US20110245928A1 - Femoral and Tibial Bases - Google Patents
Femoral and Tibial Bases Download PDFInfo
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- US20110245928A1 US20110245928A1 US12/755,335 US75533510A US2011245928A1 US 20110245928 A1 US20110245928 A1 US 20110245928A1 US 75533510 A US75533510 A US 75533510A US 2011245928 A1 US2011245928 A1 US 2011245928A1
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- bases
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
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- 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
- A61F2/3836—Special connection between upper and lower leg, e.g. constrained
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B2017/567—Joint mechanisms or joint supports in addition to the natural joints and outside the joint gaps
Definitions
- Various embodiments disclosed herein are directed to structure for attachment to body anatomy, and more particularly, towards approaches for providing mounting members for trans-articular implantable mechanical energy absorbing systems.
- Joint replacement is one of the most common and successful operations in modern orthopaedic surgery. It consists of replacing painful, arthritic, worn or diseased parts of a joint with artificial surfaces shaped in such a way as to allow joint movement. Osteoarthritis is a common diagnosis leading to joint replacement. Such joint replacement procedures are a last resort treatment as they are highly invasive and require substantial periods of recovery.
- Total joint replacement also known as total joint arthroplasty, is a procedure in which all articular surfaces at a joint are replaced.
- hemiarthroplasty half arthroplasty
- unincompartmental arthroplasty in which the articular surfaces of only one of multiple compartments at a joint (such as the surfaces of the thigh and shin bones on just the inner side or just the outer side at the knee) are replaced.
- Arthroplasty is an orthopaedic procedure which surgically alters the natural joint in some way. Arthroplasty includes procedures in which the arthritic or dysfunctional joint surface is replaced with something else as well as procedures which are undertaken to reshape or realigning the joint by osteotomy or some other procedure.
- a previously popular form of arthroplasty was interpositional arthroplasty in which the joint was surgically altered by insertion of some other tissue like skin, muscle or tendon within the articular space to keep inflammatory surfaces apart.
- Another less popular arthroplasty is excisional arthroplasty in which articular surfaces are removed leaving scar tissue to fill in the gap.
- arthroplasty Among other types of arthroplasty are resection(al) arthroplasty, resurfacing arthroplasty, mold arthroplasty, cup arthroplasty, silicone replacement arthroplasty, and osteotomy to affect joint alignment or restore or modify joint congruity.
- arthroplasty procedures including joint replacement, osteotomy procedures and other procedures in which the joint surfaces are modified are highly invasive procedures and are characterized by relatively long recovery times.
- arthroplasty results in new joint surfaces which serve the same function in the joint as did the surfaces that were removed.
- Any chodrocytes (cells that control the creation and maintenance of articular joint surfaces), however, are either removed as part of the arthroplasty, or left to contend with the resulting new joint anatomy and injury. Because of this, none of these currently available therapies are chondro-protective.
- a widely-applied type of osteotomy is one in which bones beside the joint are surgically cut and realigned to improve alignment in the joint.
- a misalignment due to injury or disease in a joint related to the direction of load can result in an imbalance of forces and pain in the affected joint.
- the goal of osteotomy is to surgically re-align the bones at a joint such as by cutting and reattaching part of one of the bones to change the joint alignment. This realignment relieves pain by equalizing forces across the joint. This can also increase the lifespan of the joint.
- HTO high tibial osteotomy
- tibia the surgical re-alignment of the upper end of the shin bone (tibia) to address knee malalignment
- HTO results in a decrease in pain and improved function.
- HTO does not address ligamentous instability—only mechanical alignment. Good early results associated with HTO often deteriorate over time.
- Prior approaches to treating osteoarthritis have also failed to account for all of the basic functions of the various structures of a joint in combination with its unique movement.
- an ultimately successful approach must also acknowledge the dampening and energy absorption functions of the anatomy.
- Prior devices designed to reduce the load transferred by the natural joint typically incorporate relatively rigid constructs that are incompressible.
- Device constructs which are relatively rigid do not allow substantial energy storage as they do not allow substantial deformations—do not act through substantial distances. For these relatively rigid constructs, energy is transferred rather than stored or absorbed relative to a joint.
- the natural joint is a construct comprised of elements of different compliance characteristics such as bone, cartilage, synovial fluid, muscles, tendons, ligaments, and other tissues.
- These dynamic elements include relatively compliant ones (ligaments, tendons, fluid, cartilage) which allow for substantial energy absorption and storage, and relatively stiffer ones (bone) that allow for efficient energy transfer.
- the cartilage in a joint compresses under applied force and the resultant force displacement product represents the energy absorbed by cartilage.
- the fluid content of cartilage also acts to stiffen its response to load applied quickly and dampen its response to loads applied slowly. In this way, cartilage acts to absorb and store, as well as to dissipate energy.
- the structure should also provide a base for attachment of complementary structure across articulating joints.
- implant structures For these implant structures to function optimally, they should not cause a disturbance to apposing tissue in the body, nor should their function be affected by anatomical tissue. Moreover, there is a need to reliably and durably transfer loads across members defining a joint. Such transfer can only be accomplished where the base structure is securely affixed to anatomy. It has also been found desirable that a base have a smaller bone contact footprint. In this way, a less invasive implantable procedure can be possible, surgical time can be decreased, and larger variations in and greater members of patients can be accommodated with the same base geometries.
- the disclosure is directed to bases that are mountable to a bone and may be used for cooperation with an implantable trans-articular system.
- the bases facilitate mounting an extra-articular implantable absorber or mechanical energy absorbing system.
- the bases of the energy absorbing system are curved to match the bone surfaces of the femur and tibia and are secured with bone screws.
- the base has a bone contacting surface area of less than 750 mm 2 .
- the base includes a total of three threaded holes for receiving locking screws.
- the base includes a single hole adapted to receive a compression screw and certain bases can further include at least one hole sized to accept a K-wire (Kirschner wire) or Steinmann pin.
- the base of the present disclosure contemplates the use of locking screws with threaded heads as well as bases with three threaded holes forming a triangular pattern.
- a non-threaded hole for receiving a compression screw is configured entirely or at least partially within an area defined by the triangle pattern.
- One contemplated femoral base can include three threaded holes having axes all three with non-parallel trajectories.
- the femoral base can include a K-wire hole having an axis which is substantially parallel to an axis of a non-threaded opening provided for a compression screw.
- the tibial base can have a hole for a compression screw which is perpendicular to bone. Further, the position and number of locking screw holes of the bases are selected to reduce moment forces on the bases as well as provide an anti-rotation function.
- femoral and tibial bases can be provided so that larger segments of the population can be treated.
- three versions of femoral bases can be provided as a kit.
- Such femoral bases can be characterized by the angle between the plane in which locking screws affixing the femoral base to bone contact the bone and a line perpendicular to the sagittal plane of the patient. In this regard, angles of 40°, 45° and 50° are contemplated.
- the various tibial bases which can be provided as a kit and can include 11 mm, 14 mm and 17 mm versions. Such dimensions represent the distance from bone to a center of rotation of a ball and socket arrangement associated with the particular tibial base.
- the femoral and tibial bases are also designed to preserve the articulating joint and capsular structures of the knee. Accordingly, various knee procedures, including uni-compartmental and total joint replacement, may be subsequently performed without requiring removal of the bases.
- the bases each include a body having an inner surface that is curved in shape to mate with a bone surface.
- the inner surface contacts the bone surface and may be porous, roughened or etched to promote osteointegration.
- Osteointegration is a process of bone growth onto and about an implanted device that results in integrating the implant to the bone, thereby facilitating the transfer of load and stress from the implant directly to the bone.
- the inner surface can be coated with an osteointegration composition.
- the base is also shaped to avoid and preserve structures of the knee.
- the base is configured to locate a mounting member on the bone in order to position a kinematic load absorber for optimal reduction of forces on a joint.
- the base is a relatively rigid structure that may be made from metal, polymer or ceramic materials including titanium, cobalt chrome, or polyetheretherketone (PEEK) or a combination thereof.
- the base can be formed at least partially from flexible material.
- the base includes a low-profile body that is generally elongate and includes first and second end portions.
- the first end terminates in a curved manner and the second end includes structure for mating with a mount for an absorber arrangement.
- the body is non-planar such that the second end of the body is elevated as compared to the first end of the body.
- the inner surface of the body can be curved so as to be shaped to fit to the medial surface of the femur and/or tibia on opposite sides of a knee joint.
- the inner surface can also be curved to mate with other surfaces such as lateral surfaces of the femur and tibia.
- FIG. 1 is a side view, depicting an energy absorbing system attached across a knee joint
- FIG. 2 is a side view, depicting the system of FIG. 1 with the joint anatomy shown in a hidden format;
- FIG. 3 is an enlarged side view, depicting the system of FIG. 1 removed from anatomy
- FIG. 4 is an enlarged side view, depicting a femoral base of the system of FIG. 3 with a socket removed;
- FIG. 5 is an enlarged side view, depicting a tibial base of the system of FIG. 3 with a socket removed;
- FIGS. 6A-6E are various angled views of the femoral base shown in FIG. 4 ;
- FIG. 7 is a perspective view, depicting three embodiments of a femoral base
- FIGS. 8A-E are various coupled views of the tibial base shown in FIG. 5 ;
- FIG. 9 is a perspective view, depicting three embodiments of a tibial base.
- femoral and tibial bases are provided for attachment of an extra-articular implantable mechanical energy absorbing system to the body anatomy.
- the femoral and tibial bases are shaped to match the medial surfaces of the femur and tibia, respectively.
- the bases have a low-profile design and curved surfaces thereby minimizing the profile of the bases when mounted to the bone surface and enabling atraumatic motion of the adjoining soft tissues over the bases.
- the bases are secured to bone surfaces with one or more fastening members.
- the base can be configured to be an anchor for the extra-articular implantable absorber or mechanical energy absorbing system used to reduce forces on the knee or other joints (e.g., finger, toe, elbow, hip, ankle)
- the base also can be designed to distribute loads onto the bone from an extra-articular implantable absorber or mechanical energy absorbing system while avoiding articulating joint and capsular structures.
- bases are contemplated and described. Moreover, it is contemplated that various sized and similar shaped bases be made available to a physician in a kit so that a proper fit to variably sized and shaped bones can be accomplished. In that regard, it is contemplated that up to three or more different femoral and tibial bases can be available to a physician.
- the bases disclosed herein are structures that are different and distinct from bone plates. As defined by the American Academy of Orthopedic Surgeons, bone plates are internal splints that hold fractured ends of bone together. In contrast, the bases disclosed herein are designed to couple to and transfer loads from a absorber of an implanted extra-articular system to the bones of the joint. Furthermore, the loading conditions of a bone plate system are directly proportional to the physiological loads of the bone it is attached to, by contrast the loading conditions of a base is not directly proportional to the physiological loading conditions of the bone but is directly proportional to the loading conditions of the absorber to which it is coupled.
- the base is configured to transfer the load through the fastening members used to secure the base to the bone and/or one or more osteointegration areas on the base.
- the bases are designed and positioned on the bone adjacent a joint to achieve desired kinematics of the absorber when the absorber is attached to the bases.
- the approaches to the bases disclosed herein address needs of the anatomy in cyclic loading and in particular, provides an approach which achieves extra-cortical bony in-growth under cyclic loading.
- shear strength of about 3 MPa or more can be expected.
- FIGS. 1-9 there are shown various embodiments of a base that may be fixed to a bone.
- the terms distal and proximal as used herein refer to a location with respect to a center of rotation of the articulating joint.
- FIG. 1 illustrates one embodiment of an extra-articular implantable mechanical energy absorbing system 100 as implanted at a knee joint to treat the symptoms of pain and loss of knee motion resulting from osteoarthritis of the medial knee joint.
- the mechanical energy absorbing system 100 includes femoral and tibial bases 110 , 120 , respectively.
- An articulated absorber 130 is connected to both the femoral and tibial bases 110 , 120 .
- the knee joint is formed at the junction of the femur 152 , the tibia 154 and the fibula 156 .
- the absorber assembly 130 of the mechanical energy absorbing system 100 can function to absorb and reduce load on the knee joint 150 defined by a femur 152 and a tibia 154 .
- the system 100 is placed beneath the skin (not shown) and outside the joint using a minimally invasive approach and resides at the medial aspect of the knee in the subcutaneous tissue.
- the system 100 requires no bone, cartilage or ligament resection. The only bone removal being the drilling of holes for the screws which quickly heal if screws are removed.
- the placement of the bases 110 , 120 on the bones without interfering with the articular surfaces of the joint is made such that further procedures, such as a total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA) or other arthroplasty procedure, can be conducted at the joint at a later date.
- TKA total knee arthroplasty
- UMA unicompartmental knee arthroplasty
- the bases 110 , 120 can remain in place after removing the absorber assembly 130 or both the absorber assembly and bases can be removed.
- the absorber assembly 130 can be changed out with a new absorber assembly without having to replace the bases.
- the bases 110 , 120 may be made from a wide range of materials.
- the bases are made from metals, metal alloys, or ceramics such as, but not limited to, Titanium, stainless steel, Cobalt Chrome or combinations thereof.
- the bases are made from thermo-plastic materials such as, but not limited to, high performance polyketones including polyetheretherketone (PEEK) or a combination of thermo-plastic and other materials.
- Various embodiments of the bases are relatively rigid structures.
- the material of the base is selected so that base stiffness approximates the bone stiffness adjacent the base to minimize stress shielding.
- the femoral and tibial bases 110 , 120 include various surfaces 170 , 172 which are curved to substantially match the surfaces of bones to which they are affixed. Moreover, it is apparent that various affixating structures, such as screws 180 , 182 , are contemplated for affixing the bases 110 , 120 to body anatomy.
- a femoral base 110 fixable to a medial surface of a femur 152 is illustrated. It is to be recognized, however, that the base 110 can be configured to be fixed to a lateral side of the femur 152 or other anatomy of the body.
- the femoral base 110 includes an outer surface 190 and an inner surface 170 .
