Bone anchor and articular system

Abstract

To provide a humeral head assembly that includes an articular body 1404 and a coupler 1424.SOLUTION: An articular body includes a coupling portion disposed on a side of the articular body opposite an articular surface 1408. The coupling portion includes a continuous zone of eccentricity adjustment. A coupler portion optionally includes one or more discrete positioning sites. The coupler includes a first portion 1428 and a second portion 1436 opposite the first portion. The first portion is configured to mate with the coupling portion and the second portion is configured to mate with another member of a joint prosthesis. A coupling portion with the continuous range of eccentricity adjustment can be provided on a bone anchor and the eccentricity of another component can be selected by motion of a coupler, such as a tray for reverse humeral assemblies, along the coupling portion of the anchor.SELECTED DRAWING: Figure 18A

Description

[Technical field]

[0001] (CROSS REFERENCE TO RELATED APPLICATIONS) This application claims priority to U.S. Provisional Application No. 62 / 740,342, filed October 2, 2018, the entire contents of which are incorporated herein by reference.

[0002] The present invention relates to humeral head assemblies and components thereof as well as methods for assembling and implanting the same. [Background technology]

[0003] Skeletal joints have a variety of configurations that provide a wide range of smooth movement of two or more bones relative to one another. For example, in the shoulder joint, the articular surface at one end of the humerus interacts with the articular surface at the glenoid cavity of the scapula in a manner similar to a "ball and socket" joint. Joint conditions can develop that induce pain and limit shoulder joint movement. Implanting artificial components in one or both articular surfaces of the joint can improve such conditions.

[0004] A typical anatomical shoulder replacement attempts to mimic the natural joint anatomy. For example, a humeral anchor (e.g., stemmed or stemless anchor) may be attached to the humerus and a convex humeral head may be assembled to the anchor. Together, these structures replace the humeral articular surface of the shoulder joint. The humeral head may articulate with a glenoid resurfacing device configured to replace the natural glenoid socket or articular surface of the glenoid. In either case, the relative position of the humerus to the scapula depends on non-skeletal factors, such as the condition and position of the soft tissues that connect to the bones and fix the bones in position relative to one another during rest and movement.

[0005] The position of the humeral head relative to the humerus is important to the safety of the humeral head assembly and the kinematics of the joint after surgery. Summary of the Invention [Problem to be solved by the invention]

[0006] There is a need for greater flexibility in component selection and arrangement to provide desired post-operative humerus and scapular positions. There is also a need for increased control over the tension in the connective tissue after surgery. Additionally, there is a need for a humerus anchor that allows the surgeon to secure both anatomical and reverse shoulder joint components to the humerus while maintaining control over the tension in the connective tissue. There is also a need for improved flexibility in the placement of the humeral head relative to the humeral anchor for the shoulder joint. There is a need for a humeral head assembly that allows the articular surface of the humeral head to be centered or eccentric from the axis to which the humeral head and humeral anchor are attached. There is a need for a humeral head assembly that provides a variety of eccentricities relative to the assembly axis so that the needs of various patients can be met by the assembly. [Means for solving the problem]

[0007] In one embodiment, a humeral head system is provided that includes an articular body, a coupler, and at least one discrete positioning site. The articular body has a convex articular surface and a joint. The joint is disposed on a side of the articular body opposite the convex articular surface. The coupler has a first portion configured to mate with the joint and a second portion opposite the first portion. The second portion is configured to mate with another member of the joint prosthesis. At least one discrete positioning site is disposed between the coupler and the convex articular surface. The discrete positioning site provides a fixed rotational position between the articular body and the coupler.

[0008] In some embodiments, the interface of the articulating body can include a continuous area of ​​eccentric adjustment. In some embodiments, the continuous area of ​​eccentric adjustment includes at least one discrete positioning site. The coupler can include a first portion configured to mate with the interface of the articulating body.

[0009] In some embodiments, the first portion of the coupler includes a tapered protrusion that couples with the articulating body with an interference fit. The second portion of the coupler can be tapered. In some examples, the first portion of the coupler is disposed in a first configuration relative to the coupling, a rotational position of the coupler relative to the articulating body is adjusted along successive sections to select different amounts of eccentricity along the successive sections, and the coupler can be secured to the articulating body at the coupling in a second configuration. In other embodiments, the coupling includes multiple successive sections of eccentricity adjustment.

[0010] The coupler can also include a collar disposed between the first and second portions, the collar including a protrusion configured to be positionable along at least the continuous section of eccentric adjustment. In some examples, the coupling portion includes a radial notch configured to receive the protrusion. When the protrusion is received in the notch, relative rotation of the coupler with respect to the articulating body is prevented. The location of the protrusion and notch can be reversed such that the coupling portion includes one or more protrusions at discrete positioning locations and the collar includes a notch configured to receive the protrusion. In some embodiments, the radial notch is disposed circumferentially adjacent the continuous section of eccentric adjustment. In other specific embodiments, the radial notch is disposed in a location where when the protrusion is disposed in the notch, no eccentricity is provided between the coupler and the articulating body.

[0011] The coupling may, in some embodiments, include a single radial notch, and the eccentricity may be provided by selecting a coupler that produces a selected amount of eccentricity.

[0012] In some examples, the continuous zone of eccentric adjustment and the at least one discrete positioning site are coplanar. In some embodiments, the plurality of discrete eccentric locations are disposed on lateral sides of the articular body opposite the convex articular surface, the plurality extending along opposing angular ranges of the continuous zone of eccentric adjustment. The continuous range can provide at least 90 degrees of eccentricity. In other embodiments, the continuous range provides between about 90 degrees and about 180 degrees of eccentricity. In some embodiments, the plurality of discrete eccentric locations include at least three discrete locations corresponding to eccentric locations in a first direction. In some examples, the at least three discrete locations corresponding to eccentric locations are disposed between a location corresponding to a position of no eccentricity and a location corresponding to a position of maximum eccentricity. In some embodiments, the location of no eccentricity is rotationally offset 180 degrees from the location of maximum eccentricity.

[0013] In some embodiments, the coupling includes discrete eccentric positions where a first portion of the coupler can be positioned in a first configuration relative to the coupling and a rotational position of the coupler relative to the articulating body is fixed. In some examples, the coupling includes a plurality of continuous zones of eccentric adjustment, one of the plurality of zones located on each side of the discrete eccentric positions. In some embodiments, the coupling includes a plurality of discrete eccentric positions, the continuous zones of eccentric adjustment being between the discrete eccentric positions. In some embodiments, the coupling includes a plurality of discrete eccentric positions and a plurality of continuous zones of eccentric adjustment, the discrete eccentric positions alternating with the continuous zones of eccentric adjustment.

[0014] The humeral head assemblies described herein can include indicia indicating the amount of eccentricity. The amount of eccentricity can be displayed at predetermined spaced locations of the contiguous zone. The indicia can be located on a side of the articular body opposite the convex articular surface. In some embodiments, the indicia includes a plurality of marks on a side of the articular body opposite the convex articular surface. The amount of eccentricity provided by a particular rotational position of the coupler relative to the articular body can be determined by determining whether the protrusion is The amount of eccentricity can be indicated on a lateral surface of the articular body opposite the articular surface. For example, multiple indicia can be provided on a lateral surface of the articular body opposite the articular surface. To provide the proper eccentricity, the coupler can be configured to engage the articular body such that the indicia on the coupler aligns with one of the multiple indicia.

[0015] In another embodiment, a humeral head assembly is provided that can include an articular body and a coupler. The articular body can include a convex articular surface and an interface. The interface can be disposed on a side of the articular body opposite the convex articular surface. The interface can include a recess extending from an opposite side of the convex articular surface toward the convex articular surface. The recess can have a periphery with at least one radial notch disposed along the recess. The coupler can include a first portion and a second portion. The first portion can be configured to mate with the interface. The coupler can include a radial protrusion disposed thereon. The second portion is opposite the first portion and can be configured to mate with another member of the joint prosthesis. The first portion of the coupler can be disposed relative to the interface such that the radial protrusion is received in the radial notch.

[0016] In yet another embodiment, a humeral head assembly is provided that can include an articular body, a bone anchor, an interface, and a coupler. The articular body can include an articular surface and an interface. The interface can be located on a side of the articular body opposite the articular surface. The bone anchor includes a proximal surface and a distal end configured to be plugged into a bone. In one embodiment, the interface includes at least one discrete positioning site located between the convex articular surface and the distal end of the bone anchor. The interface can selectively include a continuous area of ​​eccentric adjustment between the convex articular surface and the distal end of the bone anchor. The coupler includes a first portion configured to mate with the interface and a second portion opposite the first portion. The second portion is configured to couple the articular body with the bone anchor.

[0017] In another embodiment, the bone anchor includes a stem portion configured to be positioned in the intramedullary canal. In another embodiment, the bone anchor includes a stemless anchor configured with a distal portion to reside in the metaphysis or centrally in the metaphysis. The coupling portion of the bone anchor can be positioned on a medial surface of the bone anchor. In another embodiment, the bone anchor optionally includes a continuous zone of eccentric adjustment including an arcuate segment of a circular recess that provides for rotation of the radial projection of the coupler therein. The bone anchor can include at least one discrete positioning site including a radial notch aligned with the continuous zone of eccentric adjustment.

[0018] In embodiments where the coupling portion is disposed on the bone anchor, multiple couplers can be provided in the kit, and the couplers can be configured to provide different amounts of eccentric adjustment when a radial protrusion on the second portion aligns with a radial notch on the coupling portion.

[0019] In some embodiments, the glenoid components of the shoulder prosthesis can be assembled by engaging a first end of a coupler with an interface of the glenoid body. Assembly of the shoulder prosthesis can include providing relative rotation of the glenoid body about the first end of the coupler. The rotation, if provided, can be along a continuous range of rotational positions while the first end engages the interface. The relative rotation can be provided such that the coupler aligns with a radial notch or other discrete positioning feature. Assembly of the glenoid components can include selecting an amount of eccentricity that corresponds to a position within the continuous range of rotational positions. Assembly of the glenoid components can include selecting an amount of eccentricity that corresponds to one or more notches or other discrete positioning features. Assembly of the glenoid components can include selecting a coupler configured to provide an amount of eccentricity when mated with either a radial notch or a plurality of radial notches. Assembly of the glenoid components can include selecting a coupler configured to provide an amount of eccentricity when mated with the radial notch or any of a plurality of radial notches. Assembly of the glenoid components can include selecting a coupler configured to provide an amount of eccentricity when mated with the selected coupler. When combined with, the method may include securing the articulating body about the first end of the coupler at a selected amount of eccentricity along a continuous section or with discrete positioning features.

[0020] Also, assembly of the joint components can include positioning a protrusion of the coupler along the continuous section, where the protrusion is disposed between the first end and the second end of the coupler, hi some embodiments, assembly of the joint components includes preventing relative rotation of the coupler with respect to the articular body by engaging the protrusion with a radial notch of the joint.

[0021] In some examples, assembling the articular component includes aligning an eccentricity indicator located on or adjacent to the joint of the articular body with an alignment feature of the coupler, and assembling the articular component can include aligning one of a plurality of eccentricity indicia located on the articular body with a radial protrusion of the coupler.

[0022] In some embodiments, multiple couplers are provided to facilitate discretizing the eccentricity position or amount of eccentricity, in other embodiments, the coupling includes multiple discrete positioning features, each providing a different amount of eccentricity for a selected coupler, and includes selecting between the discrete positioning feature corresponding to the lesser eccentricity and the discrete positioning feature corresponding to the greater eccentricity when providing relative rotation to align the coupler and the discrete positioning feature.

[0023] In another embodiment, a joint component is provided that includes an articular body, a bone anchor, and an interface. The articular body includes an articular surface, e.g., a convex or concave articular surface. The bone anchor has a proximal surface and a distal end configured to be plugged into bone. The interface selectively has a continuous area of ​​eccentric adjustment. The interface can have one or more discrete positioning sites disposed between the articular surface and the distal end of the bone anchor. The coupler can have a first portion configured to mate with the interface and a second portion opposite the first portion. The second portion is configured to directly or indirectly couple the articular body with the bone anchor. In some embodiments, the coupler is one of a plurality of couplers with each coupler providing a different degree of eccentric adjustment when coupled with a discrete positioning site, e.g., a radial notch.

[0024] In one variation, a method of assembling articular components of a shoulder prosthesis is provided. A first end of a coupler is engaged with a coupling portion. The coupling portion may be at an articular body or an intermediate coupler to which the articular body is connected. Relative rotation may be provided between the articular body and the coupler about the first end of the coupler. The rotation, if provided, may be along a continuous range of rotational positions while the first end is engaged with the coupling portion. The rotation may align the coupler with a discrete positioning feature, such as a radial notch. The coupler may be selected from a plurality of couplers configured to provide different amounts of eccentric adjustment when a protrusion of the coupler couples with the discrete positioning feature. The amount of eccentricity, if provided, corresponding to a position within the continuous range of rotational positions, may be selected. The articular body is secured about the first end of the coupler with the eccentricity provided by positioning along the continuous range or by coupling a selected coupler with the discrete positioning feature.

[0025] In another embodiment, a method of assembling glenoid components of a shoulder prosthesis is provided, in which an end of a coupler of a glenoid implant engages a mating portion of another component of the glenoid implant. The end engages a mating portion of the other component of the glenoid implant while providing relative rotation along a continuous range of rotational positions between the end of the coupler and the mating portion of the other component of the glenoid implant. An amount of eccentricity corresponding to a position within the continuous range of rotational positions is selected. The other component of the glenoid implant couples the end of the coupler at the selected amount of eccentricity. In one variation, the coupling has one or more discrete positioning sites, e.g., notches, and the amount of eccentricity is provided by selecting a coupler configured to provide the desired amount of eccentricity.

[0026] In some embodiments, the components of the second portion can extend from a first perimeter to a second perimeter. The first perimeter is smaller than the second perimeter. The perimeter can include, for example, a surface or surfaces disposed circumscribing a longitudinal axis of the coupler. The coupler can include a window that provides for viewing of offset indicia formed on or opposite the coupling portion.

[0027] In one embodiment, a joint component is provided that includes an articular body, a bone anchor, a coupling portion, and a coupler. The articular body has an articular surface. The bone anchor includes a proximal surface and a distal end configured to be plugged into a bone. The coupling portion includes a radial notch disposed between the articular surface and the distal end of the bone anchor. The coupler includes a first portion configured to mate with the coupling portion. The coupler also includes a second portion opposite the first portion configured to couple the articular body and the bone anchor directly or indirectly.

[0028] In one embodiment, a humeral head system is provided that includes an articular body and a coupler. The articular body has a convex articular surface and a coupling portion, the coupling portion being disposed on a side of the articular body opposite the convex articular surface. The coupler has a first portion configured to mate with the coupling portion and a second portion opposite the first portion. The second portion is configured to mate with another member of the joint prosthesis. The coupler is configured to provide a fixed rotational position between the articular body and the coupler to provide a selected degree of offset of the articular surface to the other member of the joint prosthesis.

[0029] In some embodiments, the coupler has an offset window disposed between the first and second portions of the coupler. In some embodiments, the coupler has a plate extending transversely relative to the second portion. The offset window has a slot formed in the plate configured to expose indicia indicative of a degree of eccentricity of the articular body relative to another member of the articular prosthesis. In some embodiments, the humeral anchor includes the other component of the articular prosthesis. The humeral anchor has eccentric indicia, the slot exposing different indicia at different rotational positions of the coupler relative to the humeral anchor. The rotational positions are changed by rotation about a longitudinal axis extending through the second portion of the coupler.

[0030] In some embodiments, the coupler has a threaded channel extending from a first end face of the coupler to a second end face of the coupler. The channel provides access to a surface of either or both of the articular body and other members of the joint prosthesis. In some embodiments, the threaded channel is formed through the first and second portions of the coupler.

[0031] In some embodiments, the coupler has a prying ledge including an inclined surface disposed between the first and second portions. The prying ledge is responsive to an applied radial load to transmit a longitudinal force along a longitudinal axis of the first or second portions of the coupler. In some embodiments, the prying ledge extends radially between the disk member of the coupler and a periphery of the coupler. The prying ledge is accessible from the periphery of the humeral head system when the humeral head system is fully assembled.

[0032] In one variation, a method of disassembling a humeral prosthesis is provided, where a periphery of the humeral prosthesis is accessible exposed in a gap between an articular body and a humeral anchor, and a prying tool can be advanced into the gap, and further advancement of the prying tool against a prying ledge formed on a coupler disposed between the articular body and the humeral anchor breaks the prying ledge. A radial load against the prying ledge can be applied to the end of the prying tool. The prying ledge can be angled relative to the direction of application of the radial load. The radial load can result in an axial load that separates the articular body from the humeral anchor.

[0033] In another embodiment, a method of disassembling a humeral prosthesis is provided. In the method, an elongated shaft can be advanced through a channel formed in a coupler, the channel extending between a first end of the coupler engaged with the articular body and a second end of the coupler opposite the first end. The elongated shaft can engage the coupler, the end engaging a surface of the articular body. An opposing load can be provided to the coupler and the articular body by the elongated shaft to separate the articular body from the coupler. In one variation, engaging the elongated shaft with the coupler includes engaging an external thread of the elongated shaft with an internal thread of the coupler.

[0034] In another embodiment, a method of disassembling a humeral prosthesis is provided. In the method, an elongated shaft can be advanced through a channel formed in a coupler. The channel can extend between a first end of the coupler and a second end of the coupler opposite the first end. The second end of the coupler can engage with a humeral anchor. The elongated shaft can engage with the coupler, the end of which can engage a surface of the humeral anchor. A counterload can be provided to the coupler and the humeral anchor by the elongated shaft to separate the coupler from the humeral anchor.

[0035] Any feature, structure, or step disclosed herein may be substituted, combined, or omitted with any other feature, structure, or step disclosed herein. In addition, certain aspects, advantages, and features of the invention are disclosed herein for purposes of summarizing the disclosure. It is to be understood that not necessarily all or any such advantages will be achieved in accordance with any particular embodiment of the invention disclosed herein. No aspect of the invention is essential or required.

[0036] These and other features, aspects and advantages are described below with reference to the drawings, which are for illustrative purposes and should not be construed as limiting the scope of the embodiments in any way. Also, various features of different disclosed embodiments can be combined to form additional embodiments that are part of this disclosure. In the drawings, like reference characters indicate corresponding features consistently throughout similar embodiments. Below is a brief description of each of the drawings. [Brief description of the drawings]

[0037] [Figure 1A] 1 is a side view of an anchor in an anatomical configuration and combined with an articular body to form a humeral head assembly, the anchor configured to receive the articular body below the humeral resection surface. [Figure 1B] FIG. 1B is a perspective view of the inner surface of the anchor of FIG. [Figure 1C]FIG. 1 is a perspective view of an embodiment of a reverse shoulder joint; [Figure 1D] FIG. 13 is a perspective view of another embodiment of a reverse shoulder joint. [Figure 1E] FIG. 2 is a side view of a humerus with an implanted humeral head assembly. [Figure 1F] 1 shows a humeral head with a central coupler and a suitable implantation site for the central coupler. [Figure 1G] 1 shows a humeral head having an eccentric coupler and an implantation site that would benefit from coupling with the eccentric coupler humeral head. [Diagram 2] 1 illustrates one embodiment of a humeral head assembly showing a first configuration with zero eccentricity of a portion of a coupler adapted to align a humeral anchor with the articular surface of an articular body. [Diagram 3] FIG. 3 is an exploded bottom view of the humeral head assembly of FIG. 2. [Figure 4] FIG. 3 is a lateral view of the humeral head assembly of FIG. 2. [Figure 4A] FIG. 4B shows a detail of FIG. 4A in FIG. 4 showing the radial overlap of the protrusions of the coupler with the periphery of the articular body. [Diagram 5] This is a cross section taken through the plane 5-5 shown in FIG. [Figure 5A] FIG. 13 is a detailed view of the recess in the joint of the articular body. [Figure 6] 3 includes an embodiment of the humeral head assembly of FIG. 2 showing a second configuration in which the portion of the coupler adapted to align the humeral anchor with the articular surface of the articular body has a non-zero eccentricity. [Figure 7] FIG. 3 is a side view of an articular body that can be used in the humeral head assembly of FIG. 2. [Figure 8A] FIG. 3 is a bottom view of the articular body of the humeral head assembly of FIG. 2. [Figure 8B] 8B is a cross-sectional view of the articular body of the humeral head assembly of FIG. 2 taken through the plane 8B-8B shown in FIG. 8A. [Figure 9] FIG. 3 is a side view of the coupler of the humeral head assembly of FIG. 2. [Figure 10] FIG. 10 is a center side view of the coupler of FIG. [Figure 11] FIG. 10 is an exterior side view of the coupler of FIG. [Figure 12] FIG. 13 is a lateral side view of a further embodiment of an articular body suitable for another embodiment of the humeral head assembly. [Figure 12A] FIG. 13 is a lateral side view of a further embodiment of an articular body suitable for another embodiment of the humeral head assembly. [Figure 13A] 1 illustrates one embodiment of a bond on the surface of a stem. [Figure 13B] 1 illustrates one embodiment of a bond on the surface of a stem. [Figure 13C] 1 illustrates one embodiment of a bond on the surface of a stem. [Figure 14A] 1 illustrates a humeral implant assembly and its components suitable for adjusting the offset of a reverse articulating body humeral assembly. [Figure 14B] 1 illustrates a humeral implant assembly and its components suitable for adjusting the offset of a reverse articulating body humeral assembly. [Figure 14C] 1 illustrates a humeral implant assembly and its components suitable for adjusting the offset of a reverse articulating body humeral assembly. [Figure 15] FIG. 1 is a schematic diagram of an anatomical humerus assembly placed on a resected humerus. [Figure 16] 1 illustrates a kit including a humeral head and a number of couplers configured to provide various offsets when aligned with the humeral head. [Figure 16A] 1 illustrates a kit including a humeral head and a number of couplers configured to provide various offsets when aligned with the humeral head. [Figure 17A] 16A-16C show various humeral head assemblies in the kit. [Figure 17B] 16A-16C show various humeral head assemblies in the kit. [Figure 17C] 16A-16C show various humeral head assemblies in the kit. [Figure 18]1A and 2, the humeral head assembly includes a coupler having a window to confirm a selected orientation or degree of offset. [Figure 18A] FIG. 19 is an exploded view of the components of the humeral head assembly of FIG. 18. [Figure 18B] FIG. 19 is a cross-sectional view of the humeral head assembly of FIG. 18 . [Figure 18C] A humeral head assembly kit similar to the kit of FIG. 16A. [Figure 19] 19 illustrates an example of a coupler that can be used with the humeral head assembly of FIG. 18, said coupler providing an offset between the longitudinal axes of both ends of the coupler. [Figure 19A] 19 illustrates an example of a coupler that can be used with the humeral head assembly of FIG. 18, said coupler providing an offset between the longitudinal axes of both ends of the coupler. [Figure 19B] 19 illustrates an example of a coupler that can be used with the humeral head assembly of FIG. 18, said coupler providing an offset between the longitudinal axes of both ends of the coupler. [Figure 19C] 19 illustrates an example of a coupler that can be used with the humeral head assembly of FIG. 18, said coupler providing an offset between the longitudinal axes of both ends of the coupler. [Figure 19D] 19 illustrates an example of a coupler that can be used with the humeral head assembly of FIG. 18, said coupler providing an offset between the longitudinal axes of both ends of the coupler. [Figure 19E] 19 illustrates an example of a coupler that can be used with the humeral head assembly of FIG. 18, said coupler providing an offset between the longitudinal axes of both ends of the coupler. [Figure 20] 19 illustrates yet another example of a coupler that can be used with the humeral head assembly of FIG. 18, said coupler providing longitudinal axes for both ends of the coupler that are aligned. [Figure 20A] 19 illustrates yet another example of a coupler that can be used with the humeral head assembly of FIG. 18, said coupler providing longitudinal axes for both ends of the coupler that are aligned. [Figure 21A]FIG. 13 is a perspective view of the cam disc assembly engaged with the anchor. [Figure 21B] FIG. 13 is a perspective view of the cam screw assembly engaged with the anchor. [Figure 22A] FIG. 22 is a top view of the cam disc assembly engaged with the anchor of FIG. 21. [Figure 22B] FIG. 59 is a top view of the cam screw assembly engaged with the anchor of FIG. 58. [Figure 23] FIG. 22 is an exploded view of the cam disc assembly with the anchor of FIG. 21. [Figure 24] 24 is a cross section taken through the plane 24-24 shown in FIG. [Diagram 25] 22 shows top and bottom views of the coupler of the cam disc assembly shown in FIG. 21. [Figure 26] 22 shows top and bottom views of the coupler of the cam disc assembly shown in FIG. 21. [Figure 27] 22A and 22B are perspective and plan views of the fixing portion of the cam assembly of the cam disc assembly shown in FIG. 21. [Figure 28] 22A and 22B are perspective and plan views of the fixing portion of the cam assembly of the cam disc assembly shown in FIG. 21. [Figure 29] 27-28 to form a cam assembly for the cam disc assembly shown in FIG. 21. FIG. [Diagram 30] 27-28 to form a cam assembly for the cam disc assembly shown in FIG. 21. FIG. [Diagram 31] 27-28 to form a cam assembly for the cam disc assembly shown in FIG. 21. FIG. [Diagram 32] FIG. 1 is a perspective view of a taper cam and slot assembly. [Diagram 33] FIG. 33 is an exploded view of the taper cam and slot assembly of FIG. [Diagram 34] 33 shows top and bottom views of the tapered cam and slot assembly of FIG. 32. [Diagram 35] 33 shows top and bottom views of the tapered cam and slot assembly of FIG. 32. [Diagram 36] 36 is a cross section taken through the plane 36-36 shown in FIG. [Figure 37] 33 shows top and bottom views of the coupler of the taper cam and slot assembly of FIG. [Figure 38] 33 shows top and bottom views of the coupler of the taper cam and slot assembly of FIG. [Figure 39] 33A and 33B show perspective, top, and side views of the actuator of the cam assembly of the taper cam and slot assembly of FIG. [Diagram 40] 33A and 33B show perspective, top, and side views of the actuator of the cam assembly of the taper cam and slot assembly of FIG. [Diagram 41] 33A and 33B show perspective, top, and side views of the actuator of the cam assembly of the taper cam and slot assembly of FIG. [Diagram 42] 42A and 42B show perspective and side views of a fixture configured to engage with the actuator of FIGS. 39-41 to form a cam assembly of the tapered cam and slot assembly of FIG. 32. [Diagram 43] 42A and 42B show perspective and side views of a fixture configured to engage with the actuator of FIGS. 39-41 to form a cam assembly of the tapered cam and slot assembly of FIG. 32. [Diagram 44] FIG. 2 is a perspective view of a collet lock assembly. [Diagram 45] FIG. 45 is an exploded perspective view of the collet lock assembly of FIG. 44. [Diagram 46] FIG. 45 is a top view of the collet lock assembly of FIG. [Figure 47] FIG. 45 is a bottom view of the collet lock assembly of FIG. [Figure 48] FIG. 13 is a top view of the coupler of the collet lock assembly. [Figure 49] This is a cross section taken through the plane 49-49 shown in FIG. [Figure 50] 49 shows a perspective view of the coupler of FIG. 48 engaging with a humeral head assembly. [Figure 51] 13 illustrates a portion of a method for implanting a humeral anchor with a reamer advanced into the surface of the resected humerus. [Figure 52A] 52 shows a portion of the method after reaming as illustrated in FIG. 51, where one embodiment of an anchor is inserted into the surface of the resected humerus. [Figure 52B] 52 shows a portion of the method after reaming as illustrated in FIG. 51, where another embodiment of the anchor is inserted into the surface of the resected humerus. [Figure 53] 1 shows an exploded view of the components of the humeral head assembly impacting into anchors inserted into the surface of the resected humerus. [Figure 54] 19 shows a perspective view of a prying tool for separating components of a humeral head assembly, such as the components of the humeral head assembly of FIG. 18 . [Figure 55A] A method of using the pry tool of FIG. 54 to separate the components of the humeral head assembly of FIG. 18 is presented. [Figure 55B] A method of using the pry tool of FIG. 54 to separate the components of the humeral head assembly of FIG. 18 is presented. [Figure 56] 19 shows a perspective view of a coupler separator for separating components of a humeral head assembly, such as the components of the humeral head assembly of FIG. 18 . [Figure 57A] 57 illustrates a method of using the coupler separator of FIG. 56 to separate components of the humeral head assembly of FIG. 18. [Figure 57B] 57 illustrates a method of using the coupler separator of FIG. 56 to separate components of the humeral head assembly of FIG. 18. [Figure 57C] 57 illustrates a method of using the coupler separator of FIG. 56 to separate components of the humeral head assembly of FIG. 18. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0038] This application relates to orthopaedic assemblies that can be applied to long bones in arthroplasty. Section I describes such assemblies in the context of shoulder arthroplasty. The orthopaedic assembly can include a humeral system that can secure an anatomical glenoid body above the humeral resection and a portion of a reverse glenoid body below the humeral resection. This facilitates revision surgery and improves soft tissue accommodation, as described below. Section II describes certain components, systems, and kits that include the humeral anchors described in Section I to improve eccentric adjustment of the glenoid body. Section III describes variations of the components described in Sections I and II. Section IV describes variations of the couplers of the humeral system described in Sections I-III. Section V describes various methods of assembling the humeral head and reverse bearing assemblies disclosed herein.

