U.S. patent application number 13/156242 was filed with the patent office on 2012-01-19 for implant components and methods.
This patent application is currently assigned to SMITH & NEPHEW, INC.. Invention is credited to Justin Steve Conway, David C. Kelman, Jeffrey A. Sharp, Jeffrey Joel Shea, Brian Ronald Yokoo.
Application Number | 20120016487 13/156242 |
Document ID | / |
Family ID | 45098648 |
Filed Date | 2012-01-19 |
United States Patent
Application |
20120016487 |
Kind Code |
A1 |
Conway; Justin Steve ; et
al. |
January 19, 2012 |
IMPLANT COMPONENTS AND METHODS
Abstract
Systems, devices, and methods are provided for orthopedic
implants. The implants may include a base member, such as an
acetabular shell or an augment, that is configured to couple with
an augment, flange cup, mounting member, or any other suitable
orthopedic attachment. An augment provided for an acetabular
implant may be adjustably positionable around the implant. An
implant may have one or more slots that mate with connections on
the augment and allow the augment to move within the slot. An
augment may be translated, rotated, or moved in any other way to
achieve a desired orientation prior to locking the augment in place
relative to the implant. The augment may be locked by a screw or
other locking mechanism that holds the augment in place. The
locking mechanism may be releasable to allow for repositioning of
the augment.
Inventors: |
Conway; Justin Steve; (Olive
Branch, MS) ; Kelman; David C.; (Collierville,
TN) ; Sharp; Jeffrey A.; (Salt Lake City, UT)
; Shea; Jeffrey Joel; (Memphis, TN) ; Yokoo; Brian
Ronald; (Riverton, UT) |
Assignee: |
SMITH & NEPHEW, INC.
Cordova
TN
|
Family ID: |
45098648 |
Appl. No.: |
13/156242 |
Filed: |
June 8, 2011 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
61352705 |
Jun 8, 2010 |
|
|
|
61352722 |
Jun 8, 2010 |
|
|
|
61422903 |
Dec 14, 2010 |
|
|
|
61466817 |
Mar 23, 2011 |
|
|
|
Current U.S.
Class: |
623/22.38 |
Current CPC
Class: |
A61B 17/866 20130101;
A61F 2002/30538 20130101; A61F 2/34 20130101; A61F 2002/30326
20130101; A61F 2002/4619 20130101; A61F 2002/3412 20130101; A61F
2002/30579 20130101; A61F 2002/30841 20130101; A61F 2/30965
20130101; A61F 2002/30891 20130101; G06F 9/45533 20130101; A61F
2/30942 20130101; A61F 2002/30578 20130101; A61F 2002/30736
20130101; A61B 17/8066 20130101; A61B 17/82 20130101; A61F
2002/30507 20130101; A61F 2002/3441 20130101; A61B 17/8685
20130101; A61F 2002/30471 20130101; A61F 2/30734 20130101; A61F
2/30907 20130101; A61F 2002/30189 20130101; A61F 2002/30617
20130101; A61F 2002/4615 20130101; A61F 2002/30011 20130101; A61F
2002/3082 20130101; B33Y 80/00 20141201; A61F 2/30771 20130101;
A61F 2002/3092 20130101; A61F 2002/30985 20130101; A61F 2002/3096
20130101; A61F 2002/3429 20130101; A61F 2002/30331 20130101; A61F
2002/3093 20130101; A61F 2002/30169 20130101; A61F 2002/3448
20130101; A61F 2002/3487 20130101; A61F 2/30749 20130101; A61F
2002/30387 20130101; A61F 2002/30474 20130101; A61F 2002/348
20130101; A61F 2/4609 20130101; A61F 2002/30449 20130101; A61F
2002/30604 20130101; A61F 2002/30462 20130101; A61F 2002/30952
20130101 |
Class at
Publication: |
623/22.38 |
International
Class: |
A61F 2/34 20060101
A61F002/34 |
Claims
1. An orthopedic implant system comprising: an acetabular implant
having a track that includes a plurality of slots and an exterior
surface; an augment having a protrusion that moves within the
plurality of slots, the augment having a first cam surface that
forms an interface with the exterior surface; and wherein the
protrusion has an adjustable fastener that, upon adjusting, fixes
the augment with respect to the implant to impede further
movement.
2. The orthopedic implant system of claim 1, wherein the augment
rotates about the exterior surface.
3. The orthopedic implant system of claim 1, wherein the adjustable
fastener is a tightening screw that extends through a through-hole
in the augment.
4. The orthopedic implant system of claim 3, wherein the tightening
screw, upon tightening, expands the protrusion and thereby tightens
the augment within the track.
5. The orthopedic implant system of claim 4, wherein the protrusion
is flared outwardly.
6. The orthopedic implant system of claim 3, wherein the tightening
screw has a head that fits within a slot and faces an interior
portion of the implant.
7. The orthopedic implant system of claim 6, wherein the slot has
an interior opening that aligns with the head.
8. The orthopedic implant system of claim 7, wherein the interior
opening receives a tightening rod to tighten the screw.
9. The orthopedic implant system of claim 1, wherein the track
includes a dovetail joint that receives the protrusion.
10. The orthopedic implant system of claim 1, wherein the track
includes a straight portion and a curved portion.
11. The orthopedic implant system of claim 10, wherein the track
includes two straight slots and a curved portion.
12. The orthopedic implant system of claim 1, wherein the track
includes a J-shaped slot with a wall of the implant.
13. The orthopedic implant system of claim 1, wherein the
protrusion is part of an intermediate locking member that is
integral to the augment.
14. The orthopedic implant system of claim 1, wherein the first cam
surface of the augment includes at least one trough that receives
cement to bind the augment to the shell.
15. The orthopedic implant system of claim 14, wherein the augment
includes a plurality of projections that form a gap.
16. The orthopedic implant system of claim 15, further comprising a
flange attached to the augment.
17. A method of preparing an orthopedic implant, comprising the
step of: providing an implant having a curved external surface and
an opening in the surface, the opening having at least two portions
that join at a common region but are separated by an angle of less
than 180.degree.; providing an augment having a first surface that
interfaces with the curved external surface; coupling the augment
and implant by an intermediate locking member; and tightening the
intermediate locking member.
18. The method of claim 17, including the step of securing the
augment to the implant by disposing cement within a trough located
on the first surface.
19. The method of claim 17, further comprising the step of rotating
the augment with respect to the implant about the curved external
surface prior to tightening the intermediate locking member.
20. The method of claim 19, further comprising the step of moving
the intermediate locking member within the opening prior to
tightening.
21. The method of claim 17, further comprising the steps of
applying a fastener to the implant, so that the fastener extends
outwardly from the external surface, and positioning the augment
about the external surface so that the extended fastener fits
between two protrusions of the augment.
22. The method of claim 21, wherein the intermediate locking member
is tightened with respect to the augment by a screw.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims the benefit of U.S. Provisional
Patent Application No. 61/352,705, filed Jun. 8, 2010, U.S.
Provisional Application No. 61/352,722, filed Jun. 8, 2010, U.S.
Provisional Application No. 61/422,903, filed Dec. 14, 2010, and
U.S. Provisional Application No. 61/466,817, filed Mar. 23, 2011,
which are hereby incorporated by reference herein in their
entireties.
BACKGROUND
[0002] Joints often undergo degenerative changes due to a variety
of reasons. When joint degeneration becomes advanced or
irreversible, it may become necessary to replace the natural joint
with a prosthetic joint. Artificial implants, including hip joints,
shoulder joints, and knee joints are widely used in orthopedic
surgery. Specifically, hip joint prostheses are common. The human
hip joint acts mechanically as a ball and socket joint, wherein the
ball-shaped head of the femur is positioned within the
socket-shaped acetabulum of the pelvis. Various degenerative
diseases and injuries may require replacement of all or a portion
of a hip using synthetic materials, typically metals, ceramics, or
plastics.
[0003] More particularly, natural hips often undergo degenerative
changes, requiring replacement of the hip joint with a prosthetic
joint. Often, the hip is replaced with two bearing surfaces between
the femoral head and the acetabulum. The first bearing surface is
typically a prosthesis shell or acetabular cup, which may be formed
of metal, ceramic material, or as otherwise desired. A liner
(conventionally formed of polyethylene material such as ultra high
molecular weight polyethylene, a ceramic material, or in some
cases, even a metal liner) is then fit tightly within the shell to
provide an inner bearing surface that receives and cooperates with
an artificial femoral head in an articulating relationship to track
and accommodate the relative movement between the femur and the
acetabulum.
[0004] The cup (or a cup and liner assembly) is typically fixed
either by placing screws through apertures in the cup or by
securing the cup with cement. In some cases, only a liner is
cemented in a patient due to poor bone stock. In other cases, a cup
having a porous surface may be press fit into the reamed acetabular
surface.
[0005] It may become necessary to conduct a second or subsequent
surgery in order to replace a prosthetic joint with a (often
larger) replacement joint. Such surgeries often become necessary
due to further degeneration of bone or advancement of a
degenerative disease, requiring removal of further bone and
replacement of the removed, diseased bone with a larger or enhanced
prosthetic joint, often referred to as a revision prosthesis. For
example, bone is often lost around the rim of the acetabulum, and
this may provide less rim coverage to securely place a press-fit
cup. Such surgeries may thus be referred to as revision
surgeries.
[0006] In acetabular revision surgery, an acetabular prosthesis
generally includes additional mounting elements, such as augments,
flanges, hooks, plates, or any other attachment or mounting points
or members that provide additional support and/or stability for the
replacement prosthesis once positioned. These additional mounting
or attachment members are often required due to bone degeneration,
bone loss, or bone defects in the affected area (in this instance,
the hip joint).
