U.S. patent application number 13/355168 was filed with the patent office on 2012-05-10 for femoral trochlea prostheses.
This patent application is currently assigned to ZIMMER TECHNOLOGY, INC.. Invention is credited to Jeffrey D. Brown, Toby N. Farling, Adam M. Griner, Robert A. Hodorek, Raymond C. Parisi, Brian E. Vanskyock.
Application Number | 20120116525 13/355168 |
Document ID | / |
Family ID | 39323792 |
Filed Date | 2012-05-10 |
United States Patent
Application |
20120116525 |
Kind Code |
A1 |
Brown; Jeffrey D. ; et
al. |
May 10, 2012 |
FEMORAL TROCHLEA PROSTHESES
Abstract
Various embodiments of femoral trochlea prostheses useable in a
knee joint. The knee joint includes a patella and a distal femur
with a femoral trochlea, or patello-femoral groove. In one
embodiment, a femoral trochlea prosthesis includes a
nonarticulating surface including contoured surfaces and/or planar
surfaces. The present disclosure also provides a method for
preparing a bone surface for receiving the prostheses described
herein.
Inventors: |
Brown; Jeffrey D.; (Palo
Alto, CA) ; Griner; Adam M.; (Columbia City, IN)
; Hodorek; Robert A.; (Warsaw, IN) ; Parisi;
Raymond C.; (Wakarusa, IN) ; Vanskyock; Brian E.;
(Fort Wayne, IN) ; Farling; Toby N.; (Warsaw,
IN) |
Assignee: |
ZIMMER TECHNOLOGY, INC.
Warsaw
IN
|
Family ID: |
39323792 |
Appl. No.: |
13/355168 |
Filed: |
January 20, 2012 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
11671645 |
Feb 6, 2007 |
8128704 |
|
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13355168 |
|
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Current U.S.
Class: |
623/20.35 ;
606/86R |
Current CPC
Class: |
A61F 2/3877 20130101;
A61F 2002/30878 20130101; A61F 2002/30892 20130101; A61F 2002/3895
20130101 |
Class at
Publication: |
623/20.35 ;
606/86.R |
International
Class: |
A61F 2/38 20060101
A61F002/38; A61B 17/56 20060101 A61B017/56 |
Claims
1-11. (canceled)
12. A method for preparing an anatomical structure to receive a
femoral trochlea prosthesis and for implanting the prosthesis in
the anatomical structure, comprising the steps of: resecting a
portion of the anatomical structure by making one of: a single
planar resection along a line disposed at an angle with respect to
a coronal plane of the anatomical structure; and at least a pair of
planar resection lines, at least one of said pair of planar
resection lines disposed at an angle with respect to a coronal
plane of the anatomical structure; selecting a prosthesis to match
the resection of said resecting step; and implanting the prosthesis
with respect to the prepared anatomical structure.
13. The method of claim 12, further comprising the step of
implanting an augment prosthesis between the prosthesis and the
anatomical structure.
14. The method of claim 13, wherein said step of implanting the
prosthesis with respect to the prepared anatomical structure
precedes said step of implanting an augment prosthesis between the
prosthesis and the anatomical structure.
15. The method of claim 12, wherein said resecting step defines a
resected surface for an anterior nonarticulating surface of the
prosthesis.
16. The method of claim 15, wherein said resecting step further
comprises two planar cuts defining a resected surface for a pair of
distal nonarticulating surfaces of the prosthesis.
17. A method for preparing an anatomical structure to receive a
femoral trochlea prosthesis and for implanting the prosthesis in
the anatomical structure, comprising the steps of: resecting a
portion of the anatomical structure by making at least two
noncoplanar cuts at a distal end of the anatomical structure, the
two noncoplanar cuts defining a resected surface for a pair of
distal nonarticulating surfaces of the prosthesis; selecting a
femoral trochlea prosthesis to match the resection of said
resecting step; and implanting the prosthesis with respect to the
prepared anatomical structure.
