Cutting guide systems and methods

Abstract

A cutting guide system for adjusting and stabilizing a cutting instrument is disclosed. An exemplary cutting guide system may be used in orthopedic surgery. In some embodiments, the cutting guide system includes a support mount, a joint, and a cutting tool support, where the joint allows the cutting tool support to be adjusted relative to the support mount. The joint allows the cutting tool support to be rotated about at least two axes. The cutting tool may be rotatable and / or longitudinally movable relative to the cutting tool support. In some embodiments, the cutting guide system includes a track, where the cutting tool support is coupled to the track in a manner that allows the cutting tool support to move along a path. Methods of using the cutting guide system are also disclosed.

Description

[Technical field]

[0001] SUMMARY The present disclosure relates to cutting guide systems, methods of making and assembling cutting guide systems, and methods of using cutting guide systems.

[0002] [Citation to Related Applications] This application claims priority to U.S. Provisional Patent Application No. 63 / 154,367, entitled "Cutting Guide Systems," filed February 26, 2021, and U.S. Provisional Patent Application No. 63 / 195,994, entitled "Cutting Guide Systems and Methods," filed June 2, 2021, which are incorporated by reference in their entireties.

[0003] This application is also related to U.S. Provisional Patent Application No. 63 / 058,216, filed July 29, 2020, entitled "Thin Single Width Chain Saw," U.S. Provisional Patent Application No. 63 / 085,290, filed September 30, 2020, entitled "Thin Single Width Chain Saw," U.S. Provisional Patent Application No. 63 / 147,033, filed February 8, 2021, entitled "Chain Saws and Components for Chain Saws," U.S. Provisional Patent Application No. 63 / 154,379, filed February 26, 2021, entitled "Systems and Methods for Manufacturing Saws and Saw Components," and U.S. Provisional Patent Application No. 63 / 209,525, filed June 11, 2021, entitled "Devices for Maintaining Tension in Chain Saws and Components for Chain Saws." No. 63 / 209,540, filed June 11, 2021, entitled Systems for Robotic Surgery, U.S. Nonprovisional Patent Application No. 17 / 443,646, filed July 27, 2021, entitled Chain Saws, Components for Chain Saws, and Systems for Operating Saws, and International Application No. PCT / US2021 / 043433, filed July 28, 2021, entitled Chain Saws, Components for Chain Saws, and Systems for Operating Saws. These patent documents are incorporated by reference in their entirety. [Background technology]

[0004] Many people suffer from orthopedic conditions where cutting of bone or other tissue is necessary or effective. As an example, many people have serious joint problems that require a surgical procedure or procedure to implant an artificial joint. Each year, doctors implant millions of artificial joints, but such procedures require the patient's bone to be reshaped to accept the implant. The most common joint surgery is knee replacement. Bone repair in knee replacement involves making a series of uniform cuts or incisions at the ends of the two major adjacent long bones that are to be joined by the implant. Ideally, these cuts are made to be exactly complementary to the shape of the implant. The flat surface of the healthy bone faces the analogous surface of the implant, resulting in the strongest healing of the joint with reduced risk of complications or implant failure.

[0005] The requirements for sawing bone or other tissue during a surgical procedure exceed those of other sawing applications. Specifically, in a surgical procedure, the saw must be sterile, the saw burr must be easy to control by the surgeon, and vibration and loud noise must be minimized. In addition, among other considerations, the saw must perform the cut in a manner that does not create excessive heat, the surgical procedure must not introduce metal particles or other contaminants into the surgical field, and the surgical procedure must result in the cutting of hard bone or other tissue while minimizing trauma to adjacent soft tissue.

[0006] The cut made by a bone saw is ideally uniform in the plane of the sawbar and ideally straight at the cut boundary. This is necessary to allow optimal healing when two bone surfaces face each other or when one faces an implant surface. Surfaces that are not in the same plane, i.e. uneven surfaces, create voids that may take a long time to heal or may never heal. Some saws are prone to drifting away from the intended plane of the sawbar, called skiving, which is undesirable. Also, some saws have cutting elements that are prone to a grabbing action, resulting in unguided movement of the sawbar, which is also undesirable.

[0007] In surgical procedures, bone saws are operated by a surgeon in an operating room environment. The saw preferably produces minimal vibration so that it can be easily controlled by the surgeon. This is important for a number of reasons. Bones are usually located next to important and sensitive soft tissues, such as blood vessels and nerves, and uncontrolled motion can result in damage to such tissue. Also, uncontrolled motion can result in a less desirable cut.

[0008] Historically, when a very simplified resurfacing of the articular surfaces of the distal femur and proximal tibia and even the patella was performed for knee arthroplasty (more than 40 years ago), cuts were made freehand in an iterative process of cutting and sizing the bone to fit and align the implants. Finally, a cutting block was used that was oriented and fixed to the bone after positioning against natural anatomical markers for cut depth, after flexion / extension, and after varus / valgus positioning. The cutting block guides the saw blade to make the cut for knee implantation. This type of cutting block system is still in use today, with tens of thousands of sets of orthopedic tools in use around the world. Typically, cutting blocks have specific sizes for different sizes of knee implants, just as people have different shoe sizes.

[0009] Although chainsaws have long been used in applications such as wood cutting, to date such chainsaws have not been successfully deployed for general surgical use. This is due to the many technical challenges of chainsaws for the specific requirements of bone or other surgery. U.S. Patent No. 9,616,512 to Viola discloses a bone cutting chainsaw. U.S. Patent No. 9,616,512 is incorporated by reference herein in its entirety.U.S. Provisional Patent Application No. 63 / 058,216 (title: Thin Single Width Chain Saw), filed on July 29, 2020; U.S. Provisional Patent Application No. 63 / 085,290 (title: Thin Single Width Chain Saw), filed on September 30, 2020; U.S. Provisional Patent Application No. 63 / 147,033 (title: Chain Saws and Components for Chain Saws), filed on February 8, 2021; U.S. Provisional Patent Application No. 63 / 154,379 (title: Systems and Methods for Manufacturing Saws and Saw Components), filed on February 26, 2021; U.S. Provisional Patent Application No. 63 / 209,525 (title: Devices for Maintaining Tension in Chain Saws), filed on June 11, 2021 No. 63 / 209,540, filed June 11, 2021, entitled Systems for Robotic Surgery, U.S. Nonprovisional Patent Application No. 17 / 443,646, filed July 27, 2021, entitled Chain Saws, Components for Chain Saws, and Systems for Operating Saws, and International Application PCT / US2021 / 043433, entitled Chain Saws, Components for Chain Saws, and Systems for Operating Saws, disclose chainsaws, chainsaw components, methods of making the chainsaws and components, and methods of using the chainsaws and components, which are hereby incorporated by reference in their entireties. [Prior art documents] [Patent documents]

[0010] [Patent Document 1] U.S. Patent No. 9,616,512 [Patent Document 2] U.S. Provisional Patent Application No. 63 / 058,216 [Patent Document 3] U.S. Provisional Patent Application No. 63 / 085,290 [Patent Document 4] U.S. Provisional Patent Application No. 63 / 147,033 [Patent Document 5] U.S. Provisional Patent Application No. 63 / 154,379 [Patent Document 6] U.S. Provisional Patent Application No. 63 / 209,525 [Patent Document 7] U.S. Provisional Patent Application No. 63 / 209,540 [Patent Document 8] U.S. Nonprovisional Patent Application No. 17 / 443,646 [Patent Document 9] International application PCT / US2021 / 043433 specification Summary of the Invention [Problem to be solved by the invention]

[0011] Improvements in the cutting of bone and other objects, including other fields (e.g., architecture), are desirable. It would be advantageous to achieve one or more of the following advantages: lower cost, easier to use, more accurate alignment, more accurate cuts, shorter cutting time, shorter procedure time, shorter recovery time, and / or better results. [Means for solving the problem]

[0012] The present invention relates to a cutting guide system for adjusting and stabilizing a cutting instrument. Certain embodiments of the cutting guide system disclosed herein can be used to adjust and stabilize a cutting instrument in orthopedic surgery, such as orthopedic knee surgery, spine surgery, or other orthopedic surgery. Certain embodiments of the cutting guide system disclosed herein can be used to adjust and stabilize a bone or tissue cutting instrument, such as a chainsaw or other type of bone or tissue cutting saw. Certain embodiments of the cutting guide system disclosed herein can be used to adjust and stabilize a cutting instrument in other fields, such as reconstruction. Certain embodiments of the cutting guide system disclosed herein can be used to adjust and stabilize an instrument for cutting wood, drywall, plastic, and other objects, such as a chainsaw or other type of cutting tool.

[0013] In some embodiments, a cutting guide system for stabilizing a cutting tool includes a support mount mountable in fixed relationship to an object to be cut by the cutting tool, a joint, and a cutting tool support, the joint configured to allow the cutting tool support to be adjusted relative to the support mount, and preferably the joint configured to allow the cutting tool support to be rotated about at least two axes.

[0014] In some embodiments, the joint may be of the ball and socket type. The ball and socket may be lockable relative to one another. The cutting tool support may have a stem connected to the ball or socket.

[0015] In some embodiments, the joint can include a first hinge with a first rod and a first opening, the first rod positioned within the first opening to allow relative rotational movement between the first rod and the first opening such that the first adjustment guide can pivot about a first axis relative to the support mount. The first adjustment guide and the support mount can be lockable relative to one another. The cutting guide system can further include a first transducer adapted to detect an amount of rotation of the first adjustment guide about the first axis.

[0016] In some embodiments, the joint can further include a second hinge with a second rod and a second opening, the second rod positioned within the second opening to allow relative rotational movement between the second rod and the second opening, such that the first adjustment guide can pivot about the second axis relative to the support mount. The second adjustment guide and the first adjustment guide can be lockable relative to one another. The cutting guide system can further include a second transducer adapted to detect an amount of rotation of the second adjustment guide about the second axis.

[0017] In some embodiments, the cutting tool support can be adapted to support the cutting tool such that the cutting tool is pivotable relative to the cutting tool support, hi some embodiments, the cutting tool support can be adapted to support the cutting tool such that the cutting tool can move longitudinally back and forth relative to the cutting tool support.

[0018] In some embodiments, the cutting tool support can include a stem. The cutting tool support can further include a first saw clamp and a second saw clamp. The position of the cutting tool along the longitudinal axis of the stem can be adjustable. The position of the cutting tool along the longitudinal axis of the stem can be fixable.

[0019] In some embodiments, the cutting tool support may include a saw mount, the position of which relative to the adjustment guide may be adjustable. The position of the saw mount relative to the adjustment guide may be fixable.

[0020] In some embodiments, the stem is adapted to pass through a slot in the cutting tool such that the cutting tool can rotate relative to the stem and the cutting tool can move longitudinally back and forth relative to the stem.

[0021] In some embodiments, the cutting tool may include a saw.The cutting tool may include a chainsaw.

[0022] In some embodiments, the cutting guide system may further include a guide mount for positioning the cutting mount block, the position of the guide mount being longitudinally adjustable relative to the adjustment guide. The cutting mount block may be adapted to be fastened to an object to be cut by the cutting tool. The cutting guide system may further include an adapter for attaching the cutting tool to the cutting mount block.

[0023] In some embodiments, a cutting guide system for stabilizing a cutting tool includes a track defining a path and a cutting tool support coupled to the track in a manner that stabilizes the cutting tool support relative to the track while allowing the cutting tool support to move in the direction of the path of the track.

