U.S. patent application number 15/863421 was filed with the patent office on 2018-06-21 for patient-specific acetabular alignment guides.
The applicant listed for this patent is Biomet Manufacturing, LLC. Invention is credited to Mark A. Bollinger, Jason D. Meridew, Robert Metzger, Bryan Morrison, Lance Dean Perry, W. Jason Slone, Aaron P. Smith, John R. White, Tyler D. Witt.
Application Number | 20180168822 15/863421 |
Document ID | / |
Family ID | 46178817 |
Filed Date | 2018-06-21 |
United States Patent
Application |
20180168822 |
Kind Code |
A1 |
White; John R. ; et
al. |
June 21, 2018 |
PATIENT-SPECIFIC ACETABULAR ALIGNMENT GUIDES
Abstract
An acetabular device includes a patient-specific acetabular
alignment guide including a bone engagement surface. The bone
engagement surface has a first portion configured and shaped to be
conforming and complementary to an acetabular rim surface and a
second portion configured and shaped to be conforming and
complementary to a periacetabular area of an acetabulum of a
patient. The acetabular alignment guide includes a plurality of
guiding formations extending through the second portion for guiding
a plurality of alignment pins therethrough. The bone engagement
surface and the plurality of guiding formations are prepared from a
three-dimensional model of the acetabulum of the specific patient
reconstructed pre-operatively from a scan of the patient.
Inventors: |
White; John R.; (Winona
Lake, IN) ; Perry; Lance Dean; (Warsaw, IN) ;
Smith; Aaron P.; (Warsaw, IN) ; Meridew; Jason
D.; (Warsaw, IN) ; Morrison; Bryan; (Goshen,
IN) ; Slone; W. Jason; (Silver Lake, IN) ;
Witt; Tyler D.; (Warsaw, IN) ; Bollinger; Mark
A.; (Fort Wayne, IN) ; Metzger; Robert;
(Wakarusa, IN) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Biomet Manufacturing, LLC |
Warsaw |
IN |
US |
|
|
Family ID: |
46178817 |
Appl. No.: |
15/863421 |
Filed: |
January 5, 2018 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
15267714 |
Sep 16, 2016 |
9913734 |
|
|
15863421 |
|
|
|
|
14100134 |
Dec 9, 2013 |
9480580 |
|
|
15267714 |
|
|
|
|
13111007 |
May 19, 2011 |
8603180 |
|
|
14100134 |
|
|
|
|
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61F 2/4609 20130101;
A61F 2002/4687 20130101; A61F 2002/30617 20130101; A61F 2002/4668
20130101; A61B 17/1666 20130101; A61F 2002/4662 20130101; A61F
2002/4633 20130101; A61F 2/30942 20130101; A61B 34/10 20160201;
B33Y 80/00 20141201; A61B 17/1642 20130101; A61F 2250/0097
20130101; A61B 2034/252 20160201; A61B 2034/105 20160201; A61B
17/1617 20130101; A61B 2034/108 20160201; A61B 17/1746 20130101;
A61B 2017/922 20130101; B33Y 70/00 20141201; A61F 2/3603
20130101 |
International
Class: |
A61F 2/46 20060101
A61F002/46; A61B 17/16 20060101 A61B017/16; A61B 34/10 20160101
A61B034/10; A61B 17/17 20060101 A61B017/17; A61F 2/36 20060101
A61F002/36 |
Claims
1.-20. (canceled)
21. A method for inserting an acetabular implant into an acetabulum
of a patient, the method comprising: engaging a patient-specific
side of an acetabular alignment guide to a complementary rim
surface and periacetabular area of a pelvis outside the acetabulum
of the patient; inserting a plurality of alignment pins through
corresponding alignment apertures of the acetabular alignment guide
and into the periacetabular area of the pelvis outside the
acetabulum of the patient; removing the acetabular alignment guide
without removing the plurality of alignment pins from the
periacetabular area of the pelvis of the patient; coupling an
acetabular instrument to a patient-specific alignment adapter
having a plurality of openings located at patient-specific
locations, each of the plurality of openings configured to align
with one of the plurality of alignment pins; and guiding the
patient-specific alignment adapter along the plurality of alignment
pins to engage the acetabular instrument with the acetabulum.
22. The method of claim 21, wherein engagement of the acetabular
instrument with the acetabulum comprises reaming the acetabulum
with a reamer.
23. The method of claim 21, wherein guiding the patient-specific
alignment adapter along the plurality of alignment pins comprises
adjusting arms of the patient-specific alignment adapter to move
the plurality of openings to the patient-specific locations.
24. The method of claim 23, wherein adjusting arms of the
patient-specific alignment adapter comprises adjusting a position
of a pair of parallel arms in a plane.
25. The method of claim 21, further comprising coupling an
instrument shaft to the acetabular instrument.
26. The method of claim 25, wherein the patient-specific alignment
adapter includes a quick-connect coupler for connecting to the
instrument shaft.
27. The method of claim 25, further comprising: slidably attaching
a scale to one of the plurality of alignment pins; and determining
a size of an implant for the acetabulum using the scale.
28. The method of claim 27, further comprising attaching an
acetabular implant to the acetabulum using an inserter coupled to
another patient-specific alignment adapter mounted to at least one
of the plurality of alignment pins.
29. A method of preparing an acetabulum of a patient for receiving
an acetabular implant, the method comprising: positioning a
patient-specific acetabular alignment guide against bone adjacent
to the acetabulum, the patient-specific acetabular alignment guide
including first and second alignment apertures; inserting first and
second alignment pins through the first and second alignment
apertures, respectively; coupling a patient-specific alignment
adapter to the first and second alignment pins, the
patient-specific alignment adapter comprising: first and second
arms including first and second openings, respectively, for
receiving the first and second alignment pins, respectively; a
reaming head supported by the first and second arms; and a
quick-connect coupler connected to the reaming head for receiving a
drive shaft; connecting the drive shaft to the quick-connect
coupler; and reaming the acetabulum with the reaming head.
30. The method of claim 29, wherein positioning the
patient-specific acetabular alignment guide against bone adjacent
to the acetabulum comprises locating the first and second alignment
apertures at patient-specific locations on an acetabular rim
surface of the acetabulum.
31. The method of claim 29, wherein coupling the patient-specific
alignment adapter to the first and second alignment pins comprises
adjusting a location of the first and second arms relative to each
other within a plane to align the first and second openings with
the first and second alignment pins.