18. The method of claim 17, further comprising the step of
implanting an augment prosthesis between the prosthesis and the
anatomical structure.
19. The method of claim 18, wherein said step of implanting the
prosthesis with respect to the prepared anatomical structure
precedes said step of implanting an augment prosthesis between the
prosthesis and the anatomical structure.
Description
BACKGROUND
[0001] 1. Field of the Invention
[0002] The present invention relates to knee joint prostheses. More
particularly, the present invention relates to various embodiments
of exemplary femoral trochlea prostheses.
[0003] 2. Description of the Related Art
[0004] Disease and trauma affecting the patello-femoral joint of a
knee are commonly treated by surgically replacing the femoral
trochlea with femoral trochlea implants or prostheses according to
a procedure known as a patello-femoral joint (PFJ) replacement.
Although femoral trochlea prostheses are provided in a range of
varying sizes and are selected by surgeons to best fit the anatomy
of a particular patient, improvements in the design of femoral
trochlea prostheses are desired.
SUMMARY
[0005] The present disclosure provides various embodiments of
femoral trochlea prostheses useable in a knee joint. The knee joint
includes a patella and a distal femur with a femoral trochlea, or
patello-femoral groove. In one embodiment, a femoral trochlea
prosthesis includes a nonarticulating surface including contoured
surfaces and/or planar surfaces. The present disclosure also
provides a method for preparing a bone surface for receiving the
prostheses described herein.
[0006] In one form thereof, the present disclosure provides a
femoral trochlea prosthesis, including an articulating surface; a
plurality of nonarticulating surfaces, the plurality of
nonarticulating surfaces including at least one of: a first and a
second planar distal nonarticulating surfaces, the first planar
distal nonarticulating surface noncoplanar with the second planar
distal nonarticulating surface; and a first and a second planar
anterior nonarticulating surfaces, the first planar anterior
nonarticulating surface noncoplanar with the second planar anterior
nonarticulating surface.
[0007] In another form thereof, the present disclosure provides a
femoral trochlea prosthesis, including an articulating surface; a
plurality of nonarticulating surfaces, the plurality of
nonarticulating surfaces including: a planar anterior
nonarticulating surface; a first planar distal nonarticulating
surface; and a second planar distal nonarticulating surface, the
first planar distal nonarticulating surface noncoplanar with the
second planar distal nonarticulating surface.
[0008] In yet another form thereof, the present disclosure provides
a method for preparing an anatomical structure to receive a femoral
trochlea prosthesis and for implanting the prosthesis in the
anatomical structure, including the steps of resecting a portion of
the anatomical structure by making one of a single planar resection
along a line disposed at an angle with respect to a coronal plane
of the anatomical structure; and at least a pair of planar
resection lines, at least one of the pair of planar resection lines
disposed at an angle with respect to a coronal plane of the
anatomical structure; selecting a prosthesis to match the resection
of the resecting step; and implanting the prosthesis with respect
to the prepared anatomical structure.
[0009] In a still further form thereof, the present disclosure
provides a method for preparing an anatomical structure to receive
a femoral trochlea prosthesis and for implanting the prosthesis in
the anatomical structure, including the steps of resecting a
portion of the anatomical structure by making at least two
noncoplanar cuts at a distal end of the anatomical structure, the
two noncoplanar cuts defining a resected surface for a pair of
distal nonarticulating surfaces of the prosthesis; selecting a
femoral trochlea prosthesis to match the resection of the resecting
step; and implanting the prosthesis with respect to the prepared
anatomical structure.
