Shield guide assembly

Abstract

The present disclosure relates to a shroud guide assembly and method for restoring function to a joint. The shroud guide assembly disclosed herein includes a shroud sized to block access to an adjacent bone surface region through the shroud during formation of one or more features along a surgical site.

Description

[0001] Cross-referencing related applications

[0002] This disclosure claims priority to U.S. Application No. 17 / 214,067, filed on March 26, 2021. Background Technology

[0003] This disclosure relates to orthopedic surgery, and more specifically to a shield guide assembly for repairing joints.

[0004] Many bones in the human musculoskeletal system include joint surfaces. Joint surfaces work together to facilitate different types and degrees of joint movement. Joint surfaces may erode or experience bone loss over time due to repeated use or wear, or they may fracture due to traumatic impact. These types of bone defects can lead to joint instability and pain. Several techniques can utilize prostheses to repair joint surfaces. Before placing a prosthesis, tissue can be separated from the bone. The tissue can then be reattached to the bone using one or more fasteners adjacent to the prosthesis. Summary of the Invention

[0005] This disclosure relates to a shield guide assembly for use in orthopedic surgery. The shield guide assembly can be used to at least partially block access to local surface areas of bone during preparation of the surgical site.

[0006] An exemplary aspect of this disclosure for a shield guide assembly for orthopedic surgery may include, in particular, an elongated guide arm configured to be releasably secured to a base of an implant, extending from the base along an arm axis, and a shield translatable along the arm axis to position the shield relative to the base. The shield may include a shield body that establishes a periphery of the shield. The dimensions of the shield body may be configured to prevent access through the shield body to adjacent bone surface areas associated with the projection of the shield periphery.

[0007] An exemplary aspect of this disclosure for orthopedic surgery includes, in particular, a shield guide assembly configured to be releasably secured to a base of an implant, a guide arm extending from the base, and a shield movable relative to the guide arm. The shield includes a shield body sized to prevent access through the shield, such that the projection of the periphery of the shield body can outline the periphery of the implant.

[0008] Kits for orthopedic surgery according to exemplary aspects of this disclosure may in particular include an implant comprising an implant body configured to be at least partially received in bone and a shield guide assembly. The shield guide assembly may include a base configured to be releasably secured to the implant, a guide arm extending from the base, and a shield translatable along the length of the guide arm to position the shield relative to the implant. The shield may include a shield body that establishes a periphery of the shield. The dimensions of the shield body may be configured to prevent access through the shield body to adjacent bone surface areas associated with the projection of the shield periphery.

[0009] A method for installing an orthopedic surgical implant according to an exemplary aspect of this disclosure may particularly include positioning the implant in bone and securing a shield guide assembly to the implant. The shield guide assembly may include a base, a guide arm extending from the base, and a shield secured to the guide arm. The securing step may include mounting the base to the implant. The method may include moving the shield along the guide arm to position the shield relative to the implant. The shield body may be sized to prevent access through the shield body to a bone surface area associated with the projection of the shield periphery from the positioned location. The method may include forming at least one opening in the bone adjacent to the bone surface area and the shield. Attached Figure Description

[0010] Figure 1 A perspective view of an exemplary shield guide assembly including a base, guide arms, and a shield is shown.

[0011] Figure 2 It shows Figure 1 Plan view of the protective shield guide assembly.

[0012] Figure 3 It shows along Figure 2 The cross-sectional view of the protective cover guide assembly taken from line 3-3.

[0013] Figure 3A The outline of an example shield is shown.

[0014] Figure 4 It shows along Figure 2 The cross-sectional view of the protective cover guide assembly taken from line 4-4.

[0015] Figure 5 It shows Figure 1 End view of the protective guide assembly.

[0016] Figures 5A to 5B The shield is shown in the first and second positions relative to the guide arm.

[0017] Figure 6 This shows the difference between the local bone surface area and the periphery of the implant. Figure 5 The perimeter of the protective cover guide component.

[0018] Figure 7 The periphery of another shield guide relative to the periphery of the implant is shown.

[0019] Figures 8 and 9 show perspective views and exploded views of an exemplary implant.

[0020] Figure 10 An exemplary method for installing an orthopedic surgical implant system at a surgical site is shown.

[0021] Figure 11 The removed bone is shown.

[0022] Figure 12 It shows along Figure 11 The implant is positioned by removing the bone.

[0023] Figures 13 to 14 An exemplary shield guide assembly positioned relative to the surgical site is shown.

[0024] Figure 15 It shows the location at the surgical site. Figure 12 Implants.

[0025] Figure 16 The tissue attached to the surgical site is shown.

[0026] Figure 17 The fastener positioned in the orifice is shown.

