US20220104948A1 - Arthroplasty systems and methods - Google Patents

Abstract

Systems for joint arthroplasty include prostheses which are secured to bone with sliding anchors. Examples include unicondylar and bicondylar knee prostheses for hemi-arthroplasty and total arthroplasty. Instruments guide the anchors into proper engagement with the prosthetic components. Methods of using the prostheses and instruments are disclosed.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application is a continuation of U.S. patent application Ser. No. 16/502,015 filed on Jul. 2, 2019 which issued on Dec. 14, 2021 as U.S. Pat. No. 11,197,763, entitled ARTHROPLASTY SYSTEMS AND METHODS, which is a continuation of U.S. patent application Ser. No. 15/892,005, filed Feb. 8, 2018, which issued on Jul. 9, 2019 as U.S. Pat. No. 10,342,667, entitled ARTHROPLASTY SYSTEMS AND METHODS.
• U.S. patent application Ser. No. 15/892,005 is a continuation of:
• U.S. patent application Ser. No. 13/328,592, filed Dec. 16, 2011, entitled ARTHROPLASTY SYSTEMS AND METHODS, Attorney's docket no. BAE-6, which issued as U.S. Pat. No. 9,925,051 on Mar. 27, 2018.
• U.S. patent application Ser. No. 13/328,592 claims the benefit of:
• U.S. Provisional Patent Application No. 61/423,827, filed Dec. 16, 2010, entitled TIBIAL TRAY FIXATION, Attorney's docket no. BAE-6 PROV, which is expired;
• U.S. Provisional Patent Application No. 61/442,464, filed Feb. 14, 2011, entitled SYSTEM AND METHOD FOR TIBIAL TRAY FIXATION, Attorney's docket no. BAE-7 PROV, which is expired; and
• U.S. Provisional Patent Application No. 61/450,753, filed Mar. 9, 2011, entitled FEMORAL AND HEMI-ARTHROPLASTY FIXATION USING ANCHOR TECHNOLOGY, Attorney's docket no. BAE-9 PROV, which is expired.
• The above referenced documents are hereby incorporated by reference in their entirety.
BACKGROUND OF THE INVENTION
• This disclosure relates to systems and methods for joint resurfacing, replacement, and the like. While the examples in the present disclosure relate to the knee joint, the systems and methods are applicable to other synovial joints in the body.
• Arthroplasty procedures seek to replace a natural joint that has deteriorated in its functionality, range of motion, weight bearing, and most, if not all, other performance and lifestyle attributes. Joint resurfacing typically involves removal of at least a portion of a natural articular surface of a bone in order to replace the removed tissue with a prosthesis having an articular surface that replicates at least the removed portion of the natural articular surface. Joint replacement may involve more extensive bone removal and subsequent replacement with a more substantial prosthesis. In this disclosure, remarks about resurfacing are to be considered equally relevant to replacement, and vice versa.
• Arthroplasty procedures may involve one or more articular surfaces of a joint. In the knee, for example, the medial femoral condyle, the lateral femoral condyle, the medial tibial condyle, the lateral tibial condyle, the trochlear groove, and/or the patella may be resurfaced or replaced. A procedure may be described as unicondylar if one condyle of the joint is treated, such as the medial tibial condyle. Bicondylar procedures may treat two condyles of a bone, such as the medial and lateral tibial condyles. A procedure may be described as unicompartmental if one compartment of the joint is treated, such as the medial compartment of the knee. Bicompartmental procedures may treat two compartments, such as the medial and lateral compartments of the knee. A procedure may be described as a total joint procedure if most or all opposing articular surfaces of the joint are resurfaced or replaced. A procedure may be described as a hemiarthroplasty procedure if the prosthetic component articulates against an opposing natural articular surface, such as the prosthetic medial tibial component articulating against the natural medial femoral condyle.
BRIEF DESCRIPTION OF THE DRAWINGS
• Various examples of the present technology will now be discussed with reference to the appended drawings. It is appreciated that these drawings depict only typical examples of the invention and are therefore not to be considered limiting of its scope.
