Method of implanting an acetabular shell and an augment

Abstract

Systems, devices, and methods are provided for orthopedic implants. The implants may include a base member, such as an acetabular shell or an augment, that is configured to couple with an augment, flange cup, mounting member, or any other suitable orthopedic attachment. An implant may include a base member that has at least two projections with a gap between the projections. The gap between the projections allows the implant to fee implanted around another implanted component, such as around a bone screw of an acetabular shell. The implant may include a fixation element, such as a screw or a cement trough, on one or more projections to couple the implant to an implanted acetabular shell. The implant may also include timing marks to facilitate alignment with corresponding marks on another implanted component.

Claims

1. A method of implanting an orthopedic device in a patient's acetabulum, the method comprising: preparing the patient's acetabulum to receive an acetabular shell; securing the acetabular shell to the patient's acetabulum; preparing a space in the patient's acetabulum; inserting an augment into the prepared space, the augment comprising at least two projections defining a gap therebetween, with at least one of the projections defining a cement trough, the cement trough having an opening defined in a terminal top surface of the augment and an open side that extends an axial length of the cement trough from the opening; and after inserting the augment into the prepared space, pouring cement through the opening in the top terminal surface of the augment and thereby into the open side of the cement trough.

2. The method of claim 1, further comprising fixing the augment using an augment screw.

3. The method of claim 1, further comprising attaching the augment to a driver handle to facilitate the inserting.

4. The method of claim 1, wherein the preparing the space in the patient's acetabulum is by use of a broach.

5. The method of claim 4, wherein the preparing the space in the patient's acetabulum comprises rasping or reaming the patient's acetabulum using the broach.

6. The method of claim 4, further comprising limiting an amount of bone removed from the patient's acetabulum by using a depth stop on the broach.

7. The method of claim 4, wherein a cross-sectional profile of the broach is approximately the same as a cross-sectional profile of the augment.

8. The method of claim 1, wherein the augment further comprises flanges, or plates attached thereto.

9. The method of claim 1, further comprising while inserting the augment, matching timing markings on the augment to timing marks of the acetabular shell.

10. The method of claim 9, further comprising aligning the augment relative to the acetabular shell using the timing markings of each of the augment and the acetabular shell to facilitate positioning of a fastener in the gap between the projections during the inserting of the augment into the prepared space, the fastener securing the acetabular shell to the patient's acetabulum.

11. The method of claim 1, wherein the space is prepared at a location adjacent to the acetabular shell that has been secured to the patient's acetabulum.

12. The method of claim 1, wherein the securing the augment comprises securing, using the poured cement, the augment to the acetabular shell that has been secured to the patient's acetabulum.

13. The method of claim 1, wherein the securing the augment comprises securing, using the poured cement, the augment to at least one of the patient's acetabulum and the acetabular shell that has been secured to the patient's acetabulum.

14. The method of claim 1, wherein securing the augment by pouring cement comprises directly pouring cement through the opening and into the cement trough.

15. The method of claim 1, wherein the cement trough extends between the opening and a closed end of the cement trough.

16. A method of implanting an orthopedic device in a patient's acetabulum, the method comprising: preparing the patient's acetabulum to receive an acetabular shell; securing the acetabular shell to the patient's acetabulum; preparing a space in the patient's acetabulum; inserting an augment into the prepared space, the augment comprising at least two projections defining a gap therebetween, with at least one of the projections defining a cement trough; and after inserting the augment into the prepared space, securing the augment by pouring cement into the cement trough; wherein the securing comprises fastening the acetabular shell to the patient's acetabulum by a fastener; and wherein the inserting comprises positioning the augment around the fastener such that the fastener is positioned in the gap between the at least two projections.

17. The method of claim 16, further comprising while inserting the augment into the prepared space, aligning the augment relative to the acetabular shell to facilitate positioning of the fastener in the gap between the projections.

