US20150250472A1 - Delivery System for Articular Surface Implant - Google Patents
Delivery System for Articular Surface Implant Download PDFInfo
- Publication number
- US20150250472A1 US20150250472A1 US14/640,667 US201514640667A US2015250472A1 US 20150250472 A1 US20150250472 A1 US 20150250472A1 US 201514640667 A US201514640667 A US 201514640667A US 2015250472 A1 US2015250472 A1 US 2015250472A1
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- US
- United States
- Prior art keywords
- anchor
- implant
- driver
- suture
- bone
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
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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
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00011—Metals or alloys
Definitions
- the present disclosure relates to delivery systems for bone implants, and more particularly, to delivery systems for articular surface implants.
- hyaline cartilage found at the ends of articulating bone in the body, is typically composed of hyaline cartilage, which has many unique properties that allow it to function effectively as a smooth and lubricious load-bearing surface. When injured, however, hyaline cartilage cells are not typically replaced by new hyaline cartilage cells. Healing is dependent upon the occurrence of bleeding from the underlying bone and formation of scar or reparative cartilage called fibrocartilage. While similar, fibrocartilage does not possess the same unique aspects of native hyaline cartilage and tends to be far less durable.
- an implant it may be necessary or desirable to repair the damaged articular cartilage using an implant.
- One method of installing an implant involves applying a blunt force, e.g., a hammer/mallet or the like, to the implant.
- a blunt force e.g., a hammer/mallet or the like
- some of the blunt force is transmitted from the implant into the surrounding bone and/or tissue and can cause damage to the bone/tissue. This is particularly problematic in small bones (such as, but not limited to, bones in the hand and/or foot) as well as patients who suffer from reduced bone mass and density that can lead to fracture (such as, but not limited to, osteoporosis or the like).
- FIG. 1 generally illustrates a cross-sectional view of one embodiment of an implant system consistent with the present disclosure secured within an excision site in a bone;
- FIG. 2 generally illustrates a cross-sectional view of one embodiment of an assembled implant system consistent with the present disclosure
- FIG. 3 generally illustrates a cross-sectional view of one embodiment of an unassembled implant system consistent with the present disclosure
- FIG. 4A generally illustrates an exploded, cross-sectional view of one embodiment of an implant delivery system consistent with the present disclosure
- FIG. 4B generally illustrates a partial view of another embodiment of an implant delivery system consistent with the present disclosure
- FIG. 5 generally illustrates an assembled, cross-sectional view of one embodiment of an implant delivery system consistent with the present disclosure
- FIG. 6 generally illustrates an assembled, perspective view of one embodiment of an implant delivery system consistent with the present disclosure
- FIG. 7 generally illustrates a cross-sectional view of one embodiment of an implant delivery system securing an anchor within an excision site in a bone consistent with the present disclosure
- FIG. 8 generally illustrates a cross-sectional view of an anchor secured within an excision site in a bone consistent with the present disclosure
- FIG. 9 generally illustrates a cross-sectional view of an implant delivery system securing an implant to an anchor consistent with the present disclosure
- FIG. 10 generally illustrates a perspective view of an implant delivery system for securing an implant to an anchor consistent with the present disclosure
- FIG. 11 generally illustrates another cross-sectional view of an implant delivery system securing an implant to an anchor consistent with the present disclosure.
- FIG. 12 generally illustrates another perspective view of an implant delivery system for securing an implant to an anchor consistent with the present disclosure.
- the present disclosure may feature systems, devices and/or methods for installing an implant anchor and/or delivering and attaching an implant to the anchor.
- an implant delivery system for use with an implant system having an anchor and an implant (e.g., implant body) configured to be secured thereto.
- the implant delivery system may be used to facilitate delivering (e.g., securing) the anchor to the bone beneath a patient's articular surface and/or to couple, mount, or otherwise secure the implant body to the anchor.
- the implant delivery system may be configured to generate sufficient force to allow the implant body to be secured to the anchor without applying any force to the surrounding bone or tissue.
- the implant delivery system may generate and apply a biasing force against the implant and the anchor which urges the implant body into engagement with the anchor, thereby securing the implant body to the anchor without applying any force to the surrounding bone.
- the biasing force generated by the implant delivery system may therefore be applied only to the implant system, and not the surrounding bone or tissue.
- the implant delivery system may reduce, minimize, and/or eliminate damage to the surrounding bone while securing the implant body to the anchor, thereby allowing the implant delivery system to be used with small bones (such as, but not limited to, phalange bones and/or metatarsal bones in the foot and/or hands) as well with patients who suffer from reduced bone mass and density that can lead to fracture (such as, but not limited to, osteoporosis or the like). Additionally, because the implant delivery system is capable of generating high biasing forces without transmitting/applying the biasing force to the surrounding bone or tissue, the connection between the implant body and the anchor may be stronger and more robust, thereby increasing the life expectancy of the implant system.
- FIGS. 1-3 one embodiment of an implant system 10 which may be used with an implant delivery system consistent with the present disclosure is generally illustrated.
- FIG. 1 generally illustrates the implant system 10 installed in the articular surface 12 of a patient's bone 14
- FIG. 2 generally illustrates an assembled implant system 10
- FIG. 3 generally illustrates an exploded, unassembled implant system 10 consistent with the present disclosure.
- the implant system 10 may generally include an implant (e.g., implant body) 16 configured to be secured to an anchor 18 .
- the anchor 18 is configured to be secured to the bone 14 within an excision site 20 formed beneath the patient's articular surface 12 such that a load bearing surface 22 of the implant 16 is generally flush with the patient's surrounding articular surface 12 as generally illustrated in FIG. 1 .
- the excision site 20 may be formed using any method and system known to those skilled in the art, such as, but not limited to, as the systems and methods as described in U.S. Pat. Nos. 6,520,964, 6,610,067, 6,679,917, 7,678,151, 7,896,883, 8,177,841, and 8,388,624, as well as U.S. Publication No. 2010/0368238, all of which are fully incorporated herein by reference.
- the anchor 18 may be secured to the bone 14 , for example, using one or more external threads, ribs, protrusions, bone cement, barbs, grooves or any other structure 21 that enables the anchor 18 to be secured to the bone 14 .
- the use of threads 21 as generally illustrated may advantageously allow the height of the implant 12 to be adjusted by rotating the anchor 18 within the bone 14 such that the implant 16 is flush with the surrounding articular surface 12 .
- the implant delivery system 10 illustrated is provided for illustrative purposes, and that the implant delivery system may be used with any multi-piece implant having an anchor that is coupled (either directly or indirectly) to an implant/implant body.
- the implant delivery system may be used with implant systems for replacing any articular surface such as, but not limited to, shoulder joints (e.g., but not limited to, the glenohumeral joint), hip joint (e.g., but not limited to, the acetabulofemoral joint), foot and/or hand joints (e.g., but not limited to, metacarpophalangeal joints, metatarsophalangeal joints, and/or interphalangeal joints), or the like.
- shoulder joints e.g., but not limited to, the glenohumeral joint
- hip joint e.g., but not limited to, the acetabulofemoral joint
- foot and/or hand joints e.g., but not limited to, metacarpophalangeal joints, metatarsophalangeal
- the implant systems may include total joint implants (wherein all or substantially all of the articular surface of at least one bone is replaced with the artificial surface of the implant) and/or partial implants (wherein substantially only the damaged portion(s) of the articular surface of a bone is replaced with the artificial surface of the implant).
- the implant delivery system may also be used to secure together a multi-piece pin or rod in a bone to facilitate healing of a fracture or broken bone.
- the implant 16 may be secured to the anchor 18 by way of a connection.
- the implant 16 may include at least one first fixation element 24 configured to engage with at least one second fixation element 26 of the anchor 18 to secure the implant 16 to the anchor 18 .
- the first and the second fixation elements 24 , 26 may include one or more recesses, groves, slots or the like configured to corresponding to one or more protrusions, ribs, barbs, or the like, for example, in a snap-fit arrangement in which the first and/or second fixation elements resiliently deflect.
- the first and second fixation elements 24 , 26 may be disposed about the entire perimeter/periphery of the implant 16 and anchor 18 , and/or about one or more regions of the perimeter/periphery.