[0024] In some embodiments, one of the track and the cutting tool support may comprise a channel and the other of the track and the cutting tool support may comprise a protrusion that fits into the channel, thereby preventing separation of the cutting tool support from the track while allowing the cutting tool support to move in the direction of the path of the track.

[0025] In some embodiments, the cutting tool support includes a stem, a first saw clamp, and a second saw clamp. The position of the cutting tool along the longitudinal axis of the stem can be adjustable and fixable. The stem can extend through a slot in the cutting tool, and the cutting tool can be pivoted relative to the stem and the cutting tool can move longitudinally back and forth relative to the stem.

[0026] In some embodiments, a method of stabilizing a cutting tool includes (i) mounting a support mount of a cutting guide system in fixed relationship to an object to be cut by the cutting tool, the cutting guide system further including a joint and a cutting tool support, and (ii) adjusting a position of the cutting tool support relative to the support mount by moving the cutting guide system at the joint. The method may further include fixing the position of the cutting tool support relative to the support mount after adjusting the position of the cutting tool support relative to the support mount by moving the cutting guide system at the joint. The joint may be of the ball-and-socket type. The joint may include (i) a first hinge having a first rod and a first opening, the first rod positioned within the first opening for relative rotational movement between the first rod and the first opening, thereby allowing the first adjustment guide to pivot relative to the support mount about a first axis, and (ii) a second hinge having a second rod and a second opening, the second rod positioned within the second opening for relative rotational movement between the second rod and the second opening, thereby allowing the second adjustment guide to pivot relative to the first adjustment guide about a second axis. The cutting tool may be pivotable relative to the cutting tool support, and may move longitudinally back and forth relative to the cutting tool support.

[0027] Other embodiments and features of the present invention will be apparent from the drawings and detailed description.

[0028] The accompanying drawings illustrate devices, components, and methods disclosed herein and, together with the description, serve to explain the principles of the invention. [Brief description of the drawings]

[0029] [Figure 1] FIG. 1 illustrates one embodiment of a cutting guide system of the present invention. [Diagram 2] FIG. 2 is an exploded view of the cutting guide system of FIG. 1. [Diagram 3] FIG. 1 illustrates another embodiment of a cutting guide system of the present invention. [Figure 4A] FIG. 4 illustrates the cutting guide system of FIG. 3 with the saw starting the cut from the right side. [Figure 4B] 4B illustrates the cutting guide system of FIG. 3 with the saw advanced from the position of FIG. 4A. FIG. [Figure 4C] FIG. 4 illustrates the cutting guide system of FIG. 3 with the saw directed toward the middle of the bone to be cut. [Figure 4D] 4C is a diagram of the cutting guide system of FIG. 3 with the saw advanced from the position of FIG. 4C. [Figure 4E] FIG. 4 illustrates the cutting guide system of FIG. 3 with the saw starting the cut from the left side. [Figure 4F] FIG. 4B illustrates the cutting guide system of FIG. 3 with the saw advanced from the position of FIG. 4E. [Figure 5A] FIG. 1 illustrates another embodiment of a cutting guide system of the present invention. [Figure 5B] FIG. 5B is another view of the cutting guide system of FIG. 5A. [Figure 5C] FIG. 5B is another view of the cutting guide system of FIG. 5A. [Figure 6] FIG. 1 illustrates another embodiment of a cutting guide system of the present invention. [Figure 7] FIG. 7 is another view of the cutting guide system of FIG. [Figure 8] FIG. 7 is another view of the cutting guide system of FIG. [Figure 9] FIG. 7 is another view of the cutting guide system of FIG. [Figure 10] FIG. 7 illustrates the cutting guide system of FIG. 6 with the first adjustment guide rotated in a first direction about the first rod axis. [Figure 11] 7 illustrates the cutting guide system of FIG. 6 with the first adjustment guide rotated in a second direction about the first rod axis. [Figure 12] 7 illustrates the cutting guide system of FIG. 6 with the second adjustment guide rotated in a first direction about the second rod axis. [Figure 13] 7 illustrates the cutting guide system of FIG. 6 with the second adjustment guide rotated in a second direction about the second rod axis. [Figure 14A] FIG. 13 is a schematic diagram of one embodiment of a hinge showing a rod positioned within an opening that allows relative rotational movement between the rod and the opening. [Figure 14B] 7A-7C show an exemplary transducer that may be incorporated as part of a cutting guide system of the present invention, such as the cutting guide system of FIG. 6. [Figure 15] 7 shows the cutting guide system of FIG. 6 positioned to cut a bone. [Figure 16] 1A-1D show several representative bone cuts made in the femur for knee replacement surgery. [Figure 17] 1 illustrates one embodiment of a support mount for the cutting guide system of the present invention. [Figure 18] 18 illustrates an assembly of components (including the support mount of FIG. 17) of another embodiment of the cutting guide system of the present invention. [Figure 19] FIG. 19 shows the assembly of FIG. 18 with alignment rods attached to the assembly. [Figure 20]FIG. 19 is another view of the assembly of FIG. 18, showing an alignment rod attached to the assembly. [Figure 21] FIG. 19 illustrates the assembly of FIG. 18 with an alignment rod attached to the assembly and a first adjustment guide rotated in a first direction about a first rod axis. [Figure 22] 19 illustrates the assembly of FIG. 18 with the alignment rod attached to the assembly and the first adjustment guide rotated in a second direction about the first rod axis. [Figure 23] FIG. 19 is another view of the assembly of FIG. 18, showing an alignment rod attached to the assembly. [Figure 24] FIG. 19 is another view of the assembly of FIG. 18, showing an alignment rod attached to the assembly. [Diagram 25] FIG. 20 illustrates one embodiment of a cutting guide system of the present invention, showing a saw mount connected to the assembly of components of FIG. 18. [Figure 26] 26 illustrates the cutting guide system of FIG. 25 at another stage in the connection of the saw mount to the component assembly of FIG. 18. FIG. [Figure 27] FIG. 26 shows the cutting guide system of FIG. 25 mounting a saw to make the distal femoral cut. [Figure 28] FIG. 26 is another view of the cutting guide system of FIG. 25 mounting a saw used to make the distal femoral cut. [Figure 29] FIG. 26 illustrates the cutting guide system of FIG. 25, showing a guide mount coupled to the assembly of components of FIG. 18 to position the cutting mount block. [Diagram 30] 26 illustrates the cutting guide system of FIG. 25, showing another stage in the connection of the guide mount to the assembly of components of FIG. 18 to position the cutting mount block. [Diagram 31]FIG. 26 illustrates the cutting guide system of FIG. 25, showing a mechanism for adjusting the anterior-posterior (front-rear) position of the cutting mount block. [Diagram 32] FIG. 26 illustrates the cutting guide system of FIG. 25 showing the angular position of the cutting mount block adjusted in a first direction. [Diagram 33] FIG. 26 illustrates the cutting guide system of FIG. 25 showing the angular position of the cutting mount block adjusted in a second direction. [Diagram 34] FIG. 26 is another view of the cutting guide system of FIG. 25 showing the position of the cutting mount block. [Diagram 35] FIG. 35 shows the cutting mount block of FIGS. 29-34 attached to a bone. [Diagram 36] FIG. 36 illustrates a first adapter configured to couple to the cutting mount block of FIGS. 29-35. [Figure 37] FIG. 37 is another view of the first adapter of FIG. 36. [Figure 38] FIG. 37 shows the first adapter of FIG. 36 positioned over the cutting mount block of FIGS. 29-35. [Figure 39] 36 is positioned over the cutting mount block of FIGS. 29-35 while the first adapter of FIG. 36 is attached to the anterior surface of the first adapter securing the saw to make the anterior femoral cut. [Diagram 40] FIG. 37 is another view of the saw attached to the anterior surface of the first adapter of FIG. 36 securing the saw to make the anterior femoral cut while the first adapter of FIG. 36 is positioned over the cutting mount block of FIGS. 29-35 . [Diagram 41] 36 is positioned over the cutting mount block of FIGS. 29-35 while the first adapter of FIG. 36 is attached to the posterior surface of the first adapter securing the saw to make the posterior femoral cut. [Diagram 42]FIG. 37 is another view of the saw attached to the posterior surface of the first adapter of FIG. 36 securing the saw to make the posterior femoral cut while the first adapter of FIG. 36 is positioned over the cutting mount block of FIGS. 29-35 . [Diagram 43] FIG. 36 shows a second adapter positioned over the cutting mount block of FIGS. 29-35 mounting a saw for making the front chamfer cut. [Diagram 44] FIG. 36 is another view of the second adapter positioned over the cutting mount block of FIGS. 29-35 mounting a saw for making the front chamfer cut. [Diagram 45] FIG. 36 shows a second adapter positioned over the cutting mount block of FIGS. 29-35 mounting a saw for making the rear chamfer cut. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0030] The accompanying drawings can be better understood with reference to the following detailed description.

[0031] For purposes of promoting an understanding of the principles of the present disclosure, reference will now be made to the embodiments shown in the drawings, with specific language being used to describe these and other embodiments. It will nevertheless be understood that the scope of the invention as claimed is not intended to be limited by the embodiments shown in the drawings or described herein. Any modifications and further adaptations of the illustrated or described systems, devices, components, or methods, and any further applications of the principles of the invention, as would normally occur to one skilled in the art to which the invention pertains, are fully contemplated. In particular, features, components, and / or steps described with respect to one embodiment of the invention may be combined with features, components, and / or steps described with respect to other embodiments of the invention.

[0032] The designations "first" and "second" as used herein do not designate or imply any particular positioning or other characteristics. Rather, when the designations "first" and "second" are used herein, they are used only to distinguish one component or part from another component or part. The expressions "attached," "coupled," "connected," and the like, mean the attachment, connection, coupling, etc. of one part to another part, either directly or indirectly, by one or more other parts, unless a direct or indirect attachment, connection, coupling, etc. is specified. The term "user" means one or more persons who use the devices, systems, and / or methods described herein, for example, one or more surgeons, physicians, operators, or other persons who use the devices, systems, and / or methods.

[0033] Figure 1 illustrates a first exemplary embodiment of a cutting guide system 12. Figure 1 illustrates the cutting guide system 12 attached to the proximal (upper) end of a generally vertically oriented tibia T. Figure 1 illustrates the cutting guide system 12 being used to guide a saw to make a transverse cut into the tibia T in a horizontal plane of the body.

[0034] FIG. 2 is an exploded view of cutting guide system 12 showing the individual components of cutting guide system 12.

[0035] As shown in FIG. 1, the cutting guide system 12 includes a support mount 9A that is mountable to a bone, for example, the proximal anterior tibia T. The support mount 9A can be mounted to the bone in a conventional manner. For example, the support mount 9A can be attached to the bone by one or more fasteners passing through one or more holes 22 in the support mount 9A and penetrating the bone. The fasteners can be conventional fixation pins, trocar-tipped pins, screws, and / or other fasteners. Additionally or alternatively, spikes can be provided on a contact surface of the support mount 9A that can be driven into the bone to mount the support mount 9A to the bone and / or aid in the stability and rigidity of the support mount 9A relative to the bone. The support mount can be mounted in fixed relationship to the bone or other object to be cut by a cutting tool directly or via one or more other components.