[0007] Various types of these mounting members (which term is
intended to include but not be limited to flanges, blades, plates
and/or hooks) may be provided in conjunction with a prosthesis
system in order to help the surgeon achieve optimal fixation,
non-limiting examples of which include iliac flanges (providing
securement and fixation in and against the ilium region of the
pelvis), ischial blades (providing securement and fixation in and
against the ischium), and obturator hooks (providing securement and
inferior fixation by engaging the obturator foramen). Although
there have been attempts to provide such mounting attachments with
modularity, the solutions to date have generally fallen short of
providing true modularity. Instead, they typically provide a few
discrete positions at which the mounting members may be positioned,
without providing the surgeon a fuller range of decision
options.
[0008] Additionally, in some primary surgeries and more often in
revision surgeries, the acetabulum may have a bone defect or void
that the surgeon must fill with bone grafts before inserting a new
shell. This can be time consuming and expensive, and may subject
the patient to additional health risks. Some techniques use an
augment in connection with the acetabular shell, which can be
coupled to or otherwise attached to the outer surface of the
shell.
[0009] With current augments, the surgeon can attach the augment to
the bone and then implant the cup. However, many acetabular shells
rely on bone screws to achieve proper fixation and the augment
often gets in the way of a screw. In short, surgeons need the
freedom to place screws in the best location, but this compromises
their ability to use augments. With current systems, it also takes
an increased amount of time surgical time to trial the component
orientation and then try to find good bone fixation for the cup.
The surgeon will often have to free-hand the amount of bone removed
while estimating the size of augment needed. In the cases where
bone is often deficient, surgeons are hesitant to take away any
more bone than necessary.
[0010] Various additional features and improved features intended
for use and application with various types of joint implants are
also described herein, such as improved bone screws, improved
coatings, and various augment removal and insertion options.
SUMMARY
[0011] Disclosed herein are systems, devices, and methods for
providing modular orthopedic implants. The implants may include a
base member, such as an acetabular shell or an augment, that is
configured to couple with an augment, flange cup, mounting member,
any other suitable orthopedic attachment, or any combinations
thereof. Mounting members include, for example, flanges, blades,
hooks, and plates. In some embodiments, the orthopedic attachments
may be adjustably positionable about the base member or other
attachments thereby providing modularity for assembling and
implanting the device. Various securing and/or locking mechanisms
may be used between the components of the implant. In certain
embodiments, the orthopedic attachments are removably coupled to
the base member or other components. In certain embodiments, the
orthopedic attachments are integrally provided on the base member
or other components, yet may still be adjustably positionable
thereabout. In some embodiments, expandable augments, base members,
or other bone filling devices are provided. In some embodiments,
surface features are provided that create friction and allow for
surrounding bone ingrowth at the interface of the implants and a
patient's bone.
[0012] Systems, devices, and methods described herein provide
implants having augments configured to attach to acetabular shells
or cages, mounting members, or other augments with or without
cement and configured to allow fine positional adjustments for best
bone fit, coverage, and stability. In certain embodiments, an
orthopedic implant includes an acetabular implant having a track
that includes a plurality of slots and an exterior surface, an
augment having a protrusion that moves within the plurality of
slots, the augment having a first cam surface that forms an
interface with the exterior surface, where the protrusion has an
adjustable fastener that, upon adjusting, fixes the augment with
respect to the implant to impede further movement. In some
embodiment, the augment may rotate about the exterior surface. The
adjustable fastener may be a tightening screw that extends through
a through-hole in the augment and, upon tightening, expands the
protrusion (which may be flared outwardly) and thereby tightens the
augment within the track. In some embodiments, the tightening screw
has a head that fits within a slot and faces an interior portion of
the implant, where the slot has an interior opening that aligns
with the head, and where the interior opening receives a tightening
rod to tighten the screw. In some embodiments, the track includes a
dovetail joint that receives the protrusion. In some embodiments,
the track includes a straight portion and a curved portion. For
example, the track can include two straight slots and a curved
portion. In some embodiments, the track includes a J-shaped slot
with a wall of the implant. The protrusion may be part of an
intermediate locking member that is integral to the augment. In
some embodiments, the first cam surface of the augment includes at
least one trough that receives cement to bind the augment to the
shell. In some embodiments, the augment includes a plurality of
projections that form a gap and may further include a flange
attached to the augment.
[0013] In certain embodiments, a method of preparing an orthopedic
implant includes the steps of providing an implant having a curved
external surface and an opening in the surface, the opening having
at least two portions that join at a common region but are
separated by an angle of less than 180.degree., providing an
augment having a first surface that interfaces with the curved
external surface, coupling the augment and implant by an
intermediate locking member, and tightening the intermediate
locking member. In some embodiments, the method may further include
the step of securing the augment to the implant by disposing cement
within a trough located on the first surface. In some embodiments,
the method may further include the step of rotating the augment
with respect to the implant about the curved external surface prior
to tightening the intermediate locking member, and moving the
intermediate locking member within the opening prior to tightening.
In some embodiments, the method may further include the steps of
applying a fastener to the implant, so that the fastener extends
outwardly from the external surface, and positioning the augment
about the external surface so that the extended fastener fits
between two protrusions of the augment, where the intermediate
locking member is tightened with respect to the augment by a
screw.
BRIEF DESCRIPTION OF THE DRAWINGS
[0014] The foregoing and other objects and advantages will be
apparent upon consideration of the following detailed description,
taken in conjunction with the accompanying drawings, in which like
reference characters refer to like parts throughout, and in
which:
[0015] FIG. 1 shows an illustrative augment configured to attach to
acetabular shells or cages, mounting members, or other
augments;
[0016] FIGS. 2 and 3 show an illustrative acetabular shell or cage
that includes a track;
[0017] FIG. 4 shows an illustrative augment that includes a through
hole;
[0018] FIG. 5 shows an illustrative fastener having an expanding
portion configured to be inserted through a track on an acetabular
shell and into an augment;
[0019] FIGS. 6 and 7 show illustrative augments configured to
secure to an acetabular shell or cage, mounting member, or other
augment prior to insertion into a prepared bone void;
[0020] FIG. 8 shows an augment having an illustrative intermediate
adapter member;
[0021] FIG. 9 shows an illustrative insertion opening in a shell
adapted to receive features of the intermediate adapter system of
FIG. 8;
[0022] FIG. 10 shows an illustrative expansion member inserted into
an intermediate adapter member to secure the adapter in a desired
location;
[0023] FIGS. 11 and 12 show examples of a prior mounting member or
augment adapted for securement to a shell;
[0024] FIGS. 13-15 show an illustrative mounting member or augment
provided with an opening having multiple fixed directional threaded
screw holes;
[0025] FIG. 16 shows an illustrative mounting member or augment
having an expandable or deformable spherical ball member;
[0026] FIG. 17 shows an illustrative mounting member or augment
having a rotatable inner cylinder insert member;
[0027] FIG. 18 shows an illustrative mounting member or augment
similar to FIG. 17 that is configured for use with a polyaxial
fastener;
[0028] FIG. 19 shows an illustrative mounting member and an
illustrative augment member provided with a dovetail feature;
[0029] FIGS. 20 and 21 show an illustrative dovetail feature
configured to receive a fastener;
[0030] FIGS. 22 and 23 show an illustrative chock
distally-connected to a surgical cable and positioned within a
portion of an augment;
[0031] FIGS. 24 and 25 show an illustrative chock having an angled
or inclined surface configured to receive an expansion member;
[0032] FIG. 26 shows an illustrative cable tensioning device
provided on a mounting member or augment;
[0033] FIGS. 27-29 show an illustrative mounting member or augment
that may be attached to an acetabular shell, cage or other augment
using a separate expandable chock member and an intermediate
connecting member;
[0034] FIG. 30 shows an illustrative expanding element that may be
provided in an aperture of a mounting member or augment;
[0035] FIG. 31 shows an illustrative ferrule on a cable that may be
positioned against an augment;
[0036] FIGS. 32 and 33 show illustrative geometries for a receiving
portion of a shell, cage, or augment;
[0037] FIG. 34 shows illustrative indicia for indicating a
positional relationship between the mounting member or augment and
the implant to which it is to be attached;
[0038] FIG. 35 shows illustrative spikes that may be provided on
mounting members or augments for improving fixation;
[0039] FIG. 36 shows an illustrative bi-lobe cup or shell;
[0040] FIG. 37 shows two augments attached together via an
illustrative fastening device;
[0041] FIG. 38 shows an illustrative augment with integral
spikes;
[0042] FIG. 39 shows an illustrative augment with built-in
securement features;
[0043] FIG. 40-42 show various illustrative augments or porous
coating portions having one or more cross-sectional areas of
reduced material;
[0044] FIG. 43 shows an illustrative rotary tool;
[0045] FIGS. 44-47 shows various connection devices for securing a
mounting member or an augment to an acetabular shell or cage;
[0046] FIGS. 48-50 show illustrative augments provided with an
elongated undercut groove configured to receive a cam locking
pin;
[0047] FIG. 51-54 show illustrative cleats provided proximate to a
rim of an acetabular shell or cage, mounting member, or
augment;
[0048] FIG. 55 shows illustrative cleat portions configured for
securing soft tissues;
[0049] FIGS. 56 and 57 show an illustrative augment attached
peripherally to an acetabular shell or cage via a recess;
[0050] FIGS. 58 and 59 show an illustrative mounting member
attached peripherally to an acetabular shell or cage via a
recess;
[0051] FIG. 60 shows an acetabular shell or cage having an
illustrative annular protrusion;
[0052] FIG. 61 shows a mounting member having an illustrative
orthopedic mesh;
[0053] FIG. 62 shows an illustrative mesh portion placed on an
outer portion of a shell;
[0054] FIG. 63 shows an illustrative mesh that includes a plurality
of trim lines that may be cut to separate the mounting members
attached thereto;
[0055] FIG. 64 shows illustrative separated mounting members from
the mesh of FIG. 63 placed into a patient's hip region; and
[0056] FIGS. 65 and 66 show an illustrative honeycomb design that
may be provided on a mounting member or augment.