• FIG. 1 is a bottom perspective view of a knee tibial prosthesis with a bicondylar tibial component and fixation elements;
• FIG. 2A is a top view of one of the fixation elements ofFIG. 1; andFIG. 2B is a side view of the fixation element ofFIG. 2A;
• FIG. 3A is a bottom view of the tibial component ofFIG. 1; andFIG. 3B is a top view of the tibial component ofFIG. 1;
• FIG. 4 is a bottom detail view of a portion of the knee tibial prosthesis ofFIG. 1;
• FIG. 5A is a bottom perspective view of another knee tibial prosthesis with a bicondylar tibial component and fixation elements; andFIG. 5B is a front oblique view of the knee tibial prosthesis ofFIG. 5A;
• FIG. 6A is a top view of one of the fixation elements ofFIG. 5A; andFIG. 6B is a side view of the fixation element ofFIG. 6A;
• FIG. 7 is a bottom view of the tibial component ofFIG. 5A;
• FIG. 8A is a bottom detail view of a portion of the knee tibial prosthesis ofFIG. 5A; andFIG. 8B is a bottom perspective detail view of the portion of the knee tibial prosthesis ofFIG. 5A;
• FIG. 9A is a top perspective view of the tibial component ofFIG. 1 engaged with a fixation element guide instrument, a portion of the instrument not shown; andFIG. 9B is a bottom perspective view of the tibial component and instrument ofFIG. 9A engaged with the fixation elements ofFIG. 1, a portion of the instrument not shown;
• FIG. 10 is a bottom perspective view of yet another knee tibial prosthesis with a unicondylar tibial component and a fixation element;
• FIG. 11A is a side perspective view of the fixation element ofFIG. 10; andFIG. 11B is a top view of the fixation element ofFIG. 10;
• FIG. 12A is a bottom perspective view of the tibial component ofFIG. 10; andFIG. 12B is a top perspective view of the tibial component ofFIG. 10;
• FIG. 13A is a top perspective view of the tibial component ofFIG. 10 engaged with a fixation element guide instrument; andFIG. 13B is a bottom perspective view of the tibial component and instrument ofFIG. 13A engaged with the fixation element ofFIG. 10;
• FIG. 14 is a side view of a knee femoral prosthesis with a bicondylar femoral component and fixation elements;
• FIG. 15 is a top view of another knee femoral prosthesis with a bicondylar femoral component and fixation elements;
• FIG. 16A is a side view of yet another knee femoral prosthesis with a unicondylar femoral component and a fixation element; andFIG. 16B is a front cross section view of the knee femoral prosthesis ofFIG. 16A sectioned alongline16B-16B ofFIG. 16A; and
• FIG. 17A is a front view of another knee tibial prosthesis with a unicondylar hemiarthroplasty tibial component and a fixation element; andFIG. 17B is a bottom view of the knee tibial prosthesis ofFIG. 17A.
DETAILED DESCRIPTION
• In this specification, standard medical directional terms are employed with their ordinary and customary meanings. Superior means toward the head. Inferior means away from the head. Anterior means toward the front. Posterior means toward the back. Medial means toward the midline, or plane of bilateral symmetry, of the body. Lateral means away from the midline of the body. Proximal means toward the trunk of the body. Distal means away from the trunk.
• In this specification, a standard system of three mutually perpendicular reference planes is employed. A sagittal plane divides a body into bilaterally symmetric right and left portions. A coronal plane divides a body into anterior and posterior portions. A transverse plane divides a body into superior and inferior portions.
• In this specification, standard knee anatomical terms are employed with their ordinary and customary meanings.
• An example of a joint arthroplasty system includes a prosthetic articular surface which replaces at least a portion of a natural articular surface of a bone and a prosthetic component including a bone-contacting surface. The bone-contacting surface includes at least one undercut channel extending across at least a portion of the bone-contacting surface and through a perimeter edge of the bone-contacting surface. The system also includes an anchor with a rail, a blade, and a support. The rail has at least one lateral protrusion. The blade is offset from the rail. The support connects the rail and the blade. The rail is insertable into the channel to connect the anchor to the prosthetic component. When the rail is inserted into the channel, the lateral protrusion plastically deforms, the support protrudes through the bone-contacting surface, and the blade is carried at a distance from the bone-contacting surface.
• In other examples of this system, the prosthetic component may be selected from the group consisting of a knee tibial component, a knee femoral component, and a knee patellar component. The prosthetic articular surface may be opposite the bone-contacting surface. A transverse cross section of the channel and a transverse cross section of the rail may be complementary negative and positive shapes, respectively. The blade may be inclined at an acute angle relative to the bone-contacting surface when the rail is in the channel. A leading end of the anchor may include oblique sharpened edges. The channel may include at least one shoulder formed in an edge of the channel, wherein the shoulder deforms the lateral protrusion when the rail is inserted into the channel.
