Sigmoid notch implant

Abstract

A sigmoid notch resurfacing prosthesis for application to the sigmoid notch of the distal radius. The sigmoid notch prosthesis generally includes a saddle and a radius portion for attachment to the distal radius. The saddle may be formed from ultra high molecular weight polyethylene or another durable self-lubricating material. The saddle includes an at least partially concave contoured depression having rounded edges that is securable to the radius portion. The saddle may be secured by a sliding notch snap fit design. The prosthesis may be adapted for articulation with the natural head of the ulna or with an ulnar head prosthesis that has replaced the ulnar head.

Claims

1. A prosthesis for implantation in a patient, the prosthesis comprising: a radial component comprising a first side having a first stem extending therefrom, the first stem being sized and configured for insertion into an ulnar-facing surface of the distal end of a radius bone of the patient; an articular component comprising a bottom face securable to a second side of the radial component and an articular face opposite the bottom face, the articular face having a convex portion and a concave portion, the first stem being substantially perpendicular to a surface of the bottom face and the articular face positioned to face an ulna bone when the bottom face is secured to the second side of the radial component; and an ulnar component sized and configured to replace a distal head of the ulna bone of the patient, the ulnar component comprising a second stem sized and configured for insertion into an intramedullary canal of the ulna bone and a head component, a portion of the head component positioned to face the radius bone and configured to articulate with the articular face, the head component being positionable to articulate with the articular face when the second stem is inserted into the intramedullary canal of the ulna bone and the first stem is inserted into the ulnar-facing surface of the distal end of the radius bone.

2. The prosthesis of claim 1, wherein the second side of the radial component comprises a retainer configured to surround a portion of the articular component when the articular component is secured to the second side of the radial component.

3. The prosthesis of claim 1, wherein the bottom face has a recess for receiving a portion of the radial component when the bottom face is secured to the second side of the radial component.

4. The prosthesis of claim 3, wherein the recess is positioned at a periphery of the bottom face.

5. The prosthesis of claim 1, wherein the concave portion is smoothly curved and configured to receive and articulate with the head component.

6. The prosthesis of claim 1, wherein the concave portion includes a radius of curvature that is larger than a radius of curvature of the convex portion.

7. The prosthesis of claim 1, wherein the concave portion is adjacent to the convex portion.

8. The prosthesis of claim 1, wherein the first stem comprises a tapered shape.

9. The prosthesis of claim 1, wherein the radial component is formed from a single piece of material.

10. The prosthesis of claim 1, wherein the radial component further comprises a hole extending from the first side to the second side, and wherein the prosthesis further comprises a bone screw having a shaft positionable through the hole at different angles with respect to the first stem.

11. The prosthesis of claim 1, wherein the head component includes suture holes to allow for anchoring of the head component to soft tissues of the patient.

12. The prosthesis of claim 1, wherein the articular face substantially conforms to a shape of the head component.

13. The prosthesis of claim 1, wherein the head component includes a convex surface configured to be received in the concave portion.

14. The prosthesis of claim 1, wherein the second stem includes a collar configured to limit insertion of the second stem into the intramedullary canal of the ulna bone.

15. A method for arthroplasty comprising: obtaining a first prosthesis adapted for implantation at the distal end of a radius bone of a patient, the first prosthesis comprising: a radial component comprising a first side having a first stem extending therefrom, the first stem being sized and configured for insertion into an ulnar-facing surface of the distal end of the radius bone; and an articular component comprising a bottom face securable to a second side of the radial component and an articular face opposite the bottom face, the articular face having a convex portion and a concave portion, the first stem being substantially perpendicular to a surface of the bottom face when the bottom face is secured to the second side of the radial component; and obtaining a second prosthesis to replace a distal head of an ulna bone of the patient, the second prosthesis comprising: a head component configured to articulate with the articular face; and a second stem sized and configured for insertion into an intramedullary canal of the ulna bone, implanting the first prosthesis, comprising inserting the first stem into the ulnar-facing surface of the distal end of the radius bone; and implanting the second prosthesis, comprising inserting the second stem into the intramedullary canal of the ulna bone, wherein, once the first and second prostheses are implanted, the articular face faces the ulna bone such that the concave portion of the articular face is adjacent the head component and the convex portion of the articular face is proximal to the concave portion.

16. The method of claim 15, wherein implanting the first prosthesis comprises inserting the first stem into the radius bone, and wherein implanting the second prosthesis further comprises positioning the head component to articulate with the articular face.

