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WO2023041819A1 - System for navigation during the implantation of a knee revision prosthesis - Google Patents

System for navigation during the implantation of a knee revision prosthesis Download PDF

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Publication number
WO2023041819A1
WO2023041819A1 PCT/ES2022/070513 ES2022070513W WO2023041819A1 WO 2023041819 A1 WO2023041819 A1 WO 2023041819A1 ES 2022070513 W ES2022070513 W ES 2022070513W WO 2023041819 A1 WO2023041819 A1 WO 2023041819A1
Authority
WO
WIPO (PCT)
Prior art keywords
adapter
follower
femoral
femur
sheath
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/ES2022/070513
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Spanish (es)
French (fr)
Inventor
Igor González González
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Individual
Original Assignee
Individual
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Filing date
Publication date
Application filed by Individual filed Critical Individual
Publication of WO2023041819A1 publication Critical patent/WO2023041819A1/en
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools for implanting artificial joints
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
    • A61B17/1659—Surgical rasps, files, planes, or scrapers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
    • A61B17/1662—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1675—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans for particular parts of the body for the knee
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1764—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the knee
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools for implanting artificial joints
    • A61F2/4603—Special tools for implanting artificial joints for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2/461—Special tools for implanting artificial joints for insertion or extraction of endoprosthetic joints or of accessories thereof of knees
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
    • A61B17/164—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans intramedullary
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8866—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices for gripping or pushing bones, e.g. approximators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/92—Impactors or extractors, e.g. for removing intramedullary devices
    • A61B17/921—Impactors or extractors, e.g. for removing intramedullary devices for intramedullary devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046—Tracking techniques
    • A61B2034/2055—Optical tracking systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3983—Reference marker arrangements for use with image guided surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/38—Joints for elbows or knees
    • A61F2/3886—Joints for elbows or knees for stabilising knees against anterior or lateral dislocations
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30667—Features concerning an interaction with the environment or a particular use of the prosthesis
    • A61F2002/3069—Revision endoprostheses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30721—Accessories
    • A61F2/30734—Modular inserts, sleeves or augments, e.g. placed on proximal part of stem for fixation purposes or wedges for bridging a bone defect
    • A61F2002/30738—Sleeves