32. The method of claim 29, wherein reaming the acetabulum with the
reaming head comprises transmitting rotational force from the drive
shaft to the reaming head through the quick-connect coupler.
33. The method of claim 29, wherein positioning the
patient-specific acetabular alignment guide against bone adjacent
to the acetabulum comprises: positioning a first portion configured
and shaped to be conforming and complimentary to an acetabular rim
surface of the patient against the acetabular rim surface of the
patient, the first portion configured to extend around the entire
acetabulum to form an opening through which the acetabulum is
accessible; and positioning a second portion configured and shaped
to be conforming and complementary to a periacetabular area of an
acetabulum of the patient against the periacetabular area of the
acetabulum of the patient, the second portion configured to extend
around the entire periacetabular area of the acetabulum to provide
locations for the first and second alignment apertures.
34. The method of claim 33, further comprising shaping the first
portion and the second portion of the patient-specific acetabular
alignment guide in accordance with a three-dimensional model of the
acetabulum of the patient reconstructed pre-operatively from an
image scan of the patient.
35. The method of claim 29, further comprising removing the
patient-specific acetabular alignment guide from the bone adjacent
to the acetabulum before coupling the patient-specific alignment
adapter to the first and second alignment pins.
36. The method of claim 29, further comprising: removing the
patient-specific alignment adapter from the first and second guide
pins; coupling an inserter to the first and second guide pins with
a patient-specific inserter adapter to insert an acetabular implant
into the acetabulum; removing the inserter from the
patient-specific inserter adapter; coupling an impactor to the
patient-specific inserter adapter; and impacting the acetabular
implant with the impactor.
37. A method of preparing an acetabulum of a patient for receiving
an implant, the method comprising: positioning a patient-specific
acetabular alignment guide against the acetabulum, the
patient-specific acetabular alignment guide including: a
closed-loop body configured to three-dimensionally conform and
complement the acetabulum of the patient in only one position, the
closed-loop body defining an opening to access the acetabulum and
an acetabular centering axis; and first and second alignment
apertures extending through the closed-loop body outside of the
opening; inserting first and second alignment pins through the
first and second alignment apertures, respectively; adjusting a
patient-specific alignment adapter to receive the first and second
alignment pins, the patient-specific alignment adapter comprising:
first and second arms including first and second openings,
respectively, the first and second arms rotatable about the
acetabular centering axis; a reaming head supported by the first
and second arms; and a quick-connect coupler connected to the
reaming head for receiving a drive shaft; connecting the drive
shaft to the quick-connect coupling; and reaming the acetabulum
with the reaming head.
38. The method of claim 37, wherein adjusting the patient-specific
alignment adapter to receive the first and second alignment pins
comprises adjusting a location of the first and second arms
relative to each other within a plane to align the first and second
openings with the first and second alignment pins,
respectively.
39. The method of claim 37, wherein reaming the acetabulum with the
reaming head comprises transmitting rotational force from the drive
shaft to the reaming head through the quick-connect coupler.
40. The method of claim 37, further comprising: slidably attaching
a scale to at least one of the first and second alignment pins; and
determining a size of an implant for the acetabulum using the
scale.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims the benefit of U.S. Provisional
Application No. 61/446,660, filed on Feb. 25, 2011.
[0002] This application is a continuation-in-part of U.S.
application Ser. Nos. 13/041,469, 13/041,495, 13/041,665 and
13/041,883, each filed on Mar. 7, 2011, each of which is a
continuation-in-part of U.S. application Ser. No. 12/978,069 filed
Dec. 23, 2010, which is a continuation-in-part of U.S. application
Ser. No. 12/973,214, filed Dec. 20, 2010, which is a
continuation-in-part of U.S. application Ser. No. 12/955,361 filed
Nov. 29, 2010, which is a continuation-in-part of U.S. application
Ser. Nos. 12/938,913 and 12/938,905, both filed Nov. 3, 2010, each
of which is a continuation-in-part of U.S. application Ser. No.
12/893,306, filed Sep. 29, 2010, which is a continuation-in-part of
U.S. application Ser. No. 12/888,005, filed Sep. 22, 2010, which is
a continuation-in-part of U.S. application Ser. No. 12/714,023,
filed Feb. 26, 2010, which is a continuation-in-part of U.S.
application Ser. No. 12/571,969, filed Oct. 1, 2009, which is a
continuation-in-part of U.S. application Ser. No. 12/486,992, filed
Jun. 18, 2009, and is a continuation-in-part of U.S. application
Ser. No. 12/389,901, filed Feb. 20, 2009, which is a
continuation-in-part of U.S. application Ser. No. 12/211,407, filed
Sep. 16, 2008, which is a continuation-in-part of U.S. application
Ser. No. 12/039,849, filed Feb. 29, 2008, which: (1) claims the
benefit of U.S. Provisional Application No. 60/953,620, filed on
Aug. 2, 2007, U.S. Provisional Application No. 60/947,813, filed on
Jul. 3, 2007, U.S. Provisional Application No. 60/911,297, filed on
Apr. 12, 2007, and U.S. Provisional Application No. 60/892,349,
filed on Mar. 1, 2007; (2) is a continuation-in-part U.S.
application Ser. No. 11/756,057, filed on May 31, 2007, which
claims the benefit of U.S. Provisional Application No. 60/812,694,
filed on Jun. 9, 2006; (3) is a continuation-in-part of U.S.
application Ser. No. 11/971,390, filed on Jan. 9, 2008, which is a
continuation-in-part of U.S. application Ser. No. 11/363,548, filed
on Feb. 27, 2006, now U.S. Pat. No. 7,780,672, issued on Aug. 24,
2010; and (4) is a continuation-in-part of U.S. application Ser.
No. 12/025,414, filed on Feb. 4, 2008, which claims the benefit of
U.S. Provisional Application No. 60/953,637, filed on Aug. 2,
2007.
[0003] This application is continuation-in-part of U.S. application
Ser. No. 12/872,663, filed on Aug. 31, 2010, which claims the
benefit of U.S. Provisional Application No. 61/310,752 filed on
Mar. 5, 2010.
[0004] This application is a continuation-in-part of U.S.
application Ser. No. 12/483,807, filed on Jun. 12, 2009, which is a
continuation-in-part of U.S. application Ser. No. 12/371,096, filed
on Feb. 13, 2009, which is a continuation-in-part of U.S.
application Ser. No. 12/103,824, filed on Apr. 16, 2008, which
claims the benefit of U.S. Provisional Application No. 60/912,178,
filed on Apr. 17, 2007.
