Method and apparatus for manufacturing an implant

Abstract

An orthopedic implant manufacturing method. The method includes preparing a pre-operative surgical plan for a specific patient, the surgical plan including a three-dimensional image of a patient's joint indicating at least one resection plane, communicating the surgical plan to a surgeon of the patient, and receiving approval of the surgical plan and the resection plane by the surgeon. The method also includes providing automated osteophyte/protrusion removal control for surgeon manipulation, receiving a modified three-dimensional image of a patient's joint indicating an osteophyte/protrusion removal and a recommendation for a corresponding selected orthopedic implant from the surgeon, and requesting manufacture of the selected orthopedic implant.

Claims

1. An orthopedic implant manufacturing method comprising: preparing a pre-operative electronic surgical plan for a specific patient, the electronic surgical plan including a three-dimensional image of a patient's joint indicating a resection plane, the electronic surgical plan viewable on an electronic screen; communicating the electronic surgical plan in a digital form to a surgeon of the patient; receiving approval of the surgical plan and the resection plane by the surgeon; providing electronic automated control of removal of an image of an osteophyte for electronic manipulation of the three-dimensional image of the patient's joint on the electronic screen; receiving a modified three-dimensional image of the patient's joint indicating electronic removal of the image of the osteophyte on the modified three-dimensional image of the patient's joint in the electronic surgical plan and a recommendation for a corresponding selected orthopedic implant from the surgeon; and manufacturing the selected orthopedic implant by transforming an article to correspond to the modified three-dimensional image of the patient's joint.

2. The method of claim 1, further comprising identifying a location of the image of the osteophyte on the three-dimensional image of the patient's joint in the electronic surgical plan.

3. The method of claim 2, further comprising providing a plurality of electronic depth contours in relation to the image of the osteophyte on the three-dimensional image of the patient's joint in the electronic surgical plan.

4. The method of claim 3, further comprising providing at least one electronic removal tool associated with the image of the osteophyte on the three-dimensional image of the patient's joint in the electronic surgical plan for manipulation by the surgeon.

5. The method of claim 3, wherein the plurality of the electronic depth contours is continuous.

6. The method of claim 5, further comprising referencing the plurality of the electronic depth contours from a landmark location associated with the image of the osteophyte on the three-dimensional image of the patient's joint in the electronic surgical plan.

7. The method of claim 2, further comprising determining a tissue overhang protruding from an edge of the resection plane on the three-dimensional image of the patient's joint in the electronic surgical plan.

8. The method of claim 1, further comprising receiving a recommendation for a selected patient-specific alignment guide from the surgeon.

9. The method of claim 8, further comprising manufacturing the selected patient-specific alignment guide and providing the patient-specific selected alignment guide and selected orthopedic implant to the surgeon in one package.

10. The method of claim 1, wherein the selected orthopedic implant is a femoral joint component.

11. The method of claim 10, wherein the femoral joint component is custom made for the specific patient.

12. The method of claim 10, wherein the femoral joint component is semi-custom made.

13. The method of claim 1, wherein the selected orthopedic implant is a tibial joint component.

14. The method of claim 13, wherein the tibial joint component is custom made for the specific patient.

15. The method of claim 13, wherein the tibial joint component is semi-custom made.

16. An orthopedic implant manufacturing method comprising: preparing a pre-operative electronic surgical plan for a specific patient, the electronic surgical plan viewable on an electronic screen and including a three-dimensional image of a patient's joint indicating at least one resection plane; communicating the electronic surgical plan to a surgeon of the patient; receiving approval of the electronic surgical plan and the resection plane by the surgeon; identifying on the electronic screen a location of at least one image of an osteophyte on the three-dimensional image of the patient's joint in the electronic surgical plan; providing a plurality of electronic depth contours in relation to the image of the osteophyte on the three-dimensional image of the patient's joint in the electronic surgical plan; providing at least one electronic graphical removal tool associated with the image of the osteophyte for electronic manipulation by the surgeon on the three-dimensional image of the patient's joint in the electronic surgical plan; receiving a modified three-dimensional image of the patient's joint indicating removal of the image of the osteophyte on the modified three-dimensional image of the patient's joint in the electronic surgical plan and a recommendation for a corresponding selected orthopedic implant from the surgeon; and manufacturing the selected orthopedic implant by transforming an article to correspond to the modified three-dimensional image of the patient's joint.

