such a simulation, the user can adjust the position of the stock prosthetic implant with respect to the patient tissue, even to the extent of simulating the dynamic interaction between the two, to refine the selection, placement, and orientation of the stock prosthetic implant for a desired patient outcome.

Once a chosen stock prosthetic implant has been virtually placed in a desired position and orientation with respect to the patient tissue (it will be understood that some mechanical modification might need to be made to the native patient tissue to accomplish this implant placement), the fastener placement can also be planned through the use of the computer simulation, with consideration of the location, amount, and pathology of the patient tissue, or any other desired factors, being taken into account in fastener placement planning. By hand and/or with automatic computer assistance, the user can experiment with various fastener sizes, placements, and orientations for securing the stock prosthetic implant to the patient tissue. When the fastener positioning has been finalized, with the implant virtually positioned in a predetermined implant orientation with respect to the patient tissue, a location and target trajectory can be defined for each of the fasteners to follow during installation. The term "trajectory" is used herein to indicate an invisible line along which an elongate body will travel under guidance from the trajectory-defining structure.

The fastener location and target trajectory information for the particular patient tissue achieved via preoperative imaging and/or computer simulation/modeling may be transferred to a physical aid for the user through the custom manufacture of a guide <NUM>, such as those shown in various configurations in <FIG>. When the preoperative planning has been finalized, a virtual guide <NUM> is generated at a predetermined guide orientation with respect to the virtual implant and the virtual patient tissue. The user may then have the opportunity to adjust the virtual guide <NUM>, if desired, before a physical guide <NUM> is produced.

With reference to <FIG>, the guide <NUM> (hereafter described as being physical, not virtual) includes a lower guide surface <NUM> (visible in <FIG>) configured to contact an upper implant surface <NUM> of the stock prosthetic implant, here presumed to be an acetabular cup implant <NUM>, when the lower implant surface <NUM> is in contact with the acetabulum <NUM>. At least a portion of the lower guide surface <NUM> is contoured to substantially mate with at least a portion of the upper implant surface <NUM>, as will be discussed below. The term "mate" is used herein to indicate a relationship in which the contours of two structures are at least partially matched or coordinated in at least two dimensions. For example, both the lower guide surface <NUM> and the upper implant surface <NUM> could have profiles that are concavely curved, convexly curved, planar/linear, or any combination of those or other profile shapes. The guide <NUM> also includes an upper guide surface <NUM> spaced longitudinally apart from the lower guide surface <NUM> by a guide body <NUM>. The upper guide surface <NUM> is accessible to a user when the lower guide surface <NUM> is in contact with the upper implant surface <NUM>.

The patient's name, identification number, surgeon's name, and/or any other desired identifier may be molded into, printed on, attached to, or otherwise associated with the guide <NUM> in a legible manner. The guide <NUM> may be made by any suitable method such as, but not limited to, selective laser sintering ("SLS"), fused deposition modeling ("FDM"), stereolithography ("SLA"), laminated object manufacturing ("LOM"), electron beam melting ("EBM"), <NUM>-dimensional printing ("3DP"), contour milling from a suitable material, computer numeric control ("CNC"), other rapid prototyping methods, or any other desired manufacturing process.

At least one guiding aperture <NUM> extends through the guide body <NUM> between the upper and lower guide surfaces <NUM> and <NUM> at a predetermined aperture location with respect to the guide body (i.e., a predetermined placement of the guiding aperture <NUM> on the guide body). As shown in <FIG>, the at least one guiding aperture <NUM> defines a predetermined target trajectory <NUM> through the guide body <NUM>. At least one of the target trajectory <NUM> and the aperture location of each guiding aperture <NUM> can be preselected responsive to preoperative imaging of the patient tissue, as previously described. When the guide <NUM> is placed atop the acetabular cup implant <NUM> as described above (with the lower guide surface <NUM> substantially mated with at least a portion of the upper implant surface <NUM>), at least one of the guiding apertures <NUM> is collinear with a corresponding fastener aperture <NUM> in the acetabular cup implant, as will be discussed below. The term "collinear" is used herein to indicate that central axes of each of two structures lie along the same line. However, the diameters of the "collinear" guiding apertures <NUM> and fastener apertures <NUM> could differ from each other. In short, the aperture locations of the guiding apertures <NUM> are preselected to facilitate placement of a fastener into the stock prosthetic implant (e.g., the acetabular cup implant <NUM> for the embodiment of <FIG>) and the underlying patient tissue at a preselected fastener location and a preselected fastener trajectory after removal of the guide <NUM> from the stock prosthetic implant.

The lower guide surface <NUM> shown in <FIG> includes at least one locating protrusion <NUM>. Each of the locating protrusions <NUM>, when present, extends from the lower guide surface <NUM> and is configured to nest into, or mate with, a preselected fastener aperture <NUM> of the acetabular cup implant <NUM>, to assist with mating of the lower guide surface with at least a portion of the upper implant surface <NUM>. As can be seen in <FIG>, the locating protrusions <NUM> in the depicted embodiment are simple protrusions and are not configured to accept a fastener.

