# US 11,298,245 B2 · Method for surgical application of a glenoid prosthesis component of a shoulder joint prosthesis and relating surgical instruments

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- Number: US 11,298,245 B2
- Document ID: US11298245B2
- Status: Granted
- Kind: B2
- Application number: 15/872,303
- Filed: 2018-01-16
- Published: 2019-07-18
- Granted: 2022-04-12
- Earliest claimed: 2018-01-16
- Assignees: Limacorporate S.P.A.
- Applicants: Limacorporate S.P.A.
- Inventors: Paul Paterson; Michele Pressacco; Andrea Fattori; Marco Dosso
- Web page: https://patentgrep.com/patent/US11298245B2

## CPC

- A61F 2/4612: {of shoulders}
- A61B 17/16: Instruments for performing osteoclasis; Drills or chisels for bones; Trepans {(arthroscopic bone cutters A61B17/320016)}
- A61B 17/1615: {Drill bits, i.e. rotating tools extending from a handpiece to contact the worked material}
- A61B 17/1659: {Surgical rasps, files, planes, or scrapers}
- A61B 17/1684: {for the shoulder}
- A61B 17/1778: {for the shoulder}
- A61F 2/30749: {Fixation appliances for connecting prostheses to the body}
- A61F 2/40: for shoulders
- A61F 2/4059: {Humeral shafts}
- A61F 2/4081: {Glenoid components, e.g. cups}
- A61F 2/4601: {for introducing bone substitute, for implanting bone graft implants or for compacting them in the bone cavity}
- A61B 17/02: for holding wounds open, e.g. retractors; Tractors
- A61F 2/4014: {Humeral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic humeral shafts}
- A61F 2002/30332: {Conically- or frustoconically-shaped protrusion and recess}
- A61F 2002/30405: {made by screwing complementary threads machined on the parts themselves}
- A61F 2002/30878: {with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts}
- A61F 2220/0008: Fixation appliances for connecting prostheses to the body
- A61F 2220/0025: Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- 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 (dental prosthetics A61C)
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)

## Abstract

The invention relates to a method for surgical application of a glenoid anchor of a shoulder joint prosthesis and instruments advantageously used in the method. The method includes making a delto-pectoral incision providing a delto-pectoral access to a shoulder joint; with the delto-pectoral access being suitable for inserting at least one machining tool; and making a trans-deltoid incision providing a trans-deltoid access to the humeral head; with the trans-deltoid access being suitable for inserting a stem of a machining instrument to be mounted on the machining tool for machining the glenoid cavity.

## Claims

### Claim 1

A method for surgical application of a glenoid anchor or a glenoid prosthesis component of a shoulder joint prosthesis, comprising:
making a delto-pectoral incision providing a delto-pectoral access to a shoulder joint, the shoulder joint comprising a humeral head of a humerus facing a glenoid cavity of a shoulder blade;
inserting a machining tool in the delto-pectoral access;
making a trans-deltoid lateral incision providing a trans-deltoid lateral access to the humeral head;
inserting a stem of a machining instrument in the trans-deltoid lateral access;
mounting the machining tool on the stem of the machining instrument; and
machining, with the machining tool, the glenoid cavity.

### Claim 2 (depends on 1)

The method according to claim 1 further comprising:
exposing the humeral head dislocating the humerus by an external rotation of the arm;
making a through trans-humeral hole into the humeral head extending in medio-lateral direction;
returning the humeral head facing the glenoid cavity;
providing a retractor instrument introduced through the delto-pectoral access the retractor instrument having an abutting element at least partially abutting against the humeral head and the shoulder blade keeping free the trans-humeral hole and the glenoid cavity;
keeping, with the retractor instrument, a predetermined glenohumeral clearance between the humeral head and the glenoid cavity;
providing the machining tool in the glenohumeral clearance introduced through the delto-pectoral access;
introducing the stem of a machining instrument through the trans-deltoid lateral access and then the trans-humeral hole until a stem free end of the stem reaches the glenohumeral clearance;
mounting the machining tool on the stem free end for machining the glenoid cavity.

### Claim 3 (depends on 2)

The method according to claim 2, wherein the step of making a through trans-humeral hole in the humeral head comprises:
providing a guidewire;
providing a cannulated centering device having a centering device guide passage for the guidewire and an abutting portion for abutting against a humeral head top of the humeral head;
abutting the abutting portion against the humeral head top orienting the centering device guide passage in medio-lateral direction;
introducing the guidewire through the centering device guide passage inserting a guidewire tip into the humeral head;
guiding, with the guidewire, a cannulated drill bit; and
drilling the humeral head by the cannulated drill bit using the guidewire as guide.

### Claim 4 (depends on 3)

The method according to claim 3 further comprising resecting the humeral head top.