17. The method of claim 16, wherein the plurality of electronic depth contours is continuous.

18. The method of claim 17, further comprising referencing the plurality of electronic depth contours from a landmark location associated with the osteophyte on the modified three-dimensional image of the patient's joint in the electronic surgical plan.

19. The method of claim 17, further comprising determining a tissue overhang protruding from an edge of the resection plane on the three-dimensional image of the patient's joint in the electronic surgical plan.

20. The method of claim 17, further comprising receiving a recommendation for a selected alignment guide from the surgeon and manufacturing the selected alignment guide.

21. An orthopedic implant manufacturing method comprising: preparing a pre-operative electronic surgical plan for a specific patient, the electronic surgical plan viewable on an electronic screen and including a three-dimensional image of a patient's joint indicating at least one resection plane; identifying a location of at least one image of an osteophyte on the three-dimensional image of the patient's joint in the electronic surgical plan; providing a plurality of electronic depth contours on the electronic screen in relation to the image of the osteophyte on the three-dimensional image of the patient's joint in the electronic surgical plan; providing at least one electronic graphical removal tool associated with the image of the osteophyte on the three-dimensional image of the patient's joint in the electronic surgical plan for manipulation by a user on the electronic screen; communicating the electronic surgical plan to a user; receiving a modified three-dimensional image of the patient's joint indicating removal of the image of the osteophyte on the modified three-dimensional image of the patient's joint in the electronic surgical plan and a recommendation for a corresponding selected orthopedic implant from a user; and manufacturing the selected orthopedic implant by transforming an article to correspond to the modified three-dimensional image of the patient's joint.

22. The method of claim 21, further comprising forwarding the selected orthopedic implant for implantation.

23. An orthopedic implant manufacturing method comprising: generating preoperatively a three-dimensional computer image of a patient's joint from imaging information obtained from the patient on an electronic screen; generating preoperatively a modified three-dimensional computer image of the patient's joint by removing an image of a bone protrusion shown in the three-dimensional computer image of the patient's joint using a computer graphical tool on the electronic screen; selecting an orthopedic implant corresponding to the modified three-dimensional computer image of the patient's joint; and manufacturing the selected orthopedic implant by transforming an article to correspond to the modified three-dimensional image of the patient's joint.

24. The method of claim 23, further comprising receiving approval of the modified three-dimensional computer image of the patient's joint before manufacturing the orthopedic implant.

25. The method of claim 23, wherein the bone protrusion is an osteophyte.

26. The method of claim 23, further comprising superposing an orthopedic implant image on the modified three-dimensional computer image of the patient's joint on the electronic screen before selecting an orthopedic implant.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) The present teachings will become more fully understood from the detailed description and the accompanying drawings, wherein:

(2) FIG. 1 is a flowchart of an implant manufacturing method according to the present teachings;

(3) FIG. 2 is a diagram illustrating a computer interface for an implant manufacturing method according to the present teachings;

(4) FIG. 3 is perspective view of a generic casting of an implant according to the present teachings;

(5) FIG. 4 is a side view of a generic casting according to the present teachings;

(6) FIG. 5 is a plan view of a generic casting according to the present teachings;

(7) FIG. 6 is a flow chart for an osteophyte/protrusion removal control method according to the present teachings;

(8) FIG. 7 is a representative image of a patent's anatomy showing osteophyte/protrusion control tools for modifying the image;

(9) FIGS. 8 and 9 are representative images of a patent's anatomy showing exemplary osteophyte/protrusion locations;

(10) FIG. 10 is a representative image of a patent's anatomy showing representative depth control selections for surgeon manipulation; and

(11) FIGS. 11 and 12 are representative images of a patent's anatomy after osteophyte/protrusion removal with exemplary implants attached thereon.