An orienting feature <NUM>, such as the depicted extension in <FIG>, may be provided to the guide <NUM>. As shown here, for use with the acetabular cup implant <NUM>, the orienting feature <NUM> may extend, perhaps substantially, longitudinally and/or laterally from the guide <NUM>, but the direction, amount, and type of extension will depend upon the location and type of body tissue with which the guide <NUM> is being used. The orienting feature <NUM> may be configured to enter a predetermined orienting relationship with a landmark (not shown), such as a guide pin, wire, marking, and/or other location indicator previously placed in a predetermined relationship with the patient tissue, such predetermined orienting relationship occurring when the lower guide surface <NUM> is in mating contact with at least a portion of the upper implant surface <NUM> in a predetermined relative guide/implant orientation. (The predetermined relative guide/implant orientation is achieved when the guide <NUM> and acetabular cup implant <NUM> are mated in a desired manner, as predetermined via preoperative imaging and/or analysis. ) The landmark may be any suitable two- or three-dimensional landmark such as, but not limited to, a native or acquired anatomical feature of the patient tissue and/or a separately provided landmark placed with the assistance of a guide as disclosed in co-pending U. Patent Application No. to be determined, filed October <NUM>, <NUM>, titled "System and Method for Association of a Guiding Aid with a Patient Tissue" and claiming priority to <CIT> and titled "System and Method for Association of a Guiding Aid with a Patient Tissue".

The landmark could also or instead be placed using a robotic surgical aid, adjustable reusable (e.g., "dial-in") tools, intraoperative imaging, or any other suitable placement aid. For example, a portion of the orienting feature <NUM> could be configured to mate with a preselected surface of the patient tissue acting as a landmark such that the mating of the orienting feature and the patient tissue indicates that the predetermined orienting relationship between the orienting feature and this patient tissue landmark has been achieved.

Optionally, an original landmark could have been previously placed, then removed for any reason (e.g., to facilitate machining of the acetabulum <NUM> surface). A second landmark may then be placed at the same location and with the same location as the original landmark, such as via reusing the cavity in the surface left by the removal of the original landmark. Indeed, the remaining cavity in the surface itself may serve a landmarking function. Through these or any other such transformations of physical manifestations, the position information represented by the original landmark and preoperatively planned may be preserved and used during various stages of the surgical procedure regardless of the way in which that position landmark is made available to the user at those various stages. Optionally, the orienting feature <NUM> may include an orienting indicator <NUM>. When present, the orienting indicator <NUM> may be configured to achieve a predetermined signaling relationship (the signaling relationship being directly related to the orienting relationship) with the landmark, as will be described below, while the guide <NUM> and the stock prosthetic implant -- here, the acetabular cup implant <NUM>--are in the predetermined relative guide/implant orientation. For example, in the first configuration of the first embodiment shown in <FIG>, the orienting feature <NUM> is a bridge-type structure extending from the guide body <NUM> and the orienting indicators <NUM> are notches in the orienting feature <NUM>, each shaped to somewhat closely surround at least a portion of the diameter of a guide pin or other three-dimensional landmark to achieve the predetermined signaling relationship. The landmark(s) were previously placed in any suitable manner in predetermined locations at the surgical site. Accordingly, the predetermined signaling relationship between the landmark(s) and the orienting indicator(s) <NUM> assists the user in placing the guide <NUM> into a predetermined guide orientation with respect to the patient tissue.

When the guide <NUM> and the stock prosthetic implant are held in a predetermined relative guide/implant orientation (e.g., through the use of locating protrusions <NUM>, frictional engagement, any other mechanical linkage [e.g., nesting], or even merely coordinated movement of each by the user), then the stock prosthetic implant is manipulated in concert with the guide. Accordingly, movement of the guide <NUM> into the predetermined guide orientation--as signaled by coordination of the landmark(s) and the orienting feature <NUM>--will concurrently move the stock prosthetic implant into a predetermined implant orientation with respect to the patient tissue. One of ordinary skill in the art can readily preoperatively plan the placement and type of landmark(s), as well as the structure and type of orienting feature(s) <NUM> and/or orienting indicator(s) <NUM> to assist the user in guiding the stock prosthetic implant into the predetermined implant orientation and/or location with respect to the patient tissue for a particular application of the present invention.

While the orienting indicator <NUM> is shown in <FIG> as being a notch, any suitable structure, notch-like or otherwise, could be used as an orienting indicator. For example, the orienting indicator <NUM> could be a lug extending from the orienting feature <NUM>, a visual indicator such as a line drawn or etched on the orienting protrusion, or even a mechanical system such as a latch or trip-wire.

As another example, a second configuration of the first embodiment of the present invention is shown in <FIG>. Structures of <FIG> that are the same as or similar to those described with reference to <FIG> have the same reference numbers. As with all alternate configurations shown and described herein, description of common elements and operation similar to those in previously described configurations will be omitted, for clarity. In the second configuration, the guide <NUM> includes multiple locating protrusions <NUM> and multiple orienting features <NUM>. One of the orienting features <NUM> includes a notchlike orienting indicator 442a configured to interact with a landmark in an active (e.g., mechanically interacting) signaling relationship, and the other of the orienting features <NUM> includes a more passive orienting indicator 442b, which is depicted here as an inscribed line on the orienting feature and is configured to provide a more passive (e.g., visually observed) signaling relationship with a landmark.

As depicted in <FIG>, the guide <NUM> may include at least one central guide aperture <NUM> extending through the guide body <NUM> between the upper and lower guide surfaces <NUM> and <NUM>. The central guide aperture <NUM> may be configured to accept a landmark placed in a predetermined relationship with the patient tissue. For example, the central guide aperture <NUM> of the second configuration is substantially centrally located in the guide body <NUM>. If a central landmark (not shown) is placed in a similarly central location of the patient tissue at the surgical site and accepted through the central guide aperture <NUM>, the guide body <NUM> could pivot about that central landmark (as if on an axis) under rotational force exerted by the user. In such manner, the guide <NUM> (and, by extension, the stock prosthetic implant when held in the predetermined relative guide/implant relationship) can initially be placed in a desired position with respect to the patient tissue--agnostic of rotational orientation--and then the rotational orientation can be set via pivoting of the guide and stock prosthetic implant about the central landmark until the orienting feature <NUM> achieves the predetermined orienting relationship with an other landmark, spaced apart from the central landmark. Optionally the central landmark could be a guidewire (not shown), such as that disclosed in co-pending <CIT>.