- the outer surface 190 of the base has a low-profile and is curved to eliminate any edges or surfaces that may damage surrounding tissue when the base is affixed to bone.
- the inner surface 170 and outer surface 190 are not coplanar and serve differing functions which the inner surface conforming to the bone shape and the outer surface providing a smooth transition between the bone and the absorber assembly 130 .
- the proximal end of the outer surface 190 of the femoral base 110 may reside under the vastus medialis and is designed to allow the vastus medialis muscle to glide over the outer surface of the base.
- the femoral base 110 is intended to be positioned on the femur at a location that allows the center of knee rotation to be aligned relative to a center of rotation of a femoral articulation, such as the ball and socket joint 204 of the absorber assembly 130 .
- the base 110 is mounted to the medial epicondyle of the femur 152 so that a mounting structure 220 (described below) connecting the absorber to the femoral base 110 is located anterior and superior to the center of rotation of the knee. Mounting the absorber 130 at this location allows the extra-articular mechanical energy absorbing system 100 to reduce forces during the “stance” or weight bearing phase of gait between heal strike and toe-off.
- the femoral base may be mounted at different positions on the femur to reduce forces during different phases of a person's gait.
- the femoral base 110 is generally elongate and includes a first curved end 193 and a second squared mounting end 195 which is raised to suspend the absorber 130 off the bone surface to avoid contact between the absorber and the knee capsule and associated structures of the knee joint.
- the body of the base 110 includes a curved portion and the squared second end 195 is at an angle with respect to the first end 193 .
- the absorber 130 be offset approximately 2-15 mm from the surface of the joint capsule.
- the entire second end 195 which is connectable with an associated socket structure 200 is offset from the capsular structure of the knee.
- the system 100 is extra-articular or outside of the capsular structure of the knee.
- the system 100 is also trans-articular or extends across the articular structure of the joint.
- the second end 195 is designed to be located offset approximately 3 mm from the capsular structure. In another approach, the offset is approximately 6 mm from the capsular structure. Accordingly, the base 110 allows for positioning of an extra-articular device on the knee joint while preserving the knee structures including the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), Pes anserius tendon, and allowing future surgical procedures such as TKA or UKA.
- ACL anterior cruciate ligament
- PCL posterior cruciate ligament
- Pes anserius tendon
- FIG. 2 Also shown in FIG. 2 is an embodiment of a tibial base 120 that is mountable to the medial surface of the tibia 154 .
- the tibial base 120 has an overall elongate shape and a curved portion end portion.
- An outer surface of the body 192 is curved convexly where the center of the body is thicker than the edges of the body.
- the tibial base 120 also includes rounded edges in order to minimize sharp edges that may otherwise cause damage to surrounding tissues when the base is coupled to the tibia 154 .
- the body includes a rounded first end 196 and a squared-off second end 198 which defines an angle with respect to the elongate portion of the body.
- the second end 198 is configured to be spaced from bone as well as attach to the absorber 130 .
- the underside 172 of the body is the portion of the tibial base 120 that contacts the tibia.
- the squared off end 198 is offset medially from the bone.
- the squared off second ends 195 , 198 of the femoral 110 and tibial 120 bases are shaped to mate with socket structures 200 , 202 .
- the sockets 200 , 202 each include a post 210 which is press fit into a corresponding bore 220 , 222 formed in the squared off ends of the bases 110 , 120 .
- the sockets 200 , 202 receive ball structures forming ends of the absorber 130 , as shown most clearly in FIG. 2 .
- the inner surfaces 170 , 172 of the bases 110 , 120 can include bone contacting surfaces 170 , 172 shaped to match and directly contact the bone surface as well as curved offset surfaces 174 , 176 between the bone contacting surfaces and the squared off mounting ends 195 , 198 .
- These inner curved offset surfaces 174 , 176 are designed to not come into contact with bone and to provide an offset of the tibia articulation, such as the ball and socket joints 204 , 206 , in the medial direction from the joint.
- the inner bone contacting surfaces 170 , 172 may be curved in an anterior to posterior direction as well as superior to inferior directions to conform to the shape of the typical patient femur. According to one embodiment, the inner bone contacting surfaces 170 , 172 includes one or more compositions that induce osteointegration to the cortex of long bones in the body. Additionally or alternatively, the inner bone contacting surfaces 170 , 172 can be roughened or etched to improve osteointegration. The inner bone contacting surfaces of the bases 110 , 120 conform to the bone surface area. The amount of bone contacting surface area can vary depending on the load.
- the surface area of the bone contacting surface 170 provided by the femoral and tibial bases 110 , 120 is significantly less than other bases due to the improved fit and improved fixation provided by the new base shape and improved screw arrangement.
- the bone contacting surface area desired for a base is determined based on the amount of load on the absorber and the calculated shear strength of the interfaces between the bone and the base.
- the surface area of the inner bone contacting surface 170 of the femoral base 120 is less than 650 mm 2 , preferably less thank 500 mm 2 , for secure fixation to the femur and is capable of carrying 60 pounds in 4 mm of compression of a kinematic load absorber 130 .
- a safety factor may be built into base as larger surfaces may be used in other embodiments.
- a femoral base can include an osteointegration surface area of approximately 350 mm 2 . Since a limited number of base shapes and sizes are generally available to a surgeon, a perfect fit of a base to a bone is not always achieved. With a smaller base size, an adequate fit can be achieved with a reduced number of bases because there is less surface area to be matched with bone shape. In this way the same number of bases are also able to accommodate a larger selection of patient anatomies.
- compression screws are described herein, the methods and systems described can be employed without the use of a compression screw and may use the alternative of an instrument designed for delivering compression while locking screws are placed.
- the bone contacting inner surface 172 is less than 750 mm 2 , preferably less than 700 mm 2 for secure fixation to the tibia.
- the load transferred from the absorber to the base can change over time. For example, when the base is initially fixed to the bone, the fastening members carry all the load. Over time, as the base may become osteointegrated with the underlying bone at which time both the fastening members and the osteointegrated surface carry the load from the implanted system.
- the loading of the bases also varies throughout motion of the joint as a function of the flexion angle and based on patient activity.
- the femoral and tibial bases 110 , 120 include a plurality of openings that are sized to receive fastening members used to permanently secure the base to the bone.
- the openings define through-holes that may receive fastening members such as compression screws and/or locking screws.
- the openings may have divergent bore trajectories to further maximize the pull forces required to remove the base from the bone. Although divergent bore trajectories are shown, converging trajectories may also be used as long as interference between the screws is avoided.
- the number and trajectories of the openings may be varied in alternate embodiments.
- the femoral base 110 includes a plurality of openings 230 a , 230 b , 232 , 234 a , 234 b and 234 c .
- Openings 230 a , 230 b have a diameter sized to receive standard K-wires or Steinmann pins that are used to temporarily locate the base 110 on the bone.
- Openings 232 and 234 a - c are sized to receive fastening members used to permanently secure the base 110 to the bone.
- Opening 232 defines a through hole for a compression screw 180 , such as a cancellous bone screws. The compression screw generates compression of bone underneath the base.
- Openings 234 a - c are configured to receive locking screws 182 (see FIG. 2 ).
- the locking screws 182 can include a threaded head that engages threaded locking screw holes 234 a - c and generally do not provide the bone compression that a compression screw does.
- locking screws with threaded heads and corresponding threaded openings have been described, other types of locking screws are also know having heads that are locked to the base in a manner other than by threading, such as by a sliding lock on the base or an insertable locking member.
- the locking screw openings 234 a - c are threaded and the K-wire holes 230 and compression screw opening 232 are non-threaded.
- the K-wire hole 230 a has a trajectory or axis parallel to that of the compression screw hole 232 .
- two of the locking screw openings 234 a , 234 b are located near the square mounting end 195 of the femoral base 110 in order to receive fasteners which securely fix the base to the bone and maximize resistance to pull-out forces and other forces which might tend to loosen the fasteners.
- a third locking screw hole 234 c is spaced from the other two and closer to the first end 193 of the base 110 .
- the position of the three locking screw holes 234 a - c in a triangular arrangement on the base 110 functions to maximize bone quality at the fastener locations and reduce both moments and forces on the base which might cause the base or the fasteners to loosen.
- the various energy absorbing devices in the present application are shown without a protective covering or sheath but it is contemplated that they can be within a protective covering or sheath to protect the moving elements from impingement by surrounding tissues and to prevent the devices from damaging surrounding tissue.
- the bases 110 , 120 may be provided with attachment means such as holes 238 for receiving a fastener to attach the sheath to the bases.
- the compression screw hole 232 is positioned generally at a center of the femoral base 110 and at least partially within a triangle formed by the locking screw holes 234 a - c . It is contemplated that the compression screw hole 232 be unthreaded and is the first hole to receive a fastening structure in the form of the compression screw 180 so as to pull the base 110 tightly against bone. Once the femoral base 110 is so configured against bone, the locking screws 182 are employed to fix the base 110 in place.
- Each of the locking screw holes 234 a - c are oriented in inwardly converging, non-parallel trajectories (i.e.
- each of the locking screws 182 has a trajectory converging in the direction of insertion with each of the other locking screws) to add strength to the fixation to bone.
- the parallel trajectories of the K-wire hole 230 and compression screw hole 232 reduce or eliminate displacement of the base 110 during initial fixation by the compression screw 235 .
- the parallel trajectory of the K-wire hole 230 also substantially eliminates the occurrence of binding of the K-wire in the hole after screw fixation.
- the third locking screw hole 234 c positioned near the first end 193 of the base 110 operates to provide an anti-rotation feature.
- the openings 234 a - c may also have divergent bore trajectories to further maximize the pull forces required to remove the base from the bone. The number and trajectories of the openings may be varied in alternate embodiments.
- the femoral base 110 can also be provided with a post access port 240 positioned near the squared, mounting end 193 of the base 110 .
- the post access port 240 is sized to receive a tool (not shown) that allows for locking of a socket member 240 (See FIG. 4 ) to the base 110 by pulling the post 210 of the socket member 240 into the base 110 .
- the openings 232 , 234 a - c can be countersunk to allow the fastening members to sit below the surface of the base body as shown in FIG. 2 .
- the openings 232 , 234 a - c are sized to accommodate 4.0 mm screws. In other approaches, the openings may be sized to accommodate 3.5 mm, 4.5 mm, 5.0 mm, or 6.5 screws.
- FIG. 6B illustrates a view of the inner surface 170 of the femoral base 110 .
- the inner surface bone contacting surface 170 can be roughened or etched to improve osteointegration.
- the inner surface bone contacting surface 170 can be modified in other ways to induce bone growth.
- the inner surface bone contacting 170 may be coated with bone morphogenic protein 2 (BMP-2), hydroxyapatite (HA), titanium, cobalt chrome beads, any other osteo-generating substance or a combination of two or more coatings.
- BMP-2 bone morphogenic protein 2
- HA hydroxyapatite
- titanium cobalt chrome beads
- any other osteo-generating substance or a combination of two or more coatings According to one embodiment, a titanium plasma spray coating having a thickness of approximately 0.025 in. ⁇ 0.005 in. is applied to the inner bone contacting surface 170 .
- a HA plasma spray having a thickness of approximately 35 ⁇ m ⁇ 10 ⁇ m is applied to facilitate osteointegration.
- the portions of the inner surfaces of the base which are not in contact with the bone including the curved offset surfaces 174 of the bases may or may not be treated in the same manner to improve osteointegration at the bone contacting surface.
- the inner surface 170 has a first radius of curvature at the first end 193 of the base 110 and a second radius of curvature at the second end 195 of the inner surface 170 , where the first radius of curvature can differ from the second radius of curvature. Additionally, the inner surface 170 is generally helical in shape when moving from the first end 193 to the second end 195 of the base 110 . That is, the inner surface 170 twists when moving from the top of the inner surface to the bottom of the inner surface. The helical nature of the inner surface 170 generally follows the shape of the distal medial femur when moving distally (down the femur) and posteriorly (front to back).
- the curved shape of the inner surface 170 helps to reduce the overall profile of the base 110 when affixed to the medial surface of the femur. Additionally, the matching curved shape of the inner surface 28 increases the surface area in which the femoral base 110 contacts the femur thereby improving load distribution.
- the curved shape of the outer surface 190 softens the transitions between the absorber 130 and the femoral base 110 , between the base and bone, and improves the smooth motion of skin, muscle, and other anatomy over the base.
- femoral base 110 can be provided in two or more versions to accommodate patient anatomies.
- the two or more versions of the femoral base 110 form a set of bases of different shapes and/or sizes which are modular in that any one of these bases can be used with the same absorber.
- three base shapes are provided and designated 40°, 45°, 50° bases 110 a , 110 b , 110 c (See FIG. 7 ). These angles represent the angle between a plane formed by the three points where the locking screws 234 contact the bone and a line perpendicular to the saggital plane (vertical A-P plane through the joint) of the patient.
- the femoral bases 110 are substantially the same size and shape, but are each rotated by 5 degrees about the center of rotation of a ball and socket joint attached to the base (See FIGS. 1 and 2 ).
- Such femoral base versions allow improved kinematics by allowing the base to be selected and placed for each particular patient in order to achieve a desired location of the center of rotation.
- the location of the center of rotation of the ball and socket joint 204 at a desired location allows improved range of motion and desired kinematics for different patient bone geometries.
- the orientation of the mounting end 195 at a desired orientation is also important to allowing desired kinematics.
- the desired location of the center of rotation of the femoral ball and socket joint 204 is slightly anterior and distal to the radiographic center of rotation of the knee joint.
- a center of rotation of the knee joint can be approximated by locating the midpoint of Blumensatt's line.
- the center of rotation of the femoral ball and socket joint can also be arranged to be located at a desired offset distance from the bone. This offset distance is about 2 to 15 mm, preferably about 5 to 12 mm.
- the implantable mechanical energy absorbing systems described herein have a total of 7 degrees of freedom including two universal joints each having three degrees of freedom and the absorber having one degree of freedom.
- other combinations of joints may be used to form an implantable energy absorbing system, such as a system having 5 or 6 degrees of freedom.
