U.S. patent application number 10/121455 was filed with the patent office on 2002-12-05 for method and system for mammalian joint resurfacing.
Invention is credited to Arsenyev, Alexander, Buscemi, Paul J., Felt, Jeffrey C., Porter, Christopher H., Rydell, Mark A..
Application Number | 20020183850 10/121455 |
Document ID | / |
Family ID | 22857197 |
Filed Date | 2002-12-05 |
United States Patent
Application |
20020183850 |
Kind Code |
A1 |
Felt, Jeffrey C. ; et
al. |
December 5, 2002 |
Method and system for mammalian joint resurfacing
Abstract
A method and system for the creation or modification of the wear
surface of orthopedic joints, involving the preparation and use of
one or more partially or fully preformed and procured components,
adapted for insertion and placement into the body and at the joint
site. In a preferred embodiment, component(s) can be partially
cured and generally formed ex vivo and further and further formed
in vivo at the joint site to enhance conformance and improve long
term performance. In another embodiment, a preformed balloon or
composite material can be inserted into the joint site and filled
with a flowable biomaterial in situ to conform to the joint site.
In yet another embodiment, the preformed component(s) can be fully
cured and formed ex vivo and optionally further fitted and secured
at the joint site. Preformed components can be sufficiently pliant
to permit insertion through a minimally invasive portal, yet
resilient enough to substantially assume, or tend towards, the
desired form in vivo with additional forming there as needed.
Inventors: |
Felt, Jeffrey C.;
(Greenwood, MN) ; Rydell, Mark A.; (Golden Valley,
MN) ; Buscemi, Paul J.; (Long Lake, MN) ;
Arsenyev, Alexander; (Eagan, MN) ; Porter,
Christopher H.; (Woodinville, WA) |
Correspondence
Address: |
Philip M. Goldman
FREDRIKSON & BYRON, P.A.
1100 International Centre
900 Second Avenue South
Minneapolis
MN
55402-3397
US
|
Family ID: |
22857197 |
Appl. No.: |
10/121455 |
Filed: |
April 12, 2002 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10121455 |
Apr 12, 2002 |
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10098601 |
Mar 15, 2002 |
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10098601 |
Mar 15, 2002 |
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PCT/US01/41908 |
Aug 28, 2001 |
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60228444 |
Aug 28, 2000 |
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Current U.S.
Class: |
623/20.16 |
Current CPC
Class: |
C08G 18/10 20130101;
C08G 18/61 20130101; A61F 2/389 20130101; C08G 18/10 20130101; A61F
2/38 20130101; A61F 2002/30535 20130101; A61L 27/18 20130101; C08G
18/4854 20130101; A61L 27/18 20130101; A61F 2/3877 20130101; A61B
17/562 20130101; A61F 2/34 20130101; A61F 2250/0058 20130101; A61F
2/30721 20130101; C08G 18/32 20130101; C08L 75/04 20130101; A61L
2430/24 20130101; C08G 18/69 20130101; A61F 2/3872 20130101 |
Class at
Publication: |
623/20.16 |
International
Class: |
A61F 002/38 |
Claims
What is claimed is:
1. A system for the creation or modification of an orthopedic joint
within a mammalian body, the system comprising one or more
partially or fully preformed polymeric components, adapted to be
inserted and positioned at a joint site to provide an implant
having at least one major surface in apposition to supporting bone,
and at least a second major surface in apposition to opposing bone,
wherein the implant is provided in the form of a preformed knee
implant prepared using an ex vivo mold and having a first major
surface adapted to be positioned upon and congruent with the tibial
surface, and a second major surface being suitably textured to
improve surface lubricity and adapted to be positioned against the
femoral condyle, and wherein the second major surface is provided
with a femoral glide path to facilitate its performance in situ,
the glide path being in the form of a generally central depression,
the implant further comprising at least one ancillary component
integrated into, and partially extending from, the implant to
provide anterior fixation.
2. A system according to claim 1 wherein one or more of the
polymeric components are formed at the time of use, by the use of a
curable polymer system adapted to be at least partially cured and
partially formed by ex vivo molding in order to provide an
implantable component adapted to be inserted and positioned in
vivo, under conditions suitable to permit the implanted component
to become finally formed upon reestablishing the natural joint
space and in conformance with the opposing bone surfaces of the
orthopedic joint site.
3. A system according to claim 1 wherein the polymeric components
comprise a plurality of packaged, preformed components adapted to
be assembled at the orthopedic joint site in a minimally invasive
fashion to provide a final prosthesis having surfaces in
conformance with at least one of the opposing bone surfaces of the
orthopedic joint site.
4. A system according to claim 1 further comprising an ex vivo mold
having a molding surface adapted to provide a roughened, patterned,
and/or contoured surface to the partially preformed component, in a
manner sufficient to provide improved retention and fit of the
component at the joint site.
5. A system according to claim 4 wherein the mold further provides
ancillary means adapted to be incorporated into the preformed
component for securing the component once formed in the joint
site.
6. A system according to claim 5 wherein the ancillary means
comprise one or more protrusions adapted to be attached to either
soft tissue and/or bone at the joint site to improve fixation.
7. A system according to claim 4 wherein the contoured surface
comprises a contour having one or more protrusions, integral with
the preformed component, and formed during the ex vivo molding
process.
8. A system according to claim 6 wherein the protrusions are
adapted to be integrated into the preformed component during the ex
vivo molding process.
9. A system according to claim 7 wherein the protrusions are
comprised of sutures and/or fibrous biomaterials integrally formed
with the component itself.
10. A system according to claim 4 further comprising separate
means, not associated with the mold itself, for securing the
component to the joint site, selected from the group consisting of
adhesives, sutures, pins, staples, screws, and combinations
thereof.
11. A system according to claim 1 wherein the one or more preformed
polymeric component(s) are adapted to be inserted into a joint in a
minimally invasive fashion.
12. A system according to claim 2 in which the preformed
component(s) and/or corresponding mold(s) are provided in a
plurality or range of styles and sizes for selection and use in the
surgical field.
13. A system according to claim 1 wherein the implant is adapted
for use on the tibial surface of the knee, and provides portions
adapted to conform to the shape of the femoral condyle and
corresponding medial tibial plateau, lateral tibial plateau, or
both.
14. A system according to claim 1 wherein the polymeric component
is fabricated from a material selected from the group consisting of
polyurethanes, polyureas, hydrogels, polysiloxanes, polyacrylates,
and epoxies, and combinations thereof.
15. A system according to claim 14 wherein the polymeric component
comprises a polyurethane.
16. A system according to claim 15 wherein the polyurethane is
prepared from polyisocyanate(s), short and long chain polyols, and
optionally including one or more ingredients selected from the
group hydrophobic additive(s), tin and/or amine catalyst(s), and
antioxidant(s).
17. A system according to claim 16 wherein the polyurethane
comprises aromatic polyisocyanates, PTMO's, and short chain
diols.
18. A system according to claim 16 wherein the hydrophobic additive
comprises hydroxyl-terminated polybutadiene, and the tin and/or
amine catalyst(s) are adapted to promote the isocyanate--hydroxyl
reaction preferentially and are selected from the group consisting
of UL22, Cotin 222, 1,4-diazabicyclo[2.2.2]octane (dabco), and
dibutyltin dilaurate (DBTDL), and combinations thereof.
19. A system according to claim 14, wherein the preformed polymeric
component comprises one or more surfaces having attached thereto a
biologically active agent selected from the group cytokines, growth
factors, autologous growth factors, hydroxyapatite, collagen, and
combinations thereof.
20. A system according to claim 14 wherein the surface of the
preformed component is provided or modified with reactive groups to
promote tissue adhesion.
21. A system according to claim 20 wherein the reactive groups are
provided by the polymers used to fabricate the polymeric component,
and are selected from amines, hydroxyl groups, or other reactive or
hydrogen bonding functionalities.
22. A system for the creation or modification of the wear surface
of an orthopedic joint within a mammalian body, the system
comprising one or more preformed polymeric components adapted to be
positioned within the joint site and one or more flowable
biomaterial polymer compositions adapted to be arthroscopically
injected into contact with a preformed component and cured in situ
at the joint site in order to provide a composite implant.
23. A system according to claim 22 wherein the preformed polymeric
components comprise an inflatable balloon having a preformed top
weight-bearing wear portion and a preformed bottom portion adapted
to conform to the shape of supporting bone.
24. A system according to claim 23 wherein the one or more portions
of the balloon are fabricated from a natural or synthetic fabric
adapted to permit tissue in-growth, and sufficiently permeable to
permit air to escape while retaining the curable biomaterial.
25. A system according to claim 24 wherein the fabric is of
sufficient permeability to permit physical interpenetration of the
flowable polymer.
26. A system according to claim 23 wherein the bottom and/or top
portions comprise materials selected from polyurethanes,
polyethylenes, polypropylenes, metals, ceramics, biopolymers or the
like and combinations thereof.
27. A system according to claim 23 wherein the top and bottom
portions are provided with forms corresponding to the shape of a
femoral condyle and tibial plateau, respectively.
28. A system according to claim 23 wherein the balloon further
comprises a port adapted to fill the balloon with flowable
biomaterial in situ, in a manner sufficient to force the top
portion toward corresponding bone.
29. A system according to claim 23 wherein the bottom portion
provides a raised protrusion sufficient to improve retention within
the joint site and/or to provide a site for suturing, stapling,
pinning, or screwing the portion within the joint site.
30. A system according to claim 22 wherein separate means are
provided for securing the preformed component within the joint
site.
31. A system according to claim 22, further comprising one or more
biologically active agents adapted to be provided on one or more
surfaces of the resultant composite implant.
32. A system according to claim 22 wherein the surface of the
preformed component and/or resultant composite material are
provided or modified with reactive groups to promote adhesion.
33. A system according to claim 32 wherein the reactive groups are
either provided by the preformed component itself, or are
separately added by suitable surface treatment of the component or
resultant composite, and the reactive groups are selected from
amines, hydroxyl groups, or other reactive or hydrogen bonding
functionalities.
34. A system according to claim 22 in which one or more of the
preformed components are provided in a plurality or range of styles
and sizes.
35. A system according to claim 22 wherein the one or more flowable
biomaterial(s) are adapted to be inserted into a joint using
minimally invasive means.
36. A system for the creation or modification of an orthopedic
joint within a mammalian body, the system comprising a plurality of
packaged, preformed components adapted to be assembled at the
orthopedic joint site in a minimally invasive fashion to provide a
final prosthesis having surfaces in apposition to and conformance
with at least one of the opposing bone surfaces of the orthopedic
joint site.
37. A system according to claim 36 wherein one or more of the
preformed components are provided with surfaces suitably roughened,
patterned, or contoured to provide maximum adhesion and fit when
placed, and optionally further fitted and secured, within the joint
site.
38. A system according to claim 36, wherein one or more of the
preformed components are formed at the time of use by the use of a
curable biomaterial adapted to completely cure when preformed and
then placed and optionally further fitted or secured inside the
joint site.
39. A system according to claim 36 wherein one or more of the
preformed components provide means for further securing the
component once placed in the joint site.
40. A system according to claim 39 wherein the retention means to
secure the component includes the use of tissue adhesives to
improve fixation.
