PRE-OPERATIVELY PLANNED HUMERAL IMPLANT AND PLANNING METHOD

Abstract

Humeral prosthetic implants, systems, kits and methods of forming and using the humeral prosthetic implants, systems and kits are disclosed. The humeral prosthetic implants include proximal cup portions and distal stem portions, wherein the proximal cup portion is joined to the distal stem portion at a desired offset and/or angle configured based on an analysis of the humeral diaphysis and/or metaphysis offset in a patient. The humeral prosthetic implants may also include an adapter configured to join the proximal cup component with the stem component, wherein the adapter is configured to join the stem component to the stemless cup at a desired offset and/or angle.

Claims

1.-30. (canceled)

31. A pre-operative planning method for designing a humeral prosthetic implant having a proximal cup including a distal stem projecting outwardly from a surface of the proximal cup at at least one of an offset and an angle, the method comprising: analyzing one or more of humerus stem size, length, head diameter, head height, head offset, rotation (axial), humeral diaphysis and/or metaphysis offset of a patient to be treated.

32. The method of claim 31, further comprising: designing the humeral prosthetic implant based upon one or more anatomic measurements.

33. The method of claim 31, further comprising producing the humeral prosthetic implant based upon an optimized design.

34. The method of claim 31, wherein producing the humeral prosthetic implant comprises using a 3D printing device.

35. A computer readable medium having stored thereon executable instructions that when executed by the processor of a computer control the computer to perform one or more of the steps of claim 31.

36. The computer readable medium of claim 35, wherein the computer readable medium having stored thereon executable instructions that when executed by the processor of a computer control the computer to generate a virtual three dimensional model of a humeral prosthetic implant configured with one or more optimized parameters determined during pre-operative planning.

37. The computer readable medium of claim 35, wherein the computer readable medium having stored thereon executable instructions that when executed by the processor of a computer control the computer to control a 3D printing device in communication with the computer, whereby the 3D printing device prints a humeral prosthetic implant for use in shoulder replacement surgery in a patient for which optimization analysis was conducted.

38. A method of treating a patient comprising: providing a patient to be treated; completing a pre-operative planning process for designing a humeral prosthetic implant device; creating a humeral prosthetic implant based upon pre-operative planning; and treating the patient using and/or surgically implanting the humeral prosthetic implant.

39. The method of treating a patient of claim 38, wherein the subject is a human subject in need of shoulder replacement surgery.

40. A pre-operative planning and shoulder surgery kit, comprising: a set of instructions for performing measurements; and one or more humeral prosthetic implant devices, comprising a proximal cup, a distal stem projecting outwardly from a surface of the proximal cup at at least one of an offset and an angle, and a dual taper adapter configured to join the proximal cup with the distal stem.

41. The pre-operative planning and shoulder surgery kit of claim 40, wherein the humeral prosthetic implant is at least one of customizable and modular in design such that the humeral prosthetic implant is based on the pre-operative planning analysis.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0023] The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate embodiments of the invention and together with the detailed description herein, serve to explain the principles of the invention. The drawings are only for purposes of illustrating preferred embodiments and are not to be construed as limiting the invention. It is emphasized that, in accordance with the standard practice in the industry, various features are not drawn to scale. In fact, the dimensions of the various features may be arbitrarily increased or reduced for clarity of discussion. The foregoing and other objects, features and advantages of the invention are apparent from the following detailed description taken in conjunction with the accompanying drawings in which:

[0024] FIG. 1 is a top perspective view of an embodiment of a reverse humeral prosthesis or implant, in accordance with an aspect of the present invention;

[0025] FIG. 2 is a bottom perspective view of the implant of FIG. 1, in accordance with an aspect of the present invention;

[0026] FIG. 3 is a front view of the implant of FIG. 1, in accordance with an aspect of the present invention;

[0027] FIG. 4 is a side view of the implant of FIG. 1, in accordance with an aspect of the present invention;

[0028] FIG. 5 is an exploded bottom perspective view of the implant of FIG. 1, in accordance with an aspect of the present invention;

[0029] FIG. 6 is an exploded side view of the implant of FIG. 1, in accordance with an aspect of the present invention;

[0030] FIG. 7 is an exploded top perspective view of the implant of FIG. 1, in accordance with an aspect of the present invention;

[0031] FIG. 8 is a side view of the implant of FIG. 1 inserted into a portion of a humerus in a first position, in accordance with an aspect of the present invention;

[0032] FIG. 9 is a side perspective view of the implant of FIG. 1 inserted into a portion of a humerus in a second position, in accordance with an aspect of the present invention;

[0033] FIG. 10 is a side view of the implant of FIG. 1 inserted into a portion of a humerus in the second position, in accordance with an aspect of the present invention;

[0034] FIG. 11 is a cross-sectional side view of another embodiment of a reverse humeral prosthesis or implant, in accordance with an aspect of the present invention;

[0035] FIG. 12 is a cross-sectional side view of yet another embodiment of a reverse humeral prosthesis or implant, in accordance with an aspect of the present invention;

[0036] FIG. 13 is a side view of another embodiment of a reverse humeral prosthesis or implant, in accordance with an aspect of the present invention;

[0037] FIG. 14 is a front view of the implant of FIG. 13, in accordance with an aspect of the present invention;

[0038] FIG. 15 is a back view of the implant of FIG. 13, in accordance with an aspect of the present invention;

[0039] FIG. 16 is a top view of the implant of FIG. 13, in accordance with an aspect of the present invention;

[0040] FIG. 17 is an exploded side view of the implant of FIG. 13, in accordance with an aspect of the present invention;

[0041] FIG. 18 is an exploded front view of the implant of FIG. 13, in accordance with an aspect of the present invention;

[0042] FIG. 19 is an exploded back view of the implant of FIG. 13, in accordance with an aspect of the present invention;

[0043] FIG. 20 is a front view of an adapter of the implant of FIG. 13, in accordance with an aspect of the present invention;

[0044] FIG. 21 is a side view of the adapter of FIG. 20, in accordance with an aspect of the present invention;