- the figures have illustrated the implantable mechanical energy absorbing systems designed for placement on the medial side of the left knee. It is to be appreciated that a mirror image of the femoral base 110 would be fixable to the medial surface of the right femur for the purposes of unloading or reducing a load on the medial compartment of the knee.
- the femoral and tibial bases 110 , 120 and the absorber 130 may be configured to be fixed to the lateral surfaces of the left or right femur and to reduce loads on the lateral compartment of the knee.
- implantable mechanical energy absorbing systems can be fixed to both the lateral and medial surfaces of the left or right knee joint or of other joints.
- the tibial base 120 also includes a plurality of through holes 232 , 234 a - c , 236 .
- a non-threaded hole 232 is sized to receive a compression screw 180 (See FIG. 2 ) and three threaded holes 234 a - c are designed to accept locking screws 182 .
- the compression screw hole 232 is positioned generally at a center of the tibial base 120 and at least partially within a triangle formed by the locking screw holes 234 a - c .
- the three openings 234 a - c are oriented to provide differing trajectories for fastening members that maximize pull out forces thereby minimizing the possibility that the tibial base 120 is separated from the bone.
- the trajectories of the locking screws 182 in the tibial base 120 are oriented such that the hole trajectories (axes) and corresponding locking screws are normal or approximately normal to the shear loading forces on the base or normal to be surface of the adjacent bone.
- the screw trajectories are designed to minimize potential for violation of the joint space and/or posterior joint structures.
- the openings 232 , 234 a - c can be countersunk to allow the heads of fastening members to sit below the surface of the body as shown in FIG. 2 .
- the openings 232 , 234 a - c are sized to accommodate 4.0 mm diameter fastening members.
- the openings 232 , 234 may be sized to accommodate 3.5 mm, 4.5 mm, 5.0 mm or other diameter fastening members.
- a femoral base 110 is implanted by selecting a base which most closely accommodates the patients bone while locating the femoral ball and socket articulation at a desired location, placing the base on the bone, inserting a K-wire through the opening 230 a to hold the desired location, inserting the compression screw 180 followed by inserting the locking screws 182 .
- the selection of the best femoral and tibial bases 110 , 120 can be accomplished by radiographic assessment, by providing multiple trials of the different bases for manual testing, by providing a base template which represents multiple bases, or by a combination of these or other methods.
- the tibial base 120 may also include a plurality of holes 236 that may be used during alignment of the base 120 on the tibia and sized to receive structures such as a K-wire.
- the base 120 may include a plurality of holes, teeth or other surface features (not shown) to promote bone in-growth thereby improving base stability.
- the inner bone contacting surface 172 of the tibial base 120 represents the base to bone surface required to support expected shear forces resulting from 60 lbs of load carrying as well as other forces on the base.
- the inner bone contacting surface 172 can be a roughened surface for improving osteointegration.
- the inner surface 172 can be coated to induce bone growth.
- the inner surface 172 may be coated with bone morphogenic protein 2 (BMP-2) or hydroxyapatite, titanium, cobalt chrome beads.
- BMP-2 bone morphogenic protein 2
- the inner bone contacting surface 172 is a curved surface that matches the tibia shape and promotes good contact between the base 120 and the tibia.
- the inner surface facilitates the tibial base 120 absorbing and transferring load forces from the base to the tibia.
- the portions of the inner surfaces of the tibial base 120 which are not in contact with the bone including the curved offset surfaces 176 of the bases may or may not be treated in the same manner as the bone contacting surfaces 172 to improve osteointegration at the bone contacting surface.
- the tibial base 120 has a generally low-profile when mounted to the bone.
- the base 120 is mounted to the medial surface of the tibia in order to preserve critical anatomy such as, but not limited to, medial collateral ligaments.
- the tibial base shape is designed to remain on an anteriomedial surface of the tibia and to avoid important anatomical structures on the posterior aspect of the tibia.
- the second end 198 of the base 120 is offset from the surface of the tibia allowing the absorber to move throughout a range of motion while avoiding anatomical structures and maintaining a low profile of the base.
- the tibial and femoral bases 120 , 110 are configured to receive the absorber in a position where the absorber plane is substantially parallel to a line connecting the medial aspects of the femoral and tibial condyles.
- the tibial base 120 shown in the figures is configured to be fixed to the medial surface of the left tibia. As those skilled in the art will appreciate, a mirror image of the base 120 would be fixable to the medial surface of the right tibia.
- Tibial bases 120 can be provided in two or more versions to fit the different anatomy of patients.
- the two or more versions of the tibial base 120 form a set of bases of different shapes and/or sizes which are modular in that any one of these bases can be used with the same absorber.
- three versions 11 mm base 120 a, 14 mm base 120 b and 17 mm base 120 c are provided.
- These dimension identifiers represent the distance from the tibia to the center of rotation of a tibial ball and socket 206 attached to the tibial base 120 (See also FIGS. 1 and 2 ).
- the tibial bases 120 are substantially the same size and shape, but are each translated by 3 mm above the bone to form the three different versions.
- the new base versions allow improved kinematics by allowing bases to be placed in order to achieve a desired location of the center of rotation.
- the desired center of rotation of the tibial ball and socket joint 206 is selected to provide controlled clearance between the absorber and the anatomical joint and to prevent impingement of the absorber on the socket.
- a tibial base 120 is implanted by first selecting a base which most closely accommodates the patient's bone and joint anatomy. To do this, the tibial base is positioned a set distance from the femoral base with the distance there between being defined by the absorber length. Variation of this distance may occur based on absorber compression and patient activity. Once the tibial base 120 is located on the tibia one or more K-wires, compression screws 180 and/or locking screws 182 are inserted in a manner similar to the method used to secure the femoral base 110 .
- the femoral and tibial bases 110 , 120 are designed to have a relatively small footprint which results in a less invasive procedure with smaller incisions needed to implant the bases.
- the small bases also require less periosteum elevation during surgery resulting in a less invasive procedure.
- Surgical time can also be shortened by using smaller bases and associated less dissection time and involving fewer screws to insert.
- the smaller bases accommodate larger variations in patient anatomies and accommodate larger numbers of patients with the same number of base versions. This improved fit of bases is the direct result of the fact that there is less surface area that needs to fit closely to the bone.
- the mechanical energy absorbing system 100 has been illustrated as used to reduce loading on the medial knee, it may also be used in the lateral knee as well as other joints such as the finger, hand, toe, spine, elbow, hip and ankle.
- Other base configurations and shapes which may be suitable for use in some of these applications include those disclosed in U.S. Patent Publication No. 2008/0275562 which is incorporated herein by reference in its entirety.
Abstract
Various embodiments are directed to femoral and tibial bases that form structures of an implantable mechanical energy absorbing system. According to one embodiment, the bases include a low-profile body having a elongate and a curved body portion. One end of the base is elevated as compared to another end. An inner surface of the low-profile body has a raised portion extending along the elongate, straight portion of the low-profile body. The bases also include a plurality of openings positioned along the low-profile body for alignment and purposes of affixation to body anatomy.
Description
- Various embodiments disclosed herein are directed to structure for attachment to body anatomy, and more particularly, towards approaches for providing mounting members for trans-articular implantable mechanical energy absorbing systems.
- Joint replacement is one of the most common and successful operations in modern orthopaedic surgery. It consists of replacing painful, arthritic, worn or diseased parts of a joint with artificial surfaces shaped in such a way as to allow joint movement. Osteoarthritis is a common diagnosis leading to joint replacement. Such joint replacement procedures are a last resort treatment as they are highly invasive and require substantial periods of recovery. Total joint replacement, also known as total joint arthroplasty, is a procedure in which all articular surfaces at a joint are replaced. This contrasts with hemiarthroplasty (half arthroplasty) in which only one bone's articular surface at a joint is replaced and unincompartmental arthroplasty in which the articular surfaces of only one of multiple compartments at a joint (such as the surfaces of the thigh and shin bones on just the inner side or just the outer side at the knee) are replaced.
- Arthroplasty, as a general term, is an orthopaedic procedure which surgically alters the natural joint in some way. Arthroplasty includes procedures in which the arthritic or dysfunctional joint surface is replaced with something else as well as procedures which are undertaken to reshape or realigning the joint by osteotomy or some other procedure. A previously popular form of arthroplasty was interpositional arthroplasty in which the joint was surgically altered by insertion of some other tissue like skin, muscle or tendon within the articular space to keep inflammatory surfaces apart. Another less popular arthroplasty is excisional arthroplasty in which articular surfaces are removed leaving scar tissue to fill in the gap. Among other types of arthroplasty are resection(al) arthroplasty, resurfacing arthroplasty, mold arthroplasty, cup arthroplasty, silicone replacement arthroplasty, and osteotomy to affect joint alignment or restore or modify joint congruity.
- The most common arthroplasty procedures including joint replacement, osteotomy procedures and other procedures in which the joint surfaces are modified are highly invasive procedures and are characterized by relatively long recovery times. When it is successful, arthroplasty results in new joint surfaces which serve the same function in the joint as did the surfaces that were removed. Any chodrocytes (cells that control the creation and maintenance of articular joint surfaces), however, are either removed as part of the arthroplasty, or left to contend with the resulting new joint anatomy and injury. Because of this, none of these currently available therapies are chondro-protective.
- A widely-applied type of osteotomy is one in which bones beside the joint are surgically cut and realigned to improve alignment in the joint. A misalignment due to injury or disease in a joint related to the direction of load can result in an imbalance of forces and pain in the affected joint. The goal of osteotomy is to surgically re-align the bones at a joint such as by cutting and reattaching part of one of the bones to change the joint alignment. This realignment relieves pain by equalizing forces across the joint. This can also increase the lifespan of the joint. The surgical realignment of the knee joint by high tibial osteotomy (HTO) (the surgical re-alignment of the upper end of the shin bone (tibia) to address knee malalignment) is an osteotomy procedure done to address osteoarthritis in the knee. When successful, HTO results in a decrease in pain and improved function. However, HTO does not address ligamentous instability—only mechanical alignment. Good early results associated with HTO often deteriorate over time.
- Other approaches to treating osteoarthritis involve an analysis of loads which exist at a joint and attempts to correct (generally reduce) these loads. Both cartilage and bone are living tissues that respond and adapt to the loads they experience. Within a nominal range of loading, bone and cartilage remain healthy and viable. If the load falls below the nominal range for extended periods of time, bone and cartilage can become softer and weaker (atrophy). If the load rises above the nominal level for extended periods of time, bone can become stiffer and stronger (hypertrophy). Osteoarthritis or breakdown of cartilage due to wear and tear can also result from overloading. When cartilage breaks down, the bones rub together and cause further damage and pain. Finally, if the load rises too high, then abrupt failure of bone, cartilage and other tissues can result.
- The treatment of osteoarthritis and other bone and cartilage conditions is severely hampered when a surgeon is not able to control and prescribe the levels of joint load. Furthermore, bone healing research has shown that some mechanical stimulation can enhance the healing response and it is likely that the optimum regime for a cartilage/bone graft or construct will involve different levels of load over time, e.g. during a particular treatment schedule. Thus, there is a need for devices which facilitate the control of load on a joint undergoing treatment or therapy, to thereby enable use of the joint within a healthy loading zone.
- Certain other approaches to treating osteoarthritis contemplate external devices such as braces or fixators which attempt to control the motion of the bones at a joint or apply cross-loads at a joint to shift load from one side of the joint to the other. A number of these approaches have had some success in alleviating pain. However, lack of patient compliance and the inability of the devices to facilitate and support the natural motion and function of the diseased joint have been problems with these external braces.
- Prior approaches to treating osteoarthritis have also failed to account for all of the basic functions of the various structures of a joint in combination with its unique movement. In addition to addressing the loads and motions at a joint, an ultimately successful approach must also acknowledge the dampening and energy absorption functions of the anatomy. Prior devices designed to reduce the load transferred by the natural joint typically incorporate relatively rigid constructs that are incompressible. Mechanical energy (E) is the action of a force (F) through a distance (s) (i.e., E=F×s). Device constructs which are relatively rigid do not allow substantial energy storage as they do not allow substantial deformations—do not act through substantial distances. For these relatively rigid constructs, energy is transferred rather than stored or absorbed relative to a joint. By contrast, the natural joint is a construct comprised of elements of different compliance characteristics such as bone, cartilage, synovial fluid, muscles, tendons, ligaments, and other tissues. These dynamic elements include relatively compliant ones (ligaments, tendons, fluid, cartilage) which allow for substantial energy absorption and storage, and relatively stiffer ones (bone) that allow for efficient energy transfer. The cartilage in a joint compresses under applied force and the resultant force displacement product represents the energy absorbed by cartilage. The fluid content of cartilage also acts to stiffen its response to load applied quickly and dampen its response to loads applied slowly. In this way, cartilage acts to absorb and store, as well as to dissipate energy.
- With the foregoing applications in mind, it has been found to be necessary to develop effective structures for mounting to body anatomy which conform to body anatomy and cooperate with body anatomy to achieve desired load reduction, energy absorption, energy storage, and energy transfer. The structure should also provide a base for attachment of complementary structure across articulating joints.
- For these implant structures to function optimally, they should not cause a disturbance to apposing tissue in the body, nor should their function be affected by anatomical tissue. Moreover, there is a need to reliably and durably transfer loads across members defining a joint. Such transfer can only be accomplished where the base structure is securely affixed to anatomy. It has also been found desirable that a base have a smaller bone contact footprint. In this way, a less invasive implantable procedure can be possible, surgical time can be decreased, and larger variations in and greater members of patients can be accommodated with the same base geometries.
- Therefore, what is needed is an effective base for connecting an implantable trans-articular assembly and one which does so with a reduced or minimized bone contacting surface area.
- Briefly, and in general terms, the disclosure is directed to bases that are mountable to a bone and may be used for cooperation with an implantable trans-articular system. In one approach, the bases facilitate mounting an extra-articular implantable absorber or mechanical energy absorbing system.