18. A method of implanting an orthopedic device in a patient's acetabulum, the method comprising: preparing the patient's acetabulum to receive an acetabular shell; securing the acetabular shell to the patient's acetabulum; preparing a space in the patient's acetabulum; inserting an augment into the prepared space, the augment comprising at least two projections defining a gap therebetween, with at least one of the projections defining a cement trough; and after inserting the augment into the prepared space, securing the augment by pouring cement into the cement trough; wherein the securing comprises inserting a fastener through an opening in the acetabular shell and engaging the fastener to the patient's acetabulum; and wherein the inserting comprises positioning the augment around the fastener such that the fastener is positioned in the gap between the at least two projections.

19. The method of claim 18, wherein the fastener comprises a bone screw.

20. A method of implanting an orthopedic device in a patient's acetabulum, the method comprising: preparing the patient's acetabulum to receive an acetabular shell; securing the acetabular shell to the patient's acetabulum by a fastener; preparing a space in the patient's acetabulum by use of a broach; inserting an augment into the prepared space, the augment comprising at least two projections defining a gap therebetween, one or more of the at least two projections defining a cement trough, wherein the augment is inserted into the prepared space by positioning the augment around the fastener such that the fastener is positioned in the gap; and after inserting the augment into the prepared space, securing the augment by pouring cement into the cement trough.

21. The method of claim 20, further comprising while inserting the augment into the prepared space, aligning the augment relative to the acetabular shell to facilitate positioning of the fastener in the gap between the projections.

22. The method of claim 20, wherein the securing comprises inserting the fastener through an opening in the acetabular shell and engaging the fastener to the patient's acetabulum.

23. The method of claim 20, wherein a cross-sectional profile of the broach is approximately the same as a cross-sectional profile of the augment.

24. The method of claim 20, further comprising while inserting the augment, matching timing markings on the augment to timing marks of the acetabular shell.

25. The method of claim 24, further comprising aligning the augment relative to the acetabular shell using the timing markings of each of the augment and the acetabular shell to facilitate positioning of the fastener in the gap between the projections during the inserting of the augment into the prepared space.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) The foregoing and other objects and advantages will be apparent upon consideration of the following detailed description, taken in conjuction with the accompanying drawings, in which like reference characters refer to like parts throughout, and in which:

(2) FIGS. 1 and 2 show a front perspective view and a back view, respectively, of an illustrative augment;

(3) FIG. 3 shows a top plan view of an augment illustratively installed on an acetabular shell;

(4) FIGS. 4-7 illustrate exemplary methods for installing an augment into a patient's joint;

(5) FIG. 8 shows a front perspective view of an illustrative augment having three projections;

(6) FIG. 9 shows a top plan view of an augment having an illustrative flange; and

(7) FIG. 10 shows a partial cross-section elevation view of an illustrative augment with a flange installed in an acetabulum.

DETAILED DESCRIPTION

(8) To provide an overall understanding of the systems, devices, and methods described herein, certain illustrative embodiments will be described. Although the embodiments and features described herein are specifically described for use in connection with acetabular systems, it will be understood that all the components, connection mechanisms, adjustable systems, fixation methods, manufacturing methods, coatings, and other features outline below may be combined with one another in any suitable manner and may be adapted and applied to medical devices and implants to be used in other surgical procedures, including, but not limited to: spine arthroplasty, cranio-maxillofacial surgical procedures, knee arthroplasty, shoulder arthroplasty, as well as foot, ankle, hand, and other extremity procedures.

(9) Various implants and other devices described herein in their various embodiments may be used in conjunction with any appropriate reinforcement material, non-limiting examples of which include bone cement, appropriate polymers, resorbable polyurethane, and/or any materials provided by PolyNovo Biomaterials Limited, or any suitable combinations thereof. Further non-limiting limiting examples of potential materials that may be used are described in the following references: U.S. Patent Application Publication No. 2006/0051394, entitled Biodegradable Polyurethane and Polyurethane Ureas, U.S. Patent Application Publication No. 2005/0197422, entitled Biocompatible Polymer Compositions for Dual or Multi Staged Curing, U.S. Patent Application Publication No. 2005/0238683, entitled Biodegradable Polyurethane/Urea Compositions, U.S. Patent Application Publication No. 2007/0225387, entitled Polymer Compositions for Dual or Multi Staged Curing, U.S. Patent Application Publication No. 2009/0324675, entitled Biocompatible Polymer Compositions, U.S. Patent Application Publication No. 2009/0175921, entitled Chain Extenders, and U.S. Patent Application Publication No. 2009/0099600, entitled High Modulus Polyurethane and Polyurethane/Urea Compositions. Each of the prior references is incorporated by reference herein in its entirety.