• Another example of a knee arthroplasty system includes a prosthetic articular surface which replaces at least a portion of a natural articular surface of a knee joint and a bone-contacting surface. The bone-contacting surface includes at least one undercut channel extending across at least a portion of the bone-contacting surface and through a perimeter edge of the bone-contacting surface. The system also includes an anchor with a rail, a blade, and a support. The blade is offset from the rail. The support connects the rail and the blade. The rail is insertable into the channel to connect the anchor to the prosthetic component. When the rail is inserted into the channel, the support protrudes through the bone-contacting surface, and the blade is carried at a distance from the bone-contacting surface.
• In other examples of this system, the articular and bone-contacting surfaces may be carried by a prosthesis selected from the group consisting of a knee tibial prosthesis, a knee femoral prosthesis, and a knee patellar prosthesis. The prosthesis may be selected from the group consisting of a unicondylar prosthesis and a bicondylar prosthesis. A transverse cross section of the channel and a transverse cross section of the rail may be complementary negative and positive dovetail shapes, respectively. The blade may be inclined at an acute angle relative to the bone-contacting surface when the rail is in the channel. A leading end of the anchor may include oblique sharpened edges. When the rail is inserted into the channel, the rail may seize in the channel.
• An example of a method of preparing a joint arthroplasty prosthesis for replacing at least a portion of a natural articular surface of a synovial joint includes providing a prosthesis with a bone-contacting surface and an articular surface, the bone-contacting surface including at least one undercut channel extending across at least a portion of the bone-contacting surface and through a perimeter edge of the bone-contacting surface, the articular surface replicating at least a portion of a natural articular surface of a synovial joint; providing an anchor including a rail, a blade, and a support, the rail including at least one laterally protruding tab, the blade offset from the rail, the support connecting the rail and the blade; sliding the rail into the channel, wherein the tab plastically deforms as the rail slides into the channel; and sliding a portion of the support into the channel, the support protruding through the bone-contacting surface, wherein a portion of the bone-contacting surface is spaced between the blade and the rail when the rail and the support are in the channel.
• In other examples of this method, sliding the rail into the channel may be performed before sliding the portion of the support into the channel. Sliding the rail into the channel may include sliding the tab past a shoulder formed in an edge of the channel. The shoulder may deform the tab. The blade may be inclined at an acute angle relative to the bone-contacting surface when the rail is in the channel. The acute angle may open toward a leading end of the anchor. The method may also include providing a guide tool including an attachment portion and a guidance portion. The attachment portion may be releasably attachable to a portion of the prosthesis. The guidance portion may include at least one track. The method may also include attaching the attachment portion to the prosthesis. The track may coaxially align with the channel when the attachment portion is attached to the prosthesis. The method may also include inserting the rail into the track and sliding the anchor toward the prosthesis. Attaching the attachment portion to the prosthesis may include attaching a clip to the attachment portion and snapping the clip to the prosthesis.
• Another example of a method of replacing at least a portion of a natural articular surface of a synovial joint includes forming a resection surface on a bone of the synovial joint to remove at least a portion of the natural articular surface of the bone; positioning a bone-contacting surface of a prosthesis against the resection surface; positioning an articular surface of the prosthesis to replace the removed natural articular surface; and installing an anchor to fix the prosthesis to the bone. Installing the anchor includes sliding a rail of the anchor into an undercut channel of the prosthesis, the channel extending through a perimeter edge of the bone-contacting surface and across at least a portion of the bone-contacting surface, wherein a laterally protruding tab of the rail plastically deforms as the rail slides into the channel; sliding a blade of the anchor into the bone, wherein portions of the bone-contacting surface and the resection surface become situated between the blade and the rail portion as the blade slides into the bone; and sliding a support of the anchor into the channel and the bone, the support connecting the blade to the rail.
• In other examples of this method, sliding the rail into the channel may be performed before sliding the blade into the bone, which may be performed before sliding the support into the channel and the bone. Sliding the rail into the channel may include sliding the tab past a shoulder formed in an edge of the channel, wherein the shoulder deforms the tab. The blade may be inclined at an acute angle relative to the bone-contacting surface when the rail is in the channel, wherein the acute angle opens toward a leading end of the anchor. The method may also include providing a guide tool including an attachment portion and a guidance portion, the attachment portion releasably attachable to a portion of the prosthesis, the guidance portion including at least one track; attaching the attachment portion to the prosthesis, wherein the track coaxially aligns with the channel when the attachment portion is attached to the prosthesis; inserting the rail into the track; and sliding the anchor toward the prosthesis. Attaching the attachment portion to the prosthesis may include attaching a clip to the attachment portion and snapping the clip to the prosthesis.