DETAILED DESCRIPTION
[0057] To provide an overall understanding of the systems, devices,
and methods described herein, certain illustrative embodiments will
be described. Although the embodiments and features described
herein are specifically described for use in connection with
acetabular systems, it will be understood that all the components,
connection mechanisms, adjustable systems, fixation methods,
manufacturing methods, coatings, and other features outlined below
may be combined with one another in any suitable manner and may be
adapted and applied to medical devices and implants to be used in
other surgical procedures, including, but not limited to: spine
arthroplasty, cranio-maxillofacial surgical procedures, knee
arthroplasty, shoulder arthroplasty, as well as foot, ankle, hand,
and other extremity procedures.
[0058] Various implants and other devices described herein in their
various embodiments may be used in conjunction with any appropriate
reinforcement material, non-limiting examples of which include bone
cement, appropriate polymers, resorbable polyurethane, and/or any
materials provided by PolyNovo Biomaterials Limited, or any
suitable combinations thereof. Further non-limiting examples of
potential materials that may be used are described in the following
references: U.S. Patent Application Publication No. 2006/0051394,
entitled "Biodegradable Polyurethane and Polyurethane Ureas," U.S.
Patent Application Publication No. 2005/0197422, entitled
"Biocompatible Polymer Compositions for Dual or Multi Staged
Curing," U.S. Patent Application Publication No. 2005/0238683,
entitled "Biodegradable Polyurethane/Urea Compositions," U.S.
Patent Application Publication No. 2007/0225387, entitled "Polymer
Compositions for Dual or Multi Staged Curing," U.S. Patent
Application Publication No. 2009/0324675, entitled "Biocompatible
Polymer Compositions," U.S. Patent Application Publication No.
2009/0175921, entitled "Chain Extenders," and U.S. Patent
Application Publication No. 2009/0099600, entitled "High Modulus
Polyurethane and Polyurethane/Urea Compositions." Each of the prior
references is incorporated by reference herein in its entirety.
[0059] The embodiments shown in FIGS. 1-15 provide augments that
may be configured to attach to acetabular shells or cages, mounting
members, or other augments without cement, and are also configured
to allow fine positional adjustments for best bone fit, coverage,
and stability. It will be understood that the features and
components described in connection with the augments of FIGS. 1-15
may also be applied to mounting members, such as hooks, flanges
blades, or any other suitable mounting members, that may be
configured to attach to acetabular shells or cages, augments, or
other mounting members. FIG. 1 illustrates certain embodiments
wherein an augment 450 may be placed on a periphery of a
hemispherical acetabular shell, cage, or other augment. As shown in
FIGS. 2 and 3, a shell or cage 460 may comprise a track 462 that is
undercut so as to form a dovetail joint 461 with a mounting member
or an augment. The track 462 may be provided as a J-shaped slot (as
shown), T-shaped slot, H-shaped slot, or any other shape involving
combinations of straight and/or curved segments. The track 462
preferably includes at least two portions or slots, at least one of
which can receive a complementary connector or protrusion from the
augment or mounting member. As shown in FIG. 2, for example, the
first portion or slot 464 and second portion or slot 466 join about
common region 468 but are separated out at distal ends 465 and 467
by angle O, which is less than 180.degree. in the example. The at
least two portions thereby permit the augment or mounting member to
be adjustably positioned along the surface of the shell, cage, or
other augment by sliding the augment (and its connector) along the
track and securing it at the desired location. For example, the
augment could be secured in one of the at least two portions (such
as slot 464), or the other of the at least two portions (such as
slot 466), or in between.
[0060] The mounting member or augment may have a protrusion that is
flared outwardly, and may be generally frustoconical, bulbous, or
otherwise forms a portion of a male portion of a dovetail joint.
For example, as shown in FIG. 1, augment 450 includes protrusion
452 that is flared outwardly. The flared protrusion 452 may be
expandable when used with a central mandrel or expanding fastener.
Additionally or alternatively, it may be made from a deformable
material and/or may be provided as a bifurcated member having one
or more leg portions to facilitate expansion of the protrusion.
[0061] The outer peripheral surface portions 453 of the protrusion
452 may be rounded (e.g., a frustoconical shape), and the augment
450 (or, in some embodiments, mounting member) may not only be
translated within and along the track 462 on the shell 460, but
also rotated within the track 462 on the shell 460. A fastener 456
such as a screw, setscrew, mandrel, shank, rivet, or any other
fastener having a low profile head which is accessible from the
inside dome portion of the shell or cage 460 (or another augment)
is configured to engage an inner bore or opening 458 located in the
flared protrusion 452, thereby expanding the protrusion 452. The
term "expansion member" is used herein to refer to any appropriate
member, including but not limited to the fasteners listed above,
that can be used to engage and/or otherwise expand another feature.
One example of an expansion member that may be used in connection
with this embodiment comprises a setscrew/mandrel/fastener that has
a tapered outer portion or a surface having an outer diameter that
is greater than the receiving portion of the protrusion, such that
when the expansion member is threaded into the protrusion, the
protrusion expands. The expansion of the flared protrusion causes
the protrusion to frictionally engage the track in the
shell/cage/augment, thereby forming a locked dovetail connection
which secures the mounting member or augment to the shell. Once the
expansion member is completely tightened, the mounting member or
augment is locked to the shell/cage/augment in both translation and
rotation with a strong dovetail locking joint. For example, augment
450 can be attached to the track 462 by the protrusion 452. Before
tightening the protrusion 452, the augment 450 can be rotated with
respect to the shell 460, such that the augment interior surface
454 and the shell exterior surface 469 remain generally interfaced
while the augment 450 rotates about the shell 460 like a cam, until
the augment 450 is in the desired position. The protrusion 452 is
then tightened to secure the augment 450 in that position.
[0062] One advantage of such a mechanism is that the assembly of
the shell/cage/augment and the mounting member or augment may be
loosely assembled, then placed into a bone void such as an
irregularly shaped bone void. Once generally positioned, the
assembly components may be adjusted with respect to each other to
best fit an existing or prepared bone void. The assembly components
may then be tightened together such that the assembly closely
approximates the size, shape, and orientation of the existing or
prepared bone void.
[0063] While the particular embodiment shown in FIG. 1 illustrates
an expansion member 456 seated in a "blind" interior opening or
bore 458 in augment 450, an augment may alternatively or
additionally comprise a through hole such as through hole 478 of
augment 470 in FIG. 4, configured to receive an expansion or
tightening member 476, for example a long bone screw, long
fastener, or other long expansion member (such a tightening
configuration will be referred to throughout as a "long bone
screw," but it will be understood that any appropriate fastener
that can secure two components together, while also potentially
gain purchase into bone is considered appropriate for use in
connection with the described embodiment). The tightening member
476 may be configured to gain purchase in the augment 470 and/or
surrounding bone as illustrated in FIG. 4. The opening 487 in the
flared protrusion 472 that receives the bone screw 476 may
generally continue through the augment 470 and out a hole 479 in a
side of the augment 470 opposite the protrusion 472. In such
embodiments, the bone screw 476 enters the augment 470 through an
opening in the track 462 on the inside surface 463 of the
shell/cage 460 (or, in some embodiments, another augment), and
protrudes through the entire augment 470, including the flared
protrusion 472 which, during insertion of the bone screw 476, will
expand into the undercut track 461 on the shell/cage 460.
Essentially, the bone screw 476 locks the augment 470 to the
shell/cage 460 and secures the entire assembly to surrounding bone,
thereby stabilizing the assembly with respect to hip anatomy. In
this sense, not only does the bone screw 476 serve to rigidly
secure the augment 470 to the shell/cage 460 before necessarily
securing purchase of the bone screw 476 into surrounding bone, the
bone screw 476 further provides secondary fixation of the assembly
to surrounding bone by then subsequently securing purchase with
surrounding bone.
[0064] The embodiment shown in FIG. 4 allows a surgeon to lock the
augment 470 to a second component from an inside portion (e.g., an
inside portion 463 of a shell 460), after the loose assembly is
placed into the prepared bone void. In other words, the augment 470
may be loosely coupled to the shell 460 or other second component
in the patient's bone void, and a fastener is used to secure the
augment to the second component (not shown, but which may be the
shell, cage, or a second augment) and to the patient's bone. The
head is arranged within the slot of track 462 so that it is aligned
with the interior opening 478 of the augment 470 and extends
radially within the shell 460. The surgeon can then insert a
tightening rod through the interior opening 478, from inside the
shell 460, to access and tighten the screw 476.
[0065] FIG. 5 illustrates some embodiments related to those shown
in FIG. 4. A bone screw 681 or other fastener having both an
expanding portion 694 and a bone engaging portion is inserted
through an undercut recess, groove, or track 682 provided on an
acetabular shell or cage 680 (or, in some embodiments, provided on
an augment). The bone screw 681 or other fastener may be inserted
from an accessible inside portion 683 of said shell/cage 680. The
bone screw 681 or other fastener protrudes into and through an
opening 684 within an adjacent augment 686 (or, in some
embodiments, a mounting member) having a male connection member
688. The male connection member 688 may be generally cylindrical or
flared (e.g., frustoconical) and is configured to be inserted into
and move within (translate, rotate, etc.) the undercut recess,
groove, or track 682.