17. The method of claim 15, wherein the head component includes suture holes to allow for anchoring of the head component to soft tissues of the patient.

18. The method of claim 15, wherein the head component comprises a convex surface configured to be received in the concave portion.

19. The method of claim 15, wherein implanting the second prosthesis further comprises securing the head component to the second stem.

20. The method of claim 15, wherein the radial component further comprises a hole extending from the first side to the second side, and wherein the first prosthesis further comprises a bone screw having a shaft positionable through the hole at different angles with respect to the first stem.

21. The method of claim 15, further comprising the step of preparing the radius bone for implantation of the first prosthesis including burring the sigmoid notch.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) FIG. 1 is a perspective view of a sigmoid notch implant in accordance with the present invention;

(2) FIG. 2 is another perspective view of the sigmoid notch implant;

(3) FIG. 3 is a front elevational view of the sigmoid notch implant;

(4) FIG. 4 is a plan view of the sigmoid notch implant;

(5) FIG. 5 is a rear elevational view of the sigmoid notch implant;

(6) FIG. 6 is a side elevational view of the sigmoid notch implant;

(7) FIG. 7 is a perspective view of a saddle in accordance with the present invention;

(8) FIG. 8 is a front elevational view of the saddle in accordance with the present invention;

(9) FIG. 9 is a perspective view of the saddle in accordance with the present invention;

(10) FIG. 10 is a plan view of the saddle with phantom lines showing internal structures;

(11) FIG. 11 is a rear elevational view of the saddle;

(12) FIG. 12 is a side elevational view of the saddle with phantom lines depicting internal structures;

(13) FIG. 13 is a plan view of a radius component of the sigmoid notch implant;

(14) FIG. 14 is a front elevational view of the radius component;

(15) FIG. 15 is a side elevational view of the radius component;

(16) FIG. 16 is a rear elevational view of the radius component;

(17) FIG. 17 is a perspective view of the radius component;

(18) FIG. 18 is another perspective view of the radius component;

(19) FIG. 19 is an elevational view of the sigmoid notch implant and an ulnar head implant with the saddle of the sigmoid notch implant partially installed; and

(20) FIG. 20 is an elevational view of the sigmoid notch implant and an ulnar head implant with the saddle completely installed.

DETAILED DESCRIPTION OF THE INVENTION

(21) An embodiment of the sigmoid notch implant 30 generally includes radius portion 32, saddle 34 and bone screw 36. Referring to FIGS. 18 and 19 the sigmoid notch implant 30 is generally utilized along with an ulnar head implant 38. A typical ulnar head implant 38 includes a head portion 40 and a stem portion 42. One exemplary ulnar head prosthesis is disclosed in U.S. Pat. No. 6,302,915. The contents of that U.S. Patent are incorporated herein by reference.

(22) Referring to FIGS. 1-6 and 13-18, radius portion 32 generally includes stem 44 and saddle plate 46. Stem 44 may extend outwardly from saddle plate 46 at a substantially right angle.

(23) Stem 44 includes cylindrical portion 48 and rounded end 50. Stem 44 joins saddle plate 46 at fillet 52. Stem 44 may also have a tapered shape or include ridges or surface texturing thereon.

(24) Referring to FIGS. 13-18 saddle plate 46 is roughly trapezoidally shaped and may be integrally formed with stem 44. Saddle plate 46 presents saddle retainer 54 and retainer ridge 56 on a side opposite from stem 44. Saddle plate 46 also defines screw hole 58 there through.

(25) In one embodiment, saddle retainer 54 is structured to substantially surround saddle 34 on three sides. Saddle retainer 54 includes ridge 60 on three sides thereof, which together define a three-sided groove 62. Surface 64 of saddle plate 46 is substantially planar. Retaining ridge 56 extends upwardly from surface 64 at an end of saddle plate 46 substantially opposite from saddle retainer 54. Retaining ridge 56 may have a bevel 66 on the top thereof.

(26) Screw hole 58 passes through saddle plate 46. Screw hole 58 desirably includes spherical countersink 68. As seen in FIGS. 14-16 and FIG. 18, screw hole 58 also passes through collar 70 which may be integrally formed with saddle plate 46 and which joins saddle plate 46 at circular fillet 74. Collar 70 is connected to stem 44 by stiffening rib 76 which interconnects circular fillet 74 with fillet 52. Stiffening rib 76 may also be integrally formed with saddle plate 46. Screw hole 58 may be located beneath saddle 34 when saddle 34 is assembled to saddle plate 46 or screw hole 58 may be in a location left exposed when saddle 34 is assembled to saddle plate 58.