Definitions

  • the present invention belongs to the health sector, specifically to the area of traumatology and more specifically to knee prostheses.
  • the present invention refers to knee revision prostheses, which are those that are implanted when primary knee prostheses fail, and more specifically to a navigation and monitoring system for assistance in the implantation of knee revision prostheses, which is mainly made up of a set of adapters for the arrangement of the sensors or "trackers" necessary for the positioning and orientation of both the instruments necessary for the implantation of the prosthesis and each of its elements.
  • FIG. 1 schematically shows the components of primary knee prostheses.
  • Knee prostheses can be placed manually (taking into account a series of anatomical references for its correct orientation in the 3 planes of space) or computer-assisted (browsers, robots, templates).
  • a display indicates the surgeon at all times and with a precision of up to 1 degree and 1mm (the precision depends of the system used) how the bone cuts are made in which the prosthesis components will then be placed (both the orientation of the cuts in space and the quantification in millimeters of the cut being made).
  • Document ES2203556T3 shows a device for determining the position of a cutting guide.
  • Figure 2 schematically shows examples of followers, browsers or “trackers”, their arrangement and connection with the receiver.
  • Stems cylinders of the same alloy as the prosthesis with which the bone marrow canal is "threaded”, they are attached to the components, which provides extra stability to the implant placed, they can be pressed or attached to the bone with a medical cement.
  • Figure 3 shows some stems attached to the prosthesis.
  • the main difference between the sleeves and the cones, caps and sleeves is that the sleeves can be attached to the femoral and tibial component under pressure and do not require the use of medical cement for their union, while the cones, caps and sleeves require the use of medical cement for its union.
  • Document ES2544528T3 shows femoral sleeves made of porous titanium and document ES2455090T3 shows tibial sleeves made of porous titanium.
  • the revision knee prosthesis In the same way as in the primary knee prosthesis, the revision knee prosthesis must be placed as accurately as possible in the 3 planes of space, both the main components and the anchorage systems mentioned above. (stems and/or sheaths, bushings, cones or sleeves), since they are joined together and the position of some condition the position of the others. In addition, in revision surgery, the position in the space of the femoral joint interline is extremely important (place where the femoral component of the prosthesis ends and which will articulate with the insert).
  • the present invention solves the existing problems in the state of the art by means of a system for navigation in the implantation of revision knee prostheses, which is made up of the following components:
  • a femoral hook that has an adjustable clamp for fastening the femur of the patient to whom the knee revision prosthesis is going to be implanted, and a first follower or navigator adapter to the femur, which presents means for fixing said follower or navigator to the femoral hook.
  • this femoral hook allows the placement of the femoral follower, navigator or tracker without invading the medullary canal of the femur, providing a stable hold of the femoral tracker and not impeding the reaming of the canal or the implantation of the femoral sheath as it does not cross the femur with the pins, as it happens in the state of the art.
  • a second follower or navigator adapter to the milling machine in charge of making the cuts in the femur and tibia which has coupling means to couple said second adapter perpendicular to the router shank allowing rotation of the second adapter 360° around the shank.
  • This second adapter also has a slot to accommodate a follower or navigator, which allows following or navigating the varus/valgus and flexo/extension reaming, and therefore following or navigating the placement of the femoral and tibial stem on the femur and the tibia respectively.
  • the second adapter has a plurality of alignment slots arranged in the surface of the second adapter, into which a follower or navigator can be inserted, in order to be able to follow or navigate the entry point of the reamer on the femur.
  • a third follower or navigator to femoral sheath adapter having a lateral opening and a shape configured to engage longitudinally with a sheath holder, which is the conventional instrument for fixing the femoral sheath on the femur.
  • the third adapter also has at least one slot for receiving a tracker or navigator arranged on the upper and lower surfaces considered when the third adapter is in use.
  • the third adapter further has different alignment grooves disposed on the surface of the third adapter, into which a follower or navigator can be inserted, in order to be able to follow or navigate the entry point of the femoral sheath on the femur.
  • a fourth follower or navigator adapter to the tibial sheath which has coupling means to engage perpendicularly to the cylindrical body of a milling instrument for the tibial sheath, allowing the rotation of the fourth adapter around said milling instrument.
  • the fourth adapter also has at least one slot for receiving a tracker or navigator arranged in its surface.
  • the present invention and its adapters provide the advantage of allowing the use of a free-use navigation system of those that allow a priori follow or navigate the placement of any primary knee prosthesis system, to follow or navigate a revision system for which it was not initially designed nor did it have specific instruments.
  • the adapters of this system are used, which allow the conventional followers, navigators or “trackers” to be attached to the instruments of the conventional free-use navigation technique applied to the navigation of primary knee prostheses.
  • navigation software designed for initial use in primary knee replacements (which it is not designed for) can be applied to a revision prosthesis system; and thus a review system designed to be placed manually, navigated by followers, browsers or “trackers” can be implemented.
  • the femoral hook is formed by a first tubular element in which the first follower or navigator adapter to the femur is arranged, and a second element that can be inserted inside the first tubular element and slides through it. along this, whose lower end considered in the position of use of the femoral hook, together with the lower end of the first element forms the adjustable clamp for fastening the femur.
  • the upper end of the second insertable element considered in the position of use of the femoral hook protrudes from the first tubular element and is threaded for the graduation of the clamp by means of a wing nut.
  • the third follower or navigator adapter to the femoral sheath has on its upper and lower surface considered in the position of use of the adapter at least one projection for fixing elastic clamping means.
  • an elastic fastening means can be fixed to both projections, for example a rubber band or elastic band with holes, that embraces the third adapter and to case holder, so that the third adapter is more firmly attached to the case holder, thus avoiding a possible uncoupling of both elements during use.
  • the position and orientation of the slot for the accommodation of the follower or navigator of the third adapter in use corresponds to the final position and orientation that it will have.
  • the femoral joint space provided by the femoral component of the prosthesis which will serve as a guide for the surgeon in charge of performing the operation. That is, it helps to follow or navigate the position of the prosthesis, since the position of the groove coincides with the place where the prosthesis will be.
  • the position and orientation of the slot for the accommodation of the follower or navigator of the fourth adapter in use corresponds to the final position and orientation that the tibial component of the prosthesis, which will also act as a guide for the surgeon performing the operation. That is, it helps to follow or navigate the position of the prosthesis, since the position of the slot coincides with the place where the prosthesis will be.
  • Figure 1 schematically shows the components of conventional primary knee prostheses.
  • Figure 2 schematically shows examples of followers, browsers or “trackers” of the state of the art, their arrangement and connection with the receiver.
  • Figure 3 shows conventional stems attached to the prosthesis.
  • Figures 4a, 4b and 4c show conventional sheaths, bushings and cones respectively.
  • Figure 5a shows the conventional stem and sleeve combination
  • Figure 5b shows the conventional stem and cone combination.
  • Figure 6 shows the different components of a particular embodiment of the femoral hook of the system object of the present invention.
  • Figure 7a shows the femoral hook of figure 6 before it is attached to the femur
  • figure 7b shows the femoral hook already attached to the femur.
  • Figures 8a and 8b show a comparison of the fixation to the femur between the femoral hook of the system object of the present invention and the fixation by conventional pins of the state of the art.
  • Figure 8a shows both fixings in side view, and Figure 8b shows them in section.
  • Figure 9 shows a perspective view of an embodiment of a second follower-to-mill adapter.
  • Figure 10 shows the second adapter of Figure 9 attached perpendicular to the shank of a router.
  • Figure 11 shows the milling machine arranged on the femur, with the second adapter of figure 10, which incorporates a follower or navigator in a slot.
  • Figure 12 schematically shows how the alignment slots of the second adapter of Figures 9 to 11 serve to follow or navigate the entry of the milling cutter into the femur, given that the final sizes and distances of the components coincide.
  • Figure 13a shows a perspective view of the third adapter from the follower to the femoral sheath of the navigation system object of the present invention.
  • Figure 13b shows a side view of the third adapter of Figure 13a.
  • Figure 14a shows the third adapter of Figures 13a and 13b just before being coupled to a conventional case holder.
  • Figure 14b shows the third adapter already attached to the case holder.
  • Figure 14c shows an embodiment of an elastic band attachable to the projections of the third adapter of Figures 13a to 14b.
  • Figure 14d shows an embodiment in which the third adapter is already coupled to the case holder, in a similar way to figure 14b, but including the elastic band of figure 14c coupled to the projections and embracing the assembly.
  • Figure 15a front view
  • Figure 15b side view
  • Figure 16 schematically shows how the alignment slots of the third adapter of Figures 13a to 15b serve to follow or navigate the entry of the femoral sheath into the femur, given that the final sizes and distances of the components coincide.
  • Figure 17a shows a perspective view of the fourth adapter from the follower to the tibial sheath of the navigation system object of the present invention.
  • Figure 17b shows a plan view of the third adapter of Figure 17a.
  • Figure 18a shows the fourth adapter of Figures 17a and 17b just prior to being attached to a conventional tibial sheath milling instrument.
  • Figure 18b shows the fourth adapter already attached to the tibial sheath milling instrument.
  • Figure 19 shows an embodiment of the fourth adapter of figures 17a to 18b, in which the position and orientation of the slot for the accommodation of the follower or navigator in use corresponds to the final position and orientation that the tibial component of the prosthesis will have. .
  • Figure 20 shows a tibial sheath milling instrument disposed on the tibia, with the fourth adapter, which incorporates a follower or navigator in a slot.
  • the object of the present invention is a system for navigation in the implantation of revision knee prostheses.
  • the system is made up of a set of four elements that will act as supports for trackers, navigators or “trackers” to the various components of the prosthesis, the instruments to carry out its implantation and the femur, which will facilitate the positioning and orientation of all the elements involved, orienting and guiding the surgeon with precision during the implantation of the knee revision prosthesis .
  • the elements that make up the system are the following:
  • a femoral hook (7) that is formed by a graduated clamp (12) for fastening to the femur (1) and a first adapter (8) from follower (3) to femur (1), which has fixing means for a follower (3).
  • this femoral hook (7) allows the placement of the follower (3), navigator or femoral tracker without invading the medullary canal of the femur (1), providing stable support for the femoral follower (3) and not preventing drilling of the canal or the implantation of the femoral sheath (5) by not going through the femur (1) with the pins, as occurs in the systems of the state of the art.
  • Figures 8a and 8b show a comparison of the fixation to the femur (1) between the femoral hook (7) of the system object of the present invention and the conventional pin fixation of the state of the art.
  • Figure 8a shows both fixings in side view, and Figure 8b shows them in section.
  • the second adapter (9) has at least one slot (14) for a follower (3), which allows following or navigating the varus/valgus and flexion/extension of the milling, and therefore, following or navigating the femoral and tibial stem placement in the femur (1) and tibia (2) respectively.
  • the second adapter (9) has alignment slots (20) arranged on the surface of the second adapter (9), which in use allow following or navigating the entry point of the milling cutter (4) in the femur (1 ), since as can be seen in figure 12, the distance from the center of the milling instrument to each alignment slot (20) corresponds to the distance from the center of the implant stem to the anterior cut of each femoral size. Furthermore, knowing this information and given that the distance from the femoral stem to the posterior condyles is fixed (with a variation of +/-2mm if offset is used), it is possible to follow or navigate the GAP in flexion, and to determine the point of femoral entry to optimize it.
  • the second adapter (9) has a right and left side, preferably marked by an "R" and "L” respectively to be able to be used in both lower extremities.
  • a third adapter (10) from follower (3) to femoral sheath (5) which has a lateral opening (22) and a shape configured to engage longitudinally with a sheath holder (15), of those conventionally used to fix the sheath femoral (5) on the femur (1).
  • the third adapter (10) has the complementary shape of the sheath holder (15) to fit and not move in the anterior-posterior direction.
  • the third adapter (10) also has at least one housing slot (14) for a follower (3) arranged on the upper and lower surface in use of the third adapter (10) of the follower (3).
  • the third adapter (10) has alignment grooves (20) disposed on the surface of the third adapter (10), configured to in use follow or navigate the entry point and rotation of the femoral sheath (5) on the femur.
  • the distance from the center of the handle of the femoral sleeve holder (15) to each alignment slot (20) corresponds to the distance from the center of the implant stem to the anterior cut of each femoral size.
  • the GAP can be navigated in flexion, and the femoral entry point can be determined. to optimize it.
  • the third adapter (10) also has a right and left side, preferably marked by an "R” and "L” respectively to be able to be used in both lower extremities, so that the upper and lower faces in use are mirror images.
  • a fourth adapter (11) from follower (3) to tibial sheath (6) formed by coupling means to be coupled perpendicularly to the cylindrical body of a tibial sheath (6) carving instrument (16), of those conventionally used to fix the sheath tibial (6) on the tibia (2), allowing the rotation of the fourth adapter (11) around the carving instrument (16).
  • the fourth adapter (11) has at least one housing slot (14) for a follower (3). By inserting the follower (3) or navigator into the housing slot (14), the tibial slope and varus/valgus of the tibial sheath (6) can be navigated in a similar way to the housing slot (14).
  • Figure 20 shows a carving instrument (16) for a tibial sheath (6) arranged on a tibia (2), with the fourth adapter (11), which incorporates a follower (3) or navigator in a housing slot ( 14).
  • the femoral hook (7) has a first tubular element (17) in which the first adapter (8) is arranged. from follower (3) to femur (1), and a second element (18) that can be inserted inside the first tubular element (17) and slides along it, whose lower end, together with the lower end of the first element (17) forms the adjustable clamp (12) for fastening to the femur, and whose upper end in use protrudes from the first tubular element (17) and is threaded for the graduation of the clamp (12) by means of a wing nut (19).
  • FIGs 13a, 13b and 16 show a particular embodiment of the system object of the invention in which the third adapter (10) from the follower (3) to the femoral sheath (5) has on its upper and lower surface in use at least one projection (21) configured for fixing elastic fastening means.
  • a medium can be fixed to both projections (21). holding elastic, for example a rubber or elastic band (26) with holes, as can be seen in figures 14c and 14d.
  • the elastic band (26) embraces the third adapter (10) and the case holder (15), so that the third adapter (10) is more firmly attached to the case holder (15), thus avoiding possible uncoupling. of both elements during use.
  • the position and orientation of the housing slot (14) of the follower (3) of the third adapter (10) from follower to femoral sheath (5) in use corresponds to the final position and orientation that the femoral joint space will have ( 23) provided by the femoral component (24) of the prosthesis, as can be seen in figures 15a and 15b. This will help the surgeon to follow or navigate the femoral interline during the procedure.
  • the position and orientation of the housing slot (14) of the follower (3) of the fourth adapter (11) from follower to tibial sheath (6) in use corresponds to the final position and orientation that the tibial component (25) of the prosthesis will have. Since the tibial sheath (6) remains attached to the tibial component (25) of the prosthesis, the placement of the first influences the position of the second, so it can follow or navigate the position of the tibial cut for subsequent placement of the sheath. tibial sheath (6).

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  • Prostheses (AREA)

Abstract

The present invention relates to a system for navigation during the implantation of a knee revision prosthesis, comprising a femoral hook (7) for securing to the femur (1), with a first adapter (8) for adapting a tracker (3); a second adapter (9) for adapting a tracker (3) with coupling means for coupling to a reamer (4), at least one housing groove (14) for housing a tracker (3), and alignment grooves (20) for navigating and optimising the entry of the reamer (4) in the femur (1); a third adapter (10) for adapting a tracker (3) to a sleeve holder (15), with at least one housing groove (14) for housing the tracker (3), and alignment grooves (20) for navigating and optimising the entry of the femoral sleeve (5) in the femur (1); a fourth adapter (11) for adapting a tracker (3) to a tibial sleeve (6) which can be coupled to a milling instrument (16) for milling the tibial sleeve (6), with at least one housing groove (14) for housing the tracker (3).