- the first and second fixation elements 24 , 26 may prevent the implant 16 from becoming free relative to the anchor 18 (for example, to prevent axial and/or rotational movement of the implant 16 relative to the anchor 18 ).
- the implant 16 may be at least partially received in an implant cavity 28 formed in the anchor 18 such that a bone facing surface 30 of the implant 16 engages against at least a portion of the implant cavity 28 , thereby preventing the implant 16 from moving distally when a force is applied to the load bearing surface 22 .
- first and second fixation elements 24 , 26 are generally illustrated as a recess and a protrusion, respectively, the implant system 10 consistent with the present disclosure is not limited to this arrangement unless specifically claimed as such.
- the first and second fixation elements 24 , 26 may include a protrusion and a recess, respectively, as well as other embodiments.
- the anchor 18 may optionally include a passageway 32 , for example, a longitudinal passageway, configured to be advanced over a guide wire (not shown) as generally described in U.S. Pat. Nos. 6,520,964, 6,610,067, 6,679,917, 7,678,151, 7,896,883, 8,177,841, and 8,388,624, as well as U.S.
- the anchor 18 may be inserted into bone 14 or may be inserted into a shaft drilled in the bone 14 to reduce risks or complications arising from the insertion of the anchor 18 .
- a pilot hole may be formed in the bone 14 for receiving the anchor 18 prior to installing the anchor 18 .
- a diameter of the pilot hole may be smaller than the anchor 18 , although example embodiments may vary and are not limited thereto.
- the strength or ruggedness of the snap-fit connection between the implant 16 and the anchor 18 may depend on the selected materials (e.g., the rigidity) and size/dimensions. In general, more rigid (i.e., less deformable) materials and/or larger sizes/dimensions will result in a stronger, more robust connection between the implant 16 and the anchor 18 . While a stronger and more robust connection between the implant 16 and the anchor 18 is generally desirable, the resulting force necessary to make the snap-fit connection increases.
- the force necessary to secure the implant 16 to the anchor 18 has been generated using a blunt force, e.g., a hammer/mallet or the like. More specifically, with the anchor 18 secured in the bone 14 , the surgeon attempts to align the implant 16 relative to the anchor 18 and impacts the implant 16 with the hammer/mallet to force the implant 16 into engagement with the anchor 18 . As may be appreciated, however, a substantial amount of force is also applied to the surrounding bone 14 , and if the force applied to the bone 14 is too great, the bone 14 may be damaged.
- a blunt force e.g., a hammer/mallet or the like.
- the strength of the connection between the implant 16 and the anchor 18 may be limited in many applications (e.g., but not limited to, small bones in the hand and foot as well as implant system 10 installed proximate to the perimeter of a bone) by the strength of the surrounding bone 14 . Additionally, it may be very difficult for the surgeon to properly align the implant 16 with respect to the anchor 18 .
- the implant delivery system consistent with one embodiment of the present disclosure solves this problem by generating a biasing force to secure the implant 16 to the anchor 18 wherein the biasing force is only applied against the implant 16 and the anchor 18 .
- the biasing force generated by the implant delivery system may therefore be applied only to the implant system 10 , and not the surrounding bone or tissue 14 .
- An implant delivery system consistent with the present disclosure may also be used to facilitate securing the anchor 18 into the bone 14 .
- FIGS. 4-12 systems and methods for securing an anchor 18 into the bone and securing the implant 16 to the anchor 18 using an implant delivery system 100 consistent with the present disclosure are generally illustrated.
- the implant delivery system 100 may be used to secure the anchor 18 into an excision site formed in the bone.
- the delivery system 100 may be used to secure the implant 16 to the anchor 18 to assemble the implant system 10 within the excision site.
- the implant delivery system 100 may be used with any implant system 10 described herein and is not limited to the illustrated implant system 10 unless specifically claimed as such.
- the implant delivery system 100 may include a driver 110 , a biasing body 112 , and at least one suture 114 . As explained herein, the implant delivery system 100 may be configured to retain the anchor 18 into engagement with the driver 110 and to secure the anchor 18 to bone 14 within an excision site 20 (as generally illustrated in FIGS. 7 and 8 ).
- the driver 110 may be received through the biasing body 112 , and the suture 114 may be disposed around a portion of the anchor 18 to provide increased control and/or maintain contact between the driver 110 and the anchor 18 while securing the anchor 18 into the bone 14 within the excision site 20 .
- the excision site 20 may be formed using any method and system known to those skilled in the art.
- the driver 110 includes a longitudinally disposed shaft 116 having an engagement portion 118 disposed about a distal end 120 .
- the engagement portion 118 is configured to be coupled with a corresponding engagement portion 122 of the anchor 18 and to transmit torque as generally illustrated in FIGS. 5-7 .
- the engagement portion 118 may be a male-shaped coupling unit (such as, but not limited to, a splined or hex-shaped driver) configured to couple with a female-shaped coupling unit 122 (such as, but not limited to, a splined or hex-shaped recession formed in the anchor 18 ) in order to rotate or drive the anchor 18 into the bone.
- the engagement portions 118 , 122 may vary and are not limited thereto.
- the driver 110 may be configured to accept interchangeable bits having a different engagement portion 118 configurations, thereby allowing the engagement portion 118 of the driver 110 to be coupled to the engaging portion 122 of the anchor 18 using several different bits as necessary.
- the engagement portion 118 may have a female-shaped coupling unit and the anchor 18 may have a male-shaped coupling unit.
- the shape of the engaging portions 118 , 122 may be other than splined or hexagonal, and those in the art will recognize that one of any number of shapes or configuration for such components may be employed in a device or method consistent with example embodiments.
- the engagement portion 118 may be magnetized or otherwise configured to maintain contact or control over the anchor 18 .
- engaging portion 122 of the anchor 18 is shown located on an inner wall of the narrow portion of the anchor 18 , example embodiments may vary and are not limited thereto.
- the engaging portion 122 of the anchor 18 may be located on an inner wall of the wide portion of the anchor 18 and/or on an outer wall of either the narrow portion or the wide portion of the anchor 18 .
- an intermediate or adapting portion (not shown) may be used to connect the driver 110 to the anchor 18 .
- the driver 110 may optionally include a handle 124 .
- the handle 124 may facilitate grasping of the driver 110 and may be configured to cause a rotational force or a torque on the shaft 116 , which may ultimately impart a rotational force or torque on the anchor 18 to secure the anchor 18 into the bone.
- the handle 124 may be separate from the shaft 116 (either permanently or removably coupled thereto), or may be a unitary, single piece with the shaft 116 . While the handle 124 is illustrated as having a larger width than the shaft 116 , example embodiments may vary and are not limited thereto.
- the handle 124 may include a lever arm or may be configured to couple to a lever arm that is used to create the rotational force or torque.
- the handle 124 and/or the shaft 116 may be cannulated to define a longitudinal passageway 126 .
- the longitudinal passageway 126 may include proximal and distal openings 128 a , 128 b configured to be advanced over a guide wire (not shown for clarity), for example, when securing the anchor 18 into the bone within the excision site.
- the biasing body 112 defines a shaft passageway 132 extending between a first and a second end region 130 a , 130 b having a first and second opening 134 a , 134 b .
- the shaft passageway 132 is configured to receive at least a portion of the shaft 116 of the driver 110 , for example, as generally illustrated in FIGS. 5 and 6 .
- the shaft 116 and the shaft passageway 132 may be configured such that the distal end 120 of the shaft 116 extends beyond the second end 134 b of the shaft passageway 132 to allow the engagement portion 118 of the driver 110 to engage the corresponding engagement portion 122 of the anchor 18 , for example, as generally illustrated in FIGS. 5 and 6 .
- the biasing body 112 may include a driver cradle 121 , discussed in greater detail herein, which may be used to secure the implant 16 (not shown) with the anchor 18 .
- the second end region 130 b may include a fixation element 25 ( FIG. 4B ) which substantially corresponds to the first fixation element 24 of the implant 16 .
- the fixation element 25 of the second end region 130 b of the biasing body 112 may be coupled to the second fixation element 26 of the anchor 18 to generally secure the anchor 18 to the biasing body 112 .
