Prosthesis (i.e. – artificial body members) – parts thereof – or ai – Implantable prosthesis – Bone
Reexamination Certificate
2002-01-24
2004-08-31
Robert, Eduardo C. (Department: 3732)
Prosthesis (i.e., artificial body members), parts thereof, or ai
Implantable prosthesis
Bone
Reexamination Certificate
active
06783548
ABSTRACT:
FIELD OF THE INVENTION
The present invention relates to instrumentation, implants, and techniques for orthopedic surgery and, more particularly, to a transosseous core approach for joint repair, replacement, and/or treatment, wherein the treatment site is approached through a transosseous pathway constructed by taking a bone core out of a bone, at the joint.
BACKGROUND OF THE INVENTION
An orthopedic surgeon may wish to gain entry to a particular joint for multiple reasons. The surgeon may wish to alter or remove a defect in the joint, to replace an articular surface of the joint or the entire joint (i.e., total joint arthroplasty), to transplant cartilage autographs/implants and/or to alter the characteristics of soft tissues in and around the joint such as tendons, ligaments, joint capsule, etc. In a typical joint, the articular surfaces of the joint are surrounded by soft tissue structures, injury to which is often undesirable or at least to be minimized.
FIG. 1
schematically illustrates a typical joint (representative of diarthroses) and surrounding anatomical structures of the joint. The exemplary joint includes first bone “A” and second bone “B”, each including the articular surface
1
A,
1
B comprising articular cartilage enclosed within a synovial lining
2
. Articular surfaces
1
A,
1
B and synovial lining
2
are in turn surrounded by a joint capsule
3
on which a bursa
5
may be disposed. The synovial lining is also referred to as the synovial stratum, which together with the fibrous stratum, make up the articular capsule. Bones A, and B are attached to tendon
6
and muscle
7
and are coupled to each other by ligaments
4
. Blood vessels and nerves (not shown) generally run with muscle
7
, tendon
6
, and/or ligaments
4
. Each bone A, B includes portions of non-articular surface
8
A,
8
B outside joint capsule
3
that are substantially clear of the above-mentioned soft tissue structures of the joint.
Conventional methods for gaining access into the joints typically require wide exposures and joint dislocation. See for example U.S. Pat. No. 4,550,450, entitled “Total Shoulder Prosthesis System,” and U.S. Pat. No. 5,507,833, entitled “Hip Replacement and Method for Implanting The Same.” These classical wide exposures damage large area of tissue, create large scars, jeopardize neurovascular structures, produce considerable blood loss, increase the potential for other significant complications, and increase the risk of infection. Wide exposures, because of their inherent nature, traumatize tissues as they are cut, retracted, and/or divided. The amount of tissue disrupted increases the healing time and the physiological strain on the patient because the amount and severity of postoperative pain correlate directly to the size of the incision and extent of surgery. Traditional wide exposures can also create limits on the functional results of surgery to treat joint problems by the sequlae introduced by the exposure itself. More recent developments in arthroscopic techniques may reduce the amount of trauma to which a patient may be subjected, but many procedures are not amenable to arthroscopic techniques and frequently such procedures still entail damage to soft tissue structures surrounding the joint such as the articular capsule.
Patient cooperation is an important factor in postoperative rehabilitation. The ultimate result of the treatment of joint problems hinges to a major degree on this fact. Postoperative pain which is proportional to the incision size, exposure, and/or tissue damage, inhibits the rate of patient's rehabilitation. The inability to reach desired rehabilitation goals often results in an overall inferior and/or an unsatisfactory result. These additional drawbacks of conventional joint surgical exposures and treatments contribute to reduce the ultimate outcome of the surgical intervention, often introducing unwanted and unnecessary sequlae.
SUMMARY OF THE INVENTION
In the present invention, a joint is entered via a route passing through a pathway provided in a portion of a joint bone. Such pathway is made by taking out a bone core from the bone in or adjacent to the joint without substantially compromising physical integrity and physiological viability of the joint. Typically the main route for the present invention traverses through a more-accessible bone of the joint which can be aligned with a less-accessible bone of the joint to facilitate treatment of the articular surfaces and/or other structures in the joint.
The present invention thus provides a new method and instrumentation for gaining access to areas in and around the joint surfaces to treat problems of the joint as well as to provide new implants and instrumentation adapted for the new method. The transosseous core approach of the present invention has at least two main advantages over conventional surgical exposures. A first is that the present invention requires substantially smaller incisions than standard exposures. A second is that the present invention does not substantially interfere with normal anatomical structures surrounding the joint such as vascular, nervous, muscular, ligamentous, and other soft tissues of the joint and, therefore, is less invasive. Additionally, in many cases the exposure obtained by the transosseous core approach provides better and more direct access to areas of the joint not found in current exposures.
Every joint includes at least two bones arranged to allow movement thereof. Each bone includes an articular surface substantially enclosed within a joint capsule and a non-articular surface (e.g., a superficial portion thereof) disposed substantially outside the joint capsule. The present invention is based on the transosseous core approach where the articular surface of the bone and other tissues within the joint capsule can be accessed through a pathway (such as the hole) in the bone commencing from its non-articular surface and approaching its articular surface.
Accordingly, in one aspect of the present invention, a method may be provided to treat the joint by positioning the first bone with respect to the second bone, by removing a bone core from the first bone along a first axis to provide a bone core hole beginning in a first region of the first bone and approaching the first articular surface of the first bone without penetrating its articular surface wherein the first region is its non-articular surface, by performing an intervention through the bone core hole, and by replacing at least portion of the first bone core within the bone core hole. Such intervention may be implanting at least one component of a prosthetic device within the first bone core hole.
Alternatively, the method may be provided for treating the joint by positioning the first bone with respect to the second bone, by cutting the first bone starting from its first region (e.g., the first non-articular surface thereof) and approaching its first articular surface, and by ceasing cutting at a point adjacent the first articular surface without penetrating it, thereby providing the first bone with an elongated first core hole capable of receiving an implant. The first region is generally the first non-articular surface of the first bone and, preferably, superficial to a surface of a body part such as limbs.
In another aspect of the invention, an access is provided to the joint including at least one more-accessible bone, at least one less-accessible bone, and the surrounding anatomical structures by positioning the more-accessible bone with respect to the less-accessible bone, by cutting the more-accessible bone starting from a first region and approaching its articular surface, wherein the first region is its non-articular surface, and by ceasing cutting at a point adjacent the articular surface of the more-accessible bone without penetrating it. Accordingly, the more-accessible bone is provided with a more-accessible core hole providing the access to a portion of the more-accessible bone which is substantially proximate to its articular surface.
In the alternative, a met
Morgan & Lewis & Bockius, LLP
Robert Eduardo C.
LandOfFree
Modular joint prostheses does not yet have a rating. At this time, there are no reviews or comments for this patent.
If you have personal experience with Modular joint prostheses, we encourage you to share that experience with our LandOfFree.com community. Your opinion is very important and Modular joint prostheses will most certainly appreciate the feedback.
Profile ID: LFUS-PAI-O-3358049