Description

DESCRIPCIÓN DESCRIPTION

Título Qualification

Sistema para navegación en la implantación de prótesis de revisión de rodilla System for navigation in the implantation of knee revision prostheses

Campo de la invención field of invention

La presente invención pertenece al sector sanitario, específicamente al área de traumatología y más específicamente a las prótesis de rodilla. La presente invención se refiere a las prótesis de revisión de rodilla, que son las que se implantan cuando fallan las prótesis primarias de rodilla, y más concretamente a un sistema para navegación y seguimiento para la asistencia en la implantación de prótesis de revisión de rodilla, que está formado principalmente por un conjunto de adaptadores para la disposición de los sensores o “trackers” necesarios para el posicionamiento y orientación tanto de los instrumentos necesarios para la implantación de la prótesis como de cada uno de los elementos de ésta. The present invention belongs to the health sector, specifically to the area of traumatology and more specifically to knee prostheses. The present invention refers to knee revision prostheses, which are those that are implanted when primary knee prostheses fail, and more specifically to a navigation and monitoring system for assistance in the implantation of knee revision prostheses, which is mainly made up of a set of adapters for the arrangement of the sensors or "trackers" necessary for the positioning and orientation of both the instruments necessary for the implantation of the prosthesis and each of its elements.

Antecedentes de la invención Background of the invention

En la actualidad las prótesis primarias de rodilla se implantan para solucionar artrosis severa de rodilla. Estas prótesis primarias de rodilla constan fundamentalmente de un componente femoral que se coloca en el fémur y de un componente tibial que se coloca en la tibia, además de un inserto que va entre el componente femoral y el componente tibial. Para la colocación de estos componentes hay que realizar una serie de cortes en los huesos citados y estos cortes tienen que tener una adecuada orientación y dimensiones en los tres planos del espacio, dependiendo de ello la posición y orientación final de la prótesis. La figura 1 muestra de forma esquemática los componentes de las prótesis primarias de rodilla. Currently, primary knee prostheses are implanted to solve severe knee osteoarthritis. These primary knee prostheses consist primarily of a femoral component that is placed on the femur and a tibial component that is placed on the tibia, as well as an insert that goes between the femoral component and the tibial component. For the placement of these components, a series of cuts must be made in the aforementioned bones and these cuts must have an adequate orientation and dimensions in the three planes of space, depending on the final position and orientation of the prosthesis. Figure 1 schematically shows the components of primary knee prostheses.

Las prótesis de rodilla pueden ser colocadas de forma manual (teniendo en cuenta una serie de referencias anatómicas para su correcta orientación en los 3 planos del espacio) o asistidas por ordenador (navegadores, robots, plantillas ). Mediante estos últimos sistemas y gracias a un software, un display va indicando al cirujano en todo momento y con una precisión hasta de 1 grado y de 1mm (la precisión depende del sistema utilizado) cómo se van realizando los cortes óseos en los que a continuación se colocarán los componentes de la prótesis (tanto la orientación de los cortes en el espacio, como la cuantificación en milímetros del corte que se está realizando). Knee prostheses can be placed manually (taking into account a series of anatomical references for its correct orientation in the 3 planes of space) or computer-assisted (browsers, robots, templates). Through these latest systems and thanks to software, a display indicates the surgeon at all times and with a precision of up to 1 degree and 1mm (the precision depends of the system used) how the bone cuts are made in which the prosthesis components will then be placed (both the orientation of the cuts in space and the quantification in millimeters of the cut being made).

Además de considerar los costes realizados, es indispensable manejar bien los espacios o “gaps” que quedan al realizar los cortes, los cuales se deben rellenar y “balancear” con la prótesis. Para que la prótesis funcione de forma correcta y reproduzca la cinemática de la rodilla lo mejor posible debe de estar bien orientada y balanceada. In addition to considering the costs incurred, it is essential to manage well the spaces or "gaps" that remain when making the cuts, which must be filled and "balanced" with the prosthesis. In order for the prosthesis to work correctly and reproduce the kinematics of the knee as well as possible, it must be well oriented and balanced.

Tanto de la orientación de los cortes como de los espacios o “gaps” va a depender la eficacia de la prótesis, la satisfacción del paciente y la supervivencia del implante. Una prótesis mal colocada siempre va a durar menos en un paciente, del mismo modo, una prótesis en la que los espacios no estén bien “balanceados” o rellenos también va a durar menos en un paciente. Both the orientation of the cuts and the spaces or "gaps" will depend on the effectiveness of the prosthesis, patient satisfaction and the survival of the implant. A poorly placed prosthesis will always last less in a patient, in the same way, a prosthesis in which the spaces are not well "balanced" or filled will also last less in a patient.

Actualmente existen en el mercado diferentes sistemas asistidos por ordenador para realizar la cirugía de prótesis primaria de rodilla, podría decirse que cada casa comercial tiene su propio sistema, además del instrumental específico para implantarla de forma manual. There are currently different computer-assisted systems on the market to perform primary knee prosthesis surgery. It could be said that each commercial house has its own system, in addition to the specific instruments to implant it manually.

Casi todos los sistemas asistidos por ordenador constan de unos seguidores, navegadores o “trackers”, que son unos sensores que se colocan en la extremidad a intervenir por medio de unos pines y que reflejan luz infra-roja de un emisor que luego es recogida por un receptor para saber en todo momento la posición de la pierna en el espacio. Del mismo modo, a los instrumentos que se utilizan para realizar los cortes se les coloca otro seguidor, navegador o “tracker”, así se puede saber en todo momento la posición y orientación respecto a la pierna de esos cortes. Con los robots, es el brazo robótico el que lleva las ranuras de corte a su posición óptima de forma automática, y con los navegadores, es el propio cirujano el que coloca la ranura de corte en su posición óptima guiándose por la información que da el navegador o seguidor en tiempo real. Todo esto para colocar los componentes, balancear la prótesis con la mayor exactitud posible y alargar así su vida útil. El documento ES2203556T3 muestra un dispositivo para determinar la posición de una guía de corte. La figura 2 muestra de forma esquemática ejemplos de seguidores, navegadores o “trackers”, su disposición y conexión con el receptor. Almost all computer-assisted systems consist of followers, navigators or "trackers", which are sensors that are placed on the limb to be intervened by means of pins and that reflect infrared light from an emitter that is then collected by a receiver to know at all times the position of the leg in space. In the same way, another follower, navigator or "tracker" is placed on the instruments used to make the cuts, so that the position and orientation of those cuts with respect to the leg can be known at all times. With robots, it is the robotic arm that automatically brings the cutting slots to their optimal position, and with browsers, it is the surgeon himself who places the cutting slot in its optimal position, guided by the information provided by the browser or tracker in real time. All this to place the components, balance the prosthesis as accurately as possible and thus extend its useful life. Document ES2203556T3 shows a device for determining the position of a cutting guide. Figure 2 schematically shows examples of followers, browsers or "trackers", their arrangement and connection with the receiver.

Las principales causas de fracaso de una prótesis de rodilla primaria son, mal posición del implante, inestabilidad (causada por un mal balance de los espacios), aflojamiento del implante e infección. Cuando la prótesis fracasa, hay que recambiarla, y en su lugar se coloca una prótesis de revisión. Esta nueva prótesis, además de los componentes femoral y tibial y el inserto mencionados previamente, debe de incluir un sistema extra de anclaje al hueso, que básicamente puede ser de dos tipos: The main causes of failure of a primary knee prosthesis are malposition of the implant, instability (caused by a poor balance of spaces), loosening of the implant, and infection. When the prosthesis fails, it must be replaced, and a revision prosthesis is placed in its place. This new prosthesis, in addition to the previously mentioned femoral and tibial components and the insert, must include an extra system for anchoring to the bone, which can basically be of two types:

1.- Vástagos: cilindros de misma aleación que la prótesis con los que se “enhebra” el canal medular del hueso, van unidos a los componentes, lo que aporta un plus de estabilidad al implante colocado, pueden ir a presión o agarrarse al hueso con un cemento médico. La figura 3 muestra unos vástagos unidos a la prótesis. 1.- Stems: cylinders of the same alloy as the prosthesis with which the bone marrow canal is "threaded", they are attached to the components, which provides extra stability to the implant placed, they can be pressed or attached to the bone with a medical cement. Figure 3 shows some stems attached to the prosthesis.

2.- Vainas, casquillos, manguitos o conos: extensiones de titanio poroso u otro metal trabecular con formas vahadas que se colocan en el fémur o en la tibia, y pueden unirse a los componentes tibial o femoral de la prótesis a presión o mediante cemento médico, lo que aporta un plus de estabilidad. A su vez, el anclaje de estos elementos al hueso puede ser a presión o con el uso de un cemento médico. Las figuras 4a, 4b y 4c muestran vainas, casquillos y conos respectivamente. 2.- Sheaths, caps, sleeves or cones: porous titanium or other trabecular metal extensions with vahada shapes that are placed on the femur or tibia, and can be attached to the tibial or femoral components of the prosthesis by pressure or by cement doctor, which provides a plus of stability. In turn, the anchoring of these elements to the bone can be under pressure or with the use of a medical cement. Figures 4a, 4b and 4c show sheaths, caps and cones respectively.