- According to one embodiment, the bases of the energy absorbing system are curved to match the bone surfaces of the femur and tibia and are secured with bone screws. In one particular embodiment, the base has a bone contacting surface area of less than 750 mm2. In one aspect, the base includes a total of three threaded holes for receiving locking screws. In a further aspect, the base includes a single hole adapted to receive a compression screw and certain bases can further include at least one hole sized to accept a K-wire (Kirschner wire) or Steinmann pin.
- In further aspects, the base of the present disclosure contemplates the use of locking screws with threaded heads as well as bases with three threaded holes forming a triangular pattern. In one approach, a non-threaded hole for receiving a compression screw is configured entirely or at least partially within an area defined by the triangle pattern. One contemplated femoral base can include three threaded holes having axes all three with non-parallel trajectories. Additionally, the femoral base can include a K-wire hole having an axis which is substantially parallel to an axis of a non-threaded opening provided for a compression screw. The tibial base can have a hole for a compression screw which is perpendicular to bone. Further, the position and number of locking screw holes of the bases are selected to reduce moment forces on the bases as well as provide an anti-rotation function.
- It is also contemplated that various versions of both femoral and tibial bases can be provided so that larger segments of the population can be treated. In one particular approach, three versions of femoral bases can be provided as a kit. Such femoral bases can be characterized by the angle between the plane in which locking screws affixing the femoral base to bone contact the bone and a line perpendicular to the sagittal plane of the patient. In this regard, angles of 40°, 45° and 50° are contemplated.
- The various tibial bases which can be provided as a kit and can include 11 mm, 14 mm and 17 mm versions. Such dimensions represent the distance from bone to a center of rotation of a ball and socket arrangement associated with the particular tibial base.
- The femoral and tibial bases are also designed to preserve the articulating joint and capsular structures of the knee. Accordingly, various knee procedures, including uni-compartmental and total joint replacement, may be subsequently performed without requiring removal of the bases.
- In one specific embodiment, the bases each include a body having an inner surface that is curved in shape to mate with a bone surface. The inner surface contacts the bone surface and may be porous, roughened or etched to promote osteointegration. Osteointegration is a process of bone growth onto and about an implanted device that results in integrating the implant to the bone, thereby facilitating the transfer of load and stress from the implant directly to the bone. The inner surface can be coated with an osteointegration composition. The base is also shaped to avoid and preserve structures of the knee. Moreover, the base is configured to locate a mounting member on the bone in order to position a kinematic load absorber for optimal reduction of forces on a joint. The base is a relatively rigid structure that may be made from metal, polymer or ceramic materials including titanium, cobalt chrome, or polyetheretherketone (PEEK) or a combination thereof. In an alternate approach, the base can be formed at least partially from flexible material.
- It is contemplated that the base includes a low-profile body that is generally elongate and includes first and second end portions. The first end terminates in a curved manner and the second end includes structure for mating with a mount for an absorber arrangement. The body is non-planar such that the second end of the body is elevated as compared to the first end of the body. In an application relating to treating a knee joint, the inner surface of the body can be curved so as to be shaped to fit to the medial surface of the femur and/or tibia on opposite sides of a knee joint. The inner surface can also be curved to mate with other surfaces such as lateral surfaces of the femur and tibia.
- Other features and advantages will become apparent from the following detailed description, taken in conjunction with the accompanying drawings, which illustrate by way of example, the features of the various embodiments.
-
FIG. 1 is a side view, depicting an energy absorbing system attached across a knee joint; -
FIG. 2 is a side view, depicting the system ofFIG. 1 with the joint anatomy shown in a hidden format; -
FIG. 3 is an enlarged side view, depicting the system ofFIG. 1 removed from anatomy; -
FIG. 4 is an enlarged side view, depicting a femoral base of the system ofFIG. 3 with a socket removed; -
FIG. 5 is an enlarged side view, depicting a tibial base of the system ofFIG. 3 with a socket removed; -
FIGS. 6A-6E are various angled views of the femoral base shown inFIG. 4 ; -
FIG. 7 is a perspective view, depicting three embodiments of a femoral base; -
FIGS. 8A-E are various coupled views of the tibial base shown inFIG. 5 ; and -
FIG. 9 is a perspective view, depicting three embodiments of a tibial base. - Various embodiments are disclosed which are directed to bases for attachment to body anatomy. In a preferred approach, femoral and tibial bases are provided for attachment of an extra-articular implantable mechanical energy absorbing system to the body anatomy.
- In a specific embodiment, the femoral and tibial bases are shaped to match the medial surfaces of the femur and tibia, respectively. The bases have a low-profile design and curved surfaces thereby minimizing the profile of the bases when mounted to the bone surface and enabling atraumatic motion of the adjoining soft tissues over the bases. The bases are secured to bone surfaces with one or more fastening members.
- The base can be configured to be an anchor for the extra-articular implantable absorber or mechanical energy absorbing system used to reduce forces on the knee or other joints (e.g., finger, toe, elbow, hip, ankle) The base also can be designed to distribute loads onto the bone from an extra-articular implantable absorber or mechanical energy absorbing system while avoiding articulating joint and capsular structures.
- Various shapes of bases are contemplated and described. Moreover, it is contemplated that various sized and similar shaped bases be made available to a physician in a kit so that a proper fit to variably sized and shaped bones can be accomplished. In that regard, it is contemplated that up to three or more different femoral and tibial bases can be available to a physician.
- The bases disclosed herein are structures that are different and distinct from bone plates. As defined by the American Academy of Orthopedic Surgeons, bone plates are internal splints that hold fractured ends of bone together. In contrast, the bases disclosed herein are designed to couple to and transfer loads from a absorber of an implanted extra-articular system to the bones of the joint. Furthermore, the loading conditions of a bone plate system are directly proportional to the physiological loads of the bone it is attached to, by contrast the loading conditions of a base is not directly proportional to the physiological loading conditions of the bone but is directly proportional to the loading conditions of the absorber to which it is coupled. In various embodiments, the base is configured to transfer the load through the fastening members used to secure the base to the bone and/or one or more osteointegration areas on the base. The bases are designed and positioned on the bone adjacent a joint to achieve desired kinematics of the absorber when the absorber is attached to the bases.
- The approaches to the bases disclosed herein address needs of the anatomy in cyclic loading and in particular, provides an approach which achieves extra-cortical bony in-growth under cyclic loading. In certain disclosed applications, shear strength of about 3 MPa or more can be expected.
- Referring now to the drawings, wherein like reference numerals denote like or corresponding parts throughout the drawings and, more particularly to
FIGS. 1-9 , there are shown various embodiments of a base that may be fixed to a bone. The terms distal and proximal as used herein refer to a location with respect to a center of rotation of the articulating joint. -
FIG. 1 illustrates one embodiment of an extra-articular implantable mechanicalenergy absorbing system 100 as implanted at a knee joint to treat the symptoms of pain and loss of knee motion resulting from osteoarthritis of the medial knee joint. The mechanicalenergy absorbing system 100 includes femoral andtibial bases absorber 130 is connected to both the femoral andtibial bases FIG. 1 , the knee joint is formed at the junction of thefemur 152, thetibia 154 and thefibula 156. Through the connections provided by thebases absorber assembly 130 of the mechanicalenergy absorbing system 100 can function to absorb and reduce load on the knee joint 150 defined by afemur 152 and atibia 154. According to one example, thesystem 100 is placed beneath the skin (not shown) and outside the joint using a minimally invasive approach and resides at the medial aspect of the knee in the subcutaneous tissue. Thesystem 100 requires no bone, cartilage or ligament resection. The only bone removal being the drilling of holes for the screws which quickly heal if screws are removed. - It is also to be recognized that the placement of the
bases bases absorber assembly 130 or both the absorber assembly and bases can be removed. Additionally, theabsorber assembly 130 can be changed out with a new absorber assembly without having to replace the bases. - The various embodiments of the
bases - Turning now to
FIG. 2 , it can be appreciated that the femoral andtibial bases various surfaces screws bases - With reference to
FIG. 2 , afemoral base 110 fixable to a medial surface of afemur 152 is illustrated. It is to be recognized, however, that the base 110 can be configured to be fixed to a lateral side of thefemur 152 or other anatomy of the body. Thefemoral base 110 includes anouter surface 190 and aninner surface 170. Theouter surface 190 of the base has a low-profile and is curved to eliminate any edges or surfaces that may damage surrounding tissue when the base is affixed to bone. Theinner surface 170 andouter surface 190 are not coplanar and serve differing functions which the inner surface conforming to the bone shape and the outer surface providing a smooth transition between the bone and theabsorber assembly 130. The proximal end of theouter surface 190 of thefemoral base 110 may reside under the vastus medialis and is designed to allow the vastus medialis muscle to glide over the outer surface of the base. - The
femoral base 110 is intended to be positioned on the femur at a location that allows the center of knee rotation to be aligned relative to a center of rotation of a femoral articulation, such as the ball andsocket joint 204 of theabsorber assembly 130. According to one embodiment, thebase 110 is mounted to the medial epicondyle of thefemur 152 so that a mounting structure 220 (described below) connecting the absorber to thefemoral base 110 is located anterior and superior to the center of rotation of the knee. Mounting theabsorber 130 at this location allows the extra-articular mechanicalenergy absorbing system 100 to reduce forces during the “stance” or weight bearing phase of gait between heal strike and toe-off. Alternatively, the femoral base may be mounted at different positions on the femur to reduce forces during different phases of a person's gait. - As shown in
FIG. 3 , thefemoral base 110 is generally elongate and includes a firstcurved end 193 and a second squared mountingend 195 which is raised to suspend theabsorber 130 off the bone surface to avoid contact between the absorber and the knee capsule and associated structures of the knee joint. The body of thebase 110 includes a curved portion and the squaredsecond end 195 is at an angle with respect to thefirst end 193. It is contemplated that theabsorber 130 be offset approximately 2-15 mm from the surface of the joint capsule. In one specific embodiment, the entiresecond end 195 which is connectable with an associatedsocket structure 200 is offset from the capsular structure of the knee. Thus, thesystem 100 is extra-articular or outside of the capsular structure of the knee. Thesystem 100 is also trans-articular or extends across the articular structure of the joint. In one embodiment, thesecond end 195 is designed to be located offset approximately 3 mm from the capsular structure. In another approach, the offset is approximately 6 mm from the capsular structure. Accordingly, thebase 110 allows for positioning of an extra-articular device on the knee joint while preserving the knee structures including the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), Pes anserius tendon, and allowing future surgical procedures such as TKA or UKA. - Also shown in
FIG. 2 is an embodiment of atibial base 120 that is mountable to the medial surface of thetibia 154. As shown, thetibial base 120 has an overall elongate shape and a curved portion end portion. An outer surface of thebody 192 is curved convexly where the center of the body is thicker than the edges of the body. Thetibial base 120 also includes rounded edges in order to minimize sharp edges that may otherwise cause damage to surrounding tissues when the base is coupled to thetibia 154. The body includes a roundedfirst end 196 and a squared-offsecond end 198 which defines an angle with respect to the elongate portion of the body. In various embodiments, thesecond end 198 is configured to be spaced from bone as well as attach to theabsorber 130. Theunderside 172 of the body is the portion of thetibial base 120 that contacts the tibia. The squared offend 198 is offset medially from the bone. - As best seen in
FIGS. 3-5 , the squared off second ends 195, 198 of the femoral 110 and tibial 120 bases are shaped to mate withsocket structures sockets post 210 which is press fit into acorresponding bore bases sockets absorber 130, as shown most clearly inFIG. 2 . - As shown most clearly in
FIGS. 6B and 8B , it is contemplated that theinner surfaces bases bone contacting surfaces surfaces surfaces socket joints bone contacting surfaces bone contacting surfaces bone contacting surfaces bases bone contacting surface 170 provided by the femoral andtibial bases bone contacting surface 170 of thefemoral base 120 is less than 650 mm2, preferably less thank 500 mm2, for secure fixation to the femur and is capable of carrying 60 pounds in 4 mm of compression of akinematic load absorber 130. A safety factor may be built into base as larger surfaces may be used in other embodiments. For example, a femoral base can include an osteointegration surface area of approximately 350 mm2. Since a limited number of base shapes and sizes are generally available to a surgeon, a perfect fit of a base to a bone is not always achieved. With a smaller base size, an adequate fit can be achieved with a reduced number of bases because there is less surface area to be matched with bone shape. In this way the same number of bases are also able to accommodate a larger selection of patient anatomies. - Although the use of compression screws are described herein, the methods and systems described can be employed without the use of a compression screw and may use the alternative of an instrument designed for delivering compression while locking screws are placed.
- For a
tibial base 120 for secure fixation to the femur and capability of carrying 60 pounds in 4 mm of compression of akinematic load absorber 130, the bone contactinginner surface 172 is less than 750 mm2, preferably less than 700 mm2 for secure fixation to the tibia. - In certain embodiments, the load transferred from the absorber to the base can change over time. For example, when the base is initially fixed to the bone, the fastening members carry all the load. Over time, as the base may become osteointegrated with the underlying bone at which time both the fastening members and the osteointegrated surface carry the load from the implanted system. The loading of the bases also varies throughout motion of the joint as a function of the flexion angle and based on patient activity.