(10) FIGS. 1 and 2 are a front perspective view and a back view, respectively, of an augment according to certain embodiments. In FIGS. 1 and 2, augment 910 is in the shape of a staple and is provided with a number of projections and optional fixation elements. For example, augment 910 includes two projections 920 extending from a base portion or member 970, although it is possible that the augment 910 may have three or more projections that extend from a base member as described below. As shown, the projections 920 may be disposed in substantially the same direction from the augment 910 defined by the respective axis of each projection, with a gap 925 between the two projections 920. In certain embodiments the projections 920 may be angled or otherwise offset such that the projections 920 are not disposed in the same direction from the augment 910; however, there may still preferably be a gap disposed between the two projections 920. Furthermore, although the length of the projections 920 is shown as being substantially the same, it will be understood that the length of one of the projections 920 may be different than the respective length of the other projection. The base member 970, or the projections 920, or both, may have a surface that is substantially arcuate, for example, in order to complement an outer curved surface of an acetabular shell or other implant.

(11) Optional fixation elements include screw holes 930 and cement troughs 960. The fixation elements fix the augment 910 in place when implanted. Each fixation element may connect the augment 910 to a patient's bone, an acetabular shell, or both. The augment 910 may also include a connection element 940 on base member 970, for example, at the center top of the augment 910. In certain embodiments, connection element 940 is a threaded opening that may be attached to the end of a driver handle (e.g., driver handle 1060 of FIG. 7) for assisting with the implantation of the augment 910. However, the connection element 940 may be a tapered connection, a quick-connect, or any other type of fitting. The augment 910 may further include timing marks 950 to allow the augment 910 to be properly placed within the hip bone. Installation of the augment 910 is described in further detail below. As shown in at least FIG. 1, the cement troughs 960 can extend between an opening 962 at a terminal top surface 965 of the augment 910 to a closed end 964 and include an open side 966 along an axial length of the cement troughs 960.

(12) FIG. 3 is a top view of an augment installed on an acetabular shell. Augment 860 may be similar to augment 910. As shown, augment 860 is positioned next to acetabular shell 862 such that timing marks 864 disposed on the augment 860 are aligned with timing marks 866 disposed on the acetabular shell 862. The base member of augment 860 has an arcuate surface that contacts the complementary curved outer surface of the acetabular shell 862. As described above, an augment such as augment 860 may be fixed to the acetabular shell 862, a patient's bone, or both, via optional fixation elements such as screw holes and cement troughs.

(13) FIGS. 4-7 illustrate exemplary methods for installing an augment 910 into a patient's joint according to certain embodiments.

(14) FIG. 4 is a cross-sectional elevation drawing of an acetabulum 990 and an acetabular shell 1010. The acetabulum 990 would have been prepared to receive the shell 1010 by reaming, rasping or the like. Bone screws 1020 or other appropriate fixation devices have also been installed to secure shell 1010. Also shown is bone deficient area 1000. This area 1000 is a void space extending from the outer wall of the acetabular shell 1010 to the acetabulum 990.

(15) In FIG. 5, the acetabulum 990 is prepared for the augment 910 by use of broach 1030. The broach 1030 can be of any kind useful for rasping or reaming bone. For use with the augments described herein, the broach 1030 is typically provided with a depth stop 1040. Depth stop 1040 prevents the broach 1030 from removing too much bone by catching, for example, on the rim of acetabular shell 1010. The broach 1030 may have roughly the same cross-sectional profile and overall shape as the augment 910 and is typically sized to allow the augment 910 to be wedge-fitted into bone deficient area 1000. The broach 1030 may also have a slot provided therein to allow the broach 1030 to slide on either side of the installed screw 1020 to clear away bone on both sides of the screw 1020.