• This disclosure relates to systems and methods for joint resurfacing, replacement, and the like. This disclosure sets forth examples of joint prostheses with adjunctive fixation elements, or anchors. The anchors may contribute to initial and/or long term fixation of a prosthetic component to bone. The fixation elements may provide fixation alone, or in combination with other fixation means, such as bone cement or biological fixation to porous coating, to name just two examples. Each fixation element may be inserted into a complementary slot in the prosthetic component so that the fixation element protrudes from the prosthetic component into the adjacent bone. The fixation elements may be used in lieu of bone screws for component fixation.
• Referring toFIG. 1, a kneetibial prosthesis10 includes atibial component50 and at least onefixation element20. Thetibial component50 may be referred to as atibial tray50. Thetibial prosthesis10 ofFIG. 1 includes twofixation elements20, which may also be referred to as anchors20. Theanchors20 may be inserted from ananterior edge54 of thetibial tray50 and may be oriented roughly anterior-posterior, as shown. Theanchors20 may be parallel or angled relative to one another and/or thetray50. For example, theanchors20 ofFIG. 1 are angled relative to one another, with the anchors closest together at theanterior edge54 of thetibial tray50. The anchors may also be tilted with respect to thetray50, for example, tilted laterally. Theanchors20 are inserted inchannels52 in thetibial tray50. The channels may be dovetailed as shown; other undercut channel geometries are contemplated, such as T-slots. Thechannels52 ofFIG. 1 extend between anterior andposterior edges54,66 of thetray50. In some embodiments, the channels may only open at one of the anterior andposterior edges54,66, and may terminate in the main body of thetray50. In other examples, thechannels52 may be oriented exactly anterior-posterior, exactly medial-lateral, roughly medial-lateral, or in another orientation. Achannel52 may open through any perimeter edge of a bone-contactingside56 of thetray50.
• The anchors in the present disclosure may share some or all of the features of the anchors disclosed in U.S. patent application Ser. No. 12/640,892 to Bae, et al., which is incorporated by reference herein in its entirety.
• Referring toFIGS. 2A and 2B, each fixation element oranchor20 comprises ablade22 and arail24. The blade and rail extend between aleading end70 and a trailingend68 of the anchor. The leadingend70 may also be referred to as adistal end70; the trailingend68 may also be referred to as aproximal end68.Supports26 connect theblade22 to therail24.FIGS. 2A and 2B illustrate ananchor20 with threesupports26, although other examples may include any number of supports. The supports26 defineapertures27 through theanchor20. In use, theblade22 and at least a portion of thesupports26 may be inserted into bone. Theblade22 may be pointed, sharpened, and/or serrated, for ease of insertion into bone. The supports26 may also be sharpened and/or obliquely profiled for ease of insertion into bone. The blade edges may be beveled. Theblade22 may be pierced by one ormore apertures36. Longitudinal edges28 of the rail may be sized and shaped for complementary engagement with thedovetail channels52 of thetray50. In other examples, the rail may be of a complementary size and shape to engage another undercut channel geometry.
• There may be asmall tab30 projecting from therail24. The tab may be said to protrude laterally or transversely from therail24. The tab deforms as the anchor is driven into thetibial tray50, creating an interference fit. This material deformation serves to take up any relative motion between the anchor and the tibial tray as well as to lock theanchor20 into thetray50. The deformation may be characterized as plastic deformation, which may be at least partially irreversible. The deformation may cause galling, spot welding, and/or seizing to occur between the tab and thechannel52. Any of these adhesive phenomena may lock the anchor to the tray. There may be aphysical stop32 on the anchor to prevent over-insertion. Adistal tip34 of the anchor rail may be tapered for ease of insertion into, and movement along, thechannels52. InFIGS. 2A and 2B,tabs30 are located on each side of the rail near theproximal end68 andphysical stops32 are immediately proximal to eachinterference tab30. Another example may include atab30 on only one side of the rail. Other examples may includemultiple interference tabs30 along the length of therail24. This arrangement may provide even greater fixation along the length of the anchor in thechannel52. Also, in other embodiments the length, height, or other dimensions of the anchor may vary.
• To achieve optimal compression between the bone and the tibial tray, theanchor blade22 may be angled divergent from therail24. At the leading,distal end70 of theanchor20, theblade22 and therail24 may be farther apart than they are at the trailing,proximal end68 of the anchor. Thedivergence angle72 may be less than about 90 degrees. In some examples, the divergence angle may be less than about 15 degrees, less than about 5 degrees, or less than about 2 degrees. In the embodiment shown, the divergence angle between theblade22 and therail24 is 1 degree. Divergence angles of less than 1 degree are also contemplated.
