CA2196696C - Asymmetric femoral prosthesis - Google Patents
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- CA2196696C CA2196696C CA002196696A CA2196696A CA2196696C CA 2196696 C CA2196696 C CA 2196696C CA 002196696 A CA002196696 A CA 002196696A CA 2196696 A CA2196696 A CA 2196696A CA 2196696 C CA2196696 C CA 2196696C
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Abstract
A knee prosthesis includes a femoral prosthesis member (60) having anterior (12), distal (15), and posterior (13, 14) articulating surface portions. The articulating surface portions comprising a pair of condylar surface portions (13, 14, 61, 62) that are positioned at differing distances from the non-articulating surface plane. In one form the posterolateral articulating surface is a greater distance away from the anterior non-articulating surface than the posteromedial articulating surface (Figs. 1 and 15). The femoral prosthesis has a non-articulating surface that includes a plurality of intersecting surfaces including at least distal (23, 24), anterior (17, 18), and posterior (20, 21) surfaces for receiving the patient's distal femur after it has been surgically prepared. A
tibial component (50) has concave articulating surfaces that receive the femoral component articulating surface portions during use.
The angle of femoral rotation generally about the mechanical axis generally changes when going through a normal range of motion of the patient's knee while maintaining alignment of the femoral and tibial articular surfaces. The femoral prosthesis also has a proximal anterior region (65) that is concave (Fig. 19). An improved patella groove design is also shown (Figs. 20-24).
tibial component (50) has concave articulating surfaces that receive the femoral component articulating surface portions during use.
The angle of femoral rotation generally about the mechanical axis generally changes when going through a normal range of motion of the patient's knee while maintaining alignment of the femoral and tibial articular surfaces. The femoral prosthesis also has a proximal anterior region (65) that is concave (Fig. 19). An improved patella groove design is also shown (Figs. 20-24).
Description
ASYMMETRIC FEMORAL PROSTHESIS
The present invention relates to a medical prosthetic device and more particularly to an orthopedic medical prosthetic device. Even more particularly, the present invention relates to an improved asymmetric knee prosthesis and method of surgically implanting same wherein the prosthetic medial femoral condyles include a thinner medial posterior condyle and a thicker lateral posterior condyle, resulting in an elevation of the posterior medial femur joint line with the knee in flexion. The present invention also has a concave proximal anterior region.
Arthroplasty is the making of an artificial joint. In total knee arthroplasty there is a difficulty in reproducing the exact anatomy. The tibia is usually cut at ninety degrees (90°) to its axis in the frontal plane but the tibial plateau is at about eighty seven degree (87°). The disparity is due to the difficulty in accurately reproducing an eighty seven degrees (87°) cut. Also, it has been documented that with an eighty seven degrees (87°) or varus cut the tibial component has a tendency to loosen. (Proceedings of the Knee Society 1985-1986, Laskin, Varus Knee deformity). (Surgery of the Knee, 6nsall et al, 1993).
With a ninety degree (90°) cut, more bone is removed on the lateral side than on the medial side of the tibia. Neutral is defined as, parallel to a fine tangent to the intact (not wom) posterior femoral condyles. When neutral femoral cuts are performed, and implants with equal medial and lateral thicknesses are used, there is a laxity of the lateral collateral ligament at ninety degrees (90°) of flexion. The lateral collateral ligament is lax in flexion because the resection of the tibia and the posterior resection of the femur are not parallel, but the prosthesis implanted has equal medial and lateral thicknesses on the tibial component and posterior condyles of the femoral component. This results in less space on the medial side and more space on the lateral side, which causes unbalanced ligaments.
The current solution to this problem is to rotate the cutting block so that more bone is removed from the posterior medial femoral condyle, this is referred to as external rotation. By externally rotating (clockwise rotation for a left knee when viewed from the distal end), the posterior femoral resection is parallel to the WO 96103939 PCT/US95109705~
The present invention relates to a medical prosthetic device and more particularly to an orthopedic medical prosthetic device. Even more particularly, the present invention relates to an improved asymmetric knee prosthesis and method of surgically implanting same wherein the prosthetic medial femoral condyles include a thinner medial posterior condyle and a thicker lateral posterior condyle, resulting in an elevation of the posterior medial femur joint line with the knee in flexion. The present invention also has a concave proximal anterior region.
Arthroplasty is the making of an artificial joint. In total knee arthroplasty there is a difficulty in reproducing the exact anatomy. The tibia is usually cut at ninety degrees (90°) to its axis in the frontal plane but the tibial plateau is at about eighty seven degree (87°). The disparity is due to the difficulty in accurately reproducing an eighty seven degrees (87°) cut. Also, it has been documented that with an eighty seven degrees (87°) or varus cut the tibial component has a tendency to loosen. (Proceedings of the Knee Society 1985-1986, Laskin, Varus Knee deformity). (Surgery of the Knee, 6nsall et al, 1993).
With a ninety degree (90°) cut, more bone is removed on the lateral side than on the medial side of the tibia. Neutral is defined as, parallel to a fine tangent to the intact (not wom) posterior femoral condyles. When neutral femoral cuts are performed, and implants with equal medial and lateral thicknesses are used, there is a laxity of the lateral collateral ligament at ninety degrees (90°) of flexion. The lateral collateral ligament is lax in flexion because the resection of the tibia and the posterior resection of the femur are not parallel, but the prosthesis implanted has equal medial and lateral thicknesses on the tibial component and posterior condyles of the femoral component. This results in less space on the medial side and more space on the lateral side, which causes unbalanced ligaments.
The current solution to this problem is to rotate the cutting block so that more bone is removed from the posterior medial femoral condyle, this is referred to as external rotation. By externally rotating (clockwise rotation for a left knee when viewed from the distal end), the posterior femoral resection is parallel to the WO 96103939 PCT/US95109705~
ninety degree (90°) tibia) cut. This results in the collateral ligaments being balanced in extension and flexion when the prosthesis is implanted. The current industry standard is three degrees (3°) of external rotation which corresponds to .
the three degree (3°) difference between the eighty seven degree (87°) , anatomical angle of the tibia) plateau and the ninety degree (90°) angle of the tibia) resection.
The benefits of this surgical procedure have been mentioned but there are some drawbacks. The femoral component is no longer aligned with the tibia) component in full extension. The femoral component is rotated about three degrees (3°) with respect to the tibia when it is aligned parallel to the lateral plane. This malalignment potentially could cause increased wear of the tibia) insert. A possible solution to this malalignment could be to externally rotate the tibia) component, but this would result in reduced tibia) coverage, which is not desired. Another possible solution may be to design the insert at an angle, but both turning the tibia) tray externally or designing it into the insert have the problem of malalignment in flexion. With externally rotating the femoral component, there will be malalignment with the tibia) insert either in flexion or extension whether the tibia) tray or tibia) insert is aligned straight or externally rotated.
A second problem with traditional external rotation is the chance of notching the lateral anterior femoral cortex. "Notchlng° occurs when more none Is removed anterolaterally than with the neutral resections resulting in a notch being created in the anterior cortex of the femur. Notching greatly increases the chances of the femur fracturing. A related problem to this is poor anteromedial implant coverage or even a gap between the implant and bone. In order to reduce the chances of notching anteriorly, the lateral side is placed flush with the cortex and a gap develops between the implant and bone anteromedially.
Another problem with traditional external rotation is the increased complexity and difficulty in instrumentation. The alignment of the cutting blocks must be variable and there is a different setup for left and right knees.
Also, it can be difficult to accurately judge three degrees (3°) of external rotation when performing the surgery.
WO 96103939 2 ~ 9 6 6 9 6 PCT/U595/09705 Currently there are both symmetric and asymmetric femoral components available. The symmetric components all have a patella femoral groove that is located along the centerline of the component. The asymmetric components typically have a patella femoral groove which is angled but still straight.
The GENESIS knee, available from Smith & Nephew Richards Inc. is an example of this type of asymmetric femoral design. The problem with femoral components which have either design is that the patella tends to sublux laterally or to the pull toward the lateral side. This is because the patella groove is located on the centerline of the component and this is a medial to where the anatomical patella groove is located. Even with an angled patella grrove toward the lateral side the patella does not get to track a far lateral as it does normally. Most traditional femoral components have a thicker lateral anterior flange. This causes tension in the lateral retinaa~larwhich pulls.the patella lateral. The current surgical solution is a soft tissue release to allow the patella to track properly.
With external rotation, the patella tracking is altered. By rotating the component as described, the lateral anterior flange is lowered and the patella groove is sliifted laterally. This helps in reducing the tension in the lateral retinacular and to help locate the patella groove in a more anatomical lateral position. From zero degrees (0°) to ninety degrees (90°) of flexion benefits have been found because of lateralizing the patella in this flexion range. However, after ninety degrees (90°) of flexion, the patella will be medialized which can inaease the lateral force and shear force on the patella. This can lead to higher stresses at the bone implant intertace and lead to more wear of the patella implant on the patella.