[0039] The components and variations described below allow the first portion to be selectively mated with the second portion to selectively position the first portion in alignment with the second portion or eccentric relative to the second portion. The first portion can be collinear with the second portion. In applications described in detail below, the first portion can include an articulating body and the second portion can include a bone anchor portion for mating with the bone. For example, with respect to the shoulder, a humeral head assembly can be provided that allows the articular surface or other aspect of the articular body to mate with the humeral anchor in a central or eccentric position. In some variations, the glenoid anchor allows the articular body, such as the glenosphere of a reverse shoulder implant, to be positioned in a central or eccentric position relative to the anchor. In further variations, the assembly can be adapted to position the articular body of the femoral assembly relative to the femoral anchor to provide central or eccentric positioning for a hip or knee assembly. In further variations, the assembly can be adapted to position the articular body of the tibial assembly relative to the tibial anchor to provide central or eccentric positioning for a knee assembly. The ability to mate the articular surface in a central position or in one or more eccentric positions, or across a range of eccentric positions, allows the surgeon to treat a greater variety of patient anatomies with a kit having even fewer components than previously possible.

[0040] I. Anchor configured for connection to anatomical and reverse articular bodies below the resection plane 1A-1D show a reverse bearing assembly 800A including a humeral head assembly 800 and an anchor 830 that can be placed in a proximal portion of the humerus, e.g., in the metaphysis. The anchor 830 is configured to accommodate a portion of the glenoid body below the resected surface of the humerus within the metaphysis. The anchor 830 allows the surgeon to accommodate various patient soft tissues as well as advantageously invert the glenoid surface of the shoulder, as described below.

[0041] 1A shows an anchor 830 in an anatomical configuration coupled with an articular body 804 to form a humeral head assembly 800. The anchor 830 is positioned at or below the resection plane S. More specifically, the anchor 830 has a first end 832 and a second end 834. The first end 832 can be the proximal end and the second end 834 can be the distal end of the humeral anchor 830. In this regard, the distal end is the end that is positioned deeper into the metaphysis of the humerus upon implantation.

[0042] 1B shows that an inner surface 840 of the anchor 830 extends between the first end 832 and the second end 834. The inner surface 840 can form a portion of the receiving portion 836 of the anchor 830. The inner surface 840 has a first recess 842 disposed between the first end 832 and the second end 834 and a second recess 844 disposed between the first recess 842 and the second end 834. The first recess 842 is a wider recess disposed near the proximal end of the anchor 830. The second recess 844 is a narrower recess disposed between the first recess 842 and the second end 834. The second recess 842 is configured to receive a coupler 924 (described in FIGS. 16-20 below) that is secured or adapted to be secured to the anatomical articular body 804.

[0043] 1C illustrates a reverse type bearing assembly 800A that can be formed with an anchor 830 and a reverse type articulating body 804A. The articulating body 804A can be directly coupled to the anchor 830. For example, the first recess 842 of the anchor 830 can be configured to directly secure the coupling portion 846 of the articulating body 804A to the inner surface 840. The reverse type articulating body 804A can include a single molded polymeric component having a first portion including a concave articular surface 848 and a second portion including a matching or interface portion 849 that directly couples to the inner surface 840. The coupling can be achieved by a C-ring 850, an interference fit, or other locking device, or in other manners. If present, the C-ring 850 can be received in a slot 852 in the inner surface 840 that extends circumferentially around and radially outward of the first recess 842. In some embodiments, the C-ring 850 can cooperate with one or more fins 854 that can be disposed about the first recess 842 to provide an interference connection with the articulating body 804A. In some examples, the articulating body 804A and / or the C-ring 850 can provide rotational stability. The first recess 842 may interact with one or more fins to provide an interference fit between the articulating body 804A and the housing 836. In some embodiments, the C-ring 850 may be removed and an interference connection using the fins 854 or other structure alone may be used to secure the articulating body 804A to the housing 836.

[0044] In the assembled reverse shoulder implant, there is an overlap between the interface 849 of the reverse shoulder joint body 804A and the inner surface 840 of the anchor 830. This provides an advantage in that it allows the reverse shoulder joint body 800A to be fitted to patients with a small gap between the humerus H and the glenoid cavity of the scapula forming the shoulder joint. For patients with a larger gap, a spacer can be provided so that the reverse shoulder joint body 800A and its corresponding glenoid cavity implant (if present) occupies the space between the humerus and the scapula. This allows the shoulder arthroplasty to be accomplished without excessive tension on the connective tissue between the humerus and the scapula. This allows the postoperative shoulder joint to be as close to the pre-morbid biomechanics as possible. The resected inferior configuration of the reverse shoulder joint body 804A provides the surgeon with an improved ability to treat a wider variety of patients.

[0045] As mentioned above, some patients may benefit from a reverse shoulder alignment. Often, this is done after initial implantation of the anatomical assembly. To minimize the invasiveness of this revision, the anchor 800 is advantageously configured to mate with the articular body 804 or a reverse shoulder body 804. An example of a reverse shoulder body 804A is shown in FIGS. 1C and 1D. In particular, one or more couplers 924a, 924b, 924c may be provided to allow the articular body 804 to be indirectly coupled to the anchor 800, as described in more detail below. The couplers 924a, 924b, 924c may be configured to couple with the second recess 844 and occupy the first recess 842 of the anchor 830. Thus, the couplers 924a, 924b, 924c may include a spacer portion that allows the articular body 804 to be seated on the anchor 830 on the resection surface S. Thus, a first recess 842 is included in anchor 830 to allow for an initial anatomical configuration and to allow for reversal to allow the surgeon to perform a revision in the patient without having to remove or install a separate anchor for a reverse type prosthesis.

[0046] In some embodiments, anchor 830 can be configured to receive and / or engage one or more couplers 1424a, 1424b, 1424c. Alternatively, one or more couplers 924a, 924b, 924c can be configured to engage an embodiment of humeral anchor 1500, described in more detail below. Although the various components of the anchors, couplers and articular bodies will be described with reference to the individual components shown in the figures, it should be appreciated that humeral head assembly 800 and reverse style bearing assembly 800A can include any combination of the anchors, couplers, or articular bodies, described in more detail below.

[0047] II. Components, systems, and kits enabling central and eccentric humerus assemblies Figures 1E-1G show that the joint implant can provide either central or eccentric joint surface configurations. Figures 16-17C show components, systems, and kits that can incorporate or be used with humeral anchor 830 to provide various degrees of eccentricity of the joint surface. Figures 18-20A show other embodiments of components, systems, and kits that can incorporate or be used with humeral anchor 1500 (described in more detail below) to provide various directions or degrees of eccentricity of the joint surface.

[0048] FIG. 1E illustrates an example of a humeral head assembly 10 coupled to a humerus H. In the process of implanting the humeral head assembly 10 into the humerus H, the shoulder joint space is surgically approximated and the humerus is separated from the glenoid cavity of the scapula. The humeral head of the humerus H is separated from the rest of the humerus by cutting or resecting along a plane 14. This resection creates an exposed surface S of the proximal humerus H. The intramedullary canal of the humerus (a long, narrow cavity within the humerus) may then be approached and enlarged or prepared. The stem 30 may then be inserted into the mating surface 40 (see FIGS. 1F and 1G) with the intramedullary canal of the stem 30 remaining exposed or accessible from surface S. In an alternative technique, a stemless anchor is provided that does not require preparation or access of the intramedullary canal. As shown in FIG. 1F, the articular body 22 may be mated with the stem 30 to form a humeral head assembly mated with the humerus H.

[0049] Whether a stemless humeral anchor (as in FIGS. 1A-1D) or a stemmed humeral anchor (as in FIG. 1E) is used, the joint surface of the anchor placed on the surface S does not necessarily have to be in the center of the surface S. Such variations can be addressed by providing a kit in which some humeral heads are central and some are eccentric. FIG. 1F shows a stem 30 placed on the humerus H in a central position. The joint feature 44 at the center of the joint surface 40 of the stem 30 is aligned with the center 48 of the exposed surface S of the humerus H. In this configuration, a humeral head 50 with a central articular surface 54 can be used to provide good centering of the articular surface 54 relative to the exposed surface S. The center of the articular surface 54 is intersected by the longitudinal axis 56 of the stem 58 of the humeral head 50, e.g., is collinear. 1G illustrates that in some cases, the process of resecting the humerus H and positioning the stem 30 causes the coupling feature 44 to be offset from the center 48 of the exposed surface S of the humerus H. In this configuration, a humeral head 58 having an eccentric articular surface 68 can be used to provide better centering of the articular surface 68 relative to the exposed surface S. The center 70 of the articular surface 68 is not intersected by, e.g., collinear with, the longitudinal axis 72 of the stem 74 of the humeral head 64. Rather, there is an offset OS between the center 70 and the longitudinal axis 72. The offset OS shifts the articular surface 68 toward the center 48 of the surface S of the humerus H, which is often the preferred arrangement.

[0050] A kit could be provided having multiple humeral heads 50, 64 with integral or pre-connected connectors. However, such a kit would include at least one extra humeral head, which is an inefficient approach. The humeral head is a high cost component in a humeral assembly kit. Reducing waste of such components would be beneficial.

[0051] 15 illustrates another example of a humeral head assembly 800B coupled to a humerus H. The humeral head assembly 800B can include a first recess 834B and a second recess 844B. In some embodiments, the first recess 834B has a larger radius than the second recess 844B. The humeral head assembly 800B can include an outer surface 808B including a first cylindrical portion 832B disposed about the first recess 834B. The humeral head assembly 800B can also include a second cylindrical portion 844B disposed about the second recess 844B. In some embodiments, the humeral head assembly 800B can include a plurality of rotational control features 850B configured to extend radially from the second cylindrical portion 844B. In some examples, each of the plurality of rotational control features 850B is a fin extending radially outward from a central portion of the anchor.

[0052] In some embodiments, as described in more detail below, the articular body 804 can include a receiving portion 836B configured to receive a portion of the humeral head assembly 800B below the resection level of the humerus. Locating the receiving portion 836B below the resection level is advantageous in reducing the amount of hardware between the humerus and scapula while bringing the bones closer together.

[0053] 16-17C illustrate an embodiment of a humeral head assembly kit 900 in which the eccentricity of the assembly can be adjusted by coupling the articular body 904 to one of a number of different couplers (e.g., a first coupler 924a, a second coupler 924b, or a third coupler 924c). 16 and 16A, the articular body 904 and the plurality of couplers 924a, 924b, 924c are separable components of the humeral head assembly kit 900. Each coupler 924a, 924b, 924c has a discrete engagement position to facilitate selection of the amount of eccentricity or elimination of eccentricity when a selected one of the couplers 924a, 924b, 924c is engaged with the articular body 904. Different degrees of eccentricity can be reached by selecting one of the couplers 924a, 924b, 924c, as described further below.

[0054] 17A-17C show various configurations of humerus assemblies that can be formed from the humeral head assembly kit 900 when the articular body 904 is engaged with a selected one of the couplers 924a, 924b, 924c. FIG. 17A shows a humeral head assembly 901 that can be provided when the articular body 904 is mated with a first coupler 924a. The humeral head assembly 901 corresponds to a central (or non-eccentric) position or configuration. FIG. 17B shows a humeral head assembly 902 in which the articular body 904 is mated with a second coupler 924b, corresponding to a low eccentric position or configuration. FIG. 17C shows a humeral head assembly 903 in which the articular body 904 is mated with a third coupler 924c, corresponding to a high eccentric position or configuration.

[0055] 16-17C show various humeral head assemblies similar to the humeral head assembly 100 described below, and other humeral head assemblies described elsewhere herein. The description of the humeral head assemblies 901, 902, 903, kit 900, or components thereof, such as the articular body 904, and respective couplers 924a, 924b, 924c, and other humeral head assemblies described elsewhere herein will expand upon this description in more detail, and those skilled in the art will understand that such description supplements the following description of the humeral head assemblies 901, 902, 903, kit 900, articular body 904, and respective couplers 924a, 924b, 924c.

[0056] 16 and 16A show that the articular body 904 can have an articular surface 908. The articular surface 908 can be convex. The articular surface 908 can be configured to engage with a concave surface of the patient's glenoid or with the patient's glenoid. In some embodiments, as shown in FIG. 16 and 16A, the articular body 904 can also have an interface 912. The interface 912 can be located on a side of the articular body 904 opposite the articular surface 908. The humeral head assemblies 901, 902, 903 can also include at least one site 920 for discrete positioning of the articular body 904 on each coupler 924a, 924b, 924c. In some embodiments, the discrete positioning site is a radial notch 920. In some embodiments, the radial notch 920 allows one of the couplers 924a, 924b, 924c to engage with the articular body 904 at a predefined location, thereby preventing relative rotation when engaged. In some embodiments, one location (e.g., the radial notch 920) is located on the same plane, for example, on a plane transverse and perpendicular to the center of the articular surface 908. The amount of eccentricity can be selected by engaging one of the couplers 924a, 924b, 924c with the articular body 904.

[0057] The articular body 904 can be configured to engage and / or be retained by any of the couplers 924a, 924b, 924c. In some embodiments, a selected one of the couplers 924a, 924b, 924c can be coupled to a coupling portion 912 of the articular body 904 to maintain the humeral head assemblies 901, 902, 903 in a central or eccentric configuration.

[0058] 16 and 16A show that the joint 912 can include a first recess 914 disposed within the articular body 904. The first recess 914 can have an open end on a lateral side of the articular body 904. The lateral side is the side of the articular body 904 opposite the articular surface 908. The lateral surface faces away from the glenoid cavity when the humeral head assembly 901, 902, 903 is implanted. The second recess 916 can extend into the articular body 904. In some embodiments, the second recess 916 can have a closed end. The second recess 916 can be tapered to decrease in diameter over the length of the second recess 916 such that the diameter is smaller adjacent the closed end. The second recess 916 can increase in diameter toward the joint 912 of the articular body 904.

[0059] As mentioned above, the articular body 904 can be configured to engage multiple couplers to provide different eccentricities for the humeral head assembly 900. Each illustrated coupler 924a, 924b, 924c can include a first portion 928a, 928b, 928c, a disk member 932a, 932b, 932c, and a second portion 936a, 936b, 936c. In some embodiments, the couplers 924a, 924b, 924c can include an engagement portion including a collar 940a, 940b, 940c having radial projections 944a, 944b, 944c.

[0060] In some embodiments, the first portion 928a, 928b, 928c of each coupler 924a, 924b, 924c can be secured within the second recess 916 of the articulating body 904. In some examples, the collar 940a, 940b, 940c of each coupler 924a, 924b, 924c can be configured to be disposed within the first recess 914. The collar 940a, 940b, 940c can be located between the first portion 928a, 928b, 928c of each coupler 924a, 924b, 924c and the disk member 932a, 932b, 932c. The collar 940a, 940b, 940c can be used to position the articulating body 904 on or over any of the couplers 924a, 924b, 924c. In some examples, the collar 940a, 940b, 940c can include radial projections 944a, 944b, 944c configured to secure the articulating body 904 in the radial notch 920 of the articulating body 904. In some embodiments, the radial projections 944a, 944b, 944c can extend radially. The radial projections 944a, 944b, 944c can extend in a plane perpendicular to the longitudinal axis of the coupler 924a, 924b, 924c. In some examples, the radial projections 944a, 944b, 944c can circumferentially overlap a radial edge of the coupling portion 912 to lock the rotational position relative to the articulating body 904. Similar to the example of FIG. 4A described above, each radial protrusion 944 a , 944 b , 944 c can be configured to extend radially outwardly of a radially inner portion of the periphery of coupling portion 912 .

[0061] 16-17c show that couplers 924a, 924b, 924c can include disk members 932a, 932b, 932c, as described above. Disk members 932a, 932b, 932c can be located between collars 940a, 940b, 940c and second portions 936a, 936b, 936c of respective couplers 924a, 924b, 924c. Disk members 932a, 932b, 932c can be used with stemmed or stemless anchors, such as anchor 830 or anchor 830A. Anchors 830, 830A can also be coupled to reverse type articulating body 804A, as shown and detailed in FIGS. 1A-1C. As shown in FIG. 1B, in some examples, anchor 830 can include a receiving portion 836. As mentioned above, the receiving portion 836 is configured to receive a portion of the humeral head assembly 901, 902, 903 below the resection level of the humerus, e.g., below the surface S. This allows the reverse shoulder joint mass 804A to fit more compactly into the shoulder joint space, as explained above. As mentioned above, the receiving portion 836 of the anchor 830 can beneficially reduce the amount of hardware between the humerus and the scapula for a reverse shoulder assembly. This allows the humeral head assembly kit 900 to be adapted for use with more patients, and also allows the bones between the humerus and the scapula to be closer together. Partial Implementation of the Anatomical Humeral Head Assembly 800 In one embodiment, the receiving portion 836 is configured to receive a disk member 932a, 932b, 932c selected from the couplers 924a, 924b, 924c. Disk members 932a, 932b, 932c allow anchor 830 to be adapted for connection below resection plane S for use in any anatomical configuration. An embodiment of an anchor having a receiving portion adapted for direct connection to articular body 804A below resection plane S (e.g., a stemless anchor) is further described elsewhere herein. An example of a stemless bone anchor is disclosed in U.S. Provisional Application No. 62 / 740,333, filed October 2, 2018, Attorney Reference No. "TRNXSH.104PR," the entire contents of which are incorporated herein by reference.

[0062] The disk members 932a, 932b, 932c are configured to accommodate the couplers 924a, 924b, 924c within a humerus anchor that allows the surgeon to secure both the anatomical and reverse shoulder joints to the humerus while maintaining control over the tension of the connective tissue. In some embodiments, the disk members 932a, 932b, 932c are configured to accommodate the anchor 830, as shown in FIG. 1A. The disk members 932a, 932b, 932c can be located between the first portion 928a, 928b, 928c and the second portion 936a, 936b, 936c. In some embodiments, the disk members 932a, 932b, 932c can be adjacent to the collars 940a, 940b, 940c. Disc members 932a, 932b, 932c can have a curved profile configured to fit within first recess 842 of anchor 830 or anchor 830A. In some embodiments, disc members 932a, 932b, 932c can be annular, however, disc members 932a, 932b, 932c can be any shape that can be received within first recess 842.

[0063] The disk members 932a, 932b, 932c can have a longer axial length than the first portion 928a, 928b, 928c, the second portion 936a, 936b, 936c, or the collars 940a, 940b, 940c. The disk members 932a, 932b, 932c can have a shorter axial length than the first portion 928a, 928b, 928c, the second portion 936a, 936b, 936c, or the collars 940a, 940b, 940c. In some embodiments, the disk members 932a, 932b, 932c can be significantly larger than the collars 940a, 940b, 940c. In one embodiment, the disk members 932a, 932b, 932c are annular with a diameter larger than the joint portion 912 of the articular body 904. In some embodiments, the disk members 932a, 932b, 932c can have an axial length that is smaller than the axial length of the first recess 842 of the anchor 830 or anchor 830A. The disk members 932a, 932b, 932c can have a diameter that is smaller than the diameter of the first recess 842 of the anchor 830 or anchor 830A. This allows the disk members 932a, 932b, 932c to be retained within the first recess 842 while avoiding contact with the peripheral portion of the inner surface 840 therearound. In some embodiments, the axial length of the disk members 932a, 932b, 932c is configured to prevent the outer surface of the disk members 932a, 932b, 932c from engaging with the connection features (e.g., fins 854) disposed about the first recess 842. In some embodiments, the disk members 932a, 932b, 932c can have a height that is the same as or slightly greater than the height of the first recess 842. As described above, in some examples, when the disk members 932a, 932b, 932c are positioned within the first recess 842, the disk members 932a, 932b, 932c may have collars 940a, 940b, 940c and radial protrusions 944a, 944b, 944c positioned at or on the surface S.

[0064] The humeral head assemblies 901, 902, 903 may include an articulation body 904 configured to engage with any one of a plurality of couplers 924a, 924b, 924c. In the illustrative embodiment, each coupler 924a, 924b, 924c can include a radial protrusion 944a, 944b, 944c that provides a discrete eccentric adjustment position or configuration when engaged with a radial notch 920 on the first recess 914 of the articulating body 904. The radial notch 920 can be configured to receive the radial protrusions 944a, 944b, 944c of the collars 940a, 940b, 940c. The profile, contour, edge, or shape of the radial notch 920 can be concave. The profile, contour, edge, or shape of the radial protrusions 944a, 944b, 944c can be convex. The radial projections 944a, 944b, 944c can be inserted axially, for example along the longitudinal axis of the first portions 928a, 928b, 928c, into the radial notch 920 of the articular body 904. The matching or inverted configuration, for example, contour, edge, or shape, of the radial projections 944a, 944b, 944c of the selected couplers 924a, 924b, 924c and the radial notch 920 prevents relative rotation between each coupler 924a, 924b, 924c and the articular body 904 when the radial projections 944a, 944b, 944c initially engage the radial notch 920. The contact or close adjacency and / or shape of the radial notch 920 prevents rotation of the selected coupler 924a, 924b, 924c within or relative to the articular body 904, except for the selected coupler 924a, 924b, 924c, such that the radial projections 944a, 944b, 944c of the selected coupler 924a, 924b, 924c are recessed axially away from the articular body 904 to a position where the radial notch 920 is spaced from the base surface of the first recess 914 and the coupling portion 912 of the articular body 904. In this manner, the selected coupler 924a, 924b, 924c can be at least radially secured to the articular body 904 when the radial notch 920 initially receives one of the radial projections 944a, 944b, 944c. A permanent connection between the couplers 924a, 924b, 924c and the articular body 904 is then provided by snapping the articular body 904 onto the selected coupler 924a, 924b, 924c to engage the tapered surfaces.

[0065] In some embodiments, the location of the radial projections 944a, 944b, 944c and radial notch 920 may be reversed. In such an inverted configuration (not shown), the radial projections 944a, 944b, 944c described above may instead be located on the side of the articular body 904 opposite the articular surface 908, and the radial notch 920 described above may instead be located on the couplers 924a, 924b, 924c. In this inverted example, similar to the embodiment shown in FIGS. 16-20, the radial projections are configured to provide discrete eccentric adjustment positions or configurations when engaged with the radial notches on the couplers. In an inverted embodiment, the radial notches on the couplers may be configured to accommodate the radial projections on the articular surface 908. Similar to the radial projections 944a, 944b, 944c and humeral head assembly 902 described above, in the inverted configuration, the aligned or inverted configuration of the radial projections and radial notches prevents relative rotation between the coupler and the articular body 904 when the radial projections engage with the radial notches.

