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WO2000071035A1 - Guide de resection osseuse - Google Patents

Guide de resection osseuse Download PDF

Info

Publication number
WO2000071035A1
WO2000071035A1 PCT/GB2000/001839 GB0001839W WO0071035A1 WO 2000071035 A1 WO2000071035 A1 WO 2000071035A1 GB 0001839 W GB0001839 W GB 0001839W WO 0071035 A1 WO0071035 A1 WO 0071035A1
Authority
WO
WIPO (PCT)
Prior art keywords
bone
guide
cutting block
mount
arm
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/GB2000/001839
Other languages
English (en)
Inventor
Marcus Orton
Robert Bassil
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
DePuy International Ltd
Original Assignee
DePuy International Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from GBGB9911731.9A external-priority patent/GB9911731D0/en
Priority claimed from GBGB9912279.8A external-priority patent/GB9912279D0/en
Application filed by DePuy International Ltd filed Critical DePuy International Ltd
Priority to AU47707/00A priority Critical patent/AU4770700A/en
Publication of WO2000071035A1 publication Critical patent/WO2000071035A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/14—Surgical saws
    • A61B17/15—Guides therefor
    • A61B17/154—Guides therefor for preparing bone for knee prosthesis
    • A61B17/157—Cutting tibia

Definitions

  • An initial stage of preparing a bone for implantation of a component of a joint prosthesis involves resecting the bone, for example in the preparation of the tibia and the femur for implantation of a knee joint prosthesis. It is important that the resection be accurate to ensure that the prosthesis component is located appropriately to ensure good biomechanical performance of the prosthesis.
  • a guide to control the process of resecting a bone such as a tibia.
  • the guide can be fixed to the bone, and the resecting saw then positioned against a support surface of the guide during resection and slid in contact with the support surface.
  • Alignment of the guide relative to the axis of the bone can be achieved by means of a rod which can be aligned with the axis.
  • a resection guide While the use of a resection guide is common to many surgical techniques, different components of the resection instrumentation can be required to suit the requirements of a particular patient. In particular, different cutting guides can be required according to whether the knee joint that is being replaced is in the right leg or the left leg. The location of the incision relative to ligament and other soft tissue components of the natural joint can also affect the choice of an appropriate cutting guide.
  • the present invention provides a resection guide in which the cutting block and its mount between them define a track along which the cutting block can be slid.
  • the plane along which the cutting block is slid remains at a constant level relative to the bone axis throughout the movement of the block.
  • the invention provides a guide for use in resection of a patient's bone to prepare the bone for implantation of a component of a joint prosthesis, the guide comprising: a. an arm which can be positioned in general alignment with the bone axis, b. a cutting block having a control surface against which a saw can slide so as to control the a location of the saw when acting against the bone to cut it, c. a mount on the arm for the cutting block,
  • the arm and the mount having at least one attachment formation by which the guide can be fastened to the bone to prevent movement of the mount relative to the bone, and the cutting block and mount between them defining a track along which the cutting block can be slid in a plane that is oriented appropriately relative to the bone axis.
  • the guide of the present invention has the advantage that it enables the location of a cutting guide to be selected to meet the requirements of a particular patient without having to provide a range of cutting guide components.
  • the guide can be used in the implantation of a prosthesis in a left knee or in a right knee
  • the guide can also be adapted for use whether the surgeon makes a medial incision or a lateral incision, again by selection of the position of the cutting block on the mount, the plane that is defined by the control surface of the cutting block remaining at a constant level relative to the bone axis throughout the movement of the block.
  • the invention therefore enables the inventory of surgical instrumentation that is provided for a joint replacement, especially a knee joint replacement, to be reduced. This gives rise to several advantages.
  • the track along which the cutting block slides is arcuate so that it has concave and convex sides, and is arranged so that when the mount is fixed against a bone, the bone faces the concave side of the track.
  • the cutting block can effectively slide around the bone as it is slid along the track, following approximately the external shape of the bone.
  • the track is provided by a cooperating rib and groove.
  • the groove has a dove-tail configuration so that the opening into the groove is narrower than the groove at its base. The configuration of the rib should then correspond to that of the groove so that the rib cannot be removed from the groove other than by sliding the rib along the groove.
  • the rib is provided on the cutting block and the groove is provided on the mount.
  • the mount is hinged so that the angle between the control surface of the cutting block and the arm can be adjusted.
  • the bone it will be preferred for the bone to be resected in a plane that is generally perpendicular to the bone axis, preferably as close as possible to perpendicular to the bone axis.
  • a hinged mount can enable the orientation of the resection plane to be adjusted, for example to accommodate misalignment of the mount relative to the bone axis, or to accommodate the requirements of a particular patient.
  • the angle of the resection may be offset from perpendicular to the bone axis, in the anterior-posterior or in the medial-lateral aspects, according to known biomechanical principles and taking into account the design of the particular component to be implanted.