- The femoral and
tibial bases - As shown in
FIGS. 6A-6E , thefemoral base 110 includes a plurality ofopenings Openings 230 a, 230 b have a diameter sized to receive standard K-wires or Steinmann pins that are used to temporarily locate the base 110 on the bone.Openings Opening 232 defines a through hole for acompression screw 180, such as a cancellous bone screws. The compression screw generates compression of bone underneath the base.Openings 234 a-c are configured to receive locking screws 182 (seeFIG. 2 ). The locking screws 182 can include a threaded head that engages threaded lockingscrew holes 234 a-c and generally do not provide the bone compression that a compression screw does. Although locking screws with threaded heads and corresponding threaded openings have been described, other types of locking screws are also know having heads that are locked to the base in a manner other than by threading, such as by a sliding lock on the base or an insertable locking member. - In one embodiment, the locking
screw openings 234 a-c are threaded and the K-wire holes 230 andcompression screw opening 232 are non-threaded. The K-wire hole 230 a has a trajectory or axis parallel to that of thecompression screw hole 232. As shown, two of the lockingscrew openings end 195 of thefemoral base 110 in order to receive fasteners which securely fix the base to the bone and maximize resistance to pull-out forces and other forces which might tend to loosen the fasteners. A thirdlocking screw hole 234 c is spaced from the other two and closer to thefirst end 193 of thebase 110. The position of the three lockingscrew holes 234 a-c in a triangular arrangement on the base 110 functions to maximize bone quality at the fastener locations and reduce both moments and forces on the base which might cause the base or the fasteners to loosen. - The various energy absorbing devices in the present application are shown without a protective covering or sheath but it is contemplated that they can be within a protective covering or sheath to protect the moving elements from impingement by surrounding tissues and to prevent the devices from damaging surrounding tissue. The
bases holes 238 for receiving a fastener to attach the sheath to the bases. - The
compression screw hole 232 is positioned generally at a center of thefemoral base 110 and at least partially within a triangle formed by the lockingscrew holes 234 a-c. It is contemplated that thecompression screw hole 232 be unthreaded and is the first hole to receive a fastening structure in the form of thecompression screw 180 so as to pull the base 110 tightly against bone. Once thefemoral base 110 is so configured against bone, the locking screws 182 are employed to fix the base 110 in place. Each of the lockingscrew holes 234 a-c are oriented in inwardly converging, non-parallel trajectories (i.e. each of the locking screws 182 has a trajectory converging in the direction of insertion with each of the other locking screws) to add strength to the fixation to bone. The parallel trajectories of the K-wire hole 230 andcompression screw hole 232 reduce or eliminate displacement of the base 110 during initial fixation by the compression screw 235. The parallel trajectory of the K-wire hole 230 also substantially eliminates the occurrence of binding of the K-wire in the hole after screw fixation. Further, the thirdlocking screw hole 234 c positioned near thefirst end 193 of thebase 110 operates to provide an anti-rotation feature. Theopenings 234 a-c may also have divergent bore trajectories to further maximize the pull forces required to remove the base from the bone. The number and trajectories of the openings may be varied in alternate embodiments. - The
femoral base 110 can also be provided with apost access port 240 positioned near the squared, mountingend 193 of thebase 110. Thepost access port 240 is sized to receive a tool (not shown) that allows for locking of a socket member 240 (SeeFIG. 4 ) to thebase 110 by pulling thepost 210 of thesocket member 240 into thebase 110. It is to be further recognized that theopenings FIG. 2 . In one specific approach, theopenings -
FIG. 6B illustrates a view of theinner surface 170 of thefemoral base 110. The inner surfacebone contacting surface 170 can be roughened or etched to improve osteointegration. Alternatively, the inner surfacebone contacting surface 170 can be modified in other ways to induce bone growth. In one example, the inner surface bone contacting 170 may be coated with bone morphogenic protein 2 (BMP-2), hydroxyapatite (HA), titanium, cobalt chrome beads, any other osteo-generating substance or a combination of two or more coatings. According to one embodiment, a titanium plasma spray coating having a thickness of approximately 0.025 in.±0.005 in. is applied to the innerbone contacting surface 170. In another embodiment, a HA plasma spray having a thickness of approximately 35 μm±10 μm is applied to facilitate osteointegration. The portions of the inner surfaces of the base which are not in contact with the bone including the curved offsetsurfaces 174 of the bases may or may not be treated in the same manner to improve osteointegration at the bone contacting surface. - As shown in
FIGS. 6C-6E , theinner surface 170 has a first radius of curvature at thefirst end 193 of thebase 110 and a second radius of curvature at thesecond end 195 of theinner surface 170, where the first radius of curvature can differ from the second radius of curvature. Additionally, theinner surface 170 is generally helical in shape when moving from thefirst end 193 to thesecond end 195 of thebase 110. That is, theinner surface 170 twists when moving from the top of the inner surface to the bottom of the inner surface. The helical nature of theinner surface 170 generally follows the shape of the distal medial femur when moving distally (down the femur) and posteriorly (front to back). Accordingly, the curved shape of theinner surface 170 helps to reduce the overall profile of the base 110 when affixed to the medial surface of the femur. Additionally, the matching curved shape of the inner surface 28 increases the surface area in which thefemoral base 110 contacts the femur thereby improving load distribution. The curved shape of theouter surface 190 softens the transitions between theabsorber 130 and thefemoral base 110, between the base and bone, and improves the smooth motion of skin, muscle, and other anatomy over the base. - It is contemplated that
femoral base 110 can be provided in two or more versions to accommodate patient anatomies. The two or more versions of thefemoral base 110 form a set of bases of different shapes and/or sizes which are modular in that any one of these bases can be used with the same absorber. In one example, three base shapes are provided and designated 40°, 45°, 50°bases FIG. 7 ). These angles represent the angle between a plane formed by the three points where the locking screws 234 contact the bone and a line perpendicular to the saggital plane (vertical A-P plane through the joint) of the patient. Thefemoral bases 110 are substantially the same size and shape, but are each rotated by 5 degrees about the center of rotation of a ball and socket joint attached to the base (SeeFIGS. 1 and 2 ). Such femoral base versions allow improved kinematics by allowing the base to be selected and placed for each particular patient in order to achieve a desired location of the center of rotation. The location of the center of rotation of the ball and socket joint 204 at a desired location allows improved range of motion and desired kinematics for different patient bone geometries. The orientation of the mountingend 195 at a desired orientation is also important to allowing desired kinematics. Placing the femoral ball and socket joint 204 at the desired location and orientation allows controlled clearance between the bone and theabsorber 130 during full range of motion, as well as full range of motion of the knee without impingement of the absorber on the socket. In one example, the desired location of the center of rotation of the femoral ball andsocket joint 204 is slightly anterior and distal to the radiographic center of rotation of the knee joint. A center of rotation of the knee joint can be approximated by locating the midpoint of Blumensatt's line. The center of rotation of the femoral ball and socket joint can also be arranged to be located at a desired offset distance from the bone. This offset distance is about 2 to 15 mm, preferably about 5 to 12 mm. - The implantable mechanical energy absorbing systems described herein have a total of 7 degrees of freedom including two universal joints each having three degrees of freedom and the absorber having one degree of freedom. However, other combinations of joints may be used to form an implantable energy absorbing system, such as a system having 5 or 6 degrees of freedom.
- The figures have illustrated the implantable mechanical energy absorbing systems designed for placement on the medial side of the left knee. It is to be appreciated that a mirror image of the
femoral base 110 would be fixable to the medial surface of the right femur for the purposes of unloading or reducing a load on the medial compartment of the knee. In an alternate embodiment, the femoral andtibial bases absorber 130 may be configured to be fixed to the lateral surfaces of the left or right femur and to reduce loads on the lateral compartment of the knee. In yet another approach, implantable mechanical energy absorbing systems can be fixed to both the lateral and medial surfaces of the left or right knee joint or of other joints. - As shown in
FIGS. 8A-8E , thetibial base 120 also includes a plurality of throughholes non-threaded hole 232 is sized to receive a compression screw 180 (SeeFIG. 2 ) and three threadedholes 234 a-c are designed to accept locking screws 182. Thecompression screw hole 232 is positioned generally at a center of thetibial base 120 and at least partially within a triangle formed by the lockingscrew holes 234 a-c. The threeopenings 234 a-c are oriented to provide differing trajectories for fastening members that maximize pull out forces thereby minimizing the possibility that thetibial base 120 is separated from the bone. According to one embodiment, the trajectories of the locking screws 182 in thetibial base 120 are oriented such that the hole trajectories (axes) and corresponding locking screws are normal or approximately normal to the shear loading forces on the base or normal to be surface of the adjacent bone. The screw trajectories are designed to minimize potential for violation of the joint space and/or posterior joint structures. - As with the femoral base, the
openings FIG. 2 . According to one embodiment, theopenings openings - According to one embodiment, a
femoral base 110 is implanted by selecting a base which most closely accommodates the patients bone while locating the femoral ball and socket articulation at a desired location, placing the base on the bone, inserting a K-wire through the opening 230 a to hold the desired location, inserting thecompression screw 180 followed by inserting the locking screws 182. The selection of the best femoral andtibial bases - While screws are used to fix the femoral and
tibial bases - The
tibial base 120 may also include a plurality ofholes 236 that may be used during alignment of the base 120 on the tibia and sized to receive structures such as a K-wire. Optionally, thebase 120 may include a plurality of holes, teeth or other surface features (not shown) to promote bone in-growth thereby improving base stability. - As best seen in
FIGS. 8B-8E , the innerbone contacting surface 172 of thetibial base 120 represents the base to bone surface required to support expected shear forces resulting from 60 lbs of load carrying as well as other forces on the base. The innerbone contacting surface 172 can be a roughened surface for improving osteointegration. Alternatively or additionally, theinner surface 172 can be coated to induce bone growth. For example, theinner surface 172 may be coated with bone morphogenic protein 2 (BMP-2) or hydroxyapatite, titanium, cobalt chrome beads. The innerbone contacting surface 172 is a curved surface that matches the tibia shape and promotes good contact between the base 120 and the tibia. Accordingly, the inner surface facilitates thetibial base 120 absorbing and transferring load forces from the base to the tibia. The portions of the inner surfaces of thetibial base 120 which are not in contact with the bone including the curved offsetsurfaces 176 of the bases may or may not be treated in the same manner as thebone contacting surfaces 172 to improve osteointegration at the bone contacting surface. - The
tibial base 120 has a generally low-profile when mounted to the bone. Thebase 120 is mounted to the medial surface of the tibia in order to preserve critical anatomy such as, but not limited to, medial collateral ligaments. The tibial base shape is designed to remain on an anteriomedial surface of the tibia and to avoid important anatomical structures on the posterior aspect of the tibia. - As best seen in
FIG. 2 , thesecond end 198 of thebase 120 is offset from the surface of the tibia allowing the absorber to move throughout a range of motion while avoiding anatomical structures and maintaining a low profile of the base. Together the tibial andfemoral bases - The
tibial base 120 shown in the figures is configured to be fixed to the medial surface of the left tibia. As those skilled in the art will appreciate, a mirror image of the base 120 would be fixable to the medial surface of the right tibia.Tibial bases 120 can be provided in two or more versions to fit the different anatomy of patients. The two or more versions of thetibial base 120 form a set of bases of different shapes and/or sizes which are modular in that any one of these bases can be used with the same absorber. In one example, three versions 11mm base 120 a, 14mm base 120 b and 17mm base 120 c (SeeFIG. 9 ) are provided. These dimension identifiers represent the distance from the tibia to the center of rotation of a tibial ball andsocket 206 attached to the tibial base 120 (See alsoFIGS. 1 and 2 ). Thetibial bases 120 are substantially the same size and shape, but are each translated by 3 mm above the bone to form the three different versions. The new base versions allow improved kinematics by allowing bases to be placed in order to achieve a desired location of the center of rotation. The desired center of rotation of the tibial ball andsocket joint 206 is selected to provide controlled clearance between the absorber and the anatomical joint and to prevent impingement of the absorber on the socket. - According to one embodiment, a
tibial base 120 is implanted by first selecting a base which most closely accommodates the patient's bone and joint anatomy. To do this, the tibial base is positioned a set distance from the femoral base with the distance there between being defined by the absorber length. Variation of this distance may occur based on absorber compression and patient activity. Once thetibial base 120 is located on the tibia one or more K-wires, compression screws 180 and/or lockingscrews 182 are inserted in a manner similar to the method used to secure thefemoral base 110. - In one specific application, the femoral and
tibial bases - The use of a single central compression screw combined with surrounding locking screws for fixation allows fixation to be provided nearly entirely by the screws and very little osteointegration of base to bone may be needed. Thus, improved screw fixation is a key to fixation in place of increase surface area.
- Although the mechanical
energy absorbing system 100 has been illustrated as used to reduce loading on the medial knee, it may also be used in the lateral knee as well as other joints such as the finger, hand, toe, spine, elbow, hip and ankle. Other base configurations and shapes which may be suitable for use in some of these applications include those disclosed in U.S. Patent Publication No. 2008/0275562 which is incorporated herein by reference in its entirety. - The various embodiments described above are provided by way of illustration only and should not be construed to limit the claimed invention. Those skilled in the art will readily recognize various modifications and changes that may be made to the claimed invention without following the example embodiments and applications illustrated and described herein, and without departing from the true spirit and scope of the claimed invention, which is set forth in the following claims. In that regard, various features from certain of the disclosed embodiments can be incorporated into other of the disclosed embodiments to provide desired structure.
Claims (21)
1. A mechanical energy absorbing system comprising:
a femoral base having a bone contacting surface with a surface area of less than 650 mm2, the femoral base having a single non-threaded opening therein configured to receive a compression screw and a plurality of threaded openings therein configured to receive a plurality of locking screws with threaded locking heads;
a tibial base having a bone contacting surface area of less than 750 mm2;
an absorber connected between the femoral and tibial bases and configured to reduce loads born by a knee.
2. The system of claim 1 , wherein the femoral base has only three threaded openings therein.
3. The system of claim 1 , wherein the tibial base has a single non-threaded opening therein configured to receive a compression screw and a plurality of threaded openings therein configured to receive a plurality of locking screws with threaded locking heads.
4. The system of claim 1 , wherein said threaded openings are positioned at three points of a triangle.
5. The system of claim 4 , wherein the non-threaded opening is positioned at least partially within the triangle.
6. The system of claim 2 , wherein the three threaded openings each have axes which cross each other on a bone contacting side of the femoral base.
7. The system of claim 3 , wherein said threaded openings of the tibial base are positioned at three points of a triangle and the non-threaded opening is positioned at least partially within the triangle.
8. The system of claim 7 , wherein two of the threaded openings of the tibial base closest to the absorber have axes which cross each other on a bone contacting side of the tibial base.
9. The system of claim 7 , wherein a threaded opening of the tibial base furthest from the absorber has an axis which does not cross with the axes of the other two threaded openings.
