WO2024258699A1 - Saillies coniques sur tige d'implant d'arthroplastie - Google Patents

Saillies coniques sur tige d'implant d'arthroplastie Download PDF

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Publication number
WO2024258699A1
WO2024258699A1 PCT/US2024/032512 US2024032512W WO2024258699A1 WO 2024258699 A1 WO2024258699 A1 WO 2024258699A1 US 2024032512 W US2024032512 W US 2024032512W WO 2024258699 A1 WO2024258699 A1 WO 2024258699A1
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WIPO (PCT)
Prior art keywords
liner
stem
width
recess
cavity
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PCT/US2024/032512
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English (en)
Inventor
Kenneth KONYA
Forrest A. JAMES
Jacob Stegman
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Smith and Nephew Orthopaedics AG
Smith and Nephew Asia Pacific Pte Ltd
Smith and Nephew Inc
Original Assignee
Smith and Nephew Orthopaedics AG
Smith and Nephew Asia Pacific Pte Ltd
Smith and Nephew Inc
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Application filed by Smith and Nephew Orthopaedics AG, Smith and Nephew Asia Pacific Pte Ltd, Smith and Nephew Inc filed Critical Smith and Nephew Orthopaedics AG
Publication of WO2024258699A1 publication Critical patent/WO2024258699A1/fr
Anticipated expiration legal-status Critical
Pending legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/40—Joints for shoulders
    • A61F2/4014—Humeral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic humeral shafts
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
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    • A61F2/4059—Humeral shafts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2/46—Special tools for implanting artificial joints
    • A61F2/4603—Special tools for implanting artificial joints for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2/4612—Special tools for implanting artificial joints for insertion or extraction of endoprosthetic joints or of accessories thereof of shoulders
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2002/30332—Conically- or frustoconically-shaped protrusion and recess
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30359—Pyramidally- or frustopyramidally-shaped protrusion and recess
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2002/4659—Measuring instruments used for implanting artificial joints for measuring dimensions, e.g. length for measuring a diameter

Definitions

  • Shoulder replacement implants are used for restoration of functionalities of shoulders as well as to treat a variety 7 of degenerative conditions and injuries. Shoulder replacement implants typically come in two designs: anatomic and reverse.
  • Anatomic shoulder implants are used for restoration of natural kinematics of a shoulder by replacing its humeral head and glenoid with similarly shaped prosthetic designs that recreate normal anatomy.
  • the anatomic shoulder implant often has a spherical humeral head and a shallow concave glenoid that articulates with the spherical head.
  • an anatomic shoulder implant's stem is securely placed down the shaft of the humerus and the spherical head is often fixed to the stem using a mechanical taper press fit.
  • the glenoid prosthetic component (made from a polymer, e.g., ultra-high molecular weight polyethylene (UHMWPE)) is either cemented directly into the remaining intact glenoid or affixed to a metallic tray, which is secured to the native glenoid bone using bone screws, cement, or similar attachment methods.
  • UHMWPE ultra-high molecular weight polyethylene
  • the implant In the reverse shoulder implant procedure, the implant’s spherical surface is placed on the remaining intact glenoid and its concave articular surface is placed on the humerus.
  • the implant also includes a stem that is securely placed down the shaft of the humerus. A concave articular surface is fixed to the stem using a mechanical lock.
  • the liner may include one or more recess, each of the one or more recess being configured to receive therein one of the one or more protrusion, and each of the one or more recesses having a width that is narrower than the first width and wider than the second width.
  • liner it is possible for liner to include one or more protrusion corresponding to one or more recess in the stem, where each of the one or more protrusion has a profile that tapers from a first width that is wider than a width of the one or more recesses to a second width that is narrower than the width of the one or more recess.
  • a method of for shoulder arthroplasty is also disclosed.
  • the method can include inserting a stem into a patient’s humerus during a surgical procedure, the stem including a proximal portion, a distal portion, and a body disposed between the proximal portion and the distal portion, wherein the proximal portion includes a cavity extending toward the body.
  • the method can further include coupling a liner to the proximal portion of the stem by causing a portion of the liner to cooperate with a recess.