  • the mount provides for a plurality of predetermined orientations of the resection plane.
  • two mating parts of the mount can have teeth which can interengage when the resection plane is in one of its predetermined orientations.
  • the arm can be arranged to extend along the outside of the patient's bone. An arm of this kind is often referred to as an extramedullary alignment rod.
  • the length of the arm can be adjusted. This can enable the guide of the invention to be used on patients whose bone vary in length while the distal end of the guide engages the patient's bone towards its remote end, for example just above the ankle in the case of the tibia.
  • a preferred construction which enables the length of the arm to be adjusted comprises a pair of rods which have profiles which define between them an interengaging rib and groove when viewed in cross-section, with a dovetailed cross-section.
  • a clamp can be used to lock the two rods together.
  • profiled rods has the advantage that it can provide a large surface area which can provide a secure connection between the rods and therefore a stable connection between them.
  • the arm can be arranged to extend into the medullary cavity of the patient's bone.
  • the mount can then be connected to the arm by means of a member which extends generally laterally from the arm at a point towards the end which extends from the medullary cavity.
  • An arm of this kind is often referred to as an intramedullary alignment rod.
  • the guide can include both (a) an intramedullary arm which is arranged to extend into the medullary cavity of the patient's bone, and (b) an extramedullary arm which is arranged to extend along the outside of the bone.
  • the mount has at least one hole extending through it for accommodating a bone screw or other fastener (such as a pin, or drill bit) by which the mount can be fastened to the patient's bone.
  • the cutting block has at least one feature formed in it for locating accessories and attaching them to the cutting block.
  • the feature for locating accessories comprises a track in which an accessory can be slid across the control surface of the cutting block.
  • the accessories can facilitate location of the cutting block relative to features on the patient's bone to facilitate accurate resection. They can be relied on during the step of resecting the bone to control the orientation of the saw blade. They can also be used after resection during preparation of the resected bone for implantation of the prosthesis when the cutting block can effectively serve as a platform on which instruments can be mounted.
  • the guide includes at least one accessory which can be attached to the cutting block using an attachment feature thereon.
  • the accessory can comprise a stylus for calibrating the position of the cutting block relative to the patient's bone, especially the top of the bone prior to resection, or for indicating the superior aspect of the intended implant with respect to the distal cut.
  • the stylus can have associated with it means for adjusting its height above the cutting block, or its length of the stylus beyond the cutting block, or both.
  • the accessory can comprise an element which can be positioned so that it extends substantially parallel to the control surface of the cutting block to define a slot in which a saw can be slid.
  • the material that is used to make the guide of the invention should be hard wearing so that it is not deformed or subject to significant wear in use. It should of course be corrosion resistant. Commonly used materials for surgical instruments will generally be appropriate, such as for example stainless steels.
  • the cutting surface can incorporate inserts of appropriate low friction materials such as certain ceramic or polymeric materials.
  • the guide of the present invention finds particular application in preparation of a tibia for implantation of the tibial component of a knee joint prosthesis.
  • it can be used to prepare other bones for implantation of a component of a joint prosthesis.
  • it might be used to prepare the femur for implantation of a component of a knee joint prosthesis or of a hip prosthesis, or to prepare the tibia for implantation of a component of an ankle joint prosthesis, or to prepare the humerus for implantation of a component of a shoulder joint prosthesis.
  • Figure 1 is an isometric view of a guide which includes an extramedullary alignment rod.
  • Figure 2 is an isometric view of a guide which includes an intramedullary alignment rod.
  • Figure 3 is an enlarged isometric view of the top portion of the guide shown in
  • Figure 5 is a side view of a stylus accessory that can be used on the guide.
  • Figure 6 is a side view of a saw capture block accessory that can be used on the guide.
  • Figure 7 is a side view of a template clamp accessory that can be used on the guide.
  • Figure 1 shows a guide 2 for use in resection of a patient's tibia to prepare the tibia for implantation of a tibial component of a knee joint prosthesis.
  • the guide comprises an alignment rod 4 which can be positioned in general alignment with the patient's tibia. At its lower end, the alignment rod has a Y-shaped locator 6.
  • the tibia can be located between the arms of the locator.
  • a strap extending between the arms of the claim can retain the tibia in place between the arms of the locator.
  • the strap is preferably extensible, for example in the form of a spring.
  • a clamp assembly 20 is provided at the top of the alignment rod 2.
  • the assembly can be moved up and down on the rod. In the illustrated embodiment, movement is controlled by means of a toothed rack on the upper alignment rod section 10 and a cooperating toothed wheel which can be turned by means of a control knob 22.
  • the clamp assembly includes a bone fixation block 24 which has holes 26 extending through it for bone screws by which the clamp assembly can be affixed to the tibia.
  • Figure 2 shows a construction of guide in which the alignment rod 4' is configured for location within the intramedullary cavity.
  • a clamp assembly 20' is provided at the top of the alignment rod.
