Intraoperative dynamic trialing

Patent metadata

Field	Value
Publication number	US-9427336-B2
Application number	US-201313974584-A
Country	US
Kind code	B2
Filing date	Aug 23, 2013
Priority date	Aug 23, 2013
Publication date	Aug 30, 2016
Grant date	Aug 30, 2016

Abstract

A dynamic trialing method generally allows a surgeon to perform a preliminary bone resection on the distal femur according to a curved or planar resection profile. With the curved resection profile, the distal-posterior femoral condyles may act as a femoral trial component after the preliminary bone resection. This may eliminate the need for a separate femoral trial component, reducing the cost and complexity of surgery. With the planar resection profile, shims or skid-like inserts that correlate to the distal-posterior condyles of the final insert may be attached to the distal femur after the preliminary bone resection to facilitate intraoperative trialing. The method and related components may also provide the ability of a surgeon to perform iterative intraoperative kinematic analysis and gap balancing, providing the surgeon the ability to perform necessary ligament and/or other soft tissue releases and fine tune the final implant positions based on data acquired during the surgery.

First claim

The invention claimed is:

1. A dynamic trialing method comprising:
creating a bone model of a distal femur of a patient;
determining a preliminary curved resection profile on the bone model offset from distal and posterior nonresected articular surfaces of the distal femur;
determining a final desired resection profile prior to making a preliminary resection, the determined final desired resection profile being based at least in part on a planned resection of a bone surface of the preliminary curved resection profile;
resecting the distal femur by making the preliminary resection along the preliminary curved resection profile such that a first area of bone is removed from the distal femur;
engaging the resected distal femur to a tibial trial coupled to a resected proximal tibia; and
performing intraoperative kinematic analysis by at least articulating the proximal tibia with respect to the distal femur.

2. The dynamic trialing method of claim 1 , wherein the step of performing kinematic analysis further includes performing intraoperative gap balancing.

3. The dynamic trialing method of claim 2 , further comprising:
making a subsequent resection of the distal femur such that a second area of bone is removed from the distal femur.

4. The dynamic trialing method of claim 3 , wherein the subsequent resection includes making planar bone resections corresponding to mating surfaces on a femoral implant.

5. The dynamic trialing method of claim 3 , wherein the subsequent resection is performed according to the final desired resection profile.

6. The dynamic trialing method of claim 3 , wherein the subsequent resection is performed according to a modified final section profile, the modified final section profile being determined, at least in part, based upon results of the kinematic analysis.

7. The dynamic trialing method of claim 1 , wherein the tibial trial includes a first condylar portion connected to a second condylar portion, the first and second condylar portions each having a groove corresponding to an articular dish of a tibial implant plateau.

8. The dynamic trialing method of claim 7 , wherein the tibial trial includes a tibial trial insert and a template, the tibial trial insert being removable from the template.

9. The dynamic trialing method of claim 8 , further comprising the step of removing the tibial trial insert from the template and inserting an alternative modular tibial trial insert into the template.

10. The dynamic trialing method of claim 7 , wherein the tibial trial includes a first insert having a proximal surface and a distal surface and a second insert having a proximal surface, the proximal surface of the first insert having two grooves corresponding to articular dishes of the tibial implant plateau.

11. The dynamic trialing method of claim 10 , wherein the first insert has at least two pegs extending distally from the distal surface of the first insert and the second insert has at least two holes on the proximal surface of the second insert, the at least two pegs being configured to be inserted into the at least two holes.

12. The dynamic trialing method of claim 7 , wherein the tibial trial includes a tibial insert having a first condylar portion configured to mate with a first groove insert and a second condylar portion configured to mate with a second groove insert, the first and second groove inserts each having an articulation surface corresponding to the articular dish of the tibial implant plateau.

13. The dynamic trialing method of claim 1 , further comprising the step of coupling first and second femoral shims to first and second condyles of the distal femur after the step of resecting the distal femur by making a preliminary resection.

14. The dynamic trialing method of claim 13 , wherein the first and second femoral shims each have an articulation surface corresponding to a shape of a femoral implant.

15. The dynamic trialing method of claim 14 , wherein the first and second femoral shims each have a bone contacting surface with a peg extending therefrom, the pegs being configured to facilitate fixing the first and second femoral shims to the resected distal femur.

16. The dynamic trialing method of claim 1 , wherein the tibial trial includes a first condylar portion, a second condylar portion, and at least one insert surface, the at least one insert surface being connected to at least one expandable component having a volume that may expand or contract and also being configured to remain at a constant pressure.

17. The dynamic trialing method of claim 16 , wherein the tibial trial has exactly one insert surface and exactly one expandable component, the first and second condylar portions being connected to one another.

18. The dynamic trialing method of claim 16 , wherein the tibial trial has two insert surfaces and two expandable components, a first insert surface corresponding to a first expandable component and the first condylar portion, and a second insert surface corresponding to a second expandable component and a second condylar portion.

19. The dynamic trialing method of claim 18 , wherein the tibial trial includes a connecting member physically connecting the first condylar portion to the second condylar portion, the first expandable portion being fluidly isolated from the second expandable portion.

20. The dynamic trialing method of claim 16 , wherein the at least one expandable component is a bellows.

21. The dynamic trialing method of claim 20 , wherein the at least one expandable component is connected to a fluid source.

22. The dynamic trialing method of claim 21 , wherein the fluid source is configured to pump air into the at least one expandable component.

23. The dynamic trialing method of claim 21 , wherein the fluid source is configured to pump saline into the at least one expandable component.

24. A dynamic trialing method comprising:
creating a bone model of a distal femur of a patient;
determining a preliminary resection profile on the bone model;
determining a final desired resection profile prior to making a preliminary resection, the determined final desired resection profile being based at least in part on a planned resection of a bone surface of the preliminary resection profile; and
resecting the distal femur by making the preliminary resection along the preliminary resection profile such that a first area of bone is removed from the distal femur,
wherein the preliminary resection profile is determined, at least in part, based on a feature of a final design plan of a femoral implant.

25. The dynamic trialing method of claim 24 , wherein the final design plan of the femoral implant includes a femoral implant flexion axis, and the preliminary resection profile is based on the femoral implant flexion axis.

26. The dynamic trialing method of claim 25 , wherein the preliminary resection profile includes a flexion axis, the flexion axis of the preliminary resection profile being coaxial with the femoral implant flexion axis.

27. The dynamic trialing method of claim 24 , further comprising the step of performing intraoperative kinematic analysis by at least articulating the proximal tibia with respect to the distal femur.

28. The dynamic trialing method of claim 27 , further comprising the step of performing intraoperative gap balancing.

Assignees

• Stryker Corp

Inventors

• Axelson Jr Stuart L
• Hampp Emily
• Fossez John R

Classifications

• A61F2/4684 Primary

  Trial or dummy prostheses · CPC title

• A61F2002/3895

  unicompartimental · CPC title

• A61B17/025 Primary

  Joint distractors · CPC title

• A61B17/00234

  for minimally invasive surgery (A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence) · CPC title

• A61B2017/0268

  for the knee · CPC title