[0066] In use, as the bone screw 681 begins to make purchase with
bone, the expanding portion 694 of the bone screw 681 engages a
complementary expanding portion 692 of the augment 686 adjacent the
male connection member 688, thereby expanding a portion of the male
connection member 688 inside the undercut recess, groove, or track
682 and locking the augment 686 to the shell/cage 680 (or other
augment). In some embodiments, one or more of the expanding
portions of the bone screw and mounting member or augment may not
be threaded. For example, the expanding portion 694 of the bone
screw 681 may be threaded, and the expanding portion 692 of augment
686 may be a smooth tapered recess. Alternatively, the expanding
portion 694 of the bone screw 681 may be a smooth tapered surface
that seats within and wedges against a smooth tapered expanding
portion bore 684 in the augment 686. The taper angle of the bone
screw 681 expanding portion 694 may differ from the taper angle of
the expanding portion bore 684. Furthermore, the expanding portion
694 of the bone screw 681 may be an enlarged threaded section that
engages with a smooth undersized bore 684 in expanding portion 692
of the augment 686.
[0067] In further embodiments, as shown in FIGS. 6 and 7, it may be
desirable to secure a mounting member or augment to an acetabular
shell or cage, or other augment or mounting member prior to
insertion into a prepared acetabular bone void. In such instances,
the expansion member used to expand the protrusion may be made
relatively shorter, so as to be partially or completely encased by
the mounting member or augment. For example, expansion member 486
of augment 480 and expansion member 496 of augment 490 may be
relatively shorter than bone screw 476 of augment 470. The
insertion direction of the expansion member may be reversed with
respect to the aforementioned embodiments, and move in a securing
direction which is towards the acetabular shell/cage or other
augment. In this way, the mounting member or augment may be
attached to the shell/cage or other augment in a predetermined
configuration, prior to insertion of the assembly into the prepared
bone cavity.
[0068] The embodiment shown in FIG. 6 allows a surgeon to lock the
augment 480 to the shell 460 prior to insertion into the prepared
bone void, outside of the body cavity. The attachment prior to
insertion may be a tight securement or a loose coupling. If a loose
coupling is desired, such that complete securement can be completed
once the assembly has been fully positioned, an opening 499 on an
upper surface 494 of the augment 490, as shown in FIG. 7 allows
tightening once the completed assembly is positioned in the bone
cavity. In other words, this embodiment allows a surgeon to lock
the augment 490 to the shell 460 from an outside portion on
exterior surface 469 of the shell 460, after the loose assembly is
placed into the prepared bone void.
[0069] In use, the surgeon may place a frustoconical or otherwise
flared protrusion of the mounting member or augment into an
insertion clearance opening in the shell/cage or other augment, and
then may move the augment within a track extending from and
connected to the opening (as shown in FIG. 8) to a desired
rotational angle and/or location along the track. The surgeon may
rotate, translate, or otherwise position or move the mounting
member or augment as desired within the track. When the augment is
positioned and located in a desired spatial orientation relative to
the shell/cage or other augment, the expansion member can be
inserted into and through the augment, and tightened within a
threaded bore located in the protrusion.
[0070] It will be appreciated by one having ordinary skill in the
art that, while not shown, the expansion member may be internally
threaded and engageable with a male thread located within an
opening in the protrusion. It will also be appreciated that, while
not shown, the expansion member may only threadingly engage the
bulk body of the mounting member or augment and may have a distal
wedge portion provided thereon which engages a smooth tapered
opening in the protrusion. In this embodiment, when the expansion
member moves toward the protrusion in threaded engagement with the
bulk body of the mounting member or augment, its distal wedge
portion wedges open the flared projection via inclined surfaces
without actually "threadably" engaging in inner surface of the
protrusion. It should also be noted that the use of other fasteners
such as the rivet-type, or any other suitable fastener, or
combinations thereof, is envisioned.
[0071] When the expansion member is tightened or otherwise
adjusted, the arms of the bifurcated protrusion expand and move
away from each other, and therefore, the outer flared portions of
the protrusion engage the undercut walls of the track provided on
the shell/cage/augment. For example, when expansion member 456 of
FIG. 1 is tightened or otherwise adjusted, the arms of protrusion
452 may expand and engage the undercut walls 461 of the track 462
provided on shell 460 of FIG. 2. The arms of protrusions 472, 482,
and 492 may similarly be expanded when an expansion member is
tightened or otherwise adjusted. Friction between the walls of the
track and the expanded bifurcated protrusion maintain the mounting
member or augment in fixed relationship relative to the
shell/cage/augment, and the assembly may be inserted into the
prepared bony site.
[0072] As shown in FIG. 8 and for potential use in connection with
or interchangeably with the embodiments shown in FIGS. 44-47, an
intermediate adapter member may be used to secure a mounting member
or augment to an acetabular shell, cage, or other augment. For
example, adapter 502 comprises a portion that is received in an
opening (e.g., tapered hole or undercut track) in the
shell/cage/augment, and sits flush or recessed with respect to an
inner surface of the shell/cage/augment, so as to not protrude into
the inside portion of the shell/cage/augment where a liner might be
seated. The adapter 502 may have an expanding tapered or flared
head 504 (e.g., frustoconical) that protrudes outwardly from the
shell and engages an undercut slot, blind or through-slot, or a
tapered aperture in the mounting member or augment. For example,
adapter 502 includes an expanding tapered or flared head 504 that
engages undercut slot 508 of augment 500. The adapter 502 may be
entirely or partially cannulated and may be non-threaded, threaded
partially, or threaded all the way through its length. The
expanding tapered or flared head 504 of the adapter 502 may be made
bifurcated so as to have two or more arm portions 505 and 506 that
are configured to move away from each other to expand the head 504
and create a locking interference between the expanding head 504
and the undercut slot or tapered aperture 508. A small expansion
member 510, a long bone screw (not shown), or any other suitable
fastening member may be threadably received in the adapter 502 such
that when the expansion member 510, long bone screw, or other
fastening member threads into the bifurcated head portion 504, the
arms 505 and 506 of the head portion 504 expand and frictionally
engage the walls of the slot or aperture 508 to lock augment 500 to
the shell/cage 600 or other augment. A mounting member may
similarly locked to an acetabular shell or cage 600 or an augment.
The head 512 of the expansion member 510, long bone screw, or other
fastening member may lie flush with, or slightly recessed from the
inside (e.g., concave) surfaces of the shell/cage/augment, so that
a liner may be properly seated.
[0073] FIG. 9 shows an insertion opening 516 in a shell 518 adapted
to receive features of the adapter system of FIG. 8 according to
some embodiments. FIG. 10 shows a side cross-sectional view of an
adapter 520 in place within the shell 518 and an augment 522, used
to secure the two components to one another. As shown, the adapter
520 may have a frustoconical head 524, and specifically, may have a
head 524 that is bifurcated and expandable. The head 524 of the
adapter 520 may be received in an augment 522 or any other first
component (e.g., a mounting member) that is desired to be coupled
or otherwise secured to a second component (e.g., an acetabular
shell or cage). The augment 522 may have a J-slot (e.g., as shown
in more detail in FIG. 8), a dovetail configuration, or may have
any other appropriate shape, such as an undercut design, or any
other appropriate track-type slot or groove. This feature may
extend to the upper edge of augment 522 or first component (e.g.,
as shown in FIG. 8 where slot 508 extends to upper surface 514 of
augment 500) or it may be positioned in the side wall only of the
augment 522 or first component (e.g., as shown in FIG. 2 where
track 462 is provided through surfaces 463 and 469 of shell
460).
[0074] In use, the adapter head 524 slides into or is otherwise
positioned in the slot/track/undercut. The adapter tail end 526 may
extend slightly from the augment 522 or first component and extend
toward and slightly into an insertion opening in the shell 518 or
second component. As discussed above and shown clearly in FIG. 10,
it is preferable that the adapter tail 526 not extend completely
into the internal cavity of the shell 518 or second component so
that a liner 528 may be used without having the liner 528 directly
abut or otherwise contact the adapter 520. Once positioned, an
expansion member 530 is inserted into the adapter 520 to cause the
bifurcated head 524 to expand and lock, plug, or otherwise securely
lodge the adapter 520 in the desired location.
[0075] FIGS. 11 and 12 illustrate an example of a prior mounting
member or augment 531 adapted for securement to a shell 533 as
disclosed in U.S. Patent Application Publication No. 2007/0093133,
entitled "Fixing Assembly," which is incorporated by reference
herein in its entirety.
[0076] FIGS. 13-15 illustrate various embodiments of an improvement
of the devices shown in FIGS. 11 and 12. A mounting member or
augment may be provided with an opening having multiple fixed
directional threaded screw holes. For example, mounting member or
augment 540 of FIG. 13 includes an opening 542 having a plurality
of fixed directional threaded screw holes 544. In the specific
embodiments shown, there are three fixed directional threaded screw
holes (e.g., screw holes 544), but it will be understood that more
or fewer holes may be provided. The holes may be fixed in various
orientations in space with respect to each other. The holes may be
spaced apart from each other as shown by holes 546 in FIG. 15. The
holes may intersect radially as shown by holes 544 in FIG. 13. The
holes may be positioned linearly as shown by holes 548 in FIG. 14.