- the connection between the biasing body 112 and the anchor 18 may facilitate placement of the anchor 18 within the excision site by creating a generally secure connection therebetween.
- connection between the fixation element 25 of the second end region 130 b and the second fixation element 26 of the anchor 18 does not need to be as strong as the connection between the first and second fixation elements 24 , 26 since it is only generally intended to help advance the anchor 18 to and align the anchor 18 within the excision site.
- the biasing body 112 may be configured to receive a suture 114 disposed around (e.g., wrap around) a portion of the anchor 18 .
- Tension may be applied to the suture 114 to generally urge the anchor 18 into contact with the driver 110 and/or the biasing body 112 to provide more control over and/or maintain contact between the driver 110 and the anchor 18 .
- the suture 114 may be configured to extend through and/or around the biasing body 112 in any manner known to those skilled in the art.
- the suture 114 may extend through the first opening 134 a of the shaft passageway 132 of the biasing body 112 , out through one or more suture apertures/openings/passageways 136 a , 136 b , through one or more suture alignment guides 138 a , 138 b and around a contact portion 140 of the anchor 18 .
- the suture passageways 136 a , 136 b may allow the suture 114 to pass from the exterior of the biasing body 112 to the interior of the shaft passageway 132 . While the suture passageways 136 a , 136 b are illustrated in the middle of the biasing body 112 , example embodiments may vary and are not limited thereto. It should also be appreciated that the suture 114 does not have to pass through the shaft passageway 132 , and instead the biasing body 112 may include one or more separate passageways (not shown) for the suture 114 .
- the suture alignment guides 138 a , 138 b are configured to retain the suture 114 about the distal end of the biasing body 112 .
- the suture 114 may include a first and a second portion 142 a , 142 b (best seen in FIG. 6 ) which form a basket, cradle, or frame 144 extending about the contact portion of the anchor 18 .
- the first and second portions 142 a , 142 b may be formed from two or more pieces of suture, or may be formed from a single piece of suture.
- the suture alignment guides 138 a , 138 b may be configured to prevent the first and second portions 142 a , 142 b of the cradle 144 from slipping off the anchor 18 by restricting the separation angle S of the first and second portions 142 a , 142 b of the cradle 144 .
- suture alignment guides 138 a , 138 b are shown at the distal end of the biasing body 112 nearest the anchor 18 , example embodiments may vary and are not limited thereto.
- the suture alignment guides 138 a , 138 b may be located anywhere along the biasing body 112 provided the suture alignment guides 138 a , 138 b may prevent the suture 114 from slipping off the anchor 18 .
- the suture alignment guides 138 a , 138 b are shown as an exterior protrusion of the biasing body 112 with holes to allow the suture 114 to pass through, example embodiments may vary and are not limited thereto.
- the suture alignment guides 138 a , 138 b may be flush with the biasing body 112 or may protrude in an arc shape, with a gap between one edge of the suture alignment guides 138 a , 138 b and the biasing body 112 to allow the suture 114 to enter. It may also be appreciated that the length of the suture alignment guides 138 a , 138 b may vary and the suture alignment guides 138 a , 138 b may be integrated into the suture passageways 136 a , 136 b.
- contact portion 140 of the anchor 18 is shown on the bottom edge of the anchor 18 , example embodiments may vary and the contact portion 140 may be situated anywhere along the anchor 18 .
- the contact portion 140 may also be disposed about the top portion of anchor 18 .
- the contact portion 140 of the anchor 18 may include a flat edge or may include guides, grooves, slots, or channels configured to receive the suture 114 .
- the suture 114 may extend through a passageway formed in the anchor 18 such that a portion of the anchor 18 generally surrounds the suture 114 , and the cradle 144 may be eliminated.
- the suture 114 may be received through the biasing body 112 (e.g., through the first opening 134 a of the shaft passageway 132 , out through the suture passageways 136 a , 136 b , and through the suture alignment guides 138 a , 138 b ) such that the cradle 144 is disposed about the contact portion 140 of the anchor 18 as generally illustrated in FIG. 4A .
- the driver 110 may be advanced through shaft passageway 132 until the engagement portion 118 contacts the corresponding engagement portion 122 of the anchor 18 .
- the suture 114 may then be tensioned to retain the engagement between the driver 110 and the anchor 18 , for example, by applying a force against the suture 114 in a direction generally away from the anchor 18 as generally illustrated in FIGS. 5 and 6 .
- the fixation element 25 ( FIG. 4B ) of the biasing body 112 may be secured to the fixation element 26 of the anchor 18 , and the driver 110 may engage the anchor 18 as described herein.
- the anchor 18 With the anchor 18 securely engaged with the driver 110 , the anchor 18 may be advanced to and aligned with the excision site 20 (as generally illustrated in FIG. 7 ) formed in the patient's articular surface 12 and bone 14 .
- the anchor 18 may be aligned with the excision site 20 using a guide wire 146 extending outwardly from the bone 14 within the excision site 20 . Because the anchor 18 is retained against the driver 110 , it is easier for the surgeon to align the anchor 18 relative to the excision site 20 .
- the anchor 18 may optionally include a cannulated passageway 32 (best seen in FIG.
- the anchor 18 and the driver 110 may be advanced over the guide wire 146 .
- the optionally use of the cannulated passageway 32 and the guide wire 146 may further aid in aligning the anchor 18 at the desired angle with respect to the excision site 20 and the surrounding articular surface 12 .
- the driver 110 may then be used to secure the anchor 18 into the bone 14 , for example, by rotating the driver 110 , thereby causing the anchor 18 to rotate.
- the height of the anchor 18 may be verified using a trial gauge (not shown) which may be easily inserted/placed into the anchor 18 to ensure that the implant 16 (e.g., FIG. 1 ) is substantially flush with the surrounding articular surface 21 .
- the driver 110 and optionally the biasing device 112 and/or the guide wire 146 ) may be removed, leaving the anchor 18 (and optionally the suture 114 ) remaining in the bone 14 , as generally illustrated in FIG. 8 .
- anchor 18 is illustrated having threads 21 , it may be appreciated that the anchor 18 may be secured to the bone 14 using any device(s) known to those skill in the art including, but not limited to, ribs, barbs, bone cement, porous structures, and the like.
- the biasing device 112 does not have to be used when advancing and/or aligning the anchor 18 with respect the excision site 20 .
- the biasing device 112 may be eliminated and tension may be applied to the suture 114 to keep the anchor 18 engaged with the driver 110 .
- the anchor 18 may be advanced to and aligned with the excision site 20 without using the driver 110 .
- the suture 114 may be secured about a portion of the anchor 18 , and once the anchor 18 is aligned within the excision site 20 , the driver 110 may engage the anchor 18 and used to secure the anchor 18 within the excision site 20 in the bone 14 .
- the implant delivery system 100 may be configured to generate a biasing force to secure the implant 16 to the anchor 18 wherein the biasing force is only applied against the implant 16 and the anchor 18 , and not the surrounding bone or tissue 14 .
- the implant 16 may be arranged (i.e., placed) between the anchor 18 and the second end region 130 b of the biasing device 112 as generally illustrated in FIGS. 9 and 10 .
- the suture 114 may extend around the contact portion 140 of the anchor 18 , through suture alignment guides 138 a , 138 b and suture passageways 136 a , 136 b , and exit through the first opening 134 a of the shaft passageway 132 of the biasing body 112 .
- the suture 114 may also be generally coupled or secured to a portion of the driver 110 , for example, a portion of the shaft 116 .
- the driver 110 may include a suture engagement 148 configured to allow the suture 114 to be generally fixed or retained by the driver 110 .
- the suture engagement 148 may include a hole or aperture through the shaft 116 . At least a portion of the suture 114 may pass through the hole 148 , and the suture 114 may be secured within the suture engagement 148 as the driver 110 is rotated to reduce the length L of the suture 114 between the driver 110 and the anchor 18 as explained herein. It should be appreciated that the suture engagement 148 may include any device for generally securing the suture 114 to the driver 110 .
- the suture engagement 148 may include an external protrusion, a groove, non-cylindrical region, and/or a slot configured to secure the suture 114 .