BRIEF DESCRIPTION OF THE DRAWINGS
[0010] The above-mentioned and other features of this disclosure,
and the manner of attaining them, will become more apparent and
will be better understood by reference to the following description
of embodiments of the disclosure taken in conjunction with the
accompanying drawings, wherein:
[0011] FIG. 1A is a perspective view of an exemplary femoral
trochlea prosthesis according to one embodiment of the present
disclosure;
[0012] FIG. 1B is another perspective view of the prosthesis of
FIG. 1A;
[0013] FIG. 1C is another perspective view of the prosthesis of
FIG. 1A;
[0014] FIG. 2A is a perspective view of an exemplary femoral
trochlea prosthesis according to another embodiment of the present
disclosure;
[0015] FIG. 2B is another perspective view of the prosthesis of
FIG. 2A;
[0016] FIG. 2C is another perspective view of the prosthesis of
FIG. 2A;
[0017] FIG. 3A is a perspective view of an exemplary femoral
trochlea prosthesis according to yet another embodiment of the
present disclosure;
[0018] FIG. 3B is another perspective view of the prosthesis of
FIG. 3A;
[0019] FIG. 3C is another perspective view of the prosthesis of
FIG. 3A;
[0020] FIG. 3D is a perspective view of the prosthesis of FIG. 3A
implanted in a distal femur, further illustrating a relationship
between the prosthesis and a unicondylar knee prosthesis;
[0021] FIG. 4A is a conceptual view of a resection line on a distal
femur for preparing a bone to receive a femoral trochlea
prosthesis;
[0022] FIG. 4B is a conceptual view of the resection line of FIG.
4A in comparison with a bone-preserving resection line according to
a method of the present disclosure;
[0023] FIG. 4C is another conceptual view of the resection line of
FIG. 4A in comparison with a bone-preserving resection line
according to a method of the present disclosure;
[0024] FIG. 5A is a conceptual view of a femoral trochlea
prosthesis used with the resection line of FIG. 4A;
[0025] FIG. 5B is a conceptual view of a set of femoral trochlea
prostheses used with the bone-preserving resection line of FIG.
4B;
[0026] FIG. 5C is a conceptual view of a set of femoral trochlea
prostheses used with the bone-preserving resection line of FIG.
4C;
[0027] FIG. 6A is a perspective view of an exemplary femoral
trochlea prosthesis according to a still further embodiment of the
present disclosure;
[0028] FIG. 6B is another perspective view of the prosthesis of
FIG. 6A taken along line 6B-6B of FIG. 6A;
[0029] FIG. 7A is a conceptual view of a resection line on a distal
femur for preparing a bone to receive a femoral trochlea
prosthesis;
[0030] FIG. 7B is a conceptual view of the resection line of FIG.
7A in comparison with a bone-preserving resection line according to
another method of the present disclosure;
[0031] FIG. 7C is another conceptual view of the resection line of
FIG. 7A in comparison with a bone-preserving resection line
according to another method of the present disclosure;
[0032] FIG. 8A is a conceptual view of a femoral trochlea
prosthesis used with the resection line of FIG. 7A;
[0033] FIG. 8B is a conceptual view of a femoral trochlea
prosthesis used with the bone-preserving resection line of FIG.
7B;
[0034] FIG. 8C is a conceptual view of a femoral trochlea
prosthesis used with the bone-preserving resection line of FIG.
7C;
[0035] FIG. 9 is a conceptual view of a bone-preserving resection
line according to yet another method of the present disclosure;
[0036] FIG. 10 is a distal perspective view of a distal end of the
femur; and
[0037] FIG. 11 is a perspective view of a distal end of the femur,
further illustrating a pair of distal planar resections.
[0038] Corresponding reference characters indicate corresponding
parts throughout the several views. The exemplifications set out
herein illustrate embodiments of the disclosure and such
exemplifications are not to be construed as limiting the scope of
the invention in any manner.
DETAILED DESCRIPTION
[0039] The present disclosure provides various embodiments of
femoral trochlea prostheses useable in a knee joint. The prostheses
described herein may be useable in a knee joint in which a patella
is resurfaces or a knee joint in which a patella is not resurfaced.
