# US 8,784,495 B2 · Segmental knee arthroplasty

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- Number: US 8,784,495 B2
- Document ID: US8784495B2
- Status: Granted
- Kind: B2
- Application number: 12/795,935
- Filed: 2010-06-08
- Published: 2010-12-09
- Granted: 2014-07-22
- Earliest claimed: 2000-01-14
- Assignees: Bonutti Skeletal Innovations LLC
- Applicants: Peter M. Bonutti
- Inventors: Peter M. Bonutti
- Web page: https://patentgrep.com/patent/US8784495B2

## CPC

- A61B 17/157: {Cutting tibia}
- A61B 17/025: {Joint distractors}
- A61B 17/0401: {Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors (A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811)}
- A61B 17/155: {Cutting femur}
- A61B 17/158: {Cutting patella}
- A61B 17/1666: {for the acetabulum}
- A61B 17/1668: {for the upper femur (A61B17/164 takes precedence)}
- A61B 17/1675: {for the knee}
- A61B 17/1703: {using imaging means, e.g. by X-rays}
- A61B 17/1717: {for applying intramedullary nails or pins}
- A61B 17/1721: {for applying pins along or parallel to the axis of the femoral neck}
- A61B 17/1746: {for the acetabulum}
- A61B 17/1764: {for the knee}
- A61B 17/809: {with bone-penetrating elements, e.g. blades or prongs (bone staples A61B17/0642; intramedullary nails with a plate at an end A61B17/7233)}
- A61B 34/10: Computer-aided planning, simulation or modelling of surgical operations
- A61B 34/20: Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- A61B 34/30: Surgical robots
- A61B 46/00: Surgical drapes
- A61B 90/13: guided by light, e.g. laser pointers
- A61F 2/0077: {Special surfaces of prostheses, e.g. for improving ingrowth (A61F2/30767 takes precedence)}
- A61F 2/30767: {Special external or bone-contacting surface, e.g. coating for improving bone ingrowth}
- A61F 2/38: for elbows or knees
- A61F 2/3836: {Special connection between upper and lower leg, e.g. constrained}
- A61F 2/3859: {Femoral components}
- A61F 2/3868: {with sliding tibial bearing}
- A61F 2/3877: {Patellae or trochleae}
- A61F 2/389: {Tibial components (A61F2/3868 takes precedence)}
- A61F 2/461: {of knees}
- A61G 13/0045: {specially adapted for hand or wrist surgeries}
- A61G 13/0054: {specially adapted for back or spinal surgeries}
- A61G 13/0063: {specially adapted for knee surgeries}
- A61G 13/0072: {specially adapted for shoulder surgeries}
- A61G 13/0081: {specially adapted for hip surgeries}
- A61B 17/1604: {Chisels; Rongeurs; Punches; Stamps}
- A61B 17/8095: {Wedge osteotomy devices}
- A61B 42/00: Surgical gloves; Finger-stalls specially adapted for surgery; Devices for handling or treatment thereof
- A61B 90/30: Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
- A61B 90/361: {Image-producing devices, e.g. surgical cameras}
- A61B 90/37: {Surgical systems with images on a monitor during operation}
- A61B 2017/00004: {(bio)absorbable, (bio)resorbable or resorptive}
- A61B 2017/00557: {inflatable (A61B2017/22051 takes precedence)}
- A61B 2017/0268: {for the knee}
- A61B 2017/1602: {Mills}
- A61B 2017/564: {Methods for bone or joint treatment}
- A61B 2034/102: {Modelling of surgical devices, implants or prosthesis}
- A61B 2034/105: {Modelling of the patient, e.g. for ligaments or bones}
- A61B 2034/107: {Visualisation of planned trajectories or target regions}
- A61B 2034/2055: {Optical tracking systems}
- A61B 2046/201: {for extremities, e.g. having collection pouch}