• When theanchor rail24 is inserted into thechannel52 of thetibial tray50, theanchor blade22 may diverge from an inferior or bone-contactingside56 of thetray50 at thesame angle72. Alternatively, theblade22 may diverge from the inferior or bone-contacting side of thetray50 at another angle, which may be greater than or less than the blade-to-rail divergence angle72. Furthermore, the blade-to-tray divergence angle may open in the same or opposite direction as the blade-to-rail divergence angle72.
• Theangle72 between theblade22 and therail24, and/or the angle between the blade and the bone-contactingside56 may correlate to the mechanical properties of the bone into which theanchor20 will be inserted, the desired amount of compression between the bone and the bone-contacting side, the compliance of the bone-contacting side, and/or other factors. For example, larger divergence angles may be appropriate for conditions such as: softer bone, greater compression, and/or a compliant bone-contacting side; smaller divergence angles may be appropriate for conditions such as harder or stiffer bone, less compression, and/or an unyielding bone-contacting side. The divergence angle may also correlate to the length of theanchor20, with greater divergence angles possible with shorter anchors and smaller divergence angles suitable for longer anchors.
• Referring toFIGS. 3A and 3B, thetibial tray50 includes a bone-contacting, orinferior side56 across which thechannels52 are recessed. At one end of eachchannel52, shoulders59 are formed in the edges of thechannels52. InFIGS. 3A and 3B, theshoulders59 are formed in interior edges of the channel near theanterior edge54 of thetibial tray50. As seen inFIG. 4, when the anchor rails24 are inserted through the channels, theshoulders59 deform thetabs30 and engage with thestops32 to provide the interference fit between theanchors20 and thetray50, and to properly position the anchors at the correct depth relative to the tray. Astem58 provides further fixation of thetray50 in the tibia.
• Thetibial tray50 further includes a joint-facing, orsuperior side60 to which an articular insert (not shown) may be mounted. A raisedrim62 encompasses thesuperior side60, and overhangs64 are formed on a portion of therim62 for engagement with an articular insert and/or instruments.Tibial tray50 may be described as a bicondylar tibial component because it is adapted to extend across an entire resected tibial plateau to replace the medial and lateral condyles.
• In other embodiments, the features of thetibial tray50 may vary. For example, thestem58 or other fixation features may vary; the size and thickness of thetray50 may vary, the outer peripheral size and shape may vary. Different connection features for engagement with an articular insert may be incorporated. Other features of tibial trays known in the art may be included as desired. The articular insert may carry the prosthetic articular surface.
• FIGS. 5A and 5B depict another example of a kneetibial prosthesis100 which includes atibial component150, ortray150, and at least onefixation element120. Except for differences in channels for receiving the anchors,tibial tray150 may be essentially identical totray50 and as such will not be further described. Similarly, theanchors120 may be identical toanchors20, with the exception of aspring feature125 which may substitute for thetabs30 and stops32 formed onanchor20.
• Referring toFIGS. 6A and 6B,anchor120 includesblade122 andrail124.Spring feature125 is formed on the rail, and comprises a pair oftabs130 separated by agap131. Thespring feature125 may be located at aproximal end168 of theanchor120, which may also be called a trailingend168. Astop132 may be formed on the rail. Thestop132 may be on atab130, as shown, or elsewhere. Anopening134 may be formed through thetabs130 to provide a connection feature for anchor insertion and/or removal instruments.
• Referring toFIG. 7,tray150 includeschannels152 for receivinganchors120.Curbs158 may be present on either side of thechannel152, the curbs effectively narrowing a portion of the channel.Curbs158 are illustrated near ananterior edge154 of thetibial tray150, but may be located elsewhere along the channel.Shoulders159 may also be located on either side of thechannel152, and may be distal to, or posterior to, thecurbs158. Aclearance pocket160 may be defined along a portion of thechannel152 bounded by theshoulders159 at one end and thecurbs158 at the other end.
• Referring toFIGS. 8A and 8B, asanchor120 is inserted intochannel152,tabs130 are compressed together, narrowinggap131, as they pass betweencurbs158. Once thetabs130 are distal to the curbs, the tabs spring apart in theclearance pocket160. Stop132 engages withshoulder159 to prevent further insertion of theanchor120 distally. Thestop132 near theproximal anchor end168 may be said to index toshoulder159, which may be a flat face of thetibial tray150, to prevent the anchor from being over-driven. Also,tabs130 engage withcurbs158 to prevent proximal withdrawal of theanchor120 from thetibial tray150. Thespring feature125 prevents theanchor120 from backing out proximally until the spring is depressed. If removal of an anchor is desired, an instrument (not shown) may be engaged with thetabs130 to compress the tabs together and allow proximal withdrawal of the anchor.