41. A system according to claim 39 wherein the retention means
comprise one or more protrusions adapted to be sutured, pinned,
stapled, screwed or combinations thereof or otherwise mechanically
attached into the surrounding soft tissue and/or bone to improve
fixation.
42. A system according to claim 41 wherein the protrusions are
themselves integral with the preformed component.
43. A system according to claim 42 wherein the protrusions are
integrated into a flowable biomaterial during the ex vivo molding
process used to form the preformed component.
44. A system according to claim 43 wherein the protrusions are
comprised of sutures or fibrous materials.
45. A system according to claim 39 wherein means to secure the
component are external to it and secured once inside the joint site
by the use of adhesives, sutures, pins, staples, screws or the like
and combinations thereof to improve fixation to the surrounding
soft tissue and/or bone to improve fixation.
46. A system according to claim 36 wherein the one or more
preformed component(s) are adapted to be inserted into a joint in a
minimally invasive fashion.
47. A system according to claim 36 in which the one or more
preformed component(s) are provided in a plurality or range of
styles and sizes.
48. A system according to claim 37 wherein the assembled components
conform to the shape of the femoral condyle and tibial plateau,
medial, lateral or both.
49. A system according to claim 37 wherein the preformed
component(s) are fabricated from materials selected from the group
consisting of polyurethanes, polyethylenes, polyureas, hydrogels,
polysiloxanes, polyacrylates, epoxies, and combinations
thereof.
50. A system according to claim 49 wherein the material comprises a
polyurethane.
51. A system according to claim 50 wherein polyurethane is prepared
from polyisocyanate(s), short and long chain polyols, and
optionally including one or more ingredients selected from the
group hydrophobic additive(s), tin and/or amine catalyst(s), and
antioxidant(s).
52. A system according to claim 51 wherein the polyurethanes are
prepared from aromatic polyisocyanates, PTMO's, short chain
diols.
53. A system according to claim 52 wherein the hydrophobic additive
comprises hydroxyl-terminated polybutadiene, and the tin and/or
amine catalyst(s) used promote the isocyanate--hydroxyl reaction
preferentially and are selected from the group consisting of UL22,
Cotin 222, 1,4-diazabicyclo[2.2.2]octane (dabco), and dibutyltin
dilaurate (DBTDL) or the like and combinations thereof.
54. A system according to claim 36 wherein the preformed components
provide one or more surfaces having attached thereto a biologically
active agent selected from the group cytokines, hydroxyapatite,
growth factors, autologous growth factors, collagen or the like and
combinations thereof.
55. A system according to claim 36 wherein the surface of one or
more preformed component(s) is provided or modified with reactive
groups to promote tissue adhesion.
56. A system according to claim 55 wherein the reactive groups are
covalently attached to the polymers used to fabricate the preformed
component(s), and are selected from amines, hydroxyl groups, or
other reactive or hydrogen bonding functionalities.
57. A system according to claim 36 wherein the preformed
component(s) are selected from the group consisting of a) a single
preformed component, b) a plurality of components adapted to be
layered upon each other at the tissue site, c) a plurality of
components adapted to be assembled at the tissue site in an
interlocking fashion, such that the components cooperate to provide
a respective portion of the first and second major surfaces.
58. A system according to claims 1 or 22 or 36 further comprising
the use of one or more additional materials and/or steps adapted to
a) prepare the bone surface itself, b) provide a desired interface
between bone, component(s), and/or the physiologic environment,
and/or c) treat one or more surfaces of the component(s) in order
to provide them with different or improved properties as compared
to the inherent properties of the material providing the
surface.
59. A system according to claim 58 wherein the materials and/or
steps are adapted to affect, improve or provide a surface property
or function selected from adhesion, lubricity, smoothness,
conformance, tissue in-growth, or biocompatibility.
60. A system according to claims 1 or 22 or 36 wherein the system
is adapted to be used for repairing a variety of mammalian joints,
including human joints selected from the group consisting of the
tibial plateau of the knee, the acetabulum of the hip, the glenoid
of the shoulder, the acromion process of the shoulder, the
acromio-clavicular joint of the shoulder, the distal tibial surface
of the ankle, the radial head of the elbow, the distal radius of
the forearm, the proximal phalanx surface of the great toe, the
proximal metacarpal surface of the thumb, and the trapezium of the
wrist.
61. A system according to claim 60 wherein the system is adapted to
be used for repairing the tibial plateau of the knee.
62. A system according to claim 60 wherein the system is adapted to
be used for repairing the acetabulum of the hip.
63. A system according to claim 13 wherein the implant is provided
in the form of a preformed knee implant prepared using an ex vivo
mold and having a first major surface adapted to be positioned upon
the tibial surface, and a second major surface having a dimpled or
textured surface to improve surface lubricity and adapted to be
positioned against the femoral condyle.
64. A system according to claim 63 wherein the second major surface
is provided with a femoral glide path to facilitate its performance
in situ.
65. A system according to claim 64 wherein the glide path is in the
form of a generally central oval depression about 0.5 mm to about 5
mm deep at its lowest point and about 20 mm to about 50 mm in
length by 10 mm to 30 mm in width.
66. A system according to claim 63 wherein the implant also
includes a raised tibial projection adapted to catch the posterior
portion of the tibial plateau in situ.
67. A system according to claim 63 wherein the implant has
dimensions on the order of between about 30 to about 60 mm in the
anterior-posterior dimension, between about 20 mm to about 40 mm in
the medial-lateral dimension, and a maximum thickness, at the
posterior lip, of between about 8 mm and about 20 mm, or about 3 mm
greater than the thickness of the implant at the center.
68. A system according to claim 63 wherein the preformed component
includes ancillary means for securing the component once formed in
the joint site.
69. A system according to claim 68 wherein the ancillary means
comprise one or more protrusions adapted to be attached to either
soft tissue and/or bone at the joint site to improve fixation.
70. A system according to claim 68 wherein the contoured surface of
the preformed component further comprises a contour having one or
more protrusions, integral with the preformed component, and formed
during the ex vivo molding process.
71. A system according to claim 70 wherein the protrusions are
adapted to be integrated into the preformed component during the ex
vivo molding process and comprise sutures and/or fibrous
biomaterials integrally formed with the component itself.
72. A system according to claim 68 wherein the ancillary means are
selected from the group consisting of adhesives, sutures, pins,
staples, screws, and combinations thereof.
73. A system according to claim 70 wherein the implant is preformed
in a mold having an anterior cup edge that is substantially
perpendicular to the plane of the cup itself, and a posterior
mesial edge that is tapered and raised to accommodate the
corresponding shape of the tibial spine.
74. A system according to claim 73 wherein the mold is adapted to
permits control of sizing, conformance to the joint site, implant
thickness and angular correction.
75. A system according to claim 74 where the implant assumes a
generally kidney-shaped configuration, adapted to correspond with
the tibial surface, and provides a posterior mesial edge portion
having an indentation to accommodate the typical shape of the
corresponding tibial spine.
76. A system according to claim 15 wherein the polyurethane
comprises an isocyanate selected from the group consisting of
aromatic, aliphatic and arylakyl diisocyanates, and combinations
thereof.
77. A system according to claim 76 wherein the isocyanate is
selected from the group consisting of toluene diisocyanates,
naphthalene diisocyanates, phenylene diisocyanates, xylylene
diisocyanates, diphenylmethane diisocyanates, cyclohexane
diisocyanates, cyclohexyl-bis methylene diisocyanates, isophorone
diisocyanates and hexamethylene diisocyanates.
78. A system according to claim 63 further comprising a
patella-femoral joint form suitable adapted to be formed to, and
held against, the femoral bone surface, in order to permit the
delivery of curable biopolymer between the form and the bone.
79. A system according to claim 1 wherein the implant is provided
in the form of a preformed knee implant prepared using an ex vivo
mold and having a first major surface adapted to be positioned upon
the tibial surface, and a second major surface adapted to be
positioned against the femoral condyle, the implant also includes a
raised tibial projection adapted to catch the posterior portion of
the tibial plateau in situ, the implant has dimensions on the order
of between about 30 to about 60 mm in the anterior-posterior
dimension, between about 20 mm to about 40 mm in the medial-lateral
dimension, and a maximum thickness, at the posterior lip, of
between about 8 mm and about 20 mm, or about 3 mm greater than the
thickness of the implant at the center, and the preformed component
includes ancillary means for securing the component once formed in
the joint site, and the preformed component is fabricated from a
polyurethane that comprises an isocyanate comprising a phenylene
diisocyanate.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] The present application is a continuation-in-part of US
application filed Mar. 15, 2002 and assigned U.S. Ser. No.
10/098,601, which is a continuation of an international patent
application filed Aug. 28, 2001 and assigned Serial No.
PCT/US01/41908 which application has not yet been published and
which itself is a continuation-in-part of Provisional U.S.
Application Serial No. 60/228,444, filed Aug. 28, 2000, the entire
disclosures of which are incorporated herein by reference.
TECHNICAL FIELD
[0002] In one aspect, this invention relates to biomaterials formed
ex vivo for implantation and use within the body. In another
aspect, the invention relates to in situ curable biomaterials. In
yet another aspect, this invention further relates to the field of
orthopedic implants and prostheses, and more particularly, for
implantable materials for use in orthopedic joints.
BACKGROUND OF THE INVENTION
[0003] Applicant has previously described, inter alia, prosthetic
implants formed of biomaterials that can be delivered and finally
cured in situ, e.g., using minimally invasive techniques. See for
instance, U.S. Pat. Nos. 5,556,429, 5,795,353, 5,888,220,
6,079,868, 6,140,452, 6,224,630 and 6,248,131 as well as published
International Application Nos. WO 95/30388 and WO 97/26847 and
International Application PCT/US97/20874 filed Nov. 14, 1997 (the
disclosures of each of which are incorporated herein by reference).
Certain of these applications describe, inter alia, the formation
of a prosthetic nucleus within an intervertebral disc by a method
that includes, for instance, the steps of inserting a collapsed
mold apparatus (which in a preferred embodiment is described as a
"balloon") through a cannula that is itself positioned through an
opening within the annulus, and filling the balloon with a flowable
biomaterial that is adapted to finally cure in situ and provide a
permanent disc replacement. See also, Applicant's "Porous
Biomaterial and Biopolymer Resurfacing System" (PCT/US99/10004), as
well as "Implantable Tissue Repair Device (PCT/US99/11740), and
"Static Mixer" (PCT/US99/04407) applications.
[0004] See also, U.S. Pat. No. 3,030,951 (Mandarino), U.S. Pat. No.
4,203,444 (Bonnell et al.), U.S. Pat. No. 4,456,745 (Rajan), U.S.
Pat. No. 4,463,141 (Robinson), U.S. Pat. No. 4,476,293 (Robinson),
U.S. Pat. No. 4,477,604 (Oechsle, III), U.S. Pat. No. 4,647,643
(Zdrahala), U.S. Pat. No. 4,651,736 (Sanders), U.S. Pat. No.
4,722,948 (Sanderson), U.S. Pat. No. 4,743,632 (Marinovic et al.),
U.S. Pat. No. 4,772,287 (Ray et al.), U.S. Pat. No. 4,808,691
(Konig et al.), U.S. Pat. No. 4,880,610 (Constanz), U.S. Pat. No.