[0045] FIG. 22 is a top view of the adapter of FIG. 20, in accordance with an aspect of the present invention;

[0046] FIG. 23 is a bottom view of the adapter of FIG. 20, in accordance with an aspect of the present invention;

[0047] FIG. 24 is a bottom perspective view of the adapter of FIG. 20, in accordance with an aspect of the present invention;

[0048] FIG. 25 is a side view of another adapter of the implant of FIG. 13, in accordance with an aspect of the present invention;

[0049] FIG. 26 is a back view of the adapter of FIG. 25, in accordance with an aspect of the present invention;

[0050] FIG. 27 is a front view of the adapter of FIG. 25, in accordance with an aspect of the present invention;

[0051] FIG. 28 is a top view of the adapter of FIG. 25, in accordance with an aspect of the present invention;

[0052] FIG. 29 is a bottom view of the adapter of FIG. 25, in accordance with an aspect of the present invention; and

[0053] FIG. 30 is a bottom perspective view of the adapter of FIG. 25, in accordance with an aspect of the present invention.

DETAILED DESCRIPTION FOR CARRYING OUT THE INVENTION

[0054] Disclosed herein are methods, systems and devices for pre-operatively planned shoulder surgery guides and implants. Methods, systems and devices are provided for the replacement of the shoulder joint wherein the conditions of the humeral and soft tissue envelop is taken into consideration. More specifically, what is considered is that the shape and position of the glenoid and/or humeral implants is not based solely on what can be seen and measured on the scapula, but can be chosen, designed, planned and placed with incorporation of the same information related to the humerus. After all, the shoulder is a two part joint, wherein both parts work in conjunction with one another, and the factors that affect performance of the device include factors from both sides of the joint.

[0055] In this detailed description and the following claims, the words proximal, distal, anterior, posterior, medial, lateral, superior and inferior are defined by their standard usage for indicating a particular part or portion of a bone or implant according to the relative disposition of the natural bone or directional terms of reference. For example, “proximal” means the portion of a device or implant nearest the torso, while “distal” indicates the portion of the device or implant farthest from the torso. As for directional terms, “anterior” is a direction towards the front side of the body, “posterior” means a direction towards the back side of the body, “medial” means towards the midline of the body, “lateral” is a direction towards the sides or away from the midline of the body, “superior” means a direction above and “inferior” means a direction below another object or structure.

[0056] Similarly, positions or directions may be used herein with reference to anatomical structures or surfaces. For example, as the current implants, devices, instrumentation and methods are described herein with reference to use with the bones of the shoulder, the bones of the shoulder and upper arm may be used to describe the surfaces, positions, directions or orientations of the implants and methods. Further, the implants and methods, and the aspects, components, features and the like thereof, disclosed herein are described with respect to one side of the body for brevity purposes. However, as the human body is relatively symmetrical or mirrored about a line of symmetry (midline), it is hereby expressly contemplated that the implants and methods, and the aspects, components, features and the like thereof, described and/or illustrated herein may be changed, varied, modified, reconfigured or otherwise altered for use or association with another side of the body for a same or similar purpose without departing from the spirit and scope of the invention. For example, the implants and methods, and the aspects, components, features and the like thereof, described herein with respect to the right shoulder may be mirrored so that they likewise function with the left shoulder and vice versa. Further, the implants and methods, and the aspects, components, features and the like thereof, disclosed herein are described with respect to the shoulder for brevity purposes, but it should be understood that the implants and methods may be used with other bones of the body having similar structures.

[0057] Referring to the drawings, wherein like reference numerals are used to indicate like or analogous components throughout the several views, and with particular reference to FIGS. 1-30, there are illustrated exemplary embodiments of reverse humeral prostheses or implants 100, 200, 300, 400. Insertion of the implant 100, 200, 300, 400 may be optimized using a preoperative plan. The preoperative plan may provide the ability to design and surgically implant a reverse humeral prosthesis 100, 200, 300, 400 that is configured or sized and shaped to have a predetermined, neck angle and/or offset. In order to achieve optimal articular positioning, there must be recognition of and accommodation for the humeral diaphysis and metaphysis offset. Appropriate sizing, placement and orientation of the prosthesis 100, 200, 300, 400 is crucial to successful outcomes, because misaligned, oversized or “overstuffed” replacement shoulders are more likely to dislocate, loosen, be painful, and/or have decreased range of motion. In addition, replaced joints where the orientation of the prostheses 100, 200, 300, 400 is improper increases the likelihood of implant dislocation and loosening.

[0058] The reverse humeral implants 100, 200, 300, 400 may also be designed and manufactured to specifically match a patient's anatomy, including humeral and/or glenoid implant size and shape customized to the given patient. The customized implants 100, 200, 300, 400 may be designed and manufactured taking into account one or more of the following factors: (1) assessment of the reverse humeral implant fit to the humeral bone; (2) relative hardness of the patient bone preoperatively; (3) height and diameter of the reverse humeral cup; (4) orientation, or “offset” of the reverse humeral cup; and (5) optimal bone removal for preservation of soft tissue insertion and attachment. The implants 100, 200, 300, 400 may be, for example, adaptable reverse humeral implant systems or kits, which may include a stemless reverse cup 110, 210, 310, 410, a stem 140, 230, 330, 440, and an intermediate adapter 160, 250, 350, 460 configured or sized and shaped to join or align the stemless reverse cup 110, 210, 310, 410 with the stem 140, 230, 330, 440. The stem 140, 230, 330, 440 may be, for example, a relatively short stem as described in greater detail below. The adapter 160, 250, 350, 460 may be, for example, configured or sized and shaped to achieve a desired offset or angle between the cup 110, 210, 310, 410 and stem 140, 230, 330, 440. The adapter 160, 250, 350, 460 may also, for example, be a dual taper adapter that is configured or sized and shaped to provide for angle customization and/or offset customization. The angle and/or offset customization may take into account, for example, patient anatomy, humeral size, humeral diaphysis, and metaphysis offset. For example, the adapter 160, 250, 350, 460 may be configured or sized and shaped based on the following: (1) position the metaphysis; (2) assess the diaphysis; (3) determine the optimal humeral implant; (4) conceive the adapter based on these assessments; and (5) confirm constraints are met. The adapter 160, 250, 350, 460 may also be configured or sized and shaped based on the measurements for improved fixation strength and/or overall construct range of motion.