[0066] 17A-17C show three eccentric adjustments, positions or configurations that can be achieved by engaging the articular body 904 with a selected one of the couplers 924a, 924b, 924c. Each coupler 924a, 924b, 924c can provide a precise eccentric adjustment at a predetermined value when engaged with the articular body 904. It should be noted that the couplers 924a, 924b, 924c shown in FIGS. 17A-17C are only examples of some of the eccentricities that the humeral head assembly kit 900 can provide. In some embodiments, engaging the articular body 904 with a selected one of the couplers 924a, 924b, 924c can provide, for example, 0 mm, 1 mm, 2 mm, 3 mm, 4 mm, between 0 mm and 1 mm, between 1 mm and 2 mm, between 2 mm and 3 mm, between 3 mm and 4 mm, or between 0 mm and 4 mm. In some examples, the articulating body 904 and a selected one of the couplers 924a, 924b, 924c may be arranged to provide a selected eccentricity when the articulating body 904 engages the selected one of the couplers 924a, 924b, 924c. By having eccentricity provided by both the articulation body 904 and the one selected from the couplers 924a, 924b, and 924c, it may be easier to maintain some strength in the one selected from the couplers 924a, 924b, and 924c.

[0067] 18 illustrates an example embodiment of the humeral head assembly 901 in a first configuration 922a that provides a central (non-eccentric) configuration. As illustrated, when the articular body 904 engages with the coupler 924a, the humeral head assembly 901 has a first configuration 922a that provides a 0 mm offset. Thus, the first configuration 922a has a central or non-eccentric configuration. To provide a central (non-eccentric) configuration, in some examples, when the first portion 928a of the coupler 924a engages with the articular body 904, the longitudinal axis 948a of the second portion 936a of the coupler 924a aligns with a radius 948 of the articular body 904 that is perpendicular to the lateral surface of the articular body 904. In one embodiment, this radius aligns with the longitudinal axis of the second recess 916 of the articular body 904. In the illustrated embodiment, the longitudinal axis 958a of the second recess 916 is offset from the radius 948. The non-eccentric configuration is provided by the asymmetric configuration of the first portion 928a and the second portion 936a. When the collar 940a and the radial projection 944a engage the first recess 914 and the radial notch 920, respectively, the longitudinal axis 948a of the second portion 936a is aligned with It aligns with the offset from the longitudinal axis of the second recess 916 but aligns with the radius 948 of the articular surface 908 such that there is no offset between the radius 948 and the longitudinal axis 948a.

[0068] 17B illustrates an embodiment of the humeral head assembly 902 in a second configuration 922b that provides an example of a low eccentricity configuration. As illustrated, when the articular body 904 engages the coupler 924b, the humeral head assembly 902 can have an eccentricity configuration that can provide an offset of, for example, 1.75 mm. In some embodiments, the second configuration 922b provides an eccentricity configuration by engaging a first portion 928b of the coupler 924b with the articular body 904 such that a longitudinal axis 948b of a second portion 936b of the coupler 924b is offset from a radius 948 of the articular body 904 that is perpendicular to the lateral surface of the articular body 904. In some examples, the first portion 928b of the coupler 924b is aligned with the radius 948 of the second recess 916 and an offset exists between the longitudinal axis 958b of the second recess 916 and the longitudinal axis 948b of the second portion 936b. When the collar 940b and radial protrusion 944b engage the first recess 914 and radial notch 920, respectively, the longitudinal axis of the second portion 936b is misaligned with the longitudinal axis of the radius 948 and articular surface 908 to provide an offset of 1.75 mm.

[0069] FIG. 17C provides the humeral head assembly 903 in a third configuration 922c that provides a highly eccentric configuration. Similar to FIG. 17B, when the articular body 904 engages with the coupler 924c, the humeral head assembly 903 can have an eccentric configuration. In the embodiment shown in FIG. 17C, the third configuration 922c can provide an offset of 3.50 mm. In some embodiments, the third configuration 922c provides an eccentric configuration by engaging a first portion 928c of the coupler 924c with the articular body 904 such that a longitudinal axis 948c of a second portion 936c of the coupler 924c is offset from a radius 948 of the articular body 904 that is perpendicular to the lateral surface of the articular body 904. In some instances, the first portion 928c of the coupler 924c is aligned with the radius 948 of the second recess 916 and there is an offset between the longitudinal axis 958c of the second recess 916 and the longitudinal axis 948c of the second portion 936c. As described above, even though the coupler 924c is asymmetric, when the collar 940c and radial protrusion 944c engage with the first recess 914 and radial notch 920, respectively, the longitudinal axis of the second portion 936c is not aligned with the radius 948 and the longitudinal axis of the articular surface 908 to provide an offset of 3.0 mm.

[0070] In some embodiments, each coupler 924a, 924b, 924c is threaded. The threaded channel 956 may include a threaded channel 956. The threaded channel 956 may The assembly 903 can be configured to be disassembled. In some examples, the threaded channel 956 can be configured to receive and / or thread a tool (e.g., a rod) such that a load can be applied to disassemble the articulating body 904 from one of the couplers 924a, 924b, 924c to which it is coupled.

[0071] 18-20A show yet another embodiment of a humeral head system in which the eccentricity of the system can be adjusted by coupling the articular body with one of a plurality of different couplers. As shown in FIG. 18C, the articular body 1404 is configured to couple with one of a plurality of different couplers (e.g., a first coupler 1424a, a second coupler 1424b, or a third coupler 1424c). As shown in FIGS. 18A and 18C, the articular body 1404 and the plurality of couplers 1424a, 1424b, 1424c are separable components of the humeral head system 1400. When a selected one of the couplers 1424a, 1424b, 1424c engages with the articular body 1404, each coupler 1424a, 1424b, 1424c is configured to allow the surgeon to select an engagement position to facilitate selection of non-eccentricity or an amount or direction of eccentricity. As described in more detail below, different eccentricities can include selecting one of the couplers 1424a, 1424b, 1424c. Different eccentricities or eccentric directions can be further determined by the rotational positioning of the couplers 1424b, 1424c relative to the anchor.

[0072] 18C illustrates various configurations of humerus assemblies that may be formed from the humeral head system 1400 when the articular body 1404 engages with a selected one of the couplers 1424a, 1424b, 1424c. For example, the humeral head system 1401 illustrates the articular body 1404 coupled with the first coupler 1424a, corresponding to a central (or non-eccentric) position or configuration. In another example, the humeral head system 1402 illustrates the articular body 1404 coupled with the second coupler 1424b, corresponding to a low eccentric position or configuration. In some embodiments, this may correspond to a nominal 1.5 mm of eccentric adjustment. In yet another example, the humeral head system 1403 illustrates the articular body 1404 coupled with the third coupler 1424c, corresponding to a high eccentric position or configuration, which may correspond to a nominal 3.5 mm of eccentric adjustment. In each of these cases, the change in position of the articulating body 1404 can be accommodated by rotating the combination of the articulating body 1404 and couplers 1424b, 1424c relative to the recess of the second recess 1524 of the anchor 1500. Such rotation maintains the same offset distance between the center of the first recess 1416 of the articulating body 1404 and the second recess 1624 of the humeral anchor 1500 while providing eccentric adjustment of the humeral implant assembly.

[0073] 18-20A show various humeral head assemblies similar to the humeral head assembly 100 and other humeral head assemblies described elsewhere herein. As noted above, descriptions of other humeral head assembly embodiments are provided elsewhere herein with respect to descriptions of the humeral head systems 1400, 1401, 1402, 1403, articular body 1404, and their respective couplers 1424a, 1424b, 1424c.

[0074] 18 and 18B show side and cross-sectional views, respectively, of the articular body 1404. In some embodiments, the articular body 1404 can have an articular surface 1408. As shown, in some instances, the articular surface 1408 can have a convex surface. In some embodiments, the articular surface 1408 can be configured to engage with a corresponding concave surface at or in the patient's glenoid. In some instances, as shown in FIG. 18B, the articular body 1404 can have a lateral surface 1412. The lateral surface 1412 can be disposed on a side of the articular body 1404 opposite the articular surface 1408. In some embodiments, the articular body 1404 can include a first recess 1414 and a second recess 1416 disposed on the lateral surface 1412 and extending from the lateral surface 1412 of the articular body 1404 towards the articular surface 1408 of the articular body 1404. As shown in FIG. 18B, in some instances, the first recess 1414 and the second recess 1416 can be disposed on the lateral surface 1412 of the articular body 1404. The first recess 1414 and the second recess 1416 are in the center of the surface of the lateral side 1412. In some embodiments, the radius of the first recess 1414 can be greater than the radius of the second recess 1416. The first recess 1414 and the second recess 1416 can serve a similar purpose to the continuous section 424 described above with respect to the articular body 400, 404A in that they engage the couplers 1424a, 1424b, 1424c with the articular body 1404 along a range of positions that are not predefined, and also allow rotation when the couplers are inserted into the recesses 1414, 1416 but do not fully engage the articular body 1404. In some embodiments, the amount of eccentricity can be selected by rotationally positioning one of the couplers 1424b, 1424c relative to the humeral anchor 1500 prior to engagement of the coupler with the articular body 1404. Because the coupler 1424 a is rotationally symmetric, rotation does not change the eccentricity of the articulating body 1404 relative to the anchor 1500 .

[0075] In some examples, the articulating body 1404 can be configured to engage and / or be retained by any of the couplers 1424a, 1424b, 1424c. The following description of any of the couplers 1424a, 1424b, 1424c is directed to providing various amounts of eccentricity, however, it should be understood that the components of any of the couplers 1424a, 1424b, 1424c (e.g., first portion 1428, plate 1440, disk member 1432, and second portion 1436, etc.) are generally similar and a description of one of the couplers may also be used to describe any of the other couplers.

[0076] In some embodiments, a selected one of the couplers 1424a, 1424b, 1424c can be mated with the first recess 1414 and the second recess 1416 of the articular body 1404 to hold the humeral head system 1401, 1402, 1403 in a central or eccentric configuration after selecting one of the couplers 1424a-c and then rotating the selected coupler to a selected position on the anchor 1500 to select the eccentricity. In some embodiments, the articular body 1404 engages one of the couplers 924a, 924b, 924c when the various components of the humeral head system 1400 are assembled, as shown in FIG. 18B. As shown, a gap 1446 is formed between the proximal surface of the collar 1506 and the lateral surface 1412 of the articular body 1404. In some embodiments, each coupler 924a, 924b, 924c can have a plate 1440 with a ledge 1442 that forms a surface or interface between the plate 1440 and the disk member 1432. In some examples, the ledge 1442 forms an inclined surface, e.g., a surface at an acute angle to the horizontal from the perspective of FIG. 18B. As described in more detail below, a tool can be inserted into engagement with the ledge 1442 to apply a force and / or load to separate one of the couplers 924a, 924b, 924c from the attached articular body 1404 to facilitate removal of the articular body 1404 from a selected one of the couplers 924a, 924b, 924c to which it is attached.

[0077] As discussed above, FIG. 18B illustrates that the lateral surface 1412 of the articular body 1404 can include a first recess 1414 disposed within the articular body 1404. The first recess 1414 can have an open end on the lateral surface 1412 of the articular body 1404. In some embodiments, the first recess 1414 can be straight or tapered such that the radius of the first recess 1414 decreases as it extends into the articular body 1404. As shown, the lateral surface 1412 is the side of the articular body 1404 opposite the articular surface 1408. The lateral surface 1412 can be configured to face away from the glenoid cavity when the humeral head system 1401, 1402, 1403 is implanted. As discussed above, a second recess 1416 can extend into the articular body 1404. In some embodiments, the second recess 1416 can have a closed end. The second recess 1416 may be tapered to decrease in diameter over the length of the second recess 1416 such that the diameter is smaller adjacent the closed end. The second recess 1416 may be tapered to increase in diameter toward the lateral surface 1412 of the articular body 1404. As mentioned above, in some examples, the radius of the first recess 1414 can be larger than the radius of the second recess 1416.

[0078] As discussed above, the articular body 1404 can be configured to engage with any one of a number of couplers to provide different eccentricities for the humeral head system 1400. Exemplary embodiments of couplers 1424 providing eccentricity configurations are shown in FIGS. 19-19E. In particular, coupler 1424c of FIGS. 19-19E provides a relatively high nominal or maximum eccentricity position or configuration. In some embodiments, coupler 1424c can include a first portion 1428c, a disk member 1432c, and a second portion 1436c. In some embodiments, coupler 1424c can include an engagement portion including a plate 1440c. As shown in FIG. 19B, in some examples, the plate 1440c can include a window 1444c that forms a slot in the plate 1440c to expose other members of the joint prosthesis (e.g., the anchor 1500 or a glenoid component) or, in the case of a hemiarthroplasty, indicia on a corresponding anchor indicating an eccentric orientation or configuration of the glenoid body 1404 relative to the native glenoid.

[0079] In some embodiments, the first portion 1428c of the coupler 1424c can be secured within the second recess 1416 of the articular body 1404. As described herein, the second recess 1416 can be tapered such that the radius of the second recess 1416 decreases as it extends into the body of the articular body 1404. In some examples, the first portion 1428c is tapered to engage with the second recess 1416 of the articular body 1404. In some embodiments, the radius of the first portion 1428c decreases in a proximal direction. In some examples, the plate 1440c of each coupler 1424c can be configured to be disposed in the first recess 1414. The plate 1440c can be located between the first portion 1428c of each coupler 1424c and the disk member 1432c. In some embodiments, the plate 1440c can be used to position the articulating body 1404 at or over any of the couplers 1424c. As described in more detail below, the plate 1440c can include a window 1444c configured to indicate an eccentric orientation or configuration of the articulating body 1404 relative to a corresponding anchor. As shown in FIG. 19B, the window 1444c can form a U-shaped slot in a portion of the plate 1440c. In some embodiments, the window 1444c can extend radially inwardly away from the longitudinal axis of the coupler 1424c, e.g., in a plane perpendicular to the longitudinal axis of the coupler 1424c.

[0080] 19-19E show that coupler 1424c can include disk member 1432c, as described above. Disk member 1432c can be located between plate 1440c and second portion 1436c of coupler 1424c. Disk member 1432c of coupler 1424c can be secured in and used with a stemless anchor, such as anchor 830, 830A or humeral anchor 1500 described above, or in a stemmed anchor 500, such as an anchor 500 having a stem portion or a variation thereof in which notch 544 is omitted. In some embodiments, coupler 1424c (or any one of couplers 1424 described above (e.g., coupler 1424a or coupler 1424b)) can be secured in the anchor using an expandable disk, as shown in FIGS. 21A-43. For example, instead of second portion 1436c, coupler 1424c can include a bottom portion having an expandable disk similar to expandable disk 1003 of coupler 1000 for engaging first recess 1508 of humeral anchor 1500 (or the proximal opening of any one of anchors 830, 830A, 500). In some examples, coupler 1424c (or any one of couplers 1424 described above (e.g., coupler 1424a or coupler 1424b)) can be secured within an anchor using a disk similar to coupler 1304 shown in FIGS. 44-50. For example, in some embodiments, a distal portion of coupler 1424c can be secured to coupler 1306 in the proximal opening of any of the anchors disclosed above. 24c can be inserted into the tapered opening 1316 of coupler 1306 to expand and secure it.

[0081] 18-18B show an embodiment of a humerus anchor 1500 that can be configured to engage the articular body 1404 and coupler 1424 in a humeral head system 1400. In some embodiments, the humerus anchor 1500 is configured to be placed in a proximal portion of the humerus, e.g., its metaphysis. The humerus anchor 1500 is configured to accommodate a portion of the coupler 1424 (e.g., disc member 1432) below the humeral resection plane in the metaphysis. Like anchor 830, the humerus anchor 1500 advantageously allows the surgeon to accommodate a variety of patient soft tissues as well as invert the shoulder articular surface.

[0082] 18 shows the humerus anchor 1500 in an anatomical configuration and coupled with an articular body 1404 to form a humeral head system 1400. The humerus anchor 1500 is configured to be positioned at or below a resection surface (as shown in FIG. 1A). In some embodiments, the proximal recess of the anchor 1500 can have a first recess 1508 formed in a cylindrical portion 1510 at a proximal end of the humerus anchor 1500. In some examples, the recess can have a second recess 1524 formed in a distal end 1512 of the humerus anchor 1500. The first recess 1508 can be disposed between the proximal surface 1504 and a bottom surface of the first recess 1508. The second recess 1524 can be disposed between the first recess 1508 and the distal end 1512 of the humerus anchor 1500. In some examples, the first recess 1508 forms a wider portion of a recess located near the proximal end of the humeral anchor 1500. The second recess 1524 can form a narrower recess distal to the first recess 1508. In some embodiments, the second recess 1524 can be tapered such that the radius of the second recess 1524 decreases in a distal direction. As described in more detail below, the second recess 1524 is configured to receive a coupler 1424 that is secured to or adapted to the articular body 1404. In some examples, the tapered second recess 1524 is configured to engage a tapered second portion 1436 of the coupler 1424.

[0083] As shown in Figure 18B, the coupler 1424 and the humeral anchor 1500 are separable components. Figures 18A-18B show the disk member 1432 of the coupler 1424 disposed within the first recess 1508 of the humeral anchor 1500. Additionally, the second portion 1436 of the coupler 1424 is disposed within the second recess 1524 of the humeral anchor 1500.

[0084] The humerus anchor 1500 can be configured to be secured to a resected humerus. In some embodiments, the proximal surface 1504 of the humerus anchor 1500 is flush with the resected humerus such that the cylindrical portion 1510 can secure the base of the coupler 1424 (e.g., second portion 1436) in the first recess 1508 completely below the surface of the resected humerus. As mentioned above, examples of stemless bone anchors are disclosed in U.S. Provisional Application No. 62 / 740,333, filed October 2, 2018, Attorney Reference No. "TRNXSH.104PR," the entire contents of which are incorporated herein by reference.

[0085] 18A-18B, in some embodiments, the disk member 1432 of the coupler 1424 is positioned within the cylindrical portion 1510 of the humerus anchor 1500. The disk member 1432 can be positioned such that a distal side of the plate 1440 is adjacent to a surface of a collar 1506 formed at a proximal end of the cylindrical portion 1510. In some examples, the disk member 1432 can be positioned such that a proximal portion of the disk member 1432 is slightly above the proximal surface 1504 of the humerus anchor 1500. In some embodiments, the distal surface of the disk member 1432 is flush with the bottom surface of the cylindrical portion 1510. As shown in FIG. 18B, the coupler 1424 can be positioned such that a proximal portion of the disk member 1432 is slightly above the proximal surface 1504 of the humerus anchor 1500. By having a cylindrical portion 1510 that secures 1424 at or below the resection level, the base of the plate 1440 can be positioned adjacent to or directly above the resection surface so that the articular body 1404 can be coupled to the coupler 1424 at or near the same height as the resection, and in some cases can be positioned with a small gap to ensure proper connection between the articular body 1404 and the coupler 1424 and also to leave room for tools to disassemble the humeral head assembly from the coupler, if necessary.

[0086] In some examples, the humeral anchor 1500 can include additional connection features. As shown in FIG. 18B, a plurality of second features 1516 can be formed along an inner surface of the cylindrical portion 1510. The plurality of second features 1516 can be configured to provide engagement with a reverse type joint component, such as the reverse type articulating body 804A. For example, the plurality of second features 1516 can include at least one convex locking feature 1520. In some embodiments, the plurality of second features 1516 can include at least one concave locking feature 1522. In some examples, the plurality of second features 1516 are formed by interchanging the convex locking feature 1520 and the concave locking feature 1522. In some embodiments, the plurality of second features 1516 are configured to provide rotational stability to the articulating body 804A when the humeral anchor 1500 is initially installed or switched to be part of a reverse shoulder system having a reverse shoulder articulating body.

[0087] In some examples, the disc member 1432 can be configured to engage with the locking features 1520, 1522, for example, to include male or female geometries configured to correspond to or engage with at least one convex locking feature 1520 or at least one concave locking feature 1522 of the plurality of second features 1516 (not shown). Such connections may be in lieu of or in addition to the tapered connections described above. Also, the engagement features described below with respect to Figures 21-50 can be used to connect modified embodiments of the coupler 1424 to the anchor. In some embodiments, the disc member 1432 can be modified to engage with the plurality of second features 1516 (not shown). At least one convex locking feature 1520 or at least one concave locking feature 1522 of the plurality of second features 1516 engages with an outer surface of the disc member 1432, allowing the second feature 1516 to be used as an anti-rotation feature.

[0088] In some embodiments, the humeral anchor 1500 can include a plurality of tool interfaces 1528. As shown in the cross-sectional view of FIG. 18B, each of the plurality of tool interfaces 1528 can extend into a portion of the humeral anchor 1500 from a base of the first recess 1508 adjacent the distal end 1512. In some embodiments, the plurality of tool interfaces 1528 form spaced apart curved openings about the second recess 1524. In some examples, the tool interfaces 1528 are configured to engage a tool such that the humeral anchor 1500 can be inserted and / or secured into the humeral cavity. The tool interfaces 1528 can be angled toward the second recess 1524.

[0089] 18C illustrates three eccentric adjustments, positions or configurations that can be achieved by engaging the articular body 1404 with a selected one of couplers 1424a, 1424b, 1424c. Each coupler 1424b, 1424c can provide a nominal level of eccentric adjustment when engaged with the articular body 1404 and can provide adjustment based on rotation of the coupler relative to the anchor 1500 about an arc defined by the nominal level. Coupler 1424a provides a symmetrical arrangement where rotation does not result in a positional change on the resection surface. Couplers 1424b, 1424c shown in FIG. 18C illustrate some of the eccentricities that the humeral head system 1400 can provide. It should be noted that this is by way of example only. In some embodiments, engaging the articulating body 1404 with a selected one of the couplers 1424a, 1424b, 1424c may provide, for example, 0 mm, 0.5 mm, 1.0 mm, 1.5 mm, 2.0 mm, 2.5 mm, 3.0 mm, 3.5mm, 4mm, between 0mm and 0.5mm, between 0.5mm and 1.0mm, 1. Nominal levels of eccentricity adjustment may be provided, such as between 0 and 1.5 mm, between 1.5 and 2.0 mm, between 2.0 and 2.5 mm, between 2.5 and 3.0 mm, between 3.0 and 3.5 mm, between 3.5 and 4.0 mm, or between 0 and 4.0 mm. Nominal level based adjustment may be provided as generally described below. In some examples, eccentricity is provided by both the articulating body and a selected one of the couplers 1424a, 1424b, 1424c, such that the articulating body can provide a selected eccentricity when engaged with one of the couplers 1424a, 1424b, 1424c. For example, a nominal offset coupler 1242 may be provided. The articulating body 1404 may have an off-center recess and a continuous or discrete range of eccentricity adjustment, such that the amount of eccentricity can be selected in addition to the direction of eccentricity, as described with respect to Figures 3-12A. Alternatively, a nominal offset coupler 1242 can be provided and the anchors can have a continuous or discrete eccentricity adjustment range to allow for selection of the amount of eccentricity in addition to the direction of eccentricity as described with respect to Figures 13A-14C. By having the eccentricity provided by one of two or more articulating bodies, anchors, and couplers 1424a, 1424b, 1424c, the strength of the couplers 1424a, 1424b, 1424c can be maintained.

[0090] 19-19E show an example embodiment of a coupler 1424 that provides an eccentric configuration (i.e., coupler 1424c of humeral head system 1403 shown in FIG. 18). As shown, when articular body 1404 is engaged with the illustrated coupler 1424c, humeral head system 1400 can have an eccentric configuration that can provide an offset of, for example, 3.5 mm. In some embodiments, coupler 1424 shown in FIGS. 19-19E provides the eccentric configuration by engaging first portion 1428c of coupler 1424c with articular body 1404 such that longitudinal axis 1438c of disc member 1432c and second portion 1436c is perpendicular to lateral surface 1412 of articular body 1404 and offset from longitudinal axis 1430c of first portion 1428c that extends through center of articular surface 1408, as shown in side view in FIG. 19A. In some instances, the first portion 1428c of the coupler 1424c is aligned with the second recess 1416 of the articular body 1404, and an offset exists between the longitudinal axis 1430c of the first portion 1428c and the longitudinal axis 1438c of the second portion 1436c. When the plate 1440c and the first portion 1428c are engaged with the first recess 1414 and the second recess 1416, respectively, the longitudinal axis of the second portion 1436c is not aligned with the longitudinal axis of the second recess 1416 of the articular body 1404 (not shown). Because of the offset, rotation of the articular body 1404 and the coupler 1424c shifts the center location of the articular surface 1408 relative to the anchor 1500, and thus relative to the resected surface of the humerus. This movement allows the center of rotation of the humeral head system 1400 to move to a position that provides favorable biomechanical performance for a given patient.

[0091] 20-20A show an example of an embodiment of a coupler 1424 that provides a non-eccentric configuration (e.g., coupler 1424a of humeral head system 1401 shown in FIG. 18). As shown, when the articular body 1404 engages with the coupler 1424a, the humeral head system (e.g., humeral head system 1401 of FIG. 18) will have a configuration that provides a 0 mm offset of the center of the articular surface 1408 from the center of the anchor 1500, e.g., from the center of the collar 1506 or the center of the recess 1524. In some embodiments, to provide a central (non-eccentric) configuration, when the first portion 1424a of the coupler 1424a engages with the articular body 1404, the longitudinal axis 1438a of the second portion 1436a of the coupler 1424a is inserted into the lateral surface 1412 of the articular body 1404 and is aligned with the longitudinal axis of the first portion 1428 that is perpendicular. In some embodiments, the longitudinal axis 1438a of the second portion 1436a is aligned with the articular body 1404 (not shown). When the plate 1440a and first portion 1424a are engaged with the first recess 1414 and the second recess 1416, respectively, the longitudinal axis 1438a of the second portion 1436a is aligned with the longitudinal axis 1430a of the first portion 1428a and the longitudinal axis of the recess 1416 of the articular body 1404 such that there is no offset between the longitudinal axis of the second recess 1416 (not shown), the longitudinal axis 1438a of the second portion 1436a, and the longitudinal axis 1430a of the first portion 1428a.

