A device for orienting surgical instruments

Abstract

The present invention relates to a device (1) for orienting surgical instruments in order to prepare a joint for insertion of a joint implant. The device has a main body (2), at least two cut-guiding units (3, 4) and a height sensor (5), the height sensor (5) being connected to the main body (2), and the cut-guiding units (3, 4) being permanently connected to the main body (2).

Description

[0001] A device for aligning surgical tools

[0002] The invention relates to a device and a method for aligning surgical tools for preparing a joint for implantation of a joint implant.

[0003] US 7,285,122 B2 shows a method and device for resecting a distal femur and a proximal tibia in preparation for implantation of a partial knee prosthesis. The device comprises different spacers, which are selected according to the desired degree of correction for aligning the patient's leg. The spacers contain a stem on which a resector can be attached so that the resector can pivot about a stem. This allows the resector to be aligned on an axis selected by the surgeon and secured to the femur and proximal tibia with tibial pins. A cut is then made in the femur, and the resector is removed, leaving the tibial pins in place. A second resector is then placed on the pins to make the required cut in the tibia.

[0004] Disadvantages of the above-described method and device for preparing a distal femur and a proximal tibia for implanting a partial knee prosthesis are the error-prone incision and the frequent changes of device components for the preliminary preparation of a knee joint. The invention is therefore based on the object of creating a device for aligning a surgical tool for preparing a joint for implanting a joint implant and an associated method that enables the surgical tool to be easily and precisely aligned with respect to the joint so that the joint can be provided with several precisely aligned incisions.

[0005] The object is achieved by a device for aligning surgical tools for preparing a joint for implanting a joint implant, having the features of claim 1, and an associated method having the features of claim 13. Advantageous further developments are the subject of the dependent claims that refer back to this. The device according to the invention is intended to align surgical tools for preparing a joint for implanting a joint implant. The device has a base body, at least two incision guide devices, and a height sensor. The height sensor is connected to the base body. The incision guide devices are firmly connected to the base body.

[0006] The connection between the base body and the height gauge, as well as the fixed connection between the base body and the two cutting guide units, enables extremely precise alignment and guidance of the surgical tool. A particularly advantageous feature is that the fixed alignment effectively prevents the surgical tool from deviating from the optimal position, thus preventing errors in the cutting guide.

[0007] Preferably, the base body has a lower part with a bore block and an upper part with the incision guide devices. The upper part of the base body is firmly connected to the lower part of the base body via a retaining element. Dividing the base body into an upper and lower part is particularly advantageous, as this allows the device to be flexibly adapted to anatomical conditions. The precision of the incision guide is fully maintained.

[0008] Preferably, the base body of the device according to the invention for aligning a surgical tool is designed as a single piece with the at least two cutting guide devices. The single-piece design of the base body with the cutting guide devices is particularly advantageous because the cutting guide is maintained with extreme precision relative to the height gauge. The cutting guide devices preferably contain guide slots for a sawing tool. Further preferably, the guide slots are arranged parallel to one another in all planes. This advantageously allows for the creation of cutting surfaces that are particularly precisely aligned with one another.

[0009] The base body preferably has guide bores and / or fastening bores. The guide bores can also be provided in a separately designed bore block, wherein the bore block can be fixed to the base body. With the help of these guide bores, the base body and thus the device according to the invention can be held precisely in its alignment and / or fixed with the help of the fastening bores. The base body thus advantageously remains in its position, even if forces act on the device during use of the surgical tools. The height sensor is preferably designed to be inserted into a joint gap. Further preferably, at least one contact surface of the height sensor, which is in contact with the sliding surfaces of the joint, is curved.

[0010] The height sensor, which can be inserted into the joint space, particularly advantageously enables precise positioning of the device according to the invention with respect to the joint space. The curved shape of the at least one contact surface, which is in contact with the sliding surfaces of the joint, is also advantageous, as this allows for particularly precise positioning of the height sensor on the curved joint bone and / or the rounded joint bone.

[0011] The height gauge is preferably positioned between the incision guides. This arrangement allows for advantageous treatment of curved and rounded joint bones while precisely maintaining the position of the incision guide.

[0012] The base body preferably includes a holder for gauges and tools. This holder advantageously enables the attachment of gauges, such as angle gauges, drilling gauges, and distance gauges, or additional tools, in precise alignment with the base body.

[0013] The device according to the invention preferably comprises an angle gauge with an integrated drilling jig. The angle gauge with an integrated drilling jig can particularly preferably be pushed onto the holder for gauges and tools of the base body.

[0014] The angle gauge, into which the drilling gauge is integrated, advantageously enables holes to be drilled at the correct angle and position in the joint to be prepared. The angle gauge can be pushed into the base body, whereby a predetermined angle of the joint to be prepared can be set and the corresponding holes can be precisely created. The device preferably comprises a cutting block with an integrated angle gauge. The cutting block further preferably has at least one guide slot for a sawing tool. The cutting block can preferably be pushed onto the holder for gauges and tools of the base block. With the help of the cutting block, the angles of the cutting surfaces can be advantageously aligned via the angle gauge and, further advantageously, additional precisely guided cuts can be made with a sawing tool.Preferably, the holder for gauges and tools has a T-shaped guide or a dovetail guide for engaging with a corresponding T-shaped guide or dovetail guide of the gauges and tools. The T-shaped guide or dovetail guide advantageously enables particularly precise guidance of the gauges and tools mounted via the T-shaped guide or dovetail guide.

[0015] The height sensor is preferably adjustable relative to the cutting guide devices. This particularly advantageously enables a precise adjustment of the position of the device according to the invention relative to the joint gap. The height sensor particularly preferably has a height adjustment device.