[0036] As will be described in more detail below, when the support mount 9A is attached to the bone, the specific location is not critical as far as the XYZ location and XYZ rotational orientation of the support mount 9A relative to the bone are concerned. Rather than being limited to exact location and alignment, the user can position the support mount 9A on a stable topology of the patient's bone. The proximal anterior tibia has a somewhat irregular shape due to the tibial tuberosity, which is a bony prominence for anchoring the quadriceps patella flexion mechanism. Since the exact positioning of the support mount 9A relative to the bone is not critical, the user can place the support mount 9A on an area of ​​the bone that facilitates achieving stability of the support mount 9A.

[0037] FIG. 1 shows the support mount 9A as a translucent body to allow visibility of internal features, including areas sized and shaped to receive components of a ball-and-stem assembly 8, which in this embodiment is made up of portions labeled 8A, 8B, and 8C. The ball-and-stem assembly 8 includes a stem 8A, a ball 8B, and in this embodiment a fastener 8C. The stem 8A passes through a hole in the ball 8B and is secured by the fastener 8C. In some embodiments, the stem 8A and fastener 8C can be one component, such as a headed fastener, where the head of the fastener does not fit through a hole through the ball 8B. In some embodiments, the stem 8A and ball 8B can be manufactured as a single component, and the stem 8A and ball 8B can be connected to each other without the need for a fastener. In general overview, the ball-and-stem assembly 8, when assembled, resembles an upside-down spherical lollipop.

[0038] When the cutting guide system 12 is assembled, the ball-and-stem assembly 8 fits into a socket in the cutting guide system 12. The socket 14 may include a recess in the lower block 10 and a recess in the support mount 9A. The recesses may be partially spherical (e.g., hemispherical) or any other suitable shape. The two recesses form a socket 14 into which the ball 8B fits. The ball 8B, in conjunction with the socket 14 of the cutting guide system 12 that receives it, acts as a swivel joint with degrees of freedom in all planes. When the ball 8B of the ball-and-stem assembly 8 is positioned in the socket 14, it rotates in the socket 14 of the cutting guide system 12 with all degrees of freedom as a ball joint. This allows the stem 8A to be oriented and rotated at various angles. As examples of allowable directions of movement, the joint (ball 8B and socket 14) allows the stem 8A to be rotated left and right, to be rotated about a first axis, to be rotated toward or away from the object to be cut (e.g., bone), and to be rotated about a second axis.

[0039] The swivel joint consisting of ball 8B and socket 14 gives the user ultimate versatility as to where the bone cut should be positioned. The ball 8B is completely free to rotate within the socket 14 formed by the recesses in the lower block 10 and the support mount 9A until the user tightens the locking device 11, thereby drawing the lower block 10 closer to the support mount 9A and creating pressure on the ball 8B, which prevents the ball 8B from rotating. The recesses in the lower block 10 and the support mount 9A may be sized such that when the locking device 11 is placed, it clamps the ball 8B between them. In this embodiment, the locking device 11 is a bolt that threads through a hole in the block 10 and into a threaded insert 9B that threads through a hole in the support mount 9A, or alternatively, into a threaded hole in the support mount 9A. Other mechanisms, such as locking (fastening, clamping, or fixing) mechanisms, may be used for the locking device 11. Once the user has manipulated the ball-and-stem assembly 8 into the desired position, the user can then lock the position by deploying the lock 11. If the user wishes to readjust the position, the lock can be released (e.g., rotated backwards), the ball-and-stem assembly 8 can be repositioned, and the lock 11 can be re-deployed.

[0040] The cutting guide system 12 further includes a lower saw clamp 7 and an upper saw clamp 3 for securing opposite sides of the saw 4. In this embodiment, a stem 8A (either alone or in association with the lower saw clamp 7 and the upper saw clamp 3) forms a cutting tool support for supporting the saw 4 or other cutting tool. The saw clamps 3, 7 have a through hole that receives the stem 8A such that the stem 8A passes through the through holes of both saw clamps 3, 7. The positioning of the saw clamps 3, 7 along the longitudinal length of the stem 8A is adjustable. For example, the through holes of the saw clamps 3, 7 may be sized to slide over the stem 8A, and an adjustable spacer may be used to adjust the position of the saw clamp 7 relative to the support mount 9A. An example of a suitable adjustable spacer is described below.

[0041] The lower saw clamp 7 and the upper saw clamp 3 are secured to opposite sides of the saw 4 when assembled, with the stem 3A passing through a slot 4E in the saw 4. In this embodiment, the saw 4 is a chainsaw assembly including a saw bar 4A, a chain 4B, and a drive tooth assembly 4C. The illustrated chainsaw assembly may be attached to and driven by a handpiece (not shown). Components 5 and 6 represent saw components for handling the saw and / or mounting the saw to a drive mechanism. Although a chainsaw is illustrated, other types of saws may be secured by the cutting guide system 12.

[0042] The saw clamp 3 and / or saw clamp 7 may have a ridge 3A, 7A on its side facing the saw that fits into a slot 4E in the saw bar. The ridge or ridges help to guide the longitudinal movement of the saw.

[0043] The saw clamp 7 can be adjusted to a desired position by adjustable spacers as described above, and then the knob 1 can be turned to compress the saw clamp 3 against the saw clamp 7. The knob 1 can have a threaded nut or bore that engages with a threaded outer surface of the stem 8A such that turning the knob 1 moves it downward along the stem 8A, thereby moving the saw clamp 3 closer to the saw clamp 7 and securing the saw 4. A spring 2 can be used to urge the saw clamp 3 towards the saw clamp 7 to help secure the saw 4 between the saw clamps 3 and 7. The securing of the saw between the saw clamps 3, 7 prevents the saw from moving up and down along the stem 8A while the saw bar 4A can still move in a direction parallel to the length of the saw bar slot 4E by advancing or retracting it forward. 1, to advance the saw bar 4A forward relative to the support mount 9A, the saw bar 4A is moved rearward, and to retract the saw bar 4A, the saw bar 4A is moved forward. Thus, the cutting tool (e.g., saw) can move longitudinally back and forth relative to the cutting tool support (e.g., stem 8A).

[0044] In some embodiments, the saw clamp 3,7 may be rotatable about the stem 8A. In this arrangement, the saw may rotate in a plane about the stem 8A, the axis of which is the axis of rotation. This allows the user to move the saw not only forwards and backwards, but also rotationally in a plane about the axis of the stem 8A. Thus, the cutting tool (e.g., the saw) may be rotatable relative to the cutting tool support (e.g., the stem 8A).

[0045] In use, the cutting guide system 12 allows for easy fixation of the cutting guide system 12 to the bone, allows for easy positioning of the saw 4 to the bone, and allows for easy readjustment of such positioning, if necessary. The user first attaches the support mount 9A to the bone. As mentioned above, the particular location and orientation of the support mount 9A to the bone is not critical, and the user can select a fixed location on the bone that allows for stable fixation. The joint (ball 8B and socket 14) allows the cutting tool support (e.g., stem 8A) to be adjusted relative to the support mount 9A. With the support mount 9A attached to the bone, the user can manipulate the ball-stem assembly 8 to the desired position. The user then places the lock 11 to lock the position. If the user wishes to readjust the position, the lock can be released, the ball-stem assembly 8 can be repositioned, and the lock 11 can be repositioned. With the ball and stem assembly 8 locked, the user can then adjust the position of the saw clamp 3,7 along the longitudinal length of the stem 8A. This position can be locked and if the user wishes to readjust it can be unlocked and the saw clamp 3,7 can be repositioned.

[0046] In an exemplary procedure, i.e., knee surgery, positioning may include considerations such as balancing the medial and lateral collateral ligaments, as well as the anterior and posterior cruciate ligaments and the knee capsule. The primary adjustments may be for flexion / extension and varus / valgus positioning. The final adjustment may be for a single bone cut. In a knee surgery and tibial example, this final adjustment may be for a single bone cut relative to the long axis of the tibia.

[0047] Alignment guides and styli and / or pre-operative planning may be used to help reference landmarks to obtain proper placement for implant positioning, for example, in total knee arthroplasty, where the goal is to re-establish the normal anatomical kinematic behavior of the knee joint while balancing the soft tissue structures and maintaining overall stability throughout the range of motion.

[0048] There are additional advantages to the above-described design. The cutting guide system may be designed for use with a set of different implant sizes. Thus, the cutting guide system may be interchangeable with multiple sizes of cutting blocks, e.g., seven or eight different sizes, instead of the many different sizes of cutting blocks currently required. Thus, the cutting guide system described herein may significantly reduce inventory requirements and use less in-hospital storage space. The cutting guide system described herein may also be advantageous for portable military or in-hospital locations where an effective cutting system with fewer parts may be the basis. Additionally, in some embodiments, the simple design of the cutting guide system described herein lends itself to disposables.

[0049] 3 and 4A-4F illustrate another exemplary embodiment of a cutting guide system 30. The cutting guide system 30 includes a track 32. The track 32 may be curved in shape, such as an arc with a desired radius of curvature and length.

[0050] The track 32 may be attachable to a stem of the swivel joint, such as the stem 8A of the cutting guide system 12. Thus, for example, the cutting guide system 30 may include the following components of the cutting guide system 12: a support mount 9A, one or more fasteners for attaching the support mount 9A to bone, a ball-and-stem assembly 8 (stem 8A, ball 8B, and optional fastener 8C), a lower block 10 (a recess in the lower block 10 and support mount 9A forming a socket 14 for the ball 8B), and a lock 11 (an optional corresponding threaded insert 9B or threaded hole in the support mount 9A or other locking mechanism). A user uses these components in the same manner as described above, i.e., attaching the support mount 9A to the bone, manipulating the ball-and-stem assembly 8 to position the stem 8A in the desired location, and then locking the ball-and-stem assembly 8 in place with the lock 11 or other locking mechanism.

[0051] In such an embodiment, the track 32 may be mountable above the top of the stem 8A, which may be shorter than the stem shown in Figures 1 and 2, and the track 32 may be mountable to the stem 8A, either directly or via one or more other components. An adjustable spacer may be used to adjust the spacing of the track 32 relative to the support mount 9A.

[0052] In alternative cutting guide systems, the track 32 may be attached directly to the bone or may be coupled to a block that is attached directly to the bone. The track 32 may be used with or without a swivel joint. The ends of the track 32 may be fixed to the bone for stability.

[0053] The curved shape of the track 32 is oriented toward the desired target location, for example, to extend around the desired bone location, allowing the track 32 to fit closely to the bone as it wraps around the bone.

[0054] 3, the track 32 has walls 34 which define a channel 36. A narrow slot 38 in the upper wall provides access to the channel 36 and is flanked on either side by wall portions 34A, 34B.

[0055] The cutting guide system 30 further includes an upper saw clamp 42 and a lower saw clamp 44 for securing opposing sides of the saw 4 and guiding the saw 4 relative to the track 32. The lower saw clamp 44 has a protrusion 46 that fits into the channel 36 of the track 32 and a stem 48 that connects the protrusion 46 to a body of the lower saw clamp 44. In this embodiment, the stem 48 (either alone or in conjunction with the lower saw clamp 44 and the upper saw clamp 42) forms a cutting tool support that supports the saw 4 or other cutting tool. The stem 48 may pass through a slot in the cutting tool (e.g., the saw 4) so ​​that the cutting tool can rotate relative to the stem 48 and the cutting tool can move longitudinally back and forth relative to the stem 48. The stem 48 passes through a slot 38 in the track 32 and the protrusion 46 is too large to fit through the slot 38. This is a dovetail-like structure that prevents separation of the saw clamp 44 from the track 32. This configuration keeps the saw 4 connected to the track 32 with the protrusion 46 able to slide within the channel 36. This allows the lower saw clamp 44, and thus the upper saw clamp 42 and saw 4, to move in the direction of the slot 38, which in this case follows the curved path of the track 32.