The prostheses described herein may be secured to a femur with
cement or, alternatively, without cement, such as with screws
and/or cables, for example. The prostheses described herein may be
formed of metal, polymer, or hydrogel. Moreover, due to the
relatively small thicknesses of the prostheses described herein,
the prostheses do not violate a primary total knee arthroplasty
(TKA) envelope, i.e., minor or no adjustments of the primary TKA
technique are required to revise a failed patello-femoral joint to
a TKA.
[0040] Referring to FIGS. 1A, 1B, and 1C, femoral trochlea
prosthesis 20 may include articulating surface 22 and
nonarticulating surface 24. Nonarticulating or bone-facing surface
24 may be contoured to have a substantially concave shape.
Similarly, articulating surface 22 may include a convex portion,
thereby defining trochlea groove 26 generally corresponding to the
dashed lines of FIGS. 1B and 1C. Nonarticulating surface 24 also
may include portions having a planar configuration. Prosthesis 20
may define a variable thickness between articulating surface 22 and
nonarticulating surface 24. For example, prosthesis 20 may be
thinnest near trochlea groove 26 and thickest near medial and
lateral edges 28. Alternatively, the thickness of prosthesis 20 may
be substantially uniform. Nonarticulating surface 24 of prosthesis
20 may include bone pegs and a distal tail substantially similar to
those described in co-pending U.S. patent application entitled
FEMORAL TROCHLEA PROSTHESES, Attorney Docket No. ZIM0473/ZM0827
(hereinafter "the Co-Pending Application"), filed on the same day
as the present application and assigned to the assignee of the
present application, the disclosure of which is expressly
incorporated herein by reference.
[0041] Referring to FIGS. 2A, 2B, and 2C, femoral trochlea
prosthesis 30 may include a plurality of nonarticulating surfaces,
anterior articulating surface or facet 32, and distal articulating
surface or facet 34. Articulating surfaces 32 and 34 define
patello-femoral groove 36 generally corresponding to the dashed
line of FIG. 2C. Prosthesis 30 may include first anterior
nonarticulating surface or facet 38, second anterior
nonarticulating surface or facet 40, first distal nonarticulating
surface or facet 42, and second distal nonarticulating surface or
facet 44. In one embodiment, surfaces 38 and 42 are laterally
positioned and surfaces 40 and 44 are medially positioned on
prosthesis 30. In another embodiment, surfaces 38 and 42 are
medially positioned and surfaces 40 and 44 are laterally positioned
on prosthesis 30. Bone pegs 46 and distal tail 48 extending from
distal nonarticulating surfaces 42, 44 may be substantially similar
to the bone pegs and distal tails described in the Co-Pending
Application which may be used to provide additional fixation
support and strength for the femoral trochlea prostheses described
herein. Nonarticulating surfaces 38, 40, 42, and 44 each may
include pocket 50 which may be substantially similar to the pockets
described in the Co-Pending Application which may be used to
contain cement or porous material positioned between
nonarticulating surfaces 38, 40, 42, 44 and the femur. Prosthesis
30 defines medial/lateral edges 52. Prosthesis 30 may define a
variable thickness between nonarticulating surfaces 38, 40, 42, 44
and articulating surfaces 32, 34. In particular, in an exemplary
embodiment, the thickness of prosthesis 30 decreases from one edge
52 inward toward groove 36 and then increases from groove 36
outward toward the other edge 52 to form groove 36 on articulating
surfaces 32, 34.
[0042] First anterior nonarticulating surface 38 defines a first
plane, second anterior nonarticulating surface 40 defines a second
plane, first distal nonarticulating surface 42 defines a third
plane, and second distal nonarticulating surface 44 defines a
fourth plane. In an exemplary embodiment, the first, second, third,
and fourth planes are not coplanar, i.e., each of the first,
second, third, and fourth planes define unique planes which
intersect each of the other three planes.