- the suture 114 may be wrapped around the shaft 116 , and the tension generated by the rotation of the driver 110 may secure the suture 114 thereto.
- the length of the biasing body 112 may be selected to allow the surgeon sufficient room to rotate the driver 110 , and therefore may depend on the intended application.
- the driver 110 may be rotated about its longitudinal axis A as it is received within the driver cradle 121 .
- the driver cradle 121 may be configured to receive the driver 110 (e.g., the shaft 116 ) and generally retain the shaft 116 as the shaft 116 is rotated relative to the biasing body 112 .
- the driver cradle 121 may include one or ore recesses, grooves, or lips formed in the first end region 134 a of the biasing body 112 .
- the driver cradle 121 may also include one or more holes or passageways formed through the biasing body 112 configured to receive and generally retain the shaft 116 .
- the driver cradle 121 may include an enlarged opening 150 (best seen in FIG. 9 ).
- the suture 114 begins to wrap around the shaft 116 , thereby increasing the diameter of the shaft 116 .
- the enlarged opening 150 provides a void space that the suture 114 can pass through as the driver 110 is rotated and the suture 114 builds up around the shaft 116 .
- the suture 114 may generally avoid contact with the driver cradle 121 , and the torque necessary to rotate the driver 110 may be reduced.
- FIGS. 11 and 12 with the implant 16 disposed between the anchor 18 and the second end region 132 b of the biasing body 112 , and the driver 110 (along with the suture 114 generally secured thereto) disposed within the driver cradle 121 , the surgeon may rotate the driver 110 about longitudinal axis A to reduce the length L of the suture 114 extending between the driver 110 and the contact portion 120 of the anchor 118 .
- the reduction in the length L of the suture 114 generates a biasing force which urges the implant 16 into engagement with the anchor 18 .
- the implant delivery system 100 generates a biasing force which is applied against the implant 16 and anchor 18 through the suture 114 only (i.e., substantially no force is applied to the surrounding bone 14 or tissue).
- the implant delivery system 100 therefore avoids and/or reduces any impact to the bone 14 (e.g., eliminates blunt force due to a hammer/mallet or the like), and therefore avoids and/or reduces damage to the bone 16 .
- the implant delivery system 100 may be used with small bones (such as, but not limited to, phalange bones and/or metatarsal bones in the foot and/or hands. Additionally, because the implant delivery system 100 is capable of generating high biasing forces without transmitting/applying the biasing force to the surrounding bone 14 or tissue, the connection between the implant body 16 and the anchor 18 (e.g., first and second fixation elements 24 , 26 as discussed herein) may be stronger and more robust, thereby increasing the life expectancy of the implant system 10 . Moreover, the implant delivery system 100 may deliver the biasing force uniformly to the implant 16 and be self-leveling or self-aligning, thereby reducing and/or eliminating the difficulties associated with aligning the implant 16 with respect to the anchor 18 .
- small bones such as, but not limited to, phalange bones and/or metatarsal bones in the foot and/or hands.
- the connection between the implant body 16 and the anchor 18 e.g., first and second fixation elements 24 , 26 as discussed herein
- the suture 114 may be removed from the implant system 10 .
- one or more portions of the suture 114 may be cut and the resulting pieces may be removed (e.g., pulled out) from the excision site 20 .
- a first end of the suture 114 may be released and the suture 114 may be pulled through the biasing body 120 by a second end of the suture 114 , resulting in the first end traveling through the shaft passageway 132 c , through one of the suture passageways 136 a , 136 b , out one of the alignment guides 138 a , 138 b , around the anchor 18 and through the second of the alignment guides 138 a , 138 b and suture passageways 136 a , 136 b , and the shaft passageway 132 .
- example embodiments may vary and are not limited thereto.
- example embodiments may vary and may include the suture 114 having various shapes or loops.
- the suture 114 may form a basket or loop to wrap around the anchor 18 . This shape may help support the anchor 18 and may increase control over the anchor 18 prior to the suture 114 being wrapped around the driver 110 .
- the loop may extend so that the loop can be severed after installation of the implant system 10 .
- the present disclosure may feature a delivery system for securing an implant with an anchor.
- the delivery system may include a driver including a shaft and a biasing body.
- the driver may be configured to wind a portion of a suture, wherein the suture is configured to extend around a contact portion of the anchor disposed within a bone.
- the biasing body may have a first end region and a second end region.
- the first end region may include a driver cradle configured to generally retain a portion of the shaft as the driver is rotated relative to the biasing body.
- the second end region may be configured to engage a portion of the implant. Rotation of the driver applies a biasing force against the implant and the anchor to secure the implant with the anchor, wherein the biasing force is substantially not transmitted to the bone.
- the present disclosure may feature a system comprising an implant system, at least one suture, and an implant delivery system.
- the implant system includes an anchor configured to be secured in bone beneath a patient's articular surface, and an implant configured to be secured to the anchor.
- the implant is configured to replace a portion of the patient's articular surface.
- the suture has a first portion configured to be disposed about a portion of the anchor.
- the implant delivery system includes a driver including a shaft, and a biasing body having a first end region configured to engage the driver and a second end region configured to engage a portion of an implant.
- the driver is configured to wind a second portion of the suture while engaged against the first end region to reduce a length of the suture between the driver and the anchor and generate a biasing force urging the implant into engagement with the anchor, wherein the biasing force is substantially not transmitted to the bone.
- the present disclosure may feature a method of installing an articular surface implant in an excision site formed in a patient's bone.
- the method includes securing an anchor in the patient's bone within the excision site, and applying a biasing force against an implant to urge the implant into engagement with the anchor, wherein the biasing force is substantially not transmitted to the bone.
- the present disclosure may feature an implant system.
- the implant system may include an implant body and an anchor.
- the implant body may include a load bearing surface having a contour substantially corresponding to a removed portion of a patient's articular surface, a bone facing surface, and a first fixation element.
- the anchor may be configured to be secured in bone beneath the removed portion of the patient's articular surface, and may include a second fixation element.
- the first and the second fixation element may be are configured to form a snap-fit connection therebetween.
Abstract
Description
- This application claims the benefit of U.S. Provisional Application Ser. No. 61/949,774, filed Mar. 7, 2014; U.S. Provisional Application Ser. No. 61/949,789, filed Mar. 7, 2014; U.S. Provisional Application Ser. No. 61/949,824, filed Mar. 7, 2014; and U.S. Provisional Application Ser. No. 61/950,762, filed Mar. 10, 2014, the entire disclosures of which are fully incorporated herein by reference.
- The present disclosure relates to delivery systems for bone implants, and more particularly, to delivery systems for articular surface implants.
- Articular cartilage, found at the ends of articulating bone in the body, is typically composed of hyaline cartilage, which has many unique properties that allow it to function effectively as a smooth and lubricious load-bearing surface. When injured, however, hyaline cartilage cells are not typically replaced by new hyaline cartilage cells. Healing is dependent upon the occurrence of bleeding from the underlying bone and formation of scar or reparative cartilage called fibrocartilage. While similar, fibrocartilage does not possess the same unique aspects of native hyaline cartilage and tends to be far less durable.
- In some cases, it may be necessary or desirable to repair the damaged articular cartilage using an implant. One method of installing an implant involves applying a blunt force, e.g., a hammer/mallet or the like, to the implant. Unfortunately, some of the blunt force is transmitted from the implant into the surrounding bone and/or tissue and can cause damage to the bone/tissue. This is particularly problematic in small bones (such as, but not limited to, bones in the hand and/or foot) as well as patients who suffer from reduced bone mass and density that can lead to fracture (such as, but not limited to, osteoporosis or the like).