[0059] Referring now to FIGS. 1-10, the reverse humeral prosthesis or implant 100 is shown. The implant 100 includes a stemless reverse cup 110 for implantation in the proximal part of a humerus 190, a stem 140, and an adapter 160 to couple the cup 110 and the stem 140. Unlike an anatomic orientation of a humerus where the head on the humerus includes a convex surface that articulates against a concave surface of a glenoid, a reverse humeral implant provides a concave surface on the humeral head configured or sized and shaped to articulate with a convex head attached to the glenoid region of the scapula.

[0060] As shown in FIGS. 1-7, the stemless reverse cup 110 may have a first end 112 and a second end 114. The terms “stemless reverse cup,” “proximal reverse cup,” “proximal cup,” “proximal cup portion,” “proximal cup component” and “cup” may be used interchangeably herein as they each refer to the portion of a shoulder implant that engages the glenoid or glenoid replacement. The cup 110 may include a generally cup-shaped housing 116 with an outer cylindrical wall 118 defining a recess 122 on an upper surface 120 and a base portion 126 extending away from a bottom surface, lower surface or backside 124 of the cup-shaped housing 116, as shown in FIG. 7. The recess 122 may extend into the housing 116 from the first end 112 toward the second end 114 of the cup 110. The base portion 126 may extend out from the second end 114 of the cup 110. The recess 122 may be configured or sized and shaped to receive and securely hold, for example, a cup liner (not shown) made of polyethylene or another material as known by one of skill in the art. The cup liner (not shown) may be configured or sized and shaped to snap fit into the recess 122. The cup liner (not shown) may also have a concave articular surface to allow for the cup liner (not shown) to articulate with a convex head attached to, for example, the glenoid part of the scapula. The stemless reverse cup 110 may also include, for example, ribs, fins, or projections 128 extending away from the bottom surface 124. The ribs 128 may include a surface or rib-like structure projecting from the outer cylindrical wall 118 of the reverse cup 110. The ribs 128 may project from the surface of the outer cylindrical wall 118 in, for example, a generally perpendicular orientation. The ribs 128 may also be configured or sized and shaped to provide rotational control under a torsional load, i.e., resist or prevent twisting or turning of the reverse cup 110 within the implant site after implantation. The stemless reverse cup 110 may optionally be made of a metallic material, such as for example, stainless steel, cobalt-chromium, titanium alloy, or any other like material as known by one of ordinary skill in the art. It is also contemplated that the stemless reverse cup 110 may include a metallic and/or biological porous coating to enhance bony integration. The biological porous coating may be, for example, pure HA, pure TCP, or a mix of HA/TCP.

[0061] The stemless reverse cup 110 may be formed through additive manufacturing of a monolithic component. The monolithic component may include an internal plain wall partially covered on the external surfaces with a porous metallic structure. Each of the porous structure sections may include an annular plain surface distally helping the surgeon to drive the implant 100 into the bone. The stemless reverse cup 110 may also be a monolithic component with a concave, spherical articular surface on an upper surface 120 of the reverse cup 110. The concave, spherical articular surface may articulate with a convex spherical head attached to the glenoid part of the scapula and on a base portion a surface enhanced for bony integration. The monolithic cup 110 may be made of, for example, a polymer, such as, PEEK, polyethylene, polyurethane, and the like as known by one of skill in the art. The monolithic cup 110 may also include, for example, a metallic coating on the bony facing surface.

[0062] With continued reference to FIG. 7, the recess 122 may also be configured or sized and shaped to receive and securely hold a universal adapter (not shown) which may be configured or sized and shaped to snap fit into the recess 122. The universal adapter (not shown) may have a convex surface which articulates against a concave surface of a glenoid or which articulates with a concave surface attached to the glenoid part of the scapula. The universal adapter (not shown) may also include a means for engaging another component that has a convex surface.

[0063] Referring now to FIG. 5, the lower portion or backside 124 of the stemless reverse cup 110 may also include an opening 130. The opening 130 may be configured to or sized and shaped to receive an adapter 160. The opening 130 may include, for example, a receiving portion 132 built into the lower portion of the cup 110, as shown in FIG. 7. The receiving portion 132 may be, for example, substantially cylindrical. The opening 130 may have an inner wall with, for example, a tapered diameter (not shown) and may be configured to receive a similarly tapered adapter 160, as shown in FIG. 6. The tapered configuration enables the adapter 160 to be press fit or otherwise forced into the opening 130 of the reverse cup 110 to securely engage the adapter 160 with the cup 110 during implantation of the prosthetic device 100. Alternatively, or in addition, the implant 100 may include a connection means (not shown) between the adapter 160 and the cup 110. The connection means (not shown) may include, for example, a screw, a press fit configuration without a taper, a press fit configuration with a taper, and/or a snap ring.

[0064] As shown in FIGS. 5 and 7, the reverse humeral implant 100 may also include the stem 140. The terms “stem,” “distal stem,” “distal stem portion,” “stem portion,” “distal stem component,” “stem component” may be used interchangeably herein as they each refer to the portion of the shoulder implant that is inserted into at least a portion of the humeral canal. The stem 140 may be configured to be implanted within the humerus 190, for example, extending into the epiphysis and diaphysis of the humerus 190, as shown in FIGS. 8-10. The stem 140 may be, for example, a relatively short stem compared to the stems used in existing traditional prosthetic devices. The short stem 140 may be, for example, less than about 80 mm, whereas a typical stem is about 80 mm to about 120 mm, and a long stem is about 120 mm or more. The stem 140 of the reverse humeral implant 100 may include a shaft portion 142 with a first end 144 configured or sized and shaped to adjoin the adapter 160 and a second terminal end 146. The first end 144 may include, for example, a joining member 148 configured or sized and shaped to press fit or otherwise adjoin with the adapter 160. The joining member 148 may include a substantially cylindrical structure 150 projecting from the first end 144 of the stem 140. The cylindrical structure 150 of the joining member 148 may have, for example, a tapered outer diameter and be configured or sized and shaped to engage a similarly cylindrical and tapered opening 168 in the adapter 160. As shown in FIGS. 1-10, the joining member 148 may also project from the first end 144 of the stem 140 at a desired angle to orient the stem 140 in a desired position with respect to the adapter 160 and the cup 110. It is also contemplated that the joining member 148 may be, for example, a female joining member configured or sized and shaped to engage a similarly male structure projecting from the distal end of the adapter, such as shown in FIG. 12 and described in greater detail below.