DESCRIPTION OF VARIOUS ASPECTS

(12) The following description is merely exemplary in nature and is in no way intended to limit the present teachings, applications, or uses. For example, although some of the present teachings are illustrated for a knee implant, the present teachings can be used for any orthopedic implant.

(13) The present teachings provide a manufacturing method that integrates patient's anatomic and medical information with interactive participation by a surgeon to select and manufacture an implant and, optionally, related surgical instruments, for a particular patient from generally three options: a custom made implant specific to the patient; an implant that is only partially custom-made or a semi-custom implant, and a standard off-the self implant. Similarly, off-the-self or custom-made or semi-custom made instrumentation, such as alignment guides, drill guides, cutting guides or other instruments can be selected and manufactured, as recommended by the surgeon, for the surgical procedure. All the implant components, alignment guides and other disposable instruments can be included in a package provided to a surgeon for a specific patient.

(14) Referring to FIG. 1, an exemplary flowchart of an interactive implant manufacturing method according to the present teachings is illustrated. At 100, the portion of the patient's anatomy related to the orthopedic procedure and the implant is characterized and detailed with various imaging methods capable of obtaining a representation of the affected anatomy, including, for example, soft and hard tissues, such as bone, or bone joints with or without cartilage, ligaments or other soft tissue. The imaging methods can include, for example, MRI, CT, ultrasound, radiography or X-ray, cameras and other devices. The image information for the patient can be obtained at a medical facility or a doctor's office and can be sent to the manufacturer in an electronic/digital form contained in a memory storage medium, such as a CD, DVD, memory stick, CF or SD card or other storage device, or as an electronic file transmitted over the Internet or worldwide web or by using any other electronic communication methods, including e-mail or other digital transmission to any time of computer device, smart phone, PDA or other devices in which electronic information can be transmitted.

(15) With continued reference to FIG. 1, at 110, the information collected at 100 can be used to create a three-dimensional model or image of the bone or joint with or without associated soft tissue or related anatomy using commercially available computer modeling software from various vendors or developers, such as, for example, from Materialise USA, Ann Arbor, Mich. The three-dimensional model of the patient's anatomy can be viewed on a computer display or other electronic screen and can also reproduced as a hard copy on film or other medium and viewed by direct or indirect or backlight illumination.

(16) At 120, soft tissue associated with the affected anatomy can be modified, or removed or repaired, to restore alignment of the joint, for example, or to remove torn or diseased tissue, or to cut or repair ligaments, or to provide natural or artificial ligament grafts. Soft tissue information can be optionally used as an additional design parameter or input for the implant design, at 125. For example, a custom or patient-specific bearing articulation of a knee joint can be designed based on the kinematic profile and the soft tissue/ligament information available for a particular patient. Further, kinematic information for the patient can be obtained by an actual gait analysis of the patient, and can also be obtained by computer modeling software that uses the MRI images of the patient's joints and associated ligaments, muscle or other soft tissue to derive kinematic analysis of the patient and corresponding recommendations for soft tissue modification, such as releasing a ligament, for example. Such software is commercially available from the Biomechanics Research Group, Inc., of San Clemente, Calif.

(17) At 130, a preliminary pre-operative plan of the surgical procedure can be prepared for surgeon or other medical user or technician review, including the planning of various bone resections, sizes and types of implants, and various geometric requirements including relevant dimensions, such as height, width, orientation of particular features, etc. The preliminary pre-operative surgical plan can include a recommendation of particular implants and associated instruments to be used in the surgical procedure, as discussed below. The preliminary pre-operative surgical plan can be in the form of digital images that can be viewed interactively using a computer modeling software, such as the software referenced above.