Current femoral prosthesis have convex proximal anterior regions from a lateral view. This results in.the patella andlor ligaments being displaced anteriorly. By having a concave anterior region, the patella and the ligaments are displaced anteriorly less because there is less metal in the concave region.
This more closely resembles the anatomical femur and helps to improve patella tracking.
The objectives of the present invention are to balance the flexion and extension space, maintain proper alignment with the tibia, and to not notch the c anterior femoral cortex when a ninety degree (90°) tibial resection and symmetric thickness tibial component is used. A further object of the present invention is to provide an improved femoral prosthesis which allows proper patella tracking during a normal range of knee movement.
Tfie present invention provides an improved asymmetric femoral prosthesis for use in total knee arthroplasty and an improved method of implanting a femoral prosthesis on a patient's distal femur.
According to the invention, a knee prosthesis comprises a femoral component having an anterior articulating surface and distal and posterior mtiarlating portions comprising lateral and medial condylar surfaces and an internal non-articulating surface; and a tibial component having concave articulating surfaces that receive the articulating surfaces of the femoral component during use; wherein the distance between the internal non-articulating surface and the articulating of the lateral condylar portion is different from the distance between the internal non-articulating surface and the articulating surface of the medial condylar portion of the femoral component over at least a part of the articulating surface of the femoral component, whereby the angle of femoral rotation about the madianical axis changes when going through a normal rage of motion of the knee.
According to one aspect of the present invention, there is provided a knee prosthesis comprising: (a) a femoral component having distal and posterior articulating surface portions comprising lateral and medial condylar surfaces and internal non-articulating surfaces; and (6) a tibial component having concave articulating surfaces that receive the articulating surfaces of the femoral component during use, wherein the distance between the internal non-articulating surface and the posterior articulating surface of the lateral condylar surface is greater than the distance between the internal non-articulating surface and the posterior articulating surface of the media! condylar surface of the femoral component over the -posterior but not the distal surface of the articulating surface of the femoral component, whereby an angle of femoral rotation about a femoral mechanical axis changes when going through a normal range of motion of the knee.
According to a further aspect of the present invention, there is provided a knee prosthesis according to the above described one aspect, wherein the femoral component further comprises an anterior articulating surface which, in use, articulates with a patella component or natural patella of the knee; wherein a centerline of the femoral component is defined centrally between the distal condyles of the component; said femoral component has a patella groove in its anterior articulating surface within which said patella component may track during normal articulating motion of the knee; the longitudinal axis of said groove being located laterally with respect to said centerline in a superior region of the anterior articulating surface and curving in a medial direction in the distal region of the anterior articulating surtace of the femoral component.
According to another aspect of the present invention, there is provided a knee prosthesis according to the above described one aspect, wherein the femoral component further comprises an anterior articulating surface portion, where an anterior proximal portion has an arc center that is anterior to the anterior surtace portion; wherein the femoral component is concave in an anterior proximal region in a lateral view.
The preferred embodiment includes a femoral prosthesis having anterior, distal, and posterior articulating surface portions. The posterior articulating surtace portions include a pair of condylar surfaces that are positioned at differing distances from the anterior non-articulating or internal surtace portion. The posterolateral articular surface is a greater distance from the anterior non-articulating surtace than the posteromedial side. The medial and lateral articular surfaces in the distal region are the same distance from a tine transverse to the component.
The femoral prosthesis has an internal non-articulating surface that includes a plurality of surtaces for receiving a resected distal femur. Preferably, the non-articulating surtace includes distal, anterior and posterior surtaces as well as a pair of chamfer surtaces. Additional cut surtaxes may be provided. The posterior WO 96103939 2 ~ R ~ (~ ~ ~ PCTIUS95/09705 non-articulating surface preferably defines a single plane that registers against a similarly configured resected surface of the distal femur.
The tibia) component inGudes concave articulating surtaces that receive the femoral component articulating surfaces during use.
the three degree (3°) difference between the eighty seven degree (87°) , anatomical angle of the tibia) plateau and the ninety degree (90°) angle of the tibia) resection.
The benefits of this surgical procedure have been mentioned but there are some drawbacks. The femoral component is no longer aligned with the tibia) component in full extension. The femoral component is rotated about three degrees (3°) with respect to the tibia when it is aligned parallel to the lateral plane. This malalignment potentially could cause increased wear of the tibia) insert. A possible solution to this malalignment could be to externally rotate the tibia) component, but this would result in reduced tibia) coverage, which is not desired. Another possible solution may be to design the insert at an angle, but both turning the tibia) tray externally or designing it into the insert have the problem of malalignment in flexion. With externally rotating the femoral component, there will be malalignment with the tibia) insert either in flexion or extension whether the tibia) tray or tibia) insert is aligned straight or externally rotated.
A second problem with traditional external rotation is the chance of notching the lateral anterior femoral cortex. "Notchlng° occurs when more none Is removed anterolaterally than with the neutral resections resulting in a notch being created in the anterior cortex of the femur. Notching greatly increases the chances of the femur fracturing. A related problem to this is poor anteromedial implant coverage or even a gap between the implant and bone. In order to reduce the chances of notching anteriorly, the lateral side is placed flush with the cortex and a gap develops between the implant and bone anteromedially.
Another problem with traditional external rotation is the increased complexity and difficulty in instrumentation. The alignment of the cutting blocks must be variable and there is a different setup for left and right knees.
Also, it can be difficult to accurately judge three degrees (3°) of external rotation when performing the surgery.
WO 96103939 2 ~ 9 6 6 9 6 PCT/U595/09705 Currently there are both symmetric and asymmetric femoral components available. The symmetric components all have a patella femoral groove that is located along the centerline of the component. The asymmetric components typically have a patella femoral groove which is angled but still straight.
The GENESIS knee, available from Smith & Nephew Richards Inc. is an example of this type of asymmetric femoral design. The problem with femoral components which have either design is that the patella tends to sublux laterally or to the pull toward the lateral side. This is because the patella groove is located on the centerline of the component and this is a medial to where the anatomical patella groove is located. Even with an angled patella grrove toward the lateral side the patella does not get to track a far lateral as it does normally. Most traditional femoral components have a thicker lateral anterior flange. This causes tension in the lateral retinaa~larwhich pulls.the patella lateral. The current surgical solution is a soft tissue release to allow the patella to track properly.
With external rotation, the patella tracking is altered. By rotating the component as described, the lateral anterior flange is lowered and the patella groove is sliifted laterally. This helps in reducing the tension in the lateral retinacular and to help locate the patella groove in a more anatomical lateral position. From zero degrees (0°) to ninety degrees (90°) of flexion benefits have been found because of lateralizing the patella in this flexion range. However, after ninety degrees (90°) of flexion, the patella will be medialized which can inaease the lateral force and shear force on the patella. This can lead to higher stresses at the bone implant intertace and lead to more wear of the patella implant on the patella.
Current femoral prosthesis have convex proximal anterior regions from a lateral view. This results in.the patella andlor ligaments being displaced anteriorly. By having a concave anterior region, the patella and the ligaments are displaced anteriorly less because there is less metal in the concave region.
This more closely resembles the anatomical femur and helps to improve patella tracking.
The objectives of the present invention are to balance the flexion and extension space, maintain proper alignment with the tibia, and to not notch the c anterior femoral cortex when a ninety degree (90°) tibial resection and symmetric thickness tibial component is used. A further object of the present invention is to provide an improved femoral prosthesis which allows proper patella tracking during a normal range of knee movement.
Tfie present invention provides an improved asymmetric femoral prosthesis for use in total knee arthroplasty and an improved method of implanting a femoral prosthesis on a patient's distal femur.
According to the invention, a knee prosthesis comprises a femoral component having an anterior articulating surface and distal and posterior mtiarlating portions comprising lateral and medial condylar surfaces and an internal non-articulating surface; and a tibial component having concave articulating surfaces that receive the articulating surfaces of the femoral component during use; wherein the distance between the internal non-articulating surface and the articulating of the lateral condylar portion is different from the distance between the internal non-articulating surface and the articulating surface of the medial condylar portion of the femoral component over at least a part of the articulating surface of the femoral component, whereby the angle of femoral rotation about the madianical axis changes when going through a normal rage of motion of the knee.
According to one aspect of the present invention, there is provided a knee prosthesis comprising: (a) a femoral component having distal and posterior articulating surface portions comprising lateral and medial condylar surfaces and internal non-articulating surfaces; and (6) a tibial component having concave articulating surfaces that receive the articulating surfaces of the femoral component during use, wherein the distance between the internal non-articulating surface and the posterior articulating surface of the lateral condylar surface is greater than the distance between the internal non-articulating surface and the posterior articulating surface of the media! condylar surface of the femoral component over the -posterior but not the distal surface of the articulating surface of the femoral component, whereby an angle of femoral rotation about a femoral mechanical axis changes when going through a normal range of motion of the knee.
According to a further aspect of the present invention, there is provided a knee prosthesis according to the above described one aspect, wherein the femoral component further comprises an anterior articulating surface which, in use, articulates with a patella component or natural patella of the knee; wherein a centerline of the femoral component is defined centrally between the distal condyles of the component; said femoral component has a patella groove in its anterior articulating surface within which said patella component may track during normal articulating motion of the knee; the longitudinal axis of said groove being located laterally with respect to said centerline in a superior region of the anterior articulating surface and curving in a medial direction in the distal region of the anterior articulating surtace of the femoral component.