Adicionalmente, en la actualidad pueden combinarse ambos sistemas, tal y como muestran las figuras 5a (vástagos + vainas) y 5b (vástagos + conos). Additionally, currently both systems can be combined, as shown in figures 5a (stems + sheaths) and 5b (stems + cones).

La principal diferencia entre las vainas y los conos, casquillos y manguitos es que las vainas pueden unirse al componente femoral y tibial a presión y no necesitan del uso de cemento médico para su unión, mientras que los conos, casquillos y manguitos precisan del uso de cemento médico para su unión. El documento ES2544528T3 muestra unos casquillos femorales de titanio poroso y el documento ES2455090T3 muestra unos manguitos tibiales de titanio poroso. The main difference between the sleeves and the cones, caps and sleeves is that the sleeves can be attached to the femoral and tibial component under pressure and do not require the use of medical cement for their union, while the cones, caps and sleeves require the use of medical cement for its union. Document ES2544528T3 shows femoral sleeves made of porous titanium and document ES2455090T3 shows tibial sleeves made of porous titanium.

De igual forma que en la prótesis primaria de rodilla, la prótesis de revisión de rodilla debe ser colocada con la mayor exactitud posible en los 3 planos del espacio, tanto los componentes principales como los sistemas de anclaje mencionados anteriormente (vástagos y/o vainas, casquillos, conos o manguitos), puesto que están unidos entre sí y la posición de unos condicionan la posición de los otros. Además, en una cirugía de revisión, es de suma importancia la posición en el espacio de la interlínea articular femoral (lugar donde acaba el componente femoral de la prótesis y que articulará con el inserto). In the same way as in the primary knee prosthesis, the revision knee prosthesis must be placed as accurately as possible in the 3 planes of space, both the main components and the anchorage systems mentioned above. (stems and/or sheaths, bushings, cones or sleeves), since they are joined together and the position of some condition the position of the others. In addition, in revision surgery, the position in the space of the femoral joint interline is extremely important (place where the femoral component of the prosthesis ends and which will articulate with the insert).

A día de hoy, sólo existen un par de sistemas de navegación para las prótesis de revisión, sus navegadores se llaman “Orthopilot” y “Exatech GPS”. Con ambos sistemas se pueden seguir o navegar tanto los componentes, como los vástagos. Sin embargo no hay ninguna solución en el mercado para navegar o seguir las vainas ni los casquillos ni los conos. As of today, there are only a couple of navigation systems for revision prostheses, their navigators are called “Orthopilot” and “Exatech GPS”. With both systems you can follow or navigate both the components and the stems. However there is no solution on the market to navigate or follow the sheaths or bushings or cones.

Es por tanto deseable un sistema para navegación en la implantación de prótesis de revisión de rodilla que pueda proporcionar un seguimiento o navegación de todos los instrumentos y componentes para conseguir una implantación exacta, eficaz y duradera evitando los inconvenientes existentes en los sistemas del estado de la técnica. It is therefore desirable a system for navigation in the implantation of revision knee prostheses that can provide monitoring or navigation of all the instruments and components to achieve an exact, efficient and lasting implantation, avoiding the existing drawbacks in the systems of the state of the knee. technique.

Descripción de la invención Description of the invention

La presente invención resuelve los problemas existentes en el estado de la técnica mediante un sistema para navegación en la implantación de prótesis de revisión de rodilla, que está formado por los siguientes componentes: The present invention solves the existing problems in the state of the art by means of a system for navigation in the implantation of revision knee prostheses, which is made up of the following components:

Un gancho femoral que tiene una abrazadera graduable de sujeción al fémur del paciente al que se le va a realizar el implante de la prótesis de revisión de rodilla, y un primer adaptador de seguidor o navegador al fémur, que presenta medios para la fijación de dicho seguidor o navegador al gancho femoral. Así, este gancho femoral permite la colocación del seguidor, navegador o tracker femoral sin invadir el canal medular del fémur, proporcionando una sujeción estable del tracker femoral y no impidiendo el fresado del canal ni la implantación de la vaina femoral al no atravesar el fémur con los pines, como sucede en el estado de la técnica. A femoral hook that has an adjustable clamp for fastening the femur of the patient to whom the knee revision prosthesis is going to be implanted, and a first follower or navigator adapter to the femur, which presents means for fixing said follower or navigator to the femoral hook. Thus, this femoral hook allows the placement of the femoral follower, navigator or tracker without invading the medullary canal of the femur, providing a stable hold of the femoral tracker and not impeding the reaming of the canal or the implantation of the femoral sheath as it does not cross the femur with the pins, as it happens in the state of the art.

Un segundo adaptador de seguidor o navegador a la fresadora encargada de realizar los cortes en el fémur y la tibia, que tiene medios de acople para acoplar dicho segundo adaptador perpendicularmente al mango de la fresadora permitiendo la rotación del segundo adaptador 360° alrededor del mango. Este segundo adaptador también tiene una ranura de alojamiento de un seguidor o navegador, que permite seguir o navegar el varo/valgo y la flexo/extensión del fresado, y por tanto, seguir o navegar la colocación del vástago femoral y tibial en el fémur y la tibia respectivamente. A second follower or navigator adapter to the milling machine in charge of making the cuts in the femur and tibia, which has coupling means to couple said second adapter perpendicular to the router shank allowing rotation of the second adapter 360° around the shank. This second adapter also has a slot to accommodate a follower or navigator, which allows following or navigating the varus/valgus and flexo/extension reaming, and therefore following or navigating the placement of the femoral and tibial stem on the femur and the tibia respectively.

Además, el segundo adaptador presenta una pluralidad de ranuras de alineación dispuestas en la superficie del segundo adaptador, en las que se puede introducir un seguidor o navegador, para poder seguir o navegar el punto de entrada de la fresadora en el fémur. In addition, the second adapter has a plurality of alignment slots arranged in the surface of the second adapter, into which a follower or navigator can be inserted, in order to be able to follow or navigate the entry point of the reamer on the femur.

Un tercer adaptador de seguidor o navegador a vaina femoral, que presenta una abertura lateral y una forma configurada para acoplarse longitudinalmente a un porta-vainas, que es el instrumento convencional para fijar la vaina femoral en el fémur. El tercer adaptador tiene también al menos una ranura de alojamiento de un seguidor o navegador dispuesta en la superficie superior e inferior consideradas cuando el tercer adaptador está en uso. Introduciendo el seguidor o navegador en la ranura de alojamiento se puede navegar la flexo-extensión y el varo/valgo de la vaina femoral de una forma similar a como se realiza con la ranura de alojamiento de seguidor del segundo adaptador. A third follower or navigator to femoral sheath adapter, having a lateral opening and a shape configured to engage longitudinally with a sheath holder, which is the conventional instrument for fixing the femoral sheath on the femur. The third adapter also has at least one slot for receiving a tracker or navigator arranged on the upper and lower surfaces considered when the third adapter is in use. By inserting the follower or navigator into the locating slot, flexo-extension and varus/valgus of the femoral sheath can be navigated in a similar way to the follower locating slot of the second adapter.

El tercer adaptador tiene además diferentes ranuras de alineación dispuestas en la superficie del tercer adaptador, en las que se puede introducir un seguidor o navegador, para poder seguir o navegar el punto de entrada de la vaina femoral en el fémur. The third adapter further has different alignment grooves disposed on the surface of the third adapter, into which a follower or navigator can be inserted, in order to be able to follow or navigate the entry point of the femoral sheath on the femur.

Un cuarto adaptador de seguidor o navegador a vaina tibial, que presenta medios de acople para acoplarse perpendicularmente al cuerpo cilindrico de un instrumento de tallado de la vaina tibial, permitiendo la rotación del cuarto adaptador alrededor de dicho instrumento de tallado. El cuarto adaptador tiene también al menos una ranura de alojamiento de un seguidor o navegador dispuesta en su superficie. A fourth follower or navigator adapter to the tibial sheath, which has coupling means to engage perpendicularly to the cylindrical body of a milling instrument for the tibial sheath, allowing the rotation of the fourth adapter around said milling instrument. The fourth adapter also has at least one slot for receiving a tracker or navigator arranged in its surface.

De esta forma, la presente invención y sus adaptadores proporcionan la ventaja de permitir utilizar un sistema de navegación de uso libre de los que permiten a priori seguir o navegar la colocación de cualquier sistema de prótesis primaria de rodilla, para seguir o navegar un sistema de revisión para lo cual no estaba inicialmente diseñado ni poseía instrumental específico. In this way, the present invention and its adapters provide the advantage of allowing the use of a free-use navigation system of those that allow a priori follow or navigate the placement of any primary knee prosthesis system, to follow or navigate a revision system for which it was not initially designed nor did it have specific instruments.