  • the clamp assembly is able to move along an axis that is parallel to the tibial axis by rotation of a control knob 22', in a manner similar to that of the clamp assembly on the extramedullary alignment rod construction shown in Figure 1.
  • the cutting block 30 and mount 28 of the clamp assembly of the guide shown in Figure 1 are shown in detail in Figures 3 and 4.
  • the mount is provided on an arm 29 which extends laterally from the alignment rod. It is held on the arm by means of a notch 32 on a spring loaded member 34. The notch can be received in a recess (not shown) on the underside of the mount when the mount is properly located on the arm.
  • the mount has a number of holes 36 extending through it which can accommodate bone screws to fasten the mount to the tibia, instead of or in conjunction with bone screws which extend through holes in the bone fixation block 24.
  • the mount 28 has an upstanding rib 38 formed on it. The rib has a dovetailed shape when viewed in cross-section and is substantially straight.
  • the cutting block 30 has a generally planar control surface 42 against which a saw can run. Upstanding rails of a low friction material (especially a ceramic material) can be provided on the control surface.
  • the cutting block has a groove 44 in its lower surface, which is configured to receive the rib 38 on the mount 28 so that the cutting block can fit onto the rib and be slid along it.
  • the rib 38 and the groove 44 between them define at least one detent (for example two, three or four detents) to define one or more predetermined positions for the cutting block relative to the mount. They might define two detents, for example corresponding to positions for the cutting block for tibial resection in the left leg and right leg, or for medial and lateral incisions, respectively.
  • the detent might be provided in the track along which the cutting block can slide relative to its mount.
  • the cutting block is located in the detent by movement of a resiliently deformable locator.
  • the groove 44 can have one or more recesses in one of its walls, into which a spring loaded locator 46 on the rib 38 can fit when the cutting block is in one of its predetermined positions.
  • the control surface 42 has markings 48 on it to facilitate accurate location relative to the tibia.
  • the shape of the cutting block when viewed in plan can be selected to suit the requirements of a particular surgeon. It will often be preferred for the size of the block to be maximised to provide optimum stability for the saw which acts against it.
  • the cutting block will unusually have a concave edge 50 which is positioned adjacent to the tibia when the block is in use.
  • the opposite surface 52 will often be convex.
  • the side edges 54 will generally extend substantially parallel to one another. However, other shapes might be preferred.
  • the cutting block has a groove 60 formed in its control surface 42.
  • the groove has a dovetailed shape when viewed in cross-section.
  • the groove can receive an appropriately profiled foot 62 of an accessory which can be fixed to the control surface by sliding the foot into the groove. Accessories that can be used in this way are shown in Figures 4 to 7.
  • the template clamp 76 can clamp a template onto the control surface 42 of the cutting block.
  • Figure 8 shows an alternative mount 80 which comprises upper and lower portions 82, 84.
  • the upper portion has a dovetailed shaped rib formed on it which can be received in an correspondingly profiled groove 44 on a cutting block.
  • the lower portion has a groove formed in it to engage an alignment rod, for example by means of a spring loaded locking member on a transverse arm.
  • the guide is positioned adjacent to a tibia with the tibia located between the arms of the Y-shaped locator.
  • the length of the alignment rod is adjusted roughly by relative movement of the rod sections and locked using the clamp.
  • the stylus is mounted on the control surface of the cutting block and, by setting the height of the stylus above the cutting block, is used to locate the cutting block relative to the top of the tibia.
  • the clamp assembly is then fixed to the tibia by means of screws passing through holes in the bone fixation block or the mount for the cutting block or both.
  • the location of the cutting block around the axis of the tibia can be adjusted by sliding the cutting block on its mount.
  • the saw capture block is then mounted on the control surface of the cutting block and a saw inserted into the slot between the saw capture block and the cutting block which is used to resect the tibia.
  • the alignment components in particular the alignment rods and the Y-shaped locator
  • the lateral position of the cutting block on the fixation block can be adjusted.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Dentistry (AREA)
  • Biomedical Technology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Transplantation (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention se rapporte à un guide conçu pour permettre d'effectuer une résection osseuse sur un patient en vue de la préparation d'un os à l'implantation d'un composant d'une prothèse articulaire. Ce guide comporte (a) un bras qui peut être positionné en alignement avec l'axe de l'os, (b) un bloc de coupe présentant une surface de commande contre laquelle une scie peut coulisser de manière à commander le positionnement de la scie lorsque celle-ci est en contact avec l'os pour le couper et (c) un organe de montage disposé sur le bras et conçu pour bloquer le bloc de coupe. L'un au moins des deux éléments que sont le bras et l'organe de montage possède une partie destinée à la fixation au moyen de laquelle le guide peut être fixé à l'os de manière à empêcher le mouvement de l'organe de montage par rapport à l'os. Le bloc de coupe et l'organe de montage définissent entre eux une piste le long de laquelle le bloc de coupe peut coulisser dans un plan qui est orienté correctement par rapport à l'axe de l'os.
PCT/GB2000/001839 1999-05-20 2000-05-19 Guide de resection osseuse Ceased WO2000071035A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU47707/00A AU4770700A (en) 1999-05-20 2000-05-19 Bone resection guide