[0065] In one embodiment, the adapter 160 of the reverse humeral implant 100 may include an intermediate dual taper. The intermediate dual tapered adapter 160 may be configured or sized and shaped to join or align the stemless reverse cup 110 with the stem 140. For example, the outer diameter of the cylindrical member 166 of the adapter 160 may be tapered.

[0066] Correspondingly, the lower portion or backside 124 of the stemless reverse cup 110 may include an opening 130 configured or sized and shaped to receive the first end 162 of the adapter 160. The opening 130 may include an inner wall 134 with, for example, a tapered diameter that has a taper similar to the taper of the outer diameter of the cylindrical member 166. The tapered outer diameter of the adapter 160 and the tapered inner diameter of the backside 124 of the cup 110 allow for the adapter 160 to be press fitted or otherwise forced into the opening 130 of the reverse cup 110 to securely engage the adapter 160 with the cup 110 during implantation of the prosthetic device 100.

[0067] The adapter 160 may also include a substantially cylindrical member 166 with an opening 168 at one end of the cylinder 166. The opening 168 may, for example, extend into only a portion of the adapter 160 or, alternatively, the opening 168 may extend through the entire length of the cylinder 166. As shown in FIG. 5, the opening 168 may be configured or sized and shaped to receive a joining member 148, for example, a male joining member, of the stem 140. The opening 168 of the adapter 160 may include a cylindrical opening with a diameter that is tapered. The tapered opening 168 may be configured or sized and shaped to receive a similarly tapered joining member 148 of the stem 140. The tapered inner diameter of the adapter 160 may be, for example, press fit with the tapered joining member 148 of the stem 140. The tapered outer diameter and tapered inner diameter of the adapter 160 may be referred to as a dual-tapered design. Each taper of the dual-tapered design may be, for example, infinitely dialable or adjustable. Alternatively, engagement of at least one of the tapers of the dual-tapered design may be restricted to a discrete number of angular positions.

[0068] With continued reference to FIGS. 1-10, the adapter 160 may be configured to achieve a desired offset or angle between the cup 110 and stem 140. For example, the dual taper adapter 160 may be configured or sized and shaped to provide angle customization and/or offset customization. The angle customization and/or offset customization may take into account one or more of, for example, the patient anatomy, humeral size, humeral diaphysis, and metaphysis offset. The adapter 160 may also be, for example, configured to achieve a desired offset or angle between the cup 110 and stem 140. For example, the opening 168 may be positioned offset from a center point or central axis of the adapter 160. Further, the exterior size and shape of the adapter may provide the angulation of the cup 110 with respect to the stem 140. For example, the cup 110 may be offset or angled with respect to a central axis of the joining member 148 of the stem 140. Alternatively or in addition to the exterior size and shape of the adapter 160 providing the angulation of the implant 100, the opening 168 may be positioned at an angle to the central axis of the adapter 160.

[0069] Referring now to FIG. 11, an alternative reverse humeral implant 200 is shown. The reverse humeral implant 200 may include a stemless reverse cup 210, a stem 230, and an adapter 250 for coupling the cup 210 and the stem 230. The terms “stemless reverse cup,” “proximal reverse cup,” “proximal cup,” “proximal cup portion,” “proximal cup component” and “cup” may be used interchangeably herein as they each refer to the portion of a shoulder implant that engages the glenoid or glenoid replacement. The terms “stem,” “distal stem,” “distal stem portion,” “stem portion,” “distal stem component,” “stem component” may be used interchangeably herein as they each refer to the portion of the shoulder implant that is inserted into at least a portion of the humeral canal. The cup 210 may include a first end 212 and a second end 214. The cup 210 may also include a recess or interior surface 216 and a backside, exterior surface or outer surface 218. The interior surface 216 may be positioned at and extend into the first end 212 of the cup 210. The interior surface 216 may be a concave surface on the humeral head configured or sized and shaped to receive and articulate with a convex head attached to the glenoid region of the scapula. The backside 218 may extend from the first end 212 to the second end 214 on the exterior of the cup 210 and may be configured or sized and shaped to be received within the head of a humerus. The cup 210 may also include a base portion 220 at the second end 214 of the cup 210. The base portion 220 may extend away from the backside 218 of the cup 210. The base portion 220 may include a flange 222 and a recess or opening 224 extending into the cup 210 inside of the flange portion 222. The flange 222 may be, for example, a circumferential flange extending around at least a portion of the backside 218 of the cup 210.

[0070] The stem 230 may have a first end 232 and a second end 234. The stem 230 may include a base portion 236 extending from the second end 234 toward the first end 232 and a joining member 238 at the first end 232. The joining member 238 may be, for example, a male joining member 238 as shown in FIG. 11. The joining member 238 may include an outer diameter 240, for example, smaller than the outer diameter of the base portion 236. The outer diameter 240 of the joining member 238 may, for example, taper as it extends away from the base portion 236. The adapter 250 may have a first end 252 and a second end 254, as shown in FIG. 11.

[0071] The first end 252 may be configured or sized and shaped to couple to the cup 210 and the second end 254 may be configured or sized and shaped to couple to the stem 230. The adapter 250 may include a receiving portion 256 with a groove 258 inset into the first end 252 of the adapter 250. The groove 258 may be, for example, a circumferential groove inset into a portion of the adapter 250. The groove 258 may be, for example, designed or sized and shaped to mate with the flange 222 of the cup 210. The adapter 250 may also include an opening 260 extending into at least a portion of the adapter from the second end 254. As shown in FIG. 11, the opening 260 may pass through the entire length of the adapter. The opening 260 may be configured or sized and shaped to receive the joining member 238 of the stem 230. The opening 260 may be, for example, a cylindrical opening with a diameter that is tapered. The tapered opening 260 may be, for example, configured or sized and shaped to receive a similarly tapered joining member 238 of the stem 230 by press fitting the adapter 250 and stem 230 together.

