Handle-free convertible humerus shoulder joint prosthesis

Abstract

In some aspects, a shoulder implant with improved articulation activity includes a backing member (211), a neutral non-tilt bearing member (204), and a pin (206). The neutral non-tilt bearing member is located on a concave side of the backing member. And a bearing member made of a different material than the backing member and configured to contact a glenoid sphere having a center of rotation, where the bearing member is substantially radially symmetric. The plug extends from the backing member and is configured to connect to a humeral stem (207). The longitudinal axis (208) of the pin of the backing member is offset from the center of rotation of the glenosphere, and the longitudinal axis (290) of the backing member is aligned with the center of rotation of the glenosphere.

Description

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0002] This application claims priority to U.S. Provisional Application No. 63 / 322,201, filed on March 21, 2022, the entire contents of which are expressly incorporated by reference. Background Art

[0003] Shoulder replacement is a medical operation usually performed for the treatment of osteoarthritis, rheumatoid arthritis and for the treatment of certain deformities associated with tumor indications and trauma. There are two main types of articulations available for surgeons to treat: anatomical and reverse. For the anatomical, the surgeon replaces the joint surface with industrial materials so that the joint surface has a shape substantially the same as the natural anatomical structure. The stem can usually be fixed inside the canal of the humerus, and the metal joint head can be rigidly fixed to its proximal body, and the joint head has a convex joint surface suitable for articulation with a glenoid implant. The glenoid implant can include some pegs or posts or fins suitable for rigidly fixing in the glenoid fossa of the scapula on its rear side (inside) and include a concave or flat joint surface suitable for articulation with the humeral head of the humerus implant on its front side.

[0004] When a reverse prosthesis is used, the articular surfaces are reversed in that the metal ball is rigidly fixed to the glenoid socket of the scapula and the concave articular surface is rigidly fixed to the humeral bone, thereby reversing the way the prosthesis articulates.

[0005] The surgeon chooses between these two types of prostheses by evaluating many conditions of the patient, including pain level, patient activity level, severity of bone degeneration or deformity, strength of surrounding soft tissues, and presence or absence of prior surgery, and in particular the health and strength of the rotator cuff muscles and tendons. Diseases of the rotator cuff are common in patients suffering from shoulder arthritis. In this case, it is often observed that the lack of insufficiency of the rotator cuff results in an anatomical shoulder replacement prosthesis not being fully stabilized by the surrounding soft tissue. In this case, a reverse shoulder replacement prosthesis may be preferred in some cases due to the higher inherent stability of the joint connection. In addition, a reverse prosthesis can advantageously utilize the remaining muscles in the following manner: in the absence of other soft tissue structures, the remaining muscles can be more effective by adjusting the position of the articular surface within the joint.

[0006] It is not uncommon for a surgeon to choose to use an anatomical prosthesis and provide effective treatment to a patient through shoulder replacement surgery. However, over time and during the use of the prosthesis, the patient's rotator cuff complex may become inadequate, torn, or generally diseased such that it is no longer able to perform its functions associated with normal joint kinematics. In this case, the surgeon may choose to perform a second operation to remove the anatomical prosthesis and replace the anatomical prosthesis with a reverse prosthesis.

[0007] Several attempts have been made to try to solve the need for conversion of the joint surface without interrupting fixation. Firstly, these are created using two (or more) systems, in which there is a metal fixation component rigidly fixed to the glenoid fossa, and secondly a polyethylene (PE) joint component that is fixed to the metal component and provides a concave joint surface suitable for joint connection with the humeral prosthesis. Although referred to as a PE component in this article, some embodiments do not require the use of polyethylene and can be made of other biocompatible materials according to the desired clinical results. The PE component is usually fixed to the metal fixation component by conventional industrial techniques (such as snap-fit ​​mechanisms, snap rings, compression pins, PE overmolding and other such means).

[0008] In some cases, the challenge of this particular joint connection is that the glenoid fossa is relatively small, and the presence of bone in the patient suffering from arthritis is usually greatly reduced. In this context, the surgeon has limited positioning and bones to work with to cooperate in the patient. In addition, the surgeon must be careful not to overfill the joint, meaning that the implanted component moves the new joint connection surface away from its original position, so that the soft tissue is unnaturally tensioned, which may lead to instability, accelerated wear, soft tissue failure, pain, reduced range of motion or fracture of the prosthesis and surrounding bones. In the face of these conditions, the prosthesis usually needs to be designed to remain relatively thin (usually, 1 piece, wherein the PE glenoid implant usually has a 4mm thick articular surface). In order to design these modular components, little additional packaging space can be provided to cooperate with the necessary attachment mechanism without adversely affecting the performance of the entire joint replacement surgery. Therefore, usually, these designs lead to "over-optimization" of the fixed and joint parts to provide enough attachment mechanisms, so that: PE is too thin to be strong enough, the metal component is too small to provide enough fixation, or the entire mechanism is not rigid enough, thereby resulting in the presence of secondary wear surfaces, and the generation of wear particles that cause PE disease.

[0009] A problem that may exist is that in situations where the surgeon wants to change the type of prosthesis, anatomic prostheses are typically so well fixed and adapted to the patient's body that removal of the prosthesis may be very disruptive and leave residual natural bone that may not be sufficient to support fixation of a reverse prosthesis. What is needed is a prosthetic system that provides a means by which the articulating surface of an implant can be replaced so that the anatomical surface can be converted to a reverse surface without replacing the fixation components.

[0010] There is also a need for a simple device by which the surgeon can implant a drop-in anatomical articulating glenoid implant whereby the anatomical articulating surface can be removed at a later time and replaced with a reverse articulating surface so that the primary fixation device remains well secured in the glenoid socket at the time of the joint replacement.

[0011] Additionally, conventional systems can change the tilt angle of the humerus by providing increasingly tilted bearing components (e.g., polyethylene inserts), thereby medializing the center of rotation of the glenosphere and overfilling the joint. A system is needed that can change the tilt angle of the humerus without changing the center of rotation of the glenosphere and / or overfilling the joint to provide an increased range of motion. Summary of the invention

[0012] In some aspects, the technology described herein relates to a shoulder implant with improved joint mobility, the shoulder implant comprising: a backing component; a neutral, non-tilted bearing component, the neutral, non-tilted bearing component being located on a concave side of the backing component, the bearing component being made of a material different from the backing component and being configured to contact a glenosphere having a center of rotation, wherein the bearing component is substantially radially symmetrical; and a peg extending from the backing component and being configured to connect to a humeral stem; wherein a longitudinal axis of the peg of the backing component is offset from the center of rotation of the glenosphere, wherein the longitudinal axis of the backing component is aligned with the center of rotation of the glenosphere.