[0005] This application is also a continuation-in-part of U.S.
application Ser. No. 12/103,834, filed on Apr. 16, 2008, which
claims the benefit of U.S. Provisional Application No. 60/912,178,
filed on Apr. 17, 2007.
[0006] The disclosures of the above applications are incorporated
herein by reference.
INTRODUCTION
[0007] The present teachings provide a patient-specific acetabular
alignment guide and related instruments for guiding an acetabular
implant into the acetabulum of a patient.
SUMMARY
[0008] The present teachings provide an acetabular device. In one
aspect, the acetabular system includes a patient-specific
acetabular alignment guide including a bone engagement surface. The
bone engagement surface has a first portion configured and shaped
to be conforming and complementary to an acetabular rim surface and
a second portion configured and shaped to be conforming and
complementary to a periacetabular area of an acetabulum of a
patient. The acetabular alignment guide includes a plurality of
guiding formations extending through the second portion for guiding
a plurality of alignment pins therethrough. The bone engagement
surface and the plurality of guiding formations are prepared from a
three-dimensional model of the acetabulum of the specific patient
reconstructed pre-operatively from a scan of the patient.
[0009] The acetabular device can also include an acetabular
inserter including a handle, a shaft and an acetabular coupler and
a first alignment adapter removably coupled to the shaft of the
acetabular inserter. The first alignment adapter includes a
plurality of apertures configured to correspond to the guiding
formations of the acetabular alignment guide, such that the
alignment pins can pass through the apertures of the alignment
adapter after the acetabular alignment guide is removed without
removing the alignment pins from the patient.
[0010] The present teachings also provide a method for inserting an
acetabular implant into the acetabulum of a patient. The method
includes engaging a patient-specific surface of the acetabular
alignment guide to a complementary rim surface and periacetabular
area of a patient and inserting a plurality of alignment pins
through corresponding alignment apertures of the acetabular
alignment guide and into the periacetabular area of the patient.
The method further includes removing the acetabular alignment guide
without removing the alignment pins from the patient, guiding a
first alignment adapter coupled to an acetabular inserter over the
alignment pins, and implanting the acetabular implant with the
acetabular inserter.
[0011] The present teachings provide an acetabular device that
includes an annular acetabular guide including a first surface and
a second surface opposite to the first surface. The first surface
is patient-specific and made to conform to an acetabular rim
surface around an acetabulum of a patient in accordance with a
three-dimensional image of the acetabulum of the patient. The
acetabular guide includes a cylindrical inner guiding surface
oriented at patient-specific anteversion and abduction angles
relative to the first surface. The acetabular device also includes
a patient-specific adapter having an outer surface mateable with
the inner surface of the acetabular guide and having a
quick-connection component for coupling to a non-custom acetabular
instrument.
[0012] Further areas of applicability of the present teachings will
become apparent from the description provided hereinafter. It
should be understood that the description and specific examples are
intended for purposes of illustration only and are not intended to
limit the scope of the present teachings.
BRIEF DESCRIPTION OF THE DRAWINGS
[0013] The present teachings will become more fully understood from
the detailed description and the accompanying drawings,
wherein:
[0014] FIG. 1 is an exemplary illustration of a patient in
preparation of an acetabular implant procedure;
[0015] FIG. 1A is a perspective view of an acetabular guide
according to the present teachings, the acetabular guide shown in
relation to a patient's anatomy;
[0016] FIG. 2 is an environmental perspective view of the
acetabular guide of FIG. 1A shown with an acetabular inserter
holding an acetabular implant according to the present
teachings;
[0017] FIG. 3 is a perspective view of the acetabular inserter and
acetabular implant of FIG. 2;
[0018] FIG. 3A is a perspective environmental view of an acetabular
implant illustrating rotation about an anatomic axis A during
insertion according to the present teachings;
[0019] FIG. 3B is a perspective environmental view of an acetabular
implant illustrating rotation about an anatomic axis B during
insertion according to the present teachings;
[0020] FIG. 4 is an exploded view of the acetabular inserter and
acetabular implant of FIG. 3;
[0021] FIG. 4A is a perspective view of a modular reamer for use
according to the present teachings;
[0022] FIG. 4B is bottom plan view of a reamer head of the reamer
of FIG. 4A;
[0023] FIG. 4C is a perspective view of a reamer driver of the
reamer of FIG. 4A;
[0024] FIG. 4D is bottom plan view of a distal end of the reamer
driver of FIG. 4C;
[0025] FIG. 4E is a perspective view of the modular reamer of FIG.
4A shown assembled with a an adaptor for use according to the
present teachings;
[0026] FIG. 4F is top plan view of the adaptor of FIG. 4E;
[0027] FIG. 4G is bottom plan view of the adaptor of FIG. 4E;
[0028] FIG. 4H is an environmental view of an assembled of a reamer
with a patient-specific adapter according to the present
teachings;
[0029] FIG. 5 is a perspective environmental view of an exemplary
acetabular alignment guide according to the present teachings;
[0030] FIG. 6 is a perspective environmental view of the acetabular
alignment guide of FIG. 5 shown with a plurality of guiding
pins;
[0031] FIG. 7 is a perspective environmental view illustrating
inserting an acetabular cup with an instrument guided by the
guiding pins of FIG. 6;
[0032] FIG. 8 is a perspective environmental view of an exemplary
acetabular implant;
[0033] FIG. 9 is a perspective view of an exemplary impactor
according to the present teachings;
[0034] FIG. 10 is a perspective view of an exemplary offset
impactor according to the present teachings;
[0035] FIG. 11A is an environmental view of a patient-specific
acetabular guide according to the present teachings;
[0036] FIG. 11B is an environmental view of a reamer
patient-specific adapter guided for reaming the acetabulum by
alignment pins placed using the patient-specific acetabular guide
of FIG. 11A;
[0037] FIG. 11C is an environmental view of a length scale for
measuring a length of an implant, the scale guided by an alignment
pin placed using the patient-specific acetabular guide of FIG.
11A;
[0038] FIG. 12 is a perspective view of a reamer with a
patient-specific adapter guided for reaming the acetabulum by
alignment pins placed using the patient-specific acetabular guide
of FIG. 11A;
[0039] FIG. 13 is an environmental view of a patient-specific
resurfacing femoral implant according to the present teachings;
[0040] FIG. 14A is an environmental anterior view of a
patient-specific femoral implant according to the present
teachings; and
[0041] FIG. 14B is an environmental anterior view of the femoral
implant of FIG. 14A.