As an alternative to this agnostic placement of the guide <NUM> and nested/attached stock prosthetic implant at the surgical site and subsequent rotation into position, the guide <NUM> and the stock prosthetic implant could be concurrently placed into contact with at least one landmark (which could include the central landmark) at a location spaced apart from the patient tissue at the surgical site. For example, a landmark could be an elongate guide pin, and a notch-like orienting indicator <NUM> could be placed into the signaling relationship with a protruding end of the guide pin some distance from the patient tissue. In this optional situation, the stock prosthetic implant would be guided into the predetermined implant orientation concurrently with being brought into contact with the patient tissue as the orienting indicator <NUM> slides along the length of the guide pin via a rail-like dynamic guiding technique.

<FIG> depict third, fourth, and fifth configurations, respectively, of the first embodiment of the present disclosure. In the third configuration of <FIG>, the guide <NUM> is configured to substantially mate with a fairly large portion of the acetabular cup implant <NUM>. Relief slots <NUM> may extend laterally inward from an outer guide rim <NUM> and, when present, can help provide for a temporary reduction in circumference of the guide <NUM> under lateral force (e.g., a squeeze by the user) to elastically deform the guide <NUM> and facilitate placement of the guide into the acetabular cup implant <NUM>. When the lateral force is released, the guide <NUM> expands back to the original circumference to nest closely within the acetabular cup implant <NUM>.

As shown in <FIG>, a plurality of two-dimensional orienting features <NUM> are provided on the upper guide surface <NUM>. The orienting features <NUM> shown in <FIG> are visual indications--here, darkened carets--on the outer guide rim <NUM> and may help guide the user in placing the guide <NUM> in a predetermined mating relationship with the stock prosthetic implant, to assist in carrying out the preoperative plan including the placement of the fasteners to secure the stock prosthetic implant in a desired manner. For example, the orienting features <NUM> shown in <FIG> may be placed to correspond to (e.g., line up radially with) the positions of one or more landmarks previously placed on or near the acetabulum <NUM>. Optionally, the orienting features <NUM> may be placed to correspond to the position(s) of one or more landmarks previously placed on the acetabular cup implant <NUM>, to help orient the guide <NUM> into the predetermined relative guide/implant relationship with the stock prosthetic implant. This orientation between the guide <NUM> and the acetabular cup implant <NUM> may be especially important when the guide and acetabular cup implant are held relatively firmly to one another during their insertion to the surgical site.

The guides <NUM> in <FIG> each are configured to substantially mate with a much smaller portion of the acetabular cup implant <NUM> than are the guides of <FIG>. The guide <NUM> of the fourth configuration, shown in <FIG>, is shaped like a segment of a circle and may include one or more laterally oriented locating protrusions <NUM> that help steady and/or position the guide at a desired position on the acetabular cup implant <NUM>. When present, the locating protrusions <NUM> may contact the acetabular cup implant <NUM> at a predetermined position to indicate that the guide <NUM> is placed correctly on the acetabular cup implant, which could include a structure (not shown) configured to engage with the locating protrusions. The guide <NUM> of <FIG> might be placed asymmetrically upon the acetabular cup implant <NUM>, with the outer guide rim <NUM> being aligned with an outer rim of the acetabular cup implant.

Similarly to the guide <NUM> of <FIG>, the guide <NUM> of the fifth configuration, shown in <FIG>, is substantially shaped as a portion of a spherical shell and might be placed in any desired orientation on the acetabular cup implant <NUM> which would result in the desired fastener placement. As can be seen in <FIG>, locating protrusions <NUM> may extend from any surface of the guide <NUM>. For example, at least one locating protrusion <NUM> of <FIG> extends downward from the lower guide surface <NUM>, toward the upper implant surface <NUM> when the guide <NUM> is mated with the acetabular cup implant <NUM>. A locating protrusion <NUM> extending in this orientation may be configured to nest into a preselected one of the fastener apertures <NUM> to provide positive location and increased stability between the guide <NUM> and the acetabular cup implant <NUM>.

<FIG> illustrates, in schematic cross-section, an example of the guide <NUM> being used to define the predetermined target trajectories <NUM> and aperture locations, with fasteners <NUM> being temporarily placed through selected ones of the guiding apertures <NUM> in <FIG> to show the target trajectories' role in guiding fasteners, be they screws, nails, brads, rods, or any other suitable fasteners. It is contemplated, though, that in most use environments, the guide <NUM> will be removed from the acetabular cup implant <NUM> before fasteners <NUM> are installed on the acetabular cup implant.

It is apparent from <FIG> that the guide body <NUM> should be thick enough that each of the guiding apertures <NUM> can influence the trajectory of an elongate body passing therethrough. If the guide body <NUM> is too thin, the elongate body may precess within the guiding aperture <NUM> and deviate from the target trajectory <NUM>. The elongate body intended for insertion through the guiding apertures <NUM> could be a fastener, a surgical tool, a guide pin, or any other suitable structure, and could be of any suitable size with respect to a corresponding guiding aperture <NUM> and/or fastener aperture <NUM>. The elongate body could contact all, a portion of, or none of the inner walls of the guiding aperture <NUM> and/or fastener aperture <NUM>, as desired.