[0027] Figure 18 It shows Figure 16 A complete view of the repair of the attached tissue. Detailed Implementation

[0028] This disclosure relates to a shield guide assembly that can be used in orthopedic surgery to restore joint function. The shield guide assembly described herein can be used during the placement of a shoulder prosthesis in anatomical and reverse surgery to restore function in a shoulder with advanced cartilage disease. Due to placement within the bone, the visibility of portions of the prosthesis may be obscured. The shield guide assembly and techniques disclosed herein can be used to prevent access to the bone portions surrounding the prosthesis, thereby reducing the likelihood of contact with instruments and other devices that can be used to reattach any tissue stabilizing the joint, such as soft tissues including tendons, ligaments, and joint capsules, as well as other tissues that can improve healing. Tissues may include one or more rotator cuff tendons, including the supraspinatus tendon, infraspinatus tendon, teres minor tendon, and / or subscapularis tendon. For example, the surgeon can position the shield guide assembly relative to the prosthesis to reduce the likelihood of inadvertent contact with the prosthesis and the formation of holes in the prosthesis during preparation for reattaching the subscapularis tendon or other rotator cuff tendons to the bone.

[0029] An exemplary aspect of this disclosure for a shield guide assembly for orthopedic surgery may include, in particular, an elongated guide arm configured to be releasably secured to a base of an implant, extending from the base along an arm axis, and a shield translatable along the arm axis to position the shield relative to the base. The shield may include a shield body that establishes a periphery of the shield. The dimensions of the shield body may be configured to prevent access through the shield body to adjacent bone surface areas associated with the projection of the shield periphery.

[0030] In another embodiment, the shield body may include at least one slot configured to slidably receive a portion of the guide arm along the arm axis.

[0031] In another embodiment, the guide arm may have a T-shaped cross-section.

[0032] In another embodiment, the at least one slot may be a row of interconnected T-shaped slots corresponding to a respective radial position of the shield relative to the arm axis, and the length of the guide arm may be inserted into each of the T-shaped slots to set the respective radial position of the shield.

[0033] In yet another embodiment, the shield body excludes any openings between a row of slots and the periphery of the shield.

[0034] In another embodiment, the base may include a recess configured to at least partially receive the distal portion of the implant.

[0035] In another embodiment, the base may be rotated about the implant axis of the implant to change the circumferential position of the shield relative to the implant axis.

[0036] In another embodiment, the size of the shield can be set to mate with the adjacent bone surface area in the installation position.

[0037] In yet another embodiment, the adjacent bone surface area may be associated with the humerus.

[0038] An exemplary aspect of this disclosure for orthopedic surgery includes, in particular, a shield guide assembly configured to be releasably secured to a base of an implant, a guide arm extending from the base, and a shield movable relative to the guide arm. The shield includes a shield body sized to prevent access through the shield, such that the projection of the periphery of the shield body can outline the periphery of the implant.

[0039] In another embodiment, the base may be rotated about the implant axis of the implant to change the circumferential position of the shield relative to the implant axis of the implant.

[0040] In yet another embodiment, for substantially all locations along the periphery of the implant relative to the implant axis below the bottom of the base, the periphery of the shield may be offset outward from the periphery of the implant by a maximum distance not exceeding 1 mm.

[0041] In yet another embodiment, the shield may be movable relative to the guide arm to change the radial position of the shield relative to the implant axis.

[0042] In another embodiment, the size of the shield body can be set to prevent access to the adjacent bone surface area associated with the humerus through the shield.

[0043] Kits for orthopedic surgery according to exemplary aspects of this disclosure may in particular include an implant comprising an implant body configured to be at least partially received in bone and a shield guide assembly. The shield guide assembly may include a base configured to be releasably secured to the implant, a guide arm extending from the base, and a shield translatable along the length of the guide arm to position the shield relative to the implant. The shield may include a shield body that establishes a periphery of the shield. The dimensions of the shield body may be configured to prevent access through the shield body to adjacent bone surface areas associated with the projection of the shield periphery.

[0044] In another embodiment, the periphery of the shield may define a shield width greater than the width of the portion of the implant configured to be received in the bone.

[0045] In another embodiment, the implant body may extend along the implant axis between a first end portion and a second end portion. The base may be configured to be secured to the first end portion. The shield may rotate about the implant axis to change the circumferential position of the shield relative to the implant body in the installation position.

[0046] In another embodiment, the implant may include an trunnion configured to be secured to an implant body and a hinge portion configured to be secured to the implant body. The trunnion may be configured to resect along a humeral joint surface. The hinge portion may include a hinge face sized to interface with an opposing articular surface associated with the glenoid cavity or glenoid implant.

[0047] In another embodiment, a plurality of threads may extend around the circumference of the implant body, and the dimensions of the plurality of threads may be configured to secure the implant body in the bone.

[0048] A method for installing an orthopedic surgical implant according to an exemplary aspect of this disclosure may particularly include positioning the implant in bone and securing a shield guide assembly to the implant. The shield guide assembly may include a base, a guide arm extending from the base, and a shield secured to the guide arm. The securing step may include mounting the base to the implant. The method may include moving the shield along the guide arm to position the shield relative to the implant. The shield body may be sized to prevent access through the shield body to a bone surface area associated with the projection of the shield periphery from the positioned location. The method may include forming at least one opening in the bone adjacent to the bone surface area and the shield.

[0049] In another embodiment, the tissue may be soft tissue, and the method may include positioning fasteners in the at least one aperture to secure the soft tissue to the bone.