Para poder seguir o navegar esta prótesis de revisión se utilizan los adaptadores del presente sistema, que permiten acoplar los seguidores, navegadores o “trackers” convencionales al instrumental de la técnica de navegación de uso libre convencional aplicado a la navegación de prótesis primarias de rodilla. Con ello, se puede aplicar a un sistema de prótesis de revisión un software de navegación diseñado para su uso inicial en prótesis de rodillas primarias (para el cual no está diseñado); y así se puede implantar un sistema de revisión diseñado para su colocación de forma manual, de forma navegada mediante seguidores, navegadores o “trackers”. Mediante estos adaptadores se pueden seguir o navegar los pasos más críticos e importantes de la cirugía de revisión, tanto los cortes que se van a realizar, como la colocación de los vástagos, las vainas y los GAP. En definitiva, todos los pasos necesarios para la correcta colocación de todas las partes del implante en los tres planos del espacio y el manejo de los GAPs, intentado maximizar la vida útil del implante y la satisfacción del paciente. In order to follow or navigate this revision prosthesis, the adapters of this system are used, which allow the conventional followers, navigators or "trackers" to be attached to the instruments of the conventional free-use navigation technique applied to the navigation of primary knee prostheses. With this, navigation software designed for initial use in primary knee replacements (which it is not designed for) can be applied to a revision prosthesis system; and thus a review system designed to be placed manually, navigated by followers, browsers or "trackers" can be implemented. Through these adapters, the most critical and important steps of revision surgery can be followed or navigated, both the cuts to be made, as well as the placement of stems, sheaths and gaps. In short, all the necessary steps for the correct placement of all parts of the implant in the three planes of space and the management of GAPs, trying to maximize the useful life of the implant and patient satisfaction.

De acuerdo con una realización preferente de la invención, el gancho femoral está formado por un primer elemento tubular en el que está dispuesto el primer adaptador de seguidor o navegador al fémur y un segundo elemento ¡nsertable en el interior del primer elemento tubular y deslizable a lo largo de este, cuyo extremo inferior considerado en la posición de uso del gancho femoral, junto con el extremo inferior del primer elemento forma la abrazadera graduable de sujeción al fémur. El extremo superior del segundo elemento ¡nsertable considerado en la posición de uso del gancho femoral sobresale del primer elemento tubular y está roscado para la graduación de la abrazadera mediante una palomilla. According to a preferred embodiment of the invention, the femoral hook is formed by a first tubular element in which the first follower or navigator adapter to the femur is arranged, and a second element that can be inserted inside the first tubular element and slides through it. along this, whose lower end considered in the position of use of the femoral hook, together with the lower end of the first element forms the adjustable clamp for fastening the femur. The upper end of the second insertable element considered in the position of use of the femoral hook protrudes from the first tubular element and is threaded for the graduation of the clamp by means of a wing nut.

De forma particular, el tercer adaptador de seguidor o navegador a la vaina femoral tiene en su superficie superior e inferior considerada en la posición de uso del adaptador al menos un resalte para la fijación de medios elásticos de sujeción. Así, una vez acoplado el tercer adaptador al porta-vainas para la fijación de la vaina femoral en el fémur, se puede fijar a ambos resaltes un medio elástico de sujeción, por ejemplo una goma o banda elástica con orificios, que abrace al tercer adaptador y al porta-vainas, para que el tercer adaptador quede sujeto de forma más firme al porta- vainas, evitando así un posible desacoplamiento de ambos elementos durante su uso. In particular, the third follower or navigator adapter to the femoral sheath has on its upper and lower surface considered in the position of use of the adapter at least one projection for fixing elastic clamping means. Thus, once the third adapter is coupled to the sheath holder for fixing the femoral sheath on the femur, an elastic fastening means can be fixed to both projections, for example a rubber band or elastic band with holes, that embraces the third adapter and to case holder, so that the third adapter is more firmly attached to the case holder, thus avoiding a possible uncoupling of both elements during use.

Según realizaciones particulares de la invención, la posición y orientación de la ranura de alojamiento del seguidor o navegador del tercer adaptador en uso, es decir, durante la implantación de la prótesis de revisión de rodilla, se corresponde con la posición y orientación final que tendrá la interlínea articular femoral proporcionada por el componente femoral de la prótesis, lo que servirá de guía al cirujano encargado de realizar la operación. Es decir, ayuda a seguir o navegar la posición de la prótesis, dado que la posición de la ranura coincide con el lugar donde va a quedar la prótesis. According to particular embodiments of the invention, the position and orientation of the slot for the accommodation of the follower or navigator of the third adapter in use, that is, during the implantation of the knee revision prosthesis, corresponds to the final position and orientation that it will have. the femoral joint space provided by the femoral component of the prosthesis, which will serve as a guide for the surgeon in charge of performing the operation. That is, it helps to follow or navigate the position of the prosthesis, since the position of the groove coincides with the place where the prosthesis will be.

Además, según realización particular de la invención, la posición y orientación de la ranura de alojamiento del seguidor o navegador del cuarto adaptador en uso, es decir durante la implantación de la prótesis de revisión, se corresponde con la posición y orientación final que tendrá el componente tibial de la prótesis, lo que también actuará como guía para el cirujano que realiza la operación. Es decir, ayuda a seguir o navegar la posición de la prótesis, dado que la posición de la ranura coincide con el lugar donde a quedar la prótesis. In addition, according to a particular embodiment of the invention, the position and orientation of the slot for the accommodation of the follower or navigator of the fourth adapter in use, that is, during the implantation of the revision prosthesis, corresponds to the final position and orientation that the tibial component of the prosthesis, which will also act as a guide for the surgeon performing the operation. That is, it helps to follow or navigate the position of the prosthesis, since the position of the slot coincides with the place where the prosthesis will be.

Breve descripción de los dibujos Brief description of the drawings

A continuación, para facilitar la comprensión de la invención, a modo ilustrativo pero no limitativo se describirá una realización de la invención que hace referencia a una serie de figuras. Below, to facilitate the understanding of the invention, by way of illustration but not limitation, an embodiment of the invention will be described with reference to a series of figures.

La figura 1 muestra de forma esquemática los componentes de las prótesis primarias de rodilla convencionales. Figure 1 schematically shows the components of conventional primary knee prostheses.

La figura 2 muestra de forma esquemática ejemplos de seguidores, navegadores o “trackers” del estado de la técnica, su disposición y conexión con el receptor. Figure 2 schematically shows examples of followers, browsers or "trackers" of the state of the art, their arrangement and connection with the receiver.

La figura 3 muestra unos vástagos convencionales unidos a la prótesis Las figuras 4a, 4b y 4c muestran vainas, casquillos y conos convencionales respectivamente. Figure 3 shows conventional stems attached to the prosthesis. Figures 4a, 4b and 4c show conventional sheaths, bushings and cones respectively.

La figura 5a muestra la combinación de vástagos y vainas convencionales, y la figura 5b muestra la combinación de vástagos y conos convencionales. Figure 5a shows the conventional stem and sleeve combination, and Figure 5b shows the conventional stem and cone combination.

La figura 6 muestra los diferentes componentes de una realización particular del gancho femoral del sistema objeto de la presente invención. Figure 6 shows the different components of a particular embodiment of the femoral hook of the system object of the present invention.

La figura 7a muestra el gancho femoral de la figura 6 antes de ser dispuesto en el fémur, y la figura 7b muestra el gancho femoral ya dispuesto en el fémur. Figure 7a shows the femoral hook of figure 6 before it is attached to the femur, and figure 7b shows the femoral hook already attached to the femur.

Las figuras 8a y 8b muestran una comparativa de la fijación al fémur entre el gancho femoral del sistema objeto de la presente invención y la fijación por pines convencional del estado de la técnica. La figura 8a muestra ambas fijaciones en vista lateral, y la figura 8b las muestra en sección. Figures 8a and 8b show a comparison of the fixation to the femur between the femoral hook of the system object of the present invention and the fixation by conventional pins of the state of the art. Figure 8a shows both fixings in side view, and Figure 8b shows them in section.

La figura 9 muestra una vista en perspectiva de una realización de un segundo adaptador de seguidor a fresadora. Figure 9 shows a perspective view of an embodiment of a second follower-to-mill adapter.

La figura 10 muestra el segundo adaptador de la figura 9 acoplado perpendicularmente al mango de una fresadora. Figure 10 shows the second adapter of Figure 9 attached perpendicular to the shank of a router.

La figura 11 muestra la fresadora dispuesta en el fémur, con el segundo adaptador de la figura 10, el cual lleva incorporado un seguidor o navegador en una ranura. Figure 11 shows the milling machine arranged on the femur, with the second adapter of figure 10, which incorporates a follower or navigator in a slot.

La figura 12 muestra de forma esquemática como las ranuras de alineación del segundo adaptador de las figuras 9 a 11 sirven para seguir o navegar la entrada de la fresadora en el fémur, dado que coinciden los tamaños y distancias definitivos de los componentes. Figure 12 schematically shows how the alignment slots of the second adapter of Figures 9 to 11 serve to follow or navigate the entry of the milling cutter into the femur, given that the final sizes and distances of the components coincide.