According to another aspect of the present invention, there is provided a knee prosthesis according to the above described one aspect, wherein the femoral component further comprises an anterior articulating surface portion, where an anterior proximal portion has an arc center that is anterior to the anterior surtace portion; wherein the femoral component is concave in an anterior proximal region in a lateral view.
The preferred embodiment includes a femoral prosthesis having anterior, distal, and posterior articulating surface portions. The posterior articulating surtace portions include a pair of condylar surfaces that are positioned at differing distances from the anterior non-articulating or internal surtace portion. The posterolateral articular surface is a greater distance from the anterior non-articulating surtace than the posteromedial side. The medial and lateral articular surfaces in the distal region are the same distance from a tine transverse to the component.
The femoral prosthesis has an internal non-articulating surface that includes a plurality of surtaces for receiving a resected distal femur. Preferably, the non-articulating surtace includes distal, anterior and posterior surtaces as well as a pair of chamfer surtaces. Additional cut surtaxes may be provided. The posterior WO 96103939 2 ~ R ~ (~ ~ ~ PCTIUS95/09705 non-articulating surface preferably defines a single plane that registers against a similarly configured resected surface of the distal femur.
The tibia) component inGudes concave articulating surtaces that receive the femoral component articulating surfaces during use.
5 The improved femoral prosthesis of the present invention solves the above discussed problems that have attended traditional femoral components aligned in neutral or external rotation.
The femoral prosthesis of the present invention aligns properly with the tibia in extension because it is not rotated like the externally rotated component.
This results in improved femorotibial articulation and reduces the chance of severe wear. Since the tibia) component is not externally rotated there is also not rotational incongruity between the femoral and tibia) components in flexion.
The angle of femoral rotation generally about the mechanical axis gradually changes when going through a normal range of motion while maintaining alignment of the femoral and tibia) articular surfaces. A gradual change is defined as a change that does not produce a step or immediate shift in the articular geometry. A~normal range of motion that a patient would use could range from negative ten degrees (-10°) to one hundred thirty degrees (130°). During walking on a level surface a person would typically range from 0 degrees to 70 degrees.
The entire movement associated with walking is referred to as gait. The range of motion required far going up stairs is about 0 to 60 degrees and to go down stairs is about 0 to 90 degrees. Getting up out of a chair can range from 0 to 90 degrees and deep knee bending could range from 0 to 130 degrees.
Hyperextension, or a negative flexion could occur while standing of about 10 degrees.
The anterolateral cortex should not be notched because no additional bone is removed. Neutral cuts are used which do not notch the anterior femur. There is improved anterior medial bone coverage because the prosthesis is not rotated (there is no gap on the anteromedial side).
The instruments for putting in the new femoral component are simpler to use because the same procedure is used for a right or left knee and the work of positioning the three degree (3°) resection is eliminated.
WO 96103939 21 g b 6 R b P~T~S95109705 An alternative prosthesis and method according to the invention uses a ninety degree (90°) tibia) resection and a tibia) component that is thicker on the lateral side than the medial side. The femoral component then preferably provides a thinner lateral distal condyle than the medial distal condyle. The posterior condyles are preferably of equal thickness at about ninety degrees (90°) of flexion in this embodiment.
With the present invention the thickness could be altered both distally and posteriorly, simply by making an angled distal resection in the frontal plane or making an angled posterior resection with respect to neutral rotation. If the anterior resection was made neutral and the posterior resection was rotated then the cross section from anterior to posterior would be trapezoidal in shape.
Differences between the_ positions of the medial and lateral articular surfaces are independent of the box geometry and any variation of distal or posterior condyle thickness. The distal or posterior cuts could be made at an angle or at different levels in order to produce the same design objective but maintain constant condyle thicknesses or to maintain different condyle thicknesses. ~ This would produce the same results of balancing the flexion and extension spaces, with proper alignment with the tibia, and have different thicknesses than in the description of this new femoral prosthesis.
The femoral component could also be designed with more or less external rotation incorporated. With traditional neutral resections of the distal and posterior femur, in order to design for more external rotation there would be a larger difference in the thickness of the posterior condyles with the preferred embodiment. The medial posterior condyle is thinner than the lateral posterior condyle of the femoral component so that at ninety degrees (90°) of flexion the femoral joint line is angled at three (3°) of rotation along its mechanical axis.
Other angles could be designed into the femoral ranging from about one degree (1 °) to ten degrees (10°) at about ninety degrees (90°) of flexion. The articular geometry of the condyles changes such that the femoral component articulates with the tibia) component during filexion and extension without requiring the femoral component to turn relative to the alignment of the tibia) insert in the transverse plane.
WO 96/03939 219 6 6 9 6 PCT~S95109705 In order to solve the problem of improper patella tracking, the invention provides a knee prosthesis comprising a femoral component having internal non-articulating surfaces and external articulating surfaces, including an anterior articulating surface and distal and posterior lateral and medial condylar articulating surfaces, a centerline of the femoral component being defined centrally between the distal condyles of the component; a patella component or natural patella having an articulating surface which articulates with the anterior articulating surface of the femoral component in use, said femoral component having a patella groove in its anterior articulating surface within which said patella component may track during normal articulating motion of the knee; the longitudinal axis of said groove being located laterally with respect to said centerline in the superior region of the anterior articulating surface and curving in a medial direction in the distal region of the anterior articulating surface of the femoral component.
The patella groove has bean shifted laterally to allow the patella to track in its more anatomical location. The groove is located lateral of the centerline in the anterior region and then curves back, preferably to the centerline of the component. The lateral shift of the patella groove allows the patella to track in its anatomical location and it reduces the tension on the ligaments that pull the patella laterally. The lateral shift is only limited by the width of the component.
The new asymmetric femoral component may also have a concave proximal anterior region in a lateral view. This results in the femoral component being thinner in this region. The benefits are that the thickness of the implant more closely matches the thickness of the bone that is removed. The patella and the ligaments can function more anatomically because extra metal is not being added to the anterior cortex of the femur. The concave region has an arc center that is located anterior to the component where a convex region would have an arc center that is posterior to the anterior surtace of the component.
The present invention also provides an improved method of implanting a femoral prosthesis on a patient's distal femur. The distal femur is first resected with a plurality of five cuts including anterior, posterior, distal and a pair of chamfer cuts. The femoral prosthesis is affixed to the patient's resected distal femur. The femoral prosthesis is an improved asymmetric prosthesis having anterior, posterior, and distal non-articulating portions that closely fit the anterior, posterior and distal cuts on the distal femur.
The patient's tibia is reseded to receive a tibia) prosthesis. The femoral and tibia) cuts are generally parallel in full extension and relative to the tibia) prosthesis and to the femoral . prosthesis so that the angle of femur rotation generally about the patient's mechanical axis relative to the tibia gradually changes when going through a normal range of motion of the patient's knee from about minus twenty degrees (i.e. -20°) of flexion to about one hundred thirty degrees (130°) of flexion while maintaining alignment of the femoral and tibia) articular surfaces.
The femoral posterior resections are made parallel to a line tangent to the intact posterior femoral condyles with approximately the same amount of bone being removed off of each posterior condyle, but the prosthesis has a thinner medial posterior condyle than its lateral posterior condyle. The distal thickness is the same beiween the medial and lateral condyles in the preferred embodiment.
This results in balancing both the flexion and extension spaces similar to that of externally rotating a traditional femoral prosthesis.