[0056] The lower saw clamp 44 and the upper saw clamp 42, when assembled, are secured to opposite sides of the saw 4. Although a chain saw is shown, other types of saws can be secured by the cutting guide system 30. The saw bar 4A is provided with a saw bar slot 4E through which the saw bar clamps 42, 44 are coupled to one another while the saw bar 4A can move longitudinally in the direction of the saw bar slot 4E. The saw clamps 42, 44 prevent the saw bar 4 from moving away from the track 32 by advancing or retracting the saw bar 4 forward while allowing the saw bar 4 to move along the direction of the track slot 38 and further allowing the saw bar 4A to move in a direction parallel to the length of the slot 4E of the saw bar 4A. The upper saw clamp 42 and the lower saw clamp 44 may each have a ridge on their side facing the saw, similar to ridge 3A or 7A, which ridge fits into the saw bar slot 4E. The one or more ridges help guide the longitudinal motion of the saw.

[0057] Figures 4A-4F show various positions of the saw 4 with the cutting guide system 30. Figures 4A-4F show the cut beginning (Figure 4A), plunging in from the right side (Figure 4B), sweeping in and plunging or lateral towards the middle (Figures 4C and 4D), and then continuing all the way to the left side (Figures 4E and 4F).

[0058] Cutting guide system 30 provides the advantages discussed above with respect to cutting guide system 12 while allowing a user to cut bone from even more locations. The track 32 defines a path, and the cutting tool support is coupled to the track in a manner that stabilizes the cutting tool support relative to the track 32 while allowing the cutting tool support to move in the direction of the path of the track 32.

[0059] Although Figures 3 and 4A-4F show the track 32 with the channel 36 and the cutting tool support with the protrusion 46 that fits within the channel 36, other configurations are possible for coupling the cutting tool support to the track in such a way that the cutting tool support can move in the direction of the track path. For example, the cutting tool support may have a channel (such as channel 36 of track 32 described above) with a slot (similar to slot 38) and the track may have a protrusion that fits within the channel with a narrowed area between the track body and the protrusion. The narrowed area fits within the slot, such as in a dovetail configuration, thereby preventing separation of the cutting tool support from the track while allowing the cutting tool support to move in the direction of the track path.

[0060] 5A-5C illustrate another exemplary embodiment of a cutting guide system 50. The cutting guide system 50 has a track 52 similar to the track 32 described above. The track 52 may have a curved shape, for example, an arc shape with a desired radius of curvature and length.

[0061] Similar to track 32, track 52 may be attachable to a stem of a swivel joint, such as stem 8A of cutting guide system 12. Thus, for example, cutting guide system 50 may include the following components of cutting guide system 12: support mount 9A, one or more fasteners for attaching support mount 9A to bone, ball-and-stem assembly 8 (stem 8A, ball 8B, and optional fastener 8C), lower block 10 (recess in lower block 10 and support mount 9A forming socket 14 for ball 8B), and lock 11 (optional corresponding threaded insert 9B or threaded hole in support mount 9A or other locking mechanism). A user uses these components in the same manner as described above, i.e., attaching support mount 9A to bone, manipulating ball-and-stem assembly 8 to position stem 8A in a desired location, and then locking ball-and-stem assembly 8 in place with lock 11 or other locking mechanism.

[0062] In such an embodiment, the track 52 may be mounted on top of the stem 8A, similar to the mounting of the track 32. The track 52 may be attachable to the stem 8A either directly or via one or more other components. An adjustable spacer may be used to adjust the spacing of the track 52 relative to the support mount 9A.

[0063] Similar to track 32, track 52 may be attached directly to the bone or may be connected to a block that is attached directly to the bone. Track 52 may be used with or without a swivel joint. The ends of track 52 may be fixed to the bone for stability.

[0064] Similar to track 32, the curved shape of track 52 is oriented toward the desired target location, for example, to extend around the desired bone location, allowing track 52 to fit closely to the bone as it wraps around the bone.

[0065] 5A and 5B, the track 52 has walls 54 which define a channel 56. A narrow slot 58 in the upper wall provides access to the channel 56 and is flanked on either side by wall portions 54A, 54B.

[0066] The cutting guide system 50 further includes an adapter 62 for securing and guiding a saw blade 70 relative to the track 52. In this embodiment, the adapter 62 forms a cutting tool support that supports the saw blade 70 or other cutting tool. The cutting tool may be able to move longitudinally back and forth relative to the adapter 62. The bottom of the adapter 62 has a protrusion 66 that fits within the channel 56 of the track 52 and a stem 68 that connects the protrusion 66 with the body of the adapter 62. The stem 68 passes through the slot 58, and the protrusion 66 is too large to fit through the slot 58. This is similar to a dovetail configuration and prevents separation of the adapter 62 from the track 52. This configuration keeps the saw 70 connected to the track 52 with the protrusion 66 able to slide within the channel 56. This allows the adapter 62 , and thus the saw 70 , to move in the direction of the slot 58 , where this direction follows the curved path of the track 52 .

[0067] As shown in FIG. 5C, the adapter 62 has an opening for receiving the saw 70 and includes side and top wall sections for securing the saw 70 such that the saw can move longitudinally back and forth along an axis as shown. The saw shown is a precision saw blade. An example of such a saw blade is a precision saw blade available from Stryker Corporation, e.g., part number 6526-127-105. Other types of saws can be secured by the cutting guide system 50. The adapter 62 prevents the saw 70 from moving away from the track 52 by advancing or retracting the saw 70 forward, while allowing the saw 70 to move along the direction of the slot 58 in the track 52 and also allows the saw 70 to move in a direction parallel to the length of the saw bar as indicated by arrow A in FIG. 5B.

[0068] The adapter 62 can take a variety of forms to hold the saw blade in the plane of the bone cut as described, including spring loaded, lockable, fully enclosed, and dovetail type mechanisms. This system allows advancement of the saw blade without giving up in-plane guidance, as shown in FIG. 5B.

[0069] Figure 5B shows the saw blade 70 being controlled to produce a flat plane or cut. Figure 5B shows the advancement of the cutting blade from the anterior portion of the tibia toward the posterior region of the bone in preparation for an artificial tibial resurfacing implant. Using the cutting guide system 50, the saw blade 70 can be positioned in a manner similar to that shown in Figures 4A-4F.

[0070] Figure 5C shows how the adapter 62 encases the blade 70. This configuration controls the blade and stabilizes it while still allowing it to advance or retract (in the direction of arrow A in Figure 5B) depending on the user's requirements.

[0071] Like cutting guide system 30, cutting guide system 50 provides the advantages discussed above with respect to cutting guide system 12 while allowing a user to cut bone from even more locations. The track 52 defines a path, and the cutting tool support (adapter 62) is coupled to the track in a manner that stabilizes the cutting tool support relative to the track 52 while allowing the cutting tool support to move in the direction of the path of the track 52.

[0072] As discussed above with reference to Figures 3 and 4A-4F, although Figures 5A-5C show the track 52 with the channel 56 and the cutting tool support with the protrusion 66 that fits within the channel 56, other configurations are possible for coupling the cutting tool support to the track in such a way that the cutting tool support can move in the direction of the track path. For example, the cutting tool support may have a channel (such as channel 56 of track 52 described above) with a slot (similar to slot 58) and the track may have a protrusion that fits within the channel with a narrowed area between the track body and the protrusion. The narrowed area fits within the slot, such as in a dovetail configuration, thereby preventing separation of the cutting tool support from the track while allowing the cutting tool support to move in the direction of the track path.

[0073] The interface between the adapter and the saw blade can take a variety of forms. It can be spring loaded, fixed or adjustable, have a membrane, have a plastic bushing, or have any of a variety of mechanisms that dampen vibration while allowing smooth advancement and control of planar cuts. One of the advantages of a system such as cutting guide system 30 or cutting guide system 50 is that such a system allows the saw blade to be held very close to the bone. By allowing the saw blade to be held close to the object to be resected, the accuracy of the bone cut can be significantly improved compared to current cutting blocks. Stability also helps ensure the safety aspects of controlling a reciprocating oscillating saw.

[0074] An additional advantage of certain cutting guide systems described herein is that they can provide an accessible reference frame for visualization. For example, a user can look at the top of the adapter 62. The top section of the adapter is a visually accessible reference frame for reading the plunge depth markings, which may be marked on the blade. In this configuration, the user has a very precise and visual reference of the depth of the cut.

[0075] In some embodiments, the penetration depth can be measured by an electronic linear measuring device and the measurements can be transmitted, for example, via Bluetooth or Wi-Fi, to a workstation with information about the procedure.

[0076] As will be appreciated by those skilled in the art, the cutting guide system described herein can guide a saw without the use of existing cumbersome cutting blocks, and embodiments can be adapted to suit different types of saws, including chainsaws, oscillating and / or reciprocating tip-only saws, and other saws. The saw can be guided by a fitted adapter (e.g., adapter 62) that is received in a saw bar slot (e.g., saw bar slot 4E) and secures the saw while allowing longitudinal motion, or held in another manner that secures the saw while allowing longitudinal motion consistent with the present disclosure. Various such embodiments can be used with swivel joints and / or curved tracks as described herein.

[0077] The embodiments described herein can be used in a variety of ways, for example, they can be used manually or with a robotic platform, where the saw is operated by a robot.

[0078] Figures 6-15 show another exemplary embodiment of a cutting guide system 101. Figure 15 shows the cutting guide system 101 attached to the proximal (upper) end of the tibia T. Figure 15 shows the cutting guide system 101 being used to guide a saw so that a transverse cut can be made in the tibia T in a horizontal plane of the body.

[0079] The cutting guide system 101 includes a support mount 110 that can be attached to a bone, such as the proximal anterior tibia T shown in FIG. 15 or another suitable bone. The support mount 110 can be attached to the bone in a conventional manner. For example, the support mount 110 can be attached to the bone by one or more fasteners passing through one or more holes 112 in the support mount 110 and penetrating the bone. The fasteners can be conventional fixation pins, trocar-tipped pins, screws, and / or other fasteners. Additionally or alternatively, spikes can be provided on the contact surface of the support mount 110 that can be driven into the bone to attach the support mount 110 to the bone and / or aid in the stability and rigidity of the support mount 110 relative to the bone. The support mount 110 can be attached in fixed relationship to the bone or other object to be cut by a cutting tool directly or via one or more other components.

[0080] Once the support mount 110 is attached to the bone, the particular location is not important as far as the location and rotational orientation of the support mount 110 relative to the bone. Without being limited to a precise location and alignment, the user may position the support mount 110 on a stable topology of the patient's bone. Since the precise positioning of the support mount 110 relative to the bone is not critical, the user may place the support mount 110 on an area of ​​the bone that facilitates achieving stability of the support mount 110.