(18) At 140, the preliminary pre-operative surgical plan can be submitted to the surgeon (or other user) for review, either electronically or by land mail, and either in digital or hard copy form, as discussed above in connection with transmitting imaging information. In particular, the surgeon can review the resection planes shown in image of the patient's anatomy, make changes in the location, size and orientation of the resection planes and, generally, work interactively until the pre-operative plan from 130 is surgeon-approved. Specifically, the surgeon may approve the image of the patient's anatomy showing corresponding resection planes. As shown in FIGS. 7 and 8, the patient's anatomy 510 can be, for example, a distal femur with approved resection planes including medial and lateral anterior chamfer planes 513, medial and lateral anterior cut planes 511, medial and lateral posterior chamfer planes 512 and medial and lateral posterior cut planes 514. Following the surgeon's approval of the anatomy and the resection planes at 140, the surgeon is provided with the opportunity to remove one or more osteophytes/protrusions from the image of the patient's anatomy 510 at surgeon-selected locations and depths at 500 (See FIG. 6). Removal of such protrusions and smoothening of the joint surface that receives the implant can parallel the intra-operative joint preparation by the surgeon and improve the actual fit of a surgeon-selected implant, whether patient-specific, semi custom or off the shelf.

(19) An automated osteophyte/protrusion removal control module 500 can be incorporated in the planning stage of the manufacturing method illustrated in FIG. 1. The automated osteophyte/protrusion removal control module 500 can be provided as a separate pre-operative planning module, as shown in FIG. 6, or it can be incorporated and/or fully integrated with the manufacturing method illustrated in FIG. 1.

(20) Certain parts of the bone, including various bone bumps, protrusions, growths and osteophytes can be generally removed from the three-dimensional reconstruction of a patient's anatomy before designing a patient-specific implant or semi-custom implant, or before selecting an off the shelf implant. The automated osteophyte/protrusion removal control module can replace a time-consuming and potentially less accurate manual modification of the three-dimensional image to remove such bone growths or osteophytes by an experienced image or CAD technician. The automated osteophyte/protrusion removal control module 500 can provide more accurate and faster removal of such bone irregularities, which can vary in shape, location and size from patient to patient. It will be appreciated that the osteophyte/protrusion removal control module 500 can be used for smoothing out a bone surface by removing any type of bone protrusion, including bumps, irregularities and osteophytes. According to the present teachings, osteophytes are illustrated as exemplary, but not exclusive, candidates for complete or partial removal.

(21) Referring to FIG. 6, the osteophyte/protrusion removal control module 500 can start 502 with an input of the three-dimensional image of the patient's anatomy 510 including resection planes, as shown in FIGS. 7-9, after review and approval of the resection planes by the surgeon (or other user, including other professionals or technicians) at 140 of FIG. 1. In the exemplary illustration of FIG. 7, the image of the patient's anatomy 510 can be analyzed to identify osteophyte/protrusion locations 530 (at 504 of FIG. 6) by determining tissue or bone overhang protruding past outer edges 532 of the various resection planes, such as the resection planes illustrated at 511, 513, 512 and 516 in FIGS. 7-9. If such osteophyte/protrusions 530 extend beyond the edges of the resection planes in the direction of the planned or anticipated implant location, the osteophyte/protrusions 530 can interfere with implant fitting.