For a further understanding of the nature and objects of the present invention, reference should be had to the following detailed description, which is given only as an example of the present invention, taken in conjunction with the accompanying drawings, in which like parts are given like reference numerals, and wherein:
FIGURE 1 is a lateral view of the preferred embodiment of the present invention showing the medial and lateral posterior condyle thickness and the concave anterior region;
FIGURE 2 is a frontal view of the preferred embodiment of the apparatus of the present invention;
FIGURE 3 is a frontal view illustrating human femur, knee joint, and tibia and the leg mechanical axis;
FIGURE 4 is a frontal view of a human knee joint showing a ninety degree (90°) tibia resection and a parallel femoral distal resection;
R'O 96103939 ~ I ~ ~ ~ ~ ~ PCTlUS95/09705 FIGURE 5 is a frontal view of a human knee joint in ninety degree (90°) flexion illustrating the anatomical angle of the tibia at eighty seven degree (87°) and the tibia) resection at ninety degrees (90°);
FIGURE 6 is a frontal view of a human knee joint in ninety degrees (90°) of flexion illustrating neutral femoral posterior and anterior resections with a ninety degree (90°) tibia) resection;
FIGURE 7 is a frontal view of a human knee joint in ninety degrees (90°) of flexion showing a symmetric thickness tibia) and femoral prosthesis in neutral alignment;
FIGURE 8 is a frontal vigw of a human knee joint illustrating externally rotated resections on the anterior and posterior femur and showing more bone cut from the anterolateral femur and from the posteromedial femur, FIGURE 9 is a frontal view of a knee joint in ninety degrees (90°) of flexion with a symmetric thickness tibia) and femoral prosthesis externally rotated and the balanced collateral ligaments;
FIGURE 10 is a lateral view illustrating a femur that has been notched in the anterior corteX as part of a prior art knee joint replacement surgical procedure;
FIGURE 11 illustrates knee joint resections using the method of the present invention and showing the extension space parallel;
FIGURE 12 illustrates the neutral femoral resections using the method of the present invention, showing the flexion space that is trapezoidally shaped;
FIGURE 13 is a frontal view of a knee joint in ninety degrees (90°) of flexion showing neutral femoral resections of the anterior cortex and posterior condyles;
FIGURE 14 is a frontal view of the preferred embodiment of the present invention of a knee joint ninety degrees (90°) in flexion showing a thinner posteromedial condyle than the posterolateral and balanced collateral ligaments;
FIGURE 15 is a lateral view of the preferred embodiment of the asymmetric component of the present invention showing the different medial and lateral curves posteriorly;
FIGURE 16 is a frontal view of a knee in ninety degree (90°) of flexion of an alternate embodiment of the method and apparatus of the present invention showing neutral femoral resections;
WO 96/03939 _- ~ ~~ ~ PCTlUS95109705 FIGURE 17 is a frontal view of a knee joint in ninety degrees (90°) of flexion showing the alternate embodiment of the apparatus of the present invention with a tibial component that has a thicker lateral section that it's medial section;
FIGURE 18 is a lateral view of the alternate embodiment of the asymmetric 5 femoral component of the present invention showing the different medial and lateral curves distally; and FIGURE 19 is a lateral view of a femoral component showing both the traditional convex anterior and the concave anterior region.
FIGURE 20 is a frontal view of a prior art femoral component showing a 10 centrally located patella groove.
FIGURE 21 is a frontal view of a prior art femoral component showing an angled patella groove.
FIGURE 22 is a frontal view of an improved femoral component of the invention.
FIGURE 23 is a similar view showing the position of the patella FIGURE 24 is a distal view of the improved femoral component showing the location of the patella groove.
FIGURE 25 is a medial view of an improved femoral component showing the patella groove.
Figures 1 and 2 show generally the preferred embodiment of the apparatus of the present invention designated generally by the numeral 10. The asymmetric femoral component 10 includes a prosthesis articulating surface 11 that includes an anterior articulating surface portion 12, distal articulating surface 15, and a pair of condylar surfaces including lateral posterior condyle 13 having posterior condylar surface 13A and medial posterior surface condyle 14 having posterior condylar surface 14A.
The proximal side of asymmetric femoral prosthesis 10 provides a recess 16 that receives a patient's distal femur after the distal femur has been resected to fit the plurality of surfaces 17-21. Anterior proximal surtace 17 is a generally flat surface that intersects proximal anterior chamfer 18. Anterior chamfer 18 extends between anterior proximal surface 17 and proximal surface 19. Proximal posterior chamfer 20 extends between surface 19 and posterior proximal surface WO 96103939 ~ ~ ~ ~ ~ ~ ~ pCTIfTS95/09705 21. In Figure 2, asymmetric femoral prosthesis 10 has a central recess portion 22 between lateral distal surface 23 and medial distal surtace 24.
In Figure 1, there can be seen a difference in the position between the surfaces 13A-14A. A line drawn tangent to the most posterior portion of lateral posterior condyle 13, generally parallel to the frontal plane, is defined by the line 13B. A line drawn tangent to the most posterior point on posterior condylar surface 14A (generally parallel to frontal plane) is the line 14B. A distance between the lines 13B and 14B shows that the lateral posterior condyle 13 is thicker than the medial posterior condyle 14 whereas the inner surface 21 of each of the condyles 13 and 14 is the same flat surface 21, defining a plane that accepts corresponding resected surfaces on the patient's distal femur. The frontal plane or coronal plane is shown in Figure 1 as a plane going through line 12C and perpendicular to the page. It is a plane that splits the body into a front and a rear half. The transverse plane is typically a plane that goes through the waist area and cuts the body into a top and a bottom half. For ease of use it is shown in Figure 1 as a plane going through line 12d and perpendicular to the page. This plane is parallel to the typical transverse plane and for this description is functionally the same.
This femoral component 10 essentially has three degrees (3°) of external rotation built into it. This is in contrast to the current procedure of the surgeon cutting the femur at three degrees (3°) of external rotation. On the femoral component 10 of the present invention, the angle of femoral rotation generally about the mechanical axis 32 gradually changes when going through a normal range of motion of the patient's knee, typically from about zero degrees (0°) of flexion to about ninety (90°) to one hundred thirty degrees (130°) of flexion. A
normal range of motion that a patient would use could range from negative ten degrees (-10°) to one hundred thirty (130°) degrees. During walking on a level surtace a person would typically range from 0 degrees to 70 degrees. The entire movement associated with walking is referred to as gait. The range of motion required for going up stairs is about 0 to 60 degrees and to go down stairs is about 0 to 90 degrees. Getting up out of a chair can range from 0 to 90 degrees and deep knee bending could range from 0 to 130 degrees. Hyperextension, or W O 96103939 PC1'IUS95109705 a negative flexion could occur while standing of about 10 degrees. The rotation balances the flexion gap between the femoral and tibia) components as well as aligning the femoral component articular surface parallel to the lateral plane in flexion and extension. The three degrees (3°) of external rotation is generally along the mechanical axis 32 of the femur.
In total knee arthroplasty there is a difficulty in reproducing the exact anatomy. As illustrated in Figures 4 and 5, the patient's tibia 31 is usually cut at ninety degrees (90°) to its axis in the frontal plane but the tibia) plateau is at eighty seven degrees (87°). The disparity is due to the difficulty in accurately reproducing an eighty seven degree (87°) cut. Also, it has been documented that with an eighty seven degree '(87°) or varus cut the tibia) component has a tendency to loosen. (Proceedings of the Knee Society 1985-1986, Laskin, Varus Knee deformities).
With a ninety degree (90°) cut, more bone is removed on the lateral side 33 than on the medial side 34 of the tibia 31 as shown in Figures 3, 4, and 5. In Figure 4, the tibia) cut is designated as 35. Because of this, at ninety degrees (90°) of flexion, when neutral femoral cuts are performed the resection 35 of the tibia and the posterior resections 38 and 39 of the femur are not parallel.
This results in less space on the medial side 34 and more space on the lateral side 33, which causes unbalanced ligaments 40 and 41 when traditional tibia) and femoral components are used that have symmetric thicknesses on the medial and lateral sides (see Figure 7).
The current solution to this problem is to rotate the cutting block so that more bone is removed from the posteromedial femoral condyle. This is referred to in the art as external rotation. By externally rotating (clockwise rotation for a left knee when viewed from the distal end), the posterior femoral resection is parallel to the ninety degree (90°) tibia) cut (see Figure 8). This results in the collateral ligaments 40 and 41 being balanced in extension and flexion when the prosthesis is implanted as shown in Figure 9. The current industry standard is three degrees (3°) of external rotation.
One problem with traditional external rotation is the chance of notching the anterolateral femoral cortex as illustrated in Figure 10 with prior art femoral WO 96103939 219 0 ~ ~ ~ PCT~S95/09705 prosthesis F and tibial prosthesis T. Figure 8 shows that more bone is removed anterolateral and posteromedial than with the femoral neutral resections shown in Figure 6. Figure 10 illustrates the anterior cortex 42 with a notch 43, which greatly increases the chance of the femur fracturing.
In the preferred embodiment, the femoral posterior resections are made neutral with approximately the same amount of bone being removed off of each posterior condyle, but the prosthesis has a thinner medial posterior condyle than its lateral posterior condyle 13 as seen in Figure 14. The distal thickness is the same between the medial and lateral condyles in the preferred embodiment as shown in Figure 15. This results in balancing both the flexion and extension spaces similar to that of externally rotating a traditional femoral prosthesis.
Figures 11 and 12 show neutral femoral resections as used in the method of the present invention. The distal femoral resection is indicated as 44, the tibial resection as 45, defining a parallel extension space 46. The anterior resection is indicated as 48 in Figures 11 and 12. In Figure 12, posterior femoral resections 38 and 39 appear when the knee is in flexion, defining a trapezoidal flexion space 47. ' An alternative method and apparatus is shown in Figures 16 - 18. The alternate embodiment of the method and apparatus of the present invention uses a ninety degree (90°) tibial resection 51 and a tibial component 50 that is thicker on the lateral side than the medial side. The femoral component 60 would then have a thinner lateral distal condyle 61 than the medial distal condyle 62.
The posterior condyles 63 and 64 would then have the same thickness at about ninety degrees (90°) of flexion in the alternate embodiment.
With the present invention the thickness could be altered both distally and posteriorly simply by making an angled distal resection in the frontal plane or making an angled posterior resection with respect to neutral rotation. If the anterior resection was made neutral and the posterior resection was angled then the cross section from anterior to posterior would be trapezoidal in shape in the transverse plane.