  • the method may include inserting a projection of the liner within the cavity’ of the stem.
  • the stem can include one or more protrusion extending from a base of the cavity, where each of the one or more protrusion has a profile that tapers from a first width at the base to a second width that is narrower that the first width
  • the liner can include one or more recess, with each of the one or more recess being configured to receive therein one of the one or more protrusion and each of the one or more recesses having a width that is narrower than the first width and wider than the second width.
  • coupling the liner to the proximal portion of the stem can involve coupling each of the one or more recess with one of the one or more protrusion.
  • liner it is possible for liner to include one or more protrusion corresponding to one or more recess in the stem, where each of the one or more protrusion has a profile that tapers from a first width that is wider than a width of the one or more recesses to a second width that is narrow er than the width of the one or more recess.
  • the liner can include a concave articular surface configured for use in a reverse shoulder implant.
  • the liner can include a base of a substantially spherical head configured for use in an anatomic shoulder implant.
  • the cavity can include one or more edge defining an outer wall of the cavity, and the projection can be configured to engage the one or more edge.
  • a diameter of the projection is greater than a diameter of the cavity such that the projection is configured to engage the one or more edge in a friction-fit arrangement.
  • the cavity includes an undercut extending radially outward beneath the one or more edge, and the projection includes a flange that extends radially outward from the projection, wherein, when the projection is coupled within the cavity, the flange is configured to pass beneath the one or more edge and into the undercut.
  • the one or more protrusion may be a ring.
  • the ring may be a substantially continuous ring.
  • the one or more recess may include a corresponding ring-shaped recess.
  • the ring is provided on the stem, and the corresponding ring-shaped recess is formed on the liner.
  • the ring is provided on the liner, and the corresponding ring-shaped recess is formed on the stem.
  • the present disclosure relates to a method for removing a liner from a stem of a shoulder implant system.
  • the method may include selecting an osteotomy sizer that approximately matches the circumference (and/or the diameter) of the liner and centrally positioning the osteotomy sizer on the top surface of the liner, while centrally holding the osteotomy sizer on the liner, drilling an opening in the liner through the center of the osteotomy sizer, positioning a screw into the drilled opening and threading the screw through the opening until the screw contacts a bottom of the stem’s well, continue threading the screw until the liner disengages from the stem, and removing the liner and the screw.
  • the osteotomy sizer may be selected from a plurality of osteotomy sizers.
  • the opening may be made using a glenoid guide pin and/or a drill bit using a drill.
  • the opening may be a pilot opening made using the glenoid guide pin.
  • the opening may be an opening made through the liner using at least one of the: the glenoid guide pin, the drill, and any combination thereof.
  • the diameter of the glenoid guide pin and/or the drill may be less than an interior diameter of the stem’s well.
  • the diameter of the screw may be less than the interior diameter of the stem’s well.
  • the length of the screw may be greater than a depth of an interior cavity of the stem, including the depth of the stem’s well.
  • continuous threading of the screw causes interaction between a tip of the screw and a bottom surface of the stem’s well and pushing of the screw away from the bottom surface of the stem’s well, causing disengaging of the liner from the stem.
  • the tapered shape of the one or more protrusion can help secure the liner into place, acting as fmgers/anchors to reduce micromotion in each localized area and limit rotation of the liner with respect to the stem.
  • the tapered shape can facilitate alignment of the liner with the stem and provide tactile feedback to a user when coupling the liner to the stem.
  • FIG. 1 illustrates a side perspective view of a component of a shoulder implant system in accordance with one or more features of the present disclosure
  • FIG. 2 illustrates a top perspective view of a proximal portion of a stem of a shoulder implant system in accordance with one or more features of the present disclosure
  • FIG. 3 illustrates perspective views of a stem and an insert of a shoulder implant system in accordance with one or more features of the present disclosure
  • FIGS. 4 and 5 illustrate side cutaway views of a stem of a shoulder implant system in accordance with one or more features of the present disclosure
  • FIG. 6 illustrates a top perspective view of a proximal portion of a stem of a shoulder implant system in accordance with one or more features of the present disclosure
  • FIG. 7 illustrates a side cutaway view of a stem of a shoulder implant system in accordance with one or more features of the present disclosure
  • FIGS. 8A and 8B illustrate side perspective views of a stem being used in both a reverse and anatomic shoulder implant system in accordance with one or more features of the present disclosure
  • FIGS. 9A and 9B illustrate perspective views of the liner and the stem during liner removal, in accordance with one or more features of the present disclosure
  • FIGS. 10A and 10B illustrate cross-sectional views of the liner and the stem during liner removal, in accordance with one or more features of the present disclosure
  • FIG. 11 illustrates an example process for removal of a liner from a stem of an implant, in accordance with one or more features of the present disclosure.