(27) Screw hole 58 defines cylindrical portion 78 on its inner aspect. Spherical countersink 68 defines circular bevel 80 where it meets surface 64.

(28) Radius portion 32 is desirably machined, cast, molded or otherwise formed from a single piece of material. Radius portion 32 may be manufactured from implant grade 316L stainless steel or other biocompatible materials such as titanium. Biocompatible polymer or composite materials may be used as well.

(29) Radius portion 32 may be mirror polished over surface 64, saddle retainer 54 and retaining ridge 56 and any other surfaces that do not make direct contact with the bone of the radius. The surfaces of stem 44, collar 70, stiffening rib 76, fillet 52 and circular fillet 74 and any other surface that makes contact with the bone of the radius may be roughened to encourage osseointegration such as by the application of commercially pure titanium plasma coating.

(30) Saddle 34 presents articular portion 82 and securing portion 84. Referring to FIGS. 8-12, articular portion 82 presents articular face 85 which includes concave portion 86 and convex portion 88. Concave portion 86 and convex portion 88 are contoured so that articular face 85 substantially conforms to the shape of an ulnar head implant 38. Articular portion 82, desirably, has a radiused edge 90. Perimeter 92 of saddle 34 substantially conforms to the shape of the perimeter of saddle plate 46. The outline of saddle 34 is generally trapezoidal and includes rounded corners 94.

(31) In an exemplary embodiment, concave portion 86 may be substantially spherical and have a radius of curvature of about 0.709 inches. Convex portion 88 may have a radius of curvature of about 0.5 inches. These values are exemplary and should not be considered limiting. Adjacent to convex portion 88 is sloped portion 96 which maybe sloped at about seventy degrees relative to the perimeter 92 of saddle 34. Saddle 34 can be adjusted in size, thickness and shape to conform to the natural head of the radius or to various ulnar head implants 38.

(32) Securing portion 84 of saddle 34 presents bottom face 98 surrounded by tongue 100. Tongue 100 along with perimeter 92 define groove 102. Groove 102 extends substantially around perimeter 92 and is sized and structured to receive ridge 60 while tongue 100 fits into groove 62. Tongue 100 partially surrounds the edge of bottom face 98 on three sides. Tongue 100 extends outwardly from bottom face 98 and defines adjacent groove 102 which also extends around three sides of bottom face 98. Tongue 100 and groove 102 are dimensioned to mate with ridge 60 and groove 62 of saddle retainer 54.

(33) Bottom face 98 is substantially planar and further presents recess 104. Recess 104 may be substantially rectangular in shape and includes flat portion 106 and sloped portion 108. Adjacent to recess 104 and beyond the edge of sloped portion 108 is retaining slot 110. Recess 104 is dimensioned so that flat portion 106 can receive retaining ridge 56 therein when tongue 100 and groove 102 are aligned with ridge 60 and groove 62 and saddle 34 is slidably engaged with saddle retainer 54. Retaining slot 110 is dimensioned to receive retaining ridge 56 therein when saddle 34 is slidably secured to radius portion 32. Note that saddle plate 46 and/or saddle 34 resiliently flex to make the engagement between retaining slot 110 and retaining ridge 56.

(34) Saddle 34 may be formed from ultra high molecular weight polyethylene or another self-lubricating material. Saddle 34 may also be from other polymers, composite or metallic material. It is generally believed that biocompatible metallic materials are preferred for articulation with the natural head of the ulna if the sigmoid notch implant 30 is used for hemiarthroplasty. It is specifically contemplated that saddle 34 may be joined to radius portion 32 by many other techniques as understood by those of ordinary skill in the art such as the use of screws, clamps or interference fit techniques.

(35) Bone screw 36 is a spherical head bone screw. Bone screw 36 includes spherical head 112 and shaft 114. Shaft includes threaded portion 116 and unthreaded portion 118. Bone screw 36 desirably includes flutes 20 to facilitate a self-threading design. Bone screw 36 may be manufactured to the standards of ISO 5835. Referring to FIG. 5, bone screw 36 may angulate in a conical fashion at an angle alpha within spherical countersink 68. For example, bone screw 36 may articulate conically at a solid angle alpha of about thirty degrees.