10. A femoral base for a mechanical energy absorbing system comprising:
a body having a bone contacting surface and an attachment site for attaching an energy absorber;
a non-threaded opening formed in the body and configured to receive a compression screw;
a plurality of threaded openings formed in the body and configured to receive a plurality of locking screws with threaded locking heads; and
a non-threaded K-wire opening smaller than the threaded and non-threaded openings, the K-wire opening having an axis parallel to an axis of the non-threaded opening.
11. The femoral base of claim 10 , wherein the non-threaded opening is a single non-threaded opening.
12. A method of implanting a femoral base for a mechanical energy absorbing system comprising:
placing a femoral base having a bone contacting surface against the femur;
inserting a K-wire through a K-wire opening in the femoral base to hold the base in place on the femur;
inserting a compression screw through a corresponding opening formed in the base;
inserting a plurality of locking screws in threaded openings formed in the base and engaging threaded heads of the locking screws with the threaded openings, wherein the K-wire opening has an axis parallel to an axis of the compression screw opening.
13. The method of claim 12 , wherein the compression screw opening is a non-threaded opening and is the only non-threaded opening of the base.
14. A kit for implantation of a mechanical energy absorbing system, the kit comprising:
an absorber having first and second centers of rotation;
a plurality of femoral bases, each femoral base having substantially the same size and shape, while being rotated with respect to one another about the first center of rotation; and
a plurality of tibial bases, each tibial base having substantially the same size and shape, while being translated with respect to one another with respect to the second center of rotation.
15. A set of femoral bases for a mechanical energy absorbing system, the set comprising:
a set of three of femoral bases, each femoral base having substantially the same size and shape, while being rotated with respect to one another about a center of rotation.
16. A method of selecting a femoral base of a mechanical energy absorbing system for implanting in a patient, the method comprising:
providing a plurality of femoral bases having substantially the same size and shape, while being rotated with respect to one another about a center of rotation of the mechanical energy absorbing system; and
selecting one of the femoral bases from the plurality of femoral bases in order to locate the center of rotation of the mechanical energy absorbing system at a desired location with respect to a center of rotation of the knee joint and at a desired offset distance from the bone.
17. The method of claim 16 , wherein the desired offset distance is about 2 to 15 mm.
18. A set of tibial bases a mechanical energy absorbing system, the set comprising:
a set of three of tibial bases, each tibial base having substantially the same size and shape, while being translated with respect to one another such that a distance in a direction perpendicular to the bone between a mounting end of the bases and the bone contacting surfaces of the bases vary between the three bases of the set.
19. A method of selecting a tibial base of a mechanical energy absorbing system for implanting in a patient, the method comprising:
providing a plurality of tibial bases having substantially the same size and shape, while being translated with respect to a bone contacting surface; and
selecting one of the tibial bases from the plurality of tibial bases in order to locate the center of rotation of the mechanical energy absorbing system at a desired location with respect to the bone.
20. A mechanical energy absorbing system, the system comprising:
a femoral base configured for implantation on a medial aspect of the femur;
a tibial base configured for implantation on a medial aspect of the tibia;
an absorber configured to be connected to the femoral base and the tibial base in an position where the absorber is located in an absorber plane; and
wherein the bases are configured to receive the absorber in a position where the absorber plane is substantially parallel to a line connecting the medial aspects of the femoral and tibial condyles.
21. The system of claim 20 , wherein bases are configured to receive the absorber at a location offset from the line connecting the medial aspects of the femoral and tibial condyles by 2-15 mm.
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EP10762404A EP2417404A1 (en) | 2009-04-07 | 2010-04-07 | Solar receiver utilizing carbon nanotube infused coatings |
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AU2011238861A AU2011238861A1 (en) | 2010-04-06 | 2011-02-04 | Femoral and tibial bases |
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Cited By (12)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2013105906A1 (en) * | 2012-01-13 | 2013-07-18 | Sunton Wongsiri | A bone and joint fixing system |
US20130289732A1 (en) * | 2012-04-30 | 2013-10-31 | William B. Kurtz | Total Knee Arthroplasty System and Method |
US8597362B2 (en) | 2009-08-27 | 2013-12-03 | Cotera, Inc. | Method and apparatus for force redistribution in articular joints |
US20130325122A1 (en) * | 2012-06-04 | 2013-12-05 | Moximed, Inc. | Low contact femoral and tibial bases |
US20140156005A1 (en) * | 2009-08-27 | 2014-06-05 | Cotera, Inc. | Method and Apparatus for Altering Biomechanics of the Articular Joints |
WO2015117239A1 (en) * | 2014-02-04 | 2015-08-13 | Pega Medical, Inc. | Systems and methods for correcting a rotational bone deformity |
US9282996B2 (en) * | 2013-03-13 | 2016-03-15 | Moximed, Inc. | Extra-articular implantable mechanical energy absorbing assemblies |
US9468466B1 (en) | 2012-08-24 | 2016-10-18 | Cotera, Inc. | Method and apparatus for altering biomechanics of the spine |
EP2967877A4 (en) * | 2013-03-11 | 2017-03-15 | Embark Enterprises, Inc. | Quadruped stifle stabilization system |
US9668868B2 (en) | 2009-08-27 | 2017-06-06 | Cotera, Inc. | Apparatus and methods for treatment of patellofemoral conditions |
US9861408B2 (en) | 2009-08-27 | 2018-01-09 | The Foundry, Llc | Method and apparatus for treating canine cruciate ligament disease |
US10349980B2 (en) | 2009-08-27 | 2019-07-16 | The Foundry, Llc | Method and apparatus for altering biomechanics of the shoulder |
Families Citing this family (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20110245928A1 (en) | 2010-04-06 | 2011-10-06 | Moximed, Inc. | Femoral and Tibial Bases |
ITVR20130013A1 (en) * | 2013-01-21 | 2014-07-22 | Tecres Spa | EXTERNAL FIXING DEVICE FOR THE TREATMENT OF BONE FRACTURES |
US20140257501A1 (en) * | 2013-03-08 | 2014-09-11 | Moximed, Inc. | Joint Energy Absorbing System and Method of Use |
US9289303B2 (en) | 2013-05-21 | 2016-03-22 | Linares Medical Devices, Llc | Dynamic interface support established between a ceramic hip joint ball and a supporting ball stem |
US20150005831A1 (en) | 2013-06-26 | 2015-01-01 | Steven S. Sands | Medial distal femur bone plate system |
Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20080275560A1 (en) * | 2007-05-01 | 2008-11-06 | Exploramed Nc4, Inc. | Femoral and tibial base components |
US20090275947A1 (en) * | 2008-05-02 | 2009-11-05 | Thomas James Graham | Bone plate system for bone restoration and methods of use thereof |
Family Cites Families (208)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US2632440A (en) | 1947-12-17 | 1953-03-24 | John M Hauser | Leg brace joint and lock |
US2877033A (en) | 1956-03-16 | 1959-03-10 | Dreher Mfg Company | Artificial joint |
US3242922A (en) | 1963-06-25 | 1966-03-29 | Charles B Thomas | Internal spinal fixation means |
DE1906284A1 (en) | 1969-02-08 | 1970-09-03 | Dr Esfandiar Shahrestani | Endoprosthesis, especially for hip joints |
US3681786A (en) | 1970-07-13 | 1972-08-08 | Medical Eng Corp | Solid human prosthesis of varying consistency |
SU578063A1 (en) | 1971-05-20 | 1977-10-30 | Seppo Arnold | Orthopedic endoapparatus for restoring hip joint |
US3779654A (en) | 1971-08-06 | 1973-12-18 | R Horne | Artificial joint |
US3875594A (en) | 1973-08-27 | 1975-04-08 | Dow Corning | Surgically implantable prosthetic joint having load distributing flexible hinge |
CA1017641A (en) | 1974-05-21 | 1977-09-20 | George A. Taylor | Mechanical joint for an orthopedic brace or prosthesis |
US3988783A (en) | 1976-01-21 | 1976-11-02 | Richards Manufacturing Company, Inc. | Prosthetic collateral ligament |
US4054955A (en) | 1976-01-29 | 1977-10-25 | Arnold Ivanovich Seppo | Orthopaedic endoapparatus designed to grow a new live shoulder and hip joint, to reconstruct a deformed joint or to restore a pathologically dysplastic and congenitally luxated joint |
SU578957A1 (en) | 1976-03-30 | 1977-11-05 | Pozdnikin Yurij | Method of reconstruction of cotyloid cavity at dysplasia of hip joint |
SU624613A1 (en) | 1977-05-10 | 1978-09-25 | Tikhonenkov Egor S | Method of treating congenital femur dislocation |
SU640740A1 (en) | 1977-07-12 | 1979-01-05 | Предприятие П/Я В-2769 | Arrangement for developing mobility of the joint of lower extremities |
SU719612A1 (en) | 1977-10-28 | 1980-03-05 | Tikhonenkov Egor S | Method of recessing cotyloid cavity |
SU704605A1 (en) | 1978-03-14 | 1979-12-25 | Е. С. Тихоненков и С. . И. Федоров | Method of fixing fragments of the femur after intertrochanteric and supratrochateric osteotomy |
SU741872A1 (en) | 1978-05-04 | 1980-06-25 | за вители | Splint for treating femur congenital dislocation |
US4187841A (en) | 1978-07-07 | 1980-02-12 | Knutson Richard A | Bone compression or distraction device |
US4246660A (en) | 1978-12-26 | 1981-01-27 | Queen's University At Kingston | Artificial ligament |
US4308863A (en) | 1979-10-18 | 1982-01-05 | Ace Orthopedic Manufacturing, Inc. | External fixation device |
US4353361A (en) | 1980-08-25 | 1982-10-12 | Foster Robert W | Orthotic/prosthetic joint |
SU1699441A1 (en) | 1981-07-08 | 1991-12-23 | Предприятие П/Я Г-4778 | Endoprosthesis for reconstructing hip joint |
US4502473A (en) | 1981-08-06 | 1985-03-05 | National Research Development Corp. | Apparatus for external fixation of bone fractures |
US4637382A (en) | 1982-04-27 | 1987-01-20 | Brigham & Women's Hospital | Motion-guiding load-bearing external linkage for the knee |
CA1205602A (en) | 1982-09-10 | 1986-06-10 | William C. Bruchman | Prosthesis for tensile load-carrying tissue |
US4696293A (en) | 1982-09-30 | 1987-09-29 | Ciullo Jerome V | Hinged external fixator |
BE895728A (en) | 1983-01-28 | 1983-05-16 | Region Wallonne Represente Par | METHOD FOR CONTROLLING THE STABILITY OF AN ORTHOPEDIC ASSEMBLY CONSISTING OF AN EXTERNAL FIXING BAR USED FOR REDUCING FRACTURES |
JPS59131348U (en) | 1983-02-23 | 1984-09-03 | 日産自動車株式会社 | Automotive wiper circuit |
US4501266A (en) | 1983-03-04 | 1985-02-26 | Biomet, Inc. | Knee distraction device |
SU1251889A1 (en) | 1984-01-27 | 1986-08-23 | Ленинградский Ордена Трудового Красного Знамени Научно-Исследовательский Детский Ортопедический Институт Им.Г.И.Турнера | Apparatus for dynamic unloading of hip joint |
SU1186204A1 (en) | 1984-05-28 | 1985-10-23 | Московский Ордена Ленина И Ордена Октябрьской Революции Авиационный Институт Им.Серго Орджоникидзе | Apparatus for surgical treatment of hip joint injures |
SU1316666A1 (en) | 1984-09-27 | 1987-06-15 | В. В. Василенкайтис | Arrangement for relieving the load of a joint |
IT1181490B (en) | 1984-12-18 | 1987-09-30 | Orthofix Srl | ORTHOPEDIC APPARATUS FOR EXTERNAL AXIAL FIXING, WITH A WIDE RANGE OF ADAPTABILITY |
US4792336A (en) | 1986-03-03 | 1988-12-20 | American Cyanamid Company | Flat braided ligament or tendon implant device having texturized yarns |
US4759765A (en) | 1986-03-17 | 1988-07-26 | Minnesota Mining And Manufacturing Company | Tissue augmentation device |
US4776851A (en) | 1986-07-23 | 1988-10-11 | Bruchman William C | Mechanical ligament |