DESCRIPTION OF VARIOUS ASPECTS
[0042] The following description is merely exemplary in nature and
is in no way intended to limit the present teachings, applications,
or uses.
[0043] The present teachings generally provide a patient-specific
acetabular guide and associated inserter for use in orthopedic
surgery, such as in joint replacement or revision surgery, for
example. The patient-specific alignment guides can be used either
with conventional or patient-specific implant components prepared
with computer-assisted image methods. Computer modeling for
obtaining three dimensional images of the patient's anatomy using
MRI or CT scans of the patient's anatomy, the patient-specific
prosthesis components, and the patient-specific guides and
templates can be provided by various CAD programs and/or software
available, for example, by Materialise USA, Ann Arbor, Mich.
[0044] Patient-specific alignment guides and implants are generally
configured to match the anatomy of a specific patient. The
patient-specific alignment guides are generally formed using
computer modeling based on the patient's 3-D anatomic image and
have an engagement surface that is made to conformingly contact and
match a three-dimensional image/model of the patient's bone surface
(with or without cartilage or other soft tissue), by the computer
methods discussed above. The patient-specific alignment guides can
include custom-made guiding formations, such as, for example,
guiding bores or cannulated guiding posts or cannulated guiding
extensions or receptacles that can be used for supporting or
guiding other instruments, such as drill guides, reamers, cutters,
cutting guides and cutting blocks or for inserting pins or other
fasteners according to a surgeon-approved pre-operative plan. The
patient-specific alignment guides can be used in minimally invasive
surgery, and in particular in surgery with multiple
minimally-invasive incisions. Various alignment guides and
pre-operative planning procedures are disclosed in commonly
assigned and co-pending U.S. patent application Ser. No.
11/756,057, filed on May 31, 2007; U.S. patent application Ser. No.
12/211,407, filed Sep. 16, 2008; U.S. patent application Ser. No.
11/971,390, filed on Jan. 9, 2008, U.S. patent application Ser. No.
11/363,548, filed on Feb. 27, 2006; and U.S. patent application
Ser. No. 12/025,414, filed Feb. 4, 2008. The disclosures of the
above applications are incorporated herein by reference.
[0045] As disclosed, for example, in above-referenced U.S. patent
application Ser. No. 11/756,057, filed on May 31, 2007; in the
pre-operative planning stage for a joint replacement or revision
procedure, an MRI scan or a series of CT scans of the relevant
anatomy of the patient, such as, for example, the entire leg of the
joint to be reconstructed, can be performed at a medical facility
or doctor's office. The scan data obtained can be sent to a
manufacturer. The scan data can be used to construct a
three-dimensional image/model of the joint and provide an initial
implant fitting and alignment in a computer file form or other
computer representation. The initial implant fitting and alignment
can be obtained using an alignment method, such as alignment
protocols used by individual surgeons.
[0046] The outcome of the initial fitting is an initial surgical
plan that can be printed or provided in electronic form with
corresponding viewing software. The initial surgical plan can be
surgeon-specific, when using surgeon-specific alignment protocols.
The initial surgical plan, in a computer file form associated with
interactive software, can be sent to the surgeon, or other medical
practitioner, for review. The surgeon can incrementally manipulate
the position of images of implant components in an interactive
image of the joint. Additionally, the surgeon can select or modify
resection planes, types of implants and orientations of implant
insertion. For example, the surgeon may select patient-specific
anteversion and abduction angles for acetabular implants, as
discussed below. After the surgeon modifies and/or approves the
surgical plan, the surgeon can send the final, approved plan to the
manufacturer.
[0047] After the surgical plan is approved by the surgeon,
patient-specific alignment guides can be developed using a CAD
program or other imaging software, such as the software provided by
Materialise, for example, according to the surgical plan. Computer
instructions of tool paths for machining the patient-specific
alignment guides can be generated and stored in a tool path data
file. The tool path can be provided as input to a CNC mill or other
automated machining system, and the alignment guides can be
machined from polymer, ceramic, metal or other suitable material,
and sterilized. The sterilized alignment guides can be shipped to
the surgeon or medical facility, for use during the surgical
procedure.
[0048] The present teachings provide a patient-specific acetabular
guide and associated inserter for inserting an acetabular implant
in the acetabulum of a patient's pelvis in a guided orientation at
least about first and second non-parallel anatomic axes. Referring
to FIGS. 1, 3A and 3B, the first anatomic axis indicated at "A",
passes through the acetabulum 82 of a patient's pelvis 80 (only
half of the pelvis is shown) and is oriented generally in a
superior/inferior direction relative to the patient. The second
anatomic axis is indicated at "B" and is substantially
perpendicular to the first axis A. As described below, the present
teachings provide instruments and methods for guiding, orienting
and positioning an acetabular implant 200 at a selected angle of
anteversion relative to the axis A, as shown in FIG. 3A, and at a
selected angle of abduction relative to the axis B, as also shown
in FIG. 3B. The anteversion and abduction angles can be determined
interactive or other surgeon input and can be patient-specific.
[0049] Referring to FIG. 1A, an exemplary acetabular guide 100
according to the present teachings can include a first surface 108
for engaging an area surrounding the acetabulum 82 and a second
surface 110 opposite to the first surface 108. The
acetabulum-engaging first surface 108 can be custom-made or
patient-specific to conform and mirror an acetabular rim surface 84
around the acetabulum 82 of a specific patient by using
three-dimensional image or model of the acetabulum and surrounding
pelvic area of the patient, as described above. The first surface
108 enables the acetabular guide to nest or closely mate relative
to the acetabulum 82 of the patient.
[0050] The acetabular guide 100 can be temporarily and removably
attached to the pelvis 80 using temporary fasteners 120, such as
bone nails or tacks, for example, passing through corresponding
holes 104 through the acetabular guide 100. The acetabular guide
100 can be annular with an opening defined by an inner surface 102.
The inner surface 102 can be, for example, a cylindrical surface.
The inner surface 102 can be oriented relative to the first and
second surfaces 108, 110 of the acetabular guide 100 to provide a
selected anteversion angle about the first axis A and a selected
abduction angle relative to the axis B, as shown in FIGS. 2, 3A and
3B. The anteversion and abduction angles can be surgeon-selected
and patient-specific and can be determined with surgeon input
during the pre-operative planning for the specific patient.