[0016] A further aspect of the invention relates to a method for aligning surgical tools for preparing a joint for implanting a joint implant, in particular outside the human body. The method comprises a method step of displacing a height sensor of the device for aligning surgical tools. A further method step of the method is fixing the device for aligning surgical tools. In a further method step, a surgical cutting tool is guided in a first cutting guide device of the device for aligning surgical tools. A further method step comprises guiding a surgical cutting tool in a second cutting guide device of the device for aligning surgical tools.

[0017] Preferably, the method for aligning surgical tools comprises adjusting the height of the height sensor relative to the cutting guide devices before the step of moving the height sensor.

[0018] The method according to the invention particularly advantageously enables training in the preparation of a joint for implantation of a joint implant on a model outside the human body. In particular, correct incision guidance can be practiced particularly advantageously.

[0019] Exemplary embodiments of the invention are described below with reference to the drawings. The drawings show:

[0020] FIG. 1: an embodiment of a device according to the invention for aligning surgical tools for preparing a joint for implantation of a joint implant;

[0021] FIG. 2: an enlarged perspective view of the base body with the two cutting guide devices and the height sensor of the embodiment of the inventive

[0022] Device; FIG. 3: an enlarged view of the base body with the two cutting guide devices and the height sensor of the embodiment of the device according to the invention, seen from the side facing the joint;

[0023] FIG. 4: the base body with the height sensor, the two cutting guide devices and an angle gauge with integrated drilling gauge of the embodiment of the inventive

[0024] Device;

[0025] FIG. 5: a perspective view of the base body with the two cutting guide devices and a height-adjustable height sensor of a further embodiment of the device according to the invention;

[0026] FIG. 6: a detailed view of the base body, in particular the height sensor holder, of the further embodiment of the device according to the invention;

[0027] FIG. 7: a detailed view of an adjustable height sensor of the further embodiment of the device according to the invention;

[0028] FIG. 8: a sectional view of the receiving body with an adjusting screw of the further embodiment of the inventive

[0029] Device;

[0030] FIG. 9: a perspective view of the device with a base body having an upper part and a lower part, a further

[0031] Embodiment of the device according to the invention; FIG. 10: a flow chart for the method for aligning surgical tools for preparing a joint for implantation of a joint implant according to an embodiment of the invention

[0032] Example of implementation;

[0033] FIG. 11A: a displacement of the device according to an embodiment of the invention in a knee;

[0034] FIG. 11B: a fixation of the device according to an embodiment of the invention in a knee;

[0035] FIG. 11C: performing a distal femur cut using the device according to an embodiment of the invention in a knee;

[0036] FIG. 11D: sliding on the angle gauge with integrated drilling jig of the device according to an embodiment of the invention; FIG. 11E: aligning the knee using the angle gauge with integrated drilling jig of the device according to an embodiment of the invention; and FIG. 11F: creating a transverse tibial osteotomy using the device according to an embodiment of the invention in a knee. FIG. 1 shows an embodiment of the invention.

[0037] Device 1 for aligning surgical tools for preparing a joint for implanting a joint implant. The device 1 for aligning surgical tools for preparing a joint comprises a base body 2. In this embodiment, two incision guide devices 3, 4 are attached to the base body 2. Furthermore, the device 1 contains a height sensor 5 attached to the base body 2. In the embodiment shown in FIG. 1, the height sensor 5, the incision guide devices 3, 4, and the base body 2 are constructed as a single piece.

[0038] The device 1 can have a holding device 25, which is connected to the base body 2 via an angle element 26. The holding device 25 is provided for fastening the device 1 to a support device 28 with the aid of a screw 29. For fine adjustment of the device 1 to the support device 28, a slot 27 is provided in the holding device 25. With the aid of the slot 27, it is possible to finely adjust the contact force and thus the frictional force between the holding device 25 and the support device 28 via the screw 29. A spring effect in the holding device 25 generated by the slots 27 prevents the screw 29 from loosening spontaneously due to vibrations. These vibrations can occur when using surgical instruments.

[0039] FIG. 2 shows an enlarged view of the base body 2 with the two cutting guide devices 3, 4 and the height sensor 5 of the device 1 according to the invention for aligning surgical tools. As can be seen in FIG. 2, the cutting guide devices 3, 4 contain guide slots 6, 7. The guide slots 6, 7 are arranged parallel to one another in all planes, so that precisely parallel cuts can be made with the aid of these guide slots 6, 7. The upper cutting guide device 3 is connected to the lower cutting guide device 4 via a web 19. The web 19 is a component of the base body 2. The distance between the upper cutting guide device 3 and the lower

[0040] The cutting guide device 4 is determined according to the specifications of a joint implant to be implanted. The upper cutting guide device 3 is used, for example, on a knee joint for the femoral joint section and the lower cutting guide device 4 for the tibial side.

[0041] Joint section of the knee joint.

[0042] The slots in the cutting guide devices 3, 4, which form the guide slots 6, 7, are arranged so that a surgical tool can be inserted according to the

[0043] Longitudinal alignment of the height sensor 5 is guided.

[0044] The upper guide slot 6 has a width that is slightly larger than the width of the femoral joint section to be prepared. The lower guide slot

[0045] 7 is adapted to the width of the tibial joint section to be prepared. The lower guide slot

[0046] 7 in the example is wider than the upper

[0047] Guide slot 6. The difference in the width of the guide slots 6, 7 results from the different dimensions of the preparation sites of the articular bone located on the femur and the articular bone located on the tibia. In the illustrated example, the guide slots 6, 7 each have a slot width of 1.3 mm to 1.4 mm, so that they can guide, for example, a bone saw with a saw blade thickness of approximately 1.27 mm. The slot width is dimensioned such that the saw blade of the bone saw can be guided with as little resistance as possible.