In use, a protrusion member that extends from a mounting member or
augment is received in rotating engagement by a round blind
undercut recess on an acetabular shell, cage, or augment as shown
in FIG. 11. Alternatively, the protrusion member may be received in
an undercut track (e.g., as shown in FIGS. 2 and 3) provided on an
acetabular shell, cage, or augment. As shown, the projection may be
bi-forked in configuration to facilitate its expansion when one or
more screws or other fastening members are inserted through one or
more of the threaded screw holes in the mounting member or augment.
The protrusion on the mounting member or augment is generally
configured to expand upon partial screw insertion and is also
generally configured to secure and lock the mounting member or
augment to the shell/cage/augment in a desired relative spatial
orientation, regardless of whether or not the screw secures
purchase within the bone.
[0077] FIG. 16 illustrates a mounting member or augment 550
according to certain embodiments that may be used for coupling to
an acetabular shell, cage, or other augment having a round blind
undercut on the shell, one example of which is shown in FIG. 11.
Alternatively, as previously mentioned, the protrusion member 552
may be received in an undercut track (e.g., as shown in FIGS. 2 and
3) provided on an acetabular shell, cage, or augment. As shown in
FIG. 16, an expandable or deformable spherical ball member 554 is
adapted to be positioned within, located inside, or otherwise
captured within an opening 558 in a split or bifurcated mounting
member or augment 550 and captured therewithin. The ball member 554
may be undersized so as to expand when an expansion member (e.g.,
screw 556) or other fastener is inserted therein. Alternatively,
the ball member 554 may be formed of a deformable material to allow
the ball 554 to expand upon insertion of an expansion member (e.g.,
screw 556) or other fastener. Moreover, the ball member 554 may be
split to facilitate expansion of the ball member 554. The ball
member 554 is generally captured within, secured to, or otherwise
operable with the mounting member or augment 550 so as to form a
ball joint.
[0078] The ball member 554 may have a deformable smooth bore which
is ultimately deformed to be threaded by the screw fastener during
insertion. Alternatively, the ball member 554 may comprise a
threaded bore which is slightly undersized in inner diameter with
respect to the inserted screw. Alternatively, the bore in the ball
member 554 may be smooth and the ball member 554 expanded when
engaged by an expansion member or other fastener. In some
instances, as shown, a screw 556 or other fastener may be
provisionally positioned adjacent an aperture of the cannulated
ball member 554, and then oriented to a desired spatial location
and angulation with respect to a patient's anatomy for insertion
into adjacent pelvic or other bone. The expansion member (e.g.,
screw 556), long bone screw, or other fastener may be used as a
lever to move the ball 554 at any angle relative to the mounting
member or augment 550 and then inserted to secure bone
purchase.
[0079] When the screw or fastener 556 passes through the aperture
in the ball 554, the ball 554 spreads open or deforms via the
aforementioned undersized, deformable, or expandable means. In this
instance, the ball 554 expands, and in turn, also further expands
the mounting member or augment 550, which may be bifurcated, one
example of which is described above. When the mounting member or
augment 550 is expanded, the protrusion member 552, shown here as a
generally flared and bifurcated frustoconical projection, expands
within and may lock into a round, blind undercut recess or undercut
groove in the shell/cage/augment in the desired angular spatial
orientation. The mounting member or augment 550 is generally
configured to allow fixing of itself to the shell/cage/other
augment regardless of whether or not the screw 556 secures purchase
within the bone. Moreover, the ball member 554 captured within the
mounting member or augment 550 also allows the screw 556 to be
inserted in any orientation relative to both the mounting member or
augment 550 and the shell/cage/other augment.
[0080] In some embodiments, such as those shown in FIGS. 17 and 18,
an optional rotatable inner cylinder insert member may be used. The
cylinder may be split along its length and may have one or more
threaded bores extending along its length at one or more various
angles, offsets, and eccentricities for engagement with a long bone
screw or other fastener. For example, as shown in FIG. 17, a single
bore 566 may be provided in a cylindrical insert 564, the bore 566
having a smooth outer bearing surface 568 that is angled and
offset. The insert 564 shown is captured within the mounting member
or augment 564 by a knurl, step, flange, or lip 567 so as to be
rotatable with respect to the mounting member or augment 560, but
not axially displaceable from the mounting member or augment 560.
When the screw or fastener 569 is inserted into the bore 566, the
insert 564 expands, and in turn, expands a projection member 562 on
the mounting member or augment 560 or alternatively or additionally
expands the entire mounting member or augment 560. The projection
member 562 may expand within the round blind undercut on the shell,
cage, or other augment shown in FIG. 11, or alternatively may
expand within an undercut groove within said shell, cage, or other
augment as shown in FIGS. 2 and 3.
[0081] FIG. 18 depicts a mounting member or augment 570 that is
similar to the embodiment shown in FIG. 17, but instead, is
configured for use with a polyaxial screw or fastener 576 having a
smooth rounded head 577. In this exemplary embodiment, the inner
cylindrical insert 574 is not split, but is instead provided as a
larger diameter, externally-threaded body configured to be received
in a smaller diameter threaded bore 571 in the mounting member or
augment 570. The inside of the cylindrical insert 574 has one or
more "hourglass"-shaped bores 578, for instance, those that can be
used with polyaxial screw heads having rounded or spherical screw
heads. Various examples of polyaxial locking systems and methods
are shown and described in U.S. Patent Application Publication No.
2002/0147499, entitled "Locking Systems for Implants," U.S. Patent
Application Publication No. 2008/0300637, entitled "Systems and
Methods for Using Polyaxial Plates," and U.S. Provisional Patent
Application No. 61/178,633, entitled "Polyaxial Fastener Systems
and Methods," all of which are intended for potential use in
connection with the described systems and are incorporated by
reference herein in their entireties.
[0082] The bore 578 may comprise portions engageable with threads
of the polyaxial screw 576, or may contain deformable tabs in
regions proximate the head 577 for use with threaded heads. The
angle of the screw or fastener 576 can be varied within the bore
578 of the cylindrical insert 574. Regardless of whether or not the
polyaxial screw 576 is inserted into the bore 578, the mounting
member or augment 570 is positively secured and locked to the
shell/cage/augment in a desired spatial orientation and angulation
due to the expansion of the projection member 572 or the mounting
member or augment 570 as a whole. This occurs, for example, after
inserting and threadably engaging the cylindrical insert 574 with
an undersized threaded recess (e.g., bore 571) provided in the
mounting member or augment 570.
[0083] FIGS. 19-35 show certain embodiments for attaching mounting
members or augments to an acetabular shell, acetabular cage, or
other augment. Disclosed is an apparatus and method for attaching
the acetabular mounting members or augments to shells, cages, and
other augments with an amount of adjustability. A kit of different
augments may be provided for use with the same acetabular shell,
cage, or augment. Relative spatial adjustments between the mounting
member or augment position and the shell/cage/augment may be made
with multiple degrees of freedom. The mounting members and/or
augments may be attached and subsequently permanently and
irremovably secured and locked to the shell/cage/augment prior to
or after its insertion into a prepared acetabulum and/or
surrounding bone voids.
[0084] In certain embodiments shown in FIG. 19, a mounting member
580 or augment member 582 is provided with a dovetail feature 581
and 583 (that may be male or female), respectively, to connect it
to an acetabular shell or cage 584 (or, in some embodiments another
augment) having the other complementary mating female or male
dovetail feature 586. In the embodiment shown, the complementary
feature 586 on the shell 584 is a J-shaped track or J-slot, but it
will be understood that any mating features or configurations may
be used. In the specific embodiment described, the dovetail feature
586 is configured to allow the mounting member 580 or augment
member 582 to rotate and/or translate with respect to the shell 584
in a semi-locked state. The semi-locked state generally allows some
independence of movement between the two pieces, which can be
desirable to allow a surgeon to toggle between relative positions
or otherwise continue to position and adjust the members. Such a
semi-locked or loose connection can be particularly useful for
revision surgeries.
[0085] The mounting member 580 or augment member 582 may be
provided in a number of various shapes, sizes, textures, and
configurations configured to fill bone defects and voids of varying
degrees and locations with respect to a patient's anatomy. For
instance, an implant may comprise a flange member that does not
necessarily serve to fill a bone void/defect, but is instead
configured to couple with a bone surface. Dovetail features
according to FIGS. 19-35 generally mate by providing a flared male
member (e.g., member 581 or 583) that is configured to slidingly
engage one or more complementary female members such as one or more
separated or intersecting undercut grooves or recesses (e.g.,
member 586). The undercut grooves or recesses may be provided on
either component or vise versa, without limitation. A third member,
for example an expansion member (e.g., setscrew, fastener, rivet,
wedge, pin, cam, long bone screw, or any other fastener), may
further be provided and used to securely lock the two pieces
together to form a locked assembly. In some instances, the third
member will engage one or more portions of the dovetail features to
cause the male member to expand in the female member.
[0086] In other instances, for example, as shown in FIGS. 20 and
21, a fastener such as a setscrew may be inserted through a male
portion 588 of the dovetail features to move the male member 588
away from a blind portion of the female member 589, thereby
spreading the two pieces such that tapered surfaces of the dovetail
features frictionally engage each other.
[0087] FIGS. 22-26 illustrate some embodiments wherein one or more
locking chocks are distally-connected to a surgical cable and are
configured to be received and/or captured within a portion of a
mounting member or augment. For example, FIGS. 22 and 23 show a
locking chock 590 distally-connected to a surgical cable 592 and
positioned within a portion of augment 594. The cable 592 may be
introduced through a through-bore in a mounting member or augment
(e.g., bore 596 of augment 594) and tightened via a clamping
device. The chock 590 is shaped to complement a tapered hole or an
undercut groove or recess provided in an acetabular shell, cage, or
other augment (e.g., undercut recess or groove 602 of FIG. 24).