• To achieve optimal compression between the bone and the tibial tray, theanchor blade122 may be angled divergent from therail124, in the same manner as described foranchor20.
• Referring toFIGS. 9A and 9B, ananchor guide instrument200 may be used to provide guidance as the anchors slide into the channels on the tibial tray. The example shown depictsanchors20 being inserted intotray50; however the same instrumentation with little or no modification may be implemented withtray150 and anchors120.
• Theanchor guide instrument200 can attach to a polymeric (UHMW or other medically relevant polymer)clip220 that interfaces via a snap fit to thesuperior surface60 of thetibial tray50. Theclip220 may engage with theoverhangs64 on the tray to snap to thetray50, similar to the manner in which the articular insert attaches to the tray. Theanchor guide instrument200 includes anattachment portion222 and aguidance portion224. Theguidance portion224 includes twotracks226, which coaxially align with thechannels52 on thetray50 when theanchor guide instrument200 is properly attached to thetray50. Eachanchor20 may then be inserted into atrack226 and moved distally along the track until the anchor slides intochannel52. An insertion instrument may be used to tap or otherwise urge the anchor along the track and into the channel.
• In a method of use, a tibia proximal end is prepared to receivetray50 or150. A transverse resection may be made to remove the medial and lateral proximal tibial articular cartilage. Recesses for atray stem58 and/or fins may be reamed, drilled, broached, cut or otherwise prepared.Tray50 or150 is fit onto the prepared tibia, and may be implanted with or without cement.Anchors20 or120 are inserted into the channels on the tray. The blades may cut into the bone as the anchors are inserted. As the anchors are inserted, the angled configuration of the anchors causes compression of the tray toward the tibia; i.e., the tray is pulled toward the tibia. The tabs and stops on the tray and the anchors cooperate to seat the anchors at the proper depth relative to the tray, and prevent unintentional withdrawal of the anchors. An articular insert (not shown) may be coupled to the superior surface of thetray50, and may include an articular surface.
• Referring toFIG. 2B, it can be appreciated that the act of insertinganchor20 intochannel52 and adjacent bone may be described as a sequence of events. The leadingend70 is configured so that therail24 is the leading feature, and is thus the first feature to engage the channel or bone. Theblade22 is the second feature to engage, as its point penetrates the bone. Thesupport26 is the third feature to engage, as it enters the channel and the bone. The support may be said to protrude through the bone-contacting surface, since the support extends through the open side of the channel. All leading edges of the support and blade are sharpened and obliquely oriented to reduce the effort necessary to cut through the bone.
• Any of the embodiments described herein may be used in a tibial prosthesis implantation procedure to provide immediate and tight fixation of the tibial component to the prepared tibia. The angled anchor blades provide immediate compression between the tibial component and the tibia as the anchors are inserted, and may provide complete fixation (no motion permitted between the tibial component and the tibia) for the time needed for bone ingrowth to occur between the tibia and the tibial component.
• Any of the tibial trays and anchors described herein may be formed of titanium, cobalt chrome, stainless steel, or other biocompatible metals or metal alloys, or a combination thereof. In some embodiments, the anchors may be formed of a resorbable material such as PLLA. Any of the components may include a coating or treatment on part of or the entire component to promote biologic/bone ingrowth.
• In other embodiments, another joint replacement component may have the channels as described above for anchoring the component to bone with the anchors disclosed herein. For example, the channels and anchors described herein may be applied to a femoral component of a knee replacement prosthesis, a stem and/or cup component of a hip or shoulder prosthesis, ankle prostheses, elbow prostheses, or small joint prostheses. Application to all synovial joints of the body is contemplated.
• Referring toFIGS. 10-12B, another kneetibial prosthesis320 includes aunicompartmental tibial component310 and at least onefixation element350. In this example the fixation element may be inserted from an anterior edge of thetibial tray310 and may run roughly anterior-posterior. However, various anchor insertion angles are contemplated.
• The tibial component, ortray310 may include an inferior or bone-contactingsurface312 and a joint-facing, orsuperior surface314. The bone-contactingsurface312 may include at least oneanti-rotation post315.FIG. 10 shows an example with twoposts315. Other elements, such as fins, pegs, screws, or the like may be present as well. Theposts315, when embedded in the bone, may prevent thetibial component310 from rotating on the flat resected bone surface. The bone-contactingsurface312 also includes at least onetrack318. Thetrack318 is shaped to accept a complementary portion of theanchor350. The track and anchor portion may be any complementary guiding features, such as dovetail, T-shape, H-shape, or complementary curved features, among others. The track may be at least partially undercut in order to retain the anchor in thetibial component310.