[0048] The guide slots 6 and 7 also have a depth that is at least 10 times greater than the slot width. This design ensures precise guidance of the surgical tool.

[0049] Each of the cutting guide devices 3, 4 has a bore 40, 41 in the area of ​​the guide slots 6, 7. Each bore 40, 41 is centrally located relative to the slot width and slot length. This bore 40, 41 extends through the entire cutting guide devices 3, 4. The centrally located bores 40, 41 are provided for guiding an erosion wire for creating the guide slots 6, 7. These bores preferably have a diameter of less than 3.1 mm. This prevents the unauthorized insertion of a guide pin or probe.

[0050] As already described, the web 19 is intended for the mechanical connection of the two cutting guide devices 6, 7. The width of the web 19 in the exemplary embodiment is smaller than the width of the

[0051] Cutting guide devices 3, 4. The width of the web 19 is preferably less than 1 / 4 of the width of the cutting guide devices 3, 4 and particularly preferably less than 1 / 5 of the width of the cutting guide devices 3, 4. Due to the reduced width, the area of ​​the knee joint to be prepared can be viewed much better.

[0052] In the exemplary embodiment, the web 19 further has two wedge-shaped, tapered surfaces 42, 34 on a side opposite the height sensor 5. The wedge thus formed increases the stability of the connection between the two cutting guide devices 3, 4 without obstructing the visibility described above.

[0053] Furthermore, the web 19 has grooves 44 at the transition to the cutting guides 3, 4. Due to the selected perspective, only one groove 44 is visible in FIG. 2. In the exemplary embodiment, the grooves 44 form a rounded transition between the cutting guides 3, 4. The rounded transition significantly increases the mechanical strength of the connection between the web 19 and the cutting guides 3, 4 without limiting the visibility of the preparation site achieved by the reduced web width.

[0054] The holding device 25 described above has a bore 45 for receiving the screw 29 and a flattened portion 62 at the end intended for attachment to the support device 28. This flattened portion 62 increases the frictional torque between the screw 29 and the holding device 25. This increased frictional torque prevents unintentional loosening of the screw 29, which is caused in particular by vibrations of the saw or drill.

[0055] FIG. 3 shows an enlarged perspective view of the base body 2 with the two cutting guide devices 3, 4 and the height sensor 5 of the device 1 according to the invention, seen from the side facing the joint. From this perspective, it can be seen that the upper cutting guide device 3 has a horizontal extension 16 in the region of the opening of the guide slot 6 facing the knee. This horizontal extension 16 is designed such that the entire depth of the guide slot 6 is used to guide the saw. This horizontal extension 16 significantly expands the horizontal pivoting range of the saw without impairing the vertical guidance of the saw.

[0056] In the illustrated embodiment, the lower guide surface 46 of the upper guide slot 6 is extended toward the knee joint by two nose-shaped projections 47, 48. These nose-shaped projections 47, 48 are designed such that the joint-side end of the lower guide surface 46 of the upper guide slot 6 is largely adapted to the shape of the knee joint at the corresponding location. This prevents vertical deflection of the saw blade during preparation of the femoral joint ball.

[0057] In the exemplary embodiment, the lower cutting guide device 4 has a recess 18 at each of the corners facing the knee joint. These recesses 18 reduce the length of the side walls of the guide slot 6. The reduction in the side walls is dimensioned such that the connection formed by the side walls between the web 19 and the bore block 49 is sufficiently strong even under heavy loads. The recesses 18 are designed such that a maximum horizontal pivoting range of the saw is achieved without compromising the vertical guidance of the saw. This extended pivoting range is configured such that the relatively large joint bone located on the tibia can be provided with the intended saw cut in a single operation. The corners 50 formed by the recesses 18 are rounded to avoid damage to soft tissue.

[0058] The height sensor 5 formed on the base body 2 is in the embodiment between the two

[0059] Cutting guide devices 3, 4 are arranged. The height gauge 5 is designed to be inserted into the joint space, e.g., of a knee joint. A first contact surface 12 of the height gauge 5 comes into contact with the sliding surface of the femoral-side joint section of the knee joint. A second contact surface 13 of the height gauge 5 is designed to be in contact with the tibial-side sliding surface of the knee joint. The upper contact surface 12 and the lower contact surface 13 are curved in the exemplary embodiment. The curved shape allows for a large contact surface on the respective sliding surfaces of the knee joint. The height gauge 5 thus specifies an exact height measurement for the entire process of preparing the knee joint.

[0060] The height sensor 5 is connected directly to the web 19 at a small distance below the upper cutting guide device 3. In the exemplary embodiment, a transition radius 51 is provided in the area of ​​the transition from the upper contact surface 12 to the web 19. The transition between the lower contact surface 13 and the web contains a transition radius 52. The transition radii divert bending forces acting on the height sensor 5 into the web 19, so that bending or even breaking of the

[0061] Height sensor 5 is effectively avoided. As can be clearly seen in FIG. 3, height sensor 5 and web 19 have the same width. This ensures maximum stability of the transition from height sensor 5 to web 19 while maintaining full visibility of the preparation site.

[0062] In this exemplary embodiment, the base body 2 further comprises four bores 8, 9, 10, 11, which are provided in a bore block 49 of the base body 2. The bore block 49 with the bores 8, 9, 10, 11 is arranged below the lower cutting guide device 4. Each of these four bores can be used as a guide bore 8, 9, 10, 11 and / or as a fastening bore 8, 9, 10, 11. Depending on the requirements, two or more of the four bores 8, 9, 10, 11 are used.