[0072] The adapter 250 may also be, for example, configured to achieve a desired offset or angle between the cup 210 and the stem 230. For example, the opening 260 may be positioned offset from a center point or central axis of the adapter 250. Further, the exterior size and shape of the adapter 250 may provide the angulation of the cup 210 with respect to the stem 230. Alternatively or in addition to the exterior size and shape of the adapter providing the angulation of the implant 200, the opening 260 may be positioned at an angle to the central axis of the adapter 250. It is also contemplated that the adapter may be configured for angle customization and/or offset customization based on, for example, patient anatomy, humeral size, humeral diaphysis, and metaphysis offset. The adapter 250 may offset or angle the cup 210 relative to the longitudinal axis of the joining member 238 of the stem 230.

[0073] Another alternative reverse humeral implant 300 is shown in FIG. 12. The implant 300 may include a stemless reverse cup 310, a stem 330, and an adapter 350. The terms “stemless reverse cup,” “proximal reverse cup,” “proximal cup,” “proximal cup portion,” “proximal cup component” and “cup” may be used interchangeably herein as they each refer to the portion of a shoulder implant that engages the glenoid or glenoid replacement. The terms “stem,” “distal stem,” “distal stem portion,” “stem portion,” “distal stem component,” “stem component” may be used interchangeably herein as they each refer to the portion of the shoulder implant that is inserted into at least a portion of the humeral canal. The cup 310 may include a first end 312 and a second end 314. The cup 310 may also include a recess or interior surface 316 and a backside, exterior surface or outer surface 318. The interior surface 316 may be positioned at and extend into the first end 312 of the cup 310. The interior surface 316 may be a concave surface on the humeral head configured or sized and shaped to receive and articulate with a convex head attached to the glenoid region of the scapula. The backside 318 may extend from the first end 312 to the second end 314 on the exterior of the cup 310 and may be configured or sized and shaped to be received within the head of a humerus. The cup 310 may also include a base portion 320 at the second end 314 of the cup 310. The base portion 320 may extend away from the backside 318 of the cup 310. The base portion 320 may include at least one tongue, projection, or flange 322 and a recess or opening 324 positioned between the at least one projection 322. The at least one projection 322 may be, for example, a circumferential flange extending around at least a portion of the backside 318 of the cup 310.

[0074] The stem 330 may have a first end 332 and a second end 334. The stem 330 may include a base portion 336 extending from the second end 334 toward the first end 332 and a joining member 338 at the first end 332. The joining member 338 may be, for example, a female joining member 338 forming an opening 340, as shown in FIG. 12, for receiving a portion of the adapter 350. The opening 340 may include an interior or inner surface 342 with a diameter, for example, smaller than the outer diameter of the base portion 336. The walls of the interior surface 342 of the opening 340 may, for example, taper as they extend into the base portion 336. The adapter 350 may have a first end 352 and a second end 354, as shown in FIG. 12.

[0075] The first end 352 may be configured or sized and shaped to couple to the cup 310 and the second end 354 may be configured or sized and shaped to couple to the stem 330. The adapter 350 may include a receiving portion 356 with at least one recess or groove 358 inset into the first end 352 of the adapter 350. The at least one groove 358 may be, for example, a circumferential groove inset into a portion of the adapter 350. The groove 358 may be, for example, designed or sized and shaped to mate with the at least one projection 322 extending from the lower portion or backside 318 of the stemless reverse cup 310. The adapter 350 may also include a joining member 360, for example, a male joining member or tongue 360 extending away from the second end 354 of the adapter 350. The joining member 360 may be configured or sized and shaped to fit into the joining member or at least one groove 338 in an upper end 332 of the stem 230. The joining member 360 may be, for example, a cylindrical projection 360 with a diameter that is tapered as it extends away from the second end 354 of the adapter 350. The tapered joining member 360 may be, for example, configured or sized and shaped to receive a similarly tapered opening 340 in the stem 330 by press fitting the adapter 350 and stem 330 together. The adapter 350 may also be, for example, configured to achieve a desired offset or angle between the cup 310 and stem 330. For example, the joining member 360 may be positioned offset from a center point or central axis of the adapter 350. Further, the exterior size and shape of the adapter may provide the angulation of the cup 310 with respect to the stem 330. Alternatively or in addition to the adapter 350 providing the angulation, the joining member 360 may be positioned at an angle to the central axis of the adapter 350. It is also contemplated that the adapter 350 may be configured for angle customization and/or offset customization based on, for example, patient anatomy, humeral size, humeral diaphysis, and metaphysis offset.

[0076] Referring now to FIGS. 13-30, another reverse humeral implant 400 is shown. The reverse humeral implant 400 may include a stemless reverse cup 410, a stem 440, an adapter 460 for coupling the cup 410 and the stem 440, and an articulating cup liner 480. The terms “stemless reverse cup,” “proximal reverse cup,” “proximal cup,” “proximal cup portion,” “proximal cup component” and “cup” may be used interchangeably herein as they each refer to the portion of a shoulder implant that engages the glenoid or glenoid replacement. The terms “stem,” “distal stem,” “distal stem portion,” “stem portion,” “distal stem component,” “stem component” may be used interchangeably herein as they each refer to the portion of the shoulder implant that is inserted into at least a portion of the humeral canal.