[0081] A first rod 114 is part of or rigidly attached to the support mount 110. When the support mount 110 is attached to the bone, the first rod extends away from the bone. The axis 114A of the first rod is shown in FIGS. 10 and 11. A first adjustment guide 120 is attached to the first rod for rotation about the first rod axis 114A. The first adjustment guide 120 has an opening (recess or hole) that receives the first rod for relative rotational movement, thereby allowing the first adjustment guide 120 to rotate about the first rod axis 114A. In an alternative configuration, the first rod may be part of or rigidly attached to the first adjustment guide 120, and the support mount 110 may have a corresponding opening (recess or hole) that receives the first rod. In this alternative configuration, the first rod rotates with the first adjustment guide 120 (i.e., the first rod rotates within an opening in the support mount 110). In either configuration, the first adjustment guide 120 is rotatably mounted relative to the support mount 110 about the first rod axis 114A.

[0082] A second rod 124 is part of or rigidly attached to the first adjustment guide 120 extending laterally therefrom. The axis 124A of the second rod is indicated in FIGS. 12 and 13. A second adjustment guide 130 is rotatably attached to the second rod about the second rod and second rod axis 124A. The second adjustment guide 130 has an opening (recess or hole) that receives the second rod for relative rotational movement, thereby allowing the second adjustment guide 130 to rotate about the second rod and second rod axis 124A. In an alternative configuration, the second rod may be part of or rigidly attached to the second adjustment guide 130, and the first adjustment guide 120 may have a corresponding opening (recess or hole) that receives the second rod. In this alternative configuration, the second rod rotates with the second adjustment guide 130 (i.e., the second rod rotates within an opening in the first adjustment guide 120). In either configuration, the second adjustment guide 130 is rotatably mounted relative to the first adjustment guide 120 about the second rod axis 124A.

[0083] The first rod and / or the second rod need not extend continuously through their associated parts. For example, the second rod may include two rod portions extending from either side of the first adjustment guide 120, or one rod portion extending from one side of the first adjustment guide 120. The first rod and the corresponding opening in which the first rod is rotatably received together form a first hinge, which allows the first adjustment guide 120 to rotate about the first axis 114A. The second rod and the corresponding opening in which the second rod is rotatably received together form a second hinge, which allows the second adjustment guide 130 to rotate about the second axis 124A. In this embodiment, the joint for positioning the cutting tool includes a first hinge and a second hinge. Thus, as examples of permitted directions of movement, the joint allows the cutting tool support to be rotated left and right about a first axis 114A and to be rotated toward and away from an object (e.g., bone) to be cut about a second axis 124A. A schematic diagram of an example of a hinge in which rods 114, 124, 214, 224 are positioned in openings 115 to allow relative rotational movement between the rods and the openings is shown in FIG. 14A. The rods can rotate in the openings and / or the part P with the openings (e.g., adjustment guide) can rotate about the rods. The walls with the openings 115 can extend 360° around the corresponding rods or less than 360° around the corresponding rods (e.g., 270°, 225°, etc.).

[0084] A locking mechanism 126 is associated with the first adjustment guide 120 to selectively allow or prevent rotation of the first adjustment guide 120 about the first rod axis 114A. In the illustrated embodiment, the locking mechanism 126 includes a set screw 128 that can be turned to securely engage the first rod, thereby locking the first adjustment guide 120 against rotation, or can be turned the other way to release the first rod, thereby allowing the second adjustment guide 130 to rotate about the second rod axis 124A. Similarly, a locking mechanism 136 is associated with the second adjustment guide 130 to allow or prevent rotation of the second adjustment guide 130 about the second rod axis 124A. In the illustrated embodiment, the locking mechanism 136 includes a set screw 138 that can be turned to securely engage the second rod, thereby locking the second adjustment guide 130 against rotation, or can be turned the other way to release the second rod, thereby allowing the second adjustment guide 130 to rotate about the second rod axis 124A. Other locking (fastening, clamping, or securing) mechanisms can be used for the locking mechanisms 126, 136.

[0085] A transducer 140 may be provided in association with the first adjustment guide 120 and the second adjustment guide 130. The transducer 140 is adapted to detect the amount of rotation of the adjustment guides 120, 130 about their respective rotational axes 114A, 124A. The transducer 140 converts the rotational movement of the adjustment guides 120, 130 into an electrical signal such that a user may obtain an accurate measurement of the angular position of the adjustment guides 120, 130. Thus, the transducer 140 may be an electronic device that outputs the angular change or position of the respective adjustment guide 120 or 130 to a user.

[0086] An example of an exemplary transducer 140 is shown in FIG. 14B. In this exemplary embodiment, the transducer includes a stator 142 and a rotor 144. The stator 142 is adapted to remain rotationally fixed, and the rotor 144 is adapted to rotate with the adjustment guide 120 or 130 as the adjustment guide 120 or 130 rotates about its respective rod axis 114A or 124A. The stator 142 may be coupled to the rod. For example, in the illustrated embodiment, the stator includes an engagement recess 143 (e.g., hexagonal or other shape) that is adapted to mate with a correspondingly shaped outer surface of the rod. The rotor 144 may be coupled to the adjustment guide 120 or 130. For example, the rotor may include a pin 145 that fits into a corresponding hole in the adjustment guide 120 or 130 such that the rotor 144 rotates with the adjustment guide 120 or 130.

[0087] The transducer 140 may further include a housing 146 that contains components that convert the rotational motion of the adjustment guide 120 or 130 into an electrical signal. A variety of mechanisms may be used for this conversion. For example, the mechanism may be a potentiometer, an optical encoder, a capacitance-based device, or other suitable mechanism. The housing 146 may also contain a battery and / or a transmitter that transmits the signal, such as a Bluetooth transmitter or other wireless transmitter. For example, the signal may be transmitted via Bluetooth or other transmission scheme to a device, such as a computer, handheld device, cell phone, iPad, or surgical station, readable by a user.

[0088] The cutting guide system 101 further includes a stem 150 attached to or integral with the second adjustment guide 130. In the illustrated embodiment, the stem 150 extends from the top of the second adjustment guide 130 and has a lower section 158 with a first diameter and an upper section 156 with a second diameter, the first diameter being greater than the second diameter. The lower section 158 and the upper section 156 may be threadedly engaged.

[0089] The cutting guide system 101 further includes a lower saw clamp 152 and an upper saw clamp 154 ​​that secure opposite sides of the saw 4. The saw clamps 152, 154 have through holes that receive the stem 150 such that the stem 150 passes through both through holes of the saw clamps 152, 154. The positioning of the saw clamps 152, 154 along the longitudinal length of the stem 150 is adjustable (although in alternative embodiments the positioning of the saw clamps 152, 154 along the longitudinal length of the stem 150 may be fixed). For example, the through holes of the saw clamps 152, 154 may be sized to slide over and along the stem 150, and a lower adjustment nut 160 in threaded relationship with a lower section 158 of the stem 150 may be used to adjust the position of the lower saw clamp 152 relative to the second adjustment guide 130. Once the lower adjustment nut 160 and lower saw clamp 152 are in place, the upper saw clamp 154 ​​can be clamped in place by the upper adjustment nut 162 which is in threaded engagement with the upper section 156 of the stem 150. An optional spring can be used to press the saw clamps together to help secure the saw 4 between them.

[0090] The lower saw clamp 152 and the upper saw clamp 154 ​​are secured to opposite sides of the saw 4 with the stem 150 passing through a slot 4E in the saw 4 when assembled. In this embodiment, the stem 150 (either alone or in conjunction with the lower saw clamp 152 and the upper saw clamp 154) forms a cutting tool support for supporting the saw 4 or other cutting tool. The stem 150 may pass through a slot 4E in the cutting tool (e.g., the saw 4) so ​​that the cutter can rotate relative to the stem 150 and the cutting tool can move longitudinally back and forth relative to the stem 150. In this embodiment, the saw 4 is a chainsaw assembly including a saw bar 4A, a chain, and a drive tooth assembly. The illustrated chainsaw assembly may be attached to and driven by a handpiece (not shown). Although a chainsaw is illustrated, other types of saws may be secured by the cutting guide system 101.

[0091] Saw clamp 152 and / or saw clamp 154 ​​may have a ridge on its side facing the saw that fits into slot 4E in the saw bar. The ridge or ridges help guide the longitudinal motion of the saw.

[0092] Fixation of the saw between the saw clamps 152, 154 prevents the saw from moving up and down along the stem 150, but the saw bar 4A can still move in a direction parallel to the length of the saw bar slot 4E by advancing it forward or retracting it. In the embodiment of Figure 15, to advance the saw bar 4A forward relative to the support mount 110, the saw bar 4A is moved rearward, and to retract the saw bar 4A, the saw bar 4A is moved forward.

[0093] In some embodiments, the saw clamps 152, 154 may be rotatable about the stem 150. In this configuration, the saw may rotate in a plane about the stem 150, with the axis of the stem 150 being the axis of rotation. This allows a user to move the saw not only forwards and backwards, but also rotationally in a plane about the axis of the stem 150.

[0094] An example of using the cutting guide system 101 is as follows: First, the user secures the support mount 110 to the bone. Next, the user can rotate the first adjustment guide 120 or the second adjustment guide 130 to the desired position. With the attachment as shown in FIG. 15, the first adjustment guide 120 can be adjusted to adjust the valgus / varus positioning as shown in FIGS. 10 and 11. The user can visually assess the alignment with respect to anatomical landmarks, such as the top of the tibia or the center of the ankle, with or without additional alignment tools, such as an alignment rod, that can be attached to the first adjustment guide 120. Once the first adjustment guide 120 is in the desired position, the user can lock it into place using the locking mechanism 126, such as by tightening the set screw 128.

[0095] The user can then adjust the other adjustment guide. With attachment as shown in FIG. 15, the second adjustment guide 130 can be adjusted to adjust the flexion / extension positioning as shown in FIGS. 12 and 13. The user can visually assess with or without additional alignment tools, such as alignment rods, which can be attached to the second adjustment guide 130. Once the second adjustment guide 130 is in the desired position, the user can lock its position using the locking mechanism 136, such as by tightening the set screw 138. The first adjustment guide 120 can be adjusted before the second adjustment guide 130, or vice versa.

[0096] The stylus can be used to measure the desired height adjustment for the amount of bone to be removed. For example, the stylus can be positioned where the saw bar 4A will be located. The saw clamps 152, 154 and / or adjustment nuts 160, 162 can be used with the stylus or can be removed for the stylus mechanism. The stylus allows the user the ability to determine the desired height for the saw. The stylus can then be removed and the saw clamps 152, 154 and adjustment nuts 160, 162 can be used to place the saw in position with its height adjusted to the desired height.

[0097] In performing the various positioning steps, the user may be guided and / or coordinated with information from optical vision systems, pre-operative evaluations, x-rays, CAT scans, MRIs, etc. At any point, the user may release the locking mechanisms 126, 136, readjust the respective adjustment guides 120, 130, and then deploy the respective locking mechanisms 126, 136 to secure the adjustment guides 120, 130. Similarly, the user may readjust the height of the saw bar by releasing the adjustment nuts 160, 162, adjusting the height, and then relocking the saw.

[0098] The rotational position of the adjustment guides 120, 130 may be transmitted using the transducer 140 as described above. The user may use the position information to position and / or adjust and / or make additional cuts. For example, if the user desires to make an extra two degree cut, the user may use feedback from the transducer 140 to reset the first cut position to zero and move the adjustment mechanism two degrees. Optionally, the cutting guide system 101 may include a worm gear or linkage arrangement to provide micrometer-like fine rotational adjustments to the adjustment guides 120, 130 to dial in very specific degrees of rotation. As another option, the cutting guide system may be adjusted using one or more motors, e.g., stepper motors, to move the adjustment guides 120 and / or 130.