[0043] The intersection of the first plane and the second plane
defines anterior apex 54. The intersection of the third plane and
the fourth plane defines distal apex 56. Anterior apex 54 and
distal apex 56 may closely follow the deepest part of sulcus or
groove 36. Prosthesis 30 may be thinnest at anterior apex 54 and
distal apex 56 as compared to the remainder of prosthesis 30
towards each edge 52 to facilitate the thinnest profile or
thickness of prosthesis 30 along groove 36. Furthermore, the planar
facets defined by nonarticulating surfaces 38, 40, 42, 44 remove
the need to prepare a contoured surface on a distal femur to
receive prosthesis 30.
[0044] Referring to FIGS. 3A, 3B, and 3C, femoral trochlea
prosthesis 60 may include a plurality of nonarticulating surfaces,
anterior articulating surface 62, and distal articulating surface
64. Articulating surfaces 62 and 64 define patello-femoral groove
66 generally corresponding to the dashed line of FIG. 3B.
Prosthesis 60 may include anterior nonarticulating surface 68,
first distal nonarticulating surface 70, and second distal
nonarticulating surface 72. Bone pegs 74 and distal tail 76 may be
substantially similar to the bone pegs and distal tails described
in the Co-Pending Application. Nonarticulating surfaces 68, 70, and
72 each may include pocket 78 which may be substantially similar to
the pockets described in the Co-Pending Application. Prosthesis 60
defines medial/lateral edges 80. Prosthesis 60 defines a thickness
between nonarticulating surfaces 68, 70, 72 and articulating
surfaces 62, 64. In an exemplary embodiment, the thickness of
prosthesis 60 decreases from one edge 80 inward toward groove 66
and then increases from groove 66 outward toward the other edge
80.
[0045] Anterior nonarticulating surface 68 defines a first plane,
first distal nonarticulating surface 70 defines a second plane, and
second distal nonarticulating surface 72 defines a third plane. In
an exemplary embodiment, the first, second, and third planes are
not coplanar, i.e., each of the first, second, and third planes
define unique planes which intersect each of the other two
planes.
[0046] The intersection of the second plane and the third plane
defines distal apex 82. Distal apex 82 may closely follow the
deepest part of groove 66. Prosthesis 60 is thinnest at distal apex
82 as compared to the remainder of prosthesis 60 to facilitate the
thinnest profile or thickness of prosthesis 60 along groove 66.
Furthermore, the planar facets defined by nonarticulating surfaces
68, 70, 72 remove the need to prepare a contoured surface on a
distal femur to receive prosthesis 60.
[0047] Referring now to FIG. 3D, femoral trochlea prosthesis 60 may
be implanted on distal femur 84 proximate unicondylar knee
prosthesis 86. Advantageously, prosthesis 60 may include distal
cutouts 88 (FIGS. 3A-3D) such that prosthesis 60 is spaced from and
does not contact prosthesis 86. Furthermore, cutouts or scallops 88
may eliminate interference with an anterior horn or portion of a
meniscal component of the knee joint when the knee is in
extension.
[0048] Referring now to FIGS. 4A, 4B, and 4C, bone-conserving
resections are shown for a distal femur for receipt of any of the
prostheses described herein and in the Co-Pending Application. As
shown in FIG. 4A, distal femur 101 includes medial condyle 102 and
lateral condyle 104. Resection line 100 represents a typical
resection line for a normal distal femur 101. Distal femur 101 may
not, however, always include normal anatomy. As shown in FIG. 4B,
distal femur 101' includes medial condyle 102' and lateral condyle
104' which has a dysplastic condition, i.e., an abnormal anatomical
condition in which lateral condyle 104' includes less bone stock as
compared to a normal lateral condyle. Resection line 100 may
satisfactorily accomplish the resection required for implantation
of a femoral trochlea prosthesis on distal femur 101'. Resection
line 100', however, may also accomplish the required resection
while preserving bone. Similarly, as shown in FIG. 4C, distal femur
101'' includes lateral condyle 104'' and medial condyle 102'' which
has a dysplastic condition, i.e., an abnormal anatomical condition
in which medial condyle 102'' includes less bone stock as compared
to a normal medial condyle. Resection line 100'' may accomplish the
required resection while preserving bone. Advantageously, resection
lines 100' and 100'' represent a surgical technique or method to
cut a distal femur which accounts for variable anterior femoral
anatomy while simultaneously preserving as much bone as possible.