[0092] In some embodiments, each coupler 1424a, 1424b, 1424c can include a channel 1448. As described in more detail below, the channel 1448 can be configured to allow disassembly of the humeral head system 1400. In some examples, the channel 1448 can be configured to receive and / or thread a tool (e.g., an elongated shaft 1840 shown in FIG. 56 ), for example, to apply a load to disassemble the articular body 1404 from one of the couplers 1424a, 1424b, 1424c to which it is coupled. In some embodiments, a load can be applied to disassemble one of the couplers 1424a, 1424b, 1424c from the humeral anchor 1500 to which it is coupled.

[0093] As shown in FIGS. 19C and 20A, the channel 1448c,a can include a proximal end 1449c,a and a distal end 1450c,a. In some embodiments, the proximal end 1449c,a can extend distally from an opening in a surface of the first portion 1428c,a through a portion of the coupler and a portion of the disk member 1432c,a surrounded by the plate 1440c,a. In some examples, the distal end 1450c,a can extend proximally from an opening in a surface of the second portion 1436c,a through the disk member 1432c,a. In some embodiments, the channel 1448c,a includes a threaded portion 1452c,a extending between the proximal end 1449c,a and the distal end 1450c,a. In some examples, the channel 1448c,a and the distal end 1450c,a are unthreaded. As will be described in more detail, in some embodiments, a tool can be inserted at a proximal end 1449c,a of the channel 1448c,a to extend distally from the first portion 1428c,a through the disk member 1432c,a and the second portion 1436c,a. In some examples, a tool can be inserted at a distal end 1450c,a of the channel 1448c,a to extend proximally from the second portion 1436c,a through the disk member 1432c,a and the first portion 1428c,a.

[0094] As discussed above, Figures 19-19E show an eccentric coupler 1424c. As shown in the cross-sectional view of Figure 19C, in some embodiments, the channel 1448c of the eccentric coupler 1424c is disposed about the longitudinal axis 1438c of the second portion 1436c. Figures 20-20A show a non-eccentric coupler 1424a. As shown in the cross-sectional view of Figure 20A, in some embodiments, the channel 1448a of the non-eccentric coupler 1424a is disposed about the longitudinal axes 1430a, 1438a of both the first portion 1428a and the second portion 1436a.

[0095] III. Eccentric Adjustable Humeral Head Assembly 2-14C show variations of the components and kits in FIGS. 16-17C. For example, the humeral head assembly that can be formed by connecting a selected one of couplers 924a, 924b, 924c to articulating body 904 results in a single eccentric position, however, articulating body 904 can have other connection features that provide even more options in eccentricity in addition to coupling with discrete positioning sites to provide the configurations of FIGS. 17A-17C. FIGS. 18-20A show an alternative embodiment of a humeral head assembly with adjustable eccentricity. As mentioned above and described in more detail below, the eccentric position is indicated by indicia located on anchor 1500 and can be selected by connecting one of couplers 1424b, 1424c to the articulating body 904. When one is in use, it can be observed through a window which can be rotated to a suitable position on the associated anchor, for example to adjust the eccentric orientation of the coupler.

[0096] The embodiments described below facilitate providing a central or range of eccentric positioning of the humeral head relative to the resected humeral surface. The embodiments described herein can be used for other orthopedic applications, including for providing central or eccentric positioning of the glenosphere on a glenoid or scapular anchor, for providing central or eccentric positioning of the femoral articular body on a femoral anchor, for providing central or eccentric positioning of the tibial articular body on a tibial anchor, or for other orthopedic applications.

[0097] A. Continuous and discrete adjustment of the humeral head 2-11 show an embodiment of a humeral head assembly 100 that allows for adjustment of the eccentricity of the assembly as needed during implantation. FIG. 3 shows that the articular body 104 and the coupler 108 are separable components of the assembly 100. In contrast to couplers 924a, 924b, 924c, coupler 108 is not shown having a disk member similar to disk members 932a, 932b, 932c. In various combinations, coupler 108 can be modified to have a disk member that allows the configuration of humeral head assembly 100 to be used with anchor 830 or anchor 830A described above. The articular body 104 and coupler 108 can be mated in a number of different positions to facilitate adjustment or removal of the eccentricity. As will be described in more detail below, the different positions can include a predefined first position (e.g., central eccentricity, low eccentricity, or high eccentricity as described above in Figures 17A-17C) or positions reached along a continuous range of adjustment by selecting one of one or more discrete positions or by selecting from these adjustment modes. Figures 2, 4 and 5 show a first configuration 120 of the humeral head assembly 100. The first configuration 120 corresponds to a central (or non-eccentric) position. A modified embodiment of the first configuration 120 can include a combination of an articulating body and a coupler 924a having a radial projection 944a aligned at the "+0" position. The articulating body 104 also advantageously allows for further adjustment as will be described in more detail below. Figure 6 shows a second configuration 124 of an embodiment of the humeral head assembly 100. The second configuration 124 corresponds to an eccentric position.

[0098] FIG. 2 shows that the articular body 104 can have an articular surface 126. The articular surface 126 can be convex. The articular surface 126 can be configured to engage with a concave surface of the patient's glenoid or with the patient's glenoid. FIG. 3 shows that the articular body 104 also has an interface 128. The interface 128 is located on a side of the articular body 104 opposite the convex articular surface 126. As shown in FIG. 4, the interface 128 has a continuous area 140 of eccentric adjustment. For example, the shading in FIG. 4 indicates the area 140, which is an area where the articular body 104 can be positioned relative to the coupler 108. The humeral head assembly 100 also has at least one site 160 for discrete positioning of the articular body 104 on the coupler 108. There can be one, two, three, four, five, or more than five sites 160. The discrete positioning sites 160 allow the coupler 108 to connect to the articular body 104 at one or more predefined positions and, when so engaged, prevent relative rotation. In some embodiments, the continuous section of eccentric adjustment 140 and the at least one discrete positioning site 160 are located in the same plane, e.g., a plane transverse to a normal to the center of the articular surface 126. The amount of eccentricity can be selected at the continuous section 140 or the discrete positioning site 160 at the same relative axial position of the coupler 108 and the articular body 104. In some examples, the continuous section of eccentric adjustment 140 is located between the discrete positioning sites 160. FIG. 4 shows the coupler 108 engaged with the articular body 104 at one of the five discrete positioning sites 160.

[0099] 3 and 5 illustrate that the coupler 108 can have a first portion 200 configured to mate with the articulating body 104 and a second portion 204 opposite the first portion 200. 1. In one embodiment, the first portion 200 can be mated with one of the coupling parts 128. The second portion 204 can be mated with another member of the joint prosthesis (e.g., a coupling feature 44 of the humeral stem 30 or a stemless humeral anchor disposed on the surface S of the humerus H). In other applications, the second portion 204 can be mated with another anchor member, for example, at the glenoid or scapula, at the femoral epiphysis, or at the tibial epiphysis. In some embodiments, the coupler 108 is asymmetric such that the second portion 204 has a longitudinal axis that is offset from the longitudinal axis of the first portion 200. As will be described in more detail below, if the humeral head assembly 100 is comprised of an eccentric configuration, such as the second portion 124, this offset can form a lateral offset between the center of the articular body 104 and the longitudinal axis of the second portion 204.

[0100] The articular body 104 can be configured to engage and / or be retained by the coupler 108. In some embodiments, the coupler 108 can engage a coupling portion 128 of the articular body 104 to align or retain the humeral head assembly 100 in a first central (or non-eccentric) configuration 120 or a second eccentric configuration 124.

[0101] 5 and 5A show that the joint 128 can include a first recess 220 disposed within the articular body 104. The first recess 220 can have an open end 221 on a lateral surface 222 of the articular body 104. The lateral surface 222 is the side of the articular body 104 opposite the articular surface 126. The lateral surface 222 faces away from the glenoid cavity when the humeral head assembly 100 is implanted. The first recess 220 can extend to a recess surface 223. The second recess 224 can extend from the recess surface 223 into the articular body 104. The second recess 224 can have a closed end 225 and a diameter d1 that is smaller than the diameter d2 of the first recess 220. In some embodiments, the second recess 224 can be tapered to decrease in diameter over the length of the second recess 224 such that the diameter is smaller adjacent the closed end. The second recess 224 may increase in diameter towards the recessed surface 223 or towards the first recess 220 .

[0102] In some examples, the first portion 200 of the coupler 108 can be secured within the second recess 224 of the articular body 104. In some embodiments, the coupler 108 can include a collar 230 that can be configured to be disposed in the first recess 220. The collar 230 can be located between the first portion 200 and the second portion 204 of the coupler 108, for example, at a proximal end of the first portion 200 or a distal end of the second portion 204. The collar 230 can be used to position the articular body 104 on or across the coupler 108. In some embodiments, the collar 230 can include a protrusion 234 configured to secure the articular body 104 to any one of the discrete positioning sites 160 of the articular body 104. The protrusion 234 extends in a radial direction. The protrusion 234 extends in a plane perpendicular to the longitudinal axis of the coupler 108. The protrusion 234 may circumferentially overlap a radial edge (e.g., a concave portion such as a notch, cavity, or recess) of the coupling portion 128 to fix its rotational position relative to the articular body 104. Figure 4A shows that the protrusion 234 may be configured to extend radially outward of a radially inner portion 235 of a periphery 237 (e.g., a concave portion such as a notch, cavity, recess, etc. disposed in the periphery 237) of the coupling portion 128.

[0103] In some embodiments, when the first portion 200 of the coupler 108 engages the second recess 224 of the articulating body 104, there is a clearance distance 226 between the closed end 225 of the second recess 224 and a top of the first portion 200 such that the top of the first portion 200 does not engage the closed end 225 of the second recess 224. Similarly, in some embodiments, when the collar 230 of the coupler 108 engages the first recess 220 of the articulating body 104, there is a clearance distance 228 between the top (or middle) side 230a of the collar 230 and the recessed surface 223 such that the top (or middle) side of the collar 230 does not engage the recessed surface 223. Also, the coupler 108 may, for example, For example, the articulating body 104 may be engaged with a first engagement configuration that allows relative rotation along the area 140. In the first engagement configuration, the articulating body 104 may simply be placed or positioned on the first portion 200 of the coupler 108. The coupler 108 may be engaged with the articulating body 104 with a second engagement configuration that prevents relative rotation and inadvertent disengagement when an amount of eccentricity (or no eccentricity) is selected. The second configuration may be provided by applying an impact force to the articulating body 104 while holding the coupler 108 generally stationary. The clearance distances 226, 228 are generally larger in the first engagement configuration than in the second engagement configuration due to the impact force, respectively. In the second engagement configuration, the smaller (but non-zero) clearance distances 226, 228 may ensure that the coupler 108 and the articulating body 104 may be coupled with an interference fit, such as a Morse taper.

[0104] 4 shows that the lateral surface 222 of the articular body 104 can have indicia 240A to aid in positioning the articular body 140 on the coupler 108 along the continuous section 140. For example, the continuous section 140 can provide "+1", "+2" and "+3" to indicate progressively greater eccentricity adjustments. In some embodiments, the indicia 240A can correspond to millimeter offsets (e.g., 1 mm, 2 mm, 3 mm offsets, respectively) or simply indicate progressively greater magnitudes. Because the coupler 108 is free to move along the section 140, eccentricity adjustments between a position of 0 mm offset and a position of 4 mm offset can be provided, and positions between the positions shown can be provided, for example, but not limited to, between +1 and +2, e.g., +1.5.

[0105] In some embodiments, the plurality of discrete positioning sites 160 may include radial notches 244 (or other overlapping radially extending edges) that provide discrete eccentric adjustments. In some embodiments, the radial notches 244 are configured to receive the protrusions 234 of the collar 230. The profile, contour, edge, or shape of the radial notches 244 may match or be inverted with the profile, contour, edge, or shape of the protrusions 234, for example, to provide a fixed position. In one embodiment, the notches 244 may be the negative of the protrusions 234, e.g., if the protrusions 234 are convex, the notches 224 may be concave. The concave notches 244 may have a radially inner portion radially outside the protrusions 234. See FIG. 4A and corresponding description. The protrusions 234 may be axially inserted into one of the notches 244 in the illustrated embodiment. The matching or inverted configuration, e.g., contour, edge, or shape, of the projection 234 and notch 244 prevents relative rotation between the coupler 108 and the articulating body 104 when the projection 234 engages the notch 244. For example, as shown in FIG. 4, when the projection 234 is at the +0 indicia at the notch 244, the opposing side 231 of the collar 230 spaced apart from the projection 234 closely abuts or contacts the inner wall of the first recess 220 (adjacent the +4 indicia). Such contact or close abutment and / or the shape of the notch 244 prevents rotation of the coupler 108 within the articulating body 104, except for the coupler 108, so that the projection 234 retracts axially away from the articulating body 104 until the projection 234 moves away from the surface 222. Thus, when any one of the notches 244 receives the projection 234, the coupler 108 is at least radially fixed to the articulating body 104. Such a condition is referred to as the first engagement configuration, as discussed above. In other embodiments, radially oriented detents can be provided between the articulating body 104 and the coupler 108. The radial notches 244 of the discrete positioning sites 160 provide discrete (e.g., "+0", "+1", "+2", "+3", and "+4") eccentric adjustments. The discrete positions corresponding to the discrete positioning sites 160 can be indicated by indicia 240B.In some embodiments, the marks of indicia 240B correspond to millimeter offsets (e.g., 0 mm, 1 mm, 2 mm, 3 mm, and 4 mm offsets, respectively). In contrast to the continuous area 140, the discrete positioning sites 160 provide eccentric adjustment in specific fixed increments and do not allow intermediate positions, e.g., +1.5.

[0106] In one embodiment, one or more radial notches 244 are provided on both sides without surrounding the projection 234. For example, the notches 244 can provide radially extending edges that provide a positive stop at one or both ends of the continuous section 140. In such an embodiment, a position such as +0 or +4 can be identified by rotating the projection 234 by direct circumferential contact with such a notch. For example, in FIG. 4A, the circumferential edge 237 extends between two radially inner portions. One of these two portions can be removed so that a stop is provided at one or more ends of the continuous section of eccentric adjustment. This configuration is explained in detail in FIG. 12A and its description.

[0107] 7-8B show the articular body 104 in more detail. As discussed above, one side of the articular body 104 includes the articular surface 126. In this embodiment, the articular surface is convex in accordance with the anatomical configuration. The articular body 104 has a height 300 and a width 304 configured to provide a good fit in the shoulder joint space. In some instances, the height 300 of the articular body 104 may be between about 10 mm and about 30 mm, between about 13 mm and about 27 mm. In some embodiments, the height of the articular body 104 may be about 13.0 mm, about 16.0 mm, about 18.0 mm, about 19.0 mm, about 27.0 mm, etc. The articular body 104 may be manufactured from a variety of materials, such as CoCr, titanium, pyrocarbon, or other advantageous articular materials, and may include a solid or layered structure.

[0108] FIG. 8A shows the coupling portion 128 in more detail. As described above, the coupling portion 128 includes a first recess 220 in the lateral surface 222. The first recess 220 is configured to receive the first portion 200 of the coupler 108 and the collar 230. In some embodiments, the first recess 220 of the coupling portion 128 is offset from the center 122 of the articular body 104. The first recess 220 of the coupling portion 128 can have an offset between about 1.95 mm and about 2.05 mm, or can be about 1.95 mm, about 2.00 mm, or about 2.05 mm from the center 122 of the articular body 104. FIG. 8B shows that in one example, the longitudinal axis 320 of the second recess 224, which intersects its end 225 and extends perpendicular to the plane of the lateral surface 222, is offset from the center 122 of the articular surface 126 in such a manner or by such an amount.

[0109] In the embodiment shown in FIG. 8A, the continuous section 140 forms an opening configured to accommodate the collar 230, e.g., the protrusion 234 of the collar 230, through a range of eccentric adjustment. The coupling portion 128 can include indicia 240A indicating the amount of eccentricity provided when the protrusion 234 is directed to any of a variety of positions along the continuous section 140 of the coupling portion 128. For example, the coupling portion 128 of FIG. 8A can rotate along the continuous section 140 to provide an eccentric adjustment between 0 mm and 1 mm (indicia between "+0" and "+1" 240A), an eccentric adjustment between 1 mm and 2 mm, inclusive (indicia between "+1" and "+2" 240A), an eccentric adjustment between 2 mm and 3 mm, inclusive (indicia between "+2" and "+3" 240A), and an eccentric adjustment between 3 mm and 4 mm (indicia between "+3" and "+4" 240A). In some embodiments, the continuous section 140 may span an angle α4 providing approximately 122°4′ of movement. In the illustrated embodiment, the eccentric adjustment occurs by providing a relative rotation between the articular body 104 and the coupler 108. When the coupler 108 is placed and held fixed in a humeral, glenoid, scapular, femoral or tibial anchor on the humerus H, glenoid, scapular, femoral or tibial surface S, the rotation of the articular body 104 causes the center 122 of the articular body's articular surface 126 to move across the surface S. Thus, when the center configuration 120 is initially provided in the situation shown in FIG. 1B, the surgeon can provide the eccentric adjustment by rotating the articular body 104 a selected degree of rotation to move the center 122 of the articular surface 126 toward the center 48 of the surface S. Thus, the offset shown in FIG. 1B can be resolved in the second configuration 124 after some eccentric adjustment. In some examples, the continuous section 140 provides an eccentric adjustment of about 90 to about 180 degrees. can be done.

[0110] 8A, each discrete positioning site 160 is located in a corresponding radial notch 244 configured to receive the protrusion 234 of the collar 230. In some embodiments, at least one of the radial notches 244 is circumferentially disposed adjacent a continuous area of ​​eccentric adjustment. Each radial notch 244, in an engaged configuration, can prevent rotation of the articulating body 104 relative to the coupler 108, as described above. The discrete positioning sites 160 correspond to indicia 240B that indicate the amount of eccentricity provided at each discrete positioning site 160. 8A illustrates that the humeral head assembly 100 can be rotated to each of the discrete positioning sites 160 to provide 0 mm of eccentric adjustment (at "+0" indicia 240B), 1 mm of eccentric adjustment (at "+1" indicia 240B), 2 mm of eccentric adjustment (at "+2" indicia 240B), 3 mm of eccentric adjustment (at "+3" indicia 240B), and 4 mm of eccentric adjustment (at "+4" indicia 240B). In some embodiments, the no eccentric position (e.g., at "+0" indicia 240B) is rotationally offset 180 degrees from the maximum eccentric position (e.g., at "+4" indicia 240B).

[0111] In some embodiments, the coupling portion 128 is generally comprised of a continuous section 140. In some instances, the coupling portion 128 is generally comprised of a continuous section 140 having a single discrete positioning site 160, such as at a location corresponding to the central feature 120, e.g., at a "+0" radial notch 244, where such an embodiment includes discrete position indicia 240B.

[0112] In some embodiments, the angle α1 between the "+0" radial notch 244 and the "+1" radial notch 244 is 28°58' or about 28°58'. In some embodiments, the angle α2 between the "+0" radial notch 244 and the "+2" radial notch 244 is 60° or about 60°. In some embodiments, the angle α3 between the "+0" radial notch 244 and the "+3" radial notch 244 is 97°11' or about 97°11'. In some embodiments, the angle α3 between the "+0" radial notch 244 and the "+4" radial notch 244 is 180° or about 180°.

[0113] FIG. 8A illustrates the eccentric adjustment range of 0 mm to 4 mm that can be achieved by engaging the coupler 108 with the continuous section 140 of eccentric adjustment or with at least one discrete positioning site 160 for eccentric adjustment. The continuous section 140 can provide eccentric adjustment through all values ​​in the eccentric adjustment range of 0 mm to 4 mm, while the at least one discrete positioning site 160 provides precise eccentric adjustment at pre-determined values ​​(e.g., 0 mm, 1 mm, 2 mm, 3 mm, and 4 mm). In some embodiments, the coupling 128 is configured to allow the surgeon to adjust the articulating body 104 clockwise or counterclockwise to achieve the desired eccentric adjustment. This aspect can provide ease of use for the surgeon since the articulating body 104 and coupler 108 can be engaged in either orientation.

[0114] 8B illustrates the first recess 220 and the second recess 224 extending into the articular body 104. The first recess 220 can have a height 220h between about 2.669 mm and about 2.769 mm, or about 2.669 mm, about 2.719 mm, about 2.769 mm, etc. As such, the first recess 220 can be formed in or from the outer surface 222 and can form a portion of the coupling portion 128 in the articulating body 104 .

[0115] The second recess 224 can extend from the first recess 220 to the articulating body 104. In some embodiments, the second recess 224 can have a height 224h of about 8.60 mm. The second recess 224 may have a tapered profile such that the diameter 224d decreases as the second recess 224 extends into the articular body 104. The diameter 224d may have a diameter ranging from about 9.195 mm to about 9.235 mm. The second recess 224 may be configured to engage the first portion 200 of the coupler 108 with a Morse taper or other form of interference fit. The tapered walls of the second recess 224 allow the first portion 200 of the coupler 108 to be secured within the articular body 104 such that there is no relative movement between the articular body 104 and the coupler 108, e.g., between the collar 230 and the lateral surface 222. In some embodiments, the longitudinal axis 320 of the second recess 224 may be offset from the center 122 of the articular surface 126. In some embodiments, the offset is disposed between the longitudinal axis 320 of the second recess 224 and the center 122 of the articular surface 126.

[0116] 9-11 show various views of an embodiment of the coupler 108. The first portion 200 of the coupler 108 can be configured to engage with the articular body 104. In some examples, the first portion 200 can have a height 200h between about 7.90 mm and about 8.10 mm, or about 7.90, 8.00 mm, about 8.10 mm. In some embodiments, the first portion 200 can have a diameter 200d at the free end between about 9.205 mm and about 9.235 mm, or about 9.205 mm, about 9.220 mm, about 9.235 mm, etc. In some examples, the diameter 200d at the free end of the first portion 200 is larger than the diameter 224d of the second recess 224 at the end 225, but smaller than the diameter of the recess 224 at the surface 223, such that the first portion 200 can be received and secured within the second recess 224.

[0117] The second portion 204 can be configured to mate with other members of the joint prosthesis (e.g., a coupling feature 44 disposed on the humerus H, glenoid cavity, scapula, femur, or tibia surface S). In some examples, the second portion 204 can have a height 204h between about 11.90 mm and about 12.10 mm, or about 11.90 mm, about 12.00 mm, about 12.10 mm. In some embodiments, the second portion 204 can have a diameter 204d between about 9.205 mm and about 9.235 mm, or about 9.205 mm, about 9.220 mm, about 9.235 mm, etc. In some examples, the diameter 204d can vary over its length in a range from about 9.205 mm to about 9.235 mm.

[0118] The coupler 108 can include a collar 230 at a distal end of the first portion 200. The collar 230 can be configured to fit within the first recess 220 of the articular body 104. In some examples, the collar 230 can have a height between about 2.45 mm and about 2.55 mm, or about 2.45 mm, about 2.50 mm, about 2.55 mm. In some examples, the collar 230 can include a protrusion 234 configured to be retained in one of the radial notches 244 of the at least one discrete positioning site 160 or disposed within or along the continuous range 140, as described above.

[0119] In some examples, the coupler 108 is asymmetric such that the second portion 204 has a longitudinal axis 340 that is different from the longitudinal axis 344 of the first portion 200. The longitudinal axis 340 may be aligned with the center 122 of the articulating body 104 (e.g., when the protrusion 234 is aligned with the +0 portion 160). When so aligned, the assembly 100 provides a non-eccentric alignment, as in FIG. 1A. The longitudinal axis 340 may be offset from the center 122 of the articulating body 104 (e.g., when the protrusion 234 is not aligned with the +0 portion 160). When so offset, the assembly 100 provides an eccentric alignment, as in FIG. 1B. As shown in FIGS. 9-11, The distance between the longitudinal axis 340 of the second portion 204 and the longitudinal axis 344 of the first portion 200 forms an offset OS. In some embodiments, the offset OS can be in the range between about 1.95 mm and about 2.05 mm, or can be about 1.95 mm, about 2.00 mm, or about 2.05 mm.

[0120] In some embodiments, when the coupler 108 engages the articular body 104, the first portion 200 of the coupler 108 is aligned with the longitudinal axis 320 of the second recess 224. As discussed above and shown in FIG. 8B, the longitudinal axis 320 of the second recess 224 is offset from the center 122 of the articular surface 124. In some instances, because the coupler 108 is asymmetric, the longitudinal axis 340 of the second portion 204 may or may not be aligned with the center 122 of the articular surface 124 depending on the alignment of the humeral head assembly 100. As discussed above with respect to FIGS. 2 and 4-5A, when the humeral head assembly 100 is in the center configuration 120, the center 122 of the articular surface 124 may be collinear with the longitudinal axis 340 of the second portion 204. In contrast, as shown in Figure 6, when the humeral head assembly 100 is in the eccentric configuration 124, the longitudinal axis 340 of the second portion 204 is offset from the center 122 of the articular surface 124. The above illustrates that the humeral head assembly 100 can be provided with a variety of eccentric configurations, including the configuration of Figure 1A and the configuration of Figure 1B, thus providing a highly adaptable assembly and reducing the complexity of the surgical kit and any unused components thereof.

[0121] B. Humeral head having multiple continuous adjustment zones - Patents.com 12 and 12A show other embodiments of articular bodies 404, 404A that may form part of a humeral head assembly similar to humeral head assembly 100. The description of articular body 104 and humeral head assembly 100 provided above will not be repeated with respect to the description of articular body 404 and articular body 404A, but those skilled in the art will understand that such description supplements the description below of articular body 404.

[0122] The articular body 404 has a joint 408, as shown in FIG. 12. The joint 408 forms a first recess 420 in the articular body 404. The joint 408 can include a plurality of continuous sections 424 (shaded). The continuous sections 424 can be separated by one or more discrete positioning sites 428. Like the joint 128, each discrete positioning site 428 can include a radial notch 432. In some embodiments, the continuous section of eccentric adjustment 424 and the one or more discrete positioning sites 428 are disposed in the same plane between the lateral surface 222 and an articular surface (not shown, but located opposite the lateral surface 222), e.g., in a plane parallel to the lateral surface 222. In some examples, the continuous section of eccentric adjustment 424 is disposed between the discrete eccentric locations (e.g., the discrete positioning sites 428).