[0050] In another embodiment, the bone may be the humerus, the fastener may be a suture anchor, and the soft tissue may include the subscapularis tendon.

[0051] In another embodiment, the bone may be the humerus. The method may include cutting the humerus along the humeral head to create a cut surface, and then embedding at least a portion of the implant into the cut surface.

[0052] In another embodiment, the method may include rotating the shield about the implant axis to position the shield circumferentially relative to the implant. A movement step may occur such that the shield aligns with bone along a bone surface region in the set position. A formation step may occur after the rotation and movement steps.

[0053] In another embodiment, the bone may be the humerus. The method may include cutting the humerus along the humeral head to create a cut surface, and then embedding at least a portion of the implant into the cut surface.

[0054] In another embodiment, the implant may include an implant body, an axial shaft configured to be secured to the implant body, and a hinge portion. The hinge portion may include a hinge surface sized to interface with an opposing articular surface associated with the glenoid cavity or glenoid implant. Positioning the implant may include moving the axial shaft along the cut surface to engage it.

[0055] In another embodiment, a plurality of threads may extend around the circumference of the implant body. Positioning the implant may include rotating the implant body about an implant axis to securely attach the implant body to the bone. The method may include securing the hinge portion to the taenium shaft to confine the distal portion of the implant body between the taenium shaft and the hinge portion.

[0056] Figures 1 to 6 An exemplary shield guide assembly 20 is illustrated. Assembly 20 can be used in various surgical procedures, such as orthopedic surgeries for restoring joint function. Assembly 20 can be used to repair the articular surface along the humerus in anatomical and reverse shoulder replacement surgery. Assembly 20 can be used during the attachment of soft tissues, including tendons, ligaments, and joint capsules, as well as other tissues at the surgical site, such as the subscapularis tendon or other rotator cuff tendons reattached to the bone after a prosthesis is implanted into the humerus. The surgeon can position Assembly 20 during surgical site preparation to block the path to the bone portion around the implant, thereby reducing the likelihood of contact with instruments and other devices such as guide pins and fasteners that can be used for attachment of tissues. Although the assemblies disclosed herein primarily relate to shoulder reconstruction, the disclosed assemblies can be used to restore function in other positions of the patient, such as the knee and hip joints.

[0057] refer to Figure 1 The assembly 20 includes a base 22, an elongated guide arm 24, and a shield 26 carried by and secured to the guide arm 24. The base 22 is configured to be releasably secured to the implant 28 (for illustrative purposes). Figure 3 (Shown in dashed lines). Assembly 20 can be used with implants of various shapes and sizes. Figure 3 The geometry of the implant 28 is exemplary and not intended to be limiting. The shield 26 may be translated along the length of the guide arm 24 to position the shield 26 relative to the base 22 and the implant 28.

[0058] refer to Figure 2 and Figure 3 Continue to refer to Figure 1 The base 22 may have a feature for use with the implant 28 ( Figure 3 The interface has a generally dome-shaped geometry. The base 22 may extend along the base axis BA. The assembly 20 may include a handle 30, said handle being, for example, along... Figure 3The base axis BA shown extends outward from the base 22. The handle 30 is sized to be maneuverable by the surgeon to position and / or orient the assembly 20 along the surgical site. The handle 30 may have a generally cylindrical geometry. The handle 30 may be integrally formed with the base 22, or it may be a separate and distinct component mechanically attached to the base 22 with one or more fasteners.

[0059] The base 22 may include a recess 32 configured to at least partially receive a first distal portion 34 of the implant 28 to secure the base 22 to the implant 28, such as... Figure 3 As shown in the diagram. The base 22 may define one or more openings 31 (e.g., windows) for viewing the first distal portion 34 of the implant 28, which may aid in the positioning of the assembly 20. The implant 28 may include an implant body 33 extending along the implant axis IA between the first distal portion 34 and the second distal portion 35. The base axis BA may be collinear with or otherwise substantially parallel to the implant axis IA of the implant 28 in the installation location, such as... Figure 3 As shown. In other embodiments, the base 22 may be sized such that the base axis BA is transverse to the implant axis IA. For the purposes of this disclosure, unless otherwise stated, the terms “about,” “approximately,” and “substantially” mean within ±10% of the stated values ​​or relationships. The recess 32 may be sized to have the geometry of the periphery of the first distal portion 34 of the supplementary implant 28.

[0060] The base 22 is rotatable in direction R1 about the implant axis IA to change the circumferential position of the shield 26 relative to the implant axis IA of the implant 28 and the implant body 33 in the installation position. In other embodiments, the recess 32 is sized to create an interference fit with the periphery of the implant body 33 to limit or otherwise resist relative rotation.