For example, resection line 100' extends medially/laterally across
distal femur 101' as close as possible to patello-femoral groove
105' while also removing substantially equal amounts of bone from
both medial condyle 102' and lateral condyle 104'. Similarly,
resection line 100'' extends medially/laterally across distal femur
101'' as close as possible to patello-femoral groove 105'' while
also removing substantially equal amounts of bone from both medial
condyle 102'' and lateral condyle 104''. This technique
advantageously minimizes the bone removal and, consequently,
preserves as much healthy bone as possible. In an alternative
embodiment, a surgeon may choose to bias prostheses used with
resection lines 100, 100', 100'' to improve and/or restore patella
subluxation resistance. For example, a 0.degree. resection may be
made to femur 101, but a 3.degree. prosthesis may be used to bias
one anterior condyle higher than the other condyle.
[0049] As shown in FIG. 10, resections lines 100, 100', and 100''
are shown with respect to an inferior view of distal femur 101.
Resection line 100 is substantially parallel to a coronal plane of
femur 101. Resection lines 100' and 100'' are disposed at an angle
with respect to the coronal plane of femur 101.
[0050] Referring to FIGS. 5A, 5B, and 5C, fragmentary profiles of
femoral trochlea prostheses, such as those described above and in
the Co-Pending Application, useable with the techniques described
above with respect to FIGS. 4A, 4B, and 4C are shown. As shown in
FIG. 5A, femoral trochlea prosthesis 110 including nonarticulating
surface 112 may be used on distal femur 101 (FIG. 4A).
Nonarticulating surface 112 abuts resection line 100 (FIG. 4A) on
distal femur 101 when implanted on distal femur 101. As shown in
FIG. 5B, femoral trochlea prostheses 110a' and 110b' including
nonarticulating surfaces 112a' and 112b', respectively, may be used
on distal femur 101' (FIG. 4B). Advantageously, nonarticulating
surfaces 112a' and 112b' are angled with respect to surface 112
(FIG. 5A) to more closely match the prepared surface of distal
femur 101' represented by resection line 100'. Prostheses 110a' and
110b' may include a thicker lateral condyle portion to account for
the dysplastic condition and to more closely replicate normal
anatomy when implanted on distal femur 101'. As shown in FIG. 5C,
femoral trochlea prostheses 110a'' and 110b'' including
nonarticulating surfaces 112a'' and 112b'', respectively, may be
used on distal femur 101'' (FIG. 4C). Advantageously,
nonarticulating surfaces 112a'' and 112b'' are angled with respect
to surface 112 (FIG. 5A) to more closely match the prepared surface
of distal femur 101'' represented by resection line 100''.
Prostheses 110a'' and 110b'' may include a thicker medial condyle
portion to account for the dysplastic condition and to more closely
replicate normal anatomy when implanted on distal femur 101''.
Advantageously, prostheses 110, 110a', 110b', 110a'', and 110b''
are also bone conserving due to the thin nature of the
prostheses.
[0051] As shown in FIGS. 6A and 6B, femoral trochlea prosthesis 120
is shown which is substantially similar to prosthesis 60, described
above with respect to FIGS. 3A-3D. Prosthesis 120 exemplifies the
concepts illustrated in the fragmentary conceptual profiles of
prostheses 110, 110a, and 110b, described above with respect to
FIGS. 5A-5C. Femoral trochlea prosthesis 120 includes substantially
the same components as prosthesis 60 except as described below.
Anterior nonarticulating surface 122 of prosthesis 120 is angled as
compared to anterior nonarticulating surface 68 (FIGS. 3A-3C). In
this manner, anterior nonarticulating surface 122 may be configured
to match the angle of resection lines 100' (FIG. 4B) or 100'' (FIG.