Anteversion angles can be, for example, in the range of about 10-20
degrees forward relative to the first axis A, and adduction angles
can be in the range of about 40-50 degrees downward relative to the
second axis B.
[0051] Referring to FIGS. 2-4, the acetabular guide 100 can be
attached to the pelvis 80 around the acetabulum 72 after the
acetabulum 82 has been reamed and prepared for receiving the
acetabular implant 200, such as the Magnum.TM. acetabular cup
commercially available from Biomet, Inc., Warsaw, Ind. The
acetabular implant 200 can be inserted into the prepared acetabulum
82 using an inserter 300 according to the present teachings. The
inserter 300, which can also function as an impactor, can include a
handle 304 with a proximal impaction surface 318, a shaft 302 and a
guide-engaging portion 310 having a surface with a flat or planar
portion 320. The guide-engaging portion 310 can have an outer
surface 312, which conforms to and is mateable with the inner
surface 102 of the acetabular guide 100 for guiding the acetabular
implant 200. The inner surface 102 and the outer surface 312 can be
cylindrical.
[0052] Referring to FIG. 4, the inserter 300 can engage the
acetabular implant 200 via an intermediate member 250, such as the
intermediate member of the Magnum.TM. system, which is commercially
available from Biomet, Inc., Warsaw, Ind. More specifically, the
inserter 300 can include a distal portion 314, such as a
ball-bearing bushing, which can be inserted and engage a receptacle
252 of the intermediate member 250. The acetabular implant 200 can
be mounted on the inserter 300 by aligning a plurality of fingers
254 of the intermediate member 250 with corresponding cut-outs 202
on a peripheral edge of the acetabular implant 200. The acetabular
implant 200 can be secured to the inserter 300 by rotating the
acetabular implant 200 relative to the insert 300 until a
hand-tight fit is obtained.
[0053] Referring to FIG. 2, the inserter 300 with the acetabular
implant 200 mounted thereon can be directed toward the acetabular
guide 100. The outer surface 312 of the guide engaging portion 310
of the inserter 300 can be brought into contact with the inner
surface 102 of the acetabular guide 100, guiding the acetabular
implant 200 toward the selected anteversion and abduction
orientation through the acetabular guide 100. The outer surface 312
of the guide engaging portion 310 can also provide an
impaction-depth feedback by alignment with the inner surface 102 of
the acetabular guide. Full impaction of the acetabular implant 200
into the acetabulum 82 can be indicated when planar portion 320
and/or outer surface 312 of the guide-engaging portion 310 of the
inserter 300 are flush with and do not protrude over and above the
second surface 110 of the acetabular guide 100. Depth indicia 322
can also be provided on the inserter shaft 302 or on the
guide-engaging portion 310 of the inserter 300, as shown in FIG.
2.
[0054] After the acetabular implant 200 is fully seated in the
acetabulum 82 in the selected anteversion and abduction
orientations, the inserter 300 and intermediate member 250 can be
removed. The temporary fasteners 120 can be removed and the
acetabular guide released.
[0055] The acetabular guide 100 can be made of any biocompatible
material, such as metal, ceramic or polymer. The acetabular guide
100 can be constructed by various manufacturing methods depending
of the selected material, including, for example, machining,
casting, molding, stereolithography or other layer deposition
methods. In one aspect, the acetabular guide 100 can be made of
disposable plastic material.
[0056] The patient-specific acetabular guide 100 can also be used
with a standard (non patient-specific) modular reamer 331 fitted
with a patient-specific reamer adapter 360 to ream the acetabulum
of the specific patient in pre-planned patient-specific
orientations. This allows the acetabular implant 200 to be received
in the selected anteversion and abduction orientations, as shown in
FIG. 4H and discussed in connection with FIGS. 4A-4H.
[0057] FIGS. 4A-4C illustrate an exemplary modular reamer 331 that
includes a reamer driver 330 and a reamer head 350. The reamer
driver 330 can be removably coupled to the reamer head 350 with a
connecting mechanism 335, which can be a spring-loaded, or snap-fit
or other type of releasable connection, including connections
secured with a set screw or other easily removable fasteners. An
exemplary quick-connect connection is illustrated in FIGS. 4A-4D
and is also used to connect the reamer 331 to the reamer adapter
360, as illustrated in FIGS. 4E-4H.
[0058] The reamer head 350 can be in the form of a hollow cup with
a semi-spherical reaming surface 353 bounded by a periphery 351.
The reaming surface 353 defines a plurality of reaming formations
or reaming teeth 357. A number of arms or rods 342 can be connected
to the periphery 351 and form a first component of the
quick-connect mechanism 335. The arms 342 can be attached to one
another at a central hub 341 forming a frame 343, as shown in FIG.
4B.
[0059] The reamer driver 330 can include a handle or sleeve 332
receiving a driver shaft 334 for coupling to a driver tool at a
proximal end (not shown) and having a distal connector 338. The
distal connector 338 forms a second component of the quick connect
mechanism 335, which is operated with a spring-loaded slider or
trigger 336 coupled to the driver shaft 334. The distal connector
338 can include a number of openings or slots 344 and a
corresponding number of movable or retractable pins 346. The number
of slots 344 corresponds to the number of arms 342 and the slots
344 are sized and shaped to receive the arms 342. Although four
arms, slots and pins are illustrated, a smaller or greater number
can be used, for example two or three arms, slots and pins that can
be evenly positioned radially about the reamer head 350. To connect
the reamer driver 330 to the reamer head 350, the slots 344 are
placed over the arms 342 with the pins 344 in their retracted
position. The pins 344 can be retracted by moving the slider 336 in
a direction away from the distal connector 338. When the slider 336
is released, the arms 342 are gripped between the pins 344 and the
walls of the slots 344 and the reamer driver 330 is securely
connected to the reamer head 350.
[0060] Referring to FIGS. 4E-4H, the patient-specific reamer
adapter 360 can include can include a first portion 362 and a
second portion 368. The first portion 362 can have an outer surface
364. The outer surface 364 can be, for example, cylindrical. The
outer surface 364 can be shaped, sized and oriented to mate with
the inner surface 102 of the patient-specific guide 100 to provide
a selected and patient-specific anteversion angle about the first
axis A and a selected abduction angle relative to the axis B, as
shown FIG. 4H. In this respect, the outer surface 364 of the
adapter 360 is patient specific.