(22) Referring to FIGS. 6, 7 and 10, in addition to identifying the location of osteophytes/protrusions 530, the osteophyte/protrusion removal control module 500 can provide visual control for the surgeon to select the aggressiveness of osteophyte/protrusion removal, or the degree of smoothening and/or flattening of the corresponding joint anatomy. Specifically, by fine-tuning the osteophyte/protrusion locations, at 506 of FIG. 6, the surgeon can control the depth of the osteophyte/protrusion removal in a continuous or discrete manner. In one aspect, a landmark location 540 for each osteophyte/protrusion 530 can be identified and pegged for measuring from and initiating a continuous series of constant or variable depth contours 542 to aid the surgeon in selecting the depth of osteophyte/protrusion removal. The depth contours can be automatically generated by the computer software that generates a three-dimensional model or image of the anatomy, such as the software commercially available, for example, from Materialise USA, Ann Arbor, Mich. The landmark location 540 can be a location of lowest possible depth in the vicinity of the identified osteophyte/protrusion, a minimum, or a valley location, as shown in FIG. 10. Although the depth contours 542 are shown as discrete in FIG. 10, it will be appreciated that a continuous removal control can be provided, such that the surgeon can exercise unlimited choices of depth contours for removal. The depth contours 542 can represent curved smoothed-out surfaces under the original osteophyte/protrusion 530 and can be exposed after an overlying area is shaved or peeled in the image 510 by the operation of graphical or visual removal tools provided on the image 510. The surgeon or other user can manipulate the graphical removal tools with a user interface, such as a mouse, touch screen, joystick, slide pad, or other user interface.

(23) Referring to FIG. 7, various visual removal tools can be provided for on-screen manipulation and control by the surgeon, at 508 of FIG. 6. For example, a removal tool corresponding to each edge of a resection plane can be provided and used to visually/graphically remove portion of an osteophyte/protrusion associated with a particular edge 532. In FIG. 7, four such exemplary removal tools 520a, 520b, 520c, 520d (collectively referenced as 520) are shown, each removal tool associated with an edge of a resection plane, such as lateral and medial chamfer plane and lateral and medial cut plane. Although the removal tools 520 are illustrated as straight sliders in FIG. 7, the amount removed follows a depth contour 542, as illustrated in FIG. 10. The removal tools 520 can include a visual indicator 525 that can provide information to the surgeon in the form of a number on a scale indicative of the depth of aggressiveness of osteophyte/protrusion removal. In another aspect, the indicator 525 can provide visual information in terms of variable color in shades gradually changing from minimum depth removal (green, for example) to maximum depth removal (red, for example).

(24) After the surgeon completes the osteophyte/protrusion removal, the surgeon can manipulate and superimpose implant images in relation to the modified patient's anatomy 510. In FIGS. 11 and 12, exemplary images of a resected femur 510 and tibia 515 referenced in relation to a mechanical axis 522 are illustrated. The femur image illustrates the patient's anatomy 510 after the osteophytes/protrusions 530 shown in FIGS. 8 and 9 have been removed and a femoral component 560 is placed on the resulting smoothed out surface that follows one of the depth contours 542 shown in FIG. 9.

(25) Based on the preliminary pre-operative surgical plan and the patient information, the surgeon can make a recommendation regarding the design of the implant at 150, and any desired associated alignment guides at 160. At 150, the surgeon can recommend a method of designing an implant. Specifically, the surgeon can select one of the following three options: a first option of a custom or patient-specific implant at 170 or a second option of a semi-custom made implant at 180, or a third option of a standard or off-the-shelf implant at 190. It will be appreciated that, based on the surgeon's recommendation at 140, the preliminary pre-operative surgical plan can be modified at 130 and then resubmitted to the surgeon for approval.

(26) A custom-made implant is a patient-specific, one of a kind implant specifically made for a particular patient, and consequently there is no inventory associated with such implant. Standard or off-the-self-implants are available and stocked in a number of sizes, typically six or more, and a number of configurations or types, including bilateral or unilateral implants, constrained, semi-constrained, mobile, etc. Because of the variety of sizes and configurations that are kept in stock to be accommodate different patients, a large inventory of standard implants is created, and several molds for each type and size of implant may be used. As described below in detail, semi-custom implants provide an intermediate solution between custom-made and off-the-self implants. Semi-custom implants reduce the size of inventory and molds required for production, while allowing some degree of patient-specific customization.