4C), for example, while simultaneously replicating a normal anatomy
of a distal femur on which prosthesis 120 is implanted.
[0052] Referring now to FIGS. 7A, 7B, and 7C, a bone-conserving
resection is shown for a distal femur for receipt of any of the
prostheses described herein and in the Co-Pending Application. As
shown in FIG. 7A, distal femur 131 typically includes medial
condyle 132 and lateral condyle 134. Resection line 130 represents
a typical resection line for a normal distal femur 131. Distal
femur 131 may not, however, always include normal anatomy. As shown
in FIG. 7B, distal femur 131' includes medial condyle 132' and
lateral condyle 134' which has a dysplastic condition, i.e., an
abnormal anatomical condition. Resection line 130 may
satisfactorily accomplish the resection required for implantation
of a femoral trochlea prosthesis on distal femur 131'. Resection
line 130', however, may also accomplish the required resection
while preserving bone. In an exemplary embodiment, resection line
130' is formed as two noncolinear line segments, one of which
extends as a beveled cut on the normal side of distal femur 131',
i.e., medial condyle 132', and the other of which extends across
the dysplastic side of distal femur 131', i.e., lateral condyle
134', which is substantially coincident with resection line 130.
Similarly, as shown in FIG. 4C, distal femur 131'' includes lateral
condyle 134'' and medial condyle 132'' which has a dysplastic
condition. Resection line 130'' may accomplish the required
resection while preserving bone. In an exemplary embodiment,
resection line 130'' is formed as two noncolinear line segments,
one of which extends as a beveled cut on the normal side of distal
femur 131'', i.e., lateral condyle 134'', and the other of which
extends across the dysplastic side of distal femur 131'', i.e.,
medial condyle 132'', which is substantially coincident with
resection line 130. Thus, resection lines 130' and 130'' are formed
by two planar cuts formed with an obtuse, oblique angle between the
planes. A portion of resection lines 130' and 130'' may
substantially overlap or coincide with resection line 130, as shown
in FIGS. 7B and 7C. Advantageously, resection lines 130' (FIG. 7B)
and 130'' (FIG. 7B) represent a surgical technique or method to cut
a distal femur which accounts for variable anterior femoral anatomy
while simultaneously preserving as much bone as possible. For
example, resection line 130' extends medially/laterally across
distal femur 131' as close as possible to patello-femoral groove
135' while also removing substantially equal amounts of bone from
both medial condyle 132' and lateral condyle 134'. Similarly,
resection line 130'' extends medially/laterally across distal femur
132'' as close as possible to patello-femoral groove 135'' while
also removing substantially equal amounts of bone from both medial
condyle 132'' and lateral condyle 134''. This technique
advantageously minimizes the bone removal and, consequently,
preserves as much healthy bone as possible.
[0053] Referring to FIGS. 8A, 8B, and 8C, femoral trochlea
prostheses useable with the techniques described above with respect
to FIGS. 7A, 7B, and 7C are shown. As shown in FIG. 8A, femoral
trochlea prosthesis 140 including nonarticulating surface 142 may
be used on distal femur 131 (FIG. 7A). Nonarticulating surface 142
abuts resection line 130 (FIG. 7A) on distal femur 131 when
implanted on distal femur 131. As shown in FIG. 8B, femoral
trochlea prosthesis 140' including nonarticulating surface 142' may
be used on distal femur 131' (FIG. 7B). Advantageously,
nonarticulating surface 142' is beveled to more closely match the
prepared surface of distal femur 131' represented by resection line
130'. Prosthesis 140' may include a thicker lateral condyle portion
to account for the dysplastic condition and to more closely
replicate normal anatomy when implanted on distal femur 131'. As
shown in FIG. 8C, femoral trochlea prosthesis 140'' including
nonarticulating surface 142'' may be used on distal femur 131''
(FIG. 7C). Advantageously, nonarticulating surface 142'' is beveled
to more closely match the prepared surface of distal femur 131''
represented by resection line 130''. Prosthesis 140'' may include a
thicker medial condyle portion to account for the dysplastic
condition and to more closely replicate normal anatomy when
implanted on distal femur 131''.