[0061] The reamer adapter 360 can be coupled to the reamer with a
quick-connect connection. For example, the reamer adapter 360 can
be coupled between the reamer driver 330 and the reamer head 350
with corresponding components of the quick-connect mechanism 335
used for the connecting the reamer driver 330 to the reamer head
350. Referring to FIGS. 4E-4H, the first portion 362 can include a
number of arms 370 coupled to a proximal periphery 363 of the first
portion 262 and are configured to engage the distal connector 338
of the reamer driver 330, i.e. to be gripped in corresponding slots
344 by corresponding pins 346. In this regard, the arms 370 of the
first portion 362 provide a component that is complementary to the
quick-connect component of the reamer driver 330 and complete a
quick-connect mechanism 335 between the reamer drier 330 and the
reamer adapter 360.
[0062] Similarly, the second portion 368 of the reamer adapter 360
can include a quick-connect component complementary to the
quick-connect component of the reamer head 350 to complete the
quick-connect mechanism 335. More specifically, the second portion
368 can include a number of slots 374 and pin 372 for gripping the
arms 342 of the reamer head 350. Accordingly, the same type of
quick-connect mechanism 335 that is used to couple the reamer
driver 330 to the reamer head 350 can be used to couple the reamer
adapter 360 between the reamer driver 330 and the reamer head 350,
as illustrated in FIGS. 4A and 4E. It is noted that the
quick-connect mechanism 335 is not limited to the exemplary
embodiment illustrated, but can be any quick-connect mechanism used
for non-patient-specific modular reamers, include snap-fit, tapered
connectors, threaded connectors, or any other connectors with
complementary components "a" for the reamer driver 330 and "b" for
the reamer head 350, which are then used in reverse order to couple
the reamer adapter 360 therebetween in a sequence a-b-a-b. In the
illustrated quick-connect mechanism 335, component "a" includes
slots and pins and component "b" includes arms.
[0063] Referring to FIG. 4H, the assembled reamer 331 with the
patient-specific adapter 360 can be used with the patient-specific
acetabular guide 100 to ream the acetabulum 82 of the patient to
receive an implant in a selected patient-specific orientation
according to the pre-operative plan. As described above in relation
to FIGS. 1-4, the acetabular guide 100 is attached to the
acetabulum 82 in only one position, such that the inner surface 102
provides an orientation guide for the reamer head 350. In
particular, the outer surface 364 of the reamer adapter 360 mates
in a complementary close-fit manner with the inner surface 102 of
the acetabular guide 100, such that the reamer head 350 can be
oriented as specified in the pre-operative plan to ream the
acetabulum in the selected anteversion and abduction orientations
relative to the corresponding axes A and B. After the acetabulum 82
is reamed, the acetabular implant 200 can be impacted in the same
selected orientation using the inserter/impactor 300 discussed in
connection with FIGS. 2 and 3.
[0064] The exemplary acetabular guide 100 illustrated in FIGS. 1A,
2 and 4H is annular for placement around the acetabulum 82. In
other embodiments, an acetabular guide 400 positioned only in a
portion around the acetabulum 82 can also be used. Referring to
FIGS. 5-10, the patient-specific acetabular alignment guide 400 and
other instruments for guiding an acetabular implant are
illustrated. The patient-specific acetabular alignment guide 400
can be prepared during a pre-operative plan for the surgical
procedure based on a three-dimensional image of the relevant
anatomy of the patient including portions of the pelvis 80, the
acetabulum 82, the acetabular rim area 84, the periacetabular area
and generally the hip joint of the patient. The three-dimensional
image of the anatomy of the patient can be developed by
commercially available software, as discussed above, using MRI, CT,
X-rays or other scans of the particular patient.
[0065] Referring to FIGS. 5 and 6, the acetabular alignment guide
400 can include a first portion 402 configured and adapted to be
positioned around the rim surface 84 of the acetabulum 82 and a
second portion 404 configured and adapted to be positioned around
the periacetabular area of the pelvis 80 of a specific patient. The
acetabular alignment guide 400 can include a three-dimensional
curved patient-specific bone engagement surface 408. The bone
engagement surface 408 is defined to match complementarily to a
portion of the acetabular rim surface 84 and a portion of an
adjacent periacetabular area of the pelvis 80 of the patient for
close contact/nesting thereon in only one position and orientation.
The second portion 404 of the acetabular alignment guide 400 is
designed during the pre-operative plan to define a plurality of
elongated through-slots, apertures or other guiding formations 406
directed toward the periacetabular area for guiding a plurality of
alignment pins 420 parallel to an acetabular centering axis CC, the
location and orientation of which is determined according to the
preoperative plan for the specific patient. The second portion 404
can be reinforced with additional materials and/or have thicker
dimensions for stability.
[0066] Three guiding formations 406 in the form of through holes
and a corresponding number of alignment pins 420 are illustrated in
FIGS. 5 and 6. Depending on the patient and/or procedure, a
different number of guiding formations 406 and alignment pins 420
can be used. The alignment pins 420 can be parallel defining a
patient specific orientation and operable for locating the
acetabular centering axis CC. The alignment pins 420 can removably
guide along the same axis other instruments associated with the
insertion of an acetabular implant 200 after the acetabular
alignment guide 400 is removed, as shown in FIG. 7, for example.
The orientation and location of the guiding formations 406 can be
patient-specific and determined pre-operatively to facilitate
guiding and supporting the various instruments used for
positioning, inserting and impacting the acetabular implant 200, as
discussed below.
[0067] Referring to FIG. 7, after the alignment pins 420 have been
inserted into the bone, the acetabular alignment guide 400 can be
removed. An acetabular positioner or inserter or inserter/impactor
450 can be guided by the alignment pins 420 for inserting the
acetabular implant 200 in the acetabulum. The inserter 450 can
include a handle 451 with a knob 453 and a shaft 452 coupled to a
patient-specific alignment adapter 470. The patient-specific
alignment adapter 470 can include an arm 474 defining a plurality
of alignment apertures 478 complementary to the alignment pins 420,
such that the alignment adapter 470 can removably slide over the
alignment pins 420. In this respect, the shape and size of the arm
474 and the placement, arrangement and configuration of the
alignment apertures 478 can be determined during the pre-operative
plan to correspond to the guiding formations 406 of the acetabular
alignment guide 400. The alignment adapter 470 can include a
coupling opening 472 for removably receiving the shaft 452 of the
inserter 450 or can be integrally coupled to the shaft 452 of the
inserter 450. The coupling opening 472 can be, for example, an
interference fitting or snap-on side slot. Alternatively, the
coupling opening 472 can be an enclosed hole, which receives the
shaft 452 of the inserter 450, when the shaft is modularly coupled
to the inserter 450. The inserter 450 can be connected to and
disconnected from the acetabular implant 200 with a coupler 480 at
the distal end of the shaft 452 by rotating the knob 453. The
coupler 480 can also be modularly connected to the shaft 452.