(27) Custom or patient-specific implants, when approved by surgeon at 170 for a specific patient, can be manufactured for the patient by rapid prototyping methods, such as stereolithography or other similar methods, or by CNC milling, or other automated or computer-controlled machining, or by robotic methods, at 250. Manufacturing can take place at a manufacturing center or facility in situ or at remote or off-site location. It will be understood that in situ manufacturing is used as a short hand for a manufacturing site of the original equipment manufacturer (OEM), but can be physically located at a different facility of the OEM. Off-site or remote manufacturing will be understood to refer to facilities operated by other manufacturers who are contracted by the OEM for manufacturing all or some of the components or parts for the surgical procedure.

(28) Off-the-self implants, when approved by the surgeon a 190, can be manufactured by standard casting methods from bar stock or other stock material at 200, then shaped to a final shape and size by grinding or milling at 210, polished at 220, and then cleaned/passivated at 230. Such off-the-self implants can be part of an existing inventory, or mass-produced, or produced by just-in-time agile manufacturing methods.

(29) Semi-custom implants, when approved by the surgeon at 180, can be made from a generic casting at 240, as described below, or by modifying existing standard implant designs to match various features or parameters based on the anatomy of the patient, as described in co-pending patent application entitled Patient-Modified Implant and Associated Method, Ser. No. 12/103,834, filed on Apr. 16, 2008, the disclosure of which is incorporated by reference herein. After the generic casting is modified for certain parameters of a patient, it can be processed at aspects 210-230 to a passivated form. Patient-specific parameters can include parameters relating to the size of the implant, including height, width, various articulation parameters or angles, etc., as discussed in specific example below in reference to FIGS. 3-5.

(30) The surgeon's review of the surgical plan at 140 may further include, at 160, a request for one or more patient-specific alignment guides to be used with the implant. Patient-specific alignment guides are described in co-pending patent application Ser. No. 11/756,057, filed on May 31, 2007, Ser. No. 11/971,390, filed on Jan. 9, 2008, Ser. No. 12/025,414, filed on Feb. 4, 2008, and Ser. No. 12/039,849 filed on Feb. 29, 2008. The alignment guides can be manufactured at 260 with by rapid prototyping methods, such as stereolithography or other similar methods or by CNC milling, or other automated or computer-controlled machining or robotic methods, and cleaned at 270. The alignment guides, the implants and optionally other disposable instruments can be packaged and sterilized at 280, and forwarded to the surgeon or the surgeon's medical facility for implantation at 290.

(31) Referring to FIG. 2, a computer interface 400 to a computer program for the management of the manufacturing method is illustrated diagrammatically. An orthopedic system manager 402 can be in the form of software or other computer program associated with the original equipment manufacturer. The orthopedic system manager 402 can be accessible locally via dedicated computer machines or computer terminal directly communicated with software either by hard wire or wirelessly. The orthopedic system manager 402 can also be accessible remote remotely via the Internet or other remote communication portals using any electronic or other devices that can connect to the Internet or other web-based network, or other similar communication networks, including cable, satellite and telephone-based networks.

(32) The system manager 402 can provide access to patient file information, including lists of all current patients at 403, and surgery dates, surgeons, and approval status of the surgical plan for each patient, at 404. Each patient file can include personal and medical information of the patient, such as, for example, weight, height, gender, age, lifestyle, pertinent medical records and medical history, as well as information on patient assessment that includes physical and kinematic evaluation pertaining to the orthopedic procedure at 406, and soft and hard tissue analysis at 408, including information provided at aspects 120 and 125 of FIG. 1, as discussed above. Imaging center information for patient scans, as discussed in relation to aspects 100 and 110 of FIG. 1, can added or modified at 410, and an imaging center for each specific patient can be specified at 412. Surgeon profiles, including surgeon preferences regarding anatomic axes alignment or implant and instrument preferences that can be taken into account when preparing the preliminary pre-operative plan discussed at aspect 130 of FIG. 1, can be created and edited at 414. Information and selection of manufacturing centers can be accessed at 416 for manufacturing the implants and or alignment guides as discussed in relation to aspects 260, 250, 240, and 210-230 of FIG. 1. The preliminary pre-operative surgical plan for each patient can be provided at 418, as discussed above at 140 in reference to FIG. 1, and e-mailed or otherwise communicated to the patient's surgeon at 420.