4,873,308 (Coury et al.), U.S. Pat. No. 4,969,888 (Scholten et
al.), U.S. Pat. No. 5,007,940 (Berg), U.S. Pat. No. 5,067,964
(Richmond et al.), U.S. Pat. No. 5,082,803 (Sumita), U.S. Pat. No.
5,108,404 (Scholten et al.), U.S. Pat. No. 5,109,077 (Wick), U.S.
Pat. No. 5,143,942 (Brown), U.S. Pat. No. 5,166,115 (Brown), U.S.
Pat. No. 5,254,662 (Szycher et al.), U.S. Pat. No. 5,278,201 (Dunn
et al.), U.S. Pat. No. 5,525,418 (Hashimoto et al.), U.S. Pat. No.
5,624,463 (Stone et al.), U.S. Pat. No. 6,206,927 (Fell), and EP 0
353 936 (Cedar Surgical), EP 0 505 634 A1 (Kyocera Corporation), EP
0 521 573 (Industrial Res.), and FR 2 639 823 (Garcia), WO 93/11723
(Regen Corporation), WO 9531946 (Milner), WO 9531948 (Kuslich).
[0005] Applicant's PCT Application No. PCT/US97/00457 (WO
9726847A1) includes the optional use of a mold, such as a balloon,
and describes the manner in which "[t]he mold created within the
joint is preferably of sufficient shape and dimensions to allow the
resulting cured biomaterial to replace or mimic the structure and
function of the removed fibrocartilage. The mold can be formed of
synthetic and/or natural materials, including those that are
provided exogenously and those provided by the remaining natural
tissues. The mold can either be removed from the site, upon curing
of the biomaterial, or is sufficiently biocompatible to allow it to
remain in position."
[0006] Applicant's later PCT Application No. PCT/US97/20874 (WO
9820939A2) further describes the manner in which "`mold` will refer
to the portion or portions of an apparatus of the invention used to
receive, constrain, shape and/or retain a flowable biomaterial in
the course of delivering and curing the biomaterial in situ. A mold
may include or rely upon natural tissues (such as the annular shell
of an intervertebral disc) for at least a portion of its structure,
conformation or function. The mold, in turn, is responsible, at
least in part, for determining the position and final dimensions of
the cured prosthetic implant. As such, its dimensions and other
physical characteristics can be predetermined to provide an optimal
combination of such properties as the ability to be delivered to a
site using minimally invasive means, filled with biomaterial, and
optionally, then remain in place as or at the interface between
cured biomaterial and natural tissue. In a particularly preferred
embodiment the mold material can itself become integral to the body
of the cured biomaterial."
[0007] Applicant's own use of such mold apparatuses to date has
concentrated largely on the use of thin, extensible balloons
adapted to be positioned and then filled in situ with curable
biomaterial, with particular use as a replacement for the
intervertebral disc following microdiscetomy. In turn, there has
been considerably less focus, to date, on the use of any such molds
in other joints, such as the knee. FIGS. 6 and 7 of Applicant's PCT
Publication No. WO 920939 A2, for instance, shows a balloon and
corresponding drilling template for use in knee surgery, the
balloon having foot portions protruding from a generally ovoid
inflatable portion.
[0008] Finally, U.S. Pat. No. 6,206,927 describes a self-centering
meniscal prosthesis device suitable for minimally invasive,
surgical implantation into the cavity between a femoral condyle and
the corresponding tibial plateau is composed of a hard, high
modulus material shaped such that the contour of the device and the
natural articulation of the knee exerts a restoring force on the
free-floating device. In what appears to be a related manner,
Sulzer has introduced a unicompartmental interpositional spacer to
treat osteoarthritis in the knee. See "Little Device Could Pack a
Big Punch", Sulzer Medica Journal Edition 2/2000
(www.sulzermedica.com/media/smj-full-tex/2000/0002-full-text-6.html).
The device is described as a metallic kidney-shaped insert which
fills in for the damaged cartilage between the femur and the
tibia.
[0009] Such a metallic device, as described in either the Fell
patent and/or Sulzer's product literature, is described as
appropriate for use in younger patients with moderate to severe
chondromalacia, particularly since the product provides a hard,
self-centering meniscal device that is "devoid of physical means
that fix its location". In so doing, the device of Fell et al.
tends to require a significant amount of intact cartilage and
meniscus. Applicant's own products to date, including those
improved embodiments described herein, have been largely geared
toward more elderly patients, where such healthy cartilage is
lacking. In turn, Applicant's devices tend to provide angular
correction and improved anchoring of the implant at the joint
surface.
[0010] In spite of developments to date, there remains a need for a
joint prosthesis system that provides an optimal combination of
properties such as ease of preparation and use, and performance
within the body.
BRIEF DESCRIPTION OF THE DRAWING
[0011] In the Drawing:
[0012] FIG. 1 shows top and side perspectives of a preferred
preformed knee implant prepared according to the present
invention.
[0013] FIG. 2 shows an embodiment in which preformed components
adapted to be inserted and assembled in situ.
[0014] FIG. 3 shows an alternative embodiment in which preformed
components are employed.
[0015] FIGS. 4 and 5 show an embodiment in which a substantially
open (saucer-shaped) mold is inserted into the joint site, to be
filled with a corresponding curable biomateral in situ.
[0016] FIG. 6 shows a variety of alternative embodiments that
include one or more preformed component.
[0017] FIG. 7 shows a variety of alternative means for anchoring a
preformed component such as that shown in FIG. 6d.
[0018] FIG. 8 shows a further variety for anchoring or stabilizing
a preformed portion by the use of ancillary portions and/or surface
texture.
[0019] FIG. 9 shows a variety of embodiments in a substantially
closed (balloon like) mold is adapted to be inserted into the joint
site and filled with a corresponding curable biomaterial.
[0020] FIG. 10 shows a mold adapted for use as an acetabular mold
in connection with the replacement of the articulating surface in a
hip.
[0021] FIG. 11 shows a patella femoral joint form suitable for use
in combination with the method and system of this invention.
[0022] FIGS. 12 and 13 show various views of a particularly
preferred knee implant of the present invention.
SUMMARY OF THE INVENTION
[0023] The present invention provides a method and system for the
creation or modification of the wear surface of orthopedic joints,
including one or both of two articulating surfaces and/or portions
thereof, and particularly articulating joints such as the knee. In
one preferred embodiment, the method relies, at least in part, upon
the manner in which the various stages of curing a curable
biomaterial, and in turn, the various stages of forming a component
from the cured or curing biomaterial, can be correlated and
optimized in a desired manner. In turn, such a method provides the
ability to both generally and specifically form the component for
use in situ.
[0024] The present invention includes a variety of embodiments,
each of which preferably includes one or more components that are
formed ex vivo, and that are adapted to be inserted and finally
formed or assembled in situ in order to provide a final prosthesis
and articulating joint surface. Examples of the various embodiments
include, for instance,
[0025] 1) one or more components that are each partially molded ex
vivo, in a manner that permits the component to be inserted and
finally formed in situ,
[0026] 2) a plurality of preformed components adapted to be
assembled in situ, for instance in an overlapping or interlocking
fashion,
[0027] 3) an insertable open (e.g., saucer shaped) mold, adapted to
be inserted and positioned within the joint site, and there used in
combination with a flowable biomaterial adapted to be delivered to
the open mold in situ, under conditions that permit the flowable
biomaterial to cure in contact and/or combination with the mold in
order to form a final prosthesis,
[0028] 4) one or more generally extensible envelope (e.g.,
balloon-type) molds, adapted to be positioned and filled in situ
with corresponding curable biomaterials, one or more of the molds
themselves providing one or more regions of generally
non-extensible, preformed material. In one embodiment, for
instance, a plurality of such envelope portions (e.g., a
bi-compartmental single envelope) can be adapted for use on both
the medial and lateral tibial surfaces, respectively.
[0029] By the selection and use of a suitable biomaterial, and
other features as described herein, the present invention provides
an optimal combination of benefits, as compared to methods
previously described. Such benefits include those that arise in the
course of preparation and storage (e.g., sterility, storage
stability), those that arise in the surgical field itself (e.g.,
ease of use, adaptability, predictability), and those that arise in
the course of long term use within the body (e.g.,
biocompatibility, moisture cure characteristics, tissue congruity
and conformability, retention, wear characteristics, and
physical-mechanical properties).
[0030] In one preferred embodiment, the method and system involve
the preparation and use of partially cured components that can be
formed outside the body, for insertion and placement into the body,
and that can then be further formed within the joint site in order
to enhance conformance. The ability to finally form one or more
components in situ provides various additional benefits, such as
increased control over the overall size and shape of the final
prosthesis, improved shape and compliance of the surface apposing
natural bone, and finally, improved shape and compliance of the
opposite, articulating surface.
[0031] As used herein, the word "cure", and inflections thereof,
will refer to the extent to which a curable biomaterial, as used to
form a component of this invention, has begun or completed whatever
physical-chemical reactions may be contemplated in the course of
fully forming the component, at the surgical site, for long term
use in situ. In turn, the biomaterial can be considered as uncured
(as in component parts that have not yet been mixed or compositions
that have not yet been activated), or it can be partially cured
(e.g., wherein the components have been mixed, or compositions
activated, under conditions suitable to begin the curing process),
or it can be fully cured (e.g., in which case, whatever chemical
reactions may have occurred have substantially subsided).
Generally, uncured compositions are sterile, storage stable, and
often flowable, though are typically not yet formed or capable of
being formed.
[0032] Curing compositions, by contrast, generally begin as
flowable compositions, but become nonflowable over a finite time
period as they begin to gel or set. Curing compositions can also be
minimally formed, e.g., outside the body by the use of molds and/or
suitable shaping tools, and/or within the body, as by the initial
positioning of the component on supporting bone and by the
repositioning of opposing, articulating bone surfaces. Thereafter,
it is contemplated that certain compositions of this invention can
be further formed, over time, as by the gradual effect of
articulating bone in the course of long term use.
[0033] As also used herein, the word "form", and inflections and
variations thereof, will refer to the manner and extent to which a
component has been sized and shaped, in either a general and/or
specific manner, for use at a joint site. In turn, the forming of
such a component can occur either ex vivo and/or in vivo, as well
as in a general manner (e.g., by the use of an ex vivo mold or
tools) and/or a specific manner (e.g., by final curing in
apposition to supporting bone and/or opposing articulating bone
surfaces), as well as combinations thereof.
[0034] A component can be "specifically" formed in this manner in
order to conform the component (and particularly its surfaces) to
the corresponding specific shapes and dimensions of bone in situ,
including both supporting bone surfaces and/or opposing (e.g.,
articulating) bone surfaces. Such specific conformation, in turn,
can be used to improve a variety of characteristics of the final
implant, including comfort, mechanical performance, and/or long
term stability. Such conformation can also include aspects in which
one or more components, or the composite prosthesis, are
"conformed" in correspondence with the joint site (e.g., by final
shaping and curing processes that occur in situ).