[0013] In some aspects, the technology described herein relates to a shoulder implant wherein the backing component is inclined at an angle between about 1.25 degrees and about 30 degrees relative to a corresponding attachment surface of the humeral head.

[0014] In some aspects, the technology described herein relates to a shoulder implant wherein the backing component is inclined at an angle between about 2.5 degrees and about 12.5 degrees relative to a corresponding attachment surface of the humeral head.

[0015] In some aspects, the technology described herein relates to a shoulder implant wherein the glenoid implant does not change the center of rotation of the glenosphere when inserted into a patient.

[0016] In some aspects, the technology described herein relates to a shoulder implant configured for anatomical positioning.

[0017] In some aspects, the technology described herein relates to a shoulder implant configured for reverse positioning.

[0018] In some aspects, the technology described herein relates to a shoulder implant wherein the bearing component has a depth of less than about 5.5 mm.

[0019] In some aspects, the technology described herein relates to a shoulder implant wherein the bearing component has a depth of between about 3 mm and about 5 mm.

[0020] In some aspects, the technology described herein relates to a shoulder implant wherein the bearing component comprises a plastic material.

[0021] In some aspects, the technology described herein relates to a shoulder implant wherein the plastic material comprises polyethylene.

[0022] In some aspects, the technology described herein relates to a shoulder implant wherein the backing component comprises a metallic material.

[0023] In some aspects, the technology described herein relates to a shoulder implant wherein the peg comprises a Morse taper.

[0024] In some aspects, the technology described herein relates to a shoulder implant wherein at least a portion of the downwardly facing surface of the backing component configured to contact a prepared humeral surface comprises an oval or elliptical cross-section, at least a portion of the downwardly facing surface of the bearing component comprises a circular cross-section, and at least a portion of the upwardly facing surface of the backing component comprises a circular cross-section, and the portions of the downwardly facing surface of the bearing component and the upwardly facing surface of the backing component are configured to snap or otherwise mate with each other.

[0025] In some aspects, the technology described herein relates to a kit 1, wherein a plurality of implants include a first implant and a second implant, wherein a backing component of the first implant is inclined at a first angle, wherein a backing component of the second implant is inclined at a second angle different from the first angle, wherein the rotation centers of the glenospheres of the first implant and the second implant are located at the same position.

[0026] In some aspects, the technology described herein relates to a method of implanting a shoulder implant, the method comprising: reaming a cavity in a glenoid surface; sizing a first implant, the first implant comprising a first angulation relative to a stem, wherein the implant comprises a neutral bearing component and an inclined backing component, the inclined backing component comprising a first inclination angle relative to a corresponding attachment surface of the humeral head; sizing a second glenoid implant, the glenoid implant comprising a second angulation relative to the stem, wherein the glenoid implant comprises a neutral bearing component and an inclined backing component, the inclined backing component comprising a second inclination angle relative to a corresponding attachment surface of the humeral head; implanting the second glenoid implant into the glenoid cavity; wherein the center of rotation of the glenosphere does not change between the first glenoid implant and the second glenoid implant, thereby allowing adjustment of version and inclination without changing the center of rotation.

[0027] In some aspects, the technology described herein relates to a humeral prosthesis comprising: a proximal end, the proximal end comprising at least three radially outwardly extending fins; a stem, the stem extending outward from the proximal end to the distal end, wherein the proximal end comprises a proximal end diameter, the proximal end diameter being defined by a circle contacting the radially outwardmost proximal ends of the at least three radially outwardly extending fins, wherein the distal end comprises a distal end diameter, wherein the proximal end diameter is between about 30 mm and about 50 mm, wherein the distal end diameter is between about 5 mm and about 6 mm, and wherein a ratio of the proximal end diameter to the distal end diameter is between about 5 and about 9.

[0028] In some aspects, the technology described herein relates to a humeral prosthesis wherein the ratio is between about 5.5 and about 8.5.

[0029] In some aspects, the technology described herein relates to a humeral prosthesis wherein the proximal end includes a bowl-shaped concave surface.

[0030] In some aspects, the technology described herein relates to a humeral prosthesis that includes a central aperture in the proximal end configured to mate with a counter component. BRIEF DESCRIPTION OF THE DRAWINGS

[0031] Figure 1 is a side perspective view of one embodiment of a convertible humeral prosthesis according to some embodiments of the present invention.

[0032] Figure 2 yes Figure 1 A bottom perspective view of the embodiment shown in FIG.

[0033] Figure 3 yes Figure 1 , also showing an aperture centered on the upwardly facing surface of the neck of the prosthesis and configured to be utilized as a reverse adapter for facilitating placement or removal of a spherical ball on the humeral head in some circumstances.

[0034] Figure 4 yes Figure 1 0026] Figure 2 is a side view of the embodiment shown in FIG.

[0035] Figure 5 yes Figure 1 Another side view of the embodiment shown in , also illustrating the reverse adapter bore passage extending within the neck and handle.

[0036] Figure 6 is an inverted stereoscopic view, also illustrating the medial grooves along the neck and stem of the prosthesis.

[0037] Figure 7 yes Figure 1 Another stereoscopic view of the prosthesis shown in .

[0038] Fig. 7A is a side perspective view of another embodiment of a convertible humeral prosthesis according to some embodiments of the present invention.

[0039] Figure 7B yes Fig. 7A A bottom perspective view of the embodiment shown in FIG.

[0040] Figure 7C yes Fig. 7A , also showing an aperture centered on the upwardly facing surface of the neck of the prosthesis and configured to be utilized as a reverse adapter for facilitating placement or removal of a spherical ball on the humeral head in some circumstances.

[0041] Fig.7D yes Fig. 7A 0026] Figure 2 is a side view of the embodiment shown in FIG.

[0042] Fig. 7E yes Fig. 7A Another side view of the embodiment shown in , also illustrating the reverse adapter bore passage extending within the neck and handle.