[0099] The cutting guide system 101 separates the two primary degrees of freedom with independent adjustability of the first adjustment guide 120 and the second adjustment guide 130. A user can align the cutting guide system 101 in one plane or degree of freedom, lock it in place, and then adjust it in the other plane or other degree of freedom. Thus, for example, a user can separate varus / valgus adjustment from flexion / extension adjustment.

[0100] Figure 16 shows several representative bone cuts made in a femur F for a knee replacement. Figure 16 shows the distal end of the femur F, i.e., the end that faces the knee joint. The following bone cuts are made in the femur F shown in Figure 16: distal femoral cut DF, anterior femoral cut AF, posterior femoral cut PF, anterior chamfer cut AC, and posterior chamfer cut PC.

[0101] Figures 17-45 show another exemplary embodiment of cutting guide system 201. Figures 17-45 show cutting guide system 201 attached to the distal (lower) end of femur F. These figures show exemplary uses of cutting guide system 201 to make distal femoral cuts DF, anterior femoral cuts AF, posterior femoral cuts PF, anterior chamfer cuts AC, and posterior chamfer cuts PC.

[0102] The cutting guide system 201 includes a support mount 210 that can be attached to a bone, such as the anterior distal femur F shown in FIG. 17 or another suitable bone. The support mount 210 can be attached to the bone in a conventional manner. For example, one or more fasteners can be attached to the bone by inserting one or more holes in the support mount 210 and penetrating the bone. The fasteners can be conventional fixation pins, trocar-tipped pins, screws, and / or other fasteners. Additionally or alternatively, spikes can be provided on the contact surface of the support mount 210 that can be driven into the bone to attach the support mount 210 to the bone and / or aid in the stability and rigidity of the support mount 210 relative to the bone. In the illustrated embodiment, as can be seen in FIG. 24, the exemplary support mount 210 has spikes 216 that can bite into the bone, and threaded fasteners 218 can also be used to attach the support mount 210 to the bone. The support mount 210 is mountable in fixed relationship to a bone or other object to be cut by a cutting tool, either directly or via one or more other components.

[0103] 17, the exemplary support mount 210 includes a base 212 with a first rod 214 extending therefrom that extends away from the bone when the support mount 210 is attached to the bone. A spike 216 can extend from the base 212 toward the bone. A fastener 218 can fit within a hollow central region of the first rod 214 and pass through a hole in the base 212 to be driven into the bone.

[0104] As with the previous embodiments described herein, once the support mount 210 is attached to the bone, the particular location is not important as far as the location and rotational orientation of the support mount 210 relative to the bone is concerned. A user may position the support mount 210 over an area of ​​the bone that will facilitate achieving stability of the support mount 210.

[0105] The support mount 210 may be attached to the bone either by itself or with one or more other components of the cutting guide system 201 attached to it. In one embodiment, the support mount 210 may be attached to the bone and then the assembly of other components shown in Figure 18 may be attached to the support mount 210. Alternatively, the support mount 210 may be assembled to the other components shown in Figure 18 before the support mount 210 is attached to the bone.

[0106] The cutting guide system 201 further includes a first adjustment guide 220 and a second adjustment guide 230. The first adjustment guide 220 is attached to the first rod 214 for rotation about the first rod axis 214A. The first adjustment guide 220 has an opening (recess or hole) that receives the first rod 214 for relative rotational movement, thereby allowing the first adjustment guide 220 to rotate about the first rod 214 and the first rod axis 214A. In an alternative configuration, the first rod may be part of or rigidly attached to the first adjustment guide 220, and the support mount 210 may have a corresponding opening (recess or hole) that receives the first rod. In this alternative configuration, the first rod rotates with the first adjustment guide 220 (i.e., the first rod rotates within the opening of the support mount 210). In either configuration, the first adjustment guide 220 is rotatably mounted relative to the support mount 210 about the first rod axis 214A.

[0107] A second rod 224 is part of or rigidly attached to the first adjustment guide 220 extending laterally therefrom. The axis 224A of the second rod is shown in FIG. 21. A second adjustment guide 230 is rotatably attached to the second rod about the second rod and second rod axis 224A. The second adjustment guide 230 has an opening (recess or hole) that receives the second rod for relative rotational movement, thereby allowing the second adjustment guide 230 to rotate about the second rod and second rod axis 224A. In an alternative configuration, the second rod may be part of or rigidly attached to the second adjustment guide 230, and the first adjustment guide 220 may have a corresponding opening (recess or hole) that receives the second rod. In this alternative configuration, the second rod rotates with the second adjustment guide 230 (i.e., the second rod rotates within an opening in the first adjustment guide 220). In either configuration, the second adjustment guide 230 is rotatably mounted relative to the first adjustment guide 220 about the second rod axis 224A.

[0108] The first rod and / or the second rod need not extend continuously through their associated parts. For example, the second rod may include two rod portions extending from either side of the first adjustment guide 220 or one rod portion extending from one side of the first adjustment guide 220. The first rod and the corresponding opening in which the first rod is rotatably received together form a first hinge, which allows the first adjustment guide 220 to rotate about the first axis 214A. The second rod and the corresponding opening in which the second rod is rotatably received together form a second hinge, which allows the second adjustment guide 230 to rotate about the second axis 224A. In this embodiment, the joint for positioning the cutting tool includes a first hinge and a second hinge. Thus, as examples of allowable directions of movement, the joint allows the cutting tool support to be rotated left and right about a first axis 214A and to be rotated toward or away from an object (e.g., bone) to be cut about a second axis 224A.

[0109] A locking mechanism 226 is associated with the first adjustment guide 220 to selectively allow or prevent rotation of the first adjustment guide 220 about the first rod axis 214A. In the illustrated embodiment, the locking mechanism 226 includes a set screw 228 that can be turned to securely engage the first rod, thereby locking the first adjustment guide 220 against rotation, or can be turned the other way to release the first rod, thereby allowing the first adjustment guide 220 to rotate about the first rod axis 214A. Similarly, a locking mechanism 236 is associated with the second adjustment guide 230 to allow or prevent rotation of the second adjustment guide 230 about the second rod axis 224A. In the illustrated embodiment, the locking mechanism 236 includes a set screw 238 that can be turned to securely engage the second rod, thereby locking the second adjustment guide 230 against rotation, or can be turned the other way to release the second rod, thereby allowing the second adjustment guide 230 to rotate about the second rod axis 224A. Other locking (fastening, clamping, or securing) mechanisms can be used for the locking mechanisms 226, 236.

[0110] As discussed above and shown in FIGURE 14B, a transducer 140 may be provided in association with the first adjustment guide 220 and the second adjustment guide 230. The transducer 140 is adapted to detect the amount of rotation of the adjustment guides 220, 230 about their respective axes of rotation 214A, 224A. The transducer 140 converts the rotational movement of the adjustment guides 220, 230 into an electrical signal such that a user can obtain an accurate measurement of the angular position of the adjustment guides 220, 230.

[0111] As described above, the converter 140 includes a stator 142 and a rotor 144. The stator 142 is adapted to remain rotationally fixed and the rotor 144 is adapted to rotate with the adjustment guide 220 or 230 as the adjustment guide 220 or 230 rotates about its respective rod axis 214A or 224A. The stator 142 may be coupled to a rod. The rotor 144 may be coupled to the adjustment guide 220 or 230 such that the rotor 144 rotates with the adjustment guide 120 or 130. Other components of the converter 140 and their operation are similar to those described above with respect to the cutting guide system 101.

[0112] One or more features, portions, or components may be associated with the first adjustment guide 220 and / or the second adjustment guide 230 to assist the user in adjusting the alignment. For example, a protrusion 231 may extend from the second adjustment guide 230 to receive an alignment rod 232. The alignment rod 232 may be coupled to the protrusion 231 (e.g., inserted into a hole in the protrusion 231 and held by a friction fit or otherwise) after the components of FIG. 18 are attached to the bone. FIG. 19 illustrates the assembly of FIG. 18 with the alignment rod 232 attached to the assembly. Similarly, the first adjustment guide 220 may have one or more holes to receive one or more alignment rods. An alignment rod (e.g., alignment rod 232 and / or other alignment rods coupled to first adjustment guide 220 and / or second adjustment guide 230) allows the user to better visualize the positioning condition, thereby assisting in aligning the cutting guide system 201.

[0113] One or more threaded adjustment screws 233 may pass through threaded holes in the second adjustment guide 230 to help position and / or maintain its position. The threaded adjustment screws 233 may be turned so that their distal ends contact the bone. After the distal ends of the threaded adjustment screws 233 are in contact with the bone, further turning of the threaded adjustment screws rotates the second adjustment guide 230 away from the bone, thereby allowing fine positioning adjustments.

[0114] Each of the threaded adjustment screws 233 may be cannulated, i.e., have a hollow bore, allowing a fastener (e.g., a pin, e.g., a trocar-tipped pin) 234 to pass through the adjustment screw 233. Once the user has positioned the cutting guide system 201 in the desired location, the fastener 234 may be advanced into the bone to hold the cutting guide system 201 in place, as shown in FIG.

[0115] The second adjustment guide 230 has one or more recesses 239 that correspond to receive arms 256 of the saw mount 250. The saw mount 250 has an adjustable base 255 with one or more arms 256 that mate with the recesses 239. The saw mount 250 may further include a stem 251 coupled to or integral with the adjustable base 255. In the illustrated embodiment, the stem 251 extends from the top of the adjustable base 255.

[0116] In the embodiment shown, the adjustable base 255 has two arms 256, one located on each side of the adjustable base 255. The second adjustment guide 230 has two recesses 239 that are sized and positioned to receive the arms 256. To connect the saw mount 250 to the assembly of FIG. 24, a user positions the arms 256 relative to the recesses 239 and slides the arms 256 into the recesses 239 as shown in FIGS. 25 and 26.

[0117] A user can adjust how deep the arms 256 extend into the recesses 239 to position the saw mount 250 at a desired height relative to the bone. Once the saw mount 250 is at the desired height, the user can secure the position of the saw mount 250 with a locking mechanism 260. In the illustrated embodiment, the locking mechanism 260 is a clamp. The clamp has a pin 262 for each arm 256. The pins 262 are integral with or connected to a bar 264. A knob 266 is connected to or abuts the bar 264. The knob 266 turns a first threaded element (not shown) that threadably engages a second threaded element (not shown) that is attached to or integral with the second adjustment guide 230. In one version, the knob 266 turns an externally threaded element that mates with an internally threaded element that is integral with or connected to the second adjustment guide 230. In an alternative version, the knob 266 turns an internally threaded element that mates with an externally threaded element that is integral with or connected to the second adjustment guide 230. Turning the knob 266 moves the bar 264 and the pin 262 forward or backward depending on the direction of rotation of the knob 266. When the arm 256 is located within the recess 239, turning the knob 266 can force the pin 262 against the arm 256, thereby locking the saw mount 250 in place. Turning the knob 266 in the other direction disengages the pin 262 from the arm 256, thereby allowing the position of the saw mount 250 to be adjusted or the saw mount 250 to be removed. Other locking (fastening, clamping, or fastening) mechanisms may be used in place of locking mechanism 260 .