[0061] The guide arm 24 can be cantilevered from the periphery of the base 22. The guide arm 24 can extend from the base 22 along the arm axis AA. The dimensions of the guide arm 24 can be set such that the arm axis AA is substantially perpendicular to the base axis BA, and that the shield 26 is substantially parallel to the base axis BA, as shown below. Figure 3 As shown. In other embodiments, the assembly 20 may be sized such that the shield 26 is substantially not parallel to the base axis BA and is angled relative to the base 22. The shield 26 may be translated in direction D1 along the arm axis AA to position the shield 26 relative to the base 22. The exemplary position of the shield 26 along the guide arm 24 is determined by... Figure 3The protective covers 26-1 and 26-2 are shown (26-2 is indicated by a dashed line for illustrative purposes). The periphery of the base 22 can define the innermost axial position of the protective cover 26 relative to the arm axis AA. The protective cover 26 can be moved along the guide arm 24 in direction D1 such that the protective cover 26 aligns with the bone B in the set position (for illustrative purposes, in...). Figure 2 Bone B is shown in dashed lines.

[0062] The guide arm 24 can be sized to restrict the rotation of the shield 26 about the arm axis AA. In other embodiments, the shield 26 can rotate about the arm axis AA. The guide arm 24 may include a body 36 extending along the arm axis AA and a pair of rails 38 on opposite sides of the body 36. Figure 2 Track 38 can be arranged along body 36 such that the length of guide arm 24 has a substantially T-shaped cross-sectional geometry, such as... Figure 4 As shown. The track 38 can be sized to extend from the periphery of the base 22 and can be spaced apart from the docking portion 40 at the free end of the guide arm 24 to create a pair of opposing slots 42. Figure 3 The docking part 40 can define the outermost axial position of the guard 26 relative to the arm axis AA.

[0063] The shield 26 may include a shield body 44, which is sized relative to the predetermined implant geometry to, for example, block pathways or passages through the shield body 44 to adjacent local bone surface areas during the formation of one or more openings for reattaching tissue, including any tissue disclosed herein, such as the subscapularis tendon or other rotator cuff tendons after the implant 28 has been at least partially embedded in the bone.

[0064] refer to Figure 5 Continue to refer to Figures 2 to 3 The shield body 44 may include a first portion 46 and a second portion 48. The first portion 46 may face the free end of the guide arm 24, and the second portion 48 may face the base 22. The first portion 46 and the second portion 48 may be integrally formed, or they may be separate and distinct components mechanically attached to or otherwise fixed to each other. The first portion 46 may have a substantially rectangular geometry. The second portion 48 may include a pair of wings 50 sized to extend outward from the first portion 46. The first portion 46 and the second portion 48 of the shield body 44 cooperate to establish a shield perimeter 52 (shown in dashed lines for illustrative purposes).

[0065] The shield body 44 can be sized relative to the geometry of the surgical site. The shield body 44 may have a substantially planar geometry along the second portion 48, such as... Figure 3As shown in the diagram. In other embodiments, the dimensions of the shield 26 may be set to substantially complement or approximate the contour of the adjacent surface of bone B, as shown in the diagram. Figure 3A The shield body 144 is shown in the figure. Contouring the shield body 144 reduces the likelihood of placing instruments and other devices between the shield body 144 and bone B. In this disclosure, where appropriate, the same reference numerals denote the same elements, and the addition of one hundred or multiples of reference numerals denotes modified elements, which are understood to incorporate the same features and benefits of the corresponding original elements.

[0066] The shield 26 is movable relative to the guide arm 24 to change the radial position of the shield 26 relative to the implant axis IA of the implant 28. The shield body 44 may include at least one slot 54 extending through the first portion 46 and the second portion 48. The slot 54 is configured to slidably receive a portion of the guide arm 24 along the arm axis AA, such as Figure 3 As shown. The slot 54 can have various geometries, such as a row of interconnected T-shaped slots 57. The T-shaped slots 57 can correspond to a respective radial position of the shield 26 relative to the arm axis AA and / or a set of predetermined implant sizes. For example, the shield body 44 can define four slots 57 corresponding to a set of predetermined implant sizes (e.g., small, medium, large, and extra-large). The shield body 44 can be aligned with one of the slots 57 in the guide arm 24, and then the shield 26 can be moved in direction D2 to set the radial position of the shield 26 relative to the arm axis AA, such as... Figures 5A to 5B The protective covers 26-3 and 26-4 are shown in the diagram. Tracks 38 along the length of the guide arm 24 can be inserted into each of the T-slots 57 to set the radial position of the protective cover 26 relative to the arm axis AA. The protective cover 26 can be sized such that the cover body 44 excludes any openings between the row of slots 57 and the cover perimeter 52, as shown in the diagram. Figure 5 As shown in the image.

[0067] refer to Figure 6 Continue to refer to Figure 3 and Figure 5The shield perimeter 52 can be sized relative to a predetermined geometry of the implant or assembly of implants. For example, the implant 28 can form the implant perimeter 58. The implant perimeter 58 can correspond to a portion of the implant 28 configured to be received in bone, or it can correspond to the entire implant 28, including portions configured to extend outward from the bone. The dimensions of the shield perimeter 52 can be set such that the projection of the shield perimeter 52 substantially or completely surrounds the implant perimeter 58. The dimensions of the shield 26 can be set to prevent access through the shield body 44 to the adjacent local bone surface region 60 associated with the projection of the shield perimeter 52. The bone surface region 60 can be formed along the outer surface contour of bone B, which at least partially receives the implant 28, such as the humeral head. The dimensions of the shield 26 can be set to abut the bone surface region 60 in the installation position, such as... Figure 2 As shown (see also) Figure 3A For illustrative purposes, the periphery of the shield 52, the periphery of the implant 58, the bone surface area 60, and related features are described. Figure 6 It is shown in dashed lines.