- Features and advantages of the claimed subject matter will be apparent from the following detailed description of some example embodiments consistent therewith, which description should be considered with reference to the accompanying drawings, wherein:
-
FIG. 1 generally illustrates a cross-sectional view of one embodiment of an implant system consistent with the present disclosure secured within an excision site in a bone; -
FIG. 2 generally illustrates a cross-sectional view of one embodiment of an assembled implant system consistent with the present disclosure; -
FIG. 3 generally illustrates a cross-sectional view of one embodiment of an unassembled implant system consistent with the present disclosure; -
FIG. 4A generally illustrates an exploded, cross-sectional view of one embodiment of an implant delivery system consistent with the present disclosure; -
FIG. 4B generally illustrates a partial view of another embodiment of an implant delivery system consistent with the present disclosure; -
FIG. 5 generally illustrates an assembled, cross-sectional view of one embodiment of an implant delivery system consistent with the present disclosure; -
FIG. 6 generally illustrates an assembled, perspective view of one embodiment of an implant delivery system consistent with the present disclosure; -
FIG. 7 generally illustrates a cross-sectional view of one embodiment of an implant delivery system securing an anchor within an excision site in a bone consistent with the present disclosure; -
FIG. 8 generally illustrates a cross-sectional view of an anchor secured within an excision site in a bone consistent with the present disclosure; -
FIG. 9 generally illustrates a cross-sectional view of an implant delivery system securing an implant to an anchor consistent with the present disclosure; -
FIG. 10 generally illustrates a perspective view of an implant delivery system for securing an implant to an anchor consistent with the present disclosure; -
FIG. 11 generally illustrates another cross-sectional view of an implant delivery system securing an implant to an anchor consistent with the present disclosure; and -
FIG. 12 generally illustrates another perspective view of an implant delivery system for securing an implant to an anchor consistent with the present disclosure. - Although the following Detailed Description will proceed with reference being made to some illustrative example embodiments, many alternatives, modifications, and variations thereof will be apparent to those skilled in the art.
- Generally, the present disclosure may feature systems, devices and/or methods for installing an implant anchor and/or delivering and attaching an implant to the anchor. By way of a general overview, one embodiment of the present disclosure may feature an implant delivery system for use with an implant system having an anchor and an implant (e.g., implant body) configured to be secured thereto. The implant delivery system may be used to facilitate delivering (e.g., securing) the anchor to the bone beneath a patient's articular surface and/or to couple, mount, or otherwise secure the implant body to the anchor. For example, the implant delivery system may be configured to generate sufficient force to allow the implant body to be secured to the anchor without applying any force to the surrounding bone or tissue. More specifically, the implant delivery system may generate and apply a biasing force against the implant and the anchor which urges the implant body into engagement with the anchor, thereby securing the implant body to the anchor without applying any force to the surrounding bone. The biasing force generated by the implant delivery system may therefore be applied only to the implant system, and not the surrounding bone or tissue.
- Because the biasing force is not transmitted/applied into the surrounding bone or tissue, the implant delivery system may reduce, minimize, and/or eliminate damage to the surrounding bone while securing the implant body to the anchor, thereby allowing the implant delivery system to be used with small bones (such as, but not limited to, phalange bones and/or metatarsal bones in the foot and/or hands) as well with patients who suffer from reduced bone mass and density that can lead to fracture (such as, but not limited to, osteoporosis or the like). Additionally, because the implant delivery system is capable of generating high biasing forces without transmitting/applying the biasing force to the surrounding bone or tissue, the connection between the implant body and the anchor may be stronger and more robust, thereby increasing the life expectancy of the implant system.
- Turning now to
FIGS. 1-3 , one embodiment of animplant system 10 which may be used with an implant delivery system consistent with the present disclosure is generally illustrated. In particular,FIG. 1 generally illustrates theimplant system 10 installed in thearticular surface 12 of a patient'sbone 14,FIG. 2 generally illustrates an assembledimplant system 10, andFIG. 3 generally illustrates an exploded, unassembledimplant system 10 consistent with the present disclosure. Theimplant system 10 may generally include an implant (e.g., implant body) 16 configured to be secured to ananchor 18. Theanchor 18 is configured to be secured to thebone 14 within anexcision site 20 formed beneath the patient'sarticular surface 12 such that aload bearing surface 22 of theimplant 16 is generally flush with the patient's surroundingarticular surface 12 as generally illustrated inFIG. 1 . Theexcision site 20 may be formed using any method and system known to those skilled in the art, such as, but not limited to, as the systems and methods as described in U.S. Pat. Nos. 6,520,964, 6,610,067, 6,679,917, 7,678,151, 7,896,883, 8,177,841, and 8,388,624, as well as U.S. Publication No. 2010/0368238, all of which are fully incorporated herein by reference. According to one embodiment, theanchor 18 may be secured to thebone 14, for example, using one or more external threads, ribs, protrusions, bone cement, barbs, grooves or anyother structure 21 that enables theanchor 18 to be secured to thebone 14. The use ofthreads 21 as generally illustrated may advantageously allow the height of theimplant 12 to be adjusted by rotating theanchor 18 within thebone 14 such that theimplant 16 is flush with the surroundingarticular surface 12. - It should be appreciated that the
implant system 10 illustrated is provided for illustrative purposes, and that the implant delivery system may be used with any multi-piece implant having an anchor that is coupled (either directly or indirectly) to an implant/implant body. For example, the implant delivery system may be used with implant systems for replacing any articular surface such as, but not limited to, shoulder joints (e.g., but not limited to, the glenohumeral joint), hip joint (e.g., but not limited to, the acetabulofemoral joint), foot and/or hand joints (e.g., but not limited to, metacarpophalangeal joints, metatarsophalangeal joints, and/or interphalangeal joints), or the like. The implant systems may include total joint implants (wherein all or substantially all of the articular surface of at least one bone is replaced with the artificial surface of the implant) and/or partial implants (wherein substantially only the damaged portion(s) of the articular surface of a bone is replaced with the artificial surface of the implant). The implant delivery system may also be used to secure together a multi-piece pin or rod in a bone to facilitate healing of a fracture or broken bone. - As discussed above, the
implant 16 may be secured to theanchor 18 by way of a connection. For example, theimplant 16 may include at least onefirst fixation element 24 configured to engage with at least onesecond fixation element 26 of theanchor 18 to secure theimplant 16 to theanchor 18. According to one embodiment, the first and thesecond fixation elements second fixation elements implant 16 andanchor 18, and/or about one or more regions of the perimeter/periphery. The first andsecond fixation elements implant 16 from becoming free relative to the anchor 18 (for example, to prevent axial and/or rotational movement of theimplant 16 relative to the anchor 18). Optionally, theimplant 16 may be at least partially received in animplant cavity 28 formed in theanchor 18 such that abone facing surface 30 of theimplant 16 engages against at least a portion of theimplant cavity 28, thereby preventing theimplant 16 from moving distally when a force is applied to theload bearing surface 22. - It should be appreciated that while the first and
second fixation elements implant system 10 consistent with the present disclosure is not limited to this arrangement unless specifically claimed as such. For example, the first andsecond fixation elements anchor 18 may optionally include apassageway 32, for example, a longitudinal passageway, configured to be advanced over a guide wire (not shown) as generally described in U.S. Pat. Nos. 6,520,964, 6,610,067, 6,679,917, 7,678,151, 7,896,883, 8,177,841, and 8,388,624, as well as U.S. Publication No. 2010/0368238, all of which are fully incorporated herein by reference. For example, theanchor 18 may be inserted intobone 14 or may be inserted into a shaft drilled in thebone 14 to reduce risks or complications arising from the insertion of theanchor 18. Without limitation, a pilot hole may be formed in thebone 14 for receiving theanchor 18 prior to installing theanchor 18. A diameter of the pilot hole may be smaller than theanchor 18, although example embodiments may vary and are not limited thereto. - It may be appreciated that the strength or ruggedness of the snap-fit connection between the