[0063] The four bores 8, 9, 10, 11 are aligned parallel in the exemplary embodiment with respect to the cutting plane defined by the cutting guide device 4. With respect to the alignment of the height sensor 5, the bores 8 and 9 are designed as oblique bores. The oblique bores 8 and 10 run from the side of the bore block 49 facing away from the knee with a significant distance from one another (see FIG. 2) in the direction of the side of the bore block 49 facing the knee. On the side of the bore block 49 facing the knee, the bores 8 and 9 in the exemplary embodiment protrude from the bore block in such a way that they form a common

[0064] Opening merge into one another (see FIG. 3). Holes 9 and 11 are aligned parallel and run in the direction of the height sensor 5. This can be seen from the fact that both holes 9 and 11 in FIG. 2 and FIG. 3 have the same horizontal distance.

[0065] In the illustrated embodiment, the bore block 49 has inclined surfaces 53 on its sides. These inclined surfaces 53 run parallel to the respective inclined bores 8, 10. The wall thickness between surfaces 53 and the respective bores 8, 10 remains constant along their entire length. The inclined surfaces allow the user of the device to have a particularly good view of the area on the knee toward which the inclined bores 8, 10 are directed.

[0066] The four holes 8, 9, are used to create pin holes in the joint bone of the tibial joint part.

[0067] 10, 11 serve as guide bores 8, 9, 10, 11 for guiding a drill bit of a power drill. In the illustrated embodiment, bores 8, 9, 10, 11 have a diameter greater than 3.2 mm up to a maximum of 3.4 mm, with bores 8, 9, 10, 11 being designed to precisely guide a 3.2 mm drill bit without jamming, even when heated.

[0068] The second function of the holes 8, 9, 10, 11 is the use as mounting holes 8, 9, 10, 11. To

[0069] To fix device 1 from this embodiment to the tibia, up to three pins are driven through the mounting holes 8, 9, 10, and 11 into the pre-drilled holes in the tibia. Preferably, two pins are used to fix the device. The pins are each driven through one of the angled holes 8 or 10 and one of the parallel holes 9 or 11. When using three pins, the pins are each driven through the two parallel holes 9 and 11 and one of the angled holes 8 or 10.

[0070] FIG. 2 and FIG. 3 further show that the base body 2 contains a receptacle 14 for gauges and tools. In this exemplary embodiment, the receptacle 14 consists of a T-shaped groove which extends above the upper cutting guide device 3 parallel thereto in accordance with the orientation of the height gauge 5. The T-shaped groove of the receptacle 14 has a base region which is delimited by a base surface 55 and two side surfaces 56. In the exemplary embodiment, the base surface 55 has a depth which is at least as great as the width of the base surface 55. The length of the side surfaces 56 corresponds to the depth of the base surface 55. In this way, with the help of the side surfaces 56, exact longitudinal guidance of the gauges and tools can be achieved. The T-shaped groove also has upper flanks 16. These flanks 16 are arranged opposite the base surface 55. These flanks 16 are designed toTools are held vertically so that they can be moved toward the height gauge 5 while resting flat on the base surface 55. The flanks 16 of the T-shaped groove are rounded so that the associated gauges and tools can be easily inserted. The rounded flanks 16 of the T-shaped groove also allow the gauge to be rotated about the vertical axis. This rotation option allows the gauge to be aligned so that it rests flat on the bone.

[0071] FIG. 4 shows an embodiment of the device 1, which further comprises an angle gauge 20 with integrated drilling gauge

[0072] 21. The angle gauge 20 with integrated drilling gauge 21 is pushed into the holder 14 for gauges and tools of the base body 2. The angle gauge 20 with drilling gauge 21 has

[0073] Embodiment a T-shaped guide rail 22. The T-shaped guide rail 22 essentially has a rectangular base element 57 with two wing-shaped extensions 59. The wing-shaped extensions 59 are designed such that they extend a lower support surface 58 of the T-shaped guide rail 22. The lower support surface 58 of the T-shaped guide rail 22 is designed to lie flat on the base surface 55 of the T-shaped groove of the receptacle 14 and to be guided. The wing-shaped extensions 59 have a height that is suitable for forming a sliding fit between the base surface 55 and the upper flanks 16 of the T-shaped groove. The lateral surfaces of the wing-shaped extensions 59 are also dimensioned such that they form a sliding fit in combination with the lateral surfaces of the T-shaped groove.The side surfaces 60 of the rectangular base element 57 projecting beyond the wing-shaped extensions 59 are guided by the flanks in the form of a sliding fit.

[0074] The angle gauge 20 defines an angle intended for the respective application. In the exemplary embodiment, this angle is formed by a stop surface 23 facing the knee joint and the lower support surface 58 of the base element of the T-shaped guide rail 22 inserted into the holder 14. The stop surface 23 is provided on a leg 61 protruding beyond the rectangular base element. In addition to the design of the holder 14 for gauges and tools with a T-shaped guide, a dovetail guide is also suitable as an alternative. In this case, a counterpart suitable for engagement with a corresponding dovetail guide replaces the T-shaped guide rail 22.

[0075] In the exemplary embodiment, the drilling jig 21 is attached to the leg 61 projecting beyond the rectangular base element at the end of the support surface 58 opposite the guide rail 22. The drilling jig 21 contains two holes 24. These holes 24 run parallel to the T-shaped guide rail 22. The holes are provided for drilling precisely fitting holes in the femoral-side joint section, for example, in order to attach guide pins.