[0123] The coupling portion 408 can be configured to engage the collar 230 of the coupler 108. The plurality of continuous sections 424 form an opening configured to receive the collar 230, e.g., the protrusion 234 of the collar 230, through a range of eccentric adjustment. The coupling portion 408 can include a plurality of indicia 436 indicating an amount of eccentricity provided at various locations along the continuous section 424. At the coupling portion 408, the articulating body 404 can rotate in any direction to engage one of the continuous sections to provide an eccentric adjustment between 0 mm and 1 mm (indicia between "+0" and "+1" 436), an eccentric adjustment between 1 mm and 2 mm, inclusive (indicia between "+1" and "+2" 436), an eccentric adjustment between 2 mm and 3 mm, inclusive (indicia between "+2" and "+3" 436), and an eccentric adjustment between 3 mm and 4 mm (indicia between "+3" and "+4" 436). In some embodiments, one of the continuous sections 424 can provide an eccentricity of at least 90 degrees. In some examples, one of the continuous sections 424 can provide an eccentricity of between about 90 degrees and about 180 degrees.

[0124] In some embodiments, the contiguous region 424 of the plurality of contiguous regions is symmetric. In some embodiments, the contiguous region 424 of the plurality of contiguous regions is asymmetric.

[0125] The embodiment of the coupling portion 408 has two discrete positioning sites 4 on opposite sides of the coupling portion 408. 28. Each of the discrete positioning sites 428 forms a radial notch 432 configured to receive a protrusion 234 of the collar 230. In some embodiments, at least one of the radial notches 432 is circumferentially disposed adjacent to a continuous section of eccentric adjustment. As described above, each radial notch 432 can prevent rotation of the articulating body 404 relative to the coupler 108. To move from one of the notches 432 to the other notch or from one of the notches 432 to one of the continuous sections 424, the coupler 108 must be axially separated from the articulating body 404 such that at least the collar 230 is removed from the first recess 420. In other embodiments, the detent structure can provide mechanical feedback to the user to indicate engagement at the discrete positions, for example, engagement into any of the radial notches 432. Like the continuous section 424, each discrete positioning site 428 may include indicia 436 indicating the amount of eccentricity provided at each discrete positioning site 428. In the embodiment shown in Figure 12, the coupling 408 includes two discrete positioning sites 428, one with 0 mm of eccentricity adjustment (at "+0" indicia 436) and one with 4 mm of eccentricity adjustment (at "+4" indicia 436). In some embodiments, the position of no eccentricity (e.g., "+0" indicia 436) is rotationally offset 180 degrees from the position of maximum eccentricity (e.g., "+4" indicia 436).

[0126] The joint 408 of Figure 12 differs from the joint 128 in that it includes two continuous sections 424. In this embodiment, the surgeon can determine when the articular body 404 is centered on the coupler 108 and when the articular body 104 is at maximum eccentricity (e.g., 4mm) through contact and subsequent engagement with the notches 432 of the discrete positioning sites 360. Between these ranges, the surgeon can freely adjust the position of the articular body 404 relative to the coupler 108.

[0127] FIG. 12A shows the articulating body 404A in more detail. As described, the articulating body 404A is similar to the articulating body 404, except as described differently below. The description of the articulating body 404 and other articulating bodies is intended to supplement the description below and will not be repeated. The articulating body 404A includes a connecting portion 408A. The connecting portion 408A includes a first recess 420 from which the second recess 224 can extend. The first recess 420 can be bounded by multiple sections or wall segments. The first recess 420 can be bounded by one or more continuous sections 424. One or both of the continuous sections 424 can extend to an end formed by a stop 429. FIG. 12A shows that a stop 429 can be provided at each end of the first continuous section 424. The stop 429 may include a curved protrusion that extends to a peak disposed within the first recess 420. The peak of the stop 429 may extend approximately ¼ of the width of the first recess 420 from the continuous region 424 toward the second recess 224. In the illustrated embodiment, two continuous regions 424 are formed on opposite sides of the second recess 224.

[0128] The continuous section 424 may be symmetrical about a line intersecting the stops 429, for example, a line connecting the peaks of the stops 429. In some embodiments, the joints 408A of the articulating body 404A are not symmetrical, so that the indicia 436 are not spaced apart the same amount. FIG. 12A illustrates that the indicia 436 located on a portion of the lateral surface 222 located in a clockwise direction from +0 corresponds to providing an offset of 0, 1, 2, or 3 mm. More specifically, when the protrusion 234 of the coupler 108 advances into the first recess 420 and aligns with the +0 indicia 436, no further offset is provided. When the protrusion 234 advances into the first recess 420 and aligns with the +1 indicia 436, an additional offset of +1 mm is provided. The indicia 436 located on a portion of the lateral surface 222 located in a clockwise direction from +4 corresponds to providing a different range of additional offset. Indicia 436 of this portion of the outer surface 222 allows for further offset adjustment of +1 to +4 mm. Indicates the integral range.

[0129] The stop 429 differs from the radial notches 432 of the discrete positioning sites 428 in that when the protrusion 234 aligns with one of the indicia 436 at the center of the radial notch 432, the protrusion 234 is not enclosed on both sides. Rather, engagement of the protrusion 234 consists of contacting one side of it with one side of the stop 429. The advantage of this is that when the coupler 108 advances into the first recess 420 and the protrusion 234 contacts one of the stops 429, movement away from the offset position provided by this relative position can be accomplished without withdrawing the collar 230 from the first recess 420. Instantaneous relative rotation of the articulating body 404 on the coupler 108 can be provided to move from any of the discrete positions to any other position. Engagement of the protrusion 234 with the stop 429 can be easily verified by tactile methods that do not require any rotational alignment of the protrusion 234 with the notch.

[0130] Yet another variation of the assembly can be provided by modifying coupler 108 to have a concave periphery configured to receive stop 429 or, if not aligned with stop 429, to lie along continuous section 424 in first recess 420. Such a modification provides that, in this variation, both sides of stop 429 can be received within a concave recess of modified coupler 108 such that movement from the discrete position defined by stop 429 to continuous section 424 requires retracting the modified collar of coupler 108 from first recess 420.

[0131] C. Eccentric adjustment in a partially formed interface with a humeral anchor 13A-13C show another embodiment of coupling portion 528. The description of coupling portion 128 above will not be repeated with respect to the description of coupling portion 528, but those skilled in the art will understand that such a description supplements the description of coupling portion 528 below.

[0132] The interface 528 may be located between the articular surface of the articular body (e.g., articular body 104, articular body 404, articular body 804, articular body 804A) and the end of the bone anchor 500. As described above, in some embodiments, the interface may be located on the surface of the articular body (e.g., opposite the convex articular surface). In some embodiments, the interface 528 may be located on the end of the bone anchor 500. In contrast to the bone anchor 830, the bone anchor 500 has a stem and is configured to couple with the anatomical articular body by coupling with the coupler 108. In various combinations, the bone anchor 500 may be modified to have first and second recesses, as described above, to allow the articular body 804 and the articular body 804A to be used with the bone anchor 500 for connection below the resection surface. Although FIGS. 13A-13C show the bone anchor 500 having a stem 530, in some embodiments, the bone anchor may be stemless. Examples of stemless bone anchors are disclosed in US 2016 / 0324648 and US 62 / 368036, the contents of which are incorporated herein by reference in their entireties.

[0133] 13A-13C is similar to the interface 128 of the humeral head assembly 100 disclosed above. However, the interface 408 shown in FIG. 12, 12A, or any other interface disclosed herein may similarly be located on a surface of the bone anchor 500 (e.g., stemmed or stemless).

[0134] The coupling portion 528 forms a first recess 520 in a central face of the stem 530. The coupling portion 528 can include a continuous section 540 and at least one discrete positioning site 560 (shaded view). The coupling portion 528 can include at least one discrete positioning site 560. Similar to the coupling portion 128, each discrete positioning site 560 can include a radial notch 544 or other radially extending edge configured to radially overlap a portion of the coupler, as described below. In some embodiments, the continuous section 540 of eccentric adjustment and and at least one discrete positioning site 560 are disposed in the same plane, e.g., on a flat side, but parallel to the central plane of the stem 530. In some examples, a continuous area of ​​eccentric adjustment 540 is located between the discrete eccentric positions (e.g., the discrete positioning sites 560).

[0135] The coupling portion 528 can be configured to engage a collar 630 of the coupler 608 that can engage with the coupling portion 528. In contrast to couplers 924a, 924b, 924c, as described above with respect to Figures 2-11, coupler 608 is not shown to have a disk member similar to disk members 932a, 932b, 932c. In various combinations, coupler 608 can be modified to have a disk member to allow for the configuration of humeral head assembly 100 to be used with anchor 830 or anchor 830A described above. In such modifications, collar 630 can have the same or a larger diameter than disk members 932a, 932b, 932c. The continuous section 540 forms an opening configured to accommodate collar 630, e.g., protrusion 634 of collar 630, through the eccentricity adjustment range. Coupling portion 528 can include a plurality of indicia 540A indicating the amount of eccentricity provided at various locations along the continuous section 540. Coupler 608 has an eccentricity adjustment between 0mm and 1mm (indicia 540A between "+0" and "+1"), 1m The continuous section 540 can rotate at the coupling 528 to provide eccentricity adjustments between and including 2 mm (indicia between "+1" and "+2" 540A), between and including 2 mm and 3 mm (indicia between "+2" and "+3" 540A), and between and including 3 mm and 4 mm (indicia between "+3" and "+4" 540A). In some embodiments, the continuous section 540 can provide at least 90 degrees of eccentricity. In some examples, the continuous section 540 can provide between about 90 degrees and about 180 degrees of eccentricity.

[0136] One or more of the plurality of discrete positioning sites 560 may include a radial notch 544 configured to receive the protrusion 634 of the collar 630. In some embodiments, at least one of the radial notches 544 is circumferentially disposed adjacent to the continuous section of eccentric adjustment. As described above, each radial notch 544 may prevent rotation of the coupler 608 relative to the coupling portion 528 at the surface of the stem 530. The notch prevents rotation but allows for a first engagement configuration in which the coupler 608 and anchor 500 may be easily separated without being secured with an interference fit. To move from one of the radial notches 544 to the other notch or from one of the radial notches 544 to the continuous section 540, the coupler 608 may be axially separated (e.g., moved relatively centrally) from the central plane of the stem 530 such that at least the collar 630 is removed from the first recess 520. In other embodiments, a portion of the detent structure can be provided to indicate the configuration of rotational engagement to a user. Like the continuous section 540, each of the discrete positioning sites 560 can include indicia 540B indicating the amount of eccentricity provided at each of the plurality of discrete positioning sites 560. In the embodiment shown in Figures 13A-13C, the coupling portion 528 can include four discrete positioning sites 560, namely, at 0 mm of eccentric adjustment (at "+0" indicia 540B), at 1 mm of eccentric adjustment (at "+1" indicia 540B), at 2 mm of eccentric adjustment (at "+2" indicia 540B), at 3 mm of eccentric adjustment (at "+3" indicia 540B), and at 4 mm of eccentric adjustment (at "+4" indicia 540B). In some embodiments, the position of no eccentricity (eg, "+0" indicia 540A) is rotationally offset 180 degrees from the position of maximum eccentricity (eg, "+4" indicia 540A).

[0137] In some embodiments, the first recess 520 of the coupling portion 528 opens to a second recess 524. The second recess 524 can have a smaller diameter than the first recess 520. The second recess 524 can be configured to receive a tapered end of the coupler 608. The tapered end can be similar to the first portion 200 of the coupler 108. In the illustrated embodiment, the tapered end is aligned with the center of the second recess 524. The coupler 608 can be configured to receive a tapered end of the coupler 608. The tapered end can be similar to the first portion 200 of the coupler 108. In the illustrated embodiment, the tapered end is aligned with the center of the second recess 524. 8 protrudes medially from the collar 630. The medial end 632 of the coupler 608 is configured for recess engagement with an articular body which may be similar to the articular body 104. The longitudinal axis of the medial end 632 of the coupler 608 is offset from the tapered end (and from the center of the second recess 524) such that rotation of the coupler 608 along the continuous section 540 or to any of the discrete positioning sites 560 adjusts the amount of eccentricity, if any, to provide centering of the articular body across the resected surface of the humerus, even if the anchor 500 is not centered on the resected surface.

[0138] 14A to 14C show that the above-described embodiment can also be applied to a reverse shoulder assembly. FIG. 14A shows an exploded view of an anchor 500 and a tray 700 for a reverse shoulder assembly. The anchor 500 can have any of the features described above. Additionally, the anchor 500 can have any combination of continuity and locating portions. FIG. 14A shows a notch 544 formed in the first recess 520. Additionally, the anchor 500 includes a second recess 524 that extends further into the anchor 500 from the first recess 520.

[0139] The tray 700 can have a taper 704 protruding from a humerus-facing wall 724 and a recess on an opposite side of the tray 700 from the humerus-facing wall 724. The recess can be defined in part by an inner periphery 712 that is surrounded by a medial wall 716. The tray 700 can be configured to securely hold an articular body (not shown) inserted into the recess in a space surrounded by the medial wall 716. The medial wall 716 can have one or more fins 720 disposed about the medial wall 716. The fins 720, in one embodiment, can be configured to engage an outer wall of the articular body to hold the articular body in place. The articular body has a concave articular surface, as described above.

[0140] 14B shows the tray 700 in more detail. The tray 700 may be symmetrical, e.g., having a circular perimeter about the humerus-facing wall 724. The tray 700 may have a center 728 about which the radius of the circular perimeter is measured. In various advantageous embodiments, the center 728 is located offset from a center 732 of the taper 704. The offset distance between the centers 728 and 732 allows rotation of the tray 700 relative to the anchor 500 to change the position of the tray 700 relative to the resected surface of the humerus (and thereby mate with the articular body). Thus, even if the anchor 500 is offset from the center of the humerus, the tray 700 can be rotated to a position where the center 728 is centered relative to the anchor 500 and is substantially centered or closer to the humerus than the second recess 524 or taper 704. The tray 700 may include protrusions 708 that may be aligned with discrete or continuous sections, as described further below. FIG. 14C shows the opposite side of the tray 700 shown in FIG. 14B. The side shown in FIG. 14C faces the scapula when the tray 700 is implanted and may be referred to as the medial side. The tray 700 includes a wall 730 located opposite the humerus-facing wall 724. The wall 730 and the medial wall 716 at least partially define a recessed space 729 in which a glenoid insert may be placed. In one embodiment, indicia 731 are provided on the medial side, e.g., on the wall 730, to facilitate alignment of the tray 700 relative to the anchor. The indicia 731 on the wall 730 may align with the indicia on the anchor 500 to provide the offset position shown. For example, the protrusion 708 may be located at the +0 position of the anchor 500, and when so located, the +0 marking on the indicia 731 aligns with the +0 on the anchor 500. When the tray 700 is rotated so that the +1 marking on the indicia 731 moves to a horizontal position (which is +0 in FIG. 14C), the surgeon knows that the protrusion 708 aligns with the +1 on the top continuous section of the anchor 500 (as shown in FIG. 14A). When the tray 700 is rotated so that the +2 marking on the indicia 731 moves to a horizontal position, the surgeon knows that the protrusion 708 aligns with the +2 on the top continuous section of the anchor 500. 12 and 12A. When the tray 700 is rotated such that the inverted +1 mark on the indicia 731 moves to a horizontal position, the surgeon knows that the protrusion 708 aligns with the inverted +1 on the bottom of the anchor 500. A visual confirmation on the tray 700 may not require a discrete area (as under the anchor 500), but still provides a convenient visual confirmation. Alternatively, the anchor 500 can be provided with top and bottom continuous areas similar to the arrangement of FIGS. 12 and 12A. Thus, the indicia 731 can provide a visual confirmation of the position of the tray 700 relative to the anchor 500. The visual confirmation allows the surgeon to accurately position the tray 700 and record its position intraoperatively for improved patient medical records.

[0141] A method of implanting a humerus assembly including anchor 500 and tray 700 can include surgically exposing the humerus at the shoulder. The humerus is then resected to create an exposed surface S (see FIG. 1). The anchor 500 can then be placed in the humerus by creating a space for the stemmed anchor in the cancellous bone of the humerus. If a stemless anchor is used, less or no additional bone preparation may be required. After the position of the anchor 500 is placed, if it is determined that some adjustment is required, the tray 700 can be used to provide adjustment of the position of the tray 700 (and associated articular body). For example, the tray 700 can be advanced, as shown by arrow A, to mate with the anchor 500 by advancing the taper 704 into the second recess 524 until the tray 700 is seated on the anchor 500. The tray 700 can be rotationally oriented in either direction of arrow B as the tray 700 is advanced into the first recess 520 and the second recess 524. In one technique, the protrusion 708 is initially aligned with a +0 position such that no further offset is introduced, e.g., the center 728 is aligned with the center of the second recess 524. If an offset is required, the protrusion 708 can be moved to a +1, +2, +3, or any other position in between along the continuous section 540. The protrusion 708 can be moved to any one of the notches 544, e.g., to a +1, +2, +3, or +4 position. The position can be visually confirmed by reference to the indicia 731, as described above. Once alignment is confirmed, the tray 700 can be secured to the anchor 500 by engaging the taper 704 with the wall of the second recess 524, e.g., with a Morse taper connection. The method can include selecting from two continuous adjustment sections in some embodiments of the anchor 500. After the tray 700 is secured to the anchor 500 , the reverse type articulating body can be coupled to the tray 700 , for example, by engaging the fins 720 within the inner wall 716 .

[0142] Although illustrated in FIG. 14A as being coupled to tray 700, anchor 500 can have two recesses, such as anchor 830 or anchor 830A, such that articular body 804A can connect directly to anchor 500 at a proximal recess, such as first recess 842.

[0143] Although anchor 500 is illustrated configured to be implanted in the humerus, anchor 500 can be adapted to be implanted in the glenoid cavity, scapula, femur, or tibia to provide advantageous positioning of the articular body in a central or across a range of eccentric positions, as described herein.

[0144] D. Offset coupler with window to aid in selection of eccentricity configuration 18-20A show yet another embodiment of a humeral head system 1400 having a joint 1532. The description of joint 128 and joint 528 will not be repeated, but one skilled in the art will understand that such description supplements the description of joint 1532 below.

[0145] In some embodiments, as shown in FIG. 18A, the coupling portion 1532 may include a humerus anchor. 1500 on a proximal surface 1504 of a collar 1506. Although a stemless humerus anchor 1500 is shown, in some embodiments, the bone anchor can include a stem. Further examples of stemless bone anchors are disclosed in US 2016 / 0324648 and US 62 / 368036, the contents of which are incorporated herein by reference in their entireties.

[0146] The coupling portion 1532 shown in FIG. 18A is generally similar to the coupling portion 128 and the coupling portion 528 of the humeral head assembly 100 described above. However, as shown in FIG. 18A, the coupling portion 1532 does not include any discrete positioning sites, but instead includes indicia located on the proximal surface 1504 of the collar 1506. In some embodiments, the indicia of the coupling portion 1532 are equally spaced apart on the proximal surface 1504 similar to a clock face. As described above, in some embodiments, each indicia is configured to indicate an orientation. As described above, the humeral anchor 1500 is configured to couple with the coupler 1424 (e.g., one of the couplers 1424a, 1424b, 1424c). The humerus anchor 1500 includes a first recess 1508 configured to receive a disk member 1432 (e.g., one of disk members 1432a, 1432b, 1432c) of a coupler 1424 (e.g., one of couplers 1424a, 1424b, 1424c). As described above, the disk member 1432 (e.g., disk member 1432a, 1432b, 1432c) is adjacent a plate 1440 (e.g., plates 1440b, 1440c) that includes a window 1444 (e.g., window 1444b, 1444c). Like the radial notches described above, the window 1444 can be configured to indicate an eccentric orientation, direction, or configuration relative to the humerus anchor 1500 that is provided when one of the couplers 1424a, 1424b, 1424c is inserted into the humerus anchor 1500. In some examples, when coupler 1424 is inserted into humerus anchor 1500, plate 1440 of coupler 1424 covers all indicia on coupling portion 1532 except for user-selected indicia exposed through window 1444 in plate 1440.

[0147] The mating portion 1532 can be configured to interact with the plate 1440 of the coupler 1424 such that the window 1444 indicates indicia corresponding to an eccentric orientation or configuration relative to the humeral anchor 1500 provided at various positions along the proximal surface 1504 of the collar 1506. FIG. 18A shows that in one embodiment, the rotational orientation indicia includes numbers in a clock face shape to indicate 12 discrete rotational positions. Rotational orientation indicia of this shape are intuitive, and the indicia can be fewer or more numbers, letters, hues, other indicia, or combinations of indicia. In some cases, the joint assembly or component mated with the humeral anchor 1500 is asymmetric such that its rotational position relative to the humeral anchor 1500 changes the biomechanics of the assembly. The indicia on the proximal surface 1504 of the collar 1506 can guide the surgeon in positioning the joint assembly or component. The indicia on the humeral anchor 1500 can be used during testing for joint components or assemblies to indicate a desired position. Then, when the final implant is first placed into the open joint space, the orientation indicated by the indicia can be replicated prior to permanently connecting the final joint component or assembly with the humeral anchor 1500. The indicia and window 1444 primarily allow the surgeon to repeatably orient the eccentricity offset determined during intraoperative testing procedures. For example, if testing indicates an orientation for eccentricity toward the 2 o'clock indicia, the surgeon can replicate this intraoperatively by aligning the window 1444 with the 2 o'clock indicia of the coupling portion 1523. In some embodiments, the amount of eccentricity adjustment can be selected by inserting the coupler 1424 into the second recess 1524 of the humeral anchor 1500.

[0148] Although the humerus anchor 1500 is illustrated as being configured to be implanted in the humerus, the humerus anchor 1500 may also be implanted in the glenoid cavity, scapula, femur, or tibia. The present invention can be adapted to provide advantageous positioning of the articular body in a central or over a range of eccentric positions, as described herein.

[0149] IV. Expandable coupler for connecting an articular body to a bone anchor - Patents.com The embodiments described below provide for coupling the articular body to the humeral anchor using an expandable coupler. The disclosed embodiments can provide improved rotational position control of the components of the humeral head assembly. Additionally, the disclosed non-permanent assemblies can eliminate tolerance stack-up typically associated with conventional connections. Additionally, the next coupler can securely engage the humeral anchor without having to snap the articular body into the humeral anchor. In some instances, the expandable coupler facilitates partial removal of the humeral head assembly, for example, in a revision surgery where an anatomical prosthesis is removed and replaced with a reverse prosthesis.

[0150] The embodiments described below can be used for other orthopedic applications, including for providing an expandable fixation assembly of a glenosphere on a glenoid or scapular anchor, for providing a non-permanent fixation assembly of a femoral articular body on a femoral anchor, for providing a non-permanent fixation assembly of a tibial articular body on a tibial anchor, or for other orthopedic applications.

[0151] A. Expansion coupler having cam disc assembly 21-31 show an embodiment of a coupler 1000 that provides an expandable disk 1003 for coupling the articular body to the humeral anchor. The coupler 1000 includes a cam disk assembly for locking the articular body to the humeral anchor. FIGS. 21-24 show the expandable disk 1003 disposed within a recess 1108 of an anchor 1100. As shown in FIG. 23, the coupler 1000 and the anchor 1100 are separable components. As described in more detail below, the coupler 1000 shown in FIGS. 25-26 can be configured to engage a humeral head and can be removably secured to the anchor 1100 by actuating a cam assembly 1068. FIGS. 27-31 show multiple views of the actuator 1032 and the locking portion 1056 that form the cam assembly 1068. As described in more detail below, the cam assembly 1068 can be actuated (rotated) to lock the coupler 1000 to the anchor 1100.

[0152] 21-24 show an expandable disk 1003 engaged with an anchor 1100. The anchor 1100 can be similar to anchor 830, for example, having a recess 1108 similar to recess 842. The anchor 1100 can include a distal end 1112 and a cylindrical portion 1110 that forms the recess 1108 in a proximal surface 1104 of the anchor 1100. As shown with respect to anchor 830 in FIG. 1A and anchor 830B in FIG. 15, the anchor 1100 is configured to be secured to a resected humerus. In some embodiments, the proximal surface 1104 of the anchor 1100 is flush with the resected humerus such that the cylindrical portion 1110 can secure the base (e.g., second portion 1012) of the coupler 100 in the recess 1108 completely below the surface of the resected humerus. As mentioned above, examples of stemless bone anchors are disclosed in U.S. Provisional Application No. 62 / 740,333, filed October 2, 2018, Attorney Reference Number "TRNXSH.104PR," the entire contents of which are incorporated by reference herein.

[0153] 24, in some embodiments, the second portion 1012 of the coupler 1000 is located within the cylindrical portion 1110 of the anchor 1100. The second portion 1012 can be located such that the first surface 1001 is slightly below or aligned with the proximal surface 1104 of the anchor 1100. In some examples, the second portion 1012 can be located such that the first surface 1001 is slightly above the proximal surface 1104 of the anchor 1100. For example, The anatomic humeral head can be adapted to receive a portion of the second portion 1012 that extends above the proximal surface 1104 of the anchor 1100. In some embodiments, the second surface 1002 of the second portion 1012 is flush with the bottom surface 1111 of the cylindrical portion 1110. As shown in FIG. 24 , having the cylindrical portion 1110 that secures the coupler 1000 at or below the level of the resection allows the base of the first portion 1008 to be positioned at the resection surface such that the anatomic humeral head can couple to the coupler 1000 at or near the same level as the resection.