[0068] The periphery 52 of the shield 26 can be established with a first width W1. The first width W1 can extend between a pair of sidewalls of the shield body 44. The periphery 58 of the implant 28 can be established with a second width W2. The dimensions of the shield body 44 can be set such that the shield width W1 is greater than the implant width W2, for at least a portion of the implant 28 configured to be received in the bone, such as... Figure 6 As shown. The size of the shield 26 can be set to have a height greater than or equal to the height of the implant body 33, such that the periphery 52 of the shield 26 extends above and / or below the periphery 58 of the implant 28 relative to the implant axis IA, as shown. Figure 3 As shown. Figure 7 As shown, the dimensions of the shield 26' can be set to closely approximate the contour of the implant 28'. The dimensions of the periphery 52' of the shield 26' can be set to substantially follow the periphery 58' of the implant 28', such that the projection of the periphery 52' of the shield 26' delineates the contour of the periphery 58' of the implant 28', thereby preventing access to the adjacent local bone surface area 60' through the shield body 44'. The first width W1' of the shield 26' can be substantially equal to the second width W2' of the implant 28'. The periphery 52' of the shield 26' can be offset outward from the periphery 58' of the implant 28' by a maximum distance not exceeding 1 millimeter (mm), continuing along at least most or substantially all locations of the periphery 58', including at least the location of the periphery 58' below the bottom 37' of the base 22' relative to the implant axis IA' (see also...). Figure 3 (Bottom 37 of the base 22 in the middle). The disclosed technique can facilitate closer positioning of the device relative to the implant 28' during the formation of one or more features in the bone B', which can improve patient fixation and healing.

[0069] Figures 8 and 9 illustrate an exemplary orthopedic surgical implant 128 that can be used with the shield guide assembly 20. Implant 128 may be represented under the trademark name Eclipse System. TM Sold and by The shankless implant manufactured by Inc. Assembly 20 and the disclosed implant can be provided to surgeons as a kit for performing orthopedic surgery. The kit can include implants of various shapes and sizes. A specific implant can be selected from the kit based on the patient's anatomy. Other implants can be used in conjunction with the teachings disclosed herein, including implants having a shank portion received within the lumen of bone, intramedullary nails, and bone plates.

[0070] Implant 128 may include an implant body 133, an trunnion 172, and a hinge portion 174. The implant body 133 may be configured to be received at least partially in the bone, for example, along a resected surface of the humeral head. The implant body 133 may be a cage screw including one or more threads 171 extending circumferentially around the implant body 133. The threads 171 may be sized to secure the implant body 133 in the bone. The implant body 133 may be rotated about the implant axis IA in direction R3 (FIG. 9) to secure the implant body 133 in the bone. The implant body 133 may define a hollow cavity 173 and one or more openings 177 in the walls of the implant body 133. The openings 177 may facilitate bone growth from the surrounding bone into the cavity 173, which may improve patient healing.

[0071] The truncated shaft 172 can be configured to be secured to the implant body 133. The truncated shaft 172 can be configured to engage with a resected surface of bone, such as along a resected surface of the humerus (see example...). Figure 12 The trunnion 172 may include a channel 176 (FIG. 9) configured to receive the implant body 133 at least partially along the implant axis IA. During assembly, the implant body 133 may move in a direction D3 along the implant axis IA and into the channel 176 until a collar 179 of the implant body 133 abuts the body 181 of the trunnion 172. The trunnion 172 may include one or more protrusions 178 configured to engage bone surfaces for securing the implant 128.

[0072] The hinge portion 174 can be configured to be secured to the implant body 133. The hinge portion 174 may include a hinge surface 175, which is sized to interface with an opposing hinge surface. The opposing hinge surface may be associated with a glenoid or glenoid implant used in anatomical or reverse shoulder repair surgery. The hinge surface 175 may have a convex geometry for anatomical shoulder surgery, as shown in Figures 8 and 9, or it may have a concave surface for reverse shoulder surgery. The hinge portion 174 can be moved along the implant axis IA in direction D3 and impact or otherwise secured to the body 181 of the implant body 133 and / or the trunnion 172.

[0073] Figure 10 An exemplary method for implanting an orthopedic surgical implant is illustrated in flowchart 290. For example, method 290 can be used to perform arthroplasty to restore function to a shoulder joint, for example, in patients with advanced cartilage disease. Method 290 can be used with either the shield guide assembly 20 or any of the orthopedic surgical implants disclosed herein. Method 290 can be used to attach any tissue disclosed herein, including soft tissues such as tendons, ligaments, and joint capsules. The tissue can be one of the patient's rotator cuff tendons, including the supraspinatus tendon, infraspinatus tendon, teres minor tendon, and / or subscapularis tendon. Within the scope of this disclosure, fewer or more steps than those listed below may be performed, and the order of the listed steps is not intended to limit this disclosure.