(16) In FIG. 6, the acetabulum 990 has been prepared for the augment 910. Bone deficient area 1000 has been replaced with prepared space 1050 between the acetabulum 990 and the acetabular shell 1010, the prepared space including screw 1020.

(17) The next step in the procedure is illustrated in FIG. 7. The augment 910 is attached to driver handle 1060 and inserted into prepared space 1050. During insertion, the surgeon matches the timing marks 950 on the top of the augment 910 to timing marks (e.g., timing marks 886) on the acetabular shell 1010 to ensure that bone screw 1020 is avoided. The augment 910 is inserted into the prepared space by positioning the augment around the screw 1020 (or any other fixation member) such that the screw 1020 extends through the gap 925 between projections 920 of augment 910. Once the augment 910 has been pushed into place by hand, it may be tapped into its final position with a hammer. If the surgeon desires, the surgeon may then fix the augment 910 even further by using augment screws placed into screw holes 930 and then into the patient's bone. Alternatively or additionally, the surgeon can pour bone cement down the troughs 960 illustrated in FIG. 1. The cement may bind the augment 910 to the acetabular shell 1010, the patient's bone, or both.

(18) In some embodiments, the augment 910 is held in place solely by a friction fit. In some embodiments, fixation devices like bone screws or cement may be used to secure augment 910 in place, for example, via crew holes 930 or cement troughs 960, respectively. Any kind of bone screw or cement familiar to one or ordinary skill in the art may be used.

(19) FIG. 8 shows a front perspective view of an augment having three projections extending from a top or base member according to certain embodiments. For example, augment 910 may be similar to augment 910 of FIG. 1, but augment 910 includes three projections 920 extending from the top member 970. It will be understood that in certain embodiments an augment may include more than three projections.

(20) In some embodiments, the augments described above may be provided with flanges, blades, plates, hooks, any other suitable mounting members, or any combinations thereof. For example, FIG. 9 shows a top plan view of an augment 1080 with flange 1090. Flange 1090 may provide additional support for the augment 1080 on the outside of the acetabulum (e.g., acetabulum 1092 of FIG. 10). FIG. 10 illustrates a partial cross-section elevation view of an augment 1080 installed in acetabulum 1092 with flange 1090 having bone screw 1094 provided therethrough.

(21) The augments described herein may be made of a number of materials, including Titanium, Cobalt-Chromium, Zirconium oxide, any other biocompatible materials or alloys that have the appropriate strength, resistance to wear, etc., or any combinations thereof. The augments may also be made fully porous or partially porous to allow for greater bone in-growth, for example, and the augments may be coated with hydroxyapatite or any other bone-promoting agents or combinations thereof.

(22) The embodiments described preferably above allow a surgeon to implant the acetabular shell or cup first and gain desired screw fixation and then prepare the bone minimally to fit a desired augment. This enables the surgeon to get the desired fixation for the acetabular shell without compromising the surgeon's ability to use an augment. An additional advantage is that the surgeon removes no more bone than is necessary.

(23) The foregoing is merely illustrative of the principles of the disclosure, and the systems, devices, and methods can be practiced by other than the described embodiments, which are presented for purposes of illustration and not of limitation. It is to be understood that the systems, devices, and methods disclosed herein, while shown for use in acetabular systems, may be applied to medical devices to be used in other surgical procedures including, but not limited to, spine arthroplasty, cranio-maxillofacial surgical procedures, knee arthroplasty, shoulder arthroplasty, as well as foot, ankle, hand, and extremities procedures.

(24) Variations and modifications will occur to those of skill in the art after reviewing this disclosure. The disclosed features may be implemented, in any combination and subcombinations (including multiple dependent combinations and subcombinations), with one or more other features described herein. The various features described or illustrated above, including any components thereof, may be combined or integrated in other systems. Moreover, certain features may be omitted or not implemented.

(25) Examples of changes, substitutions, and alterations are ascertainable by one skilled in the art and could be made without departing from the scope of the information disclosed herein. All references cited herein are incorporated by reference in their entirely and made part of this application.