[0154] In some embodiments (not shown), the expandable disk 1003 can include multiple external engagement portions. The external engagement portions are similar to the external engagement portions 128 shown in FIGS. 32-33 below. The external engagement portions can be configured such that when the expandable disk 1003 is disposed within the cylindrical portion 1110 of the anchor 1100, the external engagement portions can engage with an inner surface of the recess 1108 of the anchor 1100 at a location distal to the second feature 1116 on the inner surface of the cylindrical portion 1110. In some examples, the external engagement portions provide multiple spaced apart, arcuate contact points. This configuration provides a contact area between the outer engagement portions and the inner surface that avoids contact with the second feature 1116 such that these features are not compressed or altered by contact with the external engagement portions. In some embodiments, the external engagement portions are configured to engage the slots 852, e.g., to be disposed within the slots 852. Engagement of the exterior engagement portion with slot 852 (eg, being disposed within slot 852 ) can prevent separation of the assembly due to overlap between the engagement portion and the material forming slot 852 .

[0155] In some examples, the anchor 1100 can include additional connection features. As shown in FIGS. 21-22, in some examples, a plurality of second features 1116 can be formed along an inner surface of the cylindrical portion 1110. These second features 1116 can be configured to provide additional engagement and / or fixation with a portion of the coupler 1000. For example, the second features 1116 can each include a ridge 1120. As described in more detail below, the ridge 1120 of each of the second features 1116 can be configured to engage with an outer surface of the second portion 1012 of the coupler 1000 when the coupler 1000 expands and is fixed within the cylindrical portion 1110 of the anchor 1100. In some embodiments, the second features 1116 are configured to provide rotational stability when the anchor 1100 is exchanged to fix a reverse shoulder joint (e.g., joint body 804A). In other embodiments, as described below, the coupler 1000 can include an expandable disk portion (e.g., expandable disk 1003) configured to be secured to the cylindrical portion 1110. In some examples, the expandable disk portion can include a female geometry or can deform to accommodate a ridge 1120 of a second feature 1116 (not shown). By engaging the ridge 1120 of the second feature 1116 with a female geometry on the expandable disk portion of the coupler 1000, the second feature 1116 can act as an anti-rotation feature.

[0156] 21-26 illustrate that the coupler 1000 can include a first portion 1008 and a second portion 1012. In some embodiments, the first portion 1008 can be configured to engage an articular body of a humeral head assembly, and the second portion 1012 can be configured to be removably secured to a cylindrical portion 1110 of the anchor 1100. As shown in FIGS. 21, 22, 25, and 26, the second portion 1012 of the coupler 1000 can include an expandable disk 1003 having a first slot 1016 and a second slot 1020. The first slot 1016 can include an opening (e.g., a proximal opening 1024 and a distal opening 1028, described below) configured to accommodate a cam assembly 1068. As described in more detail below, the first slot 1016 and the second slot 1020 allow the second portion 1012 of the coupler 1000 to expand in size when the cam assembly 1068 is actuated. In some embodiments, the proximal opening 102 4 can include a plurality of radial notches 1030. As described in more detail below, each radial notch 1030 can be configured to engage a radial protrusion 1054 located on an actuator 1032.

[0157] The coupler 1000 can be configured to receive a cam assembly 1068, as shown in FIGS. 21-24. In some examples, the cam assembly 1068 can include an actuator 1032 and a fixed portion 1056. The actuator 1032 can be configured to rotate relative to the coupler 1000. In some embodiments, the actuator 1032 is retained in the second portion 1012 of the coupler 1000 by the fixed portion 1056. As shown in FIGS. 25 and 26, the coupler 1000 can include a proximal opening 1024 on the first surface 1001 and a distal opening 1028 on the second surface 1002 of the second portion 1012. FIG. 24 illustrates a cross-sectional view of the cam assembly 1068 retained in the second portion 1012 of the coupler 1000. In some examples, the proximal end 1036 of the actuator 1032 is retained in the proximal opening 1024. The actuator 1032 can be secured within the coupler 1000 by engaging the distal end 1044 of the actuator 1032 with the fastener 1056. In some embodiments, a second portion 1064 of the fastener 1056 is retained within the distal opening 1028 of the second portion 1012. The second portion 1064 can be press fit into the distal end 1044 of the actuator 1032 to secure the actuator 1032 in place. In some embodiments, the second portion 1064 can be laser welded or permanently secured to the distal end 1044 of the actuator 1032 to prevent the cam assembly 1068 from being disassembled. In some embodiments, a first portion 1060 of the fastener 1056 is retained within a channel 1048 at the distal end 1044 of the actuator 1032.

[0158] 27-28 show perspective and side views of the stationary portion 1056, while Figures 29-31 show various views of the actuator 1032. Returning first to the stationary portion 1056, in some embodiments, the stationary portion 1056 includes a first portion 1060 and a second portion 1064. In some examples, the first portion 1060 can be cylindrical and have a smaller radius than the second portion 1064.

[0159] 30-31 show that the actuator 1032 can include a proximal end 1036 and a distal end 1044. The proximal end 1036 can include a tool interface 1040 extending through a portion of the proximal end 1036. In some embodiments, the tool interface 1040 is configured to engage a tool such that the actuator 1032 can rotate. As shown in FIGS. 29-30, the tool interface 1040 can have a hexagonal shape. In other embodiments, the tool interface 1040 can have other configurations that allow a tool to engage the actuator 1032, such as at least one flat surface or a non-circular shape. As described above, in some embodiments, the distal end 1044 of the actuator 1032 can be received in the proximal opening 1024 of the coupler 1000. The distal end 1044 can be configured to engage the fastener 1056 such that the actuator 1032 is secured within the coupler 1000 to form a cam assembly 1068. For example, the distal end 1044 can include a channel 1048 extending through the distal end 1044. As described above, a first portion 1060 of the fastener 1056 can engage with the channel 1048 to retain the actuator 1032 within the coupler 1000.

[0160] The actuator 1032 can have an oblong (e.g., oval) shape such that the actuator 1032 is longer along a first axis than along a second axis when the cam assembly 1068 is actuated to lock the anchor 1100 and coupler 1000. In the example shown in FIG. 30, the actuator 1032 is at its widest along the major axis 1052. The actuator 1032 may also include a radial protrusion 1054. In some embodiments, the radial protrusion 1054 extends from an actuation surface disposed on the exterior of the proximal end 1036 of the actuator 1032. In some examples, the radial protrusion 1054 may have an inverse shape to the shape of the radial notch 1030 of the proximal opening 1024. As described below, the inverse shape of the protrusion relative to the notch allows the radial notch 1030 of the proximal opening 1024 to fixedly receive the radial protrusion 1054 of the actuator 1032.

[0161] As discussed above, the coupler 1000 is configured to provide an expandable fixation assembly (e.g., a humeral head assembly) for orthopedic applications. A portion of the coupler 1000 is configured to be fitted to the anchor 1100, the anchor 830, or the anchor 830A and expand / contract so that the outer periphery of the coupler 1000 engages the inner surface or periphery of the recess of the anchor 1100. The anchors 830 and 830A are not further described below, but may be substituted for the anchor 1100 in the description of the use of the coupler 1000. As discussed above with respect to FIG. 22, the expandable disk 1003 of the coupler 1000 includes a first slot 1016 and a second slot 1020. The proximal opening 1024 located on the first surface 1001 of the second portion 1012 is rectangular to accommodate the rectangular profile of the actuator 1032. In some embodiments, as the actuator 1032 rotates, the actuation surface of the proximal end 1036 can force the expansion of the proximal opening 1024 and associated first slot 1016. In some instances, the actuator 1032 can rotate 90 degrees such that the radial protrusion 1054 of the actuator 1032 can be retained in one of the radial notches 1030. In some embodiments, one of the radial notches 1030 can be configured to lock the actuator 1032 in place. The expansion of the proximal opening 1024 and first slot 1016 can cause the second slot 1020 to compress and absorb any expansion provided by the rotation of the actuator 1032. In some embodiments, the expansion of the first slot 1016 and compression of the second slot 1020 can engage the outer periphery of the second portion 1012 of the coupler 1000 with the inner periphery of the recess 1108 of the anchor 1100. In some examples, the ridges 1120 of the second features 1116 can be configured to provide additional engagement points to further secure the coupler 1000 within the anchor 1100. The ridges 1120 can be spaced from an outer surface of the expandable disk 1003 in the second portion 1012 of the coupler 1000 prior to expansion. During expansion, the expandable disk 1003 can expand to an extent equal to or greater than the perimeter that intersects the peaks of the ridges 1120.This can provide interference between the ridge 1120 and the outer periphery of the expandable disk 1003 that improves fixation, if the ridge 1120 is present.

[0162] After the coupler 1000 is secured in place, for example, an anatomical articular body similar to articular body 804 can be secured to the coupler at a first portion 1008 of the coupler 1000 .

[0163] In some embodiments, the coupler 1000 can be separated from the anchor 1100 by rotating the actuator 1032 another 90 degrees so that the rectangular profile of the actuator 1032 realigns with the profile of the proximal opening 1024. In this manner, the actuator 1032 does not further expand the proximal opening 1024 and the first slot 1016 so that the first slot 1016 and the second slot 1020 can return to their original configurations. This allows the expandable disk 1003 of the second portion 1012 to return to its unexpanded configuration.

[0164] In a revision arthroplasty, an anatomical articular body (similar to articular body 804) is configured with an opposing convex articular surface. The coupler 1000 can then be removed by forcing a wedge into the gap between the side of the articular body adjacent to it and the first surface 1001. The wedge can overcome the interference connection between the first portion 1008 and the tapered recess of the articular body such that the articular body is separated from the coupler 1000. The coupler 1000 can then be removed by actuating the projections 1054 out of the radial notches 1030. After the expandable disk 1003 has contracted, the coupler 1000 can be removed.

[0165] In one embodiment, the ridges 1120 of the anchor 1100 are held out of contact with the expandable disk 1003 of the coupler 1000 when the actuator 1032 rotates to expand the expandable disk 1003. A gap extends between the radially inward maximum and the ridges 1120. In a revision procedure, after the anatomical head and the coupler 1000 are removed, a reverse type articulating body similar to the articular body 804A can be inserted into the recess 1108. For example, an interface of a distal portion of the reverse type articulating body similar to the interface 849 can engage with an inner surface of the anchor 1100. The interface can include a surface configured to engage the ridges 1120 with an interference fit. The interface can include a locking device similar to the C-ring 850. In this case, the inner surface disposed around the recess 1108 can include a radially outward channel to accommodate a portion of the C-ring. The interface portion may include a locking device that provides both engagement with a C-ring or other locking device and an interference fit with the interface portion.

[0166] By configuring the coupler 1000 to actuate from an expanded configuration (with the radial projection 1054 engaged in the radial notch 1030) to a smaller configuration (with the radial projection 1054 outside of the radial notch 1030, e.g., aligned with the first slot 1016), the coupler 1000 can be removed from the recess 1108 without exerting excessive force on the anchor 1100. This minimizes the disturbance that is exerted on the reverse type articulating body.

[0167] The anchor 1100 and coupler 1000 allow both the anatomical articular body 804 and the reverse style articular body 804A to couple to the anchor 1100 at the resection surface. The anchor 1100 and reverse style articular body 804A eliminate potential tolerance stack-up that typically occurs with an intervening tray between the reverse style insert and the anchor.

[0168] B. Expansion coupler having screw and tapered extension 21B and 22B show an embodiment of a coupler 1000b similar to coupler 1000 shown in FIGS. 21A and 22A. Coupler 1000b can include an expandable disk 1003b for coupling the articular body to the humeral anchor. Like coupler 1000, coupler 1000b can include an actuator for expanding coupler 1000b to secure the articular body to the humeral anchor. As described in more detail below, the actuator for coupler 1000b includes a screw 1032b adapted to forcibly expand expandable disk 1003b or to contract disk 1003b.

[0169] 21B and 22B show an expandable disk 1003b disposed within a recess 1108 of anchor 1100 or anchor 804. Coupler 1000b and anchor 1100 are separable components. Coupler 1000b can be configured to engage the humeral head and can be removably secured to anchor 1100 by actuating screw 1032b. As described in more detail below, screw 1032b can be actuated (e.g., rotated) to secure coupler 1000b to anchor 1100.

[0170] In some embodiments, the expandable disk 1003b is configured to seat in a recess 1108 of the anchor 1100. As shown in FIGS. 21B and 22B, in some embodiments, the second portion 1012b of the coupler 1000b seats within the cylindrical portion 1110, e.g., a proximal recess of the anchor 1100. The second portion 1012b can be positioned such that the first surface 1001b is slightly below or aligned with the proximal surface 1104 of the anchor 1100. In some instances, the second portion 1012b can be positioned such that the first surface 1001b is slightly above the proximal surface 1104 of the anchor 1100 when an associated humeral head is adapted to receive a portion of the second portion 1012 that extends above the proximal surface 1104 of the anchor 1100. In some embodiments, a second surface (not shown) of the second portion 1012b opposite the first surface 1001b is placed flush with the bottom surface 1111 of the cylindrical portion 1110. Locating the distal-most end of the first portion 1008b at the cutting surface ensures that the anatomical head is flush or nearly flush with the cutting portion when the anatomical head couples to the coupler 1000b.

[0171] The expandable disk 1003b can include a plurality of external engagement portions similar to the external engagement portion 1228 shown in Figures 32-33 below. The external engagement portions can be configured such that when the expandable disk 1003b is disposed within the cylindrical portion 1110 of the anchor 1100, the engagement portions can engage an inner surface of the recess 1108 of the anchor 1100 at a location distal to the second connection feature 1116 on the inner surface of the cylindrical portion 1110. In some examples, the external engagement portions can include a plurality of spaced apart arcuate contact points, further structures and uses of which are described elsewhere herein.

[0172] 21B and 22B show that, like coupler 1000, coupler 1000b can include a first portion 1008b and a second portion 1012b. In some embodiments, the first portion 1008b can be configured to engage an articular body of a humeral head assembly, and the second portion 1012b can be configured to be removably secured to the cylindrical portion 1110 of the anchor 1100. As shown in FIGS. 21B and 22B, the second portion 1012b of coupler 1000b can include an expandable disk 1003b including a first slot 1016b and a second slot 1020b. The first slot 1016b can include an opening (e.g., aperture 1022b, described below) configured to receive a screw 1032b. As described in more detail below, the first slot 1016b and the second slot 1020b allow the second portion 1012b of the coupler 1000b to expand in size as the screw 1032b advances into the expandable disk 1003b. In some embodiments, the screw 1032b can be tapered such that the size, e.g., radius, of the head of the screw 1032b at a first position adjacent the proximal end 1036b is larger than the radius of the head of the screw 1032b at a second position on the head of the screw 1032b distal to the first position. The second position can be on the distal end 1044b of the head of the screw 1032b. In other embodiments, the channel 1028b may be tapered such that the size, e.g., radius, of the opening 1024b at a first location at or adjacent the first surface 1001b is greater than the size, e.g., radius, of the opening 1024b between the first location and an opposing second surface of the expandable disk 1003b (not shown). In further embodiments, both the screw 1003 and the channel 1028b may be tapered. As described in more detail below, the tapering of the screw 1032b or the channel 1028b is configured to allow the expandable disk 1003b of the second portion 1012b to expand and engage the coupler 1000b in the anchor 1100 as the screw 1032b advances into the channel 1028b.

[0173] As described, the coupler 1000b can be configured to receive the screw 1032b. In some embodiments, the screw 1032b can be configured to rotate relative to the coupler 1000b. 2b is held in the second portion 1012b of the coupler 1000b. As shown in FIG. 21B, the coupler 1000b can include an opening 1024b on the first face 1001b and a channel 1028b extending through the body of the second portion 1012b. In some embodiments, the opening 1024b has a larger radius than the channel 1028b. The screw 1032b can be secured within the coupler 1000b by inserting the distal end 1044b of the screw 1032b into the channel 1028b. As described in more detail below, the outer surface of the distal end 1044b of the screw 1032b and the inner surface of the channel 1028b can be threaded such that the external threads of the screw 1032b and the internal threads of the channel 1028b can engage as the screw 1032b rotates into the channel 1028b.

[0174] 21B shows a perspective view of the screw 1032b. As mentioned above, in some examples, the screw 1032b includes a proximal end 1036b and a distal end 1044b. The proximal end 1036b can include a tool interface 1040b configured to engage with a tool such that the screw 1032b can rotate. The tool interface 1040b can have a hexagonal shape, a flat surface, a non-circular shape, or other configuration that allows a tool to drive the screw 1032b.

[0175] The channel 1028b of the second portion 1012b can receive the distal end 1044b of the screw 1032b. The threads on the inner surface of the channel 1028b are configured to engage with the threads on the outer surface of the distal end 1044b. When the screw 1032b is actuated, the threads on the channel 1028b are configured to retain the distal end 1044b within the coupler 1000b.

[0176] As described above, the distal end 1044b of the screw 1032b, the channel 1028b, or both, are tapered. When the screw 1032b is actuated, the expandable disk 1003b of the second portion 1012b expands to engage an inner surface of the anchor 1100. As described above, the coupler 1000b is configured to provide an expandable fixation assembly (e.g., a humeral head assembly) for orthopedic applications. A portion of the coupler 1000b is configured to be fitted to the anchor 1100, anchor 830, or anchor 830A and expand / contract such that the outer periphery of the coupler 1000b engages an inner surface or periphery of a recess in the anchor 830, 830A, 1100.

[0177] As described above with respect to Figures 21B and 22B, the expandable disk 1003b of the coupler 1000b includes a first slot 1016b and a second slot 1020b. An opening 1024b located in the second portion 1012b is configured to receive a screw 1032b. In some embodiments, as the screw 1032b rotates, the screw 1032b can force the opening 1024b and the associated first slot 1016b to expand. The opening 1024b can expand when the screw 1032b or the channel 1028b is tapered.

[0178] In some embodiments, the distal end 1044b of the screw 1032b is tapered. In some examples, the distal end 1044b of the screw 1032b can have a first radius adjacent the proximal end 1036b of the screw 1032b that is greater than a second radius at the distal end of the distal end 1044b. The tapered screw 1032b is configured to engage with the channel 1028b. The channel 1028b has a radius that is smaller than the first radius but is the same as or slightly larger than the second radius. The tapered screw 1032b rotates such that the threads of the distal end 1044b engage the threads of the channel 1028b. In this manner, the tapered screw 1032b advances through the channel 1028b. Because the radius of the channel 1028b is smaller than the second radius of the distal end 1044b of the tapered screw 1032b, as the screw 1032b advances through the channel 1028b When this occurs, channel 1028b expands to accommodate the larger radius of distal end 1044b.

[0179] In other embodiments, the channel 1028b is tapered. In some examples, the channel 1028b has a first radius adjacent the opening 1024b on the first surface 1001b of the second portion 1012b that is greater than a second radius of the channel 1028b between the first surface 1001b and a surface of the second portion 1012b opposite the first surface 1001b. The tapered channel 1028b is configured to accommodate the screw 1032b. In this embodiment, the distal end 1044b of the head of the screw 1032b has a radius that is the same as or smaller than the first radius of the head of the screw 1032b and is greater than the second radius of the head of the screw 1032b. The distal end 1044b of the screw 1032b rotates such that the threads on the distal end 1044b engage with threads disposed (e.g., distally) within the tapered portion of the tapered channel 1028b. In this manner, the distal end 1044b of the screw 1032b advances through the tapered channel 1028b. Advancement of the screw 1032b through the tapered channel 1028b causes the tapered channel 1028b to expand.

[0180] Additionally, the expansion of the channel 1028b corresponds to the expansion of the first slot 1016b. This ultimately allows the second slot 1020b, if present, to compress and absorb at least a portion of the expansion of the second portion 1012b. In some embodiments, the expansion of the first slot 1016b and the compression of the second slot 1020b can engage the outer periphery of the second portion 1012b of the coupler 1000b with the inner periphery of the recess 1108 of the anchor 1100b. The ridge 1120 is generally spaced apart from the coupler 1000b even in the expanded state of the anchor 1100. In some examples, the ridge 1120 of the second feature 1116 can be configured to provide an additional engagement point to further secure the coupler 1000b within the anchor 1100. The ridge 1120 can be spaced apart from the outer surface of the expandable disk 1003 of the second portion 1012 of the coupler 1000b prior to expansion. Upon expansion, the expandable disk 1003b can expand as much as or more than the perimeter that intersects the peak of the ridge 1120. This can provide interference between the ridge 1120 and the perimeter of the expandable disk 1003b that improves fixation, if the ridge 1120 is present.

[0181] After the coupler 1000b is secured in place, for example, an anatomical articular body similar to articular body 804 can be secured to the coupler at a first portion 1008b of the coupler 1000b.

[0182] In some embodiments, coupler 1000b can be separated from anchor 1100 by rotating screw 1032b to retract or withdraw screw 1032b from channel 1028b such that channel 1028b returns to its unexpanded state. This allows expandable disk 1003b of second portion 1012b to return to its unexpanded configuration so that coupler 1000b can be removed.

[0183] In one embodiment, as the expandable disk 1003b expands, a gap extends between the radially inwardmost portion of the ridges 1120 and the expandable disk 1003b of the coupler 1000b. In a reverse configuration, for example in a revision after the anatomical head and coupler 1000b have been removed, the reverse type articulating body 804A can be inserted into the recess 1108. An interface 849 at a distal portion of the reverse type articulating body 804A can engage an inner surface of the anchor 1100. The interface 849 can include a surface configured to engage the ridges 1120 with an interference fit. The interface 849 can include a locking device similar to a C-ring 850. In this case, an inner surface disposed around the recess 1108 can be configured to extend radially outwardly to accommodate a portion of the C-ring. The interface portion 849 may include a locking device that provides both engagement with a C-ring or other locking device and an interference fit with the interface portion.

[0184] By configuring the coupler 1000b to actuate from the expanded configuration to the smaller configuration, the coupler 1000b can be removed from the recess 1108 without applying excessive force to the anchor 1100. This minimizes the disruption that is placed on the reverse type articulating body. The coupler 1000b can be removed without applying a lateral load, such as a wedge tool, between the articulating body 804 and the anchor 1100.

[0185] The anchor 1100 and coupler 1000b allow the anatomical articular body 804 and the reverse style articular body 804A to couple to the anchor 1100 at the resection surface. The direct coupling of the anchor 1100 and the reverse style articular body 804A eliminates potential tolerance stack-up that typically occurs with an intervening tray between the reverse style insert and the anchor.

[0186] C. Expansion coupler having tapered cam and slot assembly 32-43 illustrate a coupler 1200 that provides another embodiment of an expandable coupler for coupling an articular body to a humeral anchor. The coupler 1200 can include a tapered cam and slot assembly for securing the articular body to the humeral head anchor. Similar to the coupler 1000 described above, the coupler 1200 includes an expandable disk 1204 that can be removably secured to the anchor 1100. As shown in FIGS. 32-43, the coupler 1200 differs from the coupler 1000 in that a cam assembly can be disposed within a portion of the coupler that is configured to engage and secure the humeral head assembly (see, for example, first portion 200 of coupler 108 or first portion 1008 of coupler 1000).

[0187] 32-33 show the expandable disk 1204 of the taper cam and slot assembly 1200. In some embodiments, the expandable disk 1204 can be configured to engage with the anchor 1100. Similar to the expandable disk 1003, the expandable disk 1204 can be received within the cylindrical portion 1110 of the anchor 1100. Similar to the coupler 1000, the coupler 1200 can be used with the anchor 830 or the anchor 830A, and those skilled in the art will appreciate that the description of the anchor 830 or the anchor 830A can be substituted for the description of the anchor 1100 below. When positioned within the cylindrical portion 1110, the first surface 1205 of the expandable disk 1204 can be slightly below or aligned with the proximal surface 1104 of the anchor 1100. In some examples, the expandable disk 1204 can be positioned such that the first surface 1205 is slightly above the proximal surface 1104 of the anchor 1100. For example, the associated humeral head can be adapted to receive a portion of the expandable disk 1204 that extends above the proximal surface 1104 of the anchor 1100. In some instances, the second surface 1206 of the expandable disk 1204 is placed flush with the bottom surface (e.g., bottom surface 1111) of the cylindrical portion 1110 of the anchor 1100. As described above, having the cylindrical portion 1110 that secures the expandable disk 1204 at or below the resection level can position the distal end 1244 of the proximal end 1236 of the actuator 1232 at the resection surface such that the distal end 1244 of the proximal end 1236 of the actuator 1232 is flush or nearly flush with the resection surface. The anatomical articular body 804 can be coupled to the expandable disk 1204 directly above the resection surface. For example, a Morse taper can be formed between the articular body 804 and the actuator 1232 of the expandable disk 1204.

[0188] In some embodiments, the expandable disk 1204 can include a number of exterior engagement portions 1228. As described in more detail below, when the expandable disk 1204 is positioned within the cylindrical portion 1110 of the anchor 1100, each exterior engagement portion 1228: The external engagement portion 1228 can be configured to engage an inner surface of the recess 1108 of the anchor 1100 at a location distal to the second feature 1116 on the inner surface of the cylindrical portion 1110. The external engagement portion 1228 can include a plurality of spaced apart arcuate contact points. This configuration provides an area of ​​contact between the outer engagement portion 1228 and the inner surface that avoids contact with the second feature such that these features do not compress or deform upon contact with the external engagement portion 1228. In some embodiments, the external engagement portion 1228 is configured to engage with a slot 852 of the anchor 1100, which can be configured to receive a C-ring 850, as described above. Engagement of the external engagement portion 1228 with the slot 852 can provide a second locking mechanism to prevent separation of the assembly.

[0189] In some embodiments, the expandable disk 1204 includes a tapered coupler configured as an actuator 1232 and an expandable disk that can include a first slot 1208 and a second slot 1212. The first slot 1208 can include an opening (e.g., a proximal opening 1216 and a distal opening 1220) configured to receive a cam assembly 1276. As described in more detail below, when the cam assembly 1276 is actuated in a circumferentially expanded configuration to lock onto the anchor 1100, the first slot 1208 can expand and the second slot 1212 can contract. When the cam assembly 1276 is actuated in a circumferentially contracted configuration to separate the anchor 1100, the first slot 1208 can contract and the second slot 1212 can expand. In some embodiments, the proximal opening 1216 can include a plurality of radial notches 1230. Each radial notch 1230 can be configured to engage a radial protrusion 1246 located on the actuator 1232. Also, in some cases, the actuator 1232 is configured as a taper of the expandable disk 1204 to facilitate connection to the actuator / expandable disk 1204 taper.