[0074] refer to Figure 11 Continue to refer to Figure 10 In step 290A, the surgical site S can be prepared. The surgical site S can be a joint, such as the shoulder joint including the glenoid G and the humerus H (see example). Figure 15 The surgical site S can be established along a bone B associated with an articular surface of the shoulder joint, such as the humeral head HH of the humerus. One or more operations can be performed to prepare the surgical site S, such as one or more reaming, milling, and drilling operations, to establish the desired geometry of the surgical site S.

[0075] Step 290A may include removing a portion of bone B at step 290B to establish a resection surface RS. Step 290B may include removing a portion of the humerus along the humeral head HH at a resection angle α relative to the axis BB of bone B to establish a resection surface RS. For example, bone B may be removed using one or more cutting instruments and guide blocks.

[0076] Step 290A may include forming a bone cavity BC along the resection surface RS and into the bone B. The bone cavity BC may be a ring-shaped region, such as... Figure 11 As shown in the diagram. The size of the bone cavity BC can be set to receive at least a portion of the implant body 233 of the implant 228, as shown in the diagram. Figure 12As shown in the diagram. In other embodiments, the core CC can be removed, leaving the bone cavity BC substantially hollow. Various techniques for forming the bone cavity BC can be utilized, such as impacting an annular core template into the resection surface RS, or reaming or drilling operations.

[0077] refer to Figure 12 Continue to refer to Figure 10 At step 290C, implant 228 may be at least partially positioned in bone B. Implant 228 may be a stalkless implant. Other implants may be used with method 290 and shield guide assembly 20, including implants having an elongated rod receiving the humeral canal and any implants disclosed herein. Step 290C may include embedding at least a portion of implant body 233 into the resection surface RS after bone B has been removed. Auricle 272 may be movable to engage or otherwise positioned along the resection surface RS.

[0078] The implant body 233 can be at least partially positioned in the bone cavity BC, which can occur after the taenium 272 has been positioned. The implant body 233 can be moved along the implant axis IA in direction D3 and at least partially into the channel 276 of the taenium 272 until the collar 279 of the implant body 233 abuts the body 281 of the taenium 272. Step 290C may include rotating the implant body 233 about the implant axis IA in direction R3 to securely attach or otherwise fix the implant body 233 in the bone B along the bone cavity BC.

[0079] refer to Figures 13 to 14 Continue to refer to Figure 10 In step 290D, the shield guide assembly 220 is releasably secured to the implant 228 to at least partially block access to the local bone surface area 260 along the surgical site S (see...). Figure 14 The shield guide assembly 220 may include a base 222, a guide arm 224, and a shield 226. Step 290D may include mounting the base 222 to another portion of the trunnion 272 or implant 228, such as... Figure 14 As shown in the diagram. In other embodiments, assembly 220 can be directly mounted to implant body 233 (as shown in the diagram). Figure 12 The assembly 220 can be secured to the implant 228, such that the guide arm 224 is cantilevered from the periphery of the base 222.

[0080] At step 290E, the position of the shield 226 may be set relative to the implant 228. Step 290E may include aligning the shield body 244 of the shield 226 with a selected T-slot 257 in the guide arm 224, and then moving the shield 226 in direction D2 to set a radial position of the shield 226 relative to the arm axis AA of the guide arm 224. Step 290E may include inserting one or more rails 238 of the guide arm 224 into one of the selected T-slots 257 to set the corresponding radial position of the shield 226. The dimensions of the rails 238 and the slots 257 may be configured to limit the relative radial movement of the shield 226 relative to the arm axis AA, such that the shield 226 is positioned at a substantially constant height on the guide arm 224 along the length of the rails 238.

[0081] Step 290E may include rotating the shield 226 about the implant axis IA in direction R1 to set the circumferential position of the shield 226 relative to the implant 228. Figure 12 The dimensions of assembly 220 may be configured such that shield 226 can rotate approximately 360 degrees about the base axis BA to block bone B approaching the implant 228. In some embodiments, the dimensions of assembly 220 may be configured such that shield 226 can rotate less than 360 degrees about the base axis BA, for example, equal to or less than about 180 degrees.

[0082] Step 290E may include moving the shield 226 along the length of the guide arm 224 in direction D1 to position the shield 226 relative to the implant 228. For example... Figure 14 As shown (see also) Figure 2 This allows the shield 226 to move along the guide arm 224 in direction D1, such that the shield 226 aligns with bone B along the bone surface region 260 at a predetermined position. The bone surface region 260 can be correlated with the projection of the shield periphery 252 (for illustrative purposes, in...). Figures 13 to 14 252 and 260 are shown in dashed lines respectively. See also... Figure 6 The size of the shield body 244 can be set to prevent access to the bone surface area 260 through the shield body 244 at a set location.