(36) In operation, sigmoid notch implant 30 articulates with ulnar head implant 38 to restore stability and pain free natural motion to the distal radial ulnar joint. To implant sigmoid notch implant 30 the surgeon first exposes the distal radial ulnar joint. In this discussion of the implantation of sigmoid notch implant 30 it will be assumed that an ulnar head implant 38 having a metallic articular surface has already been implanted to replace the head of the ulna. It is specifically contemplated that sigmoid notch implant 30 may also be implanted to articulate with the natural head of the ulna as a hemiarthroplasty. If this aspect of the invention is practiced it is to be understood that saddle 34 may be formed of a metallic material or another biocompatible material appropriate to articulate with living bone. At this time, it is generally thought that for two surface arthroplasty a metal to polymer interface is preferred and for hemiarthroplasty a metallic to bone interface is preferred but these beliefs should not be considered to be limiting.

(37) Once the joint is exposed the surgeon removes the head portion 40 of the ulnar head implant 38 and sets it aside. First however, the surgeon measures from the distal face of the existing ulnar head implant 38 to determine the location for drilling a hole to accept the stem 44 of radius portion 32. The surgeon should estimate the drilled depth required to accept stem 44. The surgeon then drills a hole in the distal radius utilizing, for example, a 3.5-millimeter drill.

(38) Once the hole to receive stem 44 is drilled the surgeon will use a trial radius portion (not shown) which has an undersized trial stem to preserve a press fit for the sigmoid notch implant 30. Once the trial implant is satisfactorily placed in the drilled hole the surgeon drills a pilot hole for the self-tapping bone screw 36 using an appropriately sized drill. The pilot hole is located so that the pilot hole is substantially centered in screw hole 58. The pilot hole may be angled for optimal placement of bone screw 35. The pilot hole may be angled as needed to avoid pre-existing implant hardware, or to assist in fracture fixation or to avoid fractured portions of the bone. If the pilot hole is drilled non-parallel to the hole to receive stem 44 axial pullout strength is increased.

(39) Once the pilot hole for bone screw 36 is made, the surgeon removed the trial radius portion and burrs down the sigmoid notch to provide a flat buttress for saddle plate 46. The surgeon also burrs a small countersink to receive collar 70 and a space to receive stiffening rib 76.

(40) The surgeon places radius portion 32 of sigmoid notch implant 30 so that stem 44 is in the drilled hole. The surgeon then impacts radius portion 32 until it is secured by press fit in the predrilled hole by stem 44 and flush against the flat buttress surface of the radius. If the hole is too small to receive stem 44, the surgeon should consider removing radius portion 32 and redrilling to remove debris rather than applying excessive force to radius portion 32 in an effort to insert it.

(41) Once radius portion 32 is in place, bone screw 36 is inserted and tightened. It is important that bone screw 36 be tightened evenly and that saddle plate 46 be evenly supported against the radius to avoid bending saddle plate 46. In addition, care should be taken to protect the polished surfaces of the ulnar head implant 38 and the radius portion 32 (for example by handling head portion 40 carefully). Any scratches on the polished surfaces of the ulnar head implant 38 may decrease the wear life of saddle 34. Scratches on portions of the components that articulate with surrounding tissues may encourage inflammation.

(42) Referring to FIGS. 18 and 19, the surgeon slides saddle 34 (of UHMWPE or other polymer material) into radius portion 32 so that tongue 100 and groove 102 mate with groove 62 and ridge 60. When the saddle 34 is about 75 percent engaged sloped portion 96 of saddle 34 will engage bevel 66 of retaining ridge 56. If need be, the surgeon can stake an osteotome into the radius and pry against saddle 34 to overcome the resistance of retaining ridge 56 against sloped portion 108. Once saddle 34 snaps into place in saddle retainer 54 implantation of the sigmoid notch implant 30 is complete.

(43) The surgeon then replaces the head portion 40 of ulnar head implant 38 and reduces the joint to assess range of motion. Assuming that range of motion and alignment is acceptable, the surgeon repairs the joint capsule and closes the skin.

(44) If the invention is practiced as a hemiarthroplasty, saddle may be formed of metallic material and be secured to radius portion 32 by another technique as discussed above. In a hemiarthroplasty, the head of the ulna will, of course remain intact.

(45) The present invention may be embodied in other specific forms without departing from the central attributes thereof, therefore, the illustrated embodiments should be considered in all respects as illustrative and not restrictive, reference being made to the appended claims rather than the foregoing description to indicate the scope of the invention.