[0076] A cutting block with an integrated angle gauge (not shown here) belonging to the device 1 can also be inserted into the holder 14 for gauges and tools. Such a cutting block has at least one guide slot for a sawing tool, with which at least one further cut can be made in the femoral joint section. The guide slots each have suitable angles according to the requirements of the required cutting guide. In addition to the guide slots, the cutting block can also contain guide surfaces designed to guide a saw blade flatly on one side.

[0077] FIG. 5 shows another embodiment of a base body 63 of the device 1 according to the invention for aligning surgical tools. The base body 63 contains two incision guide devices 3, 4, a height adjustment device 64, and a height-adjustable height sensor 65. The incision guide devices 3, 4 are described in detail above.

[0078] The device 1 can have a holding device 25, which is connected to the base body 63 via an angle element 26. In this exemplary embodiment, the base body 63 has four bores 8, 9, 10, 11, which are arranged in a bore block 49. The bores 8, 9, 10, 11 are arranged below the lower cutting guide device 4 and above the angle element 26. The number of bores is not limited to four and can be at least one bore in further exemplary embodiments. The holding device 25, the angle element 26, and the bore block 49 with the bores 8, 9, 10, 11 are described in detail above.

[0079] In the embodiment shown in FIG. 5, the base body 63 contains a receptacle 14 for gauges and tools, which corresponds to the receptacle 14 already described above. The receptacle 14 contains in this

[0080] In this embodiment, a T-shaped groove extends parallel to the upper cutting guide device 3 according to the orientation of the height sensor 65. The receptacle 14 is not limited to the design shown in this embodiment.

[0081] In this embodiment, the base body 63 has a height sensor receptacle 66. The height sensor receptacle 66 is arranged between the upper cutting guide device 3 and the lower cutting guide device 4. The upper cutting guide device 3 is connected to the lower cutting guide device 4 via the height sensor receptacle 66. A distance between the

[0082] The position of the cutting guide devices 3, 4, and thus between the guide slots 6, 7, is determined according to the specifications of a joint implant to be implanted. The cutting guide devices 3, 4 are held by the height sensor holder 66 such that the guide slots 6, 7 contained therein are arranged parallel to one another in all planes. In this embodiment, the height sensor holder 66 is provided to hold the adjustable height sensor 65. The adjustable height sensor 65 is arranged such that a surgical tool is guided through the guide slots 6, 7 according to its longitudinal orientation.

[0083] The adjustable height sensor 65 is vertically movable. The vertical displacement is achieved by a height adjustment device 64, which is arranged in the height sensor holder 66. By vertically displacing the adjustable height sensor 65, a precise vertical distance of the adjustable height sensor 65 relative to the guide slots 6, 7 can be set. In this embodiment, the upper cutting guide device 3 has a bore 67. The bore 67 penetrates the cutting guide device vertically. The bore 67 is provided so that a height adjustment tool can penetrate the upper cutting guide device. Thus, with the help of the height adjustment tool, the height adjustment device 64 can be actuated and thus the adjustable height sensor 65 can be adjusted.

[0084] The height sensor receptacle 66 has a height scale 68. In this exemplary embodiment, the height scale 68 is formed by three notches. The adjustable height sensor 65 has a marking 69. The marking 69 and the height scale 68 are designed such that a set height of the adjustable height sensor 65 can be determined visually and / or haptically based on the position of the marking 69 in relation to the height scale 68. The height scale 68 can be divided into scale divisions, preferably in 1 mm increments and particularly preferably in 0.5 mm increments.

[0085] FIG. 6 shows a detailed view of the base body 63, in particular the height sensor receptacle 66, for the exemplary embodiment of the device 1 according to the invention for aligning surgical tools. The height sensor receptacle 66 contains a first side wall 70 and a second side wall 71. The side walls 70 and 71 are spaced parallel to one another and oriented perpendicular to the incision guide devices 3 and 4. The side walls 70 and 71 define a distance between the upper incision guide device 3 and the lower incision guide device 4 according to the specifications of a joint implant to be implanted. The side walls each have a recess 72 and 73. The recesses 72 and 73 are designed in the shape of an elongated hole. The recesses 72 and 73 facilitate cleaning of the device, particularly in the area of ​​the height sensor receptacle 66.

[0086] The height sensor holder 66 further comprises two guide elements 74 and 75. The guide elements 74 and 75 are each attached to the height sensor-side ends of the side walls 70 and 71. In doing so, they form

[0087] Connection to the side walls 70 and 71, respectively, each has an L-shaped cross-section. The short legs of the L-shape formed by the guide elements 74 and 75, respectively, are arranged such that they are aligned with each other. The guide elements 74 and 75 are spaced apart such that the adjustable height sensor 65 can protrude between the guide elements 74 and 75.

[0088] In FIG. 6, the previously described height scale 68 is clearly visible on the height sensor mount 66. The height scale is formed by three notches. In further embodiments, the height scale can be applied by engraving, laser marking, etching, printing, etc.

[0089] The base body 63 contains a bore 67 in the upper cutting guide device 3, which penetrates the cutting guide device 3 vertically. The bore 67 is provided so that an adjustment tool can penetrate the upper cutting guide device 3. The adjustment tool actuates the height adjustment device 64 and thus the height adjustment of the height sensor 65.