The asymmetric femoral prosthesis components 10 and 60 shown in Figures 13 -18 show that the difference between the medial and lateral sides is WO 96/03939 ~ ~ ~ c~ 5 9 6 PCTIUS95/09705 independent of the box geometry and any variation of distal or posterior condyle thickness. The distal or posterior cuts could be made at an angle or at different levels in order to produce the same design objective but maintain constant condyle thicknesses or to maintain different condyle thicknesses. This would produce the same results of balancing the flexion and extension spaces, with proper alignment with the tibia, and have different thicknesses in the condyles than in the description of this new femoral prosthesis.
The femoral component could also be designed with more or less external rotation built in. With traditional neutral resections of the distal and posterior femur, there would be a larger difference in the thickness of the posterior prosthesis condyles to produce more external rotation.
The new femoral component design is intended to be placed to compensate for a ninety degree (90°) tibial resection. Resetting the tibia at ninety degrees (90°) in the frontal plane and placing a prosthetic tibial component, which has the same thickness medially and laterally, results in an elevated medial compartment of the tibia. To compensate for this, the femoral component of the present invention, iri conjunction with the resections of the distal and posterior femur, elevate the media( joint line relative to the femur to compensate for the elevation that occurs in the tibia.
On the posterior femur, this is accomplished by resetting the posterior femur roughly parallel to the posterior femoral condyle joint line. The prosthetic medial femoral condyle is thinner than the resection that occurs medially.
This results in an elevation of the posterior medial femoral joint line with the knee in flexion.
The distal resection of the femur is accomplished by removing asymmetrical amounts of bone from the medial and lateral condyles of the femur. The distal medial and lateral surfaces are then replaced with equal thicknesses of prosthetic medial and lateral surfaces. Because additional bone has been removed from the medial distal femoral condyle, this results in an elevation of the medial distal femoral joint line with the knee in extension. This too compensates for elevation of the medial compartment of the tibial that occurs due to the ninety degree (90°) tibial resection in the frontal plane.
W096/03939 2 ~ g d 6 ~ ~ PCTIUS95109705 Figure 19 shows a lateral view of a femoral component. The anterior region 65 shows the concave region of the new femoral where the arc center is located anterior to the component. The anterior region 66 shows the convex region of a traditional femoral component where the aro center is located posterior to the 5 anterior surface. The concave anterior results in less metal anteriorly as shown in Figure 19 which more closely replaces the resected bone with the same amount of metal.
Figures 20 and 21 show prior art prostheses in which the patella groove 67 is either centrally positioned with respect to the centerline 68 of the femoral 10 component (fig 20) or is angled (fig 21 ).
By contrast, the improved femoral component of figure 22 has a patella groove which is positioned lateral of and about parallel to centerline 68 in the anterior region 65 of the component and then curves back to the centreline 68 at the intracondylar notch 70. The depth of the groove 67 is shown in fig 25 by line 15 72. By lateralizing the patella femoral groove, the ligaments are more balanced and the patella potentially tracks smoother and properly in the patella femoral groove. The t~ew design is a patella femoral groove which is aligned virtually straight in the anterior region but shifted lateral to the centerline and which gradually transitions into the intracondylar notch region. This type of patellofemoral groove design causes the patella to track much more lateral at higher degrees of flexion than compared to a centerline or angled patella femoral groove design. This has a clinical advantage because it allows the patella to track properly which should avoid the need for soft tissue lateral releases.
The patella is allowed to track laterally up to about 40 to 50 degrees of flexion before it gradually transitions to the centerline of the component in the intracondylar notch as shown in figure 24. It transitions into the intracondylar notch so that there is good contact between the femoral component and the patella at high degrees of flexion.
The following table fists the parts numbers and parts descriptions as used herein and in the drawings attached hereto.
WO 96103939 ~ ~ (~ ~ ~ ~ 6 PCTIUS95109705 PARTS LIST
Part Number Description 10 asymmetrical femoral prosthesis 11 prosthesis articulating surface 12 anterior articulating surface ' 12p anterior tangent line 12B anterior concave surtace 12C frontal plane 12D transverse plane 13 . lateral posterior condyle 13A posterior condylar surface 13B posterolateral tangent line 14 medial posterior condyle 14A posterior condylar surface 14B posteromedial tangent line 15 distal surtace 16' proximal recess 17 anterior proximal surtace 18 proximal anterior chamfer 19 proximal surtace 20 proximal posterior chamfer 21 posterior proximal surtace 22 recess 23 lateral distal surface 24 medial dital surface 25 offset distance 26 medial distal surtace 27 lateral distal surface 2B angle 29 anatomical angle tibia 30 femur 31 tibia 2196b96 y 32 mechanical axis 33 lateral side 34 medial side 35 ninety degree tibia) resection 36 distal femoral resection 37 extension space 38 femoral resection - posteromedial 39 femoral resection - posterolateral 40 lateral collateral ligament 41 medial collateral ligament 42 anterior femoral cortex 43 notch 44 distal femoral resection 45 ninety degree tibia) resection 46 extension space - parallel 47 flexion space - trapezoidal 48 ' anterior resection 49 angle 50 tibia) component 51 tibia) resection F femoral prosthesis T tibia) prosthesis 60 femoral component 61 lateral distal condyle 61A lateral distal surface 62 medial distal condyle 62A medial distal surface 63 posterolateral condyle 64 posteromedial condyle 65 concave anterior region of new asymmetric femoral 66 convex anterior region of traditional femoral 67 patella groove WO 96/03939 PCTlUS95/09705 68 centerline of the femoral component 69 longitudinal axis of patella groove 70 intracondylar notch 71 patella component 72 line showing depth of patella groove Because many varying and different embodiments may be made within the scope of the inventive concept herein taught, and because many modifications may be made in the embodiments herein detailed in accordance with the descriptive requirement of the law, it is.to be understood that the details herein are to be interpreted as illustrative and not in a limiting sense.
The femoral prosthesis of the present invention aligns properly with the tibia in extension because it is not rotated like the externally rotated component.
This results in improved femorotibial articulation and reduces the chance of severe wear. Since the tibia) component is not externally rotated there is also not rotational incongruity between the femoral and tibia) components in flexion.
The angle of femoral rotation generally about the mechanical axis gradually changes when going through a normal range of motion while maintaining alignment of the femoral and tibia) articular surfaces. A gradual change is defined as a change that does not produce a step or immediate shift in the articular geometry. A~normal range of motion that a patient would use could range from negative ten degrees (-10°) to one hundred thirty degrees (130°). During walking on a level surface a person would typically range from 0 degrees to 70 degrees.
The entire movement associated with walking is referred to as gait. The range of motion required far going up stairs is about 0 to 60 degrees and to go down stairs is about 0 to 90 degrees. Getting up out of a chair can range from 0 to 90 degrees and deep knee bending could range from 0 to 130 degrees.
Hyperextension, or a negative flexion could occur while standing of about 10 degrees.
The anterolateral cortex should not be notched because no additional bone is removed. Neutral cuts are used which do not notch the anterior femur. There is improved anterior medial bone coverage because the prosthesis is not rotated (there is no gap on the anteromedial side).
The instruments for putting in the new femoral component are simpler to use because the same procedure is used for a right or left knee and the work of positioning the three degree (3°) resection is eliminated.
WO 96103939 21 g b 6 R b P~T~S95109705 An alternative prosthesis and method according to the invention uses a ninety degree (90°) tibia) resection and a tibia) component that is thicker on the lateral side than the medial side. The femoral component then preferably provides a thinner lateral distal condyle than the medial distal condyle. The posterior condyles are preferably of equal thickness at about ninety degrees (90°) of flexion in this embodiment.
With the present invention the thickness could be altered both distally and posteriorly, simply by making an angled distal resection in the frontal plane or making an angled posterior resection with respect to neutral rotation. If the anterior resection was made neutral and the posterior resection was rotated then the cross section from anterior to posterior would be trapezoidal in shape.
Differences between the_ positions of the medial and lateral articular surfaces are independent of the box geometry and any variation of distal or posterior condyle thickness. The distal or posterior cuts could be made at an angle or at different levels in order to produce the same design objective but maintain constant condyle thicknesses or to maintain different condyle thicknesses. ~ This would produce the same results of balancing the flexion and extension spaces, with proper alignment with the tibia, and have different thicknesses than in the description of this new femoral prosthesis.
The femoral component could also be designed with more or less external rotation incorporated. With traditional neutral resections of the distal and posterior femur, in order to design for more external rotation there would be a larger difference in the thickness of the posterior condyles with the preferred embodiment. The medial posterior condyle is thinner than the lateral posterior condyle of the femoral component so that at ninety degrees (90°) of flexion the femoral joint line is angled at three (3°) of rotation along its mechanical axis.
Other angles could be designed into the femoral ranging from about one degree (1 °) to ten degrees (10°) at about ninety degrees (90°) of flexion. The articular geometry of the condyles changes such that the femoral component articulates with the tibia) component during filexion and extension without requiring the femoral component to turn relative to the alignment of the tibia) insert in the transverse plane.