[0077] As shown in FIGS. 17-19, the cup 410 may include a first end 412 and a second end 414. The cup 410 may also include a recess or interior surface 416 and a backside, exterior surface or outer surface 418. The interior surface 416 may be positioned at and extend into the first end 412 of the cup 410. The interior surface 416 may be configured or sized and shaped to receive an articulating liner 480 which can receive a convex head attached to the glenoid region of the scapula. The backside 418 may extend from the first end 412 to the second end 414 on the exterior of the cup 410 and may be configured or sized and shaped to be received within the head of a humerus. The cup 410 may include an upper interior surface 420 with a recess 422 extending into the cup 410 for receiving a snap ring 490. The recess 422 may be configured or sized and shaped to receive and securely hold, for example, a liner 480 made of polyethylene or another material as known by one of skill in the art. The liner 480 may be configured or sized and shaped to snap fit into the recess 422. The liner 480 may also have a concave articular surface 486 to allow for the liner 480 to articulate with a convex head attached to, for example, the glenoid part of the scapula. The cup 410 may also include at least one protrusion 424 extending away from the first end 412 of the cup 410. The at least one protrusion 424 aligns with and engages a corresponding recess 488 in the liner 480. The cup 410 may also include, for example, a base portion 426 with at least one fin, rib, or projection 428 extending away from the base portion 426. The ribs 428 may include a surface or rib-like structure projecting from the base portion 426 of the reverse cup 410. The ribs 428 may project from the surface of the base portion 426 in, for example, a generally perpendicular orientation. The ribs 428 may also be configured or sized and shaped to provide rotational control under a torsional load, i.e., resist or prevent twisting or turning of the reverse cup 410 within the implant site after implantation. The stemless reverse cup 410 may optionally be made of a metallic material, such as for example, stainless steel, cobalt-chromium, titanium alloy, or any other like material as known by one of ordinary skill in the art. It is also contemplated that the stemless reverse cup 410 may include a metallic and/or biological porous coating to enhance bony integration. The biological porous coating may be, for example, pure HA, pure TCP, or a mix of HA/TCP.

[0078] The stem 440 may have a first end 442 and a second end 444. The stem 440 may include a base portion 446 extending from the second end 444 toward the first end 442 and a joining member 448 at the first end 442. The joining member 448 may be, for example, a male joining member 448, as shown in FIGS. 17-19. The joining member 448 may include an outer diameter 450, for example, smaller than the outer diameter of the base portion 446. The outer diameter 450 of the joining member 448 may, for example, taper as it extends away from the base portion 446.

[0079] With continued reference to FIGS. 17-19 and reference to FIGS. 20-30, the adapter 460 may have a first end 462 and a second end 464. The first end 462 may be configured or sized and shaped to couple to the cup 410 and the second end 464 may be configured or sized and shaped to couple to the stem 440. The adapter 460 may include at least one hole 466 inset into the first end 462 of the adapter 460. The at least one hole 466 may be, for example, designed or sized and shaped to secure the cup 410 to the adapter 460. The adapter 460 may also include an opening 468 extending into at least a portion of the adapter 460 from the second end 464. As shown in FIGS. 17-19, the opening 468 may pass through the entire length of the adapter 460. The opening 468 may be configured or sized and shaped to receive the joining member 448 of the stem 440. The opening 468 may be, for example, a cylindrical opening with a diameter that is tapered. The tapered opening 468 may be, for example, configured or sized and shaped to receive a similarly tapered joining member 448 of the stem 440 by press fitting the adapter 460 and stem 440 together. The opening 468 may extend through the adapter 460, for example, along the central axis of the adapter 460, as shown in FIG. 22-24, or alternatively, the opening 468 may be offset from the center point or central axis of the adapter 460, such as shown in FIGS. 28-30. The position of the opening 468 may be selected to achieve a desired offset between the cup 410 and stem 440, along a longitudinal axis of the joining member 448 of the stem 440.

[0080] As shown in FIGS. 19, 23-24, and 29-30, the adapter 460, 460′ may include a first set of feet, protrusions, or projections 472, 472′ and a second set of feet, protrusions, or projections 474, 474′. As shown in FIGS. 20-24, each of the feet 472, 474 may, for example, have the same width and extend away from the second end 464 of the adapter 460 the same distance. Alternatively, as shown in FIGS. 25-30, the first feet 472′ may, for example, have a first width and extend away from the second end 464′ a first distance and the second feet 474′ may, for example, have a second width and extend away from the second end 464′ a second distance. The first distance may be, for example, smaller than the second distance. The first width may be smaller than the second width. The varying width of the first feet 472′ compared to the second feet 474′ allows for the adapter to provide angulation of the cup 410 with respect to a longitudinal axis of the joining member 448 of the stem 440. It is also contemplated that the adapter 460 may be configured for angle customization and/or offset customization based on, for example, patient anatomy, humeral size, humeral diaphysis, and metaphysis offset.

[0081] As shown in FIGS. 17-19, the articulating cup liner 480 may include a first end 482 and a second end 484. The liner 480 may include an articulating surface 486 at the first end 482. In addition, the liner 480 may include grooves 488 around the exterior surface of the liner 480 at the first end 482 and the grooves 488 may open toward the second end 484. The grooves 488 may be sized and shaped to receive the protrusions 424 on the cup 410 to assist with aligning and coupling the liner 480 to the cup 410. The liner 480 may further include a groove or recess 489 extending around a portion of the liner 480 near the second end 484 for receiving a snap ring 490, as shown in FIGS. 17 and 19. A portion of the snap ring 490 may be inserted into the groove 489 in the liner 480 and a portion of the snap ring 490 may fit into the recess 422 in the cup 410 to secure the liner 480 to the cup 410.

[0082] Referring now to FIGS. 1-30, one or more of the components of the prosthetic devices and systems 100, 200, 300, 400 disclosed herein can be customized or patient specific. For example, the below methods, analyses and optimizations, including associated computer readable medium and 3D printing devices, can be used to develop and create patient specific shoulder implant devices 100, 200, 300, 400, including the disclosed prosthetic including an inlay stemless reverse cup 110, 210, 310, 410, a stem 140, 230, 330, 440, and an intermediate dual taper adapter 160, 250, 350, 460.

[0083] In some aspects, a patient specific or customized intermediate dual taper adapter 160, 250, 350, 460 may include a desired angle and/or offset based on the methods of analysis and optimization disclosed herein. By way of example and not limitation, the angle and/or offset of the stem 140, 230, 330, 440 when connected to the cup 110, 210, 310, 410 by way of the adapter 160, 250, 350, 460 may be calculated based on an analysis of a patient's humeral diaphysis and metaphysis offset, among other things, using one or more pre-operative planning approaches disclosed herein.