GB8622563D0 (en) | 1986-09-19 | 1986-10-22 | Amis A A | Artificial ligaments |
DE3701533A1 (en) | 1987-01-21 | 1988-08-04 | Medi System Gmbh | OSTEOSYNTHESIS TOOLS |
US4846842A (en) | 1987-06-25 | 1989-07-11 | Connolly & Mcmaster | Body joint rotation support device |
US4871367A (en) | 1987-09-03 | 1989-10-03 | Sutter Biomedical Corporation | Surgically implanted prosthesis |
SE466732B (en) | 1987-10-29 | 1992-03-30 | Atos Medical Ab | LED PROTES, INCLUDING A LED BODY BETWEEN ONE COUPLE OF TAPS FOR INSTALLATION |
DE3837228A1 (en) | 1987-11-05 | 1990-05-03 | Robert Dr Sturtzkopf | DEVICE FOR EXTERNAL DETERMINATION OF BONE FRAGMENTS |
SU1588404A1 (en) | 1988-06-12 | 1990-08-30 | Тартуский государственный университет | Device for functional unloading of coxofemoral joint in fractures of cotyloid cavity |
GB2223406A (en) | 1988-08-01 | 1990-04-11 | Univ Bristol | External fixator device |
IT1228305B (en) | 1989-01-04 | 1991-06-11 | Confida Sas | BONE SUPPORT DEVICE. |
DE8901908U1 (en) | 1989-02-15 | 1989-03-30 | Mecron Medizinische Produkte Gmbh, 1000 Berlin, De | |
IT1234756B (en) | 1989-03-17 | 1992-05-26 | Orthofix Srl | EXTERNAL FIXER PARTICULARLY SUITABLE TO BE APPLIED ON THE BASINS. |
US4959065A (en) | 1989-07-14 | 1990-09-25 | Techmedica, Inc. | Bone plate with positioning member |
US5002574A (en) | 1989-08-18 | 1991-03-26 | Minnesota Mining And Manufacturing Co. | Tensioning means for prosthetic devices |
US4923471A (en) | 1989-10-17 | 1990-05-08 | Timesh, Inc. | Bone fracture reduction and fixation devices with identity tags |
US5121742A (en) | 1989-10-27 | 1992-06-16 | Baylor College Of Medicine | Lower extremity orthotic device |
DE3991804C2 (en) | 1989-11-14 | 1994-12-15 | Lazar L Vovic Dr Rodnjanskij | Hip joint support |
IT1236172B (en) | 1989-11-30 | 1993-01-11 | Franco Mingozzi | EXTERNAL FIXER FOR THE TREATMENT OF LONG BONE FRACTURES OF THE LIMBS. |
US5352190A (en) | 1990-03-16 | 1994-10-04 | Q-Motus, Inc. | Knee brace |
US5100403A (en) | 1990-06-08 | 1992-03-31 | Smith & Nephew Richards, Inc. | Dynamic elbow support |
US5103811A (en) | 1990-07-09 | 1992-04-14 | Crupi Jr Theodore P | Body part or joint brace |
FR2676911B1 (en) | 1991-05-30 | 1998-03-06 | Psi Ste Civile Particuliere | INTERVERTEBRAL STABILIZATION DEVICE WITH SHOCK ABSORBERS. |
US5318567A (en) | 1991-07-02 | 1994-06-07 | Olivier Vichard | Screw-on plate for treatment of fractures of the odontoid apophysis |
JP2532346Y2 (en) | 1991-07-05 | 1997-04-16 | 本田技研工業株式会社 | Fuel vapor emission suppression device for internal combustion engine |
US5201881A (en) * | 1991-08-13 | 1993-04-13 | Smith & Nephew Richards Inc. | Joint prosthesis with improved shock absorption |
DE69323116T2 (en) | 1992-06-18 | 1999-06-24 | Barclay Slocum | Register for osteotomy |
FR2692952B1 (en) | 1992-06-25 | 1996-04-05 | Psi | IMPROVED SHOCK ABSORBER WITH MOVEMENT LIMIT. |
PL169633B1 (en) | 1992-09-15 | 1996-08-30 | Jaroslaw Deszczynski | Dynamical compensating stabilizer |
US5302874A (en) | 1992-09-25 | 1994-04-12 | Magnetic Bearing Technologies, Inc. | Magnetic bearing and method utilizing movable closed conductive loops |
US5624440A (en) | 1996-01-11 | 1997-04-29 | Huebner; Randall J. | Compact small bone fixator |
US5405347A (en) | 1993-02-12 | 1995-04-11 | Zimmer, Inc. | Adjustable connector for external fixation rods |
IT1262781B (en) | 1993-03-15 | 1996-07-04 | Giovanni Faccioli | TOOL AND METHOD FOR THE EXTERNAL REDUCTION OF FRACTURES |
US5415661A (en) | 1993-03-24 | 1995-05-16 | University Of Miami | Implantable spinal assist device |
GB2280608A (en) | 1993-08-05 | 1995-02-08 | Hi Shear Fasteners Europ Ltd | External bone fixator |
JP3683909B2 (en) | 1993-10-08 | 2005-08-17 | ロゴジンスキ,チェーム | Device for treating spinal conditions |
US7141073B2 (en) | 1993-11-01 | 2006-11-28 | Biomet, Inc. | Compliant fixation of external prosthesis |
GB9325698D0 (en) | 1993-12-15 | 1994-02-16 | Richardson James B | Patient-operated orthopedic device |
GB9403158D0 (en) | 1994-02-18 | 1994-04-06 | Draper Edward R C | Medical apparatus |
US5601553A (en) | 1994-10-03 | 1997-02-11 | Synthes (U.S.A.) | Locking plate and bone screw |
RU2085148C1 (en) | 1994-12-02 | 1997-07-27 | Научно-производственное внедренческое малое предприятие "Медилар" | Endoapparatus for restoring coxofemoral joint |
IT1271315B (en) | 1994-12-23 | 1997-05-27 | Medical High Tech Srl | CUSTOMIZABLE COMPUTERIZED SYSTEM FOR THE EXTERNAL FIXATION OF JOINTS TO A DEGREE OF HANDLING |
US5695496A (en) | 1995-01-17 | 1997-12-09 | Smith & Nephew Inc. | Method of measuring bone strain to detect fracture consolidation |
DE29501880U1 (en) | 1995-02-06 | 1995-05-24 | Leibinger Medizintech | Bone extension device |
US5662650A (en) | 1995-05-12 | 1997-09-02 | Electro-Biology, Inc. | Method and apparatus for external fixation of large bones |
IL114714A (en) | 1995-07-24 | 1998-12-27 | Hadasit Med Res Service | Orthopedic fixator |
US5976125A (en) | 1995-08-29 | 1999-11-02 | The Cleveland Clinic Foundation | External distractor/fixator for the management of fractures and dislocations of interphalangeal joints |
EP0863727B1 (en) | 1995-11-30 | 2001-01-17 | SYNTHES AG Chur | Bone-fixing device |
SE510125C2 (en) | 1996-01-22 | 1999-04-19 | Handevelop Ab | A prosthetic device |
FR2778085B1 (en) | 1998-04-30 | 2001-01-05 | Fred Zacouto | SKELETAL IMPLANT |
US6835207B2 (en) | 1996-07-22 | 2004-12-28 | Fred Zacouto | Skeletal implant |
IT1287564B1 (en) | 1996-09-04 | 1998-08-06 | Maurizio Carta | PROCEDURE FOR THE PRODUCTION OF VARIABLE THICKNESS PLATES FOR OSTEOSYNTHESIS. |
US6139550A (en) | 1997-02-11 | 2000-10-31 | Michelson; Gary K. | Skeletal plating system |
CA2445319C (en) | 1997-02-11 | 2006-01-10 | Gary Karlin Michelson | Anterior cervical plating system |
US6540707B1 (en) | 1997-03-24 | 2003-04-01 | Izex Technologies, Inc. | Orthoses |
US6280472B1 (en) | 1997-07-23 | 2001-08-28 | Arthrotek, Inc. | Apparatus and method for tibial fixation of soft tissue |
US5954722A (en) | 1997-07-29 | 1999-09-21 | Depuy Acromed, Inc. | Polyaxial locking plate |
US5984925A (en) | 1997-07-30 | 1999-11-16 | Cross Medical Products, Inc. | Longitudinally adjustable bone plates and method for use thereof |
US5928234A (en) | 1997-10-10 | 1999-07-27 | Manspeizer; Sheldon | External fixture for tracking motion of a joint |
US6045551A (en) | 1998-02-06 | 2000-04-04 | Bonutti; Peter M. | Bone suture |
US6221075B1 (en) | 1998-03-06 | 2001-04-24 | Bionx Implants Oy | Bioabsorbable, deformable fixation plate |
US5976136A (en) | 1998-05-11 | 1999-11-02 | Electro Biology, Inc. | Method and apparatus for external bone fixator |
CA2332542C (en) | 1998-05-19 | 2006-02-14 | Synthes (U.S.A.) | Clamp assembly for an external fixation system |
US6113637A (en) | 1998-10-22 | 2000-09-05 | Sofamor Danek Holdings, Inc. | Artificial intervertebral joint permitting translational and rotational motion |
DE19855254B4 (en) | 1998-11-30 | 2004-08-05 | Richard, Hans-Albert, Prof. Dr. | Device for the retention and protection of damaged bones |
FR2787992B1 (en) | 1999-01-04 | 2001-04-20 | Aesculap Sa | TIBIAL KNEE PROSTHESIS WITH DOUBLE INSERTED BALL JOINT |
US6162223A (en) | 1999-04-09 | 2000-12-19 | Smith & Nephew, Inc. | Dynamic wrist fixation apparatus for early joint motion in distal radius fractures |
US6315779B1 (en) | 1999-04-16 | 2001-11-13 | Sdgi Holdings, Inc. | Multi-axial bone anchor system |
AU754857B2 (en) | 1999-09-13 | 2002-11-28 | Synthes Gmbh | Bone plate system |
US6875235B2 (en) | 1999-10-08 | 2005-04-05 | Bret A. Ferree | Prosthetic joints with contained compressible resilient members |
US6530929B1 (en) | 1999-10-20 | 2003-03-11 | Sdgi Holdings, Inc. | Instruments for stabilization of bony structures |
US6277124B1 (en) | 1999-10-27 | 2001-08-21 | Synthes (Usa) | Method and apparatus for ratcheting adjustment of bone segments |
JP4278018B2 (en) | 1999-11-19 | 2009-06-10 | 直秀 富田 | Knee joint unloading device |
AU778410B2 (en) | 1999-12-01 | 2004-12-02 | Henry Graf | Intervertebral stabilising device |
US6527733B1 (en) | 2000-02-22 | 2003-03-04 | Dj Orthopedics, Llc | Hinge assembly for an orthopedic knee brace and knee brace incorporating the hinge assembly |
US6893462B2 (en) | 2000-01-11 | 2005-05-17 | Regeneration Technologies, Inc. | Soft and calcified tissue implants |
US7776068B2 (en) | 2003-10-23 | 2010-08-17 | Trans1 Inc. | Spinal motion preservation assemblies |
US6540708B1 (en) | 2000-02-18 | 2003-04-01 | Sheldon Manspeizer | Polycentric joint for internal and external knee brace |
US6402750B1 (en) | 2000-04-04 | 2002-06-11 | Spinlabs, Llc | Devices and methods for the treatment of spinal disorders |
US6592622B1 (en) | 2000-10-24 | 2003-07-15 | Depuy Orthopaedics, Inc. | Apparatus and method for securing soft tissue to an artificial prosthesis |
US6692498B1 (en) | 2000-11-27 | 2004-02-17 | Linvatec Corporation | Bioabsorbable, osteopromoting fixation plate |
US6663631B2 (en) | 2000-12-01 | 2003-12-16 | Charles A. Kuntz | Method and device to correct instability of hinge joints |
US6494914B2 (en) | 2000-12-05 | 2002-12-17 | Biomet, Inc. | Unicondylar femoral prosthesis and instruments |
US6355037B1 (en) | 2000-12-05 | 2002-03-12 | Smith & Nephew, Inc. | Apparatus and method of external skeletal support allowing for internal-external rotation |
US6752831B2 (en) | 2000-12-08 | 2004-06-22 | Osteotech, Inc. | Biocompatible osteogenic band for repair of spinal disorders |
US6599322B1 (en) | 2001-01-25 | 2003-07-29 | Tecomet, Inc. | Method for producing undercut micro recesses in a surface, a surgical implant made thereby, and method for fixing an implant to bone |
US6620332B2 (en) | 2001-01-25 | 2003-09-16 | Tecomet, Inc. | Method for making a mesh-and-plate surgical implant |
US7018418B2 (en) | 2001-01-25 | 2006-03-28 | Tecomet, Inc. | Textured surface having undercut micro recesses in a surface |
US6673113B2 (en) | 2001-10-18 | 2004-01-06 | Spinecore, Inc. | Intervertebral spacer device having arch shaped spring elements |
GB0107708D0 (en) | 2001-03-28 | 2001-05-16 | Imp College Innovations Ltd | Bone fixated,articulated joint load control device |
FR2823096B1 (en) | 2001-04-06 | 2004-03-19 | Materiel Orthopedique En Abreg | PLATE FOR LTE AND LTE VERTEBRATE OSTEOSYNTHESIS DEVICE, OSTEOSYNTHESIS DEVICE INCLUDING SUCH A PLATE, AND INSTRUMENT FOR LAYING SUCH A PLATE |
US6699252B2 (en) * | 2001-04-17 | 2004-03-02 | Regeneration Technologies, Inc. | Methods and instruments for improved meniscus transplantation |
US6972020B1 (en) | 2001-06-01 | 2005-12-06 | New York University | Multi-directional internal distraction osteogenesis device |
AU2002322028C1 (en) | 2001-06-04 | 2008-06-26 | Warsaw Orthopedic, Inc. | Anterior cervical plate system having vertebral body engaging anchors, connecting plate, and method for installation thereof |
US6890335B2 (en) | 2001-08-24 | 2005-05-10 | Zimmer Spine, Inc. | Bone fixation device |
FR2829920B1 (en) | 2001-09-26 | 2004-05-28 | Newdeal Sa | PLATE FOR FIXING THE BONES OF A JOINT, PARTICULARLY A METATARSO-PHALANGIAN JOINT |
US7235077B1 (en) | 2001-11-09 | 2007-06-26 | Board Of Regents Of The University And Community College System Of Nevada On Behalf Of The University Of Nevada, Reno | Bone fixation device and method |
US6572653B1 (en) | 2001-12-07 | 2003-06-03 | Rush E. Simonson | Vertebral implant adapted for posterior insertion |
US7238203B2 (en) | 2001-12-12 | 2007-07-03 | Vita Special Purpose Corporation | Bioactive spinal implants and method of manufacture thereof |
RU2217105C2 (en) | 2002-01-21 | 2003-11-27 | Федеральное государственное унитарное предприятие "Красноярский машиностроительный завод" | Endoapparatus for repairing hip joint |
US7322983B2 (en) | 2002-02-12 | 2008-01-29 | Ebi, L.P. | Self-locking bone screw and implant |
US6966910B2 (en) | 2002-04-05 | 2005-11-22 | Stephen Ritland | Dynamic fixation device and method of use |
US7235102B2 (en) | 2002-05-10 | 2007-06-26 | Ferree Bret A | Prosthetic components with contained compressible resilient members |