[0083] At step 290F, when assembly 220 is secured to implant 220, one or more features may be formed at the surgical site S adjacent to implant 228. Step 290F may occur after the position of shield 226 is set at step 290E. Features may include recesses or orifices 292 configured to receive corresponding fasteners, such as suture anchors. Orifices 292 and other features may be formed using various techniques, such as drilling, punching, inserting needles, etc., into bone B. Step 290G may include forming one or more orifices 292 in bone B adjacent to bone surface region 260 and shield 226, such as... Figures 13 to 14 As shown in the diagram. The orifice 292 can be formed in the humeral head HH on the outer side of the shield periphery 252 and the bone surface region 260, as shown. Figures 14 to 15 As shown. For illustrative purposes, four openings 292 formed in the humeral head HH are shown. However, while the shield guide assembly 220 is secured to the implant 228, a different number of openings 292 may be formed in the bone B along the surgical site S, for example, only one or two openings 292. Step 290F may include: forming one or more openings 292-1 associated with a first bone surface region 260-1 corresponding to a first circumferential position of the shield 226 relative to the base axis BA, rotating the shield 226 in direction R1 to a second different circumferential position associated with a second different bone surface region 260-2 at step 290E, and then forming one or more openings 292-2 adjacent to the second bone surface region 260-2, as shown. Figure 14 As shown (see also) Figure 15 After feature 292 is formed, assembly 220 can be removed from surgical site S.

[0084] refer to Figure 15 Continue to refer to Figure 10 At step 290H, the hinge portion 274 can be mounted to the implant body 233 to secure the hinge portion 274 to bone B. Step 290H can occur, thereby confining the distal portion of the implant body 233 between the trunnion 272 and the hinge portion 274 (see also FIG8). The hinge portion 274 may include a hinge surface 275, the hinge surface being sized to interface with an opposing articular surface AS. The articular surface AS may be associated with the glenoid G or the glenoid implant GI. The hinge surface 275 may have, for example, Figure 15 The generally convex geometry shown may have a generally concave geometry.

[0085] refer to Figure 16 Continue to refer to Figure 10 At step 290I, tissue T may be reattached along the surgical site S or otherwise fixed to bone B. For illustrative purposes, tissue T is... Figure 16The tissue is shown in dashed lines. Step 290I may include attaching one or more sutures of one or more lengths SS to the distal portion of the tissue T at step 290J. The tissue T may include any tissue disclosed herein, including tendons, ligaments, or joint capsules. The tissue T may be one of the rotator cuff tendons, including the supraspinatus tendon, infraspinatus tendon, teres minor tendon, and / or subscapularis tendon associated with the patient's humerus H. Step 290I may occur after the assembly 220 has been removed from the surgical site S. Step 290A may include dissecting or otherwise moving a portion of the tissue T away from the humeral head HH to provide access for positioning the implant 228. Step 290I may include moving a portion of the tissue T over the hinge portion 274 and moving it to a position substantially close to the initial position of the tissue T before placement of the implant 228.

[0086] Step 290I may include securing tissue T with one or more fasteners 294 attached or otherwise secured to bone B. Step 290I may include positioning one or more fasteners 294 in a corresponding orifice 292 at step 290K to secure tissue T to bone B. Step 290K may include positioning fasteners 294 in a corresponding orifice 292 to secure tissue T, such as the subscapularis tendon, to the humeral head HH of the humerus. Exemplary fasteners may include anchors, which include various materials such as polyetheretherketone (PEEK), metals and biocomposite materials, suture materials, other natural and synthetic materials, and / or one or more sutures.

[0087] Fastener 294 may be, for example, a suture anchor fixed to the suture SS. Step 290K may include inserting fastener 294 at least partially into the corresponding orifice 292 to secure the suture SS at a corresponding location along the surgical site S. Fastener 294 may have various geometries and configurations. For example, fastener 294 may have one or more threads or ribs to establish an interference fit with the surface along the corresponding orifice 292, such as... Figure 17 As shown.

[0088] At step 290I, various techniques can be used to fix tissue T. In some embodiments, tissue T can utilize, for example... Figure 16 The double-row technique shown is used to fix the bone to B. Two rows of openings 292 can be formed outwardly along the surgical site S from the corresponding bone surface area 260 associated with the projection of the periphery 252 of the protective shield (see [link]). Figures 13 to 15 Fasteners 294 are located in corresponding orifices 292 to secure sutures SS and tissue T to bone B along the surgical site S. The sutures SS may be arranged in a generally X-shaped pattern between the two rows of fasteners 294. In other embodiments, step 290I may include performing a single-row technique to secure tissue to bone B, forming a pair of orifices 292 in the bone B to secure the corresponding fasteners 294. Figure 18The completed repair is shown, including the reattachment of tissue T as a result of step 290I, wherein tissue T is the subscapularis tendon reattached to the humeral head HH. One or more reconstructive procedures may be performed at step 290L, including occlusion of the surgical site S.

[0089] The novel shield guide assembly and method disclosed herein can be used to prevent access to bone portions surrounding the embedded implant, which reduces the likelihood of contact or perforation of the implant bone during one or more features immediately adjacent to the implant formation. The shield guide assembly can be positioned circumferentially around the implant and / or at one or more heights to provide versatility in selecting various implant geometries and to accommodate the patient's corresponding bone contour. Orifices and other features can be immediately adjacent to the implant formation to provide improved bone retrieval and fixation for tendons or other tissues.