implant 16 and theanchor 18 may depend on the selected materials (e.g., the rigidity) and size/dimensions. In general, more rigid (i.e., less deformable) materials and/or larger sizes/dimensions will result in a stronger, more robust connection between theimplant 16 and theanchor 18. While a stronger and more robust connection between theimplant 16 and theanchor 18 is generally desirable, the resulting force necessary to make the snap-fit connection increases. - Traditionally, the force necessary to secure the
implant 16 to theanchor 18 has been generated using a blunt force, e.g., a hammer/mallet or the like. More specifically, with theanchor 18 secured in thebone 14, the surgeon attempts to align theimplant 16 relative to theanchor 18 and impacts theimplant 16 with the hammer/mallet to force theimplant 16 into engagement with theanchor 18. As may be appreciated, however, a substantial amount of force is also applied to the surroundingbone 14, and if the force applied to thebone 14 is too great, thebone 14 may be damaged. Consequently, the strength of the connection between theimplant 16 and theanchor 18 may be limited in many applications (e.g., but not limited to, small bones in the hand and foot as well asimplant system 10 installed proximate to the perimeter of a bone) by the strength of the surroundingbone 14. Additionally, it may be very difficult for the surgeon to properly align theimplant 16 with respect to theanchor 18. - As discussed herein, the implant delivery system consistent with one embodiment of the present disclosure solves this problem by generating a biasing force to secure the
implant 16 to theanchor 18 wherein the biasing force is only applied against theimplant 16 and theanchor 18. The biasing force generated by the implant delivery system may therefore be applied only to theimplant system 10, and not the surrounding bone ortissue 14. An implant delivery system consistent with the present disclosure may also be used to facilitate securing theanchor 18 into thebone 14. Features and aspects of an implant delivery system consistent with the present disclosure will generally be described. - Turning now to
FIGS. 4-12 , systems and methods for securing ananchor 18 into the bone and securing theimplant 16 to theanchor 18 using animplant delivery system 100 consistent with the present disclosure are generally illustrated. In a first mode (as generally illustrated inFIGS. 4-8 ), theimplant delivery system 100 may be used to secure theanchor 18 into an excision site formed in the bone. In a second mode (FIGS. 9-12 ), thedelivery system 100 may be used to secure theimplant 16 to theanchor 18 to assemble theimplant system 10 within the excision site. As may be appreciated, theimplant delivery system 100 may be used with anyimplant system 10 described herein and is not limited to the illustratedimplant system 10 unless specifically claimed as such. - With reference to
FIGS. 4-8 , one embodiment of system and method for using theimplant delivery system 100 to secure theanchor 18 to bone within an excision site is generally illustrated. Theimplant delivery system 100 may include adriver 110, a biasingbody 112, and at least onesuture 114. As explained herein, theimplant delivery system 100 may be configured to retain theanchor 18 into engagement with thedriver 110 and to secure theanchor 18 tobone 14 within an excision site 20 (as generally illustrated inFIGS. 7 and 8 ). For example, thedriver 110 may be received through the biasingbody 112, and thesuture 114 may be disposed around a portion of theanchor 18 to provide increased control and/or maintain contact between thedriver 110 and theanchor 18 while securing theanchor 18 into thebone 14 within theexcision site 20. Theexcision site 20 may be formed using any method and system known to those skilled in the art. - The
driver 110,FIG. 4A , includes a longitudinally disposedshaft 116 having anengagement portion 118 disposed about adistal end 120. Theengagement portion 118 is configured to be coupled with acorresponding engagement portion 122 of theanchor 18 and to transmit torque as generally illustrated inFIGS. 5-7 . For example, theengagement portion 118 may be a male-shaped coupling unit (such as, but not limited to, a splined or hex-shaped driver) configured to couple with a female-shaped coupling unit 122 (such as, but not limited to, a splined or hex-shaped recession formed in the anchor 18) in order to rotate or drive theanchor 18 into the bone. However, theengagement portions driver 110 may be configured to accept interchangeable bits having adifferent engagement portion 118 configurations, thereby allowing theengagement portion 118 of thedriver 110 to be coupled to the engagingportion 122 of theanchor 18 using several different bits as necessary. Alternatively (or additionally), theengagement portion 118 may have a female-shaped coupling unit and theanchor 18 may have a male-shaped coupling unit. The shape of the engagingportions engagement portion 118 may be magnetized or otherwise configured to maintain contact or control over theanchor 18. - While the engaging
portion 122 of theanchor 18 is shown located on an inner wall of the narrow portion of theanchor 18, example embodiments may vary and are not limited thereto. For example, the engagingportion 122 of theanchor 18 may be located on an inner wall of the wide portion of theanchor 18 and/or on an outer wall of either the narrow portion or the wide portion of theanchor 18. Optionally, an intermediate or adapting portion (not shown) may be used to connect thedriver 110 to theanchor 18. - The
driver 110 may optionally include ahandle 124. Thehandle 124 may facilitate grasping of thedriver 110 and may be configured to cause a rotational force or a torque on theshaft 116, which may ultimately impart a rotational force or torque on theanchor 18 to secure theanchor 18 into the bone. Thehandle 124 may be separate from the shaft 116 (either permanently or removably coupled thereto), or may be a unitary, single piece with theshaft 116. While thehandle 124 is illustrated as having a larger width than theshaft 116, example embodiments may vary and are not limited thereto. For example, thehandle 124 may include a lever arm or may be configured to couple to a lever arm that is used to create the rotational force or torque. - The
handle 124 and/or theshaft 116 may be cannulated to define alongitudinal passageway 126. Thelongitudinal passageway 126 may include proximal anddistal openings anchor 18 into the bone within the excision site. - The biasing
body 112 defines ashaft passageway 132 extending between a first and asecond end region second opening shaft passageway 132 is configured to receive at least a portion of theshaft 116 of thedriver 110, for example, as generally illustrated inFIGS. 5 and 6 . Theshaft 116 and theshaft passageway 132 may be configured such that thedistal end 120 of theshaft 116 extends beyond thesecond end 134 b of theshaft passageway 132 to allow theengagement portion 118 of thedriver 110 to engage thecorresponding engagement portion 122 of theanchor 18, for example, as generally illustrated inFIGS. 5 and 6 . Optionally, the biasingbody 112 may include adriver cradle 121, discussed in greater detail herein, which may be used to secure the implant 16 (not shown) with theanchor 18. - Additionally, the
second end region 130 b may include a fixation element 25 (FIG. 4B ) which substantially corresponds to thefirst fixation element 24 of theimplant 16. In this manner, thefixation element 25 of thesecond end region 130 b of the biasingbody 112 may be coupled to thesecond fixation element 26 of theanchor 18 to generally secure theanchor 18 to the biasingbody 112. The connection between the biasingbody 112 and theanchor 18 may facilitate placement of theanchor 18 within the excision site by creating a generally secure connection therebetween. It may be appreciated, however, that the connection between thefixation element 25 of thesecond end region 130 b and thesecond fixation element 26 of theanchor 18 does not need to be as strong as the connection between the first andsecond fixation elements anchor 18 to and align theanchor 18 within the excision site. - Alternatively (or in addition to), the biasing
body 112,FIG. 4A , may be configured to receive asuture 114 disposed around (e.g., wrap around) a portion of theanchor 18. Tension may be applied to thesuture 114 to generally urge theanchor 18 into contact with thedriver 110 and/or the biasingbody 112 to provide more control over and/or maintain contact between thedriver 110 and theanchor 18. Thesuture 114 may be configured to extend through and/or around the biasingbody 112 in any manner known to those skilled in the art. For example, thesuture 114 may extend through thefirst opening 134 a of theshaft passageway 132 of the biasingbody 112, out through one or more suture apertures/openings/passageways contact portion 140 of theanchor 18. The suture passageways 136 a, 136 b may allow thesuture 114 to pass from the exterior of the biasingbody 112 to the interior of theshaft passageway 132. While thesuture passageways body 112, example embodiments may vary and are not limited thereto. It should also be appreciated that thesuture 114 does not have to pass through theshaft passageway 132, and instead the biasingbody 112 may include one or more separate passageways (not shown) for thesuture 114. - The suture alignment guides 138 a, 138 b are configured to retain the