  • shoulder implant system As disclosed herein can be embodied in many different forms and can selectively include one or more concepts, features, or functions described herein. As such, the shoulder implant system should not be construed as being limited to the specific examples set forth herein. Rather, these examples are provided so that this disclosure will convey certain features of the shoulder implant system to those skilled in the art.
  • shoulder implants are intended to restore the natural kinematics of a patient's shoulder by replacing the patient’s humeral head and/or glenoid with similarly shaped orthopedic implants that recreate normal anatomy.
  • a shoulder implant system that provides improved resistance to micromotion and rotation is disclosed.
  • FIG. 1 illustrates an example of a shoulder implant system, generally designated 100. Moreover, the illustrated system 100 is shown as a reverse shoulder implant configuration.
  • the shoulder implant system 100 includes a stem 101 coupled to a cup or liner 120.
  • the liner 120 is a polymer liner.
  • Specific material options include, but are not limited to, ultra-high-molecular- eight polyethylene (UHMWPE) (e.g.. cross-linked, non-cross-linked, stabilized with Vitamin E).
  • UHMWPE ultra-high-molecular- eight polyethylene
  • the stem 101 can be arranged and configured for insertion into the patient’s humerus during a surgical procedure (e.g., arthroplasty). In particular, the stem 101 can be appropriately sized and/or shaped for such insertion.
  • the stem 101 can be arranged and configured to be a unitary 7 structure, which can be helpful during its manufacturing process.
  • the stem 101 includes a distal portion 102, a proximal portion 103, and a body 110 disposed between the distal portion 102 and the proximal portion 103.
  • the distal portion 102 can be narrower than the proximal portion 103.
  • the body 110 can be arranged and configured to be inserted into a cavity (not shown) formed in the humeral bone during the surgical procedure, with the distal portion 102 being inserted first.
  • the body 110 can be angled and have a partially flattened profile that can aid during positioning of the implant system 100 in the humeral bone.
  • proximal portion 103 of the stem is shown without the liner 120.
  • the proximal portion 103 includes a cavity 104 that extends partially into the body 110 of the stem 101.
  • the cavity 104 extends partially into the body 110 of the stem 101. In some examples, the cavity
  • the cavity 104 has a stepped internal configuration, with its internal diameter varying from a relatively larger diameter at the rim 105, positioned at the proximal portion 103, to a relatively smaller diameter at abase 114 of the cavity 104 that is recessed inward toward the body 110.
  • the cavity 104 includes a well 108 (e.g., a morse taper) that is further recessed into the body 110.
  • the well 108 can have a diameter that is smaller than that of the base 114.
  • the well 108 can be used during the surgical procedure for aligning various components of the system 100. such as, for example, a glenoid guide pin (not shown).
  • the liner 120 can include an inwardly projecting curved articulating surface 122 (See also, e.g., FIG. 8A).
  • the curvature of the surface 122 can be arranged and configured to project toward the cavity 104 with the lowest point on the curvature being positioned substantially proximate to the well 108.
  • the surface 122 can be arranged and configured to interact with other components of shoulder prosthesis to enable a more natural range of motion.
  • the cavity' 104 also includes one or more edge 106 disposed around an internal circumference of the cavity' 104 and defining a wall of the cavity' 104.
  • the edge 106 can be arranged and configured to interact with a corresponding projection 126 that extends from an interfacing bottom surface of the liner 120 to ensure proper seating and/or positioning of the liner 120 with respect to the proximal portion 103 of the stem 101.