(33) As discussed above at aspects 150 to 190 of FIG. 1, one implant option includes manufacturing semi-custom implants by generic casting. Illustrative examples of generic casting of a semi-custom femoral component are shown in FIGS. 3-5. A generic casting 300 of the implant is a casting that is more specialized than ordinary bar stock, from which any size of component can be made, but less specialized than the off-the-self components that are available in a particular number of sizes, typically six-to ten sizes and are finished from specific castings of those sizes. The generic casting can be made in a size and shape that can accommodate a range of variable features for the component, and at the same time can be machined to multiple sizes, such as three or four smaller sizes. In contrast, off-the-self implants require a mold or casting for each offered size, and a larger inventory of available sizes for each implant component. The generic casting can generally include geometric features which are size/shape and/or patient-independent or universal, and also features that are size/shape or patient-specific, as discussed in the examples below. More particularly, the generic casting can include at least one geometric feature that will remain unchanged for any patient or universal feature, and at least one geometric feature that can be specifically customized for and is specific to a particular patient.

(34) Referring to FIGS. 4 and 5, an exemplary generic casting 300 of a femoral component is illustrated. In this example, the generic casting 300 can have an anterior flange 302 of medial-lateral width W, and/or a height H and/or other geometric dimensions to accommodate multiple sizes of femoral components. For example, multiple sizes of left-sided implants 304a, 304b, and various sizes of right-sided implants 306a, 306b can be formed by a single generic casting. Appropriate markings or indentations or score lines for cutting to size can be provided, such as height markings 330, for example. The implant for a particular patient can be formed from the generic casting 300 by selecting particular features, such as the width W or height H, or other geometric features for a particular patient and machining the generic casting 300 to provide the size, dimension or shape, or combinations thereof for that particular geometric feature.

(35) Referring to FIG. 5, the generic casting 300 does not include a patella track feature, but provides an area in which a custom patella track 308 can be machined at a custom angle for each specific patient. The generic casting 300 can also include additional material in the inner condylar notch area 310 to allow for custom machining of the intercondylar notch area 310 to accommodate various types of articulation or constraint in relation to a tibial component, such cams or intercondylar boxes, and other contact areas for articulation with the tibial component in accordance with a kinematic plan for the joint of the specific patient. Separate molds for posterior stabilized and cruciate retaining articulations can be made, each mold capable of accommodating multiple sizes of the corresponding implant type. For example, the intercondylar notch area 310 can be machined for line or area contact with the articular surfaces of a tibial component of various degrees of flexion. Exemplary articulations are disclosed in commonly assigned U.S. Pat. No. 6,589,283, U.S. Pat. No. 6,413,279, and U.S. Pat. No. 6,165,223, and in co-pending U.S. patent application Ser. No. 10/840,765 filed on May 6, 2004, all of which are incorporated herein by reference. Various markings 332 corresponding to different sizes can be provided.

(36) Referring to FIG. 3, the generic casting 300 can include at least one patient-independent or universal feature, such as, for example, universal cement wells 312 or other universal features. Such universal features can be used with any internal geometry 314, which can be machined into the generic casting 300 to accommodate the appropriate shape and/or size for a specific patient.

(37) It will be appreciated from the above discussion that generic casting can greatly reduce inventory, machining costs and investment in mold tooling, while at the same time accommodating sizes and geometric features specific to a patient. Specifically, each implant type can be formed from a generic casting that can accommodate multiple sizes, such as four sizes, for example. For implants that are available in eight sizes, generic casting can reduce inventory by a half, using two molds total for eight sizes. Further, additional reductions in inventory can be obtained by combining right and left side implants into a single generic casting, as discussed above in relation to FIG. 4.

(38) 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.