suture 114 about the distal end of the biasingbody 112. According to one embodiment, thesuture 114 may include a first and asecond portion 142 a, 142 b (best seen inFIG. 6 ) which form a basket, cradle, or frame 144 extending about the contact portion of theanchor 18. The first andsecond portions 142 a, 142 b may be formed from two or more pieces of suture, or may be formed from a single piece of suture. The suture alignment guides 138 a, 138 b may be configured to prevent the first andsecond portions 142 a, 142 b of thecradle 144 from slipping off theanchor 18 by restricting the separation angle S of the first andsecond portions 142 a, 142 b of thecradle 144. - While the suture alignment guides 138 a, 138 b are shown at the distal end of the biasing
body 112 nearest theanchor 18, example embodiments may vary and are not limited thereto. For example, the suture alignment guides 138 a, 138 b may be located anywhere along the biasingbody 112 provided the suture alignment guides 138 a, 138 b may prevent thesuture 114 from slipping off theanchor 18. Additionally, while the suture alignment guides 138 a, 138 b are shown as an exterior protrusion of the biasingbody 112 with holes to allow thesuture 114 to pass through, example embodiments may vary and are not limited thereto. For example, the suture alignment guides 138 a, 138 b may be flush with the biasingbody 112 or may protrude in an arc shape, with a gap between one edge of the suture alignment guides 138 a, 138 b and the biasingbody 112 to allow thesuture 114 to enter. It may also be appreciated that the length of the suture alignment guides 138 a, 138 b may vary and the suture alignment guides 138 a, 138 b may be integrated into thesuture passageways - While the
contact portion 140 of theanchor 18 is shown on the bottom edge of theanchor 18, example embodiments may vary and thecontact portion 140 may be situated anywhere along theanchor 18. For example, thecontact portion 140 may also be disposed about the top portion ofanchor 18. Thecontact portion 140 of theanchor 18 may include a flat edge or may include guides, grooves, slots, or channels configured to receive thesuture 114. For example, thesuture 114 may extend through a passageway formed in theanchor 18 such that a portion of theanchor 18 generally surrounds thesuture 114, and thecradle 144 may be eliminated. - To secure the
anchor 18 to thebone 14 within theexcision site 20, thesuture 114 may be received through the biasing body 112 (e.g., through thefirst opening 134 a of theshaft passageway 132, out through thesuture passageways cradle 144 is disposed about thecontact portion 140 of theanchor 18 as generally illustrated inFIG. 4A . Thedriver 110 may be advanced throughshaft passageway 132 until theengagement portion 118 contacts thecorresponding engagement portion 122 of theanchor 18. Thesuture 114 may then be tensioned to retain the engagement between thedriver 110 and theanchor 18, for example, by applying a force against thesuture 114 in a direction generally away from theanchor 18 as generally illustrated inFIGS. 5 and 6 . Alternatively (or in addition), the fixation element 25 (FIG. 4B ) of the biasingbody 112 may be secured to thefixation element 26 of theanchor 18, and thedriver 110 may engage theanchor 18 as described herein. - With the
anchor 18 securely engaged with thedriver 110, theanchor 18 may be advanced to and aligned with the excision site 20 (as generally illustrated inFIG. 7 ) formed in the patient'sarticular surface 12 andbone 14. Optionally, theanchor 18 may be aligned with theexcision site 20 using aguide wire 146 extending outwardly from thebone 14 within theexcision site 20. Because theanchor 18 is retained against thedriver 110, it is easier for the surgeon to align theanchor 18 relative to theexcision site 20. As discussed herein, theanchor 18 may optionally include a cannulated passageway 32 (best seen inFIG. 4A ) that is generally aligned with (e.g., generally co-axial) thelongitudinal passageway 126 of the driver 110 (as best illustrated inFIG. 7 ) such that theanchor 18 and the driver 110 (and optionally the biasing device 112) may be advanced over theguide wire 146. The optionally use of the cannulatedpassageway 32 and theguide wire 146 may further aid in aligning theanchor 18 at the desired angle with respect to theexcision site 20 and the surroundingarticular surface 12. - Once the
anchor 18 is aligned with respect to theexcision site 20, thedriver 110 may then be used to secure theanchor 18 into thebone 14, for example, by rotating thedriver 110, thereby causing theanchor 18 to rotate. The height of theanchor 18 may be verified using a trial gauge (not shown) which may be easily inserted/placed into theanchor 18 to ensure that the implant 16 (e.g.,FIG. 1 ) is substantially flush with the surroundingarticular surface 21. Once the height of theanchor 18 is verified, the driver 110 (and optionally thebiasing device 112 and/or the guide wire 146) may be removed, leaving the anchor 18 (and optionally the suture 114) remaining in thebone 14, as generally illustrated inFIG. 8 . While theanchor 18 is illustrated havingthreads 21, it may be appreciated that theanchor 18 may be secured to thebone 14 using any device(s) known to those skill in the art including, but not limited to, ribs, barbs, bone cement, porous structures, and the like. - It should also be appreciated that the
biasing device 112 does not have to be used when advancing and/or aligning theanchor 18 with respect theexcision site 20. For example, thebiasing device 112 may be eliminated and tension may be applied to thesuture 114 to keep theanchor 18 engaged with thedriver 110. Alternatively, theanchor 18 may be advanced to and aligned with theexcision site 20 without using thedriver 110. For example, thesuture 114 may be secured about a portion of theanchor 18, and once theanchor 18 is aligned within theexcision site 20, thedriver 110 may engage theanchor 18 and used to secure theanchor 18 within theexcision site 20 in thebone 14. - Turning now to
FIGS. 9-12 , systems and methods for securing animplant 16 to theanchor 18 using animplant delivery system 100 consistent with the present disclosure are generally illustrated. As discussed herein, theimplant delivery system 100 may be configured to generate a biasing force to secure theimplant 16 to theanchor 18 wherein the biasing force is only applied against theimplant 16 and theanchor 18, and not the surrounding bone ortissue 14. - With the
anchor 18 secured to thebone 14 and thesuture 114 disposed about thecontact portion 140 of theanchor 18 as described herein, theimplant 16 may be arranged (i.e., placed) between theanchor 18 and thesecond end region 130 b of thebiasing device 112 as generally illustrated inFIGS. 9 and 10 . Thesuture 114 may extend around thecontact portion 140 of theanchor 18, through suture alignment guides 138 a, 138 b andsuture passageways first opening 134 a of theshaft passageway 132 of the biasingbody 112. Thesuture 114 may also be generally coupled or secured to a portion of thedriver 110, for example, a portion of theshaft 116. For example, thedriver 110 may include asuture engagement 148 configured to allow thesuture 114 to be generally fixed or retained by thedriver 110. - According to one embodiment, the
suture engagement 148 may include a hole or aperture through theshaft 116. At least a portion of thesuture 114 may pass through thehole 148, and thesuture 114 may be secured within thesuture engagement 148 as thedriver 110 is rotated to reduce the length L of thesuture 114 between thedriver 110 and theanchor 18 as explained herein. It should be appreciated that thesuture engagement 148 may include any device for generally securing thesuture 114 to thedriver 110. For example, thesuture engagement 148 may include an external protrusion, a groove, non-cylindrical region, and/or a slot configured to secure thesuture 114. Alternatively, thesuture 114 may be wrapped around theshaft 116, and the tension generated by the rotation of thedriver 110 may secure thesuture 114 thereto. The length of the biasingbody 112 may be selected to allow the surgeon sufficient room to rotate thedriver 110, and therefore may depend on the intended application. - With the
suture 114 generally secured to thedriver 110, thedriver 110 may be rotated about its longitudinal axis A as it is received within thedriver cradle 121. Thedriver cradle 121 may be configured to receive the driver 110 (e.g., the shaft 116) and generally retain theshaft 116 as theshaft 116 is rotated relative to the biasingbody 112. For example, thedriver cradle 121 may include one or ore recesses, grooves, or lips formed in thefirst end region 134 a of the biasingbody 112. Thedriver cradle 121 may also include one or more holes or passageways formed through the biasingbody 112 configured to receive and generally retain theshaft 116. - Optionally, the
driver cradle 121 may include an enlarged opening 150 (best seen inFIG. 9 ). As thedriver 110 is rotated, thesuture 114 begins to wrap around theshaft 116, thereby increasing the diameter of theshaft 116. Theenlarged opening 150 provides a void space that thesuture 114 can pass through as thedriver 110 is rotated and thesuture 114 builds up around theshaft 116. As a result, thesuture 114 may generally avoid contact with thedriver cradle 121, and the torque necessary to rotate thedriver 110 may be reduced. - Turning now to