[0043] Figure 7F is an inverted stereoscopic view, also illustrating the medial grooves along the neck and stem of the prosthesis.

[0044] Figure 7G yes Figure 7F Another stereoscopic view of the prosthesis shown in .

[0045] Figure 8-Figure 11 Various views of another embodiment of a humeral replacement prosthesis are illustrated.

[0046] Fig.12 is an illustration of one potential embodiment of the present invention, which depicts a conventional glenoid implant with a deviated bearing component.

[0047] Fig.13 is an illustration of one embodiment of a backing member that allows for a 2.5 degree tilt deviation.

[0048] Fig.14 is an illustration of one embodiment of a backing member that allows for a 7.5 degree tilt deviation.

[0049] Fig.15 The use of one embodiment of a backing member that allows for a 12.5 degree tilt offset is illustrated.

[0050] Fig.16A One embodiment of a stemmed humeral implant is illustrated.

[0051] Fig. 16B One embodiment of a stemless humeral implant is illustrated.

[0052] Fig.17A Illustrated Fig.16A Side view of a stemmed humeral implant.

[0053] Fig. 17B Illustrated Fig. 16B Side view of a stemless humeral implant.

[0054] Fig.18A Illustrated Fig.16A Cross-sectional side view of a stemmed humeral implant.

[0055] Fig.18B Illustrated Fig. 16B Cross-sectional side view of a stemless humeral implant.

[0056] Fig.19A Illustrated Fig.16A A stemmed humeral implant wherein a mounting base is attached to the stemmed humeral implant.

[0057] Fig.19B An example of a glenosphere Fig. 16B A stemless humeral implant, wherein a mounting base is attached to the stemless humeral implant.

[0058] Fig.19C Illustrated Fig.19A A stemmed humeral implant wherein the glenosphere is mounted to a mounting base of the stemmed implant.

[0059] Fig.19D An example of a glenosphere-free Fig.19B A stemless humeral implant and wherein the mounting base is attached to the stemless humeral implant.

[0060] Fig. 20A yes Fig. 16B Stereoscopic view of a sessile implant.

[0061] Fig. 20B yes Fig. 20A Side view of a sessile implant.

[0062] Fig. 20C yes Fig. 20B Top view of the sessile implant.

[0063] Fig.20D It is taken along line AA Fig. 20C Side cross-sectional view of a stemless implant.

[0064] Fig.20E yes Fig.20D A detailed view of a portion of a view.

[0065] Fig.20F yes Fig. 20B Another side view of the sessile implant.

[0066] Figure 20G It was intercepted along the DD line. Fig. 20C Side view of a sessile implant.

[0067] Fig. 20H It was intercepted along CC Fig. 20C Side cross-sectional view of a stemless implant.

[0068] Fig.21 is a side view of a broach used to prepare a humerus to receive one of the stemmed or sessile implants described herein.

[0069] Fig. 22 yes Fig.21 Another side view of a reamer used to prepare a humerus to receive one of the stemmed implants or sessile implants described herein.

[0070] Fig.23 yes Fig. 22 A stereoscopic view of a humerus after it has been prepared to receive one of the stemmed implants or stemless implants described herein.

[0071] Fig.24 yes Fig.23 A lateral view of a humerus with a stemmed humeral implant implanted therein.

[0072] Fig.25 yes Fig.24 Cross-sectional view of the humerus and stemmed humeral implant.

[0073] Fig.26 yes Fig.23 Side view of a humerus and stemmed humeral implant with the glenosphere attached to the stemmed humeral implant.

[0074] Fig. 27 yes Fig.23 A lateral view of a humerus with a stemless humeral implant implanted therein.

[0075] Fig.28 yes Fig. 27 Side view of a humerus and a stemless humeral implant with the glenosphere attached to the stemless humeral implant.

[0076] Fig.29 yes Fig.23 A lateral view of a humerus showing a stemmed implant and a stemless implant implanted therein for comparison purposes.

[0077] Fig.30 It is a method of implanting a stemless humeral implant.

[0078] Fig.31 One embodiment of a stemmed humeral implant system is illustrated.

[0079] Fig.32A An exploded view of another embodiment of a stemmed humeral implant system is illustrated.

[0080] Fig.32B An exploded view of one embodiment of a stemless humeral implant system is illustrated. DETAILED DESCRIPTION

[0081] In particular, some embodiments of the present invention focus on advantageously changing the articular surface of the glenoid from a concave shape to a convex shape by utilizing a convertible humeral prosthesis without removing components or interfaces associated with fixation of the implant into the glenoid socket.

[0082] In some embodiments, embodiments of the present invention may be used or modified with use to have specific advantages in using embedded glenoid fixation techniques in anatomical shoulder arthroplasty, such as described, for example, in U.S. Pat. No. 8,007,538 to Gunther, the entire contents of which are hereby incorporated by reference. In some embodiments, an embedded method includes: identifying a patient having a glenoid surface; reaming a cavity into the glenoid surface; and inserting a glenoid implant into the cavity, the glenoid implant having a body and a single radially symmetrical center plug oriented along a central axis of the implant, the body having a bearing surface on its peripheral edge so that at least a portion of the peripheral edge of the body is inserted relative to the cavity and resides beneath the adjacent glenoid surface, and the portion residing beneath the adjacent glenoid surface is circumferentially surrounded by cortical bone of the glenoid.

[0083] Further described are methods by which a surgeon can achieve use of a recessed glenoid technique with an anatomical articulation while having the ability to convert the technique to a reverse articulation without requiring removal of the rigid fixation between the recessed fixation and the scapula bone (in other words, allowing the rigid fixation support between the recessed fixation and the scapula bone to remain in place during conversion from an anatomical prosthesis to a reverse prosthesis).