  • the external dimensions of the projection 126 are slightly larger than the internal dimensions of the edge 106 such that, when the liner 120 is positioned onto the stem 101, the projection 126 and the edge 106 are arranged and configured to create a friction-fit coupling to secure at least a portion of the liner 120 within the stem 101.
  • the projection 126 further includes an extension 128 that, when positioned on the stem 101, is configured to be inserted (at least partially) into the well 108 of the cavity 104.
  • the liner 120 can be removable and interchangeable to achieve a desired configuration of the implant 100.
  • one or more liners 120 can be used for a single, corresponding stem 101.
  • Each liner 120 can have a particular size, articulating surface diameter, offset, and/or any other characteristics that can be selected to best correspond to the anatomy of the patient. This configurability permits a surgeon to select an appropriate liner 120 for placement during shoulder reconstruction surgery. Alternatively, or in addition, if an additional liner height can be desired, a spacer can be positioned between the liner 120 and the stem 101.
  • one or more protrusion 111 can be provided on the base 114 of the cavity- 104.
  • the projection 126 of the liner 120 can include one or more recess 121 that is configured to matingly receive the one or more respective protrusion 111 upon positioning of the spacer 120 on the stem 101.
  • two protrusions 111 and two recesses 121 can be provided.
  • three or more protrusion-recess pairs may be provided.
  • the one or more protrusion 111 is arranged in available space on the base 114 of the cavity 104 that is spaced apart from one or more slot 109 that is formed through the stem 101 to provide access beyond the proximal portion during a surgical procedure. such as to allow insertion of an osteotome.
  • the one or more recess 121 is provided as an arrangement of slots that are recessed into the projection.
  • the one or more recess 121 can have a shape that substantially corresponds to a shape of the associated protrusions.
  • providing the one or more recess 121 as an arrangement of slots can exhibit improved surface contact with the sides of the one or more protrusion 111.
  • mating of the one or more recess 121 and the one or more protrusion 111 can be configured to prevent rotation of the spacer 120 once it is positioned on the stem 101.
  • protrusion 111 being provided on the stem 101 and the corresponding one or more recess 121 being provided on the liner 120
  • protrusions are formed on the liner 120 and are configured to be received in recesses formed in the stem 101.
  • arranging protrusions on the liner 120 may not provide the same resistance to rotation that is possible where the protrusions are formed on the stem 101 due to the difference in material composition of the different components.
  • the one or more protrusion 111 has a tapered shape along its height.
  • each of the one or more protrusion 111 can be designed to have a first width tl at or near its interface with the base 114 of the stem 101 and a second width t2 at its free end that extends away from the base 114, where the first width tl is greater than the second width t2.
  • the one or more recess 121 formed in the liner 120 can have a width that is greater than the second width t2 but less than or equal to the first width tl.
  • each of the one or more protrusion 111 can have a substantially constant width, but the width of each of the one or more recess 121 can be tapered such that the opening of each recess 121 is relatively wider than the protrusion 111 and tapers toward a relatively narrow width at the base of the recess 121.
  • protrusions having a desired tapered shape can be more readily verified (e.g., using a coordinate-measuring machine (CMM)) than tapered recesses.
  • CCM coordinate-measuring machine
  • the added tolerance provided by the relatively narrow free end of each of the one or more protrusion 111 can facilitate insertion of the one or more protrusion 111 into the one or more recess 121.
  • the insertion of the one or more protrusion 111 into the corresponding one or more recess 121 can provide tactile feedback of progressive tightening, which can allow the user to recognize that proper alignment has been achieved prior to complete insertion/fixation. Full insertion can then result in a press-fit/interference-fit arrangement of the relatively wide base of the one or more protrusion 111 being secured within the one or more recess 121.
  • the tapered shape of the one or more protrusion 111 can help secure the liner 120 into place, acting as fingers/anchors to reduce micromotion in each localized area and limit rotation of the liner 120 with respect to the stem 101.
  • the projection 126 of the liner 120 can be configured to include a flange 127 that extends radially outward relative to adjacent portions of the projection 126 and is configured to fit within an undercut 107 formed beneath the edge 106, such as is shown in FIG. 4.