[0084] The components of a humeral implant 100, 200, 300, 400 including, for example, a cup 110, 210, 310, 410, an adapter 160, 250, 350, 460 and a stem 140, 230, 330, 640 may be customized based on pre-operative planning. At least one of the cup 110, 210, 310, 410, the adapter 160, 250, 350, 460, and the stem 140, 230, 330, 440 may be customized. If only some of the components are customized, then, the remaining components may be at least one of “off-the-shelf” and standardized. For example, the cup 110, 210, 310, 410 and stem 140, 230, 330, 430 may be standardized, or come in an array of standardized shapes and sizes for selection as appropriate to the patient, while the adapter 160, 250, 350, 460 can be customized for each patient. The cups 110, 210, 310, 410, adapters 160, 250, 350, 460, and stems 140, 230, 330, 430 whether customized or standardized may be, for example, 3D printed.

[0085] Pre-operative planning methods and systems are also provided for selecting and/or designing a shoulder implant, including for example the prosthetic devices 100, 200, 300, 400 and systems disclosed herein. Such pre-operative planning may in some aspects take into consideration a plurality of factors and assessments, including, for example, one or more of the following, the combination and order of which may vary:

[0086] 1. aligning the posterior edge of the glenoid implant with the posterior edge of the glenoid bone;

[0087] 2. adjusting the glenoid retroversion to be about 0 degrees (0°) to a maximum of about 10 degrees (10°);

[0088] 3. adjusting the augmentation of the glenoid implant or the total distance necessary in the latero-medial direction between the center of rotation of the glenoid implant and the spino-glenoid notch to achieve the operative plan;

[0089] 4. adjusting the inclination of the glenoid implant;

[0090] 5. evaluating the back-side bone support for the glenoid implant, or the amount of the backside surface of the glenoid implant which is supported by or touching bone;

[0091] 6. adjusting the medialization of the glenoid implant, or the volumetric amount of bone removed by reaming in order to shape the bone to match the operative plan, or the minimum total distance of reaming necessary in the medial direction to achieve the operative plan;

[0092] 7. analyzing the fixation support;

[0093] 8. analyzing the joint line, including comparing the premorbid joint line and the pathologic joint line and the new joint line, with the new joint line being as similar to a joint line defined based on several factors including the difference between the premorbid joint line and the pathologic joint line;

[0094] 9. measuring and matching widths of the glenoid implant and the glenoid bone after reaming and aligning the inferior/superior axes of the glenoid implant and bone;

[0095] 10. comparing vectors in three dimensions which represent the distance and direction between tendon and muscle insertions on the scapula and the humerus for measuring the distance of relocation of humeral tuberosity compared to the scapula;

[0096] 11. determining the diameter of the humeral head, the height of humeral head, and location of humeral cut;

[0097] 12. assessing the diameter of the humeral cut and determining the best size and location of humeral stemless cup from the internal size of the humeral bone with or without a factor applied according to Houndsfield unit measured by CT scan;

[0098] 13. assessing the size and position of the diaphysis of the humeral shaft relative to the humeral metaphysis and selecting a modular stem size, shape, and an adapter from a range of adapters that will provide effective fixation of both the humeral cup and humeral stem;

[0099] 14. determining the best fit size of implant from a range of sizes (length of stem, diameter of stem, diameter of stemless cup, height of stemless cup, height of humeral liner, diameter of humeral liner, offset and angle of adapter, diameter of adapter, height of adapter, radius of curvature of the articular surface);

[0100] 15. conducting range of motion analysis, including virtually positioning implants through extreme ranges of motion to measure impact locations and compensate for necessary functional range of motion, wherein range of motion analysis can comprise optimization of adduction and/or abduction, elevation, flexion, extension, external and internal rotation range, and complex compound movements;

[0101] 16. conducting soft tissue analysis, comprising determining key soft tissue insertion points, measuring distances in three dimensions for comparison to pre-operative conditions, and assessing lengths at extreme ranges of motion, such that total soft tissue length change or contraction is substantially maintained within anatomical ranges in order to substantially achieve most common activities of daily living;

[0102] 17. assessing and adjusting as needed the thickness/height of the glenoid implant;

[0103] 18. assessing and adjusting as needed the depth of the glenoid fossa;

[0104] 19. assessing and adjusting as needed a graft, for example, graft thickness;

[0105] 20. assessing and adjusting the size, shape and/or position of the stemless humeral cup;

[0106] 21. assessing and adjusting the size, shape and/or position of the humeral stem and adapter; and/or

[0107] 22. repeat steps 15 through 22 as necessary to achieve objectives.

[0108] In some embodiments, analyzing the joint line may include comparing the premorbid joint line, the pathologic joint line and the new joint line and analyzing the humeral lateralization. Humeral lateralization may be determined by the distance the humeral shaft is moved laterally relative to the scapula after the implants are placed.