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
GB9911731.9 1999-05-20
GBGB9911731.9A GB9911731D0 (en) 1999-05-20 1999-05-20 Bone resection guide
GB9912279.8 1999-05-27
GBGB9912279.8A GB9912279D0 (en) 1999-05-27 1999-05-27 Bone resection guide

Publications (1)

Publication Number Publication Date
WO2000071035A1 true WO2000071035A1 (fr) 2000-11-30

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ID=26315574

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/GB2000/001839 Ceased WO2000071035A1 (fr) 1999-05-20 2000-05-19 Guide de resection osseuse

Country Status (2)

Country Link
AU (1) AU4770700A (fr)
WO (1) WO2000071035A1 (fr)

Cited By (14)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2005110249A1 (fr) * 2004-05-17 2005-11-24 Imp Limited Dispositif de chirurgie orthopedique
GB2426198A (en) * 2005-05-17 2006-11-22 Biomet Uk Ltd Stylus assembly for use with a surgical jig
FR2915870A1 (fr) * 2007-05-10 2008-11-14 Euros Soc Par Actions Simplifi Guide de coupe d'un viseur tibial.
EP2116199A2 (fr) 2008-05-09 2009-11-11 DePuy Products, Inc. Instrument de résection de guidage d'un tubercule supérieur
GB2480846A (en) * 2010-06-03 2011-12-07 Biomet Uk Ltd Tool with adjustable guide surface.
US9078669B2 (en) 2006-04-05 2015-07-14 Depuy International Limited Orthopaedic cutting guide instrument
EP2984997A1 (fr) * 2014-08-11 2016-02-17 DePuy (Ireland) Instrument chirurgical et système d'instruments chirurgicaux
ITUA20161716A1 (it) * 2016-03-16 2017-09-16 Medacta Int Sa Strumento di resezione ossea
US10182829B2 (en) 2015-09-04 2019-01-22 Depuy Ireland Unlimited Company Surgical instrument and system of surgical instruments
WO2021209496A3 (fr) * 2020-04-15 2021-12-09 Aesculap Ag Dispositif d'alignement servant à effectuer une résection du tibia
US11666346B2 (en) 2007-03-23 2023-06-06 Xiros Limited Surgical templates
US11751883B2 (en) 2018-11-28 2023-09-12 Aesculap Ag Fixing system and aligning device
US12042157B2 (en) 2019-02-15 2024-07-23 Aesculap Ag Fixing clamp and aligning device
US12490993B2 (en) 2020-04-15 2025-12-09 Aesculap Ag Alignment device for a tibial resection guide

Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2679126A1 (fr) * 1991-06-26 1993-01-22 Chagneau Francis Dispositif chirurgical pour pratiquer une osteotomie.
US5342368A (en) * 1992-07-08 1994-08-30 Petersen Thomas D Intramedullary universal proximal tibial resector guide
US5342367A (en) * 1992-02-20 1994-08-30 Wright Medical Technology, Inc. Rotationally and angularly adjustable tibial cutting guide and method of use
US5395376A (en) * 1990-01-08 1995-03-07 Caspari; Richard B. Method of implanting a prosthesis
EP0709062A1 (fr) * 1994-10-27 1996-05-01 Merck Biomaterial France Instrumentation de coupe tibiale
US5681316A (en) * 1996-08-22 1997-10-28 Johnson & Johnson Professional, Inc. Tibial resection guide
EP0839501A2 (fr) * 1996-10-30 1998-05-06 Osteonics Corp. Appareil et méthode pour l'alignement d'une prothèse totale de genou