- A61B 2046/205: {Adhesive drapes}
- A61B 2046/236: {with means for collecting drain fluid, e.g. drain tubes}
- A61B 2090/064: {for measuring force, pressure or mechanical tension}
- A61B 2090/366: {using projection of images directly onto the body}
- A61B 2090/376: {using X-rays, e.g. fluoroscopy}
- A61B 2217/005: with suction drainage system
- A61B 2217/007: with irrigation system
- A61F 2/30721: {Accessories}
- A61F 2/30724: {Spacers for centering an implant in a bone cavity, e.g. in a cement-receiving cavity}
- A61F 2/30771: {applied in original prostheses, e.g. holes or grooves}
- A61F 2/34: Acetabular cups
- A61F 2/3872: {Meniscus for implantation between the natural bone surfaces}
- A61F 2/4609: {of acetabular cups}
- A61F 2/4684: {Trial or dummy prostheses}
- A61F 2002/2817: {Bone stimulation by chemical reactions or by osteogenic or biological products for enhancing ossification, e.g. by bone morphogenetic or morphogenic proteins [BMP] or by transforming growth factors [TGF]}
- A61F 2002/2825: {Femur}
- A61F 2002/2835: {Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material}
- A61F 2002/30079: {magnetic}
- A61F 2002/30326: {differing in height or in length}
- A61F 2002/30331: {made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit}
- A61F 2002/30364: {Rotation about the common longitudinal axis}
- A61F 2002/30387: {Dovetail connection}
- A61F 2002/30398: {Sliding}
- A61F 2002/30433: {using additional screws, bolts, dowels, rivets or washers e.g. connecting screws}
- A61F 2002/30507: {using a threaded locking member, e.g. a locking screw or a set screw}
- A61F 2002/30761: {Support means for artificial cartilage, e.g. cartilage defect covering membranes}
- A61F 2002/30883: {dovetail-shaped}
- A61F 2002/30892: {parallel}
- A61F 2002/3092: {having an open-celled or open-pored structure}
- A61F 2002/30934: {Special articulating surfaces}
- A61F 2002/30975: {made of two halves}
- A61F 2002/3401: {with radial apertures, e.g. radial bores for receiving fixation screws}
- A61F 2002/3403: {Polar aperture}
- A61F 2002/3895: {unicompartimental}
- A61F 2002/4631: {the prosthesis being specially adapted for being cemented}
- A61F 2002/4635: {using minimally invasive surgery}
- A61F 2002/4677: {using a guide wire}
- A61F 2210/009: magnetic
- A61F 2220/0025: Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F 2220/0033: made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
- A61F 2220/0041: using additional screws, bolts, dowels or rivets, e.g. connecting screws
- A61F 2250/0037: differing in height or in length
- A61F 2310/00011: Metals or alloys
- A61F 2310/00017: Iron- or Fe-based alloys, e.g. stainless steel
- A61F 2310/00023: Titanium or titanium-based alloys, e.g. Ti-Ni alloys
- A61F 2310/00029: Cobalt-based alloys, e.g. Co-Cr alloys or Vitallium
- A61F 2310/00131: Tantalum or Ta-based alloys
- A61F 2310/00365: Proteins; Polypeptides; Degradation products thereof
- A61G 13/1245: {Knees, upper or lower legs}
- A61G 13/125: {Ankles or feet}
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)
- 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)
- A61G: TRANSPORT, PERSONAL CONVEYANCES OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS (appliances for aiding patients or disabled persons to walk A61H3/00); OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES (embalming corpses A01N1/00)