[0084] Figure 1-Figure 7Various views of a humeral replacement prosthesis 100 according to some embodiments of the present invention are illustrated. The prosthesis 100 may optionally include a proximal ring element 102, such as a collar (which may be configured to attach to a spherical ball head portion, not shown), the collar having a peripheral edge 103, the peripheral edge may be annular, such as circular as shown, with a downwardly facing surface, the downwardly facing surface may optionally be concave (including a convex or flat bowl-like shape) and include a cavity or include an inline in other embodiments. The humeral prosthesis 100 may include an upwardly facing surface 114 of the proximal end 106, and as shown is concave and bowl-shaped, wherein the base and deepest portion of the bowl is proximal to the center of the upwardly facing surface 114 of the proximal end 106, so that there is a space 113 between the downwardly facing surface of the humeral head portion (not shown) and the upwardly facing surface 114 of the proximal end 106 of the prosthesis 100. In some embodiments, the depth of the bowl at the center of the concave curvature is between about 3 mm and about 7 mm, such as between about 4 mm and about 6 mm deep, such as about 5 mm deep. The proximal end 106 of the prosthesis 100 may include spaced flanges 107, such as three flanges 107 that are equally spaced, wherein the apex 111 of the flanges 107 extends radially outward while narrowing from the center of the proximal end 106 of the prosthesis 100. In some cases, the three-flange design can provide improved stability and rotation prevention as well as other advantages. Extending distally from the proximal end 106 at an angle relative to the longitudinal axis of the proximal end / neck 106 are the handle 110 and the distal end 108 of the prosthesis 100.

[0085] In some embodiments, the stem 110 and distal end 108 of the prosthesis have a reduced thickness, for example, tapering in width dimension to no greater than about 6 mm, 5.5 mm, 5 mm, 4.5 mm, 4 mm, or less, such as between about 5.5 mm to about 6 mm, and ranges including any two of the foregoing values, to advantageously reduce the amount of native humerus that needs to be removed and allow for a stem 110 that is 3-4 mm or longer than a conventional stem 100 and to allow the majority of fixation to occur in the proximal portion of the prosthesis (e.g., the neck 106). Figure 1 is a side perspective view of one embodiment of a prosthesis; Figure 2 yes Figure 1 A bottom perspective view of the embodiment shown in ; Figure 3 yes Figure 1 The top view of the embodiment shown in , also shows an aperture 120, which is centered on the upward facing surface 114 of the neck 106 of the prosthesis and is configured to be utilized as a reverse adapter, in some cases, to facilitate placement or removal of a spherical ball on the humeral head. Figure 4 yes Figure 1 A side view of the embodiment shown in; Figure 5 yes Figure 1Another side view of the embodiment shown in FIG. 1 also illustrates the passage 124 of the reverse adapter aperture 120 extending within the neck 106 and the stem 110 . Figure 6 is an inverted perspective view, also illustrating the medial groove 126 along the neck 106 and stem 110 of the prosthesis 100. Figure 7 yes Figure 1 Another stereoscopic view of the prosthesis shown in .

[0086] Figure 7A-7G A view illustrating another embodiment of a humeral replacement prosthesis is shown which is somewhat similar and may include, for example, Figure 1-Figure 7 Any number of features shown in . Fig. 7A A stereoscopic view of a prosthesis 700 is illustrated, the prosthesis including an optional proximal ring element 702, such as an axle collar, having a peripheral edge 703, which can be annular, such as circular as shown, with a downwardly facing surface, which can optionally be concave (including a convex or flat bowl-like shape) and include a cavity or include an inline in other embodiments. The humeral prosthesis 700 can include an upwardly facing surface 714 of the proximal end 706, and as shown is concave and bowl-shaped, wherein the base and deepest portion of the bowl is near the center of the upwardly facing surface 714 of the proximal end 106, so that there is a space 713 between the downwardly facing surface of the humeral head portion (not shown) and the upwardly facing surface 714 of the proximal end 706 of the prosthesis 700. The proximal end 706 of the prosthesis 700 may include spaced flanges 707, such as three flanges 707 equally spaced, wherein the apex 711 of the flanges 707 extends radially outward while narrowing from the center of the proximal end 706 of the prosthesis 700. Extending distally from the proximal end 106 at an angle relative to the longitudinal axis of the proximal end / neck 706 are the stem 710 and the distal end 708 of the prosthesis 700. A transition zone 747 is also illustrated, wherein proximal to the zone 747, the prosthesis 700 includes a porous coating, and distal to the zone 747, the prosthesis 700 does not include a porous coating. The coating may include, for example, plasma spray, porous metal, hydroxyapatite, or other components that may promote cementless fixation to the bone. However, in some embodiments, cement fixation may be utilized.

[0087] Fig. 7A is a side perspective view of one embodiment of a prosthesis; Figure 7B yes Fig. 7A A bottom perspective view of the embodiment shown in ; Figure 7C yes Fig. 7A The top view of the embodiment shown in , also shows an aperture 120, which is centered on the upward facing surface 114 of the neck 106 of the prosthesis and is configured to be utilized as a reverse adapter, in some cases, to facilitate placement or removal of a spherical ball on the humeral head. Fig.7D yes Fig. 7A A side view of the embodiment shown in; Fig. 7E yes Fig. 7A Another side view of the embodiment shown in FIG. 1 also illustrates the passage 124 of the reverse adapter aperture 120 extending within the neck 106 and the stem 110 . Figure 7F is an inverted perspective view, also illustrating the medial groove 126 along the neck 106 and stem 110 of the prosthesis 100. Figure 7G yes Figure 7 Another stereoscopic view of the prosthesis shown in .

[0088] Figure 8-Figure 11 Various views of another embodiment of a humeral replacement prosthesis are illustrated. Figure 8 Illustrated is a humeral prosthesis, which may be as described elsewhere herein, configured to be connected to a humeral head 801 . Fig. 9 A perspective view of a humeral prosthesis 800 is illustrated, including a stem 806 , a flange 807 , and an adapter aperture 820 on a proximal end 806 , and a distal end 808 . Fig.10 A side view of a humeral prosthesis 800 is illustrated. Fig.11 Illustrated is a humeral head prosthesis 801 that is configured to connect to an adapter aperture 820 of a humeral prosthesis 800 via a protrusion 899 , such as via a press fit, threads, adhesive, or other technique.