When the surgical cable 592 is tightened around the mounting member
or augment adjacent bone or to any other plating structures, the
chock 592 is pulled toward the undercut surfaces of the tapered
hole undercut groove/recess and is expanded by an expansion member
598, for example, by a ball crimped to a distal portion of the
surgical cable or any of the other expansion members described
herein. The chock 590 may engage the undercut groove or recess. As
shown in FIGS. 24 and 25, an internal portion of a chock 604 may
have an angled or inclined surface 600, which is adapted to receive
an expansion member 606.
[0088] In use, the chock rides along the cable and once positioning
is desired, the wings of the chock may be forced apart for
securement. For example, wings 595 and 597 of chock 590 shown in
FIG. 23 may be forced apart for securement. When the cable is
tightened, this can (a) pull the augment towards the
shell/cage/other augment and (b) pull the ball or other expansion
member at the end of the cable inside the chock so that the wings
will expand and the chock will be secured in place. For example,
when cable 601 of FIG. 24 is pulled in the direction of arrow 608,
this can pull expansion member 606 inside the chock 604 so that the
wings 605 and 607 of chock 604 expand, thereby securing the chock
604 in place.
[0089] Alternatively, while not shown, the chocks may be separate
pieces attached to the surgical cable at different portions and
provided with inclined surfaces that ride together to facilitate
expansion and frictional engagement with the tapered hole or
undercut groove/recess. The one or more locking chocks may be
oblong for easy insertion into the undercut groove or recess. Once
the cable is pulled tight, it may be used as cerclage cable or
K-wire and tightened around bone or other anatomical structures,
keeping the mounting member or augment attached to the shell, cage,
or other augment.
[0090] Alternatively, as shown in FIG. 26, the cable 610 may be
tensioned using a cable tensioning device provided on the mounting
member or augment 614. For instance, as shown, a tensioning screw
member 612 may threadingly engage a female thread 616 located in
the mounting member or augment 614. As the tensioning screw member
612 is turned, the cable 610 is pulled into tension, thereby moving
an expansion member (e.g., a crimped ball) against inner inclined
surfaces located on the one or more locking chocks such as inclined
surface 600 of chock 604. When the expansion member (e.g.,
expansion member 606) reaches a point of interference with the one
or more locking chocks, the tensioning screw member may be turned
further to spread the chocks apart and lock the mounting member or
augment to the shell, cage, or other augment via a tightened
dovetail joint.
[0091] FIGS. 27-29 illustrate some embodiments wherein a mounting
member or augment 628 may be attached to an acetabular shell, cage,
or other augment 629 using a separate expandable chock member 620
and an intermediate connecting member 622. The intermediate
connecting member 622 serves to temporarily loosely couple the
mounting member or augment 628 to the shell/cage/augment 629, and
also serves to expand the separate chock member 620 and lock the
two components together. In some embodiments, it is preferred that
the separate expandable chock member 620 is provided as a generally
frustoconical portion or a male portion of a dovetail connection.
The separate expandable chock member 620 may be inserted into and
captured within an undercut recess, groove, or track (e.g.,
undercut recess, groove, or track 624) in an acetabular shell,
cage, or other augment 629. In some embodiments, the separate
expandable chock member 620 is movably captured and may be
positioned at various locations and orientations within said
undercut recess, groove, or track.
[0092] The mounting member or augment 628 is then placed adjacent
to the shell/cage/other augment 629, and the intermediate
connecting member 622 inserted through an aperture, opening, or
recess 626 in the mounting member or augment 628 to engage an
undersized or tapered female thread 627 in the separate expandable
chock member 620. The mounting member or augment 628 may be moved
to a desired position relative to the shell/cage/augment 629 by
virtue of the loose connection and undercut recess, groove, or
track, and then locked in a desired relative spatial orientation by
engaging the intermediate connecting member.
[0093] In the embodiment shown, the intermediate member 622 is
provided as a headed bolt that threadingly engages the separate
expandable chock member 620 to expand the separate expandable chock
member 620. When the separate expandable chock member 620 is fully
expanded, a frictional dovetail locking connection is achieved,
which locks the mounting member or augment 628 to the
shell/cage/other augment 629 in the desired relative spatial
orientation.
[0094] FIG. 30 illustrates an alternative embodiment to FIGS.
27-29, which is similar to the embodiment shown in FIGS. 6 and 7. A
small expanding element 630 is provided within an aperture,
opening, or recess 632 in a mounting member or augment 634
configured to be loosely attached and locked to an acetabular
shell, cage, or other augment 636. The mounting member or augment
634 includes a male portion of a dovetail. The male portion of a
dovetail may be formed by a deformable or expandable protrusion 638
which may be bifurcated and/or initially flared outwardly in an
un-deformed/unstressed state. Alternatively, while not shown, in
some embodiments, the expandable protrusion 638 may be provided as
a generally cylindrical member which can be first introduced into
an undercut recess, groove, or track, and then expanded within said
undercut recess, groove, or track by the expanding element in order
to provide a locking function between the mounting member or
augment and the shell/cage/augment. As shown in FIG. 30, the
expanding element 630 may be provided as a small tapered setscrew
which engages a complementary tapered or otherwise undersized
thread 640 inside the male portion of a dovetail. A flexible driver
642 may be used to access the small expanding element 630. Upon
torsional engagement with the expanding element 630, a dovetail
locking connection is formed, thereby securing the mounting member
or augment 634 to the acetabular shell, cage, or other augment 638
in a desired configuration and relative spatial orientation.
[0095] FIG. 31 shows an alternate and additional feature relating
to the cable and chock embodiments of FIGS. 22-30. FIG. 31 shows a
ferrule 700 on a cable 702 that may be positioned against an
augment 704. A tensioning tool 706 may be used to hold the cable
702 tight and the ferrule 700 can be crimped onto the cable 702.
When the cable 702 is pulled tight, the chock (e.g., chock 590 of
FIG. 22) engages the dovetail slot and the tension pushes the chock
towards or into the augment 704, held in place by the ferrule
700.
[0096] FIG. 32 shows one potential geometry for a receiving portion
650 (such as an undercut recess, groove, or track) in a shell,
cage, or augment according to some embodiments. In this example,
the receiving portion is a double J-slot formed by slots 652, 654,
and 656. FIG. 33 shows a further optional geometry, where J-slots
are provided in opposing directions formed by slots 662, 664, and
667.
[0097] As shown in FIGS. 33 and 34, any of the mounting members or
augments shown and described herein may comprise tick marks or
other indicia for indicating a positional relationship between
itself and the implant to which it is to be attached. For example,
an augment 670 may comprise a plurality of peripheral markings 672
or central markings (not shown) for alignment with markings 661
provided in an acetabular shell or cage 660 (or, in some
embodiments, another augment). In use, a surgeon may loosely insert
the mounting member or augment (e.g., augment 670) and the
shell/cage/augment (e.g., shell 660) into a patient's bone void,
prior to assembling the two. The surgeon may then position both
components and possibly other components to determine the best
relative spatial orientation to best fill a volume of the void. The
surgeon may then observe, compare, and note the relative positions
of the markings or indicia between the bodies, thereby receiving
repeatable and reproducible information about the desired spatial
orientation. The surgeon may then remove both bodies from the
surgical environment, realign them in the desired spatial
orientations (facilitated by the markings or indicia), and then
cement or otherwise secure the two bodies together in said desired
spatial orientation. Subsequently, the assembled implant may be
introduced into the void and the surgery completed in a normal
fashion.
[0098] Moreover, as shown in FIG. 35, mounting members or augments
shown and described in the figures contained herein may comprise
tacks, spikes, coatings, or textured surfaces 674 so as to improve
initial fixation. The geographic locations of said tack, spike,
coatings, or textured surface structures 674 may be strategically
placed on select portions so as to evenly load the implant assembly
and obtain the best biologic response initially, and over an
extended period of time.
[0099] FIG. 36 shows a bi-lobe cup or shell 710, which is a shell
710 having a lobe 712 extending therefrom. Typical bi-lobe shells
are made of solid material, but this embodiment shows a bi-lobe
shell 710 having a lobe 712 of porous material. The lobe 712 may
have some solid portions for receiving screws other fastening
members. As shown, additional augment members 714 may be attached
to the lobe 712 of porous material or to the solid shell 710. Areas
of the porous lobe 712 may be provided with areas of solid,
non-porous material having apertures or other structures for
receiving and locking to screws, such as polyaxial bone screws.
Moreover, the porous lobe 712 may comprise holes 716 extending
through fully porous sections for insertion of bone screws.
[0100] FIG. 37 shows two augments 720 and 722 attached together via
a fastening device 724 such as a screw or a shape-memory polymer
peg according to some embodiments. It will be understood that
although augments are shown, the securement mechanisms described
herein may also be used with any type of mounting member, shell, or
cage as well. In some embodiments, a peg of shape memory material
may extend from one or more augments and into a prepared hole in
bony anatomy. The shape memory peg may then be activated (via
thermal changes or an applied electric current) and expanded within
the prepared hole to fix an augment or mounting member to the
patient's bone. Non-limiting examples of further features for such
shape memory plugs are that they may comprise outer textured
surfaces, may be porous, and may comprise barbs, flutes, ridges,
grooves, spines, any other suitable features, or combinations
thereof.
[0101] FIG. 38 shows an augment 726 with integral spikes 728
according to some embodiments. The spikes 728 may allow the augment
726 to be positioned initially in bone, without the augment 726
having to be first secured to a shell, cage, mounting member, or
other augment or without the use of bone cement. The augment 726
may be positioned and then impacted or otherwise pressed into a
bone void to achieve instant fixation.