WO 96/03939 219 6 6 9 6 PCT~S95109705 In order to solve the problem of improper patella tracking, the invention provides a knee prosthesis comprising a femoral component having internal non-articulating surfaces and external articulating surfaces, including an anterior articulating surface and distal and posterior lateral and medial condylar articulating surfaces, a centerline of the femoral component being defined centrally between the distal condyles of the component; a patella component or natural patella having an articulating surface which articulates with the anterior articulating surface of the femoral component in use, said femoral component having a patella groove in its anterior articulating surface within which said patella component may track during normal articulating motion of the knee; the longitudinal axis of said groove being located laterally with respect to said centerline in the superior region of the anterior articulating surface and curving in a medial direction in the distal region of the anterior articulating surface of the femoral component.
The patella groove has bean shifted laterally to allow the patella to track in its more anatomical location. The groove is located lateral of the centerline in the anterior region and then curves back, preferably to the centerline of the component. The lateral shift of the patella groove allows the patella to track in its anatomical location and it reduces the tension on the ligaments that pull the patella laterally. The lateral shift is only limited by the width of the component.
The new asymmetric femoral component may also have a concave proximal anterior region in a lateral view. This results in the femoral component being thinner in this region. The benefits are that the thickness of the implant more closely matches the thickness of the bone that is removed. The patella and the ligaments can function more anatomically because extra metal is not being added to the anterior cortex of the femur. The concave region has an arc center that is located anterior to the component where a convex region would have an arc center that is posterior to the anterior surtace of the component.
The present invention also provides an improved method of implanting a femoral prosthesis on a patient's distal femur. The distal femur is first resected with a plurality of five cuts including anterior, posterior, distal and a pair of chamfer cuts. The femoral prosthesis is affixed to the patient's resected distal femur. The femoral prosthesis is an improved asymmetric prosthesis having anterior, posterior, and distal non-articulating portions that closely fit the anterior, posterior and distal cuts on the distal femur.
The patient's tibia is reseded to receive a tibia) prosthesis. The femoral and tibia) cuts are generally parallel in full extension and relative to the tibia) prosthesis and to the femoral . prosthesis so that the angle of femur rotation generally about the patient's mechanical axis relative to the tibia gradually changes when going through a normal range of motion of the patient's knee from about minus twenty degrees (i.e. -20°) of flexion to about one hundred thirty degrees (130°) of flexion while maintaining alignment of the femoral and tibia) articular surfaces.
The femoral posterior resections are made parallel to a line tangent to the intact posterior femoral condyles with approximately the same amount of bone being removed off of each posterior condyle, but the prosthesis has a thinner medial posterior condyle than its lateral posterior condyle. The distal thickness is the same beiween the medial and lateral condyles in the preferred embodiment.
This results in balancing both the flexion and extension spaces similar to that of externally rotating a traditional femoral prosthesis.
For a further understanding of the nature and objects of the present invention, reference should be had to the following detailed description, which is given only as an example of the present invention, taken in conjunction with the accompanying drawings, in which like parts are given like reference numerals, and wherein:
FIGURE 1 is a lateral view of the preferred embodiment of the present invention showing the medial and lateral posterior condyle thickness and the concave anterior region;
FIGURE 2 is a frontal view of the preferred embodiment of the apparatus of the present invention;
FIGURE 3 is a frontal view illustrating human femur, knee joint, and tibia and the leg mechanical axis;
FIGURE 4 is a frontal view of a human knee joint showing a ninety degree (90°) tibia resection and a parallel femoral distal resection;
R'O 96103939 ~ I ~ ~ ~ ~ ~ PCTlUS95/09705 FIGURE 5 is a frontal view of a human knee joint in ninety degree (90°) flexion illustrating the anatomical angle of the tibia at eighty seven degree (87°) and the tibia) resection at ninety degrees (90°);
FIGURE 6 is a frontal view of a human knee joint in ninety degrees (90°) of flexion illustrating neutral femoral posterior and anterior resections with a ninety degree (90°) tibia) resection;
FIGURE 7 is a frontal view of a human knee joint in ninety degrees (90°) of flexion showing a symmetric thickness tibia) and femoral prosthesis in neutral alignment;
FIGURE 8 is a frontal vigw of a human knee joint illustrating externally rotated resections on the anterior and posterior femur and showing more bone cut from the anterolateral femur and from the posteromedial femur, FIGURE 9 is a frontal view of a knee joint in ninety degrees (90°) of flexion with a symmetric thickness tibia) and femoral prosthesis externally rotated and the balanced collateral ligaments;
FIGURE 10 is a lateral view illustrating a femur that has been notched in the anterior corteX as part of a prior art knee joint replacement surgical procedure;
FIGURE 11 illustrates knee joint resections using the method of the present invention and showing the extension space parallel;
FIGURE 12 illustrates the neutral femoral resections using the method of the present invention, showing the flexion space that is trapezoidally shaped;
FIGURE 13 is a frontal view of a knee joint in ninety degrees (90°) of flexion showing neutral femoral resections of the anterior cortex and posterior condyles;
FIGURE 14 is a frontal view of the preferred embodiment of the present invention of a knee joint ninety degrees (90°) in flexion showing a thinner posteromedial condyle than the posterolateral and balanced collateral ligaments;
FIGURE 15 is a lateral view of the preferred embodiment of the asymmetric component of the present invention showing the different medial and lateral curves posteriorly;
FIGURE 16 is a frontal view of a knee in ninety degree (90°) of flexion of an alternate embodiment of the method and apparatus of the present invention showing neutral femoral resections;
WO 96/03939 _- ~ ~~ ~ PCTlUS95109705 FIGURE 17 is a frontal view of a knee joint in ninety degrees (90°) of flexion showing the alternate embodiment of the apparatus of the present invention with a tibial component that has a thicker lateral section that it's medial section;
FIGURE 18 is a lateral view of the alternate embodiment of the asymmetric 5 femoral component of the present invention showing the different medial and lateral curves distally; and FIGURE 19 is a lateral view of a femoral component showing both the traditional convex anterior and the concave anterior region.
FIGURE 20 is a frontal view of a prior art femoral component showing a 10 centrally located patella groove.
FIGURE 21 is a frontal view of a prior art femoral component showing an angled patella groove.
FIGURE 22 is a frontal view of an improved femoral component of the invention.
FIGURE 23 is a similar view showing the position of the patella FIGURE 24 is a distal view of the improved femoral component showing the location of the patella groove.
FIGURE 25 is a medial view of an improved femoral component showing the patella groove.
Figures 1 and 2 show generally the preferred embodiment of the apparatus of the present invention designated generally by the numeral 10. The asymmetric femoral component 10 includes a prosthesis articulating surface 11 that includes an anterior articulating surface portion 12, distal articulating surface 15, and a pair of condylar surfaces including lateral posterior condyle 13 having posterior condylar surface 13A and medial posterior surface condyle 14 having posterior condylar surface 14A.
The proximal side of asymmetric femoral prosthesis 10 provides a recess 16 that receives a patient's distal femur after the distal femur has been resected to fit the plurality of surfaces 17-21. Anterior proximal surtace 17 is a generally flat surface that intersects proximal anterior chamfer 18. Anterior chamfer 18 extends between anterior proximal surface 17 and proximal surface 19. Proximal posterior chamfer 20 extends between surface 19 and posterior proximal surface WO 96103939 ~ ~ ~ ~ ~ ~ ~ pCTIfTS95/09705 21. In Figure 2, asymmetric femoral prosthesis 10 has a central recess portion 22 between lateral distal surface 23 and medial distal surtace 24.
In Figure 1, there can be seen a difference in the position between the surfaces 13A-14A. A line drawn tangent to the most posterior portion of lateral posterior condyle 13, generally parallel to the frontal plane, is defined by the line 13B. A line drawn tangent to the most posterior point on posterior condylar surface 14A (generally parallel to frontal plane) is the line 14B. A distance between the lines 13B and 14B shows that the lateral posterior condyle 13 is thicker than the medial posterior condyle 14 whereas the inner surface 21 of each of the condyles 13 and 14 is the same flat surface 21, defining a plane that accepts corresponding resected surfaces on the patient's distal femur. The frontal plane or coronal plane is shown in Figure 1 as a plane going through line 12C and perpendicular to the page. It is a plane that splits the body into a front and a rear half. The transverse plane is typically a plane that goes through the waist area and cuts the body into a top and a bottom half. For ease of use it is shown in Figure 1 as a plane going through line 12d and perpendicular to the page. This plane is parallel to the typical transverse plane and for this description is functionally the same.