## Abstract

A method for unicompartmental knee replacement. Replacement of a medial or lateral compartment may be through a limited incision and patellofemoral replacement may be through the same incision or another incision. An embodiment may include a trochlear implant and medial implant. Implants may be dimensioned and configured so that bone is located between the implants. Implants may be modular, being assembled inside the body or outside the body prior to implantation.

## Claims

### Claim 1

A method for segmental, unicompartmental replacement of at least two portions of a knee joint, the method comprising:
identifying at least two of a medial joint articulation surface, lateral joint articulation and trochlear joint articulation surface of a femur;
selecting at least two joint replacement components configured for alignment relative to each other and configured to replace at least part of the at least two articulations surfaces of the femur; and
replacing at least two of the medial, lateral, and trochlear joint articulation surfaces of the femur with the at least two joint replacement components, wherein the at least two joint replacement components are proximate each other on the same femur.

### Claim 2 (depends on 1)

The method of claim 1, wherein the replacing act includes the use of a custom jig based on patient specific information.

### Claim 3 (depends on 1)

The method of claim 1, wherein the replacing act includes the use of an extramedullary instrument.

### Claim 4 (depends on 1)

The method of claim 1, wherein the replacing act includes the use of an intramedullary instrument.

### Claim 5 (depends on 1)

The method of claim 1, wherein at least one of the joint replacement components is at least partially inset in at least one of the joint surfaces.

### Claim 6 (depends on 1)

The method of claim 1, wherein the replacing act includes the use of a robotic instrument.

### Claim 7 (depends on 1)

The method of claim 1, wherein at least a portion of the medial, lateral, and trochlear joint surfaces are replaced.

### Claim 8 (depends on 1)

The method of claim 1, wherein the replacing act includes sparing at least a portion of an anterior cruciate ligament.

### Claim 9 (depends on 1)

The method of claim 1, wherein the replacing act includes sparing at least a portion of a posterior cruciate ligament.

### Claim 10 (depends on 1)

The method of claim 1, wherein the replacing act includes the use of imaging guidance.

### Claim 11 (depends on 1)

The method of claim 1, wherein the replacing act includes the use of computer navigation.

### Claim 12 (depends on 1)

The method of claim 1, wherein the replacing act includes alignment of mechanical axis.

### Claim 13 (depends on 1)

The method of claim 1, wherein the replacing act includes alignment of rotation.

### Claim 14 (depends on 1)

The method of claim 1, wherein the replacing act includes alignment of flexion and extension.

### Claim 15 (depends on 1)

The method of claim 1, wherein the replacing act includes alignment of at least two axes of deformity.

### Claim 16 (depends on 1)

The method of claim 1, wherein the replacing act includes removing at least a portion of at least one of the medial, lateral, and trochlear joint surfaces.

### Claim 17 (depends on 1)

The method of claim 1, wherein the replacing act includes sawing at least a portion of at least one joint surface and milling at least a portion of at least one joint surface.

### Claim 18 (depends on 1)

The method of claim 1, wherein a patella is not surfaced.

### Claim 19 (depends on 1)

The new method of claim 1, further comprising making an incision proximate the knee joint, wherein the incision is made medial to patella.

### Claim 20 (depends on 1)

The method of claim 1, further comprising making an incision proximate the knee joint, wherein the incision is made lateral to a patella.

### Claim 21 (depends on 1)

The method of claim 1, further comprising making an incision proximate the knee joint, wherein the incision has a length of between approximately 7 cm and 13 cm of less.

### Claim 22 (depends on 1)

The method of claim 1, wherein the knee joint is positioned in flexion for at least a portion of the method, by supporting an upper portion of the leg substantially horizontally and allowing a lower portion of the leg to suspend substantially vertically.

### Claim 23 (depends on 1)

The method of claim 1, further comprising cutting an anterior surface of the femur generally parallel to an epicondylar axis, to define a generally flat anterior cut surface, with the patella offset to one side.

### Claim 24 (depends on 1)

The method of claim 1, wherein a patella is moved to an everted orientation.

### Claim 25 (depends on 1)

The method of claim 1, further comprising examining an inner surface of a patella.

### Claim 26 (depends on 1)

The method of claim 1, wherein a patella is moved to a lateral side of the knee joint.

### Claim 27 (depends on 1)

The method of claim 1, wherein a patella is moved to a position offset from the incision.

### Claim 28 (depends on 1)

The method of claim 1, further comprising making an incision proximate the knee joint and elastically expanding the incision.

### Claim 29 (depends on 28)

The method of claim 28, wherein a patella is moved after the incision is elastically expanded.

### Claim 30

The method for segmental, unicompartmental replacement of at least two portions of a knee joint, the method comprising:
placing an instrument configured to align at least two of a trochlear portion, medial portion, and lateral portion of the knee joint;
removing at least part of at least two of the trochlear, medial, and lateral portions of a femur;
positioning a first arthroplasty component adjacent at least one of the medial and lateral portions and a second arthroplasty component adjacent the trochlear portion, wherein the instrument positions the first and second arthroplasty components for alignment relative to each other and for replacing at least a part of an articulation surface of the at least one of the medial and lateral portions and the trochlear portion of the femur; and
positioning the first and second arthroplasty components proximate one another on the same femur.