FIGS. 11 and 12 , with theimplant 16 disposed between theanchor 18 and the second end region 132 b of the biasingbody 112, and the driver 110 (along with thesuture 114 generally secured thereto) disposed within thedriver cradle 121, the surgeon may rotate thedriver 110 about longitudinal axis A to reduce the length L of thesuture 114 extending between thedriver 110 and thecontact portion 120 of theanchor 118. The reduction in the length L of thesuture 114 generates a biasing force which urges theimplant 16 into engagement with theanchor 18. As may be appreciated, theimplant delivery system 100 generates a biasing force which is applied against theimplant 16 andanchor 18 through thesuture 114 only (i.e., substantially no force is applied to the surroundingbone 14 or tissue). - More specifically, because the
suture 114 supports theanchor 18, rotation of thedriver 110 about longitudinal axis A increases the tension on the suture 114 (and therefore the biasing force between theimplant 16 and the anchor 18) in an opposite direction of the downward force being placed upon theimplant 16 by the biasingbody 112. Continued rotation of thedriver 110 increases the biasing force between theimplant 16 and theanchor 18 and, once the biasing force exceeds the required threshold to install theimplant 16, theimplant 16 may be successfully installed (e.g., secured) in theanchor 18. Thus, as a result of thesuture 114 applying a relatively equal and opposite force to theanchor 18 and the biasing device 110 (and therefore the implant 16), the underlyingbone 14 and other structures are not affected, preventing or reducing potential injury from securing theimplant 16 into theanchor 18. Theimplant delivery system 100 therefore avoids and/or reduces any impact to the bone 14 (e.g., eliminates blunt force due to a hammer/mallet or the like), and therefore avoids and/or reduces damage to thebone 16. - Because the biasing force is not transmitted/applied into the surrounding
bone 14 or tissue, theimplant delivery system 100 may be used with small bones (such as, but not limited to, phalange bones and/or metatarsal bones in the foot and/or hands. Additionally, because theimplant delivery system 100 is capable of generating high biasing forces without transmitting/applying the biasing force to the surroundingbone 14 or tissue, the connection between theimplant body 16 and the anchor 18 (e.g., first andsecond fixation elements implant system 10. Moreover, theimplant delivery system 100 may deliver the biasing force uniformly to theimplant 16 and be self-leveling or self-aligning, thereby reducing and/or eliminating the difficulties associated with aligning theimplant 16 with respect to theanchor 18. - Once the
implant 16 is secured to theanchor 18, thesuture 114 may be removed from theimplant system 10. For example, one or more portions of thesuture 114 may be cut and the resulting pieces may be removed (e.g., pulled out) from theexcision site 20. Alternatively, a first end of thesuture 114 may be released and thesuture 114 may be pulled through the biasingbody 120 by a second end of thesuture 114, resulting in the first end traveling through the shaft passageway 132 c, through one of thesuture passageways anchor 18 and through the second of the alignment guides 138 a, 138 b andsuture passageways shaft passageway 132. However, example embodiments may vary and are not limited thereto. - If the
suture 114 is cut prior to removal, example embodiments may vary and may include thesuture 114 having various shapes or loops. For example, thesuture 114 may form a basket or loop to wrap around theanchor 18. This shape may help support theanchor 18 and may increase control over theanchor 18 prior to thesuture 114 being wrapped around thedriver 110. In this configuration, the loop may extend so that the loop can be severed after installation of theimplant system 10. - According to one aspect, the present disclosure may feature a delivery system for securing an implant with an anchor. The delivery system may include a driver including a shaft and a biasing body. The driver may be configured to wind a portion of a suture, wherein the suture is configured to extend around a contact portion of the anchor disposed within a bone. The biasing body may have a first end region and a second end region. The first end region may include a driver cradle configured to generally retain a portion of the shaft as the driver is rotated relative to the biasing body. The second end region may be configured to engage a portion of the implant. Rotation of the driver applies a biasing force against the implant and the anchor to secure the implant with the anchor, wherein the biasing force is substantially not transmitted to the bone.
- According to another aspect, the present disclosure may feature a system comprising an implant system, at least one suture, and an implant delivery system. The implant system includes an anchor configured to be secured in bone beneath a patient's articular surface, and an implant configured to be secured to the anchor. The implant is configured to replace a portion of the patient's articular surface. The suture has a first portion configured to be disposed about a portion of the anchor. The implant delivery system includes a driver including a shaft, and a biasing body having a first end region configured to engage the driver and a second end region configured to engage a portion of an implant. The driver is configured to wind a second portion of the suture while engaged against the first end region to reduce a length of the suture between the driver and the anchor and generate a biasing force urging the implant into engagement with the anchor, wherein the biasing force is substantially not transmitted to the bone.
- According to yet another aspect, the present disclosure may feature a method of installing an articular surface implant in an excision site formed in a patient's bone. The method includes securing an anchor in the patient's bone within the excision site, and applying a biasing force against an implant to urge the implant into engagement with the anchor, wherein the biasing force is substantially not transmitted to the bone.
- According to a further aspect, the present disclosure may feature an implant system. The implant system may include an implant body and an anchor. The implant body may include a load bearing surface having a contour substantially corresponding to a removed portion of a patient's articular surface, a bone facing surface, and a first fixation element. The anchor may be configured to be secured in bone beneath the removed portion of the patient's articular surface, and may include a second fixation element. The first and the second fixation element may be are configured to form a snap-fit connection therebetween.
- The terms and expressions which have been employed herein are used as terms of description and not of limitation, and there is no intention, in the use of such terms and expressions, of excluding any equivalents of the features shown and described (or portions thereof), and it is recognized that various modifications are possible within the scope of the claims. Accordingly, the claims are intended to cover all such equivalents. Various features, aspects, and embodiments have been described herein. The features, aspects, and embodiments are susceptible to combination with one another as well as to variation and modification, as will be understood by those having skill in the art. The present disclosure should, therefore, be considered to encompass such combinations, variations, and modifications.
- All definitions, as defined and used herein, should be understood to control over dictionary definitions, definitions in documents incorporated by reference, and/or ordinary meanings of the defined terms.
- The indefinite articles “a” and “an,” as used herein in the specification and in the claims, unless clearly indicated to the contrary, should be understood to mean “at least one.”
- The phrase “and/or,” as used herein in the specification and in the claims, should be understood to mean “either or both” of the elements so conjoined, i.e., elements that are conjunctively present in some cases and disjunctively present in other cases. Other elements may optionally be present other than the elements specifically identified by the “and/or” clause, whether related or unrelated to those elements specifically identified, unless clearly indicated to the contrary.
- All references, patents and patent applications and publications that are cited or referred to in this application are incorporated in their entirety herein by reference.
Claims (31)
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US11399948B2 (en) | 2017-12-11 | 2022-08-02 | Howmedica Osteonics Corp. | Stemless prosthesis anchor components and kits |
US11478358B2 (en) | 2019-03-12 | 2022-10-25 | Arthrosurface Incorporated | Humeral and glenoid articular surface implant systems and methods |
US11642223B2 (en) | 2019-10-01 | 2023-05-09 | Howmedica Osteonics Corp. | Shoulder prosthesis components and assemblies |
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US20190029836A1 (en) | 2019-01-31 |
US9861492B2 (en) | 2018-01-09 |
US20230255780A1 (en) | 2023-08-17 |
US20220054274A1 (en) | 2022-02-24 |
US20220062000A1 (en) | 2022-03-03 |
US20210022877A1 (en) | 2021-01-28 |
US20230248529A1 (en) | 2023-08-10 |
US9931219B2 (en) | 2018-04-03 |
US10624754B2 (en) | 2020-04-21 |
US11766334B2 (en) | 2023-09-26 |
US20150250594A1 (en) | 2015-09-10 |
US20190105165A1 (en) | 2019-04-11 |
US11083587B2 (en) | 2021-08-10 |
US10575957B2 (en) | 2020-03-03 |
US20150250602A1 (en) | 2015-09-10 |
US9962265B2 (en) | 2018-05-08 |
US20190105166A1 (en) | 2019-04-11 |
US20150250475A1 (en) | 2015-09-10 |
US20210030549A1 (en) | 2021-02-04 |
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