La figura 13a muestra una vista en perspectiva del tercer adaptador de seguidor a vaina femoral del sistema para navegación objeto de la presente invención. La figura 13b muestra una vista lateral del tercer adaptador de la figura 13a. La figura 14a muestra el tercer adaptador de las figuras 13a y 13b justo antes de ser acoplado a un porta-vainas convencional. La figura 14b muestra el tercer adaptador ya acoplado al porta-vainas. La figura 14c muestra una realización de una banda elástica acoplable a los resaltes del tercer adaptador de las figuras 13a a 14b. La figura 14d muestra una realización en la que el tercer adaptador está ya acoplado al porta-vainas, de forma similar a la figura 14b, pero incluyendo la banda elástica de la figura 14c acoplada a los resaltes y abrazando al conjunto. Figure 13a shows a perspective view of the third adapter from the follower to the femoral sheath of the navigation system object of the present invention. Figure 13b shows a side view of the third adapter of Figure 13a. Figure 14a shows the third adapter of Figures 13a and 13b just before being coupled to a conventional case holder. Figure 14b shows the third adapter already attached to the case holder. Figure 14c shows an embodiment of an elastic band attachable to the projections of the third adapter of Figures 13a to 14b. Figure 14d shows an embodiment in which the third adapter is already coupled to the case holder, in a similar way to figure 14b, but including the elastic band of figure 14c coupled to the projections and embracing the assembly.

La figura 15a (vista frontal) y figura 15b (vista lateral) muestran una realización particular del tercer adaptador en el que la ranura de alojamiento del seguidor tiene una posición y orientación en uso que se corresponde con la posición y orientación final de la interlínea articular femoral. Figure 15a (front view) and Figure 15b (side view) show a particular embodiment of the third adapter in which the follower housing slot has a position and orientation in use that corresponds to the final position and orientation of the joint space. femoral.

La figura 16 muestra de forma esquemática como las ranuras de alineación del tercer adaptador de las figuras 13a a 15b sirven para seguir o navegar la entrada de la vaina femoral en el fémur, dado que coinciden los tamaños y distancias definitivos de los componentes. Figure 16 schematically shows how the alignment slots of the third adapter of Figures 13a to 15b serve to follow or navigate the entry of the femoral sheath into the femur, given that the final sizes and distances of the components coincide.

La figura 17a muestra una vista en perspectiva del cuarto adaptador de seguidor a vaina tibial del sistema para navegación objeto de la presente invención. La figura 17b muestra una vista en planta del tercer adaptador de la figura 17a. Figure 17a shows a perspective view of the fourth adapter from the follower to the tibial sheath of the navigation system object of the present invention. Figure 17b shows a plan view of the third adapter of Figure 17a.

La figura 18a muestra el cuarto adaptador de las figuras 17a y 17b justo antes de ser acoplado a un instrumento de tallado de vaina tibial convencional. La figura 18b muestra el cuarto adaptador ya acoplado al instrumento de tallado de vaina tibial. Figure 18a shows the fourth adapter of Figures 17a and 17b just prior to being attached to a conventional tibial sheath milling instrument. Figure 18b shows the fourth adapter already attached to the tibial sheath milling instrument.

La figura 19 muestra una realización del cuarto adaptador de las figuras 17a a 18b, en el que la posición y orientación de la ranura de alojamiento del seguidor o navegador en uso se corresponde con la posición y orientación final que tendrá el componente tibial de la prótesis. Figure 19 shows an embodiment of the fourth adapter of figures 17a to 18b, in which the position and orientation of the slot for the accommodation of the follower or navigator in use corresponds to the final position and orientation that the tibial component of the prosthesis will have. .

La figura 20 muestra un instrumento de tallado de vaina tibial dispuesta en la tibia, con el cuarto adaptador, el cual lleva incorporado un seguidor o navegador en una ranura. En estas figuras se hace referencia a un conjunto de elementos que son: Figure 20 shows a tibial sheath milling instrument disposed on the tibia, with the fourth adapter, which incorporates a follower or navigator in a slot. These figures refer to a set of elements that are:

1. fémur 1. femur

2. tibia 2. tibia

3 seguidor 3 follower

4. fresadora de fémur y tibia 4. Femur and Tibia Reamer

5. vaina femoral 5. femoral sheath

6. vaina tibial 6. tibial sheath

7. gancho femoral 7. femoral hook

8. primer adaptador de seguidor a fémur 8. First adapter from follower to femur

9. segundo adaptador de seguidor a fresadora 9. second adapter from follower to mill

10. tercer adaptador de seguidor a vaina femoral 10. Third Follower to Femoral Sheath Adapter

11. cuarto adaptador de seguidor a vaina tibial 11. fourth follower adapter to tibial sheath

12. abrazadera graduable de sujeción al fémur 12. adjustable femur clamp

13. mango de la fresadora 13. router handle

14. ranura de alojamiento del seguidor 14. follower housing slot

15. porta-vainas 15. pod holder

16. instrumento de tallado de vaina tibial 16. Tibial Sheath Milling Instrument

17. primer elemento tubular del gancho femoral 17. first tubular element of the femoral hook

18. segundo elemento del gancho femoral 18. second element of the femoral hook

19. palomilla de fijación del gancho femoral 19. Femoral hook fixation wing nut

20. ranuras de alineación 20. alignment slots

21. resalte del tercer adaptador de seguidor a vaina femoral 21. Boss of Third Follower Adapter to Femoral Sheath

22. abertura lateral del tercer adaptador de seguidor a vaina femoral 22. Lateral opening of the third follower adapter to femoral sheath

23. interlínea articular femoral 23. femoral joint space

24. componente femoral de la prótesis 24. femoral component of the prosthesis

25. componente tibial de la prótesis 25. tibial component of the prosthesis

26. banda elástica 26. elastic band

Descripción detallada de la invención Detailed description of the invention

El objeto de la presente invención es un sistema para navegación en la implantación de prótesis de revisión de rodilla. The object of the present invention is a system for navigation in the implantation of revision knee prostheses.

Tal y como se puede observar en las figuras, el sistema está formado por un conjunto de cuatro elementos que actuarán como soportes de seguidores, navegadores o “trackers” a los diversos componentes de la prótesis, los instrumentos para realizar su implante y al fémur, lo que facilitará el posicionamiento y orientación de todos los elementos implicados orientando y guiando al cirujano con precisión durante la implantación de la prótesis de revisión de rodilla. Los elementos que componen el sistema son los siguientes: As can be seen in the figures, the system is made up of a set of four elements that will act as supports for trackers, navigators or "trackers" to the various components of the prosthesis, the instruments to carry out its implantation and the femur, which will facilitate the positioning and orientation of all the elements involved, orienting and guiding the surgeon with precision during the implantation of the knee revision prosthesis . The elements that make up the system are the following:

Un gancho femoral (7) que está formado por una abrazadera graduadle (12) de sujeción al fémur (1) y un primer adaptador (8) de seguidor (3) a fémur (1), el cual tiene medios de fijación de un seguidor (3). Así, este gancho femoral (7) permite la colocación del seguidor (3), navegador o tracker femoral sin invadir el canal medular del fémur (1), proporcionando una sujeción estable del seguidor (3) femoral y no impidiendo el fresado del canal ni la implantación de la vaina femoral (5) al no atravesar el fémur (1) con los pines, como sucede en los sistemas del estado de la técnica. Las figuras 8a y 8b muestran una comparativa de la fijación al fémur (1) entre el gancho femoral (7) del sistema objeto de la presente invención y la fijación por pines convencional del estado de la técnica. La figura 8a muestra ambas fijaciones en vista lateral, y la figura 8b las muestra en sección. A femoral hook (7) that is formed by a graduated clamp (12) for fastening to the femur (1) and a first adapter (8) from follower (3) to femur (1), which has fixing means for a follower (3). Thus, this femoral hook (7) allows the placement of the follower (3), navigator or femoral tracker without invading the medullary canal of the femur (1), providing stable support for the femoral follower (3) and not preventing drilling of the canal or the implantation of the femoral sheath (5) by not going through the femur (1) with the pins, as occurs in the systems of the state of the art. Figures 8a and 8b show a comparison of the fixation to the femur (1) between the femoral hook (7) of the system object of the present invention and the conventional pin fixation of the state of the art. Figure 8a shows both fixings in side view, and Figure 8b shows them in section.

Un segundo adaptador (9) de seguidor (3) a fresadora (4) de fémur (1) y tibia (2), que tiene a su vez medios de acople del segundo adaptador (9) perpendicularmente al mango (13) de la fresadora (4) permitiendo la rotación del segundo adaptador (9) alrededor del mango (13). Además, el segundo adaptador (9) tiene al menos una ranura de alojamiento (14) de un seguidor (3), que permite seguir o navegar el varo/valgo y la flexo/extensión del fresado, y por tanto, seguir o navegar la colocación del vástago femoral y tibial en el fémur (1) y la tibia (2) respectivamente. A second adapter (9) from a follower (3) to a milling machine (4) for the femur (1) and tibia (2), which in turn has coupling means for the second adapter (9) perpendicular to the handle (13) of the milling machine. (4) allowing the rotation of the second adapter (9) around the handle (13). In addition, the second adapter (9) has at least one slot (14) for a follower (3), which allows following or navigating the varus/valgus and flexion/extension of the milling, and therefore, following or navigating the femoral and tibial stem placement in the femur (1) and tibia (2) respectively.