At least one depth limiting feature <NUM> may be provided to the guide <NUM> to limit further motion of the elongate body along the target trajectory and into the patient tissue past a predetermined depth. When the elongate body is a surgical tool, for example, the depth limiting feature <NUM> may be a blocking stud, as shown in <FIG>, which "catches" a drill chuck, a reamer shoulder, or another structure associated with the surgical tool when the surgical tool has reached the predetermined depth. It is contemplated that the depth limiting feature <NUM> might be custom-designed and -manufactured for that particular patient tissue with the assistance of preoperative imaging. The depth limiting feature <NUM> may also or instead be provided by the fastener <NUM>, such as, but not limited to, a head of the fastener having a diameter greater than the shaft and preventing the fastener head from passing through the fastener aperture <NUM>--in this example, the depth limiting feature is the fastener head and may be adequately provided by a stock fastener.

<FIG> show top and cross-sectional side views of a portion of a surgical procedure in which the guide <NUM> may assist with providing target trajectories <NUM> and locations for fasteners <NUM> to secure an acetabular cup implant <NUM> to an acetabulum <NUM>. In <FIG>, the distal ends of three landmarks <NUM> (shown here as guide pins) have been placed in the hip bone <NUM> in or near the acetabulum <NUM> (optionally with the assistance of a pin guide, not shown). The acetabular cup implant <NUM> has been placed in contact with a prepared acetabulum <NUM>. Here, the acetabular cup implant <NUM> includes orienting features 440a to help the user rotationally orient the acetabular cup implant with the visual assistance of the two landmarks <NUM> located outside the acetabulum <NUM> on the hip bone <NUM>. The orienting features 440a might not be used for situations in which the acetabular cup implant <NUM> is rotationally symmetrical, but could be provided even with a symmetrical acetabular cup implant for any other desired reason.

Additionally, in <FIG>, a chosen one of the fastener apertures <NUM> of the acetabular cup implant <NUM> has been passed or slid over at least a portion of a landmark <NUM> (which may be a central landmark, as shown) previously placed in the acetabulum <NUM> to help orient the acetabular cup implant within the acetabulum. Incidentally, this central landmark might have been used to help prepare the acetabulum <NUM>, such as by guiding a reamer (not shown) to ream the acetabulum into a more standardized spherical shape to accept the stock acetabular cup implant <NUM>. Optionally, this chosen one of the fastener apertures <NUM> may differ in size, shape, or any other characteristic from the other fastener apertures, to indicate and/or facilitate its use with the central landmark <NUM>. At the stage shown in <FIG>, the acetabular cup implant <NUM> is either sitting loosely in the acetabulum <NUM> or has a tenuous press-fit relationship with the acetabulum--in any case, there have been no fasteners <NUM> installed, and the acetabular cup implant <NUM> is thus not yet a functional portion of a prosthetic hip joint.

<FIG> show the hip bone <NUM> and acetabular cup implant <NUM> of <FIG> with the addition of an overlying guide <NUM> according to the present disclosure. Similar to the orientation of the acetabular cup implant <NUM>, the guide <NUM> in <FIG> has a guiding aperture <NUM> which been passed or slid over at least a portion of the central landmark <NUM> previously placed in the acetabulum <NUM> to help achieve a predetermined guide orientation within the acetabular cup implant. The guide <NUM>, as shown, includes inscribed orienting features 440b (to distinguish from the orienting features 440a of the acetabular cup implant <NUM>) which help rotationally orient the acetabular cup implant with the assistance of the two landmarks <NUM> located outside the acetabulum <NUM> on the hip bone <NUM>. The guide <NUM> of <FIG> also includes a bridge-like orienting feature <NUM> including orienting indicators <NUM> which are in the signaling relationship with two of the landmarks <NUM> in the pictured view. Optionally and as previously discussed, at least a portion of the bridge-like orienting feature <NUM> could include a shaped profile (not shown) which achieves the signaling relationship through mating with a preselected portion of the patient tissue.

The stock acetabular cup implant <NUM> has a predetermined number of fastener apertures <NUM>, at least one of which may be extraneous, as previously discussed. The guide <NUM> also has a predetermined number of guiding apertures <NUM>, which may be any number, but is contemplated to be no more than the predetermined number of fastener apertures <NUM> in the acetabular cup implant. At least one guiding aperture <NUM> should be collinear or otherwise coincident in some physical property with a predetermined one of the fastener apertures <NUM>. In this manner, the guide <NUM> acts as a "mask" to obscure those fastener apertures <NUM> which are not predetermined to receive a fastener <NUM>, while providing a location and target trajectory <NUM> for installation of fasteners <NUM> into those fastener apertures which are to be used in securing the acetabular cup implant <NUM> to the hip bone <NUM>.

As is apparent from the cross-sectional view of <FIG>, the locating protrusions <NUM> on the underside of the guide <NUM> each nest into preselected ones of the fastener apertures <NUM> to help provide positive locating and stabilizing features to the guide <NUM>. Regardless of the presence of locating protrusions <NUM>, however, it is contemplated that at least a portion of the guide <NUM> will be in contact with the acetabular cup implant <NUM> in a predetermined orientation when the structures have achieved the configuration shown in <FIG>. The locating protrusion <NUM> shown in <FIG> nests into a central one of the fastener apertures <NUM>, which also holds a central landmark <NUM>. Accordingly, this locating protrusion <NUM> doubles as a guiding aperture <NUM> and can accept a fastener or other structure inserted thereinto.