[0102] FIG. 39 shows other embodiments of an augment 730 having
built-in securement features. Embodiments of this augment may have
one or more integral spikes, barbs, screws, or other fasteners
pre-positioned therein. For example, augment 730 includes integral
fastener 732 which may be a spike having barbs 734. When the
augment 730 is positioned as desired, the surgeon may screw, impact
or tack the augment 730 in place, causing the integral fastener 732
to extend and secure bone purchase. One advantage of this
embodiment is that is can prevent the surgeon from having to locate
and insert separate fasteners. In some embodiments, there is
provided a breakable or frangible connector 736 that is sheared
once the fastener 732 has been impacted, twisted, or otherwise
activated by a force or moment. A further advantage of the
described embodiments is that the augment 730 is a one-piece
component that can be positioned without additional fasteners or
other components attached thereto, simplifying some aspects of
insertion. Moreover, the surgeon may desire to place the augment
730 first, and then quickly secure it to the other implant portions
to be used. Integral fasteners which are not utilized may be
removed by a pulling out force, and breaking the connector.
Fasteners such as integral fastener 732 may be configured to
connect the augment to bone or to other implant devices such as
other augments, acetabular shells, acetabular cages, and/or bone
plates.
[0103] FIGS. 40-42 illustrate various augments or porous coating
portions comprising one or more cross-sectional areas 740, 742, and
744 of reduced material which are "designed" for easy drilling,
shaping, and screw insertion. In some embodiments, a bulk porous
structure is provided with waffle patterns of recesses defined
therein. The recesses may be externally provided, internally
provided, or combinations thereof. External recesses may be created
using rapid manufacturing, wire EDM, milling, or other processes.
Internal recesses may be created using rapid manufacturing (e.g.,
selective laser sintering with an EOS machine or EBM process using
an Arcam machine), cross-drilling processes, any other suitable
processes, or any combinations thereof. The areas of reduced
cross-section 740, 742, and 744 make it easier for a surgeon to
drill through the augments or porous coating portions, orient
screws, and burr, mill, cut, break, bend, or otherwise shape with a
rotary tool 746 such as the one shown in FIG. 43. Other
modification tools such as reciprocating saws or oscillating saws
may be utilized to shape the augments or porous coating portions.
Recesses may extend in various patterns in two-dimensional or
three-dimensional space, and may vary in width, depth, aperture,
thickness, density, and length.
[0104] FIGS. 44-47 illustrate some embodiments of a connection
device for securing a mounting member or an augment to an
acetabular shell or acetabular cage. Certain embodiments of the
connection device comprise an intermediate locking member 750 that
may be placed between an acetabular shell or cage and a mounting
member or augment, the intermediate locking member 750 configured
to provide initial loose and adjustable attachment of the mounting
member or augment to the acetabular shell or cage. After or before
impaction, the mounting member or augment position relative to the
shell or cage may be adjusted and then fixed with respect to the
shell or cage by engaging a portion of the intermediate locking
member 750. After the intermediate locking member 750 is engaged to
lock the adjacent components together against relative movement, a
liner may be inserted into the shell or cage. The intermediate
locking member 750 may either be a separate portion or integral to
one of the shell, cage, mounting member or augment.
[0105] Portions of the intermediate locking member 750 may be low
profile and configured to be received in and locked within an
acetabular shell (e.g., via a threaded, smooth, or tapered screw
hole). In the embodiment shown, the intermediate locking member 750
is provided within an acetabular shell as disclosed in the '705
application. Intermediate locking member 750 may comprise, as
shown, a cam locking pin 752 and a locking head screw 754. The
mounting member or augment may comprise an undercut recess 759
which has an opening of any appropriate shape, such as oblong,
scalloped, triangular, dovetail, or any other option. A distal end
756 of the cam locking pin 752 has a complementary shape (oblong,
scalloped, triangular, dovetail, or any other appropriate
complementary shape) and is flared or tapered radially outwardly to
engage one or more undercut surfaces forming the undercut recess
759.
[0106] As shown in FIGS. 45 and 46, a proximal end 757 of the cam
locking pin 752 may have a shaft 758 with engageable threads
axially-disposed therein. A locking head screw (shown for example,
as locking head screw 754 of FIG. 47) is configured to engage the
threads on the shaft 758 of the cam locking pin 752. The threads of
the locking head screw may be female or male, and the threads of
the cam locking pin 752 may be the other of male or female. Locking
screws prevent the cam locking pin 752 from backing out once
properly positioned. During use, the cam locking pin 752 is
positioned within a receiving groove or recess and rotated to lock
the cam locking pin 752 in place. The complementary shapes of the
distal end 756 of cam locking pin 752 and a receiving groove or
recess allow the cam locking pin 752 to be inserted into the groove
or recess in a first orientation and then rotated to a second
orientation in which it cannot be removed from the groove or
recess.
[0107] The shaft portion 758 of the cam locking pin 752 may be
provided with one or more flats on the outside (e.g., a hexagonal
outer cross section for the shaft) to allow turning of the cam.
Alternatively, a cruciform recess or hexagonal recess or other
driving structure may be provided on the cam locking pin 752. In
some embodiments, the female thread in the cam locking pin 752 may
be substituted for threads on the outside of the shaft 758 of the
cam locking pin 752 which engage a partially cannulated locking
screw having an internally-threaded aperture extending axially
through the shaft of the locking screw. In such latter embodiments,
outer portions of the locking screw may be smooth. The head 755 of
the locking head screw 752 may alternatively be rounded for
polyaxial movement (exemplary polyaxial locking options are
provided in more detail below) within the hole in the acetabular
shell or cage. It will be understood by those of ordinary skill in
the art that the connection shown in the figures may also be used
to connect augments or mounting members together, without
limitation.
[0108] FIGS. 48-50 illustrate some embodiments wherein a mounting
member or augment, for example, as disclosed in FIGS. 44-47, is
provided with an elongated undercut groove which is configured to
receive a cam locking pin. The elongated undercut groove allows the
mounting member or augment to be radially adjusted in space and
locked in an orbital position around a corresponding acetabular
shell or cage. In some embodiments, portions of the mounting member
or augment proximate the elongated groove may be made solid, rather
than porous for strength, and outer regions of the mounting member
or augment may be smooth, textured, coated (e.g., hydroxyapatite),
porous, or combinations thereof in order to encourage biologic
fixation and ingrowth in select regions.
[0109] FIG. 49 illustrates a cross-sectional view of an augment 764
and a cam locking pin 752 being inserted into an elongated undercut
groove 768 of the augment 764 in an insertion position. The cam
locking pin 752 is positioned into the groove 768 by rotating the
cam locking pin 752 along its axis such that the insert width 762
of the distal end 756 of the cam locking pin 752 (as shown in FIGS.
44-46) fits through the insert width 770 of the elongated undercut
groove 768. FIG. 50 illustrates a cross-sectional view of the
augment 764 with the cam locking pin 752 locked into the elongated
undercut groove 768 of the augment 764 in a locking position. In
the locking position, the cam locking pin 752 may generally be
rotated along its axis between 50 and 130 degrees, preferably
around 90 degrees (i.e., a "quarter-turn"). The locking width 760
prevents the distal end 756 of the cam locking pin 752 from fitting
through the insert width 770 of the elongated undercut groove 768.
In some embodiments, cam locking pin 752 may be symmetrical and may
have a flared end (e.g., distal end 756) comprising a generally
frustoconical surface, and the undercut groove 768 in the augment
764 (or, in some embodiments, an undercut groove in a mounting
member) may have one or more enlarged openings to receive the
flared end of the cam locking pin 752. In such alternative
embodiments, a locking screw (e.g., locking head screw 754 of FIG.
47) may threadingly engage the cam locking pin 752 to apply a
tensile force to the cam locking pin 752 against another implant
such as a mounting member, augment, shell, or cage.
[0110] In the embodiments shown in FIGS. 51-54, cleats may be
provided proximate to a rim of an acetabular shell, cage, mounting
member, or augment. For example, in some embodiments, one or more
cleats 780 and 781 may extend or project from a superior aspect of
a rim portion 782 of an acetabular shell 784 as shown. Cleats 780
and 781 may be used to secure soft tissues to the acetabular shell
784 or may serve as a means to attach secondary augments or any
type of mounting member 786 to the acetabular shell 784. In the
particular instance shown in FIGS. 53 and 54, a "quarter-turn"
fastener connector arrangement is utilized. The quarter-turn
fastener arrangement may comprise, for instance, a generally
T-shaped male member 790 located on one or more regions of an
acetabular shell, cage, or augment, and one or more complementary
female members 792 located on more secondary augments or mounting
members. The one or more secondary augments or mounting members
engage the one or more male members 790 on the acetabular shell,
cage, or augment in one degree of rotation, and then are rotated by
a specified or variable number of degrees (e.g., 90 degrees) to
lock the one or more secondary augments or mounting members to the
one or more male members 790. Of course, one of ordinary skill in
the art would appreciate that the male and female members could be
reversed to provide the same function. It should also be understood
that other locking mechanisms may be used.