This femoral component 10 essentially has three degrees (3°) of external rotation built into it. This is in contrast to the current procedure of the surgeon cutting the femur at three degrees (3°) of external rotation. On the femoral component 10 of the present invention, the angle of femoral rotation generally about the mechanical axis 32 gradually changes when going through a normal range of motion of the patient's knee, typically from about zero degrees (0°) of flexion to about ninety (90°) to one hundred thirty degrees (130°) of flexion. A
normal range of motion that a patient would use could range from negative ten degrees (-10°) to one hundred thirty (130°) degrees. During walking on a level surtace a person would typically range from 0 degrees to 70 degrees. The entire movement associated with walking is referred to as gait. The range of motion required for going up stairs is about 0 to 60 degrees and to go down stairs is about 0 to 90 degrees. Getting up out of a chair can range from 0 to 90 degrees and deep knee bending could range from 0 to 130 degrees. Hyperextension, or W O 96103939 PC1'IUS95109705 a negative flexion could occur while standing of about 10 degrees. The rotation balances the flexion gap between the femoral and tibia) components as well as aligning the femoral component articular surface parallel to the lateral plane in flexion and extension. The three degrees (3°) of external rotation is generally along the mechanical axis 32 of the femur.
In total knee arthroplasty there is a difficulty in reproducing the exact anatomy. As illustrated in Figures 4 and 5, the patient's tibia 31 is usually cut at ninety degrees (90°) to its axis in the frontal plane but the tibia) plateau is at eighty seven degrees (87°). The disparity is due to the difficulty in accurately reproducing an eighty seven degree (87°) cut. Also, it has been documented that with an eighty seven degree '(87°) or varus cut the tibia) component has a tendency to loosen. (Proceedings of the Knee Society 1985-1986, Laskin, Varus Knee deformities).
With a ninety degree (90°) cut, more bone is removed on the lateral side 33 than on the medial side 34 of the tibia 31 as shown in Figures 3, 4, and 5. In Figure 4, the tibia) cut is designated as 35. Because of this, at ninety degrees (90°) of flexion, when neutral femoral cuts are performed the resection 35 of the tibia and the posterior resections 38 and 39 of the femur are not parallel.
This results in less space on the medial side 34 and more space on the lateral side 33, which causes unbalanced ligaments 40 and 41 when traditional tibia) and femoral components are used that have symmetric thicknesses on the medial and lateral sides (see Figure 7).
The current solution to this problem is to rotate the cutting block so that more bone is removed from the posteromedial femoral condyle. This is referred to in the art as external rotation. By externally rotating (clockwise rotation for a left knee when viewed from the distal end), the posterior femoral resection is parallel to the ninety degree (90°) tibia) cut (see Figure 8). This results in the collateral ligaments 40 and 41 being balanced in extension and flexion when the prosthesis is implanted as shown in Figure 9. The current industry standard is three degrees (3°) of external rotation.
One problem with traditional external rotation is the chance of notching the anterolateral femoral cortex as illustrated in Figure 10 with prior art femoral WO 96103939 219 0 ~ ~ ~ PCT~S95/09705 prosthesis F and tibial prosthesis T. Figure 8 shows that more bone is removed anterolateral and posteromedial than with the femoral neutral resections shown in Figure 6. Figure 10 illustrates the anterior cortex 42 with a notch 43, which greatly increases the chance of the femur fracturing.
In the preferred embodiment, the femoral posterior resections are made neutral with approximately the same amount of bone being removed off of each posterior condyle, but the prosthesis has a thinner medial posterior condyle than its lateral posterior condyle 13 as seen in Figure 14. The distal thickness is the same between the medial and lateral condyles in the preferred embodiment as shown in Figure 15. This results in balancing both the flexion and extension spaces similar to that of externally rotating a traditional femoral prosthesis.
Figures 11 and 12 show neutral femoral resections as used in the method of the present invention. The distal femoral resection is indicated as 44, the tibial resection as 45, defining a parallel extension space 46. The anterior resection is indicated as 48 in Figures 11 and 12. In Figure 12, posterior femoral resections 38 and 39 appear when the knee is in flexion, defining a trapezoidal flexion space 47. ' An alternative method and apparatus is shown in Figures 16 - 18. The alternate embodiment of the method and apparatus of the present invention uses a ninety degree (90°) tibial resection 51 and a tibial component 50 that is thicker on the lateral side than the medial side. The femoral component 60 would then have a thinner lateral distal condyle 61 than the medial distal condyle 62.
The posterior condyles 63 and 64 would then have the same thickness at about ninety degrees (90°) of flexion in the alternate embodiment.
With the present invention the thickness could be altered both distally and posteriorly simply by making an angled distal resection in the frontal plane or making an angled posterior resection with respect to neutral rotation. If the anterior resection was made neutral and the posterior resection was angled then the cross section from anterior to posterior would be trapezoidal in shape in the transverse plane.
The asymmetric femoral prosthesis components 10 and 60 shown in Figures 13 -18 show that the difference between the medial and lateral sides is WO 96/03939 ~ ~ ~ c~ 5 9 6 PCTIUS95/09705 independent of the box geometry and any variation of distal or posterior condyle thickness. The distal or posterior cuts could be made at an angle or at different levels in order to produce the same design objective but maintain constant condyle thicknesses or to maintain different condyle thicknesses. This would produce the same results of balancing the flexion and extension spaces, with proper alignment with the tibia, and have different thicknesses in the condyles than in the description of this new femoral prosthesis.
The femoral component could also be designed with more or less external rotation built in. With traditional neutral resections of the distal and posterior femur, there would be a larger difference in the thickness of the posterior prosthesis condyles to produce more external rotation.
The new femoral component design is intended to be placed to compensate for a ninety degree (90°) tibial resection. Resetting the tibia at ninety degrees (90°) in the frontal plane and placing a prosthetic tibial component, which has the same thickness medially and laterally, results in an elevated medial compartment of the tibia. To compensate for this, the femoral component of the present invention, iri conjunction with the resections of the distal and posterior femur, elevate the media( joint line relative to the femur to compensate for the elevation that occurs in the tibia.
On the posterior femur, this is accomplished by resetting the posterior femur roughly parallel to the posterior femoral condyle joint line. The prosthetic medial femoral condyle is thinner than the resection that occurs medially.
This results in an elevation of the posterior medial femoral joint line with the knee in flexion.
The distal resection of the femur is accomplished by removing asymmetrical amounts of bone from the medial and lateral condyles of the femur. The distal medial and lateral surfaces are then replaced with equal thicknesses of prosthetic medial and lateral surfaces. Because additional bone has been removed from the medial distal femoral condyle, this results in an elevation of the medial distal femoral joint line with the knee in extension. This too compensates for elevation of the medial compartment of the tibial that occurs due to the ninety degree (90°) tibial resection in the frontal plane.
W096/03939 2 ~ g d 6 ~ ~ PCTIUS95109705 Figure 19 shows a lateral view of a femoral component. The anterior region 65 shows the concave region of the new femoral where the arc center is located anterior to the component. The anterior region 66 shows the convex region of a traditional femoral component where the aro center is located posterior to the 5 anterior surface. The concave anterior results in less metal anteriorly as shown in Figure 19 which more closely replaces the resected bone with the same amount of metal.
Figures 20 and 21 show prior art prostheses in which the patella groove 67 is either centrally positioned with respect to the centerline 68 of the femoral 10 component (fig 20) or is angled (fig 21 ).
By contrast, the improved femoral component of figure 22 has a patella groove which is positioned lateral of and about parallel to centerline 68 in the anterior region 65 of the component and then curves back to the centreline 68 at the intracondylar notch 70. The depth of the groove 67 is shown in fig 25 by line 15 72. By lateralizing the patella femoral groove, the ligaments are more balanced and the patella potentially tracks smoother and properly in the patella femoral groove. The t~ew design is a patella femoral groove which is aligned virtually straight in the anterior region but shifted lateral to the centerline and which gradually transitions into the intracondylar notch region. This type of patellofemoral groove design causes the patella to track much more lateral at higher degrees of flexion than compared to a centerline or angled patella femoral groove design. This has a clinical advantage because it allows the patella to track properly which should avoid the need for soft tissue lateral releases.
The patella is allowed to track laterally up to about 40 to 50 degrees of flexion before it gradually transitions to the centerline of the component in the intracondylar notch as shown in figure 24. It transitions into the intracondylar notch so that there is good contact between the femoral component and the patella at high degrees of flexion.
The following table fists the parts numbers and parts descriptions as used herein and in the drawings attached hereto.