[0089] As shown, some potential advantages of humeral implant configuration as described herein include fixation to proximal concentration, to preserve natural bone.In certain embodiments, prosthesis can be cemented or non-cemented.Prosthesis geometry allows easy use, minimizes surgical steps and is robust owing to can easily absorb errors.Prosthesis can also be convertible to reverse, which increases the probability of success and prevents or minimizes overfilling.Prosthesis can also advantageously be cheap, logically simple and have minimum inventory requirements, because the diameter at or near the distal end of the handle can be constant, and the diameter at or near the proximal end of the handle can change.For example, the operator can select a small number of humeral stem implants, for example, with 34mm, 38mm and 44mm proximal diameter (it can be measured as the smallest circle of the most proximal radially outward end element that can surround the fin), all these humeral stem implants have the same distal diameter, such as about 5.5mm or about 6mm, or not more than about 7mm, 6.5mm, 6mm, 5.5mm, 5mm or less, or include any two of the scopes of the aforementioned values. In certain embodiments, the most proximal diameter can be between about 25mm and about 50mm, such as about 25, 30, 35, 40, 45, 50mm, or a scope including any two of the aforementioned values. In certain embodiments, the humeral stem implant can have the most proximal diameter of the humeral stem and the ratio of the most distal diameter, and this ratio is between about 5 and about 9, between about 5.5 and about 8.5, about 4.5, 4.75, 5, 5.25, 5.5, 5.75, 6, 6.25, 6.5, 6.75, 7, 7.25, 7.5, 7.75, 8, 8.25, 8.5, 8.75, 9, 9.25, 9.5, 9.75, 10, or a scope including any two of the aforementioned values. The ability to provide a set or batch of humeral stem implants can be contrasted with conventional humeral stem prostheses: the doctor can select from the set or batch of humeral stem implants with different most proximal diameters, each of which has the same or substantially the same small most distal diameter, and in conventional humeral stem prostheses, the most distal diameter generally increases as the most proximal diameter increases within a set of different humeral stem sizes. In some embodiments, the prosthesis is collarless. In some embodiments, the prosthesis has a total length of about or at least about 50mm, 51mm, 52mm, 53mm, 54mm, 55mm, 56mm, 57mm, 58mm, 59mm, 60mm, 65mm, 70mm or larger, or a range comprising any two of the above values.

[0090] Figure 12-Figure 15 Various views of several embodiments of components of a glenohumeral replacement prosthesis are illustrated. Fig.12 Can be used to compare Figure 13-Figure 15The effects of several different embodiments of the present invention are described in FIG.

[0091] Fig.12 A conventional shoulder implant component is depicted inserted into a socket of a scapula 201, such as, for example, the glenoid or humerus. Fig.12 An implant is depicted having an inclined, offset bearing component 204 (referring to a center axis of the bearing component that is offset from a center axis of a backing component) having a backing component 205 aligned with a center of rotation 208. The prosthesis is embedded on or in a bone cavity 203 and includes a bearing surface 204 embedded on a backing component (e.g., a recessed tray) 205. The bearing surface 204 lines the backing component 205 and can be made of any suitable material, such as a non-metallic, biocompatible material (e.g., polyethylene). The backing component is connected to an elongated stem 207 embedded in the bone 202. The backing component 205 is connected to the elongated stem 207 by a bolt or keel (e.g., a Morse taper) 206. In Fig.12 2, the stem has a neck axis angle of about 132.5 degrees α formed by the intersection of the axis of the elongated stem 209 and the center of rotation 208. The backing component 205 is aligned with the axis of the socket 210. Since the bearing component 204 is offset, the center of rotation 208 of the glenosphere 214 is medially.

[0092] Fig.13 A different embodiment is illustrated in which the inclination angle of the humeral angle can be controlled exclusively by the offset backing component 211, while the bearing component is not offset. By offsetting, the peg 206 of the backing component 211 is positioned so that a first distance from the peg 206 to a first end of the offset backing component 211 is not equal to a second distance from the peg 206 to a second end of the offset backing component 211. In some embodiments, the first distance is less than about, about, or not greater than about 5%, 10%, 15%, 20%, 25%, or greater than or less than the second distance, or a range including any two of the foregoing values. This is consistent with Fig.12 In sharp contrast, Fig.12 In the embodiment, the bearing member (eg, polyethylene) is offset relative to the central axis of the backing member. Fig.13 The effect of reverse articulation at 135 degrees using a backing component that provides a 2.5 degree tilt 211 when attached to the elongated stem 207 is shown. The rotation β1 represents a 2.5 degree rotation about the axis of the glenoid socket 210. When added to the angle α, a 135 degree reverse articulation is achieved. Fig.12 Therefore, the center of rotation of the glenosphere 215 remains constant and does not move medially (or laterally) away from the center of rotation 208. In addition, the central axis 290 of the backing component 211 is offset from the central axis 208 of the plug.

[0093] Fig.14 Similar to Fig.13 , with the exception of the different inclination angles of the backing member. Fig.14 The desired 140 degree angle is shown, where the backing component provides a 7.5 degree tilt 212 when attached to the elongated stem 207. The rotation β2 represents a 7.5 degree rotation about the axis of the glenoid socket 210. When added to the angle α, a 140 degree reverse articulation is achieved. Fig.12 Therefore, the center of rotation of the glenosphere 215 does not move inward away from the center of rotation 208 and remains in contact with it. Fig.13 in the same position.

[0094] Fig.15 An angle of 145 degrees is illustrated, where the backing component provides a 12.5 degree tilt 213 when attached to the elongated stem 207. Rotation β3 represents a 12.5 degree rotation about the axis of the glenoid socket 210. When added to angle α, 145 degrees of reverse articulation is achieved. Fig.12 Therefore, the center of rotation of the glenosphere 215 does not move inward away from the center of rotation 208 and remains in contact with it. Fig.13 and Fig.14 in the same position.

[0095] In some embodiments of the present invention, the range of the inclination angle produced by the backing member above and beyond the neck axis angle of the slender handle can be approximately 1.25, 2.5, 3.75, 5, 7.5, 10, 12.5, 15, 17.5, 20, 22.5, 25, 27.5, 30, 32.5, 35 degrees, or a range including any two of the above values.

[0096] The natural prepared surface of the humerus against which the downwardly facing surface of the backing component abuts after implementation typically has an oval or elliptical cross-section. In some embodiments, the downwardly facing surface of the backing component also has an oval or elliptical cross-section that substantially matches the cross-section of the surface of the humerus bone. In some embodiments, at least a portion of the downwardly facing surface of the bearing component (e.g., in some cases a polyethylene component) has a circular cross-section and is configured to snap into or otherwise mate with a complementary portion of the upwardly facing surface of the backing component, which may also have a circular cross-section.