  • insertion of the projection 126 of the liner 120 into the cavity 104 can proceed until the flange 127 of the projection 126 passes beyond the edge 106 and is received within the undercut 107. Removal of the liner 120 from this position can thus be resisted by the engagement of the flange 127 with an underside of the edge 106 within the undercut 107.
  • the material composition of the liner 120 and/or the shape and configuration of the flange 127 can be designed to be resiliently deformable. In this way the flange 127 can be compressed radially inwardly when the protrusion is inserted to allow the flange 127 to pass beyond the edge 106, but the flange 127 can return to its original shape once aligned with the undercut 107.
  • the tapered shape of the one or more protrusion 111 relative to the one or more recess 121 and the mismatch between the width of the one or more recess 121 and the first width of the one or more protrusion 111 can cause an upward force to be exerted on the liner 120 as the one or more protrusion 111 resists being fully inserted into an interference fit with the one or more recess 121.
  • This lifting action can urge the flange 127 of the projection 126 towards the edge 106 of the stem 101 such that the flange 127 engages the lower surface of the edge 106 within the undercut 107.
  • the position of the projection 126 relative to the depth of the cavity 7 104 at which the width of the one or more recess 121 is substantially equal to the width of the one or more protrusion 111 can substantially correspond to the depth at which the flange 127 is aligned with the undercut 107.
  • the system 100 in place of the one or more protrusion 111, can include a continuous or substantially continuous extruded ring 113 positioned around the center of the base 114 (e.g., surrounding the well 108) as shown in FIGS. 6 and 7.
  • the ring 113 can be configured to be coupled with a corresponding ring-shaped recess 123 formed within the projection 126 of the liner 120.
  • the ring 113 has a tapered shape along its height.
  • the ring 113 can be designed to have a first width tl’ at or near its interface with the base 114 of the stem 101 and a second width t2’ at its free end that extends away from the base 114. where the first width tl’ is greater than the second width t2’.
  • the ring-shaped recess 123 formed in the liner 120 can have a width that is greater than the second width t2’ but less than or equal to the first width tl’.
  • the ring 113 can have a substantially constant width, but the width of the ring-shaped recess 123 can be tapered such that the opening of the ringshaped recess 123 is relatively wider than the proximal portion of the ring 113 and tapers toward a relatively narrow' width at the base of the ring-shaped recess 123.
  • the tapered w idth of one of the ring 113 or the ringshaped recess 123 can help secure the liner 120 into place, reducing micromotion of the liner 120 with respect to the stem 101.
  • the ring 113 can provide increased surface area of contact relative to one or more protrusions 111.
  • the extrusion of the ring 113 can also be easier to manufacture than one or more protrusions 111.
  • the ring 113 cannot limit rotation of the liner 120 with respect to the stem 101 in the same way as the one or more protrusions 111 since the liner 120 need not clocked to a specific rotational position to align with the stem 101, although the circumferential engagement of the ring 113 with the ring-shaped cavity 123 can provide some resistance to rotation due to the frictional engagement/interference-fit of the elements.
  • the disclosed system 100 can be used to improve a reverse shoulder implant configuration in which the liner 120 includes a concave articular surface such as is shown in FIG. 8A. which can be configured to engage the metal spherical head coupled to the glenoid.
  • the configuration of stem 101 disclosed herein can be adapted for use in an anatomic shoulder implant in which the stem 101 is coupled to a spherical humeral head 130.
  • liner removal can be anecessary step to either replace the liner (e g., to change the lateral offset with a different liner height) ), to add a spacer, to add a humeral head (if switching from an anatomic to reverse), and/or to replace the stem (which can require liner removal to attach the stem removal tool to the stem implant). It is important that during liner removal procedure, the stem (including its internal features, such as the morse taper, that interact with the humeral head 130 (as shown in FIG.
  • FIGS. 9A-10B illustrate an example process for removal of a liner from the stem, according to some examples of the current subject matter.
  • FIGS. 9A and 9B illustrate perspective views of the liner and the stem.