[0090] Although different non-limiting embodiments are shown to have specific components or steps, the embodiments disclosed herein are not limited to those specific combinations. It is possible to combine some components or features from any non-limiting embodiment with features or components from any other non-limiting embodiment.

[0091] It should be understood that throughout the various figures, the same reference numerals identify corresponding or similar elements. It should also be understood that although particular arrangements of components are disclosed and shown in these exemplary embodiments, other arrangements may also benefit from the teachings of this disclosure.

[0092] The foregoing description should be interpreted as illustrative and not in any restrictive sense. Those skilled in the art will understand that certain modifications may fall within the scope of this disclosure.

Claims

1. A protective shield guide assembly for orthopedic surgery, comprising: A base, the base being configured to be releasably secured to the implant; A slender guide arm that extends longitudinally from the base along the arm axis; as well as A shield, carried by the guide arm, is translatable along the length of the arm axis to adjust the distance between the shield and the base, wherein the guide arm interconnects the shield and the base, the shield including a shield body that establishes a shield perimeter, and the shield body being sized to prevent access through the shield body to adjacent bone surface areas within the shield perimeter and associated with the projection of the shield perimeter.

2. The shield guide assembly of claim 1, wherein the shield body includes at least one slot configured to slidably receive a portion of the guide arm along the arm axis.

3. The protective shield guide assembly according to claim 2, wherein the length of the guide arm has a T-shaped cross-section.

4. The shield guide assembly of claim 3, wherein the shield is axially translatable along the length of the arm axis to adjust the distance between the shield and the base, the at least one slot being a row of interconnected T-shaped slots corresponding to a corresponding radial position of the shield relative to the arm axis of the guide arm in the radial direction, and the length of the guide arm being insertable into each of the T-shaped slots to set the corresponding radial position of the shield.

5. The shield guide assembly of claim 4, wherein the shield body excludes any openings between the row of interconnected T-slots and the periphery of the shield.

6. The shield guide assembly of claim 1, wherein the base includes a recess configured to at least partially receive the distal portion of the implant.

7. The shield guide assembly of claim 6, wherein the base is rotatable about the implant axis of the implant to change the circumferential position of the shield relative to the implant axis.

8. The shield guide assembly of claim 1, wherein the shield is sized to mate with the adjacent bone surface area in the installation position.

9. The shield guide assembly of claim 1, wherein the adjacent bone surface area is associated with the humerus.

10. A protective shield guide assembly for orthopedic surgery, comprising: A base, the base being configured to be releasably secured to the implant; A guide arm that extends from the base; as well as A shield, supported by the guide arm, is movable along the length of the guide arm to adjust the distance between the shield and the base, wherein the guide arm interconnects the shield and the base, and the shield includes a shield body that establishes a shield perimeter and is sized to block access through the shield to the perimeter, such that the projection of the shield body onto the perimeter outlines the perimeter of the implant.

11. The shield guide assembly of claim 10, wherein the base is rotatable about the implant axis of the implant to change the circumferential position of the shield relative to the implant axis of the implant.

12. The shield guide assembly of claim 11, wherein for all positions along the periphery of the implant relative to the axis of the implant below the bottom of the base, the periphery of the shield is offset outward from the periphery of the implant by a maximum distance not exceeding 1 mm.

13. The shield guide assembly of claim 11, wherein the shield is movable relative to the guide arm to change the radial position of the shield relative to the axis of the implant.

14. The shield guide assembly of claim 10, wherein the shield body is sized to prevent access through the shield to adjacent bone surface areas associated with the humerus.

15. A kit for orthopedic surgery, comprising: An implant, the implant comprising an implant body configured to be received at least partially in bone; as well as The shield guide assembly includes: A base, the base being configured to be releasably secured to the implant; A guide arm extending from the base; and A shield, carried by the guide arm, is translatable along the length of the guide arm to adjust the distance between the shield and the implant, wherein the guide arm interconnects the shield and the base, the shield including a shield body that establishes a shield perimeter, and the shield body being sized to prevent access through the shield body to adjacent bone surface areas within the shield perimeter and associated with the projection of the shield perimeter.

16. The kit of claim 15, wherein the periphery of the shield defines a shield width greater than the implant width of the portion of the implant configured to be received in the bone.

17. The kit of claim 15, wherein the implant body extends along an implant axis between a first end portion and a second end portion, the base is configured to be secured to the first end portion, and the shield is rotatable about the implant axis in an installation position to change the circumferential position of the shield relative to the implant body.

18. The kit according to claim 15, wherein: The implant includes an augen shaft configured to be fixed to the body of the implant and a hinge portion configured to be fixed to the body of the implant; The trunnion is configured to cut along the humeral joint resection surface; and The hinge portion includes a hinge surface, the dimensions of which are determined to interface with a relative articular surface associated with the glenoid or glenoid implant.

19. The kit of claim 18, wherein a plurality of threads extend around the circumference of the implant body, and the plurality of threads are sized to secure the implant body in the bone.

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