[0090] FIG. 7 shows an embodiment of an adjustable height sensor 65 according to the invention. The adjustable height sensor 65 is intended to be inserted into the joint space, e.g., of a knee joint. A first contact surface 76 of the height sensor 65 comes into contact with the sliding surface of the femoral-side joint section of the knee joint. A second contact surface 77 of the height sensor 65 is designed to be in contact with the tibial-side sliding surface of the knee joint. The upper contact surface 76 and the lower contact surface 77 run largely parallel in the embodiment and are curved. The front region 78 of the upper and lower contact surfaces 76, 77, which first come into contact with the joint space upon insertion, are designed at an angle to one another in this embodiment. The angled design of the front region 78 enables easy insertion of the adjustable height sensor 65, even in tight spaces.

[0091] Joint spaces. The curved shape allows for a large contact surface on the respective sliding surfaces of the knee joint. The height gauge 65 thus provides an exact height measurement for the entire process of preparing the knee joint. The adjustable height gauge 65 has a receiving body 79 with a first lateral guide surface 80 and a second lateral guide surface 81. The lateral guide surfaces 80 and 81 are arranged parallel. The distance between the lateral guide surfaces 80 and 81 is designed such that the adjustable height gauge 65 is slidably guided on the lateral inner walls 82 and 83 of the height gauge holder 66 (see FIG. 7). The lateral guide surfaces 80 and 81 in conjunction with the lateral inner walls of 82 and 83 are designed such that they form a sliding fit.The sliding seat is characterized in that the height sensor 65 can be moved in the height sensor holder 66 without any effort and the height sensor 65 is guided with little play in the horizontal direction.

[0092] The mounting body 79 further has two frontal guide surfaces 84. The frontal guide surfaces 84 are provided to be in flat contact with the guide elements 74 and 75 of the height sensor mount 66 and to form a linear guide.

[0093] The receiving body 79 of the height sensor 65, shown in FIG. 7, has a bore 86. An adjusting screw 90 (see FIG. 8) is held in this bore 86 so that the height of the adjustable height sensor 65 can be adjusted by turning the adjusting screw 90. The bore 86 and the adjusting screw 90 provided for this purpose will be described in detail later.

[0094] A spring element 87 is provided on the adjustable height sensor 65. The spring element 87 contains two S-shaped curved springs. The S-shape of the springs 88 and 89 allows the springs 88 and 89 to operate within the elastic range of the spring material throughout the entire adjustment range of the adjustable height sensor 65. In this embodiment, the springs 88, 89 are spaced apart by a distance greater than the outer diameter of the adjustment screw 90. Thus, the spring action of the springs 88 and 89 is not affected by contact with the adjustment screw 90.

[0095] The springs 88, 89 are connected to the receiving body 79 by a spring transition piece 91. The spring transition piece 91 has a groove 92. The transition in the form of a groove 92 is provided to prevent the springs 88 and 89 from breaking in the transition area to the receiving body under load.

[0096] The spring element 87 further comprises a spring connecting element 93. The spring connecting element 93 is provided at one end of the springs 88 and 89 facing the cutting guide device 3. These ends of the springs 88 and 89 are connected by the spring connecting element 93. The spring force generated by the springs is introduced into the height sensor receptacle 66 via the spring connecting element. For this purpose, the spring connecting element 93 rests on the upper side of the lower cutting guide device 4.

[0097] FIG. 8 shows a sectional view of the receiving body 79 with an adjusting screw 90 for a further embodiment of the height adjustment device 64 according to the invention. The receiving body 79 has a bore 86. The bore 86 contains a thread which is suitable for receiving a thread 94 of the adjusting screw 90. The pitch of the thread 94 of the adjusting screw 90 and the bore 86 is selected such that a large angle of rotation of the screw produces a small stroke of the adjusting screw 90. In this way, the height of the adjustable height sensor 65 can be adjusted particularly precisely. The adjusting screw 90 with the thread 94 has a screw head 96. The diameter of the screw head 96 of the adjusting screw 90 is designed such that it covers the bore 67 which is perpendicular to the

[0098] Cutting guide device 3 is provided. The adjusting screw 90 has a chamfer 97 on a side facing away from the thread 94. The molded chamfer 97 is designed such that it is in contact with the edge of the bore 67 of the upper cutting guide device 3.

[0099] The bore in the receiving body 79 has a cylindrical countersink 95. The diameter of the countersink 95 is dimensioned such that the screw head 96 can be countersunk into the receiving body 79 by screwing in the adjusting screw 90. This countersink 95 expands the adjustment range of the adjustable height sensor 65.

[0100] A tool holder 98 is provided for introducing a rotational force into the adjusting screw 90. In this exemplary embodiment, the tool holder 98 consists of a hexagon socket, also called an Allen key. The shape of the tool holder 98 is not limited to the hexagon socket. Other shapes of screw head drives, such as a hexagon socket (Torx), etc., are suitable as the tool holder 98. FIG. 9 shows an exemplary embodiment of the device 1 with a base body 2, which has an upper part 100 and a lower part with a bore block 49. The device 1 can have a holding device 25, which is connected to the bore block 49 via an angle element 26. The holding device 25 has already been described in detail above. In this exemplary embodiment, the bore block 49 is provided in the lower part 101 of the base body 2. In this exemplary embodiment, the bore block 49 has four bores 8, 9, 10, 11.The bore block 49 with the four bores 8, 9, 10, 11 is arranged above the angle element 26. The four bores 8, 9, 10, 11 are aligned parallel with respect to the height sensor 5. The number of bores is not limited to four and, in further embodiments, can be at least one, e.g., three, guide bores. Furthermore, the bores 8, 9, 10, and 11 can be aligned at an angle to one another in further embodiments.