• The joint-facingsurface314 includes a negative feature, orrecess322. This feature may receive an articular insert (not shown), and may also engage an anchor guide instrument. There may be an undercutflange324 on aposterior side326 of thetibial component310, under which the articular insert or instrument snaps to be held rigidly in thetray310. In other embodiments, thesuperior surface314 may be an integral articular or bearing surface configured to replicate a removed natural articular surface, and thus configured to contact and articulate with a natural distal femur, for a hemi-arthroplasty.
• Referring toFIGS. 10-111B, theanchors350 are designed to slide into the bone. The anchors may be pushed or impacted into the bone. The anchor may include alongitudinal rail356, at least onesupport358, and ablade360. Therail356 is complementary to thetrack318, and may therefore be a dovetail, T-shape, H-shape, or complementary curved feature, among others. There may be at least oneinterference tab354 on therail356. Thetab354 deforms as theanchor350 is driven into thetrack318. This material deformation serves to take up any relative motion between theanchor350 and thetibial tray310 as well as to lock the anchor into the tray. In the example shown, a pair oftabs354 is near a trailingend368 of theanchor350, and another pair oftabs354 is centrally located along the rail. Other embodiments may includemultiple interference tabs354 along the length of therail318. The trailingend368 may also be described as theproximal end368. Theanchor350 also has an opposite leading end, ordistal end370. There may be aphysical stop tab362 on the rail. Thestop tab362 is shown immediately proximal to theinterference tab354, although other locations are contemplated. As therail356 is inserted in thetrack318, thestop tab362 may approach a matching stop feature326 on thetray310 which prevents insertion of theanchor350 beyond a prescribed point.
• To achieve optimal compression between the bone and thetibial tray310, theanchor blade360 may diverge from therail318 and/or the bone-contactingsurface312 as described fortibial prosthesis10.
• Referring toFIGS. 13A and 13B, during implantation theanchors350 may be guided into theappropriate tracks318 via ananchor guide instrument380. Theanchor guide380 may attach to ananchor guide clip390. Theclip390 may include an engagement feature which releasably connects to the anchor guide. The clip may also snap into therecess322 on thetibial tray310 and under theflanges324, as would an articular insert. Theclip390 may be ultra-high molecular weight polyethylene (UHMWPE) or other medically relevant polymer. Theanchor guide380 includes atrack382 which coaxially aligns withtrack318 on thetray310. Ananchor350 may be inserted at the free end oftrack382, urged distally alongtrack382 toward thetray310 and intotrack318 on the tray. A mallet or other instrument may be used to drive the anchor into the bone material adjacent the tibial component.
• Another example of a knee tibial prosthesis may include a unicompartmental tibial tray with a plurality oftracks318, into which a plurality ofanchors350 may be inserted. More than one anchor may be inserted per track. Althoughtrack318 is illustrated inFIG. 10 as extending generally anterior-posterior (A/P), it is appreciated that in other embodiments the track may extend generally medial-lateral (M/L), or along any vector between the A/P and L/M directions. Furthermore, thetrack318 may diverge from the bone-contactingsurface312.
• A knee femoral component includes at least one groove or track for engagement of an anchor which may slide into the groove and into an adjacent distal femur to anchor the femoral component to the distal femur. The femoral component may be a unicondylar or bicondylar femoral component. Anchors may be driven into grooves in the femoral component at any location to provide fixation and/or compression of the femoral component surface against the bone.
• Referring toFIG. 14, a kneefemoral prosthesis400 includes anouter bearing surface402 and aninner fixation surface404. The bearingsurface402 may also be called an articular surface or a joint-facing surface. Theinner fixation surface404 may also be called a bone-contacting surface. Thefixation surface404 may includemultiple segments406. Eachinner surface segment406 may be aligned along a different plane, or may be coplanar with at least one other segment. At least onesegment406 includes atrack318 shaped to hold ananchor350 as described above. The track(s)318 may run medial-lateral across theinner fixation surface404 as shown inFIG. 14, although other trajectories are envisioned, such as anterior-posterior, superior-inferior, or along an intermediate trajectory. Theanchors350 may be driven into the tracks18, providing fixation and/or compression of the femoral component to the bone.