During insertion of the acetabular implant 200, the alignment pins
420 help stabilize, guide and secure the orientation of the
inserter/impactor 450 and acetabular implant 200 and place the
acetabular implant 220 in the desired position and orientation
relative to the acetabulum 82 as determined during the
pre-operative plan using imaging scans of the patient.
[0068] Similar patient-specific alignment adapters 470 can be used
for guiding other type of inserters or impactors or reamers with
reamer driver handles or other instruments, such as, for example,
reamers and impactors that can be used during the preparation and
implantation procedure. Referring to FIGS. 9 and 10, first and
second impactors (or other acetabular instruments) 500a, 500b are
illustrated with respective first and second patient-specific
alignment adapters 470a, 470b. The first impactor 500a is an offset
impactor 500a generally used for minimally invasive procedures, and
the second impactor 500b is straight, non-offset impactor. Each of
the first and second impactors 500a, 500b can be modular and
include a handle 502 respectively coupled to a first shaft 504a or
second 504b terminating at a coupler 510 with an end connector 512.
The first shaft 504a of the first impactor 500a is offset relative
to a longitudinal axis C (designed to coincide with the acetabular
centering axis CC) passing through the handle 502 and the end
connector 512. The shaft 504b of the second impactor 500b is
coaxial with the handle 502.
[0069] As illustrated in FIG. 9, the offset first shaft 504a can
include a center portion 505c offset and substantially parallel to
the longitudinal axis C and first and second end portions 505a,
505b angled relative to the center portion 505c for defining the
offset. The first end portion 505a can be cannulated or hollow for
receiving a shaft 492 of a driver 490 coupled to the end connector
512, such that the end connector 512 can be secured to the
acetabular implant 200 by rotating a knob 494 of the driver 490.
The first alignment adapter 470a includes a coupling opening 472
(enclosed hole or side opening/slot) through which the portion 505a
can pass through. As discussed above in connection with alignment
adapter 470 and the inserter 450 of FIG. 7, the shape and size of
the arm 474 and the placement and arrangement/configuration of the
alignment apertures 478 can be determined during the pre-operative
plan to correspond to the guiding formations 406 of the acetabular
alignment guide 400 and the location and orientation of the
alignment pins 420, such that the parallel alignment pins 420 can
pass through the parallel alignment apertures 478 to guide the
first impactor 500a relative to the acetabular implant 200 and
relative to the acetabulum 82. The first alignment adapter 470a can
be removably coupled to the first impactor 500a and can be slidably
adjusted in position relative to the first portion 505a while
maintaining the alignment orientation of the alignment apertures
406 relative to axis CC and the alignment pins 420.
[0070] Referring to FIG. 10, the second impactor 500b can be used
similarly. Because the shaft 504b is substantially straight (not
offset), the end connector 512 can be attached to the acetabular
implant 200 by simply rotating the handle 502 or a knob attached to
the handle (not shown), similarly to the inserter 450 shown in FIG.
7. Each impactor 500a, 500b can be modular, such that the handle
502, the shaft 504a, 504b and/or the coupler 510 can be
disassembled for removably mounting the alignment adapter 470a,
470b. Additionally, or alternatively, the coupling opening 472 can
be a snap-on side opening or side slot for removably receiving the
alignment adapter 470a, 470b without disassembling the impactor
500a, 500b.
[0071] In some embodiments, the same alignment adapter can be used
for more than one conventional acetabular instrument. For example,
the same the alignment adapter 470 (or 470b) can be used optionally
either with the inserter/impactor 450 or the impactor 500b, or with
an acetabular reamer, such as reamer 331.
[0072] It will be appreciated from the above discussion, that
although the patient-specific acetabular alignment guide 400 has an
engagement surface 408 that is complementary to the
acetabular/periacetabular area of the patient, the alignment
adapters 470, 470a and 470b may or may not have a patient-specific
engagement surface as they are at a distance away from the bone
surface during use. Rather, the location and arrangement of the
alignment apertures 478 on the arm 474 is patient-specific, such
that the corresponding alignment adapter 470, 470a, 470b can be
mounted over the plurality of the alignment pins 420 that have been
already secured around the acetabulum 82 of the patient using
acetabular alignment guide 400.
[0073] The acetabular alignment guide 400 and the alignment
adapters 470, 470a, 470b can be made of disposable polymeric
materials or any other biocompatible materials. The alignment
adapters 470, 470a, 470b can be used with acetabular inserters,
positioners, reamers, impactors and other instruments used during
the acetabular procedure. The acetabular alignment guide 400 and
one or more alignment adapters 470 can be provided in a form of a
kit with a set of alignment pins 420. Other reusable, non custom
instruments can be also included, for example, an inserter, reamer
impactor, etc. The kit can include an acetabular implant 200, which
can be custom-made or non custom-made, as approved and selected by
the surgeon.
[0074] Referring to FIGS. 11A to 12, another patient-specific
acetabular guide 400' is illustrated for use with a reamer 331'. As
discussed above in connection with acetabular guides 100 and 400,
the acetabular guide 400', can include a first portion 402'
configured and adapted to be positioned around the rim surface 84
of the acetabulum 82 and a second portion 404' configured and
adapted to be positioned around the periacetabular area of the
pelvis 80 of a specific patient. The acetabular alignment guide
400' can include a three-dimensional curved patient-specific bone
engagement surface 408', which is the underside surface of the
first and second portions 402', 404' that nestingly mates with the
specific patient's anatomy. In the exemplary embodiment illustrated
in FIG. 11A, the first portion 402' can extend around the entire
inner rim surface 84 of the acetabulum and at least a portion of
the acetabulum 82. Similarly, the second portion 404' can extend
around the entire periacetabular area around the acetabulum 84 when
additional stability and attachment area is desired for the
particular patient or preferred by the surgeon. The bone engagement
surface 408' can be designed to match complementarily to portions
of the acetabular rim surface 84, of the acetabulum 82 and of an
adjacent periacetabular area of the pelvis 80 of the patient for
close contact/nesting thereon in only one position and orientation.