[0035] Such conformation can also include aspects in which the
components, or prosthesis itself, are adapted to be "deformed"
within the site, as by the application of force. For instance, a
substantially fully formed component can be provided to have
sufficient mechanical properties (e.g., strength and resilience) to
permit it to be inserted into a joint site and effectively deformed
under normal anatomic forces For instance, a substantially convex
component can be deformed to assume the corresponding concave shape
in situ, in, while retaining sufficient resilient strength to tend
towards its original convex shape (e.g., analogous to the manner in
which a locking washer can be deformed in use, while tending toward
its original shape). Preferably, a final knee component is adapted
to be deformed under conditions of use within the body (e.g., under
physiologic load), while maintaining desired size and tibial
congruency, and in a manner that provides desired fit and thickness
for desired angular correction.
[0036] Hence a "preformed" component will generally refer to a
component that is at least partially formed ex vivo, as by the
surgeon's selection and use of an appropriately sized ex vivo mold.
Such a preformed component can be specifically formed as well,
including in an ex vivo fashion, as by the use of a customized mold
that is itself reflective of the particular dimensions and contours
of the intended joint site. Such customized molds can be prepared,
for instance, by the use of external imaging means, and/or by the
appropriate use of negative and/or positive molds taken at the
tissue site. Optionally, and preferably, the preformed component is
specifically formed, in whole or in part, by being positioned in
situ, prior to the completion of the curing process, and in
apposition to both supporting bone and opposing bone surfaces. Once
positioned within the joint site, any such component or prosthesis
can be adapted to be deformed in order to improve its retention
and/or performance in situ, e.g., resiliently deformed upon release
of distracting forces and repositioning of the opposing bone
surface.
[0037] For instance, a preformed composition is provided, formed
initially by the ex vivo onset of cure, in which the composition
can be implanted within on the order of 10 seconds to several days
of the onset of cure, preferably within about 30 seconds to about
10 minutes, and more preferably within about one to about five
minutes, while maintaining a surface exotherm of less than about
50C, and more preferably less than about 45C once positioned within
the body.
[0038] Once positioned in vivo, preferred preformed components of
this invention are adapted to be finally shaped, for a period of
between about 10 seconds and one or more hours, and more preferably
between about one minute and about five minutes. The lower limit is
defined largely by the time it takes to effectively reposition
bone, or otherwise re-establish suitable force on the implant. The
upper limit, in turn, is generally defined by the susceptibility of
the implanted composition to further deformation or shaping. Such
final shaping is generally accomplished, at least in part, under
the force brought about by repositioning articulating bone
surfaces. In one preferred embodiment, the partially cured
composition is implanted under conditions that permit it to deform
less than about 15%, preferably less than about 10%, and most
preferably less than about 5%, under physiologic forces, while
maintaining tibial congruency and imparting desired angular
correction.
[0039] Hence, a particularly preferred preformed component of this
invention can be implanted within an initial about one to about
five minutes of the onset of its formation, and once implanted can
be further molded or formed for a further period of about one to
about five additional minutes, in a manner that permits the
resultant implant to substantially retain a desired final form and
function.
[0040] The system of the present invention thereby provides the
surgeon with a variety of options, based on the manner in which
these curing and forming processes are correlated. In one
particularly preferred embodiment, for instance, the surgeon is
provided with a composition adapted to be partially cured and
generally formed ex vivo, and then promptly inserted into the body
and positioned at the joint site, where it can be finally, and
specifically, formed in the course of becoming fully cured.
[0041] By partially curing the prosthesis ex vivo, the present
system simplifies the preparation process considerably, e.g., by
lessening or avoiding potential problems (such as curing in the
presence of moisture, and surface exotherm in the presence of
tissue) that can arise when a comparable composition is mixed and
delivered to the joint site while it is still flowable.
Surprisingly, the present system permits such prostheses to be not
only formed, but also manipulated and inserted into the joint
(e.g., through an incision of between about 1 cm and about 3 cm).
Once inserted, the prosthesis can be positioned, and further formed
in situ, all within a reasonable time frame. In fact, it has been
found that the procedure is amenable to outpatient use and even
regional anesthesia.
[0042] Moreover, the present system can avoid the use of such
processes as the drilling anchor holes into the underlying bone,
distraction of the knee joint, ligament release, leveling of the
tibial plateau, and the various other procedures typically involved
with delivering the biomaterial directly to the joint site in still
flowable form. Yet, the prosthesis of the present invention
provides a combination of properties such as the extent of
congruence with underlying bone, wear characteristics, fracture
toughness, and avoidance of fibrillated articular cartilage, that
meets or exceeds the combination of properties obtained using a
comparable biomaterial in flowable form, delivered and largely
cured in situ.
[0043] In addition to its immediate use in such joints as the knee,
the system of the present invention provides particular advantages
when applied to ball and socket joints, such as the hip. In one
such embodiment, a balloon can be filled with a biomaterial as
described herein, and inserted and positioned within the
acetabulum, prior to or following filling, to provide a soft,
conformable, durable lining for the placement of a hip prosthetic
portion. In a further embodiment, the method and system involve the
preparation and use of one or more partially or fully cured
component(s) formed outside the body, for insertion and placement
into the body and optionally further fitting and securing at the
joint site. These preformed component(s) typically require less
manipulation at the bedside and allow for alternative methods of
terminal sterilization, and final inspection and release at the
manufacturing site.
[0044] In a particularly preferred embodiment, the present
invention therefore provides an implant that is designed to be
formed to and congruent with the tibial surface, having a final
femoral surface shape that serves largely as a glide path with
respect to the femoral condyle.
[0045] This can be compared to other devices, such as that of the
'927 patent described above, which discloses a "self centering"
device, formed entirely outside the body, and generally of a hard
metal, by first determining the geometry of the entire knee
compartment, including both the femoral and tibial surfaces. The
device is designed to be very hard, and based on such things as the
concavity and convexity of various surfaces, which are designed to
permit continued movement (translational and rotational) and
re-positioning of the device within the knee compartment in the
course of use. In turn, the device is permitted and expected to
continually move within the joint over the course of its use.
[0046] The present device can be used in patients having joints
that have progressed to the stage of "bone on bone", and thus
provides a replacement for the function of articular cartilage as
well as meniscus, and particularly at the central weight-bearing
area, in order to restore alignment. The implant provides an
elastomeric, cushioning function, as compared to the rigid and hard
device of the '927 patent. The present implant is also congruent
with the tibial surface, based upon both its initial shape and the
final shaping that occurs in situ. In turn, the present implant is
more permanently anchored in place, in significant part by the
posterior lip shown in FIGS. 1, and 12-13 as well by the use of
anterior fixation means (such as embedded sutures).
[0047] Finally, the presently preferred implant has a peripheral
thickness that is generally thinner than the thickness of their
central portion, and is positioned only partially within the knee
compartment as defined in the '927 patent, having a posterior lip
that extends well beyond a compartment defined in that manner, and
that serves a key role in fixation.
DETAILED DESCRIPTION
[0048] The method and system (e.g., preformed component(s) and/or
curable biomaterial and mold) can be used to prepare a final
prosthesis, in vivo, that provides a first major surface in
apposition to and retained upon the supporting bone itself, and a
second (generally substantially parallel and opposite) major
surface adapted to provide a wear surface for opposing (e.g.,
articulating) bone. By "retained upon" it is meant that the final
prosthesis is maintained in a desired position upon the supporting
bone surface in a manner suitable for its intended use, e.g., by
the use of one or more anchor points, by the use of adhesive or
other suitable interface materials, by the use of sutures, staples,
and the like, and/or by a mechanical lock achieved by the
combination of a bone-contacting surface suitably conformed or
conformable to the terrain of supporting bone, together with the
retaining (and optionally including deforming) effect achieved upon
repositioning opposing articulating bone surface.
[0049] The first and second major surfaces can be provided in any
suitable manner, for instance, 1) by the preparation and insertion
of a single partially cured and generally preformed component into
the joint, preferably under conditions that permit the component to
become further, and specifically, formed in vivo, 2) by adding a
flowable biomaterial to an initial preformed component (e.g., in
the shape of a balloon or open mold) positioned at the tissue site,
3) by placing one or more fully cured and preformed components at
the tissue site and optionally further fitting, adapting and/or
securing the component(s) as needed, and/or 4) by assembling one or
more preformed components in situ (e.g., side by side in an
interlocking fashion upon the surface) such that the assembled
components cooperate to provide the first and second major
surfaces.
[0050] The system can therefore include modular implants, that
include one or more preformed components as described herein, in
combination with one or more other (e.g., metallic) components. Any
or all of such components can be made using materials having "shape
memory" that permits the components to be easily inserted into the
joint space, in a manner that permits the component(s) to assume or
recover an alternative shape upon the application of energy (e.g.,
heat slightly above body temperature). Optionally, such alternative
shape can be achieved prior to insertion into the body.
Alternatively, the molded in the body implant can be taken out and
reformed (e.g., by heat, radiation or other suitable means) and
reimplanted for final fit.
[0051] In addition to the partially or fully cured preformed
component(s) and/or curable biomaterial and related molds, the
method and system of this invention include the optional use of
various additional materials and/or steps, e.g., to prepare the
bone surface itself, to provide suitable interfaces (e.g., adhesive
interfaces and/or protrusions that can be further secured to the
joint site or by smoothing of the femoral condyle or tibial plateau
as needed), to treat one or more surfaces in order to provide them
with different or improved properties as compared to the inherent
properties of the material providing the surface, and the like.
Examples of such materials include, for instance, the use of
adhesive materials, tissue in-growth stimulators, and fibrous
materials (e.g., webs adapted to tether the implant and/or to
facilitate fibrous tissue ingrowth).
[0052] The partially or fully cured preformed component(s) can
themselves each provide uniform or non-uniform properties, and can
be provided in a plurality or range of styles and sizes. These
components can be designed to conform to lateral or medial
compartments, or both, and to right or left knees, or both. In a
preferred embodiment, all embodiments can be inserted into the
joint site in a minimally invasive fashion. By "minimally
invasive", in this context, it is meant that the procedure of
sizing, inserting, positioning and forming the prosthesis, in situ,
can preferably be accomplished without the need for open, invasive
incisions of the type conventionally used for inserting total knee
prostheses. In a preferred embodiment, the partially cured
preformed components can be further formed and fully cured in vivo
to enhance compliance with the joint site.
[0053] The surface of the partially or fully cured preformed
component(s) can also be modified to provide any desired properties
(e.g., promote adhesion), such as by the design and use of polymers
themselves or by surface treatment of the fully cured or curing
embodiments to provide suitable reactive groups such as amines,
hydroxyl groups, or other reactive or hydrogen bonding
functionalities. Similarly, the partially cured preformed component
or fully cured component, including balloons or composite
materials, can be provided with appropriate surface coatings, e.g.,
biologically active agents to promote desired tissue interactions,
including tissue or cellular adhesion, such as those selected from
the group consisting of cytokines, hydroxyapatite, collagen, and
combinations thereof. Such biologically active agents can also
include, for instance, anti-inflammatory agents, antitumor agents,
antibiotics, complement inhibitors, cytokines, growth factors, or
inhibitors of growth factors and cytokines, as well as combinations
of any such biologically active agents with each other and/or with
adjuvants, and the like.