Además, el segundo adaptador (9) dispone de ranuras de alineación (20) dispuestas en la superficie del segundo adaptador (9), las cuales en uso permiten seguir o navegar el punto de entrada de la fresadora (4) en el fémur (1), ya que tal y como se observa en la figura 12, la distancia del centro del instrumento de fresado a cada ranura de alineación (20) se corresponde con la distancia del centro del vástago del implante al corte anterior de cada tamaño femoral. Además, sabiendo esta información y dado que la distancia del vástago femoral a los cóndilos posteriores es fija (con una variación de +/-2mm si se usa el offset), se puede seguir o navegar el GAP en flexión, y vahar el punto de entrada femoral para optimizarlo. El segundo adaptador (9) tiene lado derecho e izquierdo, marcados preferentemente por una “R” y “L” respectivamente para poder ser utilizada en ambas extremidades inferiores. In addition, the second adapter (9) has alignment slots (20) arranged on the surface of the second adapter (9), which in use allow following or navigating the entry point of the milling cutter (4) in the femur (1 ), since as can be seen in figure 12, the distance from the center of the milling instrument to each alignment slot (20) corresponds to the distance from the center of the implant stem to the anterior cut of each femoral size. Furthermore, knowing this information and given that the distance from the femoral stem to the posterior condyles is fixed (with a variation of +/-2mm if offset is used), it is possible to follow or navigate the GAP in flexion, and to determine the point of femoral entry to optimize it. The second adapter (9) has a right and left side, preferably marked by an "R" and "L" respectively to be able to be used in both lower extremities.

Un tercer adaptador (10) de seguidor (3) a vaina femoral (5), que tiene una abertura lateral (22) y una forma configurada para acoplarse longitudinalmente a un porta-vainas (15), de los utilizados convencionalmente para fijar la vaina femoral (5) en el fémur (1). Como se puede observar en la figura 14b, el tercer adaptador (10) tiene la forma complementaria del porta-vainas (15) para encajar y no desplazarse en sentido antero-posterior. El tercer adaptador (10) presenta también al menos una ranura de alojamiento (14) de un seguidor (3) dispuesta en la superficie superior e inferior en uso del tercer adaptador (10) de seguidor (3). Introduciendo el seguidor (3) o navegador en la ranura de alojamiento (14) se puede navegar la flexo-extensión y el varo/valgo de la vaina femoral (5) de una forma similar a como se realiza con la ranura de alojamiento (14) de seguidor (3) del segundo adaptador (9). A third adapter (10) from follower (3) to femoral sheath (5), which has a lateral opening (22) and a shape configured to engage longitudinally with a sheath holder (15), of those conventionally used to fix the sheath femoral (5) on the femur (1). As can be seen in figure 14b, the third adapter (10) has the complementary shape of the sheath holder (15) to fit and not move in the anterior-posterior direction. The third adapter (10) also has at least one housing slot (14) for a follower (3) arranged on the upper and lower surface in use of the third adapter (10) of the follower (3). By inserting the follower (3) or navigator into the accommodation slot (14), the flexion-extension and varus/valgus of the femoral sheath (5) can be navigated in a similar way to the accommodation slot (14). ) of follower (3) of the second adapter (9).

Además, el tercer adaptador (10) tiene ranuras de alineación (20) dispuestas en la superficie del tercer adaptador (10), configuradas para en uso seguir o navegar el punto de entrada y la rotación de la vaina femoral (5) en el fémur (1), puesto que, tal y como se observa en la figura 16 la distancia del centro del mango del porta-vainas (15) femoral a cada ranura de alineación (20) se corresponde con la distancia del centro del vástago del implante al corte anterior de cada tamaño femoral. Además, sabiendo esta información y dado que la distancia del vástago femoral a los cóndilos posteriores es fija (con una variación de +/-2mm si se usa el offset), se puede navegar el GAP en flexión, y vahar el punto de entrada femoral para optimizarlo. In addition, the third adapter (10) has alignment grooves (20) disposed on the surface of the third adapter (10), configured to in use follow or navigate the entry point and rotation of the femoral sheath (5) on the femur. (1), since, as can be seen in figure 16, the distance from the center of the handle of the femoral sleeve holder (15) to each alignment slot (20) corresponds to the distance from the center of the implant stem to the anterior cut of each femoral size. Furthermore, knowing this information and given that the distance from the femoral stem to the posterior condyles is fixed (with a variation of +/-2mm if offset is used), the GAP can be navigated in flexion, and the femoral entry point can be determined. to optimize it.

El tercer adaptador (10) tiene también lado derecho e izquierdo, marcados preferentemente por una “R” y “L” respectivamente para poder ser utilizada en ambas extremidades inferiores, por lo que las caras superior e inferior en uso son imágenes especulares. The third adapter (10) also has a right and left side, preferably marked by an "R" and "L" respectively to be able to be used in both lower extremities, so that the upper and lower faces in use are mirror images.

Un cuarto adaptador (11) de seguidor (3) a vaina tibial (6) formado por medios de acople para acoplarse perpendicularmente al cuerpo cilindrico de un instrumento de tallado (16) de vaina tibial (6), de los utilizados convencionalmente para fijar la vaina tibial (6) en la tibia (2), permitiendo la rotación del cuarto adaptador (11) alrededor del instrumento de tallado (16). Además, el cuarto adaptador (11) presenta al menos una ranura de alojamiento (14) de un seguidor (3). Introduciendo el seguidor (3) o navegador en la ranura de alojamiento (14) se puede navegar la pendiente tibial y el varo/valgo de la vaina tibial (6) de una forma similar a como se realiza con la ranura de alojamiento (14) de seguidor (3) del segundo adaptador (9) y del tercer adaptador (10). La figura 20 muestra un instrumento de tallado (16) de vaina tibial (6) dispuesta en una tibia (2), con el cuarto adaptador (11), el cual lleva incorporado un seguidor (3) o navegador en una ranura de alojamiento (14). A fourth adapter (11) from follower (3) to tibial sheath (6) formed by coupling means to be coupled perpendicularly to the cylindrical body of a tibial sheath (6) carving instrument (16), of those conventionally used to fix the sheath tibial (6) on the tibia (2), allowing the rotation of the fourth adapter (11) around the carving instrument (16). In addition, the fourth adapter (11) has at least one housing slot (14) for a follower (3). By inserting the follower (3) or navigator into the housing slot (14), the tibial slope and varus/valgus of the tibial sheath (6) can be navigated in a similar way to the housing slot (14). follower (3) of the second adapter (9) and of the third adapter (10). Figure 20 shows a carving instrument (16) for a tibial sheath (6) arranged on a tibia (2), with the fourth adapter (11), which incorporates a follower (3) or navigator in a housing slot ( 14).

De acuerdo con una realización preferente que se puede observar en las figuras 6, 7a, 7b, 8a y 8b, el que el gancho femoral (7) tiene un primer elemento tubular (17) en el que está dispuesto el primer adaptador (8) de seguidor (3) a fémur (1), y un segundo elemento (18) ¡nsertable en el interior del primer elemento tubular (17) y deslizable a lo largo de este, cuyo extremo inferior, junto con el extremo inferior del primer elemento (17) forma la abrazadera graduable (12) de sujeción al fémur, y cuyo extremo superior en uso sobresale del primer elemento tubular (17) y está roscado para la graduación de la abrazadera (12) mediante una palomilla (19). De esta forma, tal y como se puede observar en las figuras 7a y 7b, tras colocar el gancho femoral (7) abierto abrazando el fémur (1) se gira la palomilla (19) en sentido horario, de esta forma el segundo elemento (18) se desplazará hacia arriba sobre el primer elemento tubular (17) y el gancho femoral (7) quedará agarrado al fémur (1) mediante la abrazadera (12). According to a preferred embodiment that can be seen in figures 6, 7a, 7b, 8a and 8b, the femoral hook (7) has a first tubular element (17) in which the first adapter (8) is arranged. from follower (3) to femur (1), and a second element (18) that can be inserted inside the first tubular element (17) and slides along it, whose lower end, together with the lower end of the first element (17) forms the adjustable clamp (12) for fastening to the femur, and whose upper end in use protrudes from the first tubular element (17) and is threaded for the graduation of the clamp (12) by means of a wing nut (19). In this way, as can be seen in figures 7a and 7b, after placing the femoral hook (7) open embracing the femur (1), the wing nut (19) is turned clockwise, thus the second element ( 18) will move upwards on the first tubular element (17) and the femoral hook (7) will be attached to the femur (1) by means of the clamp (12).