One example sequence of use for any configuration of the first embodiment of the present disclosure is shown in <FIG>. In <FIG>, the acetabular cup implant <NUM> has been placed in the acetabulum <NUM>. It should be understood that the acetabular cup implant <NUM> is not necessarily in the predetermined implant orientation at this point in the procedure. The guide <NUM> is then placed atop the acetabular cup implant <NUM> with the lower guide surface <NUM> in mating contact (optionally with the assistance of one or more locating protrusions <NUM>) with the upper implant surface <NUM> in the predetermined relative guide/implant orientation.

The guide <NUM> and the acetabular cup implant <NUM> are then shifted as desired, independently or concurrently and optionally with the use of one or more orienting features <NUM> and/or orienting indicators <NUM>, as described above with reference to <FIG>, until the acetabular cup implant is in the predetermined implant orientation and the guide is in a predetermined guide orientation. This view is shown in <FIG>.

Once the acetabular cup implant <NUM>, guide <NUM>, and acetabulum <NUM> have achieved the relative positioning and configuration shown in <FIG>, the user can prepare for installation of the fasteners <NUM> in the preselected aperture locations (indicated by the placement of the guiding apertures <NUM> on the guide) and along the target trajectories <NUM>. For example, when fastener cavities <NUM>, pilot or otherwise, are to be pre-drilled to receive the fasteners <NUM>, at least one guiding aperture <NUM> may be configured to guide a surgical tool <NUM> through a corresponding fastener aperture <NUM> and into the patient tissue along the target trajectory <NUM> to create the fastener cavity in the patient tissue, as shown in <FIG>. Though omitted here for clarity, a guiding sleeve (not shown) may be placed into the guiding aperture <NUM> (and optionally extend into the corresponding fastener aperture <NUM>) to protect the guide <NUM> and/or the acetabular cup implant <NUM> from the forces (e.g., rotational) exerted by the surgical tool <NUM>. When present, the guiding sleeve may also serve as an extension of the guiding aperture <NUM> to emphasize the target trajectory <NUM> and help maintain collinearity of the fastener cavity <NUM> with the target trajectory. As another example, not shown, when the fastener <NUM> does not require a pre-drilled hole (e.g., the fastener is a self-tapping screw or a nail), at least one guiding aperture <NUM> may be configured to guide the fastener itself through a corresponding fastener aperture <NUM> and into the patient tissue along the target trajectory <NUM> into the final arrangement of <FIG>.

In the former arrangement (i.e., guide <NUM> guides surgical tool <NUM>), the guide may be removed from the acetabular cup implant <NUM> once the fastener cavities <NUM> are produced, such as in <FIG>. The acetabular cup implant <NUM> is maintained in place while fasteners <NUM> are then installed directly through the selected fastener apertures <NUM> (i.e., those with associated fastener cavities already drilled) to secure the acetabular cup implant to the acetabulum <NUM>, forming the final arrangement shown in <FIG>. Optionally, the fastener apertures <NUM> may be countersunk (not shown) to accommodate each fastener head <NUM> within the material of the acetabular shell <NUM> and present a substantially smooth upper implant surface <NUM>. Alternately or additionally, at least one fastener head <NUM> could remain protruding from the acetabular shell <NUM> above the upper implant surface <NUM>, as shown in <FIG>, particularly if such would be desirable in attaching another prosthetic implant structure (e.g., an acetabular liner, not shown) to the acetabular cup implant <NUM>. As other options, the fasteners <NUM> could be substantially headless or could have fastener heads <NUM> which interact with the inner surface of the fastener apertures <NUM> to remain recessed below the upper implant surface <NUM> while still providing a securing function to the acetabular cup implant <NUM>.

In the latter arrangement (i.e., guide <NUM> guides fastener[s] <NUM>), the guide may be configured to accommodate the fastener heads <NUM>, if any, before the guide is removed from the acetabular cup implant <NUM>. For example, the guide <NUM> could be frangible and thus equipped for at least partial disassembly and removal when the fasteners <NUM> have been substantially guided along the target trajectories <NUM>. As another example, the guiding apertures <NUM> could be elongate and configured to create a slot open to the lateral edge of the guide body <NUM>, so that the guide <NUM> can be moved laterally out of engagement with the acetabular cup implant <NUM> without changing the trajectories of the partially-inserted fasteners <NUM> from the target trajectories <NUM>. Regardless of the operation or structure employed, at least one of the guiding apertures <NUM>, fastener apertures <NUM>, and fasteners <NUM> could be configured to allow removal of the guide <NUM> from the acetabular cup implant <NUM>, again without changing the trajectories of the partially-inserted fasteners from the target trajectories <NUM>. When the fasteners <NUM> are left partially inserted at the time the guide <NUM> is removed, the user may complete their insertion without the guiding influence of the guide; it will generally be desirable, however, that the guide not be removed until there is substantial certainty that the fasteners are adequately engaged with the patient tissue of the hip bone <NUM> and will continue to follow their target trajectories <NUM> during the remaining insertion operation even without the guide being present.

Regardless of the way in which the guide <NUM> is removed, the acetabular cup implant <NUM> is anticipated to be securely fastened to the acetabulum <NUM> at, or shortly after, the guide removal is accomplished. The user may then continue with the surgical processes to complete the installation of the prosthetic implant and to conclude the surgical procedure as desired.

In summary, the guide <NUM> can assist the user with placement of fasteners <NUM> into a prosthetic implant and a patient tissue in a desired fashion by providing target trajectories <NUM> and aperture (that is, insertion) locations for each fastener. Each target trajectory <NUM> and each aperture location is preselected responsive to preoperative imaging of the patient tissue, with each target trajectory and each aperture location being preselected to facilitate placement of a fastener <NUM> into a stock prosthetic implant and the underlying patient tissue at a preselected fastener location and a preselected fastener trajectory before and/or after removal of the guide <NUM> from the stock prosthetic implant. The guide <NUM> also may be configured to enter a predetermined orienting relationship, such as with the assistance of an orienting feature <NUM>, with a natural or acquired landmark (not shown), such as a guide pin, wire, marking, and/or other location indicator previously placed in a predetermined relationship with the patient tissue, to facilitate correct location of at least one target trajectory <NUM> with respect to the patient tissue.