[0054] In one embodiment of this invention, partially cured, and
generally preformed components are inserted into the joint site,
and there further and specifically formed to enhance compliance. In
an alternative embodiment, fully cured components in the shape of a
balloon or open mold are employed to provide a final composite
material by inserting the balloon or mold into the joint and there
filling it with a biomaterial that cures in situ and conforms with
the joint site. In another alternative embodiment, the fully cured
component(s) are provided and inserted into the joint either singly
or piecemeal and optionally further fitted and secured in vivo.
[0055] As an example of the first such embodiment, the invention
provides an open ex vivo mold, adapted to approximate the desired
dimensions of the joint site, and to receive a curable biomaterial.
A suitable mold can be formed, for instance, from the use of
conventional materials such as silicone materials, that permit the
curing biomaterial component to be easily and entirely removed at
the desired time. Optionally, the mold can itself be provided with
a coating or release liner, including those that can be integrated,
in whole or in part, with the component thus formed. Once the
flowable biomaterial has been delivered and partially cured in this
ex vivo mold, and any optional molding or fabricating steps have
occurred, the biomaterial can be removed from the mold and inserted
into the joint site, under conditions suitable to permit it to be
further and finally formed in vivo to enhance conformance with the
joint site. Optionally, additional ex vivo forming steps or
features can be performed, e.g., by imparting desired curvature and
femoral glide paths, prior to inserting and final forming in
vivo.
[0056] Also, in the course of molding the component ex vivo, and/or
transferring it to the tissue site, various structures and/or
materials can be incorporated into and/or onto the component
itself, to enhance its placement, retention and/or performance in
situ. For instance, the mold itself can be provided in a form
sufficient to impart various integral structural features, such as
tibial "tabs", adapted to provide or improve the retention of the
component at the tissue site. Such tabs, for instance, can be
provided in the form of one or more protrusions integral with the
mold itself and adapted to be positioned within and/or affixed to
the soft tissue and/or bone in vivo. Examples of such tabs are
shown, for instance, in FIG. 1, where reference number 18 depicts a
raised posterior portion.
[0057] An insertable component can also be provided with one or
more ancillary portions or protrusions formed of materials other
than that used to form the bulk of the component itself. For
instance, sutures or fibrous materials can be incorporated into or
onto the bulk material, for use in improving the initial and/or
long term retention of the component in situ, e.g, by tethering the
prosthesis at the joint site and in a desired position. Such other
materials can be temporarily positioned into or upon the mold
itself, for instance, or otherwise provided, in a manner that
permits them to become integrated into the biomaterial as it fills
the mold and becomes partially cured ex vivo. With the resulting
component positioned in situ, the protrusions can be used to tether
the implant, by securing them to the surrounding soft tissue and/or
bone by use of adhesives, sutures, screws, pins, staples, or the
like, and other types of anchors, or combinations thereof, which in
turn can be prepared using bioabsorbable and/or non-bioabsorbable
cements, composites, and adhesives. The materials can provide both
an immediate fixation function, and optionally also a desired long
term function, by permitting them to be either absorbed by the body
over time, and/or to permit or encourage fibrous tissue ingrowth
for long term fixation.
[0058] The reinforcing material can be provided in any suitable
form, e.g., as fibers (e.g., sutures) or as a uniform woven or
non-woven fabric, optionally including one or more reinforcing
fibers or layers. A suitable non-woven fabric, for instance, is
preferably a material such as is commercially available under the
trade name Trevira Spunbond from Hoechst Celanese Corporation. The
non-woven fabric is generally composed of continuous thermoplastic
fiber, needle punched together to yield a felt-like fabric. In
addition to fabrics like Trevira Spunbond, other materials such as
polyester staple mat, glass fiber mat, as well as other organic and
inorganic fiber mats and fabrics can be employed.
[0059] Reinforcing fibers can be included within the woven or
non-woven fabric, or provided as separate layers of a composite.
Such fiber layers can preferably include a directional reinforcing
fiber layer of organic or inorganic structural reinforcing fibers
such as fiberglass, carbon fibers, aramid fibers which is available
from DuPont Corporation under the trade name Kevlar, linear
polyethylene or polypropylene fibers such as is commercially
available from Allied-Signal, Inc. (now Honeywell) under the trade
name Spectra, or polyester fibers. The phrase "reinforcing fiber"
can include any fiber which, when used in its own right or added to
a composite fabric material, retains or enhances desired structural
properties. The fibers can be randomly oriented, or preferentially,
they can be oriented in one or more directions. While a number of
specific types of materials have been given for use as the
reinforcing fiber layer, it will be appreciated by those of
ordinary skill in the art that other equivalent-type reinforcing
fiber layers can be employed in the practice of the invention. A
reinforcing fiber layer can be itself used to secure the
prosthesis, or can be attached to a woven or non-woven fiber layer
having a number of interstices or pores. Preferably, the
reinforcing fiber layer and other fiber layers are secured to each
other mechanically, as by conventional stitching, needle punching,
stapling or buttons. In the case of certain applications, adhesives
can also be used.
[0060] Similarly, a partially cured preformed component (and/or
ancillary portions incorporated therein) can also be provided with
suitable means to improve its ability to retain the component in
situ, e.g., by the use of surface characteristics that provide
improved chemical interactions with the joint site. Such
interactions can be achieved by the judicious use of bulk material
compositions themselves and/or the use of adhesives or other
suitable interface materials. The partially cured, preformed,
component can also be physically modified to increase its
interactions with joint site, as by surface roughening, etching or
cross-hatching, which would tend to provide increased surface area,
and in turn, improved mechanical retention. A partially cured,
preformed, component can also be retained by external means that
are otherwise secured to the surrounding bone and/or soft tissue by
use of adhesives, sutures, screws, pins, staples or the like or
combinations thereof. On the major surface opposing articulating
bone, the partially cured preformed component can be provided with
suitable means as well, intended to improve or alter either its
compliance and/or interactions with the opposing bone surface.
[0061] In one particularly preferred embodiment, the system
includes a partially cured preformed component that is first molded
outside of the joint site and adapted to be delivered to a tissue
site and there positioned in a fixed position. The mold can be of
an open or closed configuration (and/or can involve a one- or
multi-step molding process), adapted to preform one or both major
surfaces, respectively. Once positioned, the partially cured
component is adapted to be initially fit and positioned within the
joint site, and to thereafter become better conformed to the
specific dimensions and/or terrain (e.g., anatomic structure) of
the joint site in vivo. Optionally, and preferably, the molds are
designed to yield components that have optimum adhesion and
conformance to the joint sites. The molds may also be heated during
the ex vivo partial curing process to optimize component properties
or to provide a component that is more formable in vivo.
[0062] In an alternative preferred embodiment, the method and
system involve the preparation and use of one or more fully or
partially cured component(s) formed outside the body, for insertion
and placement into the body and optionally further fitting and
securing at the joint site. In one embodiment, the invention
provides a single preformed component that is inserted into the
joint site and optionally further fitted or secured as needed. In
another embodiment, the invention provides a plurality of preformed
components, formed of the same or different materials, and adapted
to be delivered and positioned at the tissue site in a manner that
provides a final composite. The components can be combined at the
site in any suitable fashion, e.g., by providing a mechanical lock
and/or by the use of interfacial materials such as adhesive layers.
The components can be combined in any suitable fashion, e.g., as
layers upon the bone, or as individual side-by-side components
adapted to traverse the bone surface when combined. The use of
preformed component(s) can require less manipulation at the bedside
and allow for alternative methods of terminal sterilization, and
final inspection and release at the manufacturing site. The various
means of retaining partially cured preformed components, discussed
herein, can be adapted to work with fully cured preformed
components.
[0063] The method and system of this invention can be used for
repairing a variety of mammalian joints, including human joints
selected from the group consisting of the tibial plateau of the
knee, the acetabulum of the hip, the glenoid of the shoulder, the
acromion process of the shoulder, the acromio-clavicular joint of
the shoulder, the distal tibial surface of the ankle, the radial
head of the elbow, the distal radius of the forearm, the proximal
phalanx surface of the great toe, the proximal metacarpal surface
of the thumb, and the trapezium of the wrist.
[0064] Those portions or combinations of preformed component(s)
that contact the bone surface are preferably adapted to physically
conform closely to the prepared bone surface, e.g., to its
macroscopic physical contours. Such conformation can be provided or
enhanced in any suitable manner, e.g., 1) by providing a partially
cured preformed component that is first made in an ex vivo mold and
then adapted or modified to conform to the surface (e.g., by
further forming in vivo), and/or 2) by use of a preformed balloon
or composite mold material that is inserted into the joint site and
filled with a flowable biomaterial that cures in vivo so that it
conforms with the joint site and/or 3) by the use of fully cured
preformed component(s) that has optimum geometry for biomaterial
compliance once placed in the joint site and/or 4) by the
preparation and use of a suitable (e.g., thin) interface material
between bone and preformed component (e.g., adhesive, filler, or
cement material), and/or 5) by the use of physical restraining
means, such as adhesives, pins, staples screws, sutures or the like
that are attached to protrusions in the component itself or to an
external means of securing it.
[0065] In yet other embodiments, the system of this invention can
include the use of materials or markers (e.g., radiopaque)
positioned within or upon the implant, to aid in visualization.
e.g., using fluoroscopy or other X-ray techniques.
[0066] The method and system of this invention will be further
described with reference to the Drawing, wherein:
[0067] FIG. 1 shows a top and side perspective of a preferred
preformed knee implant (10) prepared using an ex vivo mold
according to the present invention. The implant provides a first
major surface (12) adapted to be positioned upon the tibial
surface, and a generally planar second major surface (14) adapted
to be positioned against the femoral condyle. In a typical
embodiment, the second major surface, in turn, is preferably
provided with a femoral glide path (16) to facilitate its
performance in situ, in the form of a generally central (e.g.,
oval) depression about 0.5 mm, or more preferably about 1 mm to
about 5 mm deep at its lowest point (2 mm as shown) and about 20
mm, and more preferably about 30 mm to about 50 mm in length by 10
mm to 30 mm in width (40 mm by 20 mm as shown). Those skilled in
the art, given the present description, will readily determine the
actual dimensions for optimal use, in both absolute and relative
terms, depending on such factors as the actual joint size and
desired results (e.g., angular correction). As shown, the implant
is also provided with a raised tibial projection (18), adapted to
catch the posterior portion of the tibial plateau. The body of the
implant can have dimensions on the order of between about 35 mm,
and preferably about 40 mm to about 60 mm in the anterior-posterior
dimension, between about 20 mm, and preferably 30 mm to about 35
mm, or even about 40 mm in the medial-lateral dimension, and a
maximum thickness (at the posterior lip of between about 8 mm, more
preferably about 10 mm, and about 20 mm, or about 2 mm to about 4
mm (e.g., 3 mm) greater than the thickness of the implant at the
center.
