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WO2023041819A1 - Système pour la navigation dans l'implantation d'une prothèse de révision du genou - Google Patents

Système pour la navigation dans l'implantation d'une prothèse de révision du genou 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
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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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English (en)
Spanish (es)
Inventor
Igor González González
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Individual
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Individual
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Publication of WO2023041819A1 publication Critical patent/WO2023041819A1/fr
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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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
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  • Engineering & Computer Science (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • General Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Transplantation (AREA)
  • Dentistry (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Vascular Medicine (AREA)
  • Cardiology (AREA)
  • Robotics (AREA)
  • Pathology (AREA)
  • Prostheses (AREA)

Abstract

La présente invention concerne un système pour la navigation dans l'implantation d'une prothèse de révision du genou, qui a un crochet fémoral (7) de fixation au fémur (1) avec un premier adaptateur (8) de suiveur (3); un deuxième adaptateur (9) de suiveur (3) avec des moyens d'accouplement à la fraise (4), au moins une rainure de logement (14) d'un suiveur (3) et des rainures d'alignement (20) pour naviguer et optimiser l'entrée de la fraise (4) dans le fémur (1), un troisième adaptateur (10) de suiveur (3) à un porte-gaines (15), avec au moins une rainure de logement (14) de suiveur (3) et des rainures d'alignement (14) pour naviguer et optimiser l'entrée de la gaine fémorale (5) dans le fémur (1); un quatrième adaptateur (11) de suiveur (3) à la gaine tibiale (6) pouvant être accouplé à un instrument de coupe (16) de gaine tibiale (6) avec au moins une rainure de logement (14) de suiveur (3).
PCT/ES2022/070513 2021-09-15 2022-08-01 Système pour la navigation dans l'implantation d'une prothèse de révision du genou Ceased WO2023041819A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
ESP202130857 2021-09-15
ES202130857A ES2898124B2 (es) 2021-09-15 2021-09-15 Sistema para navegacion en la implantacion de protesis de revision de rodilla

Publications (1)

Publication Number Publication Date
WO2023041819A1 true WO2023041819A1 (fr) 2023-03-23

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ES (1) ES2898124B2 (fr)
WO (1) WO2023041819A1 (fr)

Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
ES2203556T3 (es) 2000-09-26 2004-04-16 Brainlab Ag Dispositivo para determinar la posicion de una guia de corte.
ES2455090T3 (es) 2008-06-03 2014-04-14 Depuy (Ireland) Manguitos tibiales porosos en titanio
ES2544528T3 (es) 2008-06-03 2015-09-01 Depuy (Ireland) Casquillos femorales de titanio poroso
US20170167514A1 (en) * 2013-06-13 2017-06-15 Scopis Gmbh Adapter for Receiving a Medical Technical Device and a Position Detecting System
US20190110907A1 (en) * 2017-10-13 2019-04-18 Zimmer, Inc. Revision knee arthroplasty methods and instruments
US20190183590A1 (en) * 2016-09-07 2019-06-20 Andre Novomir Hladio Systems and methods for surgical navigation, including image-guided navigation of a patient's head
US20190290367A1 (en) * 2016-05-15 2019-09-26 Ortoma Ab Attachment Component, Navigation System and Method for Tracking a Surgical Instrument

Family Cites Families (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7547307B2 (en) * 2001-02-27 2009-06-16 Smith & Nephew, Inc. Computer assisted knee arthroplasty instrumentation, systems, and processes
US7708741B1 (en) * 2001-08-28 2010-05-04 Marctec, Llc Method of preparing bones for knee replacement surgery
WO2011049637A1 (fr) * 2009-10-23 2011-04-28 Synvasive Technology, Inc. Équilibrage de genou pour des interventions de révision
WO2018013848A1 (fr) * 2016-07-15 2018-01-18 Mako Surgical Corp. Procédure de révision assistée par robot.
US10537446B2 (en) * 2017-09-20 2020-01-21 Depuy Ireland Unlimited Company Method and instruments for assembling an orthopaedic prosthesis
WO2020093100A1 (fr) * 2018-11-09 2020-05-14 Signature Orthopaedics Europe Ltd Système de genou de révision

Patent Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
ES2203556T3 (es) 2000-09-26 2004-04-16 Brainlab Ag Dispositivo para determinar la posicion de una guia de corte.
ES2455090T3 (es) 2008-06-03 2014-04-14 Depuy (Ireland) Manguitos tibiales porosos en titanio
ES2544528T3 (es) 2008-06-03 2015-09-01 Depuy (Ireland) Casquillos femorales de titanio poroso
US20170167514A1 (en) * 2013-06-13 2017-06-15 Scopis Gmbh Adapter for Receiving a Medical Technical Device and a Position Detecting System
US20190290367A1 (en) * 2016-05-15 2019-09-26 Ortoma Ab Attachment Component, Navigation System and Method for Tracking a Surgical Instrument
US20190183590A1 (en) * 2016-09-07 2019-06-20 Andre Novomir Hladio Systems and methods for surgical navigation, including image-guided navigation of a patient's head
US20190110907A1 (en) * 2017-10-13 2019-04-18 Zimmer, Inc. Revision knee arthroplasty methods and instruments

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ES2898124A1 (es) 2022-03-03
ES2898124B2 (es) 2022-10-13

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