<FIG> depict a guide <NUM>' according to a second embodiment of the present disclosure and related structures. The guide <NUM>' of <FIG> is similar to the guide <NUM> of <FIG> and therefore, structures of <FIG> that are the same as or similar to those described with reference to <FIG> have the same reference numbers with the addition of a "prime" mark. Description of common elements and operation similar to those in the previously described first embodiment will not be repeated with respect to the second embodiment.

<FIG> is a partial perspective view of the scapula, with particular emphasis on the glenoid fossa <NUM>. A glenoid implant <NUM>, shown in <FIG>, is the stock prosthetic implant for use with a prosthetic shoulder replacement surgery for the second embodiment of the present disclosure.

This glenoid implant <NUM> happens to be a metaglene implant, which accepts a glenosphere component (not shown) in a known manner for a reverse shoulder prosthesis. The glenoid implant <NUM> includes a lower implant surface <NUM>', an upper implant surface <NUM>', and a plurality of fastener apertures <NUM>' extending between the lower and upper implant surfaces. Certain configurations of the glenoid implant <NUM> may also include an implant shaft <NUM>.

During installation of the glenoid implant <NUM>, a shaft aperture (not shown) is drilled into the patient tissue (here, the patient's glenoid fossa <NUM>) and the implant shaft <NUM> is placed in the shaft aperture for initial securement and stabilization before the fasteners <NUM>' are installed. The implant shaft <NUM> may act as a pivot point for rotation of the glenoid implant <NUM> during movement of the glenoid implant into the predetermined implant orientation, similar to the procedure described above for the first embodiment. In this situation, the shaft aperture serves as a landmark <NUM>' to communicate pre-operatively planned location information to the user during the surgical procedure. The implant shaft <NUM> may also act to help stabilize the glenoid implant <NUM> on an ongoing basis, after conclusion of the described surgical procedure. The glenoid fossa <NUM> could be reamed, cut, grafted, or otherwise altered from its native or pathologic state to accept the glenoid implant <NUM>, as desired according to the preoperative plan and/or an intraoperative decision.

Optionally, a landmark <NUM>' such as the previously described guidewire may be passed through the glenoid implant <NUM> and into the patient tissue of the glenoid fossa <NUM> through the use of a shaft aperture <NUM> passing through the implant shaft <NUM>. When the shaft aperture <NUM> is used in this manner, the landmark <NUM>' may be placed first, to help locate the glenoid implant <NUM> upon the glenoid fossa <NUM>, or the landmark may be placed into a glenoid implant already in place on the glenoid fossa, to help with location of the guide <NUM>' upon the glenoid implant.

The desire for use of one or more landmark(s) <NUM>' and/or guide(s) <NUM>' for the shoulder use environment stems from the relatively open plateau of the glenoid fossa <NUM>, on which the glenoid implant <NUM> can be positioned and oriented a number of different ways. In contrast, the acetabulum <NUM> tends to naturally cup and settle an appropriately sized acetabular cup implant <NUM>, inserted by a knowledgeable user, into one of a few positions, and the rotational orientation of the acetabular cup implant can then be refined through use of the orienting feature(s) <NUM>, when present. Particularly in a revision situation, due to anatomic abnormalities, it may be difficult to position either of these components in the glenoid fossa <NUM> or acetabulum <NUM>, as the case may be. This difficulty generally stems from bone loss or surgical alteration of the patient tissue resulting in a loss of natural landmarks.

A guide <NUM>' for use with the glenoid implant <NUM> is shown in <FIG>. As can be seen in <FIG>, the guide <NUM>' includes a central protrusion <NUM> configured to nest into the shaft aperture <NUM> of the glenoid implant <NUM>. In the second embodiment, the fastener apertures <NUM>' of the glenoid implant <NUM> also serve to accept the locating protrusions <NUM>' of the guide <NUM>', which surround each of the fastener apertures, as shown. The fastener apertures <NUM>' are optionally countersunk to accept the locating protrusions <NUM>'. When a countersunk fastener aperture <NUM>' is provided for a locating protrusion <NUM>', whether the countersunk feature is added by the user or originally provided by the implant manufacturer, the countersunk portion might also or instead be used to accept a fastener head <NUM>' to provide a smooth upper implant surface <NUM>' with no protruding fastener heads when securement of the glenoid implant <NUM> to the patient tissue is complete. With reference to <FIG>, the guiding apertures <NUM>' each can be seen to be located on the lower guide surface <NUM>' in a position coincident with the fastener apertures <NUM>' on the upper implant surface <NUM>' when the guide <NUM>' is mated with the glenoid implant <NUM> as shown in <FIG> (in this Figure, the glenoid implant is located directly underneath the guide <NUM>', as indicated by the dashed leader line). However, as can be seen in <FIG> and <FIG>, the location of the fastener apertures <NUM>' upon the upper guide surface <NUM>' is dictated by the target trajectory <NUM>' defined by each fastener aperture and is patient-specific, being preselected responsive to preoperative imaging of the patient tissue.