Patent Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5395376A (en) * 1990-01-08 1995-03-07 Caspari; Richard B. Method of implanting a prosthesis
FR2679126A1 (fr) * 1991-06-26 1993-01-22 Chagneau Francis Dispositif chirurgical pour pratiquer une osteotomie.
US5342367A (en) * 1992-02-20 1994-08-30 Wright Medical Technology, Inc. Rotationally and angularly adjustable tibial cutting guide and method of use
US5342368A (en) * 1992-07-08 1994-08-30 Petersen Thomas D Intramedullary universal proximal tibial resector guide
EP0709062A1 (fr) * 1994-10-27 1996-05-01 Merck Biomaterial France Instrumentation de coupe tibiale
US5681316A (en) * 1996-08-22 1997-10-28 Johnson & Johnson Professional, Inc. Tibial resection guide
EP0839501A2 (fr) * 1996-10-30 1998-05-06 Osteonics Corp. Appareil et méthode pour l'alignement d'une prothèse totale de genou

Cited By (25)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2005110249A1 (fr) * 2004-05-17 2005-11-24 Imp Limited Dispositif de chirurgie orthopedique
GB2426198A (en) * 2005-05-17 2006-11-22 Biomet Uk Ltd Stylus assembly for use with a surgical jig
GB2426198B (en) * 2005-05-17 2010-12-08 Biomet Uk Ltd Stylus assembly
US9078669B2 (en) 2006-04-05 2015-07-14 Depuy International Limited Orthopaedic cutting guide instrument
US11666346B2 (en) 2007-03-23 2023-06-06 Xiros Limited Surgical templates
US11672548B2 (en) 2007-03-23 2023-06-13 Xiros Limited Surgical templates
FR2915870A1 (fr) * 2007-05-10 2008-11-14 Euros Soc Par Actions Simplifi Guide de coupe d'un viseur tibial.
EP2116199A2 (fr) 2008-05-09 2009-11-11 DePuy Products, Inc. Instrument de résection de guidage d'un tubercule supérieur
US8226658B2 (en) 2008-05-09 2012-07-24 Depuy Products, Inc. Instrument for guiding resection of a greater tubercle
EP2422717A1 (fr) * 2008-05-09 2012-02-29 DePuy Products, Inc. Instrument de résection de guidage d'un tubercule supérieur
EP2116199A3 (fr) * 2008-05-09 2010-02-17 DePuy Products, Inc. Instrument de résection de guidage d'un tubercule supérieur
GB2480846B (en) * 2010-06-03 2017-04-19 Biomet Uk Healthcare Ltd Guiding tool
GB2480846A (en) * 2010-06-03 2011-12-07 Biomet Uk Ltd Tool with adjustable guide surface.
EP2984997A1 (fr) * 2014-08-11 2016-02-17 DePuy (Ireland) Instrument chirurgical et système d'instruments chirurgicaux
US10182829B2 (en) 2015-09-04 2019-01-22 Depuy Ireland Unlimited Company Surgical instrument and system of surgical instruments
ITUA20161716A1 (it) * 2016-03-16 2017-09-16 Medacta Int Sa Strumento di resezione ossea
JP2019509819A (ja) * 2016-03-16 2019-04-11 メダクタ・インターナショナル・ソシエテ・アノニム 骨切除用器具
US10939924B2 (en) 2016-03-16 2021-03-09 Medacta International Sa Instrument for bone resection
US11534178B2 (en) 2016-03-16 2022-12-27 Medacta International Sa Instrument for bone resection
US20190076155A1 (en) * 2016-03-16 2019-03-14 Medacta International Sa Instrument for bone resection
WO2017158459A1 (fr) * 2016-03-16 2017-09-21 Medacta International Sa Instrument de résection osseuse
US11751883B2 (en) 2018-11-28 2023-09-12 Aesculap Ag Fixing system and aligning device
US12042157B2 (en) 2019-02-15 2024-07-23 Aesculap Ag Fixing clamp and aligning device
WO2021209496A3 (fr) * 2020-04-15 2021-12-09 Aesculap Ag Dispositif d'alignement servant à effectuer une résection du tibia
US12490993B2 (en) 2020-04-15 2025-12-09 Aesculap Ag Alignment device for a tibial resection guide

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Publication number Publication date
AU4770700A (en) 2000-12-12

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