[0190] The expandable disk 1204 of the coupler 1200 can be configured to receive a cam assembly 1276, as shown in FIGS. 33 and 36. In some examples, the cam assembly 1276 can include an actuator 1232 and a fixed portion 1264. As described above, the actuator 1232 can be configured to rotate relative to the expandable disk 1204 of the coupler 1200. In some embodiments, the actuator 1232 is retained on the expandable disk 1204 by a second portion 1272. FIG. 36 shows a cross-sectional view of the cam assembly 1276 retained on the expandable disk 1204. As shown, the coupler 1200 can include a proximal opening 1216 on the first side 1205 of the expandable disk 1204 and a distal opening 1220 on the second side 1206 of the expandable disk 1204. A distal end 1244 of the actuator 1232 can be retained within the proximal opening 1216. In some embodiments, the actuator 1232 can be secured within the proximal opening 1216 of the expandable disk 1204 by engaging the distal end 1244 of the actuator 1232 with the fastener 1264. In some examples, a second portion 1272 of the fastener 1264 can be retained within the distal opening 1220 of the expandable disk 1204. In some embodiments, the second portion 1272 of the fastener 1264 can be press fit into the distal opening 1220 of the expandable disk 1204 to secure the actuator 1232 in place. In some examples, a first portion 1268 of the fastener 1264 can be retained within the distal opening 1248 at the distal end 1244 of the actuator 1232.

[0191] 39-41 show various views of the actuator 1232, while Figures 42-43 show perspective and side views of the anchor portion 1264. The actuator 1232 can include a proximal end 1236, a collar 1256, and a distal end 1244.

[0192] The actuator 1232 may include some of the features of the actuator 1032 and the first portion 1008 of the coupler 1000. As such, the actuator 1232 can be configured to engage an articular body of a humeral head assembly. Also, in some embodiments, the proximal end 1236 can include a tool interface 1240 extending through a portion of the proximal end 1236. In some examples, the actuation surface 1240 is configured to engage a tool such that the actuator 1232 can rotate. As shown in FIG. 39 , the actuation surface 1240 can have a hexagonal shape. The actuation surface 1240 can have any shape that allows a tool to engage the actuator 1232, for example, having at least one flat surface or at least one non-circular surface.

[0193] The actuator 1232 can also include a collar 1256 located between the proximal end 1236 and the distal end 1244. In some instances, as shown in FIGS. 32-36, the collar 1256 can have a radius that is larger than the proximal opening 1216, which allows the collar 1256 to rest on a surface of the expandable disc 1204. In some embodiments, the collar 1256 can include a radial protrusion 1260. The radial protrusion 1260 on the collar 1256 can provide for eccentric adjustment of the humeral head assembly, as shown in various embodiments described above. For example, as shown in the embodiments in Figures 2-11 and 16-20, the radial projection 1260 of the collar 1256 can be configured to engage with an engagement portion located on a surface of an articular body of a humeral head assembly (e.g., a humeral head assembly 100 or a humeral head assembly formed from a kit 900) as incorporated into the humeral head assembly 800 of Figures 1A, 1C and the reverse type bearing assembly 800A of Figure 15. In another example, the radial projection 1260 of the collar 1256 can be configured to engage with an engagement portion located on a surface of an anchor as shown in the embodiments in Figures 13A-13C. As described in more detail above, by adjusting an articular body, such as the articular body 804, to engage the radial projection 1260 of the collar 1256 at different positions, the relative position of the articular body with respect to the actuator 1232 can provide different eccentricities to the anchor 830 or the anchor 830A and the humerus to which they are coupled.

[0194] As described above, the distal end 1244 of the actuator 1232 can be received in the proximal opening 1216 of the expandable disk 1204 of the coupler 1200. In some embodiments, the distal end 1244 can have a smaller diameter than the collar 1256 such that the collar 1256 sits over the proximal opening 1216 of the expandable disk 1204. The distal end 1244 can be configured to engage the fastener 1264 such that the actuator 1232 is secured within the expandable disk 1204 to form a cam assembly 1276. For example, the distal end 1244 can include a distal opening 1248 at the distal end 1244. As described above, the first portion 1268 of the fastener 1264 can be adapted to engage the proximal opening 1216 of the expandable disk 1204. The actuator 1232 can engage the distal opening 1248 to retain the actuator 1232. The actuator 1232 can also include at least one radial protrusion 1246. In some embodiments, the radial protrusion 1246 extends from the distal end 1244 and is disposed outside of the distal end 1244 of the actuator 1232. In some examples, the radial protrusion 1246 can have an inverse shape to the shape of the radial notch 1230 of the proximal opening 1216. As described further below, the inverse shape of the protrusion relative to the notch allows the radial notch 1230 of the proximal opening 1216 to fixedly receive the proximal end 1236 of the actuator 1232.

[0195] Similar to coupler 1000, distal end 1244 of actuator 1232 can have a rectangular shape (e.g., oval) configured to secure expandable disk 1204 to anchor 1100 when cam assembly 1276 is actuated. In some embodiments, distal end 1244 of actuator 1232 is longer along major axis 1252 than minor axis 1254. In the example shown in FIG. 40, distal end 1244 of actuator 1232 is longer along major axis 1252 than minor axis 1254. 44 has its perimeter longest along longitudinal axis 1252. As described in more detail below, rotation of actuator 1232 causes longitudinal axis 1252 of actuator 1232 to expand and engage expandable disk 1204 with anchor 1100 (or anchor 830 or anchor 830A).

[0196] 42-43 show an embodiment of a fastener 1264 including a first portion 1268 and a second portion 1272. In some examples, the first portion 1268 can be cylindrical and have a smaller radius than the second portion 1272. The first portion 1268 is configured to be received in the distal opening 1248 of the actuator 1232. The second portion 1272 is configured to be received in the distal opening 1220 of the expandable disk 1204 of the coupler 1200.

[0197] Similar to coupler 1000, coupler 1200 is configured to provide an expandable fixation assembly (e.g., humeral head assembly) for orthopedic applications. The expandable disk 1204 of coupler 1200 is configured to be fitted to anchor 1100 and expand / contract such that a portion of the periphery of expandable disk 1204 (e.g., spaced-apart outer engagement portion 1228) engages with an inner surface or periphery of a recess of anchor 1100. In some embodiments, an inner surface or periphery of a recess of anchor 1100 (e.g., second feature 1116) is configured to be received on outer engagement portion 1228 on an outer surface of expandable disk 1204 such that there is no contact between second feature 1116 and coupler 1200. Expandable disk 1204 of coupler 1200 includes a first slot 1208 and a second slot 1212. The proximal opening 1216 located on the first surface 1205 of the expandable disc 1204 is rectangular to accommodate the rectangular profile of the distal end 1244 of the actuator 1232 .

[0198] In some embodiments, as the actuator 1232 rotates, the actuation surface of the distal end 1244 can force the expansion of the proximal opening 1216 and associated first slot 1208. In some instances, the actuator 1232 can rotate 90 degrees such that the radial protrusion 1246 of the actuator 1232 can be retained in one of the radial notches 1230. In some embodiments, one of the radial notches 1230 can be configured to lock the actuator 1232 in place. The expansion of the proximal opening 1216 and first slot 1208 can cause the second slot 1212 to compress the rotation of the actuator 1232 and accommodate any expansion. In some embodiments, the expansion of the first slot 1208 and compression of the second slot 1212 can engage the outer periphery of the expandable disk 1204 of the coupler 1200 with the inner periphery of the recess 1108 of the anchor 1100. The inner surface of the anchor 1100 can be spaced from the outer periphery of the expandable disk 1204 of the coupler 1200 prior to expansion. In one embodiment, the expanded state of the expandable disk 1204 is not altered by the engagement of the ridges 1120 with the expandable disk 1204, and the outer engagement portion 1228 engages a portion of the inner surface distal to the second feature 1116 such that these features are not contacted by the expandable disk 1204. In another embodiment, upon expansion, the expandable disk 1204 can expand to a size equal to or greater than the periphery intersecting the peak of the ridges 1120. The outer engagement portion 1228 can be located at the location of the ridges 1120. This can provide an interference between the outer periphery of the expandable disk 1204 and the ridges 1120, thereby enhancing fixation when the ridges 1120 are present.

[0199] After the coupler 1200 is secured in place, for example, an anatomical articular body similar to articular body 804 can be secured to the proximal end 1236 of the actuator 1232 .

[0200] In some embodiments, the rectangular profile of the actuator 1232 defines a proximal opening 1 216, the coupler 1200 can be decoupled from the anchor 1100. In this manner, the actuator 1232 does not further expand the proximal opening 1216 and the first slot 1208 so that the first slot 1208 and the second slot 1212 can return to their original configuration. This allows the expandable disk 1204 to return to its unexpanded configuration.

[0201] In a revision procedure, an anatomical articular body (similar to articular body 804) can be removed by forcing a wedge into the gap between the side of the articular body opposite the convex articular surface and the first surface 1205. The wedge can overcome an interference connection between the proximal end 1236 of the actuator 1232 and the tapered recess of the articular body such that the articular body is separated from the coupler 1200. The coupler 1200 can then be removed by actuating the radial projection 1246 out of the radial notch 1230. Once contracted, the coupler 1200 can be removed.

[0202] In one embodiment, the ridges 1120 of the anchor 1100 are held out of contact with the coupler 1200 when the actuator 1232 rotates to expand the expandable disk 1204. A gap extends between the radially inward maximum. In a revision procedure, after the anatomical head and coupler 1200 are removed, a reverse type articular body similar to articular body 804A can be inserted into the recess 1108. Also, as described above, the distal portion of the reverse type articular body can engage the inner surface of the anchor 1100.

[0203] By configuring the coupler 1200 to actuate from an expanded configuration (with the radial projection 1224 engaged in the radial notch 1230) to a smaller configuration (with the radial projection 1246 outside of the radial notch 1230, e.g., aligned with the first slot 1208), the expandable disk 1204 of the coupler 1200 can be removed from the recess 1108 without exerting excessive force on the anchor 1100. This minimizes the disturbance that is exerted on the reverse type articulating body.

[0204] The anchor 1100 and coupler 1200 allow both the anatomical articular body 804 and the reverse style articular body 804A to couple to the anchor 1100 at the resection surface. The anchor 1100 and reverse style articular body 804A eliminate potential tolerance stack-up that typically occurs with an intervening tray between the reverse style insert and the anchor.

[0205] D. Extension coupler with collet lock coupler 44-50 show an embodiment of coupler 1304 that provides another embodiment of an expandable coupler for coupling an articular body to a humeral anchor. Coupler 1304 includes a collet lock coupler for securing the articular body to the humeral anchor. Similar to couplers 1000 and 1200 described above, coupler 1304 is configured to be removably secured to anchor 1100, anchor 830 or anchor 830A.

[0206] As shown in Figures 44-47, the coupler 1304 differs from the couplers 1000 and 1200 described above in that the coupler 1304 is configured to expand without the use of a cam assembly. As described in more detail below, the coupler 1304 includes a tapered opening 1316 configured to accommodate a mating portion of a coupler of a humeral head assembly. For example, the coupler 1304 may be configured to accommodate the second portion 204 of the coupler 108 of the humeral head assembly 100, as shown in Figures 2-6. An exploded view of an example humeral head assembly configured to engage the coupler 1304 is shown in Figure 50 and includes an articular body 104 and a coupler 108 (which may use any of the articular bodies and couplers disclosed herein).

[0207] 32-47 show coupler 1304 engaged with anchor 1100. Like coupler 1000 and coupler 1200, coupler 1304 can be configured to engage anchor 1100. When positioned within cylindrical portion 1110, first surface 1305 of coupler 1304 can be slightly below or aligned with proximal surface 1104 of anchor 1100. In some examples, coupler 1304 can be positioned such that first surface 1305 is slightly above proximal surface 1104 of anchor 1100. For example, an associated humeral head can be configured to receive a portion of second portion 1012 that extends above proximal surface 1104 of anchor 1100. In some embodiments, second surface 1306 of coupler 1304 is positioned flush with a bottom surface (e.g., bottom surface 1111) of cylindrical portion 1110. As described above, by having a cylindrical portion 1110 that secures the coupler 1304 at or below the resection level, the base of the articular body (e.g., articular body 104 in FIG. 2) can be positioned so that the anatomical head is at or near the same height as the resection.

[0208] In some embodiments, the coupler 1304 can include a plurality of exterior engagement portions 1312. As described in more detail below, when the coupler 1304 is disposed in the cylindrical portion 1110 of the anchor 1100, each exterior engagement portion 1312 can be configured to engage with a second feature 1116 on an inner surface of the cylindrical portion 1110. In some embodiments, the exterior engagement portions 1312 are configured to engage with a slot 852 of the anchor 1100, which can be configured to receive a C-ring 850, as described above. Engagement of the exterior engagement portions 1312 with the slots 852 can provide a second locking mechanism to prevent separation of the assembly.

[0209] In some embodiments, the coupler 1304 is an expandable disk that includes multiple flexible sections or living hinges 1308 (hereinafter referred to as "hinges"). FIG. 45, FIG. 48, and FIG. 49 show various views of the multiple hinges 1308 on the coupler 1304. In some embodiments, the coupler 1304 can include multiple hinges 1308 on the first face 1305 and / or the second face 1306 of the coupler 1304. Each of the multiple hinges 1308 can extend between the tapered opening 1316 of the coupler 1304 and the outer periphery of the coupler 1304. In some examples, each of the multiple hinges 1308 is equally spaced apart from one another. For example, each of the multiple hinges 1308 on the first face 1305 can be spaced apart 45° from one another, and each of the multiple hinges 1308 can be spaced apart 45° from one another. More or less than four hinges can be provided on two opposing surfaces of coupler 1304 spaced at greater or lesser equidistant angles. In some embodiments, the multiple hinges 1308 on the first surface 1305 are in a staggered configuration with the multiple hinges 1308 on the second surface 1306.

[0210] 49 illustrates a cross-sectional view of the coupler 1304 to show a cross-section of each hinge 1308. As explained, each of the plurality of hinges 1308 can include a channel 1308a that extends through a portion of the body of the coupler 1304. In some embodiments, the channel 1308a extends sufficiently through the body of the coupler 1304 to form a bend 1308b. As explained in more detail below, the bend 1308b allows the channel 1308a of each hinge to be wider or narrower.

[0211] In some embodiments, the coupler 1304 can include a tapered opening 1316. The tapered opening 1316 can extend through the coupler 1304. As described above, the tapered opening 1316 is configured to accommodate a second portion of the coupler of the humeral head assembly. FIGS. 46-47 show top and bottom views of the coupler 1304 inserted into the anchor 1100. As shown in FIG. 47, in some embodiments, the anchor 1100 includes an opening 1128 that extends through the distal end 1112 of the anchor 1100. The opening 1128 can overlap the tapered opening 1316 such that a second portion of the coupler can extend through both of the coupler 1304 toward the opening 1128 of the anchor 1100. The opening 1128 can be used to connect the anchor 1100 to a stem by any one of the techniques disclosed in Application No. PCT / US2017 / 028470, also published as WO2017 / 184792. The tapered opening 1316 can have a radius that decreases as it extends between the first surface 1305 and the second surface 1306. As described in more detail below, the decrease in radius of the tapered opening 1316 allows the coupler 1304 to expand and engage an inner surface of the recess 1108 of the anchor 1100.

[0212] Like the coupler 1000 and the tapered cam and slot assembly 1200, the coupler 1304 is configured to provide an expandable fixation assembly (e.g., a humeral head assembly) for orthopedic applications. A portion of the coupler 1304 is configured to fit over the anchor 1100 and expand / contract such that the outer periphery of the coupler 1304 engages with an inner surface or periphery of a hinge 1308 of the anchor 1100. In some embodiments, the inner surface or periphery of the recess of the anchor 1100 is configured to engage with an outer engagement portion 1312 on an outer surface of the coupler 1304. As described above, the coupler 1304 includes a plurality of hinges 1308 on a first surface 1305 and a second surface 1306 of the coupler 1304. The tapered opening 1316 is configured to receive a portion of a coupler of a humeral head assembly (e.g., the coupler 108 of the humeral head assembly 100). In some embodiments, the entrance to the tapered opening 1316 on the first face 1305 has a radius that is the same as or slightly larger than the radius of the portion of the coupler configured for insertion into the coupler 1304 (e.g., the second portion 204).

[0213] In some embodiments, when a coupler is inserted into the coupler 1304 (e.g., the second portion 204 of the coupler 108), the tapered opening 1316 can expand such that the radius of the tapered opening 1316 is the same as the radius of the inserted coupler (e.g., the second portion 204 of the coupler 108). The expansion of the tapered opening 1316 can force the channel 1308a of each of the multiple hinges 1308 to widen. In some embodiments, the expansion of the tapered opening 1316 can expand the channel 1308a in the first face 1305 of the coupler 1304 and contract the channel 1308a in the second face 1306. The expansion of the channel 1308a in the first surface 1305 and the contraction of the channel 1308a in the second surface 1306 are configured to allow a portion of the coupler of the humeral head assembly (e.g., the coupler 108 of the humeral head assembly 100) to enter the tapered opening 1316 of the coupler 1304. The expansion of each of the hinges 1308 can engage the outer periphery of the coupler 1304 with the inner periphery of the recess 1108 of the anchor 1100. In some examples, the ridges 1120 of the second feature 1116 and the outer engagement portion 1312 of the coupler 1304 can be configured to provide additional engagement points to further secure the coupler 1304 within the anchor 1100. The ridges 1120 can be spaced from the outer surface of the coupler 1304 prior to expansion. During expansion, the coupler 1304 can expand to a size equal to or greater than the size of the periphery intersecting the peaks of the ridges 1120. This can provide interference between the outer periphery of coupler 1304 and ridge 1120, thereby enhancing fixation when ridge 1120 is present.

[0214] FIG. 50 illustrates that after the coupler 1304 is secured in place, an anatomical articular body, similar to the articular body 104, for example, can be secured adjacent to the first surface 1305 of the coupler 1304.

[0215] In some embodiments, the coupler 1304 can be separated from the anchor 1100 by pulling the coupler of the humeral head assembly from the tapered opening 1316. In this manner, the coupler of the humeral head assembly (e.g., the second portion 204 of the coupler 108) does not allow the tapered opening 1316 to expand any further so that each of the plurality of hinges 1308 can return to its original configuration, thereby allowing the coupler 1304 to return to its unexpanded configuration.

[0216] In a revision procedure, the anatomical articular body (similar to the articular body 804) can be removed by forcing a wedge into the gap between the side of the articular body opposite the convex articular surface and the first surface 1305. The wedge can overcome the interference connection between the tapered opening 1316 of the coupler 1304 and the articular body 104, 804 such that the humeral head assembly 100 is separated from the coupler 1304. The coupler 1304 can then be removed as it contracts.

[0217] In one embodiment, the ridges 1120 of the anchor 1100 are held out of contact with the coupler 1304 when the coupler 1304 is in the expanded configuration. A gap extends between the radially inwardmost portions of the ridges 1120. In a revision procedure, after the anatomical head and coupler 1304 are removed, a reverse type articular body similar to articular body 804A can be inserted into the recess 1108. Also, as described above, a distal portion of the reverse type articular body can engage the inner surface of the anchor 1100.

[0218] By configuring the coupler 1304 to actuate from an expanded configuration (with the humeral head assembly coupler (e.g., second portion 204 of coupler 108) inserted) to a smaller configuration (with the humeral head assembly coupler (e.g., second portion 204 of coupler 108) outside of the tapered opening 1316), the coupler 1304 can be removed from the recess 1108 without applying excessive force to the anchor 1100. This minimizes the disturbance caused to the reverse articular complex.

[0219] The anchor 1100 and coupler 1304 allow both the anatomical articular body 804 and the reverse style articular body 804A to couple to the anchor 1100 at the resection surface. The anchor 1100 and reverse style articular body 804A eliminate potential tolerance stack-up that typically occurs with an intervening tray between the reverse style insert and the anchor.

[0220] V. Method for assembling and disassembling a humeral head and reverse-type bearing assembly The described humeral head assembly 800 and humeral head assembly 800A allow surgeons to treat a greater variety of patient anatomies with a kit that has fewer components than previously possible. The anchor 830 of the humeral head assembly 800 and humeral head assembly 800A is configured to accommodate a portion of the glenoid body below the humeral resection surface. The anchor 830 is also configured to allow surgeons to accommodate a greater variety of patient soft tissues and invert the glenoid surface of the shoulder. Although the following method is described with respect to the humerus, the humeral head, reverse bearing assembly, anchors, and couplers as described herein can be utilized in other orthopedic applications, such as implanting a glenosphere in a joint cavity, a femoral body in the femoral epiphysis (e.g., for hip or knee surgery), or a tibial body in the tibia epiphysis for joint surgery.

[0221] The method of assembling the humeral head assembly 800 and the reverse bearing assembly 800A may include first resecting the humerus at the superior or proximal end of the humerus. The resection may be performed using a surgical guide. The surgeon may be provided with one or more sizing disks to determine the size of the metaphysis. The sizing disks may be configured to facilitate visualization of the space between the implant to be placed and the cortical border of the bone. During preparation of the glenoid or other surgical stages not involving preparation of the humerus, an appropriately sized cut protector may be provided on the resected surface.

[0222] A method of assembling the humeral head assembly 800 can include selecting an appropriately sized reamer for the resected humerus. As shown in FIG 51, the reamer 1610 is configured to create a generally concave recess surface S in the resected humerus.

[0223] The method of assembling the humeral head assembly 800 may include inserting an appropriate anchor. After reaming, an appropriate anchor may be selected for insertion into the resected surface S of the prepared humerus. FIGS. 52A-52B show anchors 830 and 830A, respectively, inserted into the recessed surface S of the resected humerus. The anchor 830 in FIG. 52A is described above in FIG. 1A as part of the humeral head assembly 800. As shown in FIG. 52A, the anchor 830 may be configured to occupy more space within the resected humerus. The anchor 830A in FIG. 52B is described above in FIG. 15 as part of the humeral head assembly 800B. As shown, in FIG. 52B, the anchor 830A may be configured to occupy less space within the resected humerus than the anchor 830. As described above, both anchors 830 and 830A are configured to couple with either the articular body 804 of the humeral head assembly 800 or the reverse articular body 804A of the reverse bearing assembly 800A. The two anchors 830, 830A include a receiving portion that can receive any of the couplers 924a, 924b, 924c or a portion of the reverse articular body 804A below the resection level of the humerus. The anchors 830, 830A eliminate a separate intermediate connector, such as a tray, between the anchors 830, 830A and the body 804A.

[0224] A method of assembling the humeral head assembly 800 can include mating the components of the humeral head assembly 800 with either the anchor 830 or the anchor 830A shown in FIGS. 52A-52B. As shown in FIG. 53, an impactor 1650 can be configured to engage the coupler 1630 and the articular body 1440 with the inserted anchor. The coupler 1630 can be any of the couplers 924a, 924b, 924c. The coupler 1630 can include any of the couplers of FIGS. 19-20A. The coupler selected is based on the patient's anatomy. In some embodiments, based on the patient's anatomy, if a centered, non-eccentric configuration is required, the coupler 924a can be selected to provide the first configuration 922a. In some instances, if a low eccentric configuration is required, the coupler 924b can be selected to provide the second configuration 922b. In some embodiments, if a highly eccentric configuration is desired, coupler 924c can be selected to provide third configuration 922c. As described above, because the inserted anchors 830, 830A have recesses below the resected humerus surface S, the impactor 1650 can engage the components of the humeral head assembly 800 such that the articular bodies 804, 904 are flush with the resected humerus surface S.

[0225] In other embodiments, the couplers 924a, 924b, 924c can be fitted to the articulating body 1640 at the back table rather than on the patient in the operating room, for example.

[0226] Prior to engagement with the articulating body 904, the first portion (one of first portions 928a, 928b, 928c) is inserted into the second recess 916. The first alignment feature (e.g., one of radial projections 944a, 944b, 944c) may be aligned with the second alignment feature (e.g., one of notches 920). Upon alignment of the first and second alignment features, the relative positions of indicia (see FIG. 16A) on the articulating body 904 can be used to provide proper positioning.

[0227] In another embodiment, the method of assembling the humeral head assembly includes engaging the articular bodies with a coupler. The method may include first engaging the coupler with the anchor before engaging the coupler with the anchor. For example, as described above with respect to Figures 18-20A, the eccentricity of any one of the couplers 1424a, 1424b, 1424c may be adjusted relative to the humeral anchor 1500 before the articular body 1404 is attached. As shown in Figure 18A, the first portion 1428 of the coupler 1424 (any one of the first portions 1428a, 1428b, 1428c of the couplers 1424a, 1424b, 1424c) is inserted into the second recess 1524 of the humeral anchor 1500 before engaging the articular body 1404. A first alignment feature (e.g., window 1444 of one of couplers 1424a, 1424b, 1424c) may be aligned with a second alignment feature (e.g., any indicia on interface 1532 on proximal surface 1504 of collar 1506 of humeral anchor 1500) before any one of couplers 1424a, 1424b, 1424c is secured to humeral anchor 1500. Upon alignment of the first alignment feature and the second alignment feature (e.g., indicia on interface 1532 of humeral anchor 1500 are shown in window 1444 of coupler 1424), the relative position of indicia on interface 1532 of humeral anchor 1500 (see FIG. 18A ) can be used to provide proper positioning.