[0101] An upper part 100 of the base body has a lower cutting guide device 4, which is connected to an upper cutting guide device 3 via a web 19. The distance between the upper cutting guide device 3 and the lower cutting guide device 4, determined by the web 19, is determined according to the specifications of a joint implant to be implanted. The upper cutting guide device 3 is provided, for example, on a knee joint for the femoral joint section, and the lower cutting guide device 4 is provided for the tibial joint section of the knee joint. Furthermore, the device 1 contains a height sensor 5 attached to the upper part 100 of the base body 2, which has already been described in detail.

[0102] In this embodiment, the upper part 100 of the base body 2 has a receptacle 14 for gauges and tools. The receptacle 14 consists, as already described in another embodiment, of a T-shaped groove. The embodiment shown in FIG. 9 shows an angle gauge 20 with an integrated drilling jig 21, which is pushed into the receptacle 14 for gauges and tools of the base body 2. The angle gauge 20 and the associated guide have already been described in detail above.

[0103] The design of the holder 14 for gauges and tools is not limited to a T-shaped guide. A dovetail guide or other guide configurations are also conceivable.

[0104] The upper part 100 of the base body, which

[0105] Cutting guide devices 3, 4, is firmly connected to the lower part 101 of the base body, which has the bore block 49, via a holding element 102, in this embodiment a holding pin. The holding element 102 in the form of a holding pin extends downward from the upper part 100 of the base body 2.

[0106] The holding element 102 is perpendicular to a predetermined by the lower cutting guide device 4

[0107] Aligned with the cutting plane. The bore block 49 has a retaining bore 103 for receiving the retaining element 102. In the exemplary embodiment, this retaining bore 103 penetrates the bore block 49 perpendicularly with respect to the bores 8, 9, 10, 11.

[0108] The angle element 25 has a clamping screw 104.

[0109] This clamping screw 104 is designed to press the holding element 102 of the upper part 100 of the base body 2 against the wall of the holding bore 103. For this purpose, the clamping screw 104 is screwed into the angle element 25 such that it exerts a force on the holding element 102. In order to set a user-specified distance between the bore block 49 and the cutting guide devices 3, 4, the fixed connection between the upper 100 and lower part 101 of the base body 2 can be loosened. The fixed connection is released by loosening the clamping screw 104. Once the specified distance between the bore block 49 and the cutting guide devices 3, 4 is reached, the clamping screw 104 is screwed in until a specified tightening torque is reached. FIG. 10 shows a flow diagram of the method for aligning surgical tools for preparing a joint for implantation of a joint implant.In this exemplary embodiment, the method steps are provided in particular for training the use of the device 1 according to the invention on a model outside the human body. In the case of an operation, the sequence is similar. In a first method step S101, the height sensor 5 of the device 1 for aligning surgical tools is moved. In a further method step S102, the device 1 for aligning surgical tools is fixed, for example, to the tibia. In a further method step S103, a surgical cutting tool is guided in a first cutting guide device of the device 1 for aligning surgical tools. A further method step S104 comprises guiding a surgical cutting tool in a second cutting guide device of the device 1 for aligning surgical tools.In a further embodiment, before the step S101 of moving the height sensor, the height of the height sensor 65 is adjusted relative to the cutting guide devices 3, 4.

[0110] The execution of the method steps is shown in detail below using FIG. 11A to FIG. 11F.

[0111] FIG. 11A shows a knee 30, a portion of the femur 31, and a portion of the tibia 32. Preferably, in this step, the femur 31 and tibia 32 are arranged at an angle of 10° to 30°. The surgical tool alignment device 1 is adjusted so that a

[0112] Support device 28 is arranged substantially parallel to the anterior edge of the tibia 32 and aligned substantially parallel to the longitudinal axis of the tibia 32. To achieve this, the height gauge 5 is displaced between the femoral condyle 33 and the tibial condyle 34. Now, the femur 31 and tibia 32 are placed in full extension to check the alignment prior to a distal femoral cut.

[0113] FIG. 11B shows the final fixation of device 1.

[0114] For this purpose, two holes are pre-drilled in the tibia bone 32 using the guide holes 8, 9, 10, 11 provided in the base body 2 and a surgical drill.

[0115] This is followed by fixing the inventive

[0116] Device 1 with two pins (not shown here).

[0117] FIG. 11C shows a distal femoral cut 38 using device 1, which is secured by two pins 99. First, the femur 31 and tibia 32 are brought into an angle of 0-5 degrees to achieve slight flexion. The saw blade 37 of the bone saw 36 is then inserted into the upper, femoral-side guide slot 6 of the upper cutting guide device 3. A guided distal femoral cut 38 is created using an oscillating bone saw 36.

[0118] FIG. 11D shows an embodiment of the sliding of the angle gauge 20 with integrated drilling gauge

[0119] 21. In preparation, the knee 30 is flexed to approximately 100°. The angle gauge 20 with integrated drilling gauge 21 is then pushed onto the corresponding receptacle 14 of the base body 2 of the device 1.

[0120] FIG. 11E shows the alignment of the knee using the angle gauge 20. The angle gauge 20 is brought into contact with the resection surface created with the femoral cut. The angle of the knee 30 is changed until the angle gauge 20 with its

[0121] The stop surface 23 comes into flat contact with the distal resection surface 39 of the femur 31. Once the flat contact has been reliably established, holes for guide pins can be created using the holes 24 of the drill guide 21.

[0122] FIG. 11F shows the creation of a transverse tibial osteotomy. For this purpose, the saw blade 37 of the oscillating bone saw 36 is inserted into the lower guide slot 7 of the lower cutting guide device 4. The transverse tibial osteotomy is then performed, guided by the lower cutting guide device 4.