### Claim 5 (depends on 4)

The method according to claim 4, wherein before the step of inserting the stem of the machining instrument through the trans-deltoid lateral access the method comprises a step of:
providing a cannulated guide retractor introduced through the trans-deltoid lateral access; the cannulated guide retractor having an instrument guide passage therethrough connecting the trans-deltoid lateral incision to the trans-humeral hole;
wherein the step of introducing the stem of the machining instrument comprises introducing the stem through the instrument guide passage of the cannulated guide retractor.

### Claim 6 (depends on 5)

The method according to claim 5, wherein the cannulated guide retractor comprises a retracting portion, and the method further comprising:
providing a cannulated guide retractor; and
retracting soft tissues located between the trans-deltoid lateral incision and the trans-humeral hole by the retracting portion of the cannulated guide retractor.

### Claim 7 (depends on 6)

The method according to claim 6, wherein the cannulated guide retractor comprises an insertion portion, and the method further comprising:
at least partially inserting the insertion portion into the trans-humeral hole;
passing the insertion portion through the instrument guide passage; and
at least partially introducing the insertion portion into the trans-humeral hole by a cannulated guide retractor.

### Claim 8 (depends on 7)

The method according to claim 7, wherein the machining tool is a cannulated machining tool having a longitudinal machining tool passage therethrough; and before the step of inserting the stem of the machining instrument, the method comprises:
introducing the guidewire through the trans-deltoid lateral access, the instrument guide passage and then the longitudinal machining tool passage until the guidewire tip is inserted into the glenoid cavity; and
wherein the step of introducing the stem of the machining instrument comprises using the guidewire to guide the stem insertion.

### Claim 9 (depends on 8)

The method according to claim 8, wherein the machining tool comprises a radial slot passing from an outer side of the machining tool to the longitudinal machining tool passage; and the method further comprises:
decoupling the stem from the machining tool; and
extracting the machining tool by passing the guidewire through the radial slot.

### Claim 10 (depends on 9)

The method according to claim 9, wherein the machining tool is a milling tool for milling the glenoid cavity exposing the subchondral bone; and the method further comprises:
providing a cannulated reamer into the glenohumeral clearance through the delto-pectoral access;
making a hole, with the cannulated reamer, into the glenoid cavity for a peg of the glenoid anchor; the cannulated reamer having a longitudinal reamer passage therethrough and a reamer radial slot extending from an outer side of the reamer to the longitudinal reamer passage;
transversally inserting the guidewire into the longitudinal reamer passage through the reamer radial slot;
mounting the reamer on the stem free end; and
making the peg hole into the glenoid cavity.

### Claim 11 (depends on 10)

The method according to claim 10 further comprising:
providing a glenoid anchor comprising a peg extending from a baseplate;
partially inserting the peg into the peg hole;
providing an impactor comprising an impactor stem and an impactor head;
abutting the impactor head inserted through the delto-pectoral access against the baseplate;
inserting the impactor stem through the trans-deltoid lateral access and the instrument guide passage until an impactor stem free end reaches the glenohumeral clearance;
mounting the impactor head on the impactor stem free end; and
fitting the peg into the peg hole medially pushing the impactor in direction of the glenoid cavity.

### Claim 12 (depends on 11)

The method according to claim 11, wherein the peg and the baseplate are two separated pieces; the baseplate having a lug adapted to be inserted into an internal cavity of the peg; the baseplate having a baseplate passage extending through the lug; the impactor stem having a impactor stem guide passage therethrough and the impactor head having a impactor head guide passage therethrough; the impactor stem guide passage and the impactor head guide passage being in communication when the impactor head is mounted to the impactor stem free end; before providing an impactor, the method further comprises partially inserting the lug into the peg; and before the step of fitting the peg into the peg hole, the method comprises:
providing a tightening rod having a rod threaded end and a rod coupling end;
inserting the rod threaded end through the impactor stem guide passage, the impactor head guide passage and the baseplate passage;
threading the rod threaded end into an internal thread of the internal cavity of the peg leaving the rod coupling end outside of the impactor stem;
providing a torque wrench mounted to the rod coupling end;
fitting the lug of the baseplate into the peg tightening the rod threaded end of the tightening rod into the peg; wherein the tightening of the rod threaded end is achieved applying a torque to the rod coupling end with the torque wrench using the impactor has counter torque.

### Claim 13 (depends on 12)

The method according to claim 12, wherein the baseplate comprises a through baseplate hole to fasten the baseplate to the glenoid cavity by bone screws; and the method further comprises making a screw hole into the glenoid cavity for the insertion of the bone screws inserting a drill bit through the trans-deltoid lateral access, the instrument guide passage and then the baseplate hole.

### Claim 14 (depends on 13)

The method according to claim 13 further comprising:
providing a bone graft from the resected humeral head top; and
introducing the bone graft into the through trans-humeral hole.