[0228] The method of assembling the humeral head assembly 800 may also include removing the humeral head assembly 800 from the anchors 830, 830A and inserting the reverse bearing assembly 800A such that the shoulder articular surface is inverted. Removing the humeral head assembly may include disconnecting one or more couplers 924a, 924b, 924c from the corresponding articular body or anchor 500, 830, 830A. For example, as shown in FIG. 17C, each coupler 924a, 924b, 924c includes a threaded channel 956. As described above, the threaded channel 956 may be configured to receive and / or thread a tool (e.g., a rod) or, in some cases, a tool similar to the coupler separator 1800 described below, such that a load may be applied to disassemble the couplers 924a, 924b, 924c from the anchors 830, 830A. In some embodiments, the articular body 904 can first be removed from the coupler 924 (e.g., one of the couplers 924a, 924b, 924c). Once the articular body 904 is removed, a first end of a tool (e.g., a threaded rod such as the coupler separator 1800) can be inserted into the threaded channel 956 from the top surface of the disc members 932a, 932b, 932c such that the tool advances from a proximal to a distal direction (e.g., from the first portion 928a, 928b, 928c toward the second portion 936a, 936b, 936c). In some embodiments, the tool is rotated to advance through the threaded channel 956 such that the tool exits the bottom surface of the disc members 932a, 932b, 932c. As the tool exits the bottom surface of the disc members 932a, 932b, 932c, the end of the tool engages the anchor 500, 830, 830A and further rotation of the tool applies a load to the surface of the anchor 500, 830, 830A to separate the coupler 924 (e.g., one of the couplers 924a, 924b, 924c) from the anchor 500, 830, 830A. In other embodiments, the coupler 924 (e.g., one of the couplers 924a, 924b, 924c) with the attached articular body 904 can first be separated from the anchor 830, 830A.Once the anchor 500, 830, 830A is removed, a first end of the tool (e.g., a threaded rod) is inserted into the threaded channel 956 from the bottom surface of the disc members 932a, 932b, 932c such that the tool advances from a distal to a proximal direction (e.g., from the second portion 936a, 936b, 936c toward the first portion 928a, 928b, 928c). In some embodiments, the tool is rotated to advance through the threaded channel 956 so that the tool exits the top surface of the disc members 932a, 932b, 932c. As the tool exits the top surface of the disc members 932a, 932b, 932c, the end of the tool engages a side of the articular body 904 to separate the coupler 924 (e.g., one of the couplers 924a, 924b, 924c) from the articular body 904. Alternatively, the assembly method of the humeral head assembly 800 may include a reverse articulation from the anchors 830, 830A to provide an anatomical configuration. This may include the steps of removing the body 804A and inserting the humeral head assembly 800.

[0229] 54-57C illustrate another embodiment of a method for removing the humeral head system 1400 from the humeral anchor 1500. As described above with respect to the humeral head assembly 800, removing the humeral head system 1400 from the humeral anchor 1500 can include first disengaging one of the couplers 1424a, 1424b, 1424c from the humeral anchor 1500 or first disengaging one of the couplers 1424a, 1424b, 1424c from the articular body 1404. FIGS. 55A-55B illustrate an embodiment in which the articular body 1404 is first removed from one of the couplers 1424a, 1424b, 1424c. 57A-57C show that one of the couplers 1424a, 1424b, 1424c is then removed from the humeral anchor 1500. As shown in FIG.

[0230] 54 illustrates a prying tool 1700 that can be configured to remove the articular body 1404 of the humeral head system 1400 from an attached coupler 1424. For purposes of this description, reference to the coupler 1424 can refer to any one of the couplers 924a, 924b, 924c. The prying tool 1700 can include a distal end 1710 and a proximal end 1720. In some examples, the proximal end 1710 of the prying tool 1700 forms a wedge portion 1730 that is attached to a distal end of a shaft 1740. In some embodiments, the wedge portion 1730 of the distal end 1710 of the prying tool 1700 can include an opening 1732 between a plurality of arms 1734. 54, the opening 1732 and the plurality of arms 1734 can form any shape capable of receiving and engaging the disk member 1432 and ledge 1442 of the coupler 1424, although the opening 1732 can form a "U-shape." In some instances, the wedge portion 1730 increases in thickness as it extends from the distal end 1710 toward the proximal end 1720. As described in more detail below, the increase in thickness of the wedge portion 1730 (e.g., resulting in a sloped surface on the top surface of the wedge portion 1730) provides a mechanical advantage by reducing the force required to be applied to the opposite end of the wedge portion 1730 to separate the articular body 1404 from the coupler 1424. In some embodiments, the wedge portion 1730 has a triangular cross-section. Additionally, the shape of the wedge portion 1730 allows the distal end 1710 of the wedge portion 1730 to be fitted between the coupler 1424 and the humeral anchor 1500 .

[0231] 55A-B show cross-sectional views of the insertion of a prying tool 1700 to separate the humeral head system 1400 and the articular body 1404 from the coupler 1424. As shown in FIG. 55A, the distal end 1710 of the wedge portion 1730 of the prying tool 1700 can be inserted into the gap 1446. As described above, the triangular or wedge shaped cross-section of the wedge portion 1730 separates the articular body 1404 from the coupler 1424 as the prying tool 1700 advances towards the coupler 1424. As the thicker portion of the wedge portion 1730 advances towards the coupler 1424, the articular body 1404 is pushed away from the proximal face 1504 of the collar 1506 to separate the articular body 1404 from the coupler 1424. In some embodiments, the angled ledge 1442 of the coupler 1424 can be configured to engage and correspond with the angled surfaces of the arms 1734 of the wedge portion 1730. In some examples, once a user has advanced the prying tool 1700 with the shaft 1740 between the articular body 1404 and the humeral anchor 1500 to engage the coupler 1424, the user may press the prying tool 1700 against the articular body 1404 to separate the first portion 1428 of the articular body 1404 from the coupler 1424. A load can be applied downward on the shaft 1740 to apply an upward force on the body 1404. As shown in FIG. 55B, in some embodiments, while the coupler 1424 is in the anchor 1500, the articular body 1404 can be removed from the first portion 1428 of the coupler 1424 such that the proximal end 1449 of the channel 1448 is exposed.

[0232] Alternatively, in some embodiments, the prying tool 1700 can be configured to remove the coupler 1424 from the humeral anchor 1500. In some examples, a user can advance the prying tool 1700 between the articular body 1404 and the humeral anchor 1500 with the shaft 1740 to engage the coupler 1424. Due to the wedge configuration, advancement of the wedge portion 1730 in the gap between the anchor 1500 and the prying ledge 1442 creates a medially directed force that can separate the coupler 1424 from the anchor 1500. If desired, the user can then load the shaft upward to apply a downward force to the articular body 1404, creating a more medially directed force that can separate the coupler 1424 from the humeral anchor 1500. In some embodiments, the articular body 1404 can be removed from the second portion 1436 of the coupler 1424 to expose the distal end 1450 of the channel 1448. In some instances, this provides the user with the coupler 1424 attached to the humeral head system 1400, as shown in FIG.

[0233] FIG. 56 illustrates a coupler separator 1800 that can be configured to be inserted into the channel 1448 of the coupler 1424. For purposes of this description, reference to the coupler 1424 can refer to any one of the couplers 924a, 924b, 924c. The coupler separator 1800 can include a distal end 1810 and a proximal end 1820. In some examples, the coupler separator 1800 includes an elongated shaft 1840, a tapered portion 1830, and an actuation portion 1850. In some embodiments, the elongated shaft 1840 of the coupler separator 1800 is located at the distal end 1810 of the coupler separator 1800. The elongated shaft 1840 can include a distal portion 1846, a proximal portion 1842, and a threaded portion 1844 extending between the distal portion 1846 and the proximal portion 1842. In some examples, the actuating portion 1850 of the coupler separator 1800 is located at the proximal end 1820 of the coupler separator 1800. As described in more detail below, the actuating portion 1850 can be grasped by a user to rotate the coupler separator 1800 to engage the threads 1844 with the threads 1452 of the channel 1448. In some examples, the tapered portion 1830 can extend between the elongate shaft 1840 and the actuating portion 1850. In some examples, the tapered portion 1830 can increase in diameter distally.

[0234] 57A-C show cross-sectional views of the coupler 1424 attached to the humerus anchor 1500 and the insertion of a coupler separator 1800 to separate the coupler 1424 from the humerus anchor 1500. As shown in FIG. 57A, the distal end 1810 of the coupler separator 1800 can be inserted into the channel 1448. In some embodiments, the distal portion 1846 of the elongate shaft 1840 can be advanced distally through the proximal end 1449 and the threaded portion 1452 until the distal end of the threaded portion 1844 engages the threaded portion 1452. In some examples, upon engaging the threaded portion 1844 with the threaded portion 1452, a user can rotate the actuation portion 1850 of the coupler separator 1800 such that the coupler separator 1800 rotates to engage the threaded portion 1844 with the threaded portion 1452. As the coupler separator 1800 rotates, it continues to advance the distal portion 1846 via the distal end 1450 towards the bottom of the second recess 1524. FIG. 57B shows an end of the coupler separator 1800, with the central length omitted for clarity. When in the position of FIG. 57B, the coupler separator 1800 can be rotated until the leading edge or tip of the threaded portion 1844 of the elongated shaft 1840 advances through the threaded portion 1452 of the channel 1448. When the tip of the threaded portion 1844 of the elongated shaft 1840 advances through the threads 1452 of the channel 1448, the distal end of the distal section 1846 engages the base of the second recessed portion 1524, the proximal section 1842 of the elongated shaft 1840 extends through the proximal end 1449 and a portion of the channel 1448, and the distal end of the tapered section 1830 advances into a portion of the proximal end 1449. As the coupler separator 1800 rotates such that the tip of the threaded portion 1844 moves through the channel 1448, the rotational force pushes the second portion 1436 of the coupler 1424. 15. The coupler 1424 is spaced from the second recess 1524. This allows the coupler 1424 to be separated from the humeral anchor 1500 so that the coupler 1424 can be removed from the humeral anchor 1500. As described above, in some embodiments, the second recess 1524 is tapered. Thus, movement of the second portion 1436 from the base of the second recess 1524 allows the coupler 1424 to be loosened from the humeral anchor 1500. In some embodiments, the tapered portion 1830 can limit how far the coupler separator 1800 advances through the channel 1448. Once the second portion 1436 is retracted from the second recess 1524, the coupler 1424 can be removed from the humeral anchor 1500, as shown in FIG. 57C.

[0235] Alternatively, in some embodiments where the humeral anchor 1500 is first removed from the coupler 1424 and the articular body 1404 is attached from the coupler 1424, the distal end 1810 of the coupler separator 1800 can instead be inserted through the distal end 1450 of the channel 1448. In some embodiments, the distal end 1810 of the coupler separator 1800 can be inserted into the distal end 1450 of the channel 1448. In some examples, the distal portion 1846 of the elongate shaft 1840 can be advanced distally through the distal end 1450 and the threads 1452 until the distal end of the threads 1844 engages the threads 1452. In some embodiments, a user can rotate the actuation portion 1850 of the coupler separator 1800 such that when the threads 1844 engage the threads 1452, the coupler separator 1800 rotates to engage the threads 1844 with the threads 1452. As the coupler separator 1800 rotates, the coupler separator 1800 continues to advance the distal portion 1846 through the proximal end 1449 and toward the upper or end wall of the second recess 1416 of the humeral head system 1400. In some embodiments, the coupler separator 1800 can be rotated until the tip of the threads 1844 of the elongate shaft 1840 advances through the threads 1452 of the channel 1448. As the threaded portion 1844 of the elongated shaft 1840 advances through or past the threaded portion 1452 of the channel 1448, the distal end of the distal section 1846 engages the top wall of the second recess 1416, the proximal section 1842 of the elongated shaft 1840 extends through the distal end 1450 and a portion of the channel 1448, and the distal end of the tapered section 1830 advances into the portion of the distal end 1450. As the coupler separator 1800 rotates such that the threaded portion 1844 moves through the channel 1448, an axial force along the longitudinal axis of the channel 1448 pushes the first portion 1428 of the coupler 1424 away from the second recess 1416. This allows the coupler 1424 to be separated from the articular body 1404 so that the coupler 1424 can be separated from the articular body 1404. As mentioned above, in some embodiments, the second recess 1416 is tapered.Thus, moving the first portion 1428 away from the top of the second recess 1416 allows the first portion 1428 to loosen from the humeral anchor 1500. In some examples, the tapered portion 1830 can limit how far the coupler separator 1800 advances through the channel 1448. Once the first portion 1428 is pushed out of the second recess 1416, the articular body 1404 can be removed from the coupler 1424, as described with respect to FIG.

[0236] Previously, commercial systems offered kits with pre-assembled multiple articulation / coupler combinations, thus allowing for fewer components, a simpler system, and a lower cost to treat a wider range of patients.

[0237] term Although specific embodiments are described herein, the implants and methods described herein may be used interchangeably with any articular component, depending on the context.

[0238] As used herein, the relative terms "proximal" and "distal" should be defined from the perspective of the implant. Thus, proximal refers to the direction of the articular component and distal refers to the direction of the implant. "Anchor" refers to the orientation of an anchor component, such as the stem, threads, porous surface of a humeral anchor, or other anchor structure of a stemless anchor, when the anchor is assembled.

[0239] Conditional language such as "can," "could," "could," or "may," unless otherwise specified or understood differently within the context in which it is used, is generally intended to convey that certain embodiments include certain features, elements, and / or steps, while other embodiments do not. Thus, such conditional language is generally not intended to imply that features, elements, and / or steps are in any way required for one or more embodiments.

[0240] Terms such as "comprising," "having," and the like are synonymous and are used inclusively in an open-ended manner and do not exclude additional elements, features, acts, operations, etc. Additionally, the term "or" is used in an inclusive (not exclusive) sense, so that, for example, when used to connect a list of elements, the term "or" may mean one, some, or all of the elements of the list. Additionally, as used in this specification and the appended claims, "a," "an," and "the" should be construed to mean "one or more" or "at least one," unless expressly indicated otherwise.

[0241] Ranges disclosed herein also include all overlaps, subranges, and combinations thereof. Language such as "up to," "at least," "greater than," "less than," "or" is inclusive of the referenced number. Numbers preceded by the terms "about" or "approximately" are inclusive of the referenced number and should be interpreted accordingly (e.g., as precisely as reasonably possible under the circumstances, e.g., ±5%, ±10%, ±15%, etc.). For example, "about 1" includes "1". Phrases preceded by terms such as "substantially," "generally," and the like are inclusive of the referenced phrase and should be interpreted accordingly (e.g., as reasonably possible under the circumstances). For example, "substantially spherical" includes "spherical." Unless otherwise specified, all measurements are made at standard conditions, including temperature and pressure.

[0242] As used herein, a phrase referring to "at least one" in a list of items refers to any combination of those items, including single members. For example, "at least one of A, B, or C" is intended to include A, B, C, A and B, A and C, B and C, and A, B and C. Connective language such as the phrase "at least one of X, Y, and Z" is understood differently in the context in which it is generally used to convey that an item, term, etc. may be at least one of X, Y, or Z, unless otherwise noted. Thus, such connective language is generally not intended to imply that a given embodiment requires at least one of X, at least one of Y, and at least one of Z to be present, respectively.

[0243] While specific embodiments and examples are described herein, it should be emphasized that many variations and modifications may be made to the humeral head assembly shown and described in this disclosure, and it is understood that these elements may be combined and / or modified differently to form further embodiments or acceptable examples. Such modifications and variations are intended to be within the scope of this disclosure. A wide variety of designs and approaches are possible. No feature, structure, or step described herein is essential or required.

[0244] Some embodiments are described in conjunction with the accompanying drawings. However, it should be understood that the drawings are not drawn to scale. Distances, angles, and the like are merely exemplary and do not necessarily relate to the actual size and layout of the depicted devices. Components may be added, removed, and / or rearranged. It should be noted that the disclosure herein of any particular feature, aspect, method, property, characteristic, quality, attribute, element, etc., of various embodiments may be used in all other embodiments described herein. Furthermore, the disclosures herein may be used in conjunction with any of the features, aspects, methods, properties, characteristics, qualities, attributes, elements, etc., of various embodiments. It will be understood that any method disclosed may be performed using any apparatus suitable for performing the recited steps.

[0245] For purposes of this disclosure, certain aspects, advantages, and novel features are described herein. It is to be understood that not all such advantages may necessarily be achieved in accordance with any particular embodiment. Thus, for example, one skilled in the art will recognize that the disclosure can be made or carried out in a manner that achieves one advantage or group of advantages as taught herein, without necessarily achieving other advantages that may be taught or suggested herein.

[0246] Also, while exemplary embodiments are described herein, those skilled in the art will understand that the scope of the present invention may be extended beyond the specifically disclosed embodiments in any embodiment having equivalent elements, modifications, omissions, combinations or subcombinations of specific features and aspects of the embodiments (e.g., aspects across various embodiments), as well as adaptations and / or modifications of the present invention and uses that may be understood by those skilled in the art based on this disclosure. The limitations of the claims must be interpreted broadly based on the language used in the claims, and not limited during the examination of the examples or applications described herein, and the examples must be interpreted as non-limiting. Also, the operations of the disclosed processes and methods may be modified in any manner, including rearranging operations and / or inserting additional operations and / or deleting operations. Accordingly, it is intended that the specification and examples be considered as merely exemplary, with the true scope and spirit being indicated by the full scope of the claims and their equivalents.

[0247] Any method disclosed herein does not have to be performed in the order recited. The methods disclosed herein include predetermined actions performed by a physician, but may also include any third party instruction of those actions, either explicitly or implicitly. For example, an action such as "inserting the humeral stem into the humerus" includes "instruction of inserting the humeral head into the humerus."

Claims

1. an articular body including a convex articular surface and a joint portion, the joint portion being disposed on a side of the articular body opposite the convex articular surface; a coupler including a first portion configured to mate with the joint and a second portion opposite the first portion configured to mate with another member of a joint prosthesis, The coupler is configured to provide a fixed rotational position between the articular body and the coupler to provide a selected degree of offset of the articular surface to other members of a joint prosthesis.

2. The humeral head system of claim 1 , wherein the coupler includes an offset window disposed between first and second portions of the coupler.

3. 3. The humeral head system of claim 2, wherein the coupler includes a plate extending transversely to the second portion, and the offset window includes a slot formed in the plate configured to expose indicia indicative of a magnitude of eccentricity of the articular body relative to other members of the articular prosthesis.

4. 4. The humeral head system of claim 3, further comprising a humeral anchor including other components of the joint prosthesis, the humeral anchor including eccentric indicia, the slot exposing different indicia at different rotational positions of the coupler relative to the humeral anchor, the rotational positions being changed by rotation about a longitudinal axis extending through a second portion of the coupler.

5. 2. The humeral head system of claim 1, wherein the coupler includes a threaded channel extending from a first end surface of the coupler to a second end surface of the coupler, the channel providing access to a surface of one or both of the articular body and other members of the articular prosthesis.

6. The humeral head system of claim 5 , wherein the threaded channel is formed through first and second portions of the coupler.

7. 2. The humeral head system of claim 1, wherein the coupler includes a prying ledge including an inclined surface disposed between the first portion and the second portion, the prying ledge responsive to an applied radial load to transmit a longitudinal force along a longitudinal axis of the first portion or the second portion of the coupler.

8. 8. The humeral head system of claim 7, wherein the prying ledge extends radially between a disk member of the coupler and a periphery of the coupler, the prying ledge being accessible from the periphery of the humeral head system when the humeral head system is fully assembled.

9. The humeral head system of claim 1 , wherein the articular body includes a recess that includes the interface portion.

10. The humeral head system of claim 9 , wherein the recess includes a central axis that is offset from a central axis of the convex articular surface of the articular body.

11. The humeral head system of claim 9 , wherein the recess includes a tapered profile.

12. a first portion of the coupler including a protrusion configured to align with the recess; The humeral head system according to claim 9.

13. 13. The humeral head system of claim 12, wherein the protrusion is an axial protrusion and further includes a radial protrusion, and at least one discrete positioning site includes a radial notch, and the radial protrusion is configured to align with the radial notch to define an eccentric adjustment amount.

14. The humeral head system of claim 13 , wherein the interface of the articular body includes a radial notch.

15. 2. The humeral head system of claim 1, wherein the coupler includes a disk member having a first surface configured to align with a recess in another member of a joint prosthesis and a second surface opposite the first surface configured to be positioned at or adjacent an exposed surface of the other member.

16. 2. The humeral head system of claim 1, further comprising at least one discrete positioning site disposed between the coupler and the convex articular surface, the discrete positioning site providing a fixed rotational position between the articular body and the coupler.

17. The humeral head system of claim 16, wherein the at least one discrete positioning site includes a single radial notch for connection between a connector and the articular body.

18. The humeral head system of claim 1 , wherein a side of the articular body opposite the convex articular surface includes indicia indicating orientation.

19. 2. The humeral head system of claim 1, wherein the coupler includes an annular projection spaced apart from a surface of the coupler configured to face a side of the articular body opposite the convex articular surface, the annular projection configured to engage a radial notch of the coupling portion in a single rotational orientation.

20. The humeral head system of claim 1 , wherein the first portion of the coupler includes a tapered projection that couples with the articular body with an interference fit.

21. The humeral head system of claim 1 , wherein the second portion is tapered.

22. The humeral head system of claim 1 , wherein the second portion includes an expandable disk configured to engage an inner periphery of a recess in a bone anchor.

23. 13. A kit including the humeral head system of claim 1, The coupler includes a first coupler having a first offset between a first coupling portion and a second coupling portion; a second coupler, the second coupler including either a second offset or no offset between the first coupling portion of the second coupler and the second coupling portion of the second coupler, the second offset being different from the first offset.

24. an articular body including an articular surface; a bone anchor including a proximal surface and a distal end configured to be inserted into a bone; an interface including a recessed area in an articular body disposed between the articular surface and a distal end of the bone anchor; 1. A coupler comprising: a first portion adapted to mate with a joint at a selected rotational position; and a second portion opposite the first portion, the second portion being adapted to rotate the articulating body relative to the bone. and a coupler configured to directly or indirectly couple with the anchor.

25. The glenoid component of claim 24 , wherein the second portion of the coupler includes an expandable disk configured to be received in a recess in a proximal surface of the bone anchor.

26. 26. The articular component of claim 25, wherein the expandable disc includes a slot having an actuator disposed therein, the actuator having a first position relative to the slot corresponding to a smaller perimeter configuration of the expandable disc and a second position relative to the slot corresponding to a larger perimeter configuration of the expandable disc.

27. 27. The articulating component of claim 26, wherein the actuator includes a rectangular perimeter configured to rotate within a rectangular opening in the expandable disc, the first position corresponding to a long axis of the rectangular perimeter being aligned with a long axis of the rectangular opening and the second position corresponding to a long axis of the rectangular perimeter being oriented transversely to the long axis of the rectangular opening.

28. 27. The articulating component of claim 26, wherein the actuator includes a threaded member configured to mate with a threaded recess in the expandable disc, the first position corresponding to a less advanced position of the threaded member in the threaded recess and the second position corresponding to a more advanced position of the threaded member in the threaded recess.

29. 29. The glenoid component of claim 28, wherein the threaded member includes a first tapered surface and the threaded recess includes a second tapered surface, the first position being provided prior to engagement of the first and second tapered surfaces and the second position being provided upon engagement of the first and second tapered surfaces.

30. 27. The articulating component of claim 26, wherein a first portion of the coupler has an end configured to be inserted into the slot, the end of the first portion including one or more protrusions configured to be inserted into the slot, the one or more protrusions aligned with the slot in the first location and transverse to the slot in the second location.

31. 27. The articulating component of claim 26, wherein a first portion of the coupler has an end configured to be inserted into the slot, the end of the first portion being tapered, the slot having a tapered recess disposed therealong, and the first position being a less advanced position and the second position being a more advanced position.

32. 27. The glenoid component of claim 26, wherein the slot is a first slot and further comprises a second slot, wherein in a larger perimeter configuration, the first slot is wider and the second slot is the same width or narrower.

33. The glenoid component of claim 25, wherein the expandable disc includes a plurality of spaced apart contact points.

34. 26. The articulating component of claim 25, wherein the coupler includes a window that provides for viewing of offset indicia formed at or opposite the joint.

35. engaging a coupling portion of the further component of the joint implant with an end of a coupler of the joint implant; The end engages with a coupling portion of another component of the joint implant, providing relative rotation between an end of the coupler and an attachment portion of another component of the joint implant along a continuous range of rotational positions; selecting an eccentricity amount corresponding to a position within the continuous range of rotational positions; and securing another component of the joint implant to the end of the coupler at the selected eccentricity.

36. 36. The method of claim 35, wherein engaging an end of the coupler further comprises advancing an offset window disposed through a portion of the coupler adjacent to an offset indicia formed on another component of the joint implant, and verifying that an observation aperture is aligned with a selected one of a plurality of the offset indicia to select an amount and / or direction of eccentricity when providing relative rotation.

37. 37. The method of claim 36, wherein the other component includes a humeral anchor and the offset indicia is formed on an exposed surface thereof.

38. exposing a periphery of the humeral prosthesis such that a gap between the articular body and the humeral anchor is accessible; advancing a prying tool into the gap; further advancing the prying tool against a prying ledge formed on a coupler disposed between the articular body and the humeral anchor until contact is made with a prying ledge; applying a radial load to the prying ledge with an end of the prying tool, the prying ledge being at an angle to a direction of application of the radial load, The method of disassembly of a humeral prosthesis, wherein the radial load results in an axial load that separates the articular body from the humeral anchor.

39. advancing an elongate shaft through a channel formed in the coupler, the channel extending between a first end of the coupler engaged with the articulation body and a second end of the coupler opposite the first end; the elongate shaft engaging the coupler and an end thereof engaging a surface of an articular body; 40. The method of claim 38, further comprising providing a counterload against the coupler and the articular body by the elongate shaft to separate the articular body from the coupler.

40. 40. The method of claim 39, wherein the step of engaging the elongate shaft with the coupler includes engaging external threads of the elongate shaft with internal threads of the coupler.

41. advancing an elongate shaft through a channel formed in the coupler, the channel extending between a first end of the coupler and a second end of the coupler opposite the first end, the second end engaging the humeral anchor; the elongate shaft engaging the coupler and an end thereof engaging a surface of the humeral anchor; and providing a counterload to the coupler and the humeral anchor by the elongated shaft to separate the coupler from the humeral anchor.

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