The second portion 404' of the acetabular alignment guide 400 is
also designed during the pre-operative plan to define a plurality
of elongated through-slots, apertures or other guiding formations
or holes 406' directed toward the periacetabular area for guiding a
plurality of alignment pins 420 parallel to the pre-determined
acetabular centering axis CC, as discussed above in connection with
FIGS. 5-7. After the alignment pins 620 are secured to the bone,
the acetabular guide 400' can be removed leaving the alignment pins
420 for use with a reamer, as discussed below.
[0075] A reamer 331' or 331'' can be guided by the alignments pins
420, as shown in FIGS. 11B and 12, respectively, along the
acetabular centering axis CC. An off-the-shelf or standard (non
custom) reamer 331', 331'' can be used in combination with an
adjustable or a patient-specific adapter 470', 470''. The adapter
470' can include one or more arms 474' (two arms 474' are
illustrated in FIG. 11B). Each arm 474' can be coupled to a shaft
330' of the reamer 431' with a quick-coupling arrangement 474',
which can be, for example, an opening in the arms configured for
receiving the shaft 330' or other coupler. Each arm 474' can
include at least one opening 478' positioned and configured for
receiving a corresponding alignment pin 420, which is secured to
the bone in a predetermined position and orientation using the
patient-specific alignment guide 400' through a corresponding hole
406 of the guide 400''. Accordingly, the location and orientation
of the openings 478' on the arms 474' and relative to the
acetabular centering axis CC are patient-specific. In some
embodiments, an arm 474' can include more than one opening 478'.
The arms 474' can be integrally attached to one another, or
modularly or separately coupled to the shaft 330'. One of the
alignment pins, pin 420' for example, can provide a fixed point of
reference for measuring the length of the leg of the patient for
determining the length of an implant 200' and the depth in the
corresponding intramedullary canal. The implant 200' can include a
head 203' and a stem 201', as shown in FIG. 11C. A scale or other
measuring device 477 can be coupled to the pin 420' for measuring
the length and sizing the implant 200'. The scale 477 can be
slidably placed over the pin 477' as shown in FIG. 11B. The length
can be measured before implantation and also-post implantation (as
shown in FIG. 11B) for confirming proper impaction and placement of
the implant.
[0076] Referring to FIG. 12, a non-custom reamer 331'' can be
coupled with a patient-specific adapter 470'' designed to slide
over the alignment pins 420, after the alignment pins 420 are
secured on the patient's pelvis 80 in a patient-specific
configuration, position and orientation, which also determines the
acetabular centering axis CC, as discussed above in connection with
FIGS. 5-7. In the embodiment illustrated in FIG. 12, the adapter
470'' can be monolithic and include two arms 474'' for receiving
respectively two alignment pins 420 through corresponding openings
478'', although different number of arms 474'' can be used and each
arm 474'' can include more than one opening 478'' for receiving
more than one pin 420. The adapter 470'' can by coupled to the
reamer 331'' with a quick-connect to the shaft of the reamer 331'',
as described above in relation to FIGS. 4A-4G, or with another type
of connection 335'', such as snap-fit or threadable socket or
bayonet coupling. The reamer 331'' can be of the blade type,
including reaming blades 333''. In one embodiment, the blades 333''
can be removable, replaceable and/or disposable. Each blade 333''
can be semicircular or quarter-circular and can be attached to a
chuck or other support 337'' of the reamer 331'' with set screws or
grooves or jaws.
[0077] In some procedures, the acetabular implant 200 discussed
above can be used to articulate with a patient-specific resurfacing
or replacement proximal femoral component, as shown in FIGS. 13,
14A and 14B. For example, a patient-specific resurfacing implant
can be designed during the pre-operative plan based on image models
reconstructed from scans of the patient.
[0078] Referring to FIG. 13, when the femoral head 92 is
salvageable and need not be resected and replaced, the diseased or
defective surface of the femoral head 92 can be identified in the
image. A femoral component 600 can be designed to replace the
defective portions, such as poor bone quality and/or avascular
regions of the femoral head 92. The femoral component 600 can
include a dome-shaped portion or dome 602 with an outer convex
articulating surface 603 for articulating with an acetabular
implant or the patient's natural acetabulum and an inner bone
engagement surface 604 that is designed to match and be
complementary and match the surface of the femoral head 92 with or
without soft tissue attached, as determined in the pre-operative
plan. The dome 602 can have a periphery 608 designed such that the
dome covers and resurfaces all the defective portions of the
femoral head 92. The femoral component 600 can have a short stem
606, which is inserted through the femoral head 92 and secured into
the femoral neck 94. The stem 606 can be designed during the
preoperative plan based on the three-dimensional reconstruction of
the patient's anatomy from the patient's scans such that the axis
of the stem D is placed in a selected position and orientation
relative to the neck 94 of the patient's and in a selected
anteversion orientation relative to the proximal femur 90.
Additionally, the length of the stem 606 and the size and shape of
the cross-section 607 along the length of the stem 606 can also be
designed based on the preoperative plan and the reconstruction
model of the neck 94 of the patient, such that bone preservation
and adequate attachment support are balanced and/or optimized for
the particular patient.
[0079] Referring to FIGS. 14A and 14B, a patient-specific femoral
implant 618 for a proximal femur in which the femoral head 92 is
resected can include a femoral head component 620, a femoral neck
component 624 and a femoral stem component 622. The femoral implant
618 can be designed during the preoperative plan based on the
three-dimensional reconstruction of the patient's anatomy from the
patient's scans such that the femoral head implant 620 and femoral
neck component 624 cooperate to retain the axis D and the center of
rotation R of the patient's femur or acetabulum, based on surgeon
determination and preference. The femoral neck component 624 can be
designed to match the patient's femoral neck 94 in size and
orientation. The femoral stem implant 622 can be selected from
standard (non custom) stem sizes) or can be customized for length,
cross-section and/or shape for the specific patient.
[0080] The foregoing discussion discloses and describes merely
exemplary arrangements of the present teachings. Furthermore, the
mixing and matching of features, elements and/or functions between
various embodiments is expressly contemplated herein, so that one
of ordinary skill in the art would appreciate from this disclosure
that features, elements and/or functions of one embodiment may be
incorporated into another embodiment as appropriate, unless
described otherwise above. Moreover, many modifications may be made
to adapt a particular situation or material to the teachings of the
invention without departing from the essential scope thereof. One
skilled in the art will readily recognize from such discussion, and
from the accompanying drawings and claims, that various changes,
modifications and variations can be made therein without departing
from the spirit and scope of the present teachings as defined in
the following claims.
* * * * *