[0068] FIG. 2 shows an embodiments in which a plurality of
preformed components are adapted to be inserted and assembled in
situ to provide the final implant (20) FIG. 2a shows an embodiment,
in which preformed components (22 through 25, respectively) are
assembled in a side-by-side manner sequentially, and in situ, and
upon the tibial surface. The matable preformed sections each
provide at least a portion of the resultant bone-contacting surface
and wear surface, as well as one or more portions adapted to
provide a mechanical lock with one or more respective other
portions. The mechanical lock can be achieved in any suitable
manner, as by the provision of corresponding male and female
portions, respectively. The portions can be mated, in situ, e.g.,
in a press fit or sliding manner, in order to attach the respective
components. As can be seen in the raised perspective of the same
embodiment, and FIG. 2b, in the resultant assembly, the combined
components cooperate to provide both a tibial bone-contacting
surface (28) and a wear surface (26).
[0069] In the alternative embodiment of FIG. 3, rather than being
positioned in a side-by-side fashion across the bone surface (as in
FIG. 2), a final implant is provided using interlocking preformed
components (show in this case as portions 31 through 33,
respectively) are instead provided in a form that permits them to
be stacked upon each other, e.g., by layering or sliding them onto
each other, and positioned upon the surface, in situ. The portions
can be assembled in any suitable fashion, e.g., entirely on the
tissue site, entirely ex vivo, or in varying combinations as
desired. Optionally, and preferably, the generally planar portions
are provided with corresponding matable portions, e.g., in the form
of grooves and tabs to provide a sliding fit, or a depression and
corresponding projection to provide either a press fit, snap fit,
or other suitable fit sufficient to prevent lateral displacement to
the extent desired. The resultant formed prosthetic implant can be
provided with various features as described herein, including
desired molded portions adapted to provide better fit or
performance. Top portion (31) is particularly well suited to
provide a desirable wear surface, while one or more intermediate
portions (as shown by element 32) are adapted to provide an optimal
combination of such properties as thickness, cushioning, and
angular correction. As shown the lowermost portion (33) is shown
with a projection (34) adapted to be retained within a
corresponding anchor hole or suitable depression formed into the
bone itself. FIGS. 3b and 3c provide generally bottom and top
views, respectively, showing the manner in which the portions can
be combined in a layered fashion.
[0070] In the embodiment of FIG. 3, preformed layers are shown
having protrusions adapted to be positioned in a corresponding
indentation within each underlying layer (or bone), in order to
form a compact stack. In such an embodiment, the corresponding
system will typically include at least two preformed components,
including the initial, bone-contacting component, and final
component providing the wear surface. The system can provide one or
more intermediate layers, e.g., the number and/or selection of
which can be used to provide a final desired height to the overall
composite, and/or to provide differing properties (e.g., with
respect to compressibility, resilience, tissue ingrowth), and/or to
provide improved retention between the first and final
components.
[0071] FIG. 4a shows an embodiment in which a substantially open
(saucer-shaped) mold (40) is inserted into the joint site, to be
filled with a corresponding curable biomateral in situ. The top
(42) of the mold is open to receive biomaterial (not show), while
the bottom (44) provides a lower major surface (46) adapted to
contact bone and terminates in a filled protrusion (48) adapted to
be positioned within a corresponding anchor point drilled in the
bone itself. The anterior edge (50) of the cup is substantially
perpendicular to the plane of the cup itself, while the posterior
edge (52) is tapered (and optionally raised) to accommodate the
corresponding shape of the tibial spine.
[0072] As shown, and for use in an adult human, the ex vivo mold
accommodates a predetermined volume of biomaterial of on the order
of about 5 ml to about 15 ml. As a further advantage of this
invention, the amount of biomaterial actually can be predetermined
and controlled to correspond with the ex vivo mold volume. In
addition the ex vivo molds are designed for optimum sizing and
conformance to the joint site and MRI software may be used to chose
best mold for joint site. Implant thickness and hence angular
correction can be controlled in this way.
[0073] FIG. 4b shows a bottom perspective view of the mold
apparatus of FIG. 4a, showing the filled protrusion (48). The
posterior edge portion (and particularly the posterior mesial edge
portion, as seen in the figure) can be seen as provided with a
groove or indentation (54), again to accommodate the typical shape
of the corresponding tibial spine. Overall, the mold can be seen as
assuming a generally kidney-shaped configuration, adapted to
correspond with the tibial surface. Such a mold can be provided in
a plurality of sizes, and shapes, to be selected at the time of use
to accommodate the particular patient's needs and surgeon's
desires.
[0074] FIGS. 5a and 5b show the mold of FIG. 4a being positioned
upon a tibial surface (FIG. 5a), with the protrusion positioned
within a corresponding anchor point, and (in FIG. 5b) with the tip
of a biomaterial delivery cannula (56) positioned upon it, and with
flowable biomaterial (58) being shown in the course of
delivery.
[0075] FIG. 6 shows a variety of alternative embodiments that
include one or more preformed component. FIG. 6a shows a simple
wedge shaped embodiment (60), in which the posterior portion (62)
is significantly increased in size as compared to the anterior
(64). FIG. 6b shows an implant (66) molded to provide portions
(here, layers) having differing wear characteristics, including a
preformed top having improved wear as compared to the separately
formed bottom portion (70). FIG. 6c, by comparison, shows a
plurality of components (72) adapted to be positioned and assembled
in situ at the time of surgery. These include an upper portion (74)
having improved wear characteristics as compared to the others, a
bottom portion (78) being suitably formed to the patient's geometry
and desired angular correction, and one (or more) central portions
(76) adapted to be positioned between the top and bottom portions
to achieve desired properties such as overall thickness, angles,
and/or physical chemical properties (such as moduli).
[0076] The embodiment of FIG. 6d shows a single piece (80) as might
be cut from preformed material at the time of surgery, while FIG. 7
shows a variety of alternative means for anchoring a preformed
component such as that shown in FIG. 6d. These include the use of a
grout (82) or other suitable interface material as shown in FIG.
7a; the use of a separate external retaining device (84) as shown
in FIG. 7b; the use of externally provided pins, screws, sutures,
etc. as exemplified by elements (86) which generally traverse the
body itself as in FIG. 7c; and the use of one or more anchor
portions (88) positioned along one or more suitable surfaces as
shown in FIG. 7d.
[0077] FIG. 8 shows a further variety for anchoring or stabilizing
a preformed portion by the use of ancillary portions and/or surface
texture, including a roughened surface (90) as in FIG. 8a; or tabs
(e.g., provided by fabric or suture like materials) as shown as
elements 92 and 94 of FIGS. 8b and 8c, respectively. The surface
texture can include, for instance, a dimpled or other suitably
textured surface to improve lubricity. In a preferred embodiment,
the texture would be sufficient to allow entrapment of lubricant
under no load or low loads, followed by obliteration of the pattern
with load. In yet another alternative embodiment, a femoral forming
device of the type described in copending U.S. Provisional
Application Serial No. ______ can be used to impart a textured
surface. In practice, the preformed components can benefit from any
suitable combination of the various features and embodiments
described or shown herein.
[0078] FIG. 9 shows a variety of embodiments in a substantially
closed (balloon like) mold is adapted to be inserted into the joint
site and filled with a corresponding curable biomaterial, the mold
itself providing a preformed articulating wear surface, including
FIG. 9a which shows an inflatable balloon portion (96) that
includes an integral preformed wear surface and portion (98), as
well as a lumen (100) adapted to fill the inflatable portion with
flowable biomaterial. FIG. 9b shows a corresponding balloon (102)
though without a preformed portion, and including its biomaterial
lumen (104). Although not shown, the balloon of this or any
embodiment can include various interior and/or exterior surface
coatings, and can have regions and/or layers having different
desired physical-chemical properties (such as porosity). FIG. 9c
shows a bi-compartmental closed balloon-like mold (106), wherein
each compartment is adapted to conform to a respective medial or
lateral tibial surface.
[0079] FIG. 10 shows a mold adapted for use as an acetabular mold
(110) in connection with the replacement of the articulating
surface in a hip, when filled with biomaterial, the mold forming a
concave portion adapted to retain a corresponding femoral head. The
mold is shown providing a thin generally cup-shaped mold adapted to
be filled in any suitable form (e.g., using a removable conduit
(not shown) attached to the space between inner and outer sealed
layers (116 and 114, respectively) forming the mold.
[0080] FIG. 11 shows a patella-femoral joint form suitable for use
in combination with the method and system of this invention. As
shown in the views of 11a through 11c, the form includes a silicone
or other suitable pad material (122) having aluminum or other
suitable stay portions (124) and terminal handle or grasping
portions (126). In use, with the knee at a generally 45 degree
angle, the piece is formed to the femoral bone surface, with its
form maintained by bending the aluminum stays. With anchor points
cut into the femoral bone, if desired, the form is held tight
against the bone with the upper handle held away from bone to
permit the delivery of curable biopolymer between the form and the
bone. As polymer is placed onto the bone (and into any anchor
points) the form is maintained for a time sufficient to suitably
form the polymer, whereafter it can be removed.
[0081] FIG. 12 shows various views of a particularly preferred
implant of the present invention, of the general type shown in FIG.
1 and described above, including a top plan view (a), front plan
view (b), side plan view (c), section view (d) taken along A-A of
FIG. 12(a) and a section view (e) taken along C-C of FIG. 12(a).
FIG. 13, in turn, show side by side top plan views (a) and (b) of
corresponding implants for the left and right knees, respectively.
Reference numbers for the various portions correspond to those
described in FIG. 1, including preformed knee implant (10), the
first major surface (12) adapted to be positioned upon the tibial
surface, and a generally planar second major surface (14) adapted
to be positioned against the femoral condyle. The second major
surface is shown having a femoral glide path surface (16) to
facilitate its performance in situ, adapted to form a generally
central depression having the dimensions described herein. The
glide path is fully formed in situ, by a suitable combination of
both shaping and repositioning of the femoral condyle in the manner
described herein.
[0082] An implant of the type shown provides various benefits,
including the correction of varus deformities, based in significant
part upon the presence and configuration of the posterior mesial
lip (18), and the cutout (kidney bean shaped) for the intercondylar
eminence (see FIG. 4b, ref 54). The raised tibial projection (18)
is adapted to catch the posterior portion of the tibial plateau.
The implant itself has dimensions as provided herein, and can be
provided using one of a collection of molds of multiple sizes
and/or styles in accordance with the various parameters of the
present invention. A kit can be provided containing molds of
various sizes, e.g., varying by 1 mm or 2 mm increments in
thickness and providing a range of anterior to posterior
dimensions. Such molds can also be used to provide implants having
bottoms of various shapes, e.g., either a flat or curved bottom,
and for either the left or right knee.
[0083] An implant such as the configuration shown in FIG. 12 is
preferably used in a method that includes first determining the
proper implant thickness needed to match physiological valgus. The
surgeon prepares the site arthroscopically, removing excess
cartilage and removing the medial meniscus to the medial ring,
using a portal of about 1 cm in order to provide suitable
arthroscopic access while maintaining the presence of fluid in the
joint. The implant can be initially molded ex vivo, using a mold
selected from those available and including one or more embedded or
attached fixation portions (e.g., anterior sutures or tabs), at
which time it is inserted into the knee. The surgeon will then
typically feel the implant once in position, to confirm that the
implant is properly seated, and will extend the knee to provide
varus stress on the lower leg, obtaining congruency as the implant
continues to cure by finally molding both surfaces of the implant
(to both the tibial surface and condyle, respectively).