[0118] The cutting guide system 201 further includes a lower saw clamp 252 and an upper saw clamp 254 for clamping opposite sides of the saw 4. In this embodiment, the saw mount 250 (either alone or in conjunction with the lower saw clamp 252 and the upper saw clamp 254) forms a cutting tool support for supporting the saw 4 or other cutting tool. The stem 251 may pass through a slot 4E in the cutting tool (e.g., the saw 4) such that the cutting tool can move longitudinally back and forth relative to the stem 251 as the cutting tool is pivotable relative to the stem 251. The saw clamps 252, 254 have a through hole that receives the stem 251 such that the stem 251 passes through both through holes of the saw clamps 252, 254. The positioning of the saw clamps 252, 254 along the longitudinal length of the stem 251 may be fixed or adjustable. For example, the saw clamps 252, 254 may be sized so that when the saw 4 is in position, they fit between the adjustment base 255 and an upper nut 257 provided on the stem 251, thereby preventing movement of the saw clamps 252, 254 along the longitudinal length of the stem.

[0119] The lower saw clamp 252 and the upper saw clamp 254, when assembled, are secured to opposite sides of the saw 4 with the stem 251 passing through a slot 4E in the saw bar 4A. In this embodiment, the saw 4 is a chainsaw assembly including a saw bar 4A, a chain, and a drive tooth assembly. The illustrated chainsaw assembly may be attached to and driven by a handpiece (not shown). Although a chainsaw is illustrated, other types of saws may be secured by the cutting guide system 210.

[0120] Saw clamp 252 and / or saw clamp 254 may have a ridge on the side thereof facing the saw that fits into slot 4E in the saw bar. The ridge or ridges help guide the longitudinal motion of the saw.

[0121] Fixation of the saw between the saw clamps 252, 254 prevents the saw from moving up and down along the stem 251, but the saw bar 4A can still move in a direction parallel to the length of the saw bar slot 4E by advancing it forward or retracting it. In the embodiment of Figures 26-28, to advance the saw bar 4A forward relative to the support mount 210, the saw bar 4A is moved rearward, and to retract the saw bar 4A, the saw bar 4A is moved forward.

[0122] In some embodiments, the saw clamps 252, 254 may be rotatable about the stem 251. In this configuration, the saw can rotate in a plane about the stem 251, the axis of which is the axis of rotation. This allows a user to move the saw not only forwards and backwards, but also rotationally in a plane about the axis of the stem 251.

[0123] When assembling the saw mount 250 into the assembly of FIG. 24, it may be advantageous for the saw mount 250 to initially support a stylus (not shown) that can be used to measure the desired cutting height, instead of the saw 4. For example, the stem 251 may carry the stylus between an adjustment base 255 and an upper nut 257 on the stem 251, which prevents movement of the stylus along the longitudinal length of the stem 251. The saw clamps 252, 254 may optionally be used to secure the stylus. The stylus may be used by a user to determine the desired height of the cut that may be used in positioning the saw. The arm 256 and the second adjustment guide 230 may have indicia to indicate the height measured by the stylus. The stylus may then be removed and replaced with the saw 4 and, optionally, the saw clamps 252, 254. For example, using the measurement height as indicated by the indicia, the user may position the saw mount 250 to the desired height for the cut.

[0124] 27 and 28 show the use of saw 4 to make the distal femoral cut DF. The position of saw 4 is defined by the positioning and locking of first adjusting guide 220, second adjusting guide 230 and saw mount 250 as described above.

[0125] After making the distal femoral cut DF, the saw mount 250 and saw 4 can be removed. Next, as shown in Fig. 29, a guide mount 270 can be coupled to the assembly of Fig. 24 for the purpose of positioning the cut mount block 280. The dimensions of the cut mount block 280 can be selected based on the size of the implant (e.g., SIZE #2 as indicated in the example drawing).

[0126] The guide mount 270 couples to the assembly of FIG. 24 in the same manner as the saw mount 250. In the embodiment shown, the guide mount 270 has a guide mount adjusting base 275 with two arms 276, one on each side of the guide mount adjusting base 275. The arms 276 are sized and positioned similarly to the arms 256 to be received by the recesses 239 of the second adjustable guide 230. To couple the guide mount 270 to the assembly of FIG. 24, the user positions the arms 276 relative to the recesses 239 and slides the arms 276 onto the recesses 239 as shown in FIGS. 29 and 30.

[0127] The user can adjust how deep the arm 276 extends into the recess 239, as well as the positioning of the saw mount 250, as described above. Once the guide mount 270 is at the desired height, the user can fix the position of the saw mount 250 with the locking mechanism 260. That is, the arm 276 can be locked by the locking mechanism 260 in the same manner as described above with respect to the arm 256.

[0128] Guide mount 270 further includes a body 272 coupled to or integral with guide mount adjustment base 275, a stem 271 extending from body 272, and an upper nut 277 threadedly engaged with stem 271. Guide mount 270 further includes an adjustment bar 278 having a slot 279 therein. When assembled, stem 271 passes through slot 279. Loosening nut 277 allows adjustment bar 278 to move back and forth, or in some embodiments, to rotate about stem 271. Tightening nut 277 can fix the position of adjustment bar 278.

[0129] The guide mount 270 carries a cutting mount block 280. In the illustrated embodiment, the cutting mount block 280 is releasably attached to the adjustment bar 278, for example, by fasteners threaded into threaded holes 282 in the cutting mount block 280. Optionally, an alignment rod 284 can be used to help align the cutting mount block 280. The alignment rod 284 may fit into holes 283 in the cutting mount block 280 by friction or other fit.

[0130] A user can adjust the positioning of the cutting mount block 280 to its desired position. The height of the cutting mount block 280 can be adjusted by the amount that the arms 276 extend into the recesses 239 and can be locked in place by the locking mechanism 260. In some embodiments, it is desirable to adjust the height so that the bottom flat surface of the cutting mount block 280 abuts and is flush with the flat surface of the distal femoral cut DF. To adjust the anterior-posterior (front-rear) position of the cutting mount block 280, the upper nut 277 can be loosened and the position of the adjustment bar 278 can be adjusted as shown in FIG. 31. The position of the adjustment bar 278 can be fixed by tightening the upper nut 277. To adjust the angular position of the cutting mount block 280, the cutting mount block can be rotated about its connection axis with the adjustment bar 278 as shown in FIGS. 32 and 33. If at any time the user wishes to use a different size cutting mount block 280, the user can use the desired substitution.

[0131] Once the cutting mount block 280 is in the desired position, it may be attached to the bone with one or more fasteners 285, for example, as shown in FIG 34. The guide mount 270 may then be removed from the cutting mount block 280, for example, by removing the fasteners (not shown) that engage with the threaded holes 282 in the cutting mount block 280. The assembly of FIG 24 may also be removed, leaving only the cutting mount block 280 (and any fasteners therefor) attached, as shown in FIG 35.

[0132] A first adaptor 290 is sized and shaped to couple to a cutting mount block 280 that positions a saw 4 to make the anterior femoral cuts AF and / or posterior femoral cuts PF as shown in Figures 36 and 37. The underside of the adaptor 290 can be shaped to fit over the cutting mount block 280. The adaptor 290 can be coupled to the cutting mount block 280 by fasteners through holes 291 in the adaptor 290 and holes 282 in the cutting mount block 280. Figure 38 shows the first adaptor 290 positioned over the cutting mount block 280.

[0133] Once the first adapter 290 is in place, the saw 4 can be attached to the first adapter. For example, FIG. 39 shows the saw 4 attached to a front surface 292 of the first adapter 290. The front surface 292 can be shaped, e.g., beveled, to position the saw 4 to make the anterior femoral cut AF. The front surface 292 can have a hole 294 that receives a stem to which the lower saw clamp 252 and the upper saw clamp 254 can be attached in a manner similar to that described above with the saw bar 4A disposed therebetween. In an alternative configuration, the stem is integral with the first adapter 290 and extends from the front surface 292 at the location of the hole 294. The saw bar 4A can be attached to the stem to allow it to be advanced forward, retracted, and rotated about the stem in the same manner as described above. Once the saw 4 is positioned on the anterior surface 292, it can be used to make the anterior femoral cut AF, as shown in FIGS.

[0134] FIG. 41 shows the saw 4 mounted on the rear surface 293 of the first adaptor 290. Like the front surface 292, the rear surface 293 may be shaped, e.g., angled, to position the saw 4 to make the rear femoral cut PF. The rear surface 293 may have a hole 294 to receive a stem to which the lower saw clamp 252 and the upper saw clamp 254 may be mounted in a manner similar to that described above with the saw bar 4A positioned therebetween. In an alternative configuration, the stem is integral with the first adaptor 290 and extends from the rear surface 293 at the location of the hole 294. The saw bar 4A may be attached to the stem to allow it to be advanced forward, retracted, and rotated about the stem in the same manner as described above. Once the saw 4 is positioned on the rear surface 293, it may be used to make the rear femoral cut PF as shown in FIGS. 41 and 42.

[0135] A second adapter 295 is sized and shaped to couple to the cutting mount block 280 which positions the saw 4 to make the anterior femoral cuts AC and / or posterior femoral cuts PC as shown in Figures 43-45. Like the first adapter 290, the underside of the second adapter 295 can be shaped to fit over the cutting mount block 280. The second adapter 295 can be coupled to the cutting mount block 280 by fasteners via holes 296 in the adapter 295 and holes 282 in the cutting mount block 280.

[0136] Once the second adapter 295 is in place, the saw 4 can be attached to the second adapter. For example, FIGS. 43 and 44 show the saw 4 attached to a front surface 297 of the second adapter 295. The front surface 297 can be shaped, e.g., angled, to position the saw 4 to make the anterior femoral cut AC. The front surface 297 can have a hole that receives a stem to which the lower saw clamp 252 and the upper saw clamp 254 can be attached in a manner similar to that described above with the saw bar 4A disposed therebetween. In an alternative configuration, the stem is integral with the second adapter 295 and extends from the front surface 297 at the location of the hole. The saw bar 4A can be attached to the stem to allow it to be advanced forward, retracted, and rotated about the stem in the same manner as described above. Once the saw 4 is positioned on the anterior surface 297, it can be used to make the anterior femoral cut AC as shown in FIGS.

[0137] FIG. 45 shows the saw 4 mounted on the rear surface 298 of the second adaptor 295. Like the front surface 297, the rear surface 298 may be shaped, e.g., angled, to position the saw 4 to make the rear femoral cut PC. The rear surface 298 may have a hole to receive a stem to which the lower saw clamp 252 and the upper saw clamp 254 may be mounted in a manner similar to that described above with the saw bar 4A positioned therebetween. In an alternative configuration, the stem is integral with the second adaptor 295 and extends from the rear surface 298 at the location of the hole. The saw bar 4A may be attached to the stem so that it can be advanced forward, retracted, and rotated about the stem in the same manner as described above. Once the saw 4 is positioned on the rear surface 298, it may be used to make the rear femoral cut PC as shown in FIG.

[0138] In an alternative embodiment, one or more of the mounting surfaces for the anterior femoral cuts AF, posterior femoral cuts PF, anterior chamfer cuts AC and / or posterior chamfer cuts PC may be part of the cutting mount block 280, and thus one or more of the separate adapters 290, 295 may not be required. For example, FIG. 31 shows one version of the cutting mount block 280 with surfaces for making one or more of these cuts.