  • FIGS. 10A and 10B illustrate cross-sectional views of the liner and the stem during liner removal.
  • a stem 301 is coupled to the liner 320. where the liner
  • an osteotomy sizer 306 may be positioned onto the liner 320.
  • the osteotomy sizer 306 may be selected in a way to best approximate the outer diameter of the liner 320.
  • the osteotomy sizer 306 may be selected to approximately match the outer circumference of the liner 320.
  • the center 308 of the sizer 306 may be arranged and configured with the center of the liner 320 and thus, be aligned with the well (e.g., corresponding to the well 108 of the stem 101 as shown in FIGS. 2 and 3) of the stem 301.
  • any size of the osteotomy sizer 306 may be selected as long as the above alignment of the sizer, the liner and the stem’s well is preserved.
  • a glenoid guide pin 310 (as shown in FIG. 9A) and/or a driver 312 (as shown in FIG. 9B) may be used to drill through the center 308 of the sizer 306 and, thus, the center of the liner 320. This creates a through opening in the liner 320.
  • a drill with a drill bit may be used to create such opening in the liner 320.
  • the glenoid guide pin 310, driver 312, and/or the drill bit may have a diameter that is smaller than the internal diameter of the well of the liner 320.
  • Such a relatively smaller diameter of the glenoid guide pin 310, driver 312 and/or the drill bit prevents the pin 310, driver 312 and/or the drill bit from contacting the well w alls of the stem and, thus, damaging the interior of the stem’s cavity during drilling. While damage to the bottom of the well of the liner’s cavity may occur, such damage does not affect other interior surfaces of the cavity of the stem 301, thereby allowing secure positioning of a new liner/spacer/humeral head/stem removal tool.
  • a 2.5 mm diameter glenoid guide pin 310 (and/or driver 312) and/or a 3 mm diameter drill bit may be used.
  • any other diameters of the guide pin 310 and/or the drill bit may be used.
  • the glenoid guide pin 310, the driver 312 may be used first to create a pilot opening in the liner 320.
  • a larger drill bit e.g., 3mm
  • any other way of creating the opening in the liner 320 may be used.
  • one or more screws 402 may be threaded through the opening.
  • the screw 402 may be positioned on a top surface of the created opening 412 in the liner 320. Once positioned, the screw 402 may be threaded through the opening 412 until it reaches a bottom surface of the well 408 (e.g., a morse taper) of the stem 301. The screw 7 402 may continue to be threaded through the opening 412 until the liner 320 is forced from the stem 301.
  • the bottom of the well 408 creates a stop surface for the screw 402 and applies a counterforce to the screw 412, thereby causing the threads of the screw 7 402 positioned in the liner 320 to apply a force (in a direction away from the interior cavity 406 and the well 408 of the stem 301) to the liner 320 to push and release it from the stem 301, as shown in FIG. 10B.
  • a force in a direction away from the interior cavity 406 and the well 408 of the stem 301
  • the screw 402 may have a diameter that is smaller than the interior diameter of the well 408 of the stem 301. This will avoid damage to the interior surfaces of the cavity 406 and the w ell 408 (except the bottom surface of the w ell). Further, the screws 402 may have a length that may be longer than the depth of the entire cavity 406 (including the depth of the well 408). In some examples, the screw- may be 30 mm long. The diameter of the screw may be slightly larger than the opening 412. For example. the screw 402 may have a 4.5 mm diameter. As can be understood, any other dimensions for the screw 402 may be used.
  • FIG. 11 illustrates an example process 500 for removal of a liner from a stem of an implant, according to some examples of the current subject matter.
  • the process 500 may be performed to remove the liner 320 from the stem 320 (as shown in FIGS. 9A-10B).
  • an osteotomy sizer that approximates the diameter of the liner 320 may be selected.
  • sizer 306, as shown in FIG. 9A can be selected.
  • the surgeon and/or any other medical professional
  • another sizer 306 may be selected and positioned on the liner to determine whether or not it is a proper fit. Once the sizer 306 is selected, the sizer may be centrally positioned on the top surface of the liner 320, e.g., as shown in FIG. 9A.
  • an opening in the liner 320 may be drilled through the center of the osteotomy sizer 306.