[0084] Optionally, and preferably, the surgeon can also use a
femoral forming device (e.g., spoon-shaped device) of the type
described in copending US Provisional Application mailed Dec. 7,
2001 and entitled "Method and Device for Smoothing The Surface of
Bone in an Articulating Joint", the disclosure of which is
incorporated herein by reference, in order to prepare a femoral
glide path and remove unwanted undulations. After a suitable time,
e.g., about 1 to about 5 minutes, and typically at about 2 minutes
using presently preferred polyurethane compositions, the implant
can be sutured to the anterior rim, and the knee can be flexed to
obtain complete range. Optionally, during or following this
procedure, the joint can be filled with a suitable fluid and
visualized, after which the knee is extended and braced, with the
access portal(s) closed by suitable means (e.g., sutured).
[0085] As described in Applicant's co-pending U.S. provisional
application No. 60/228,444, the present application describes a
method and system for the creation or modification of the wear
surface using an implanted material fixed to the support structure
of the original wear surface, to generally conform to the shape of
the original surface in a mammal. A method or system where the end
of the bony surface is a rotating, sliding or rolling surface, such
as in the knee, finger, hip, toe, spine, wrist, elbow, shoulder,
ankle, or TMJ joint. The implant will function:
[0086] a) as a spacer,
[0087] b) as an impact absorber
[0088] c) as a surface with improved coefficient of friction (as
compared to the diseased surface), and/or
[0089] d) to increase the weight bearing area and improve
congruency of the joint surface (as compared to the diseased
condition).
[0090] The method and system of this invention can be applied to
areas of aseptic necrosis, such as the nevecular bone in the wrist.
The material to be implanted consists of a plurality of materials,
such as polymers, including polyurethane, polyethyelenes,
polyureas, polyacrylates, polyurethane acrylates, hydrogels,
epoxies and/or hybrids of any of the above.
[0091] In an alternative embodiment, the surface can be provided by
any of a series of metals, including titanium, stainless steel,
cobalt chrome millithium alloys and tantalum. Other surface
materials can include various ceramics and biologic polymers.
[0092] The implantable material for the resurfacing can be formed
ex vivo and/or in vivo as an injectable material that sets up to
the molded shape. The methods for changing state from liquid to
solid state include cooling or heating, the passage of time, which
allows for a change of state, or a chemical reaction between
different reactants. The reaction can be exothermic or endothermic.
The set-up can be light activated or chemically catalyzed or it
could be heat activated. Examples of such systems include flowable
polymers of two or more components, light activated polymers, and
polymers cured either by catalysts or by heat, including body heat,
or any suitable combination thereof. Molds can be used in the form
of balloons, dams or retainers. They can be used in combination
with the local anatomy to produce the desired shape and geometry.
Molds can be of materials that are retained and becomes part of the
implant or could be removed after curing of the biomaterial
component.
[0093] In an alternative embodiment, the material would be
semi-solid and could be shaped and then set up in vivo. This would
allow for the minimally invasive application, either through an
arthroscopic portal or through a small mini arthrotomy. As a
further embodiment, the material could be synthesized ex vivo and
then machined to fit using imaging to pre-determine the desired
geometry and size of the implant. As a further alternative, a range
of implant sizes could be provided and sizing could be accomplished
during the procedure. An ex vivo mold could be fit using molding
materials and the implant could be molded on site just prior to
implantation.
[0094] Fixation methods for the implant would include biologic
glues to glue the implant to the underlying surface, trapping of
the implant into a cavity on the surface that causes a mechanical
lock, using various anchors to the underlying structure and fixing
the implant to that surface or using mold retainers and/or screws,
staples, sutures or pins. In alternative embodiment, anchors in the
underlying structure may be used for fixing the implant to that
surface and we may also use a tissue ingrowth system to secure
anchoring.
[0095] In the preferred embodiment, the patient will have a
diagnosis of osteoarthritis and have loss of cartilage on the
articulating surface. A determination will be made of the amount of
correction needed for the reestablishment of a normal angle of
articulation. The ligaments will be balanced so that there is no
loss of range of motion with the implant in place and the surface
will be placed in such a position that the eventual resulting
surface geometry reestablishes the same plane and orientation of
the original articular surface.
[0096] Access to the site is obtained in a minimally invasive way.
In a preferred embodiment, this is accomplished through
arthroscopic means with arthroscopic portals. In an alternative
embodiment, the access is accomplished by a mini arthrotomy with a
small incision that allows access to the joint without sacrificing
nerves, vessels, muscles or ligaments surrounding the joint. In the
preferred embodiment fibrillated articulating cartilage that is
degenerated is removed down to the subchondral surface. The surface
is dried and prepared for appropriate anchoring. This may include
anchor points that give a mechanical lock or that alternatively
simply supply horizontal and lateral stability. The surface may be
prepared by drying and roughening in case a tissue adhesive is
used. Pre-made anchors may be installed. These may be made of
various metallic materials or of polymers and may consist of pegs
that would extend up through the implant to anchor it to the
underlying surface. This surrounding subchondral bone may be
roughened to enhance tissue ingrowth or implant adhesion. The final
geometry of the implant may be determined by a dam or mold that is
placed on the joint at the time the material is implanted, when the
implant is installed using an in situ cured technique (in the
manner shown in FIGS. 1 and 4 of Applicant's provisional parent
application).
[0097] For pre-made material formed at the surgical site within a
mold, various forms of stabilization could be used, including
anchor points or titanium screws. Alternatively, the pre-made
material could be made off site to the specs developed from imaging
of the patient's joint surface. In a third embodiment, multiple
sizes could be made off site and the selection of the appropriate
implant size could be chosen at the time of surgery. Two
alternatives shown in FIG. 2 of the parent provisional application
include a single segment that can be installed through a portal or
a series of segments that can be installed through a portal and
locked together once inside the joint. They would be placed
sequentially and then anchored to the bone by anchor points cut in
the bone or by screws or tissue ingrowth. Finally, a robot, a jag
or other cutting fixture could be used to prepare the bony surface
for the pre-made implant to a fixed geometry of the anchor
point.
[0098] Both the preformed component(s) and flowable biomaterial, if
used, can be prepared from any suitable material. Typically, the
materials include polymeric materials, having an optimal
combination of such properties as biocompatibility, physical
strength and durability, and compatibility with other components
(and/or biomaterials) used in the assembly of a final composite.
Examples of suitable materials for use in preparing the preformed
component(s) may be the same or different from the in situ curing
biomaterial, and include polyurethanes, polyethylenes,
polypropylenes, Dacrons, polyureas, hydrogels, metals, ceramics,
epoxies, polysiloxanes, polyacrylates, as well as biopolymers, such
as collagen or collagen-based materials or the like and
combinations thereof.
[0099] Examples of suitable materials for use in preparing the
flowable biomaterial, if used, include polyurethanes, polyureas,
hydrogels, epoxies, polysiloxanes, polyacrylates, and combinations
thereof.
[0100] In a presently preferred embodiment, the preformed
component(s) and the flowable biomaterial, if included, each
comprise a biocompatible polyurethane. The same or different
polyurethane formulations can be used to form both the preformed
component(s), e.g., by an injection molding technique, as well as
for the flowable biomaterial, if present.
[0101] Suitable polyurethanes for use as either the preformed
component or biomaterial can be prepared by combining: (1) a
quasi-prepolymer component comprising the reaction product of one
or more polyols, and one or more diisocyanates, and optionally, one
or more hydrophobic additives, and (2) a curative component
comprising one or more polyols, one or more chain extenders, one or
more catalysts, and optionally, other ingredients such as an
antioxidant, and hydrophobic additive.
[0102] In the embodiment in which an in situ curing polymer is
used, the present invention preferably provides a biomaterial in
the form of a curable polyurethane composition comprising a
plurality of parts capable of being mixed at the time of use in
order to provide a flowable composition and initiate cure, the
parts including: (1) a quasi-prepolymer component comprising the
reaction product of one or more polyols, and one or more
diisocyanates, optionally, one or more hydrophobic additives, and
(2) a curative component comprising one or more polyols, one or
more chain extenders, one or more catalysts, and optionally, other
ingredients such as an antioxidant, hydrophobic additive and dye.
Upon mixing, the composition is sufficiently flowable to permit it
to be delivered to the body, and there be fully cured under
physiological conditions. Preferably, the component parts are
themselves flowable, or can be rendered flowable, in order to
facilitate their mixing and use.
[0103] The flowable biomaterial used in this invention preferably
includes polyurethane prepolymer components that react either ex
vivo or in situ to form solid polyurethane ("PU"). The formed PU,
in turn, includes both hard and soft segments. The hard segments
are typically comprised of stiffer oligourethane units formed from
diisocyanate and chain extender, while the soft segments are
typically comprised of one or more flexible polyol units. These two
types of segments will generally phase separate to form hard and
soft segment domains, since they tend to be incompatible with one
another. Those skilled in the relevant art, given the present
teaching, will appreciate the manner in which the relative amounts
of the hard and soft segments in the formed polyurethane, as well
as the degree of phase segregation, can have a significant impact
on the final physical and mechanical properties of the polymer.
Those skilled in the art will, in turn, appreciate the manner in
which such polymer compositions can be manipulated to produce cured
and curing polymers with desired combination of properties within
the scope of this invention.
[0104] The hard segments of the polymer can be formed by a reaction
between the diisocyanate or multifunctional isocyanate and chain
extender. Some examples of suitable isocyanates for preparation of
the hard segment of this invention include aromatic diisocyanates
and their polymeric form or mixtures of isomers or combinations
thereof, such as toluene diisocyanates, naphthalene diisocyanates,
phenylene diisocyanates, xylylene diisocyanates, and
diphenylmethane diisocyanates, and other aromatic polyisocyanates
known in the art. Other examples of suitable polyisocyanates for
preparation of the hard segment of this invention include aliphatic
and cycloaliphatic isocyanates and their polymers or mixtures or
combinations thereof, such as cyclohexane diisocyanates,
cyclohexyl-bis methylene diisocyanates, isophorone diisocyanates
and hexamethylene diisocyanates and other aliphatic
polyisocyanates. Combinations of aromatic and aliphatic or arylakyl
diisocyanates can also be used.
[0105] The isocyanate component can be provided in any suitable
form, examples of which include 2,4'-diphenylmethane diisocyanate,
4,4'-diphenylmethane diisocyanate, and mixtures or combinations of
these isomers, optionally together with small quantities of
2,2'-diphenylmethane diisocyanate (typical of commercially
available diphenylmethane diisocyanates). Other examples include
aromatic polyisocyanates and their mixtures or combinations, such
as are derived from phosgenation of the condensation product of
aniline and formaldehyde. It is suitable to use an isocyanate that
has low volatility, such as diphenylmethane diisocyanate, rather
than more volatile materials such as toluene diisocyanate. An
example of a particularly suitable isocyanate component is the
4,4'-diphenylmethane diisocyanate ("MDI"). Alternatively, it can be
provided in liquid form as a combination of 2,2'-, 2,4'- and
4,4'-isomers of MDI. In a preferred embodiment, the isocyanate is
MDI and even more preferably 4,4'-diphenylmethane diisocyanate.