EP1539058A4 (en) | 2002-06-28 | 2014-06-25 | Generation Ii Usa Inc | Anatomically designed orthopedic knee brace |
DE10237373A1 (en) | 2002-08-12 | 2004-03-04 | Marc Franke | Artificial joint |
US20060064169A1 (en) | 2002-09-10 | 2006-03-23 | Ferree Bret A | Shock-absorbing joint and spine replacements |
RU2241400C2 (en) | 2002-09-23 | 2004-12-10 | Малахов Олег Алексеевич | Device for carrying hip joint decompression |
WO2004039236A2 (en) | 2002-10-28 | 2004-05-13 | Blackstone Medical, Inc. | Bone plate assembly provided with screw locking mechanisms |
AU2003295749B2 (en) | 2002-11-19 | 2007-12-06 | Acumed Llc | Adjustable bone plates |
DE20300987U1 (en) | 2003-01-23 | 2003-04-10 | Stryker Trauma Gmbh | Implant for osteosynthesis |
US7241298B2 (en) | 2003-01-31 | 2007-07-10 | Howmedica Osteonics Corp. | Universal alignment guide |
US7722653B2 (en) | 2003-03-26 | 2010-05-25 | Greatbatch Medical S.A. | Locking bone plate |
BRPI0410697A (en) | 2003-05-02 | 2006-06-20 | Univ Yale | dynamic spine stabilizer and method |
DE10326643A1 (en) | 2003-06-11 | 2004-12-30 | Mückter, Helmut, Dr. med. Dipl.-Ing. | Osteosynthesis plate or comparable implant with ball sleeve |
US20040260302A1 (en) | 2003-06-19 | 2004-12-23 | Sheldon Manspeizer | Internal brace for distraction arthroplasty |
US20040267179A1 (en) | 2003-06-30 | 2004-12-30 | Max Lerman | Knee unloading orthotic device and method |
US7153325B2 (en) | 2003-08-01 | 2006-12-26 | Ultra-Kinetics, Inc. | Prosthetic intervertebral disc and methods for using the same |
DE50308440D1 (en) | 2003-09-08 | 2007-11-29 | Synthes Gmbh | DEVICE FOR BONE FIXATION |
US7306605B2 (en) | 2003-10-02 | 2007-12-11 | Zimmer Spine, Inc. | Anterior cervical plate |
DE10348329B3 (en) | 2003-10-17 | 2005-02-17 | Biedermann Motech Gmbh | Rod-shaped element used in spinal column and accident surgery for connecting two bone-anchoring elements comprises a rigid section and an elastic section that are made in one piece |
EP1673048B1 (en) | 2003-10-17 | 2013-06-19 | Biedermann Technologies GmbH & Co. KG | Flexible implant |
US7285134B2 (en) | 2003-10-22 | 2007-10-23 | Warsaw Orthopedic, Inc. | Vertebral body replacement implant |
US8632570B2 (en) | 2003-11-07 | 2014-01-21 | Biedermann Technologies Gmbh & Co. Kg | Stabilization device for bones comprising a spring element and manufacturing method for said spring element |
US7297146B2 (en) | 2004-01-30 | 2007-11-20 | Warsaw Orthopedic, Inc. | Orthopedic distraction implants and techniques |
US7282065B2 (en) | 2004-04-09 | 2007-10-16 | X-Spine Systems, Inc. | Disk augmentation system and method |
US7288095B2 (en) | 2004-08-12 | 2007-10-30 | Atlas Spine, Inc. | Bone plate with screw lock |
US8162985B2 (en) | 2004-10-20 | 2012-04-24 | The Board Of Trustees Of The Leland Stanford Junior University | Systems and methods for posterior dynamic stabilization of the spine |
US8025680B2 (en) | 2004-10-20 | 2011-09-27 | Exactech, Inc. | Systems and methods for posterior dynamic stabilization of the spine |
AU2005302633A1 (en) | 2004-10-28 | 2006-05-11 | Axial Biotech, Inc. | Apparatus and method for concave scoliosis expansion |
US8062296B2 (en) | 2005-03-17 | 2011-11-22 | Depuy Products, Inc. | Modular fracture fixation plate system with multiple metaphyseal and diaphyseal plates |
US8029540B2 (en) | 2005-05-10 | 2011-10-04 | Kyphon Sarl | Inter-cervical facet implant with implantation tool |
US7322984B2 (en) | 2005-01-06 | 2008-01-29 | Spinal, Llc | Spinal plate with internal screw locks |
US8083797B2 (en) | 2005-02-04 | 2011-12-27 | Spinalmotion, Inc. | Intervertebral prosthetic disc with shock absorption |
US8317797B2 (en) * | 2005-02-08 | 2012-11-27 | Rasmussen G Lynn | Arthroplasty systems and methods for optimally aligning and tensioning a knee prosthesis |
US7361196B2 (en) | 2005-02-22 | 2008-04-22 | Stryker Spine | Apparatus and method for dynamic vertebral stabilization |
DE502006006702D1 (en) | 2005-03-24 | 2010-05-27 | Medartis Ag | BONE PLATE |
US20060241608A1 (en) | 2005-03-31 | 2006-10-26 | Mark Myerson | Plate for fusion of the metatarso-phalangeal joint |
JP5345839B2 (en) | 2005-04-08 | 2013-11-20 | パラダイム・スパイン・リミテッド・ライアビリティ・カンパニー | Interspinous vertebrae and lumbosacral stabilization device and method of use |
BRPI0610995A2 (en) | 2005-05-02 | 2010-08-10 | Kinetic Spine Technologies Inc | spinal stabilization implant and implant kit |
US7288094B2 (en) | 2005-06-10 | 2007-10-30 | Sdgi Holdings, Inc. | System and method for retaining screws relative to a vertebral plate |
NO326166B1 (en) | 2005-07-18 | 2008-10-13 | Siem Wis As | Pressure accumulator to establish the necessary power to operate and operate external equipment, as well as the application thereof |
US7811309B2 (en) | 2005-07-26 | 2010-10-12 | Applied Spine Technologies, Inc. | Dynamic spine stabilization device with travel-limiting functionality |
CN101389562B (en) | 2005-09-06 | 2011-07-20 | 荷兰格斯特公司 | Cranes |
WO2007030003A1 (en) | 2005-09-09 | 2007-03-15 | Stichting Astron | Modular antenna and a system and method for detecting objects |
US7905909B2 (en) | 2005-09-19 | 2011-03-15 | Depuy Products, Inc. | Bone stabilization system including multi-directional threaded fixation element |
AU2006294772B2 (en) | 2005-09-27 | 2013-10-10 | Paradigm Spine, Llc. | Interspinous vertebral stabilization devices |
EP1770302A1 (en) | 2005-09-30 | 2007-04-04 | Acandis GmbH & Co. KG | Damping method and device |
CA2621477C (en) | 2005-10-10 | 2014-06-03 | Donna Jean Carver | Artificial spinal disc replacement system and method |
US8403985B2 (en) | 2005-11-02 | 2013-03-26 | Zimmer, Inc. | Joint spacer implant |
US20070102724A1 (en) | 2005-11-10 | 2007-05-10 | Matrix Semiconductor, Inc. | Vertical diode doped with antimony to avoid or limit dopant diffusion |
JP2009525060A (en) | 2005-12-06 | 2009-07-09 | グローバス メディカル インコーポレイティッド | Intervertebral joint prosthesis |
JP4591968B2 (en) | 2005-12-21 | 2010-12-01 | 国立大学法人 新潟大学 | Hip joint loader |
JP4439465B2 (en) | 2005-12-21 | 2010-03-24 | 国立大学法人 新潟大学 | Joint-free device inspection device |
JP2007170969A (en) | 2005-12-21 | 2007-07-05 | Niigata Univ | Apparatus for testing joint weight bearing device |
US7682376B2 (en) | 2006-01-27 | 2010-03-23 | Warsaw Orthopedic, Inc. | Interspinous devices and methods of use |
US7815663B2 (en) | 2006-01-27 | 2010-10-19 | Warsaw Orthopedic, Inc. | Vertebral rods and methods of use |
US7578849B2 (en) | 2006-01-27 | 2009-08-25 | Warsaw Orthopedic, Inc. | Intervertebral implants and methods of use |
US8323290B2 (en) | 2006-03-03 | 2012-12-04 | Biomet Manufacturing Corp. | Tensor for use in surgical navigation |
BRPI0601069B1 (en) | 2006-03-17 | 2014-10-14 | Gm Dos Reis Ind E Com Ltda | BONE BOARD |
WO2007108438A1 (en) | 2006-03-20 | 2007-09-27 | Rohto Pharmaceutical Co., Ltd. | External composition for promoting of glutathione production and relevant method |
WO2007108962A2 (en) | 2006-03-21 | 2007-09-27 | Nordic Information Security Group Inc. | Method for automatic encryption and decryption of electronic communication |
SE531934C2 (en) | 2006-04-04 | 2009-09-08 | Gs Dev Ab | Prosthesis device for joints |
US8048134B2 (en) | 2006-04-06 | 2011-11-01 | Andrew K. Palmer | Active compression to facilitate healing of bones |
US20070270849A1 (en) | 2006-04-21 | 2007-11-22 | Orbay Jorge L | Fixation Plate With Multifunctional Holes |
US20070288014A1 (en) | 2006-06-06 | 2007-12-13 | Shadduck John H | Spine treatment devices and methods |
US20080015592A1 (en) | 2006-06-28 | 2008-01-17 | Depuy Products, Inc. | CAM/compression lock plate |
US7927356B2 (en) | 2006-07-07 | 2011-04-19 | Warsaw Orthopedic, Inc. | Dynamic constructs for spinal stabilization |
BRPI0713478A2 (en) | 2006-07-07 | 2012-10-23 | Silica Tech Llc | plasma deposition apparatus for making polycrystalline silicon, and method for forming a polycrystalline silicon layer on a target substrate in a deposition chamber. |
US20080015591A1 (en) | 2006-07-13 | 2008-01-17 | Castaneda Javier E | Threaded Guide for an Orthopedic Fixation Plate |
US20080154378A1 (en) | 2006-12-22 | 2008-06-26 | Warsaw Orthopedic, Inc. | Bone implant having engineered surfaces |
US20110245928A1 (en) | 2010-04-06 | 2011-10-06 | Moximed, Inc. | Femoral and Tibial Bases |
US20080275567A1 (en) | 2007-05-01 | 2008-11-06 | Exploramed Nc4, Inc. | Extra-Articular Implantable Mechanical Energy Absorbing Systems |
US8425616B2 (en) * | 2007-07-09 | 2013-04-23 | Moximed, Inc. | Surgical implantation method and devices for an extra-articular mechanical energy absorbing apparatus |
US11690724B2 (en) | 2019-10-31 | 2023-07-04 | Beijing Ak Medical Co., Ltd | Metal-ceramic composite joint prosthesis and applications and manufacturing method thereof |
-
2010
- 2010-04-06 US US12/755,335 patent/US20110245928A1/en not_active Abandoned
-
2011
- 2011-02-04 EP EP11766294.0A patent/EP2555713A4/en not_active Withdrawn
- 2011-02-04 CA CA2793606A patent/CA2793606A1/en not_active Abandoned
- 2011-02-04 AU AU2011238861A patent/AU2011238861A1/en not_active Abandoned
- 2011-02-04 WO PCT/US2011/022340 patent/WO2011126590A2/en active Application Filing
- 2011-02-04 JP JP2013503749A patent/JP2013523319A/en not_active Withdrawn
-
2012
- 2012-01-23 US US13/356,271 patent/US20120123551A1/en not_active Abandoned
-
2014
- 2014-02-18 US US14/183,047 patent/US9398957B2/en active Active
Patent Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20080275560A1 (en) * | 2007-05-01 | 2008-11-06 | Exploramed Nc4, Inc. | Femoral and tibial base components |
US20090275947A1 (en) * | 2008-05-02 | 2009-11-05 | Thomas James Graham | Bone plate system for bone restoration and methods of use thereof |
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US9668868B2 (en) | 2009-08-27 | 2017-06-06 | Cotera, Inc. | Apparatus and methods for treatment of patellofemoral conditions |
US8597362B2 (en) | 2009-08-27 | 2013-12-03 | Cotera, Inc. | Method and apparatus for force redistribution in articular joints |
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US20140156005A1 (en) * | 2009-08-27 | 2014-06-05 | Cotera, Inc. | Method and Apparatus for Altering Biomechanics of the Articular Joints |
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US9795410B2 (en) | 2009-08-27 | 2017-10-24 | Cotera, Inc. | Method and apparatus for force redistribution in articular joints |
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WO2013105906A1 (en) * | 2012-01-13 | 2013-07-18 | Sunton Wongsiri | A bone and joint fixing system |
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US20130289732A1 (en) * | 2012-04-30 | 2013-10-31 | William B. Kurtz | Total Knee Arthroplasty System and Method |
US20130325122A1 (en) * | 2012-06-04 | 2013-12-05 | Moximed, Inc. | Low contact femoral and tibial bases |
US9468466B1 (en) | 2012-08-24 | 2016-10-18 | Cotera, Inc. | Method and apparatus for altering biomechanics of the spine |
US10898237B2 (en) | 2012-08-24 | 2021-01-26 | The Foundry, Llc | Method and apparatus for altering biomechanics of the spine |
EP2967877A4 (en) * | 2013-03-11 | 2017-03-15 | Embark Enterprises, Inc. | Quadruped stifle stabilization system |
US9282996B2 (en) * | 2013-03-13 | 2016-03-15 | Moximed, Inc. | Extra-articular implantable mechanical energy absorbing assemblies |
WO2015117239A1 (en) * | 2014-02-04 | 2015-08-13 | Pega Medical, Inc. | Systems and methods for correcting a rotational bone deformity |
US11241256B2 (en) | 2015-10-15 | 2022-02-08 | The Foundry, Llc | Method and apparatus for altering biomechanics of the shoulder |
Also Published As
Publication number | Publication date |
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EP2555713A2 (en) | 2013-02-13 |
CA2793606A1 (en) | 2011-10-13 |
EP2555713A4 (en) | 2015-12-09 |
WO2011126590A3 (en) | 2011-12-01 |
US9398957B2 (en) | 2016-07-26 |
JP2013523319A (en) | 2013-06-17 |
US20120123551A1 (en) | 2012-05-17 |
AU2011238861A1 (en) | 2012-10-04 |
WO2011126590A2 (en) | 2011-10-13 |
US20140188234A1 (en) | 2014-07-03 |
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