[0109] In some embodiments, the above method of creating a shoulder surgery guide based on pre-operative planning may further include one or more of the below optimization limitations. Such optimization limitation may include, for example, the identification of procedural risks based on measurements of whether: the glenoid face coverage is maximized; the overhang of the glenoid face is minimized; the bone removal on the glenoid face is minimized, such as for example less than about 2 mm of depth; the glenoid retroversion is less than about 5 degrees; the “seating” of the glenoid implant is greater than about 80%, i.e. about 80% of the back side of the glenoid implant is supported by or touching bone; the depth of any glenoid implant augment feature is as minimal as possible; there is less than about 1 mm of difference between the premorbid or the pathologic joint line and the new joint line with implants; there is minimized penetration of the glenoid cortical wall medially; there is maximized bone thickness behind glenoid, preferably greater than 3 mm; the orientation offset between the native glenoid and implant superior/inferior axis is minimized, preferably less than 5 degrees; the superior or inferior tilt versus anatomy is minimized, preferably less than 5 degrees; there is less than about 5% change in soft tissue length at extreme ranges of motion; there is an absence of a humeral cortical wall penetration by any portion of the humeral implant; there is minimal difference in diameter in the cut plane between the humeral stemless cup and the internal diameter of the humeral cortical wall, for example, less than 3 mm; there is greater tuberosity to medial head edge comparison to bony anatomy, in some embodiments less than 2 mm; the bone removal on the humeral face is minimized, such as for example, less than about two-thirds of the humeral head thickness; the seating of the stemless cup is greater than about 80%, i.e., about 80% of the backside of the stemless cup is supported by or touching bone; there is maximized bone thickness behind the stemless cup, preferably greater than 3 mm; there is minimized translation offset in the cut plane between the projection of the native humeral center of rotation and the center of rotation of the implant, preferably less than 2 mm; there is a height offset in the range of about 15 mm to about 25 mm between the native humeral center of rotation and the center of rotation of the implant to ensure adequate lengthening of the arm; there is minimized offset and tilt between the bony diaphyseal humeral axis and the stem axis, preferably, less than 2 mm and/or 5 degrees (5°); and there is maximized filling of the humeral shaft while still ensuring no implant contact with the cortical wall of the humeral shaft, for example, the filling may be in the range of 50% to 90% of intramedullary bone filled based on an identification of intramedullary bone by use of Houndsfield units.

[0110] The above method may further include recommending implants and placement positions, with recommended adjustments in glenoid implant size, augmentation depth, augment position, positioning in six degrees of freedom, fixation type, fixation size, reaming depth, reaming diameter, and reaming angle(s), seating ratio, wherein the reaming angles may include retroversion and inclination. The above method may further include recommending implants and placement positions, with recommended adjustments in humerus stem size, length, head diameter, head height, head offset, rotation (axial), humeral diaphysis and metaphysis offset.

[0111] The method of creating a patient specific adapter for the disclosed humeral implant includes: utilizing one or more of the above limitations, analyses, optimizations and recommendations to create an adaptable humeral offset prosthesis. Such prosthetic creation may include automated design and creation of a three dimensional model of a glenoid and/or humeral guide reflecting one or more optimized parameters determined during pre-operative planning based on the above described method.

[0112] The subject matter described herein may be implemented in software in combination with hardware and/or firmware. For example, the subject matter described herein may be implemented in software executed by a processor. In one exemplary implementation, the subject matter described herein may be implemented using a computer readable medium having stored thereon computer executable instructions that when executed by the processor of a computer control the computer to perform steps. Exemplary computer readable media suitable for implementing the subject matter described herein include non-transitory devices, such as disk memory devices, chip memory devices, programmable logic devices, and application specific integrated circuits. In addition, a computer readable medium that implements the subject matter described herein may be located on a single device or computing platform or may be distributed across multiple devices or computing platforms.

[0113] As used herein, the term “node” refers to a physical computing platform including one or more processors and memory.

[0114] As used herein, the terms “function” or “module” refer to hardware, firmware, or software in combination with hardware and/or firmware for implementing features described herein.

[0115] In some embodiments, a computer readable medium is provided, having stored thereon executable instructions that when executed by the processor of a computer, control the computer to perform steps including generating a virtual three dimensional model of a glenoid and/or humeral guide reflecting one or more optimized parameters determined during pre-operative planning based on the above described method. In some embodiments, a computer readable medium is provided, having stored thereon executable instructions that when executed by the processor of a computer control a 3D printing device in communication with the computer, whereby the 3D printing device prints a humeral prosthesis or component thereof, e.g. adapter, for use in shoulder replacement surgery in a patient for which the optimization analysis was conducted.

[0116] In some embodiments, methods of treating a patient, and/or surgical methods, are provided, wherein one or more of the disclosed methods of analysis and optimization are performed on a patient in need of shoulder or other joint surgery. The methods of treating a patient may include performing analysis and optimization, designing and creating an optimized prosthesis, or selecting from an array. The method of treating a patient may also include utilizing the pre-operative planning to design and optimize one or more glenoid and/or humeral implants and surgically implanting the one or more glenoid and/or humeral prosthetic devices. A kit may also be provided, wherein the kit may include a set of instructions for performing the disclosed pre-operative planning methods and analyses. Such a kit may further include one or more glenoid and/or humeral prosthetic devices, wherein the devices are customizable or modular in design such that the prosthetic device can be optimized for the patient based on the pre-operative planning analysis. In some embodiments, the kit may further have a guide for placing a prosthetic device during shoulder surgery, wherein the guide can be optimized for the patient based on the pre-operative planning analysis. The kit may also use a 3-D printing device for producing a guide and/or one or more glenoid and/or humeral prosthetic devices. Further, the kit may include a computer-readable medium (software) for use in conducting the pre-operative planning, and designing a guide, glenoid implant and/or humeral implant based on input parameters gathered during the disclosed methods of analysis.

[0117] It is contemplated that the patient may be a mammalian subject. For example, the patient may be a human subject, including an adult, adolescent or child.

[0118] The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. As used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprise” (and any form of comprise, such as “comprises” and “comprising”), “have” (and any form of have, such as “has”, and “having”), “include” (and any form of include, such as “includes” and “including”), and “contain” (and any form of contain, such as “contains” and “containing”) are open-ended linking verbs. As a result, a method or device that “comprises,” “has,” “includes,” or “contains” one or more steps or elements possesses those one or more steps or elements, but is not limited to possessing only those one or more steps or elements. Likewise, a step of a method or an element of a device that “comprises,” “has,” “includes,” or “contains” one or more features possesses those one or more features, but is not limited to possessing only those one or more features. Furthermore, a device or structure that is configured in a certain way is configured in at least that way, but may also be configured in ways that are not listed.

[0119] The invention has been described with reference to the preferred embodiments. It will be understood that the architectural and operational embodiments described herein are exemplary of a plurality of possible arrangements to provide the same general features, characteristics, and general system operation. Modifications and alterations will occur to others upon a reading and understanding of the preceding detailed description. It is intended that the invention be construed as including all such modifications and alterations.