WO 96103939 ~ ~ (~ ~ ~ ~ 6 PCTIUS95109705 PARTS LIST
Part Number Description 10 asymmetrical femoral prosthesis 11 prosthesis articulating surface 12 anterior articulating surface ' 12p anterior tangent line 12B anterior concave surtace 12C frontal plane 12D transverse plane 13 . lateral posterior condyle 13A posterior condylar surface 13B posterolateral tangent line 14 medial posterior condyle 14A posterior condylar surface 14B posteromedial tangent line 15 distal surtace 16' proximal recess 17 anterior proximal surtace 18 proximal anterior chamfer 19 proximal surtace 20 proximal posterior chamfer 21 posterior proximal surtace 22 recess 23 lateral distal surface 24 medial dital surface 25 offset distance 26 medial distal surtace 27 lateral distal surface 2B angle 29 anatomical angle tibia 30 femur 31 tibia 2196b96 y 32 mechanical axis 33 lateral side 34 medial side 35 ninety degree tibia) resection 36 distal femoral resection 37 extension space 38 femoral resection - posteromedial 39 femoral resection - posterolateral 40 lateral collateral ligament 41 medial collateral ligament 42 anterior femoral cortex 43 notch 44 distal femoral resection 45 ninety degree tibia) resection 46 extension space - parallel 47 flexion space - trapezoidal 48 ' anterior resection 49 angle 50 tibia) component 51 tibia) resection F femoral prosthesis T tibia) prosthesis 60 femoral component 61 lateral distal condyle 61A lateral distal surface 62 medial distal condyle 62A medial distal surface 63 posterolateral condyle 64 posteromedial condyle 65 concave anterior region of new asymmetric femoral 66 convex anterior region of traditional femoral 67 patella groove WO 96/03939 PCTlUS95/09705 68 centerline of the femoral component 69 longitudinal axis of patella groove 70 intracondylar notch 71 patella component 72 line showing depth of patella groove Because many varying and different embodiments may be made within the scope of the inventive concept herein taught, and because many modifications may be made in the embodiments herein detailed in accordance with the descriptive requirement of the law, it is.to be understood that the details herein are to be interpreted as illustrative and not in a limiting sense.
Claims (28)
1. A knee prosthesis comprising:
(a) a femoral component having distal and posterior articulating surface portions comprising lateral and medial condylar surfaces and internal non-articulating surfaces; and (b) a tibial component having concave articulating surfaces that receive the articulating surfaces of the femoral component during use, wherein the distance between the internal non-articulating surface and the posterior articulating surface of the lateral condylar surface is greater than the distance between the internal non-articulating surface and the posterior articulating surface of the medial condylar surface of the femoral component over the posterior but not the distal surface of the articulating surface of the femoral component, whereby an angle of femoral rotation about a femoral mechanical axis changes when going through a normal range of motion of the knee.
(a) a femoral component having distal and posterior articulating surface portions comprising lateral and medial condylar surfaces and internal non-articulating surfaces; and (b) a tibial component having concave articulating surfaces that receive the articulating surfaces of the femoral component during use, wherein the distance between the internal non-articulating surface and the posterior articulating surface of the lateral condylar surface is greater than the distance between the internal non-articulating surface and the posterior articulating surface of the medial condylar surface of the femoral component over the posterior but not the distal surface of the articulating surface of the femoral component, whereby an angle of femoral rotation about a femoral mechanical axis changes when going through a normal range of motion of the knee.
2. The knee prosthesis of claim 1, wherein the non-articulating surface comprises a plurality of intersecting surfaces including at least distal and posterior surfaces.
3. The knee prosthesis of claim 2, wherein the posterior non-articulating surface defines a single plane.
4. The knee prosthesis of claim 1, wherein the non-articulating surface comprises flat intersecting planes.
5. The knee prosthesis of claim 1 further comprising an anterior articulating surface.
6. The knee prosthesis of claim 5, wherein the non-articulating surface comprises a plurality of intersecting surfaces including at least distal and posterior surfaces, the knee prosthesis further comprising an anterior non-articulating surface, and wherein the anterior non-articulating surface is substantially flat and forms an angle of at least ninety degrees with the distal non-articulating surface.
7. The knee prosthesis of claim 2, wherein the posterior non-articulating surface is substantially flat and forms an angle of at least ninety degrees with the distal non-articulating surface.
8. The knee prosthesis of any one of claims 1 to 7, wherein the angle of femoral rotation about the femoral mechanical axis gradually changes when going through a range of motion from distal (zero degrees of flexion) to about ninety degrees of flexion.
9. The knee prosthesis of any one of claims 1 to 7, wherein the angle of femoral rotation about the mechanical axis gradually changes when going through a range of motion from distal (zero degrees of flexion) to about one hundred thirty degrees of flexion.
10. The knee prosthesis of any one of claims 1 to 7, wherein the angle of femoral rotation about the mechanical axis gradually changes when going through a range of motion from about negative twenty degrees of flexion to about ninety degrees of flexion.
11. The knee prosthesis of any one of claims 1 to 7, wherein the angle of femoral rotation about the mechanical axis gradually changes when going through a range of motion from about negative twenty degrees of flexion to about one hundred forty degrees of flexion.
12. The knee prosthesis of any one of claims 1 to 7, wherein the angle of femoral rotation about the mechanical axis gradually changes when going through a range of motion from about twenty degrees of flexion to about eighty degrees of flexion.
13. The knee prosthesis of any one of claims 1 to 7, wherein the angle of femoral rotation about the mechanical axis gradually changes when going through a range of motion of about sixty degrees.
14. The knee prosthesis of any one of claims 1 to 7, wherein the angle of femoral rotation about the mechanical axis gradually changes when going through a range of motion of about eighty degrees.
15. The knee prosthesis of any one of claims 1 to 7, wherein the angle of femoral rotation about the mechanical axis gradually changes when going through a range of motion of about ninety degrees.
16. A knee prosthesis according to claim 1, wherein the femoral component further comprises an anterior articulating surface which, in use, articulates with a patella component or natural patella of the knee; wherein a centerline of the femoral component is defined centrally between the distal condyles of the component;
said femoral component has a patella groove in its anterior articulating surface within which said patella component may track during normal articulating motion of the knee; the longitudinal axis of said groove being located laterally with respect to said centerline in a superior region of the anterior articulating surface and curving in a medial direction in the distal region of the anterior articulating surface of the femoral component.
said femoral component has a patella groove in its anterior articulating surface within which said patella component may track during normal articulating motion of the knee; the longitudinal axis of said groove being located laterally with respect to said centerline in a superior region of the anterior articulating surface and curving in a medial direction in the distal region of the anterior articulating surface of the femoral component.
17. A knee prosthesis according to claim 16 further comprising a patella component.
18. A knee prosthesis as claimed in claim 16 or 17, wherein the axis of said groove is substantially parallel to said centerline in the superior region of the anterior articulating surface.
19. A knee prosthesis as claimed in claim 16 or 17, wherein the axis of said groove is located substantially at the centerline in the distal region of the anterior articulating surface of the femoral component.
20. A knee prosthesis as claimed in any one of claims 16 to 19, wherein the change in the location of the longitudinal axis of said groove from lateral of the centerline towards medial is gradual.
21. A knee prosthesis as claimed in claim 16 or 17, wherein said patella groove is curved over at least a part of its length.
22. A knee prosthesis as claimed in claim 5, wherein said femoral component further comprises a patella groove located in the anterior articulating surface for articulation with a patella component with the patella of the knee suitably shaped, said groove having a longitudinal axis which is located laterally of a longitudinal centerline of the component, or the patella of the knee, in a superior region of the anterior articulating surface and curves towards a medial direction in the distal region of the anterior articulating surface.
23. A knee prosthesis as claimed in claim 22, wherein the axis of said groove is substantially parallel to said centerline in the superior region of the anterior articulating surface.
24. A knee prosthesis as claimed in claim 22, wherein the axis of said groove is located substantially at the centerline in the distal region of the anterior articulating surface of the femoral component.
25. A knee prosthesis as claimed in any one of claims 22 to 24, wherein the change in the location of the longitudinal axis of said groove from lateral of the centerline towards medial is gradual.
26. A knee prosthesis as claimed in claim 22, wherein said patella groove is curved over at least a part of its length.
27. A knee prosthesis according to claim 1, wherein the femoral component further comprises an anterior articulating surface portion, where an anterior proximal portion has an arc center that is anterior to the anterior surface portion; wherein the femoral component is concave in an anterior proximal region in a lateral view.
28. A knee prosthesis as claimed in claim 1 or claim 16 or 17, said femoral component further comprising an anterior articulating surface portion wherein an anterior proximal portion has an arc center which is anterior to the anterior surface portion wherein the femoral component is concave in an anterior proximal region in a lateral view.
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US08/285,917 US5549688A (en) | 1994-08-04 | 1994-08-04 | Asymmetric femoral prosthesis |
| US08/285,917 | 1994-08-04 | ||
| PCT/US1995/009705 WO1996003939A1 (en) | 1994-08-04 | 1995-08-01 | Asymmetric femoral prosthesis |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CA2196696A1 CA2196696A1 (en) | 1996-02-15 |
| CA2196696C true CA2196696C (en) | 2006-03-28 |
Family
ID=36123345
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA002196696A Expired - Fee Related CA2196696C (en) | 1994-08-04 | 1995-08-01 | Asymmetric femoral prosthesis |
Country Status (1)
| Country | Link |
|---|---|
| CA (1) | CA2196696C (en) |
Families Citing this family (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US20170290669A1 (en) * | 2016-04-11 | 2017-10-12 | Zafer Termanini | System and method for side insertion of a bicondylar mini knee implant |
-
1995
- 1995-08-01 CA CA002196696A patent/CA2196696C/en not_active Expired - Fee Related
Also Published As
| Publication number | Publication date |
|---|---|
| CA2196696A1 (en) | 1996-02-15 |
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