  • the glenoid guide pin 310 and/or a drill bit (using a drill) may be used to create an opening through the liner 320.
  • the pin 310 and/or the drill bit may be selected to be smaller than an interior diameter of the well 408 of the stem 301 (as shown in FIGS. 9A-10B).
  • the opening may be created in two stages: first, a pilot opening may be created using the glenoid guide pin, and second, a through opening may be created using a drill bit that may have a larger diameter than the guide pin.
  • a screw may be positioned into the drilled opening.
  • screw 402 may be positioned into the opening 412 of the liner 320, in a positioning step 506. Then, the screw may be threaded through the opening until it contacts a bottom of the stem' s well. Threading of the screw 402 through the liner 320 may continue until the tip of the screw 402 reaches the bottom of the well 408 of the stem 301.
  • a threading step 508 threading of the screw through the opening may continue until the liner disengages from the stem.
  • threading of the screw 402 may cause the screw 402 to push up against the bottom of the well 408.
  • Continuous threading of the screw may generate a pushing force that translates along the screw’s length to cause the screw’s threads engaged in the liner 320 to push on the liner 320 and release it from the stem’s cavity 406, as shown in FIG. 10B.
  • the liner and the screw may be removed in a removal step 510.
  • connection references e.g., engaged, attached, coupled, connected, and joined
  • connection references are to be construed broadly and can include intermediate members between a collection of elements and relative to movement between elements unless otherwise indicated. As such, connection references do not necessarily infer that two elements are directly connected and in fixed relation to each other. All rotational references describe relative movement between the various elements.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)

Abstract

L'invention concerne des systèmes et des procédés d'arthroplastie de l'épaule comprenant une tige (101) ayant une partie proximale (103), une partie distale (102) et un corps (110) agencé entre la partie proximale et la partie distale, la partie proximale comprenant une cavité (104) s'étendant vers le corps. Le système comprend en outre un revêtement (120) conçu pour être accouplé à l'intérieur de la cavité de la tige. La tige comprend une ou plusieurs saillies (111) s'étendant à partir d'une base (114) de la cavité, chaque saillie ayant un profil qui s'effile d'une première largeur (tl) au niveau de la base à une deuxième largeur (t2) qui est plus étroite que la première. Le revêtement comprend un ou plusieurs évidements (121), chaque évidement étant conçu pour recevoir à l'intérieur de celui-ci l'une des saillies et chaque évidement ayant une largeur qui est plus étroite que la première largeur et plus large que la deuxième.
PCT/US2024/032512 2023-06-13 2024-06-05 Saillies coniques sur tige d'implant d'arthroplastie Pending WO2024258699A1 (fr)

Applications Claiming Priority (6)

Application Number Priority Date Filing Date Title
US202363472692P 2023-06-13 2023-06-13
US63/472,692 2023-06-13
US202363524243P 2023-06-30 2023-06-30
US63/524,243 2023-06-30
US202363547432P 2023-11-06 2023-11-06
US63/547,432 2023-11-06

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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20190380839A1 (en) * 2014-12-10 2019-12-19 Tornier Convertible stem / fracture stem
US20210038401A1 (en) * 2018-03-12 2021-02-11 Shoulder Innovations, Inc. Convertible total shoulder prosthesis
US20210212837A1 (en) * 2016-04-19 2021-07-15 Imascap Sas Pre-operatively planned humeral implant and planning method
WO2022189532A1 (fr) * 2021-03-12 2022-09-15 Limacorporate S.P.A. Prothèse d'épaule inversée modulaire

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20190380839A1 (en) * 2014-12-10 2019-12-19 Tornier Convertible stem / fracture stem
US20210212837A1 (en) * 2016-04-19 2021-07-15 Imascap Sas Pre-operatively planned humeral implant and planning method
US20210038401A1 (en) * 2018-03-12 2021-02-11 Shoulder Innovations, Inc. Convertible total shoulder prosthesis
WO2022189532A1 (fr) * 2021-03-12 2022-09-15 Limacorporate S.P.A. Prothèse d'épaule inversée modulaire

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