An optional handling feature <NUM> is indented into the upper guide surface <NUM>' and is configured as a connection point for a handling tool (not shown), which may provide assistance with moving the guide <NUM>' within the surgical field. Because the handling feature <NUM> shown in the figures is located collinearly with the implant shaft <NUM>, the handling tool can be used to rotate the guide <NUM>' about an axis defined by the implant shaft--this axis, when present, is acting as a landmark <NUM>' by indicating information to the user regarding a pre-planned location of the surgical site. While the handling feature <NUM> shown is a void adapted to receive a hex-head driver, any suitable handling feature may protrude from, and/or be recessed into, any surface of the guide <NUM>' and may have any desired shape or configuration. Sometimes the available maneuvering space in a surgical field is relatively restricted, and it may be useful for a forceps, hex wrench (perhaps with a frictional fit or other feature to nest into the handling feature <NUM>), Kocher tool, hemostat, or other user-manipulated handling tool (not shown) to selectively interact with the handling feature to hold the guide <NUM>' steady and/or to move the guide to a desired position. One or more features, such as indents, apertures, cavities, lugs, undercuts, or any other suitable structures could be provided to the handling feature <NUM> or to any other structure of the guide <NUM>' to facilitate gripping of the guide by any handling tool, in general, and/or by a particular handling tool.

In use, the guide <NUM>' of the second embodiment operates similarly to the guide <NUM> of the first embodiment. The glenoid implant <NUM> of <FIG> is placed upon the glenoid fossa <NUM> surface. Optionally, an implant-receiving aperture (not shown) may have been previously drilled in the glenoid fossa <NUM> surface--if so, the implant shaft <NUM> is inserted into the implant-receiving aperture as a part of placing the lower implant surface <NUM>' in contact with the patient tissue. The guide <NUM>' is placed atop the glenoid implant <NUM> with the lower guide surface <NUM>' in contact with the upper implant surface <NUM>'. When present, the locating protrusions <NUM>' of the guide <NUM>' may mate with the fastener apertures <NUM>' of the glenoid implant <NUM>.

Once the glenoid implant <NUM> and guide <NUM>' are mated together in the predetermined relative guide/implant orientation atop the glenoid fossa <NUM> surface, the glenoid implant and guide can be moved concurrently to move both the guide and the glenoid implant into predetermined guide and implant orientations with respect to the glenoid surface. In other words, engagement between the guide <NUM>' and the glenoid implant <NUM> causes forces exerted upon the guide to be transferred to the glenoid implant, and the user can move both the glenoid implant and the guide concurrently by moving just the guide. For example, and presuming that the glenoid implant <NUM> includes an implant shaft <NUM> received into an implant-receiving aperture in the glenoid fossa <NUM> surface, a clockwise force (indicated by clockwise arrow <NUM> in <FIG>) exerted upon the orienting feature <NUM>' will pivot the guide <NUM>'--and thus the mated glenoid implant--about the implant shaft.

The guide <NUM>' and mated glenoid implant <NUM> may be rotated, for example, until the orienting indicator <NUM>' achieves a predetermined signaling relationship with a landmark <NUM>' such as the depicted guide pin. Accordingly, the guide <NUM>' can rotate the glenoid implant <NUM> into a predetermined implant orientation with respect to the glenoid fossa <NUM> surface. As another example, the guide <NUM>' and mated glenoid implant <NUM> could be placed with the orienting indicator <NUM>' at, or close to, the predetermined signaling relationship with the landmark <NUM>' before the glenoid implant comes into contact with the glenoid fossa <NUM>. In this latter situation, the glenoid implant <NUM> could be guided into the predetermined implant orientation concurrently with being brought into contact with the glenoid fossa <NUM> as the orienting indicator <NUM>' slides along the length of the guide pin via a rail-like dynamic guiding technique.

Once the guide <NUM>' is mated to the glenoid implant <NUM> and the orienting feature <NUM>' has been rotated or otherwise moved into the predetermined orienting relationship with the previously placed landmark <NUM>, the glenoid implant will have achieved the predetermined implant orientation. The desired fastener <NUM>' locations with respect to the glenoid fossa <NUM> surface will correspond to one or more of the fastener apertures <NUM>' of the glenoid implant <NUM> when the glenoid implant has reached the predetermined implant orientation. A surgical tool <NUM>' and/or fasteners <NUM>' can then be guided along the target trajectories <NUM>' by the guide <NUM>' through the fastener apertures <NUM>', the guide <NUM>' can be removed at an appropriate stage in the glenoid implant <NUM> securement procedure, and installation of the glenoid implant and the remainder of the prosthetic shoulder assembly can then proceed apace.

<FIG> depict a guide <NUM>" according to a third embodiment of the present disclosure. The guide <NUM>" of <FIG> is similar to the guide <NUM> of <FIG> and therefore, structures of <FIG> that are the same as or similar to those described with reference to <FIG> have the same reference numbers with the addition of a double "prime" mark. Description of common elements and operation similar to those in the previously described first and second embodiments will not be repeated with respect to the third embodiment.

In <FIG>, a patient tissue (here, a long bone <NUM>) having a malunion problem has previously been resected, optionally with the assistance of an aid such as the aforementioned guide disclosed in co-pending U. Patent Application No. to be determined, filed October <NUM>, <NUM>, titled "System and Method for Association of a Guiding Aid with a Patient Tissue" and claiming priority to <CIT> and titled "System and Method for Association of a Guiding Aid with a Patient Tissue". The resected tissue has been removed, and the long bone <NUM> has been collapsed along the resection line <NUM>. A stock prosthetic implant, shown here as bone plate <NUM>, has been placed in a predetermined implant orientation with respect to the long bone <NUM>. A guide <NUM>" has been placed into a predetermined guide/implant orientation with respect to the bone plate <NUM>. The guide <NUM>" includes at least one guiding aperture <NUM>" at a predetermined aperture location, the guiding aperture(s) <NUM>" each defining a target trajectory <NUM>. After achieving the positioning shown in the Figures, the guide <NUM>" is used to aid with the attachment of the bone plate <NUM> to the long bone <NUM> in a manner analogous to those described above with reference to the first and second embodiments of the present disclosure.