Las figuras 13a, 13b y 16 muestran una realización particular del sistema objeto de la invención en el que el tercer adaptador (10) de seguidor (3) a la vaina femoral (5) tiene en su superficie superior e inferior en uso al menos un resalte (21) configurado para la fijación de medios elásticos de sujeción. De esta forma, una vez que esté acoplado el tercer adaptador (10) al porta-vainas (15) para la fijación de la vaina femoral (5) en el fémur (1), se puede fijar a ambos resaltes (21) un medio elástico de sujeción, por ejemplo una goma o banda elástica (26) con orificios, tal y como se puede observar en las figuras 14c y 14d. Así la banda elástica (26) abraza al tercer adaptador (10) y al porta-vainas (15), para que el tercer adaptador (10) quede sujeto de forma más firme al porta-vainas (15), evitando así un posible desacoplamiento de ambos elementos durante su uso. Preferentemente, la posición y orientación de la ranura de alojamiento (14) del seguidor (3) del tercer adaptador (10) de seguidor a vaina femoral (5) en uso se corresponde con la posición y orientación final que tendrá la interlínea articular femoral (23) proporcionada por el componente femoral (24) de la prótesis, como se puede observar en las figuras 15a y 15b. Esto servirá al cirujano para seguir o navegar la interlínea femoral durante la intervención. Figures 13a, 13b and 16 show a particular embodiment of the system object of the invention in which the third adapter (10) from the follower (3) to the femoral sheath (5) has on its upper and lower surface in use at least one projection (21) configured for fixing elastic fastening means. In this way, once the third adapter (10) is coupled to the sheath holder (15) for fixing the femoral sheath (5) on the femur (1), a medium can be fixed to both projections (21). holding elastic, for example a rubber or elastic band (26) with holes, as can be seen in figures 14c and 14d. Thus, the elastic band (26) embraces the third adapter (10) and the case holder (15), so that the third adapter (10) is more firmly attached to the case holder (15), thus avoiding possible uncoupling. of both elements during use. Preferably, the position and orientation of the housing slot (14) of the follower (3) of the third adapter (10) from follower to femoral sheath (5) in use corresponds to the final position and orientation that the femoral joint space will have ( 23) provided by the femoral component (24) of the prosthesis, as can be seen in figures 15a and 15b. This will help the surgeon to follow or navigate the femoral interline during the procedure.

Además, de acuerdo con otra realización preferente, como se puede observar en la figura 19, la posición y orientación de la ranura de alojamiento (14) del seguidor (3) del cuarto adaptador (11) de seguidor a vaina tibial (6) en uso se corresponde con la posición y orientación final que tendrá el componente tibial (25) de la prótesis. Dado que la vaina tibial (6) queda solidaria al componente tibial (25) de la prótesis, la colocación de la primera influye en la posición de la segunda, por lo puede seguir o navegar la posición del corte tibial para la posterior colocación de la vaina tibial (6). In addition, according to another preferred embodiment, as can be seen in figure 19, the position and orientation of the housing slot (14) of the follower (3) of the fourth adapter (11) from follower to tibial sheath (6) in use corresponds to the final position and orientation that the tibial component (25) of the prosthesis will have. Since the tibial sheath (6) remains attached to the tibial component (25) of the prosthesis, the placement of the first influences the position of the second, so it can follow or navigate the position of the tibial cut for subsequent placement of the sheath. tibial sheath (6).

Claims

REIVINDICACIONES 1. Sistema para navegación en la implantación de prótesis de revisión de rodilla, caracterizado por que comprende un gancho femoral (7) que comprende una abrazadera graduadle (12) de sujeción a fémur (1 ) y un primer adaptador (8) de seguidor (3) a fémur (1), que comprende medios de fijación de un seguidor (3), un segundo adaptador (9) de seguidor (3) a fresadora (4) de fémur (1) y tibia (2), que comprende medios de acople configurados para acoplar dicho segundo adaptador (9) perpendicularmente al mango (13) de la fresadora (4) permitiendo la rotación del segundo adaptador (9) alrededor del mango (13), al menos una ranura de alojamiento (14) de un seguidor (3), y ranuras de alineación (20) dispuestas en la superficie del segundo adaptador (9) configuradas para navegar y optimizar el punto de entrada de la fresadora (4) en el fémur (1), un tercer adaptador (10) de seguidor (3) a vaina femoral (5), que comprende una abertura lateral (22) y forma configurada para acoplar dicho tercer adaptador (10) longitudinalmente a un porta-vainas (15) configurado para fijar la vaina femoral (5) en el fémur (1), y al menos una ranura de alojamiento (14) de un seguidor (3) dispuesta en la superficie superior e inferior en uso del tercer adaptador (10) de seguidor (3), y ranuras de alineación (20) dispuestas en la superficie del tercer adaptador (10) configuradas para navegar y optimizar el punto de entrada de la vaina femoral (5) en el fémur (1), un cuarto adaptador (11 ) de seguidor (3) a vaina tibial (6) que comprende medios de acople configurados para acoplar dicho cuarto adaptador (11) perpendicularmente al cuerpo cilindrico de un instrumento de tallado (16) de vaina tibial (6), permitiendo la rotación del cuarto adaptador (11) alrededor del instrumento de tallado (16), y al menos una ranura de alojamiento (14) de un seguidor (3), 1. System for navigation in the implantation of knee revision prostheses, characterized in that it comprises a femoral hook (7) that includes a graduated clamp (12) for fastening to the femur (1) and a first adapter (8) for follower ( 3) to femur (1), comprising fixing means for a follower (3), a second adapter (9) from follower (3) to milling machine (4) for femur (1) and tibia (2), comprising means of coupling configured to couple said second adapter (9) perpendicularly to the handle (13) of the milling machine (4) allowing the rotation of the second adapter (9) around the handle (13), at least one housing slot (14) of a follower (3), and alignment slots (20) arranged on the surface of the second adapter (9) configured to navigate and optimize the entry point of the reamer (4) into the femur (1), a third adapter (10) from follower (3) to femoral sheath (5), comprising a lateral opening (22) and a shape configured to couple said third adapter holder (10) longitudinally to a sheath holder (15) configured to fix the femoral sheath (5) on the femur (1), and at least one slot (14) for a follower (3) arranged on the upper surface and inferior in use of the third adapter (10) of follower (3), and alignment slots (20) arranged on the surface of the third adapter (10) configured to navigate and optimize the entry point of the femoral sheath (5) in the femur (1), a fourth adapter (11) from follower (3) to tibial sheath (6) comprising coupling means configured to couple said fourth adapter (11) perpendicularly to the cylindrical body of a carving instrument (16) of tibial sheath (6), allowing the rotation of the fourth adapter (11) around the grinding instrument (16), and at least one housing slot (14) for a follower (3), 2. Sistema para navegación en la implantación de prótesis de revisión de rodilla, según la reivindicación 1 , en el que el gancho femoral (7) comprende un primer elemento tubular (17) en el que está dispuesto el primer adaptador (8) de seguidor (3) a fémur (1 ), un segundo elemento (18) insertadle en el interior del primer elemento tubular (17) y deslizable a lo largo de este, cuyo extremo inferior, junto con el extremo inferior del primer elemento (17) forma la abrazadera graduadle (12) de sujeción al fémur, y cuyo extremo superior en uso sobresale del primer elemento tubular (17) y está roscado para la graduación de la abrazadera (12) mediante una palomilla (19). 2. System for navigation in the implantation of knee revision prostheses, according to claim 1, wherein the femoral hook (7) comprises a first tubular element (17) in which the first adapter (8) from follower (3) to femur (1) is arranged, a second element (18) insert it inside the first tubular element (17) and slide along it, whose lower end, together with the lower end of the first element (17) forms the graduated clamp (12) for fastening to the femur, and whose upper end in use it protrudes from the first tubular element (17) and is threaded for the graduation of the clamp (12) by means of a wing nut (19). 3. Sistema para navegación en la implantación de prótesis de revisión de rodilla, según cualquiera de las reivindicaciones anteriores, en el que el tercer adaptador (10) de seguidor (3) a vaina femoral (5) comprende en su superficie superior e inferior en uso al menos un resalte (21) configurado para la fijación de medios elásticos de sujeción. 3. System for navigation in the implantation of knee revision prostheses, according to any of the previous claims, in which the third adapter (10) from follower (3) to femoral sheath (5) comprises on its upper and lower surface in I use at least one projection (21) configured for fixing elastic fastening means. 4. Sistema para navegación en la implantación de prótesis de revisión de rodilla, según cualquiera de las reivindicaciones anteriores, en la que la posición y orientación de la ranura de alojamiento (14) del seguidor (3) del tercer adaptador (10) de seguidor a vaina femoral (5) en uso se corresponde con la posición y orientación final que tendrá la interlínea articular femoral (23) proporcionada por el componente femoral (24) de la prótesis. 4. System for navigation in the implantation of knee revision prostheses, according to any of the previous claims, in which the position and orientation of the housing slot (14) of the follower (3) of the third follower adapter (10) The femoral sheath (5) in use corresponds to the final position and orientation that the femoral joint spacing (23) provided by the femoral component (24) of the prosthesis will have. 5. Sistema para navegación en la implantación de prótesis de revisión de rodilla, según cualquiera de las reivindicaciones anteriores, en el que la posición y orientación de la ranura de alojamiento (14) del seguidor (3) del cuarto adaptador (11) de seguidor a vaina tibial (6) en uso se corresponde con la posición y orientación final que tendrá el componente tibial (25) de la prótesis. 5. Navigation system for knee revision prosthesis implantation, according to any of the previous claims, in which the position and orientation of the housing slot (14) of the follower (3) of the fourth follower adapter (11) The tibial sheath (6) in use corresponds to the final position and orientation that the tibial component (25) of the prosthesis will have.
PCT/ES2022/070513 2021-09-15 2022-08-01 System for navigation during the implantation of a knee revision prosthesis Ceased WO2023041819A1 (en)

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ES202130857A ES2898124B2 (en) 2021-09-15 2021-09-15 SYSTEM FOR NAVIGATION IN THE IMPLANTATION OF KNEE REVISION PROSTHESIS

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