[0123] Subsequently, further necessary cuts can be made on the femur using a cutting block (not shown here) with an integrated angle gauge. To do this, the cutting block's guide pins are driven into the holes created using the drill guide 21 until the cutting block, with its angle-determining stop surface, comes into flush contact with the distal resection surface of the femur. A posterior bevel cut is made on the femur using a dedicated guide slot for a sawing tool. An anterior cut is made using another guide slot for a sawing tool on the cutting block to create an anterior cutting surface at the knee joint.

[0124] In a further embodiment, the procedure shown in FIG. 11D and FIG. 11E is replaced by the following procedure: In preparation, the knee is brought into a flexion of approximately 100°. Now, the

[0125] Cutting block is pushed onto the corresponding receptacle 14 of the base body 2 of the device 1. The knee is then aligned using a stop surface of the cutting block by moving the stop surface in the direction of the resection surface created with the femoral cut in

[0126] Contact is made. The angle of the knee is changed until the stop surface is in flat contact with the distal resection surface of the femur. Once flat contact has been reliably established, a posterior bevel cut is made on the femur using a guide slot provided for this purpose for a sawing tool. Using another guide slot for a sawing tool on the cutting block, an anterior cut is made to create an anterior cutting surface on the knee joint. A transverse tibial osteotomy is then performed as shown in FIG. 11F. With these steps, the knee joint is now prepared to the extent that the attachment of a partial knee prosthesis can be practiced or performed in real life.

[0127] The invention is not limited to the illustrated embodiments. All features described above, shown in the figures, or claimed in the claims can be combined with one another as desired within the scope of the invention.

Claims

AMENDED CLAIMS received by the International Bureau on 19 December 2023 (19.12.2023) 1. A device (1) for aligning surgical tools for preparing a joint for implanting a joint implant, the device comprising: a base body (2), at least two cutting guide devices (3, 4) and a height sensor (5), the height sensor (5, 65) being connected to a first side of the Base body (2), wherein the cutting guide devices (3, 4) are fixedly connected to the base body (2), wherein the base body (2) has a pair of projections (47, 48) extending from the first side of the base body (2) near a first guide slot (6) of one of the cutting guide devices (3, 4) and wherein the base body (2) has a pair of recesses (18) on the first Side of the base body (2) near a second guide slot (7) of one of the cutting guide devices (3, 4).

2. The device (1) according to claim 1, wherein the base body (2) has a lower part (101) with a bore block (49), and wherein the base body (2) has an upper part (100) with the cutting guide devices (3, 4), and wherein the upper part (100) of the base body (2) is connected to the lower part (101) of the base body (2) is firmly connected via a holding element (102).

3. The device (1) according to claim 1, AMENDED SHEET (ARTICLE 19) wherein the base body (2) is designed in one piece with the at least two cutting guide devices (3, 4) and / or with the height sensor (5).

4. The device (1) according to one of claims 1 to 3, wherein the cutting guide devices (3, 4) contain guide slots (6, 7) for a sawing tool, and wherein the guide slots (6, 7) are arranged parallel to one another in all planes.

5. The device (1) according to one of claims 1 to 4, wherein the base body (2) has guide bores (8, 9, 10, 11) and / or fastening bores (8, 99, 10, 11).

6. The device (1) according to one of claims 1 to 5, wherein the height sensor (5, 65) is designed to be inserted into a joint space of a joint, and wherein at least one contact surface (12, 13, 76, 77) of the Height sensor (5, 65), which can be brought into contact with sliding surfaces of the joint, is curved.

7. The device (1) according to one of claims 1 to 6, wherein the height sensor (5, 65) is arranged between the cutting guide devices (3, 5).

8. The device (1) according to one of claims 1 to 7, wherein the base body (2) has a receptacle (14) for gauges and / or Contains tools. AMENDED SHEET (ARTICLE 19) 9. The device (1) according to claim 8, wherein the device comprises an angle gauge (20) with integrated drilling gauge (21), and wherein the angle gauge (20) with integrated drilling gauge (21) is inserted into the Holder (14) for gauges and tools of the base body (2) can be pushed onto.

10. The device (1) according to claim 8 or 9, wherein the device comprises a cutting block with integrated angle gauge, wherein the cutting block has at least one guide slot for a sawing tool, and wherein the cutting block can be inserted into the receptacle (14) for gauges and / or Tools of the base body can be pushed on.

11. The device (1) according to one of claims 8 to 10, wherein the receptacle (14) for gauges and / or tools has a T-shaped guide or a dovetail guide for engagement in a corresponding guide, in particular a dovetail guide, of the gauges and / or tools.

12. The device (1) according to one of claims 1 to 11, wherein the height sensor (65) is adjustable in its height relative to the cutting guide devices (3, 4).

13. The device (1) according to claim 12, wherein the height sensor (65) has a height adjustment device (64). AMENDED SHEET (ARTICLE 19) 14. A method for aligning surgical tools, in particular with a device (1) according to one of claims 1 to 13, in particular outside the human body, comprising the following steps: Moving (S101) a height sensor (5, 65) of the device (1) for aligning surgical tools, Fixing (S102) the device (1) for aligning surgical tools, guiding (3103) a surgical cutting tool in a first cutting guide device (3) of the device (1) for aligning surgical tools, and Guiding (S104) a surgical cutting tool in a second cutting guide device (4) of the device (1) for aligning surgical tools.

15. The method for aligning surgical tools according to claim 14, wherein prior to moving (S101) the height sensor, an adjustment of the Height sensor (65) in its height relative to the cutting guide devices (3, 4). AMENDED SHEET (ARTICLE 19)

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