[0054] As shown in FIG. 8B, augment 150 may be used with any of the
femoral trochlea prostheses described herein and in the Co-Pending
Application to facilitate a more accurate fit with and orientation
relative to a patient's anatomy and to more fully support a
prosthesis when implanted. Augment 150 may have a generally
triangular-shaped cross-section. Augment 150 may be formed of
material such as, but not limited to, metal, polymethylmethacrylate
(PMMA), polymer, a cobalt chromium alloy, or an open-cell porous
metal such as a material made using Trabecular Metal.TM.
technology, available from Zimmer, Inc. of Warsaw, Ind., for
example. Augment 150 may placed proximate a medial condyle and/or a
lateral condyle.
[0055] Referring to FIG. 9, distal femur 155 is shown. Distal femur
155 may include resection lines 157a, 157b, and 157c, similar to
resection lines 100', 100'', 130', 130'', described above with
reference to FIGS. 4B-4C and 7B-7C. Resection lines 157a, 157b, and
157c facilitate a bone-preserving bone resection surgical
technique. In an exemplary embodiment, resection lines 157a, 157b,
and 157c define unique planes. A plane defined by resection line
157a forms an oblique angle with a plane defined by resection line
157b. The plane defined by resection line 157b forms an oblique
angle with a plane defined by resection line 157c. A surgical
technique employing resection lines 157a, 157b, and 157c
advantageously preserves bone while simultaneously prepares a
surface of distal femur 155 to receive a femoral trochlea
prosthesis. Any of the femoral trochlea prostheses described herein
or in the Co-Pending Application may be used with a femur prepared
with resection lines 157a, 157b, and 157c. A femoral trochlea
prosthesis having at least five or six total facets on a
nonarticulating surface thereof may be used with the surgical
technique illustrated by resection lines 157a, 157b, and 157c.
Advantageously, any prosthesis used with resection lines 157a,
157b, 157c may be dimensioned, for example, smaller than the cavity
created by resection lines 157a, 157b, 157c, to permit subtle
medial-lateral adjustment/movement of the prosthesis and to permit
adjustment of the sulcus or trochlear groove angle of the
prosthesis. Augment 150 (FIG. 8B) may be used with a prosthesis
implanted after resection lines 157a, 157b, 157c are created.
Augment 150 may be used proximate a medial condyle and/or a lateral
condyle. Also, augment 150 may be used proximate resection line
157b, e.g., medially/laterally equidistant on distal femur 155.
[0056] FIG. 11 illustrates an exemplary resection for receipt of
the distal nonarticulating surfaces described herein. For example,
distal femur 161 may include planar cuts 163, 165 for receipt of
distal nonarticulating surfaces 42, 44 (FIG. 2B) or 70, 72 (FIG.
3A).
[0057] All of the prostheses disclosed herein and in the Co-Pending
Application may be specifically designed for gender specific
applications. For example, the prostheses may be specifically
designed for female anatomy and therefore include a greater lateral
trochlear groove angle and a thinner anterior flange as compared to
traditional prostheses. Further, for example, the prostheses may be
specifically designed for male anatomy and therefore include a
smaller lateral trochlear groove angle and a thicker anterior
flange as compared to traditional prostheses.
[0058] While this disclosure has been described as having exemplary
designs, the present disclosure can be further modified within the
spirit and scope of this disclosure. This application is therefore
intended to cover any variations, uses, or adaptations of the
disclosure using its general principles. Further, this application
is intended to cover such departures from the present disclosure as
come within known or customary practice in the art to which this
disclosure pertains and which fall within the limits of the
appended claims.
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