[0097] When compared Figure 12 to Figure 14 When we observe through the example Figure 13-Figure 15 Non-limiting potential advantages of the embodiments of Fig.12 Compared with the approximately 7.5 mm of the embodiment, Figure 13-Figure 15The depth of the backing member in the embodiment may be about 5 mm. Fig.12 In some embodiments, the bearing component is offset relative to the center of rotation of the glenosphere and the central axis of the backing component. In some embodiments, the depth of the backing component is less than about 6, 5.5, 5, 4.5, 4, 3.5, 3 mm or less, or within a range including any two of the above values. Figure 13-Figure 15 Changing the backing component angle, as opposed to changing the amount of polyethylene plastic or other material in the bearing component, results in an additional amount of space, such as about 2.5 mm or more or less space formed in the bowl for the glenosphere to rotate. Thus, in several of the proposed embodiments, the joint is less "filled" and not overfilled, and can potentially have a larger range of motion. In addition, the physician can choose between a series of different backing components with varying inclination angles, while the bearing component is neutral (e.g., not tilted). In this way, the inclination angle of the humerus can be controlled simply by selecting the appropriate backing component, and the center of rotation of the glenosphere remains constant regardless of the potentially varying inclination angle of the backing component.

[0098] In some embodiments, a glenohumeral implant for anatomical or reverse arthroplasty that allows for adjustable angles is provided, and the glenohumeral implant includes: a backing component; a bearing component on the concave side of the backing component, the bearing component being made of a material different from the backing component; and a bolt extending from the backing component. In addition, in some embodiments, the longitudinal axis of the backing component is offset from the center of rotation, but the center of rotation is not changed.

[0099] In some cases, it is desirable to avoid the use of a stemmed humeral implant. Different from a stemmed humeral implant, a stemless humeral implant has a shorter overall length so that any part of the implant does not enter the tube of the humerus when implanted. Instead, fixation occurs entirely in the cancellous portion of the bone. The stemless implant fin does not enter the tube of the bone, and direct bone marrow displacement does not occur during implantation. Instead, fixation is limited to the metaphyseal portion of the bone, sometimes referred to as the proximal region of the humerus. A small portion of the distal end of the stemless humeral implant can enter the diaphyseal portion of the bone, but the implant will not extend to the intramedullary canal (the position where the bone marrow is located) under any circumstances.

[0100] Stemless implants can advantageously provide at least equal fixation strength to stemmed implants, but with less invasive surgery and with less removal of natural bone structure, as discussed below. Stemless implants can simplify implantation because the diameter of the patient's humerus does not need to be determined in order to properly size the implant stem (in length or diameter). Instead, the stemless implant is press-fitted into the proximal region of the humerus without disrupting the remainder of the humerus.

[0101] Fig.16A and Fig. 16B A stereoscopic view of a stemmed humeral implant 1600 and a stemless humeral implant 1650 is shown respectively. Each implant 1600, 1650 has a base portion (sometimes referred to as a backing member) 1602, 1652 including a plurality of fins (or flanges) 1604, 1606, 1654, 1656. A stemmed humeral implant 1600 includes a stem 1601. The illustrated embodiment each includes an outer fin 1604, 1654 and two inner fins 1606, 1656. Implants 1600, 1650 are symmetrical about a plane that bisects the outer fins 1604, 1654 along their length (from the top or proximal end of the implant to the bottom or distal end of the implant). However, the fins 1604, 1606, 1654, 1656 do not have to be symmetrical about such a plane, and in fact can each have different sizes and orientations.

[0102] Implant 1600,1650 all include opening 1608,1658, and this opening is set size to receive and fix base (not shown) (sometimes referred to as non-tilted bearing component or neutral non-tilted bearing component).This opening can include slight taper, for example, Morse taper, to realize taper fit or press fit between implant 1600,1650 and base.Base can include articulation surface, such as glenosphere (for anatomical implantation) or concave base (for reverse implantation).Can utilize any technology described above for base (sometimes referred to as base portion) being attached to implant 1600,1650.

[0103] Fig.17A yes Fig.16A A side view of a stemmed humeral implant 1600, and Fig. 17B yes Fig. 16B 1602, 1652 can be covered with bone growth promoting materials, such as porous coatings, or any materials described herein. In one embodiment, the stemless implant 1650 does not include any bone growth materials at its distal end 1660. If necessary, providing an uncoated end 1660 can facilitate the removal of the implant 1650. The base portions 1600, 1650 can include any coating described herein. For example, the coating can include, for example, plasma spraying, porous metal, hydroxyapatite, or other components that can promote non-bone cement fixation to the bone. In other embodiments, the coating can include an osteoinductive surface or an osteoconductive surface to promote growth and fixation of the bone into the cavity. The surface can include, for example, cortical bone, cancellous bone, granular material, powder form, particles, debris, synthetic bone substitutes, growth factors and / or bone growth promoting proteins or combinations thereof.

[0104] Fig.18Ayes Fig.16A A cross-sectional view of a stemmed humeral implant 1600, and Fig.18B yes Fig. 16B 1600,1650. Each implant 1600,1650 includes a tapered cavity 1612,1662 and a threaded cavity 1614,1664. The tapered cavity 1612,1662 is sized and tapered to receive a base with an anatomical or reverse joint surface attached thereto. The base (not shown) is tapered to provide a tapered fit, Morse taper and / or press fit fixation to the tapered cavity 1612,1662 of the implant 1600,1650. If desired, the threaded cavity 1614,1664 can be used to fix an instrument to remove the base (not shown). For example, by using the threaded cavity 1614,1664, the base can be removed to replace the anatomical base with a reverse base, as described in more detail above.

[0105] 19A to 19D By showing the glenosphere 1700 attached to the base portion 1652 of the stemless humeral implant 1650 (eg Fig.19B ) is sized to also be attached to the base portion 1602 of the stemmed humeral implant 1600 (as shown in Fig.19C ) illustrates the compatibility between a stemmed humeral implant 1600 and a stemless humeral implant 1650. Fig.19A A stemmed humeral implant 1600 is shown without a glenosphere 1700, and Fig.19C A stemmed humeral implant 1600 with a glenosphere 1700 is shown. Fig.19B A stemless humeral implant 1650 with a glenosphere 1700 is shown, and Fig.19D A stemless humeral implant 1650 is shown without the glenosphere 1700 .