The above description presumes that the guide <NUM> is removed from the prosthetic implant component before completion of the surgery. It is contemplated, nevertheless, that the guide <NUM> and/or a stock prosthetic implant component could be configured for maintenance of the guide within the body, perhaps as a part of the completely installed prosthetic implant structure. One way in which this might be accomplished, using as an example the aforementioned acetabular cup implant <NUM>, is for the fastener apertures <NUM> to be located in an area of the acetabular shell <NUM> which has a recessed upper implant surface <NUM> to accept the guide <NUM> in a manner which results in a substantially even-profiled composite inner shell surface for smooth contact with the femoral implant component, this composite inner shell surface being comprised of the upper implant surface in combination with the upper guide surface <NUM>.

It is contemplated that the guide <NUM> could be used with an instrument or related components such as those disclosed in co-pending U. Patent Application No. to be determined, filed October <NUM>, <NUM>, titled "System and Method for Assisting with Arrangement of a Stock Instrument with Respect to a Patient Tissue" and claiming priority to <CIT> and titled "System and Method for Assisting with Arrangement of a Stock Instrument with Respect to a Patient Tissue".

While aspects of the present disclosure have been particularly shown and described with reference to the preferred embodiment above, it will be understood by those of ordinary skill in the art that various additional embodiments may be contemplated without departing from the scope of the present disclosure. For example, the specific methods described above for using the guide <NUM> are merely illustrative; one of ordinary skill in the art could readily determine any number of tools, sequences of steps, or other means/options for placing the above-described apparatus, or components thereof, into positions substantially similar to those shown and described herein. Any of the described structures and components could be integrally formed as a single piece or made up of separate sub-components, with either of these formations involving any suitable stock or bespoke components and/or any suitable material or combinations of materials; however, the chosen material(s) should be biocompatible for most applications of the present disclosure.

The mating relationships formed between the described structures need not keep the entirety of each of the "mating" surfaces in direct contact with each other but could include spacers or holdaways for partial direct contact, a liner or other intermediate member for indirect contact, or could even be approximated with intervening space remaining therebetween and no contact. Though certain components described herein are shown as having specific geometric shapes, all structures of the present disclosure may have any suitable shapes, sizes, configurations, relative relationships, cross-sectional areas, or any other physical characteristics as desirable for a particular application of the present disclosure.

An adhesive (such as, but not limited to, bone cement) could be used in conjunction with the system and method described herein. The guide <NUM> may include a plurality of structures cooperatively forming the base body and temporarily or permanently attached together in such a manner as to permit relative motion (e.g., pivoting, sliding, or any other motion) therebetween. Any structures or features described with reference to one embodiment or configuration of the present disclosure could be provided, singly or in combination with other structures or features, to any other embodiment or configuration, as it would be impractical to describe each of the embodiments and configurations discussed herein as having all of the options discussed with respect to all of the other embodiments and configurations. A sleeve (not shown) could be provided to surround the fastener <NUM> and/or surgical tool <NUM> during insertion into at least one of the guiding aperture <NUM> and the fastener aperture <NUM>--the sleeve (when present) could extend at least partially into the guiding aperture and/or the fastener aperture, and the sleeve could have variable wall thickness about a circumference thereof in order to place the elongate body in an offset relationship with a centerline of the relevant aperture(s). An adhesive (such as, but not limited to, bone cement) could be used in conjunction with the system and method described herein. Any of the components described herein could have a surface treatment (e.g., texturization, notching, etc.), material choice, and/or other characteristic chosen to provide the component with a desired interaction property (e.g., tissue ingrowth, eluting of a therapeutic material, etc.) with the surrounding tissue. A device incorporating any of these features should be understood to fall under the scope of the present invention as determined based upon the claims below.

Claim 1:
A guide (<NUM>) for assisting with attachment of a stock prosthetic implant (<NUM>) to a patient tissue (<NUM>), the patient tissue (<NUM>) having a previously placed landmark, the guide comprising:
a lower guide surface (<NUM>) configured to contact an upper implant surface (<NUM>) of the stock prosthetic implant when a lower implant surface (<NUM>) of the stock prosthetic implant is in contact with the patient tissue (<NUM>), the lower guide surface (<NUM>) being contoured to substantially mate with at least a portion of the upper implant surface (<NUM>); and
an upper guide surface (<NUM>) spaced longitudinally apart from the lower guide surface (<NUM>) by a guide body (<NUM>), the upper guide surface (<NUM>) being accessible to a user when the lower guide surface (<NUM>) is in contact with the upper implant surface (<NUM>);
characterized in that the guide (<NUM>) includes
at least one locating protrusion (<NUM>) extending from the lower guide surface (<NUM>) and configured to nest into a location aperture of the upper implant surface to assist with mating of the lower guide surface (<NUM>) with at least a portion of the upper implant surface (<NUM>), wherein the guide (<NUM>) is configured to be engaged with the stock prosthetic implant in a predetermined relative guide/implant orientation;
an orienting feature (<NUM>) that extends longitudinally and/or laterally from the guide (<NUM>) and is configured to enter a predetermined orienting relationship with the landmark while the locating protrusions are maintained in mating contact with the stock prosthetic implant in the predetermined relative guide/implant orientation.