[0139] One embodiment of using the cutting guide system 201 is as follows: First, the user secures the support mount 210 to the bone. The assembly of FIG. 18 can be attached to the support mount 210 or can be subsequently coupled to it. The user can then rotate the first adjustment guide 220 and / or the second adjustment guide 230 to the desired position. With attachment as shown in FIGS. 18-23, the first adjustment guide 220 can be adjusted for valgus / varus positioning and the second adjustment guide 230 can be adjusted for flexion / extension positioning. The user can visually assess the alignment relative to anatomical landmarks with or without additional alignment tools, such as alignment rods that can be attached to the first adjustment guide 220 and / or the second adjustment guide 230. Once first adjustment guide 220 and / or second adjustment guide 230 are in the desired position, the user can lock the position with locking mechanisms 226 and / or 236, for example, by tightening set screws 228 and / or 238. First adjustment guide 220 can be adjusted and then second adjustment guide 230 can be adjusted, and vice versa, and each can be readjusted after the other is adjusted.

[0140] The saw mount 250 may be attached to the assembly of Figures 18-24 as described above. As described above, a stylus may be used to measure the desired height adjustment for the amount of bone to be removed. For example, the stylus may be positioned at the location of the saw bar 4A. Saw clamps 252, 254 may be used with the stylus or may be removed for the stylus mechanism. Alternatively, a stylus mount may be used in place of the saw mount 250. The stylus allows the user the ability to determine the desired height for the saw. The stylus may then be removed and the saw mount 250 used to place the saw in place with its height adjusted to the desired height. The saw mount 250 may be locked into place using a locking mechanism 260.

[0141] In performing the various positioning steps, the user may be guided and / or coordinated with information from optical vision systems, pre-operative evaluations, x-rays, CAT scans, MRIs, etc. At any point, the user may release the locking mechanisms 226, 236, readjust the respective adjustment guides 220, 230, and then deploy the respective locking mechanisms 226, 236 to secure the adjustment guides 220, 230. Similarly, the user may readjust the height of the saw bar by releasing the locking mechanism 260, adjusting the height, and then re-locking the saw mount 250 with the locking mechanism 260.

[0142] The rotational position of the adjustment guides 220, 230 may be transmitted through the use of transducers 140 as described above. A user may use the position information to position and / or adjust and / or make additional cuts. Optionally, the cutting guide system 201 may include a worm gear or linkage arrangement to provide micrometer-like fine rotational adjustments to the adjustment guides 220, 230 for dialing in very specific degrees of rotation. As another option, the cutting guide system may be adjusted through the use of one or more motors, e.g., stepper motors, to move the adjustment guides 220 and / or 230.

[0143] The cutting guide system 201 separates the two primary degrees of freedom with independent adjustability of the first adjustment guide 220 and the second adjustment guide 230. A user can align the cutting guide system 201 in one plane or degree of freedom, lock it in place, and then adjust it in the other plane or other degree of freedom. Thus, for example, a user can separate varus / valgus adjustment from flexion / extension adjustment.

[0144] The cutting guide system 201 can be used to make a distal femoral cut DF as shown in FIGS. 27 and 28. After making the distal femoral cut DF, the saw mount 250 and saw 4 can be removed. The guide mount 270 can then be coupled to the assembly of FIG. 24 as shown in FIG. 29. The user can adjust the positioning of the cutting mount block 280 to a desired position. The user can adjust the height of the cutting mount block 280 by the amount that the arms 276 extend into the recesses 239 and are locked in place by the locking mechanism 260. The user can adjust the anterior-posterior (front-rear) position of the cutting mount block 280 by adjusting the position of the adjustment bar 278 as shown in FIG. 31. The user can adjust the angular position of the cutting mount block 280 by rotating the cutting mount block 280 about its axis of connection with the adjustment bar 278 as shown in FIGS. 32 and 33.

[0145] Once the cutting mount block 280 is in the desired position, the user can attach the cutting mount block 280 to the bone with one or more fasteners 285, as shown in FIG. 34, for example. The guide mount 270 can then be removed from the cutting mount block 280, for example, by removing the fasteners (not shown) that engage the threaded holes 282 in the cutting mount block 280. The assembly of FIG. 24 can also be removed, leaving only the cutting mount block 280 (and any fasteners therefor) attached, as shown in FIG. 35. The cutting mount block 280 can be used by the user to optionally make anterior femoral cuts AF, posterior femoral cuts PF, anterior chamfer cuts AC, and / or posterior chamfer cuts PC using one or more adapters 290, 295.

[0146] Some or all of the components of the cutting guide system described herein may be reusable or disposable. For example, the support mounts 110, 210 and adjustment guides 120, 130, 220, 230 may be made of surgical stainless steel or anodized aluminum and may be sterilized and reused. The transducer 140 may be made of plastic and may be inexpensive and disposable. Similarly, the sawbar clamps and sawbars may be disposable.

[0147] In use, certain embodiments of the cutting guide system described herein allow for simple fixation of the cutting guide system to the bone, easy positioning of the saw relative to the bone, and easy readjustment of that positioning, if necessary. Certain embodiments of the cutting guide system described herein facilitate good visualization by the user. Certain embodiments of the cutting guide system described herein may be designed to be usable with a set of different sized implants.

[0148] In any of the cutting guide systems described herein, after a cut is made, a user can evaluate the cut and make one or more additional cuts. For example, a user can measure the resected bone fragment and add saw cut kerfs to determine the cut volume. The user can then evaluate whether to make one or more additional cuts.

[0149] After making the desired cuts using one or more of the cutting guide systems described herein, the user can place a trial prosthesis for testing. For example, the user can place a trial femoral prosthesis and a trial tibial prosthesis and move the leg through a range of motion. The user, in this example, can move the patella back so that the joint is fully encased in the skin for a more complete evaluation. The user can evaluate, for example, the overall leg alignment, valgus / varus positioning, and amount of flexion / extension to avoid poor hyperextension for instability and too little flexion so that a good range of motion exists. If desired, the user can go back and make additional cuts based on the previous positioning of the cutting guide system.

[0150] Although some embodiments described herein have been described with respect to cutting bone, the cutting guide system disclosed herein can also be used in other fields, such as construction. For example, the cutting guide system can be configured and used to stabilize a cutting tool for cutting wood, drywall, plastic, and other materials. The support mount can be mountable in fixed relationship to the object to be cut by the cutting tool. For example, the cutting guide system can be used to guide a cut for an air register, a socket, a window, or other area where a cut is useful. The support mount can be mountable to the object to be cut or to an adjacent object (e.g., an adjacent beam, panel, support, or other object) in fixed relationship to the object to be cut. In one embodiment, the cutting guide system can be used to guide a cutting tool (e.g., a chainsaw, other saw, other knife, etc.) to make a break-in cut in a material (e.g., drywall, wood, etc.) and / or guide the cutting tool along a desired cutting path (e.g., an opening for an air duct, socket, light switch, window, etc.).

[0151] As mentioned above, the systems described herein can be used manually or with a robotic platform, where the cutting tool is manipulated by the robot. The cutting guide system may include, for example, a motor, a linear or rotary actuator, a stepper motor, etc., to move the cutting guide system and / or the cutting tool (e.g., to rotate joints, adjust the height of the cutting tool, advance / move the cutting tool, etc.). The motion may be programmed such that cuts (e.g., bone cuts, cuts for air ducts, sockets, light switches, openings for windows, etc.) along predetermined paths can be made in the object to be cut.

[0152] The cutting guide systems described herein may provide one or more advantages over prior art systems, including one or more of the following: lower cost, easier to use, more accurate alignment, more accurate cuts, shorter cutting times, shorter procedure times, shorter recovery times, and / or better outcomes.

[0153] As will be appreciated by those skilled in the art, the embodiments encompassed by the present invention are not limited to the specific exemplary embodiments described above. Although exemplary embodiments have been shown and described, the present invention contemplates a wide range of modifications, changes, and substitutions. As will be appreciated, such variations on the above are possible without departing from the scope of the present invention.

Claims

1. 1. A cutting guide system for stabilizing a cutting tool, the cutting guide system comprising: a support mount mountable in fixed relationship to an object to be cut by said cutting tool; Joints and a cutting tool support; the joint allows the cutting tool support to be adjusted relative to the support mount; the cutting guide system is configured to adjust the cutting tool to a plurality of positions along a longitudinal axis of the cutting tool support; the cutting guide system is configured to be able to lock the cutting tool at a selected position along the longitudinal axis of the cutting tool support, such that when the cutting tool is locked at the selected position along the longitudinal axis of the cutting tool support, the cutting tool is prevented from moving in the longitudinal axis of the cutting tool support; The cutting guide system is configured such that, when the cutting tool is locked in the selected position along the longitudinal axis of the cutting tool support, the cutting tool is movable in a linear direction in a plane perpendicular to the longitudinal axis of the cutting tool support and is movable in a rotational movement in a plane perpendicular to the longitudinal axis of the cutting tool support. A cutting guide system is configured as follows.

2. The cutting guide system of claim 1 , wherein the joint is configured to allow the cutting tool support to rotate about at least two axes.

3. The cutting guide system of claim 1 , wherein the joint is of the ball and socket type.

4. 2. The cutting guide system of claim 1, wherein the joint includes a first hinge with a first rod and a first opening, the first rod positioned within the first opening to permit relative rotational movement between the first rod and the first opening, whereby the first adjustment guide can rotate about a first axis relative to the support mount.

5. The cutting guide system of claim 4 , further comprising a first transducer adapted to detect an amount of rotation of said first adjustment guide about said first axis.

6. 5. The cutting guide system of claim 4, wherein the joint further comprises a second hinge having a second rod and a second opening, the second rod positioned within the second opening to permit relative rotational movement between the second rod and the second opening, thereby allowing the first adjustment guide to rotate about a second axis relative to the support mount.

7. The cutting guide system of claim 1 , wherein the cutting tool support comprises a stem.

8. The cutting guide system of claim 7 , wherein the cutting tool support further comprises a first saw clamp and a second saw clamp.

9. The cutting guide system of claim 7 , wherein the position of the cutting tool along the longitudinal axis of the stem is adjustable.

10. 2. The cutting guide system of claim 1, wherein the stem is adapted to pass through a slot in the cutting tool, the cutting tool is rotatable relative to the stem, and the cutting tool is movable longitudinally back and forth relative to the stem.

11. The cutting guide system of claim 1 , wherein the cutting tool comprises a chain saw.

12. The cutting guide system of claim 1, further comprising an adapter for positioning the cutting tool for a plurality of different planar cuts, the adapter including a plurality of fixed positions for the cutting tool, each of the plurality of fixed positions configured to align the cutting tool for a respective different planar cut.

13. The cutting guide system of claim 1, including a cutting mount block adapted to be fastened to an object to be cut by the cutting tool to position the adapter on the object to be cut by the cutting tool.

14. 1. A cutting guide system for stabilizing a cutting tool, the cutting guide system comprising: A trajectory that determines a route; a cutting tool support; The cutting tool support is coupled to the track in a manner that stabilizes the cutting tool support relative to the track while allowing the cutting tool support to move in the direction of the path of the track.

15. 1. A method for stabilizing a cutting tool, the method comprising: mounting a support mount of a cutting guide system in fixed relation to an object to be cut by the cutting tool, the cutting guide system further comprising a joint and a cutting tool support; adjusting a position of the cutting tool support relative to the support mount by moving the cutting guide system at the joint.

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