[0106] FIG. 20A to FIG. 20H It shows that Fig. 16B Various views of one embodiment of a sessile implant 1650 are shown in . The sessile implant 1650 includes a plurality of fins, such as three or more fins. The illustrated embodiment includes an outer fin 1654 and two inner fins 1656. Each fin 1654, 1656 has two sides and an outer edge. The sides 1670 of the outer fins 1654 are flat and can be parallel to each other (see Fig. 20C and Fig.20F ), and its outer edge 1672 has a convex curvature (see Fig. 20A , Fig. 20B , Fig.20D , Fig.20E and Figure 20G). The inner fins 1656 (sometimes referred to as the front fin and the rear fin) each have a concave surface 1674 and an opposing convex surface 1676 (see Fig. 20A and Fig. 20H ). The convex surface 1676 of each inner fin 1656 is closest to the direction of the outer fin 1654 and faces the direction of the outer fin 1654 (see Fig. 20A , Fig. 20H ). The outer edge 1678 of each medial fin 1656 has a convex curvature. In one embodiment, the curvature of the stemless implant body 1652 and the medial fins 1656 can be defined with reference to a pivot axis or radius equally spaced from the medial fins 1656 that defines the overall radius of curvature of the stemless implant 1650. The portion 1680 of the implant body 1652 between the medial fins 1656 has a concave curvature (see Fig.20D ), the portion 1682 of the implant body 1652 between the medial fin 1656 and the lateral fin 1654 has a convex curvature (see Fig. 20A , Fig. 20B , Fig.20F , Figure 20G and Fig. 20H ).

[0107] The curvature of fins 1654, 1656 provides a greater lever out load than an implant having only straight fins or fins with flat sides. The curvature of body 1652 and fins 1654, 1656 makes it stronger and more difficult to pry out from bone, thereby providing greatly improved initial and long-term fixation. The total length of implant 1650--as defined, from the outermost proximal point of stemless implant 1650 to the farthest point of implant 1650--is not longer than 40mm. In addition, when viewed from above, the outermost edges of fins 1654, 1656 can fall into or be surrounded by an oval or ellipse drawn around implant 1650. In one embodiment, the outermost edges of fins 1654, 1656 do not fall into and are not surrounded by a circle drawn around implant 1650. The radial dimension of each fin 1654, 1656 also tapers and decreases from its proximal end to its distal end. The taper allows the implant 1650 to be inserted into the bone without penetrating the sides of the bone.

[0108] Fig.21 An embodiment of a reamer 2100 is illustrated that can be used to prepare a humerus 2102 to receive a stemmed humeral implant or a stemless humeral implant. An alignment post 2104 is positioned at a desired central location on the proximal surface of the humerus 2102. A hammering force is applied to an impact plate 2106 to drive the cutting fins 2108 of the reamer into the cancellous bone at the metaphysis of the humerus 2102, such as Fig. 22When the reamer 2100 is removed, the cancellous bone has a narrow slot 2110 configured to receive a fin of a stemmed or sessile implant and a circular and / or cylindrical opening 2112 configured to receive an implant body.

[0109] Fig.24 A stemmed implant 1600 is shown implanted in a humerus 2102. The stem 1601 of the stemmed implant 1600 extends into the canal of the bone 2100. Fig.25 The implantation in the humerus 2102 is shown. Fig.24 A cross-sectional view of implant 1600. Fig.26 Shows Fig.24 An implant 1600 having an articular surface, which in this case is a glenosphere cap 1700, attached to a stemmed implant 1600.

[0110] Fig. 27 The sessile implant 1650 is shown implanted in the humerus 2102. The sessile implant 1650 does not extend into the canal of the bone 2102. Instead, it is only secured to the metaphyseal portion of the humerus 2102. Fig.28 Shows Fig. 27 A stemless implant 1650 having an articular surface, which in this case is a glenosphere cap 1700, attached to the stemless implant 1650.

[0111] Fig.29 It is shown what it would look like if both a stemmed implant 1600 and a stemless implant 1650 were inserted into the same humerus 2102. This illustration is provided for reference and comparison purposes only.

[0112] Fig.30 is an embodiment of a method 3000 for implanting a stemless implant. The method 3000 begins at block 3002. At block 3004, the humerus is prepared to receive the stemless implant. For example, a reamer can be used to cut a slot and a cylindrical opening in the metaphysis of the humerus. At block 3006, the stemless implant is then secured to the humerus. For example, the fins of the stemless implant can be inserted into the slots cut by the reamer, and the body of the stemless implant can be inserted into the cylindrical opening formed by the reamer. Securement occurs only at the metaphysis because no portion of the implant is inserted into the inner canal of the humerus. The method 3000 ends at block 3008.

[0113] Fig.31One embodiment of a stemmed humeral implant system 3100 is shown. The stemmed humeral implant system 3100 includes a stemmed humeral implant 3102 and an articular surface, which in this case is a glenosphere 3104. The stemmed humeral implant 3102 includes a base portion 3106 and a stem 3108. The base portion 3106 includes one lateral fin 3110 and two medial fins 3112.

[0114] Fig.32A and Fig.32B Exploded views of a stemmed humeral implant system 3200 and a stemless humeral implant system 3250 are shown, respectively. The stemmed humeral implant system 3200 includes a stemmed humeral implant 3202. The stemmed humeral implant 3202 includes a base portion 3204 (sometimes referred to as a backing component) and a stem 3206. The stemless humeral implant system 3250 includes a stemless humeral implant 3252. The stemless humeral implant 3252 includes a base portion 3255 (sometimes referred to as a backing component).

[0115] The humeral implant system 3200 and the stemless humeral implant system 3250 all include a base 3270 (sometimes referred to as a non-tilted bearing component or a neutral non-tilted bearing component), which can be removably attached to its corresponding base portion 3204, 3254. The non-tilted bearing component can be located at the concave side of the backing component and is made of a material different from the backing component. The base 3270 is configured to receive an articulation surface 3270, such as a concave articulation surface (as shown) or a glenosphere. The articulation surface 3270 is configured to interact with a mating articulation surface (such as a glenosphere 3280). A fixing member 3285 is provided to attach a mating articulation surface (e.g., a glenosphere 3280 in the illustrated example) to the scapula structure.