[0106] Some examples of chain extenders for preparation of the hard
segment of this invention include, but are not limited, to short
chain diols or triols and their mixtures or combinations thereof,
such as 1,4-butane diol, 2-methyl-1,3-propane diol,
1,3-propane-diol ethylene glycol, diethylene glycol, glycerol,
cyclohexane dimethanol, triethanol amine, and methyldiethanol
amine. Other examples of chain extenders for preparation of the
hard segment of this invention include, but are not limited to,
short chain diamines and their mixtures or combinations thereof,
such as dianiline, toluene diamine, cyclohexyl diamine, and other
short chain diamines known in the art.
[0107] The soft segment consists of urethane terminated polyol
moieties, which are formed by a reaction between the polyisocyanate
or diisocyanate or polymeric diisocyanate and polyol. Examples of
suitable diisocyanates are denoted above. Some examples of polyols
for preparation of the soft segment of this invention include but
are not limited to polyalkylene oxide ethers derived form the
condensation of alkylene oxides (e.g. ethylene oxide, propylene
oxide, and blends thereof), as well as tetrahyrofuran based
polytetramethylene ether glycols, polycaprolactone diols,
polycarbonate diols and polyester diols and combinations thereof.
In a preferred embodiment, the polyols are polytetrahydrofuran
polyols ("PTHF"), also known as polytetramethylene oxide ("PTMO")
or polytetramethylene ether glycols ("PTMEG"). Even more
preferably, the use of two or more of PTMO diols with different
molecular weights selected from the commercially available group
consisting of 250, 650,1000, 1400, 1800, 2000 and 2900.
[0108] Two or more PTMO diols of different molecular weight can be
used as a blend or separately, and in an independent fashion as
between the different parts of the two part system. The
solidification temperature(s) of PTMO diols is generally
proportional to their molecular weights. The compatibility of the
PTMO diols with such chain extenders as 1,4-butanediol is generally
in the reverse proportion to molecular weight of the diol(s).
Therefore the incorporation of the low molecular weight PTMO diols
in the "curative" (part B) component, and higher molecular weight
PTMO diols in the prepolymer (part A) component, can provide a
two-part system that can be used at relatively low temperature. In
turn, good compatibility of the low molecular weight PTMO diols
with such chain extenders as 1,4-butanediol permits the preparation
of two part systems with higher (prepolymer to curative) volume
ratio. Amine terminated polyethers and/or polycarbonate-based diols
can also be used for building of the soft segment.
[0109] The PU can be chemically crosslinked, e.g., by the addition
of multifunctional or branched OH-terminated crosslinking agents or
chain extenders, or multifunctional isocyanates. Some examples of
suitable crosslinking agents include, but are not limited to,
trimethylol propane ("TMP"), glycerol, hydroxyl terminated
polybutadienes, hydroxyl terminated polybutadienes (HOPB), trimer
alcohols, Castor oil polyethyleneoxide (PEO), polypropyleneoxide
(PPO) and PEO-PPO triols. In a preferred embodiment, HOPB is used
as the crosslinking agent.
[0110] This chemical crosslinking augments the physical or
"virtual" crosslinking of the polymer by hard segment domains that
are in the glassy state at the temperature of the application. The
optimal level of chemical cross-linking improves the compression
set of the material, reduces the amount of the extractable
components, and improves the biodurability of the PU. This can be
particularly useful in relatively soft polyurethanes, such as those
suitable for the repair of damaged cartilage. Reinforcement by
virtual cross-links alone may not generate sufficient strength for
in vivo performance in certain applications. Additional
cross-linking from the soft segment, potentially generated by the
use of higher functional polyols can be used to provide stiffer and
less elastomeric materials. In this manner a balancing of hard and
soft segments, and their relative contributions to overall
properties can be achieved.
[0111] Additionally, a polymer system of the present invention
preferably contains at least one or more, biocompatible catalysts
that can assist in controlling the curing process, including the
following periods: (1) the induction period, and (2) the curing
period of the biomaterial. Together these two periods, including
their absolute and relative lengths, and the rate of acceleration
or cure within each period, determines the cure kinetics or profile
for the composition. Some examples of suitable catalysts for
preparation of the formed PU of this invention include, but are not
limited to, tin and tertiary amine compounds or combinations
thereof such as dibutyl tin dilaurate, and tin or mixed tin
catalysts including those available under the tradenames "Cotin
222", "Formrez UL-22" (Witco), "dabco" (a triethylene diamine from
Sigma-Aldrich), stannous octanoate, trimethyl amine, and triethyl
amine. In a preferred embodiment, the catalyst is Formrez UL-22
(Witco). In an alternative preferred embodiment, the catalyst is a
combination Cotin 222 (CasChem) and dabco (Sigma-Aldrich).
[0112] The in vivo and ex vivo cured polyurethanes of this
invention can be formed by the reaction of two parts. Part I of
which (alternatively referred to as Part A) includes a di- or
multifunctional isocyanate or quasi-prepolymer which is the
reaction product of one or more OH-terminated components, and one
or more isocyanates. Part II of the polyurethane (alternatively
referred to as Part B herein) is a curative component that includes
of one or more chain extenders and one or more polyols, and one or
more catalysts, and other additives such as antioxidants and dyes.
For a suitable formed PU, the stoichiometry between Parts I
(quasi-prepolymer) and II (curative component), expressed in terms
of NCO:OH molar ratio of the isocyanate terminated pre-polymer
(Part I) and the curative component (Part II) is preferably within
the range of about 0.8 to 1.0 to 1.2 to 1.0, and more preferably
from about 0.9 to 1 to about 1.1 to 1.0.
[0113] Optionally, a reactive polymer additive can be included and
is selected from the group consisting of hydroxyl- or
amine-terminated compounds selected from the group consisting of
poybutadiene, polyisoprene, polyisobutylene, silicones,
polyethylene-propylenediene, copolymers of butadiene with
acryolnitrile, copolymers of butadiene with styrene, copolymers of
isoprene with acrylonitrile, copolymers of isoprene with styrene,
and mixtures of the above.
[0114] Suitable compositions for use in the present invention are
those polymeric materials that provide an optimal combination of
properties relating to their manufacture, application, and in vivo
use. In the uncured state, such properties include component
miscibility or compatibility, processability, and the ability to be
adequately sterilized or aseptically processed and stored. In the
course of applying such compositions, suitable materials exhibit an
optimal combination of such properties as flowability, moldability,
and in vivo curability. In the cured state, suitable compositions
exhibit an optimal combination of such properties as strength
(e.g., tensile and compressive), modulus, biocompatibility and
biostability.
[0115] When cured, the compositions demonstrate an optimal
combination of properties, particularly in terms of their
conformational stability and retention of physical shape,
dissolution stability, biocompatibility, and physical performance,
as well mechanical properties such as load-bearing strength,
tensile strength, shear strength, shear fatigue resistance, impact
absorption, wear resistance, and surface abrasion resistance. Such
performance can be evaluated using procedures commonly accepted for
the evaluation of natural tissue and joints, as well as the
evaluation of materials and polymers in general. In particular, a
preferred composition, in its cured form, exhibits mechanical
properties that approximate or exceed those of the natural tissue
it is intended to provide or replace.
[0116] To achieve these desirable uncured and delivery properties,
a "polymer system", as used herein refers to the component or
components used to prepare a polymeric composition of the present
invention. In a preferred embodiment, a polymer system comprises
the components necessary to form two parts: Part I being an NCO
terminated pre-polymer (optionally referred to as an "isocyanate
quasi-polymer"). The quasi-polymer of Part I typically includes a
polyol component, optionally in combination with a hydrophobic
additive component, and an excess of an isocyanate component. Part
II of the two component system can include one long-chain polyols,
chain extenders and/or cross-linkers, together with other
ingredients (e.g., catalysts, stabilizers, plasticizers,
antioxidants, dyes and the like). Such adjuvants or ingredients can
be added to or combined with any other component thereof either
prior to or at the time of mixing, delivery, and/or curing.
[0117] In a particularly preferred embodiment, a polymer system of
this invention is provided as a plurality of component parts and
employs one or more catalysts. The component parts, including
catalyst, can be mixed to initiate cure, and then delivered, set
and fully cured under conditions (e.g., time and exotherm)
sufficient for its desired purpose. Upon the completion of cure,
the resultant composition provides an optimal combination of
properties for use in repairing or replacing injured or damaged
tissue. In a particularly preferred embodiment, the formulation
provides an optimal combination of such properties as compatibility
and stability of the biomaterial parts, ex vivo or in situ cure
capability and characteristics (e.g., extractable levels,
biocompatibility, thermal/mechanical properties), mechanical
properties (e.g., tensile, tear and fatigue properties), and
biostability.
[0118] The volume ratio of the parts can also be used to improve
and affect the uncured and curing properties Compositions having
two or more parts, are preferred. Where two parts are used, the
relative volumes can range, for instance, from 1:10 to 10:1
(quasi-prepolymer to curative components, based on volume). A
presently preferred range is between 2:1 and 1:2. As those skilled
in the art will appreciate, given the present description, the
optimal volume ratio is largely determined by the compatibility and
the stability of part A and B.
[0119] In choosing an optimal volume ratio for a given formulation,
those skilled in the art, given the present description, will
appreciate the manner in which the following considerations can be
addressed. The viscosity of the reactive parts, at the temperature
used for either injection-molding preformed components, or for in
situ cure, should provide an acceptable degree of mixing and flow
rate, without causing mechanical failure of any component of the
delivery system including cartridge, static mixer, gun and other
components.
[0120] Preferably, the biomaterial is sufficiently flowable to
permit it to be delivered (e.g., injected) into the mold or tissue
site. The composition of both reactive parts must be such that
these parts are homogeneous and phase stable in the temperature
range of the application. Generally, the maximum temperature of the
reaction exotherm is proportional to the concentration of the
reactive groups in the mixed polymer. A high concentration of the
reactive groups might evolve too high reaction exothermal energy
and therefore cause thermal damage to the surrounding tissues. The
reactive parts will preferably remain substantially liquid in form
during mixing.
[0121] A desired and stable volume ratio of the components can be
achieved in any suitable manner, e.g., by the use of
dual-compartment cartridges with constant volume ratio or by using
the injectors with delivery rates independently variable for each
component.
[0122] Compatibility of the composition can also be affected (and
improved) in other ways as well, e.g., by pre-heating the
components prior to polymer application. To enhance the homogeneity
of the components, the components of a preferred composition of
this invention are preferably preheated before mixing and delivery,
e.g., by heating to about 40 C, more preferably about 60 C, to
about 80 C for about 2 to about 6 hours prior to use or for the
time necessary for complete melting and forming of the member.
Preferably, the composition parts are cooled back to about 35 C to
37 C before use in injection.
[0123] Fully cured polymeric (e.g., polyurethane) biomaterials
suitable for use in forming components of this invention provide an
optimal combination of such properties as creep and abrasion
resistance. Preferably, for instance, the biomaterial provides DIN
abrasion values of less than about 100 mm.sup.3, more preferably
less than about 80 mm.sup.3 and most preferably less than about 60
mm.sup.3, as determined by ASTM Test Method D5963-96 ("Standard
Test Method for Rubber Property Abrasion Resistance Rotary Drum
Abrader").
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