[0111] FIG. 55 further depicts one or more cleat portions 794
located at various portions of an acetabular shell or cage 796 (or,
in some embodiments, an augment) configured for securing soft
tissues. The one or more cleat portions 794 can be arranged in any
particular fashion around the acetabular shell 796; however, it is
preferred that the cleats 794 extend proximally from a rim portion
or otherwise away from the acetabular shell 796 in order to provide
clearance from liner-mating surfaces, cement mantle surfaces, bone
contacting surfaces, and bony anatomy, for example. Cleat portions
794 may comprise suturing holes, roughened surfaces, clamps, hooks,
or biologic coatings, or any other appropriate protrusions, or
combinations thereof, to encourage fixation of the soft tissues to
the implant (e.g., acetabular shell 796). For example, as shown in
the inset of FIG. 55, sutures may be wrapped around cleat portion
794 and then secured to surrounding soft tissues.
[0112] FIGS. 56-60 illustrate embodiments wherein a mounting member
802 or an augment 804 may be attached peripherally to an acetabular
shell or cage 806 via a recess 800 provided proximate a rim portion
808 of the acetabular shell or cage 806. The recess 800 is sized to
accept a protruding insertion portion 810 of the mounting member
802 or a protruding insertion portion 812 of the augment 804, and
the recess 800 may extend annularly circumferentially around the
rim portion 808 to allow orbital placement of the mounting member
802 or augment 804 around a periphery of the shell or cage 806. The
mounting member 802 or augment 804 may be inserted into the
acetabular shell or cage 806 before or after shell/cage impaction
or cementing into a prepared acetabulum. One or more screw holes in
the mounting member (e.g., screw holes 814) or augment (e.g., screw
holes 816) rigidly secure the mounting member 802 or augment 804 to
the bone and prevent orbital movement of the mounting member 802 or
augment 804 around the shell or cage 806. Screw holes 814 and 816
may include conventional holes, locking holes, or slots. The holes
may be threaded, unthreaded, or partially threaded, and may be
fixed or polyaxial. In some embodiments, screw holes 814 and 816
may include variable low-profile holes that allow for locking at a
variety of angles. Once the mounting member 802 or augment 804 is
positioned, the cantilever force pushes the rim 808 of the shell or
cage 806 toward bone. The protruding insertion portion of the
mounting member (e.g., portion 810) or augment (e.g., portion 812)
provides a hold-down force to the shell or cage 806 after a screw
is inserted through the mounting member 802 or augment 804 and into
surrounding pelvic bone.
[0113] FIGS. 56 and 57 show an augment 804 being positioned with
respect to an acetabular shell or cage 806. FIGS. 58 and 59
illustrate a mounting member 802 being positioned with respect to
an acetabular shell or cage 806. The mounting member 802 is shown
as having multiple securing holes 814 for use with fasteners.
Securing holes 814 may be smooth, tapered, or threaded and may be
used with any appropriate fastener, including but not limited to
polyaxial screws. The securing holes 814 through the mounting
member 802 (or securing holes 816 through the augment 804) may be
positioned at any appropriate angle, as shown, such as parallel to
the member, oblique through the member, or otherwise as desired.
While not shown, a honeycomb feature may be placed on outer
portions of the mounting member 802 or augment 804 to provide
spacing for a cement mantle between the mounting member 802 or
augment 804 and surrounding bone. Moreover, porous structures,
textured surfaces, biologic coatings, or orthopedic meshes may be
integrally provided on, or incorporated between outer surfaces of
the mounting members 802 or augments 804 and surrounding bone.
[0114] In the embodiments of FIGS. 58 and 59, a recess 800 in the
shell or cage 806 is defined by a proximally-extending lip 818 such
that the mounting member 802 will sit on bone surrounding the
acetabulum. In this way, the mounting members 802 will not
interfere with the press-fit area between the shell 806 and
prepared acetabulum adjacent the acetabular rim 808. Moreover,
because the connection is configured to allow mounting members 802
to sit on surrounding bone, the surrounding bone does not need to
be countersunk or otherwise prepared to receive mounting members
802.
[0115] FIG. 60 depicts an acetabular shell or cage 820 comprising
an annular protrusion 822 along a rim portion 824 of the acetabular
shell 820. The annular protrusion 822 may extend partially around
(as shown) or entirely around the circumference of the acetabular
shell 820, or one or more protrusions may be provided in any
fashion around the acetabular shell 820. The annular protrusion 822
may comprise an annular lip 826 defining an annular undercut groove
828 running circumferentially around the acetabular shell 820
proximate the rim portion 824. The annular protrusion 822 may
comprise one or more openings 830 for receiving sutures (e.g., for
soft tissue or capsule re-attachment) or fasteners 832 such as set
screws for contacting and frictionally engaging surfaces (e.g.,
divots) provided on protruding insertion portions 834 and 836 of
mounting members 840 or augments 838 alike.
[0116] Fasteners 832 may be inserted into openings 830 located
circumferentially laterally of the insertion portions 834 and 836
to serve as stops for preventing or limiting rotational movement of
the attached mounting members 840 or augments 838. The mounting
members 840 or augments 838 may be secured down to surrounding bone
after being inserted into the annular undercut groove 828 via long
bone screws, thereby providing a hold-down force to the acetabular
shell or cage 820. The hold-down forces provided may complement the
press fit, threaded fit, or cemented fixation between the
acetabular shell or cage and surrounding prepared acetabular bone.
In the instance shown, shell 820 is provided as a "hooded" shell
similar to a cage, and may act as a buttress for a cemented or
pressed-in liner to support various liner inclinations in varying
degrees of acetabular or pelvic degradation, although it will be
understood that these features may be provided on any other type of
shell or cage.
[0117] In the embodiments shown in FIGS. 61-64, one or more
mounting members and/or augments may be integrally provided with
orthopedic mesh to define one or more mesh mounts or void fillers.
FIG. 61 shows a mounting member 380 having an orthopedic mesh 382.
In FIG. 62, the orthopedic mesh portion 382 may be placed on an
outer portion 384 of the shell 386 between bone, and a cement
mantle can fill between the mesh 382. The cement mantle rigidly
connects the mounting member 380 (or, in some embodiments, an
augment) to the shell 386 via the surgical mesh 382. Rapid
manufacturing techniques may be used to simultaneously create the
mounting members or augments integrally with the orthopedic mesh
portion. The mesh 382 may be honeycomb, diamond, or other weave
pattern, or any combination thereof, and may come in multiple
thicknesses. Mesh portion 382 may be oversized, customized for an
individual patient, and/or standardized and trimmed by the surgeon
to fit a particular patient's needs. Fasteners of all types may be
inserted through one or more cells of the mesh 382, as well as
through the one or more mounting members or augments to further
secure the implant to bony anatomy. For example, as shown in FIG.
61, a first screw 388 may be inserted through cell 390, and a
second screw 394 may be inserted through one of the plurality of
screw holes 392 of mounting member 380. Screw holes 392 may include
conventional holes, locking holes, or slots. The holes may be
threaded, unthreaded, or partially threaded, and may be fixed or
polyaxial. In some embodiments, screw holes 392 may include
variable low-profile holes that allow for locking at a variety of
angles. Soft tissues may be reattached using the porosities of the
mesh 382 as suture anchors, or simply as a bioscaffold. If desired,
preformed trim lines may be provided by forming predetermined
frangible portions in various areas of the mesh, in order to help
configuration of the device for a particular patient. For example,
as shown in FIG. 63, mesh 400 includes a plurality of trim lines
402 that may be cut to separate the mounting members attached
thereto, such as mounting members 404. The separated mounting
members 404 and the mesh 400 may then be placed into a patient's
hip region 406 as shown in FIG. 64.
[0118] FIGS. 65 and 66 illustrate some embodiments of a honeycomb
design that may be provided on a mounting member or augment in
order to control cement mantle thickness and spacing between said
mounting member or augment and an adjacent acetabular shell,
augment, bone, or other implant. For example, mounting member 410
of FIG. 65 includes honeycomb portion 412 provided on an attachment
surface portion 414 of the mounting member 410. The honeycomb
feature 412 may be provided as any desired geometric shape. The
mounting member 410 (or, in some embodiments, the augment) may
comprise one or more securing holes 416 for receiving a surgical
fastener 418 such as a polyaxial screw, cancellous screw, peg, or
other securing device. The securing holes 416 may include
conventional holes, locking holes, or slots. The holes may be
threaded, unthreaded, or partially threaded, and may be fixed or
polyaxial. In some embodiments, securing holes 416 may include
variable low-profile holes that allow for locking at a variety of
angles. The attachment portion 414 of the mounting member 410 may
extend generally perpendicularly from another portion 415 of the
mounting member 410, and may comprise one or more concave curved
surfaces 417 configured to abut an outer portion 422 of an
acetabular shell 420, or one or more convex surfaces (not shown)
configured to abut an inner portion of a prepared acetabulum.
[0119] The foregoing is merely illustrative of the principles of
the disclosure, and the systems, devices, and methods can be
practiced by other than the described embodiments, which are
presented for purposes of illustration and not of limitation. It is
to be understood that the systems, devices, and methods disclosed
herein, while shown for use in acetabular systems, may be applied
to medical devices to be used in other surgical procedures
including, but not limited to, spine arthroplasty,
cranio-maxillofacial surgical procedures, knee arthroplasty,
shoulder arthroplasty, as well as foot, ankle, hand, and
extremities procedures.
[0120] Variations and modifications will occur to those of skill in
the art after reviewing this disclosure. The disclosed features may
be implemented, in any combination and subcombinations (including
multiple dependent combinations and subcombinations), with one or
more other features described herein. The various features
described or illustrated above, including any components thereof,
may be combined or integrated in other systems. Moreover, certain
features may be omitted or not implemented.
[0121] Examples of changes, substitutions, and alterations are
ascertainable by one skilled in the art and could be made without
departing from the scope of the information disclosed herein. All
references cited herein are incorporated by reference in their
entirety and made part of this application.
* * * * *