[0116] Of course, in view of the above teachings, various other modifications, adaptations and alternative designs are certainly possible. Therefore, it should be understood at this time that within the scope of the appended claims, the present invention can be practiced in a manner different from that specifically described herein. It is contemplated that various combinations or sub-combinations of the specific features and aspects of the embodiments disclosed above can be made and still fall within one or more of the present invention. In addition, the disclosure of any specific features, aspects, methods, properties, characteristics, qualities, attributes, elements, etc. of an embodiment herein can be used in all other embodiments set forth herein. Therefore, it should be understood that the various features and aspects of the disclosed embodiments can be combined or replaced with each other to form different modes of the disclosed invention. Therefore, it is intended that the scope of the present invention disclosed herein should not be limited by the specific disclosed embodiments described above. In addition, although the present invention is susceptible to various modifications and alternative forms, its specific examples have been shown in the drawings and described in detail herein. However, it should be understood that the present invention is not limited to the specific forms or methods disclosed, but on the contrary, the present invention will cover all modifications, equivalents and alternatives that fall within the spirit and scope of the various embodiments described and the appended claims. Any method disclosed herein does not have to be performed in the order described. The methods disclosed herein include certain actions taken by the practitioner; however, they may also explicitly or implicitly include any third-party instructions for those actions. For example, an action such as "inserting an implant into the glenoid cavity" includes "instructing to insert an implant into the glenoid cavity". The scope disclosed herein also encompasses any and all overlapping parts, sub-ranges, and combinations thereof. Languages ​​such as "up to", "at least", "greater than", "less than", "between..." include the recorded numbers. Numbers beginning with terms such as "approximately", "about", and "substantially" as used herein include the recorded numbers (e.g., about 10% = 10%), and also represent the amount of the stated amount that is close to still performing the desired function or achieving the desired result. For example, the terms "approximately", "about", and "substantially" may refer to an amount within less than 10%, less than 5%, less than 1%, less than 0.1%, and less than 0.01% of the stated amount.

Claims

1. A shoulder implant with improved joint mobility, comprising: Backing member; a neutral non-tilted bearing component located on a concave side of the backing component, the bearing component being made of a different material than the backing component and configured to contact a glenosphere having a center of rotation, wherein the bearing component is substantially radially symmetric; and a peg extending from the backing member and configured to be coupled to a humeral stem; wherein the longitudinal axis of the peg of the backing component is offset from the center of rotation of the glenosphere, Wherein a longitudinal axis of the backing component is aligned with the center of rotation of the glenosphere.

2. The shoulder implant according to claim 1, wherein: The backing component is inclined relative to a corresponding attachment surface of the humeral head at an angle between about 1.25 degrees and about 30 degrees.

3. The shoulder implant according to claim 1, wherein: The backing component is inclined relative to a corresponding attachment surface of the humeral head at an angle between about 2.5 degrees and about 12.5 degrees.

4. The shoulder implant according to claim 1, wherein: The glenoid implant does not change the center of rotation of the glenosphere when inserted into a patient.

5. The shoulder implant of claim 1 configured for anatomical positioning.

6. The shoulder implant of claim 1 configured for reverse positioning.

7. The shoulder implant according to claim 1, wherein: The bearing component has a depth of less than about 5.5 mm.

8. The shoulder implant of claim 1, wherein: The bearing component has a depth between about 3 mm and about 5 mm.

9. The shoulder implant of claim 1, wherein: The bearing component comprises a plastic material.

10. The shoulder implant according to claim 9, wherein: The plastic material comprises polyethylene.

11. The shoulder implant of claim 1, wherein: The backing member includes a metal material.

12. The shoulder implant of claim 1, wherein: The key includes a Morse taper.

13. The shoulder implant of claim 1, wherein: At least a portion of the downwardly facing surface of the backing component configured to contact the prepared humeral surface includes an oval or elliptical cross-section, at least a portion of the downwardly facing surface of the bearing component includes a circular cross-section, and at least a portion of the upwardly facing surface of the backing component includes a circular cross-section, the portions of the downwardly facing surface of the bearing component and the upwardly facing surface of the backing component being configured to snap or otherwise mate with each other.

14. A shoulder implant kit comprising a plurality of implants according to claim 1, wherein: The plurality of implants include a first implant and a second implant, wherein the backing component of the first implant is inclined at a first angle, wherein the backing component of the second implant is inclined at a second angle different from the first angle, and wherein the rotation centers of the glenospheres of the first implant and the second implant are located at the same position.

15. A method of implanting a shoulder implant, comprising: expanding the cavity in the glenoid surface; Sizing a first implant, the first implant comprising a first angulation relative to a stem, wherein the implant comprises a neutral bearing component and an inclined backing component, the inclined backing component comprising a first angle of inclination relative to a corresponding attachment surface of a humeral head; sizing a second glenoid implant, the glenoid implant comprising a second angulation relative to the stem, wherein the glenoid implant comprises a neutral bearing component and an inclined backing component, the inclined backing component comprising a second angle of inclination relative to a corresponding attachment surface of a humeral head; implanting the second glenoid implant into the glenoid cavity; Wherein a center of rotation of the glenosphere does not change between the first glenoid implant and the second glenoid implant, thereby allowing adjustment of version and tilt without changing the center of rotation.

16. A humeral prosthesis, comprising: a proximal end, the proximal end comprising at least three fins extending radially outward; a handle extending outwardly from the proximal end to the distal end, wherein the proximal end comprises a proximal end diameter defined by a circle contacting radially outward-most proximal ends of the at least three radially outward-extending fins, wherein the distal end comprises a distal end diameter, wherein the proximal end diameter is between about 30 mm and about 50 mm, wherein the distal end has a diameter between about 5 mm and about 6 mm, and Wherein, a ratio of the proximal end diameter to the distal end diameter is between about 5 and about 9.

17. The humeral prosthesis according to claim 15, wherein: The ratio is between about 5.5 and about 8.

5.

18. The humeral prosthesis according to claim 15, wherein: The proximal end includes a bowl-shaped concave surface.

19. The humeral prosthesis of claim 15, comprising a central bore in the proximal end, the central bore configured to mate with a counter component.

Images