• FIG. 15 shows a top-down view of another kneefemoral prosthesis500 which includes afemoral component510 and at least oneanchor350. Thefemoral component510 includes anouter bearing surface502 and aninner fixation surface504. The bearingsurface502 may also be called an articular surface or a joint-facing surface. Theinner fixation surface504 may also be called a bone-contacting surface.Component510 includes at least onetrack318. In this example, twotracks318 extend medial-lateral across thefixation surface504. Twoanchors350 are shown engaged in one of thetracks318 toward aposterior aspect514 of thefemoral component510. In other embodiments, threeanchors350 could be engaged in theposterior track318. Theanchors350 may be inserted from either or both of the medial or lateral sides of the implant. Theprosthesis500 also includes anelongated anchor410 engaged in theother track318 toward ananterior aspect512 of thefemoral component510. In other embodiments,multiple anchors350 could be used in place of theelongated anchor410, and vice versa. In other embodiments, the tracks and anchors may be angled relative to the medial-lateral dimension of the femoral component, and may be inserted from any edge, whether medial, lateral, anterior, posterior, or intermediate. The length, width, height, and/or other dimensions of theanchor350,410 may be appropriately scaled for the selected placement location on the component and the adjacent bone portion.
• Referring toFIGS. 16A and 16B, lateral and anterior views of a unicondylar knee femoral prosthesis418 are shown. Prosthesis418 includes a unicondylarfemoral component420 and at least onefixation element350.Femoral component420 includes anouter bearing surface422 and aninner fixation surface424. The bearingsurface422 may also be called an articular surface or a joint-facing surface. Theinner fixation surface424 may also be called a bone-contacting surface. At least oneanchor peg426 may protrude from theinner fixation surface424. The illustrated example shows two pegs. Theanchor350 is engaged in atapered dovetail track318 on theinner fixation surface424 to provide fixation and compression of thefemoral component420 against the bone. Although onefixation anchor350 is shown, in other embodiments multiple fixation anchors350 may be engaged in one ormore tracks318. Theanchor350 may be inserted into thetrack318 and the adjacent bone from the lateral or medial side of thefemoral component420.
• A tibial hemiarthroplasty component includes at least one groove or track for engagement of an anchor which may slide into the groove and into an adjacent proximal tibia to anchor the component to the proximal tibia.
• Referring toFIGS. 17A and 17B, a unicondylar hemiarthroplasty kneetibial prosthesis428 is shown. Theprosthesis428 includes atibial component430 and at least onefixation element350. Thetibial component430 includes atrack318 to receive ananchor350. Thetrack318,anchor350 and insertion techniques may be the same as those described above with regard toFIGS. 10-16B. Thetibial component130 has asuperior side434 and aninferior side436. Thesuperior side434 may be metal and it may form a bearing surface for articulation with a natural distal femur. It is appreciated that as needed, a single hemi-arthroplasty component430 may be implanted for a unilateral hemiarthroplasty, or two generally mirror-image components may be implanted for a bilateral hemiarthroplasty.
• In any of the examples described above, the anchors may vary in geometry and angle (for compression). The anchors may be positioned anywhere along the relative implants, i.e. medial, lateral, anterior, posterior or intermediate. Also, the dovetail track could have a different geometry than a taper dovetail. The extent of compression achieved may be adjusted by varying the angle of the blade. Advantageously, use of the disclosed anchor may prevent osteolysis, as no pathway for osteolysis is provided, unlike in screw-based fixation systems. The number of anchors used in a track or implant may vary.
• The present technology may be embodied in other specific forms without departing from its spirit or essential characteristics. It is appreciated that various features of the above described examples can be mixed and matched to form a variety of other alternatives. As such, the described examples are to be considered in all respects only as illustrative and not restrictive. The scope of the invention is, therefore, indicated by the appended claims rather than by the foregoing description. All changes which come within the meaning and range of equivalency of the claims are to be embraced within their scope.

Claims (1)

1. A joint arthroplasty system, comprising:

a prosthetic articular surface which replaces at least a portion of a natural articular surface of a bone;

a prosthetic component comprising a bone-contacting surface, the bone-contacting surface comprising at least one undercut channel extending across at least a portion of the bone-contacting surface and through a perimeter edge of the bone-contacting surface; and

an anchor comprising a rail, a blade, and a support, the rail comprising at least one lateral protrusion, the blade offset from the rail, the support connecting the rail and the blade;

wherein the rail is insertable into the channel to connect the anchor to the prosthetic component;

wherein, when the rail is inserted into the channel, the lateral protrusion plastically deforms, the support protrudes through the bone-contacting surface, and the blade is carried at a distance from the bone-contacting surface.

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