Glenoid implant component and instrument therefor

Abstract

To provide a glenosphere handling tool, which can be an inserter, which includes an elongate body and a retention portion.SOLUTION: A retention portion is disposed at a distal end of an elongate body. The retention portion includes a plurality of wall segments of the elongate body separated from each other by one or more slots. The slot(s) extends proximally from the distal end of the elongate body. The retention portion also includes an enlarged periphery at the distal end of the elongate body. The enlarged periphery comprises a proximally facing edge configured to engage an inner wall surface of a glenosphere. The retention portion is configured such that, when the retention portion is in a free state a proximally facing edge faces a surface of a glenosphere and contacts a surface of a glenosphere to retain the glenosphere. The retention portion is configured to be deflected at the distal end of the elongate body such that the enlarged periphery has a reduced outline to separate a handling tool from the glenosphere.SELECTED DRAWING: Figure 1

Description

[Technical field]

[0001] INCORPORATION BY REFERENCE TO PRIORITY APPLICATION This application claims priority to U.S. Provisional Application No. 63 / 200,288, filed February 26, 2021. Any and all applications for which a foreign or domestic priority claim is set forth in an Application Data Sheet submitted with this application are hereby incorporated by reference under 37 CFR 1.57. [Background technology]

[0002] The present application is directed to glenoid implant components and instruments for handling, delivering, and / or implanting glenoid implant components, such as convex glenoid components (e.g., glenospheres) and / or glenoid base plates during shoulder arthroplasty procedures.

[0003] 2. Description of Related Art Shoulder arthroplasty is the standard of care for treating advanced shoulder disorders such as severe arthritis. Shoulder arthroplasty can replicate the anatomy of the joint with a spherical component attached to the proximal humerus and a concave surface attached to the glenoid region of the scapula. Certain patients benefit from reverse shoulder reconstruction with a spherical component attached to the scapula and a concave surface placed on the proximal humerus.

[0004] The spherical component may be supported on a baseplate that is fixed to the scapula. The baseplate may be rotationally symmetric or rotationally asymmetric. If the baseplate is rotationally asymmetric, the surgeon may attempt to implant the baseplate in a particular rotational orientation.

[0005] The surgical procedure to install the baseplate may include coupling the baseplate to an instrument for positioning the baseplate on the scapula. This surgical procedure may be followed by a step of installing the spherical component onto the baseplate. It is desirable to reduce the complexity and time required for these surgical steps. Surgical tools for handling, delivering, and / or implanting the glenoid components must be easy to use and provide placement precision, thereby improving patient outcomes. Summary of the Invention [Problem to be solved by the invention]

[0006] Thus, there is a need for improved surgical tools for the manipulation and implantation of glenoid baseplates, as well as for the manipulation and press-fit of glenospheres and other arthroplasty glenoid bodies.

[0007] In one embodiment, an inserter is provided for coupling a glenosphere to a base plate disposed in or on a human scapula. The inserter has a handle assembly having a proximal end and a distal end. The handle assembly also includes an outer elongate body, an inner elongate body, and an actuator. The outer elongate body extends between the proximal end and the distal end. The inner elongate body extends between the proximal end and the distal end. The inner elongate body is slidably disposed within the outer elongate body. The inner elongate body has a lumen disposed therethrough and a deflectable tip disposed at a distal end thereof. An actuator is configured to slide the inner elongate body relative to the outer elongate body to extend the deflectable tip from a retracted position, e.g., relative to the distal end of the outer elongate body. The deflectable tip is deflected within the cavity of the glenosphere. The glenosphere is configured to apply a force, e.g., a radially outward and / or proximal force, to the glenosphere.

[0008] In another embodiment, a glenosphere inserter is provided that includes an outer assembly, an inner assembly, a lumen disposed through the inner elongate body, and an actuator. The outer assembly has an outer elongate body, a handle disposed at a proximal portion of the glenosphere inserter, and an impaction tip at a distal portion of the glenosphere inserter. The inner assembly has an inner elongate body and a deflectable distal portion. The inner elongate body is slidably disposed within the outer elongate body. A lumen is disposed through the inner elongate body and the deflectable distal portion disposed at a distal end thereof. The actuator is configured to slide the inner elongate body relative to the outer elongate body to extend the deflectable distal portion distally from the impaction tip. The deflectable distal portion is configured to deflect within the cavity of the glenosphere and apply a force to the glenosphere toward the handle of the outer assembly.

[0009] In another embodiment, a glenosphere handling tool is provided that includes an elongate body and a retainer. The elongate body has a proximal end and a distal end. The retainer is disposed at the distal end of the elongate body. The retainer includes a plurality of wall segments of the elongate body separated from one another by a slot. The slot extends from a proximal end of the slot to a distal end of the slot at the distal end of the elongate body. The retainer also includes an enlarged periphery at the distal end of the elongate body. The enlarged periphery includes a proximally facing edge configured to engage an inner wall surface of the glenosphere. The retainer is configured such that when the retainer is in a free state, the proximally facing edge faces a surface of the glenosphere and can contact the surface of the glenosphere to retain the glenosphere. The retainer is configured to be deflected at the distal end of the elongate body such that the enlarged periphery has a reduced profile to separate the handling tool from the glenosphere.

[0010] In another embodiment, a method of handling a glenosphere is provided. A glenosphere is provided having a convex articular surface, a concave interior space, and an opening providing access from the convex articular surface to the concave interior space. A tip of an elongate member of a handling tool is extended through the opening while a distal portion of the tip is in a lower profile configuration. The tip of the elongate member is actuated such that its proximally facing surface has a greater profile than the opening. A proximal force is applied to the glenosphere to hold it against the tip of the handling tool.

[0011] In another embodiment, a glenoid base plate is provided that includes a base plate and an anchor member. The anchor member can extend from a medial side of the base plate. The anchor member can be configured to be embedded in the scapula on the medial side of the glenoid surface of the scapula. The glenoid implant includes a lumen disposed through the anchor member. The lumen extends from a lateral portion to a medial portion. The lumen can extend completely from lateral to medial. The lumen can provide access to a glenosphere inserter tool control member, such as a surgical wire. The glenosphere inserter tool control member can be advanced from a side of the glenoid implant, e.g., a side of the base plate, to the medial side of the glenoid implant, e.g., the medial side of the anchor member. In some variations, the lumen can extend from lateral to medial, terminating in a blind hole. The glenoid implant can have a set screw preassembled with the glenosphere. The set screw can have a lumen disposed therethrough, e.g., from lateral to medial. The set screw may provide access to the lumen of the anchor member of the glenoid implant.

[0012] In another embodiment, an instrument for implanting a glenoid base plate is provided. The instrument may include a first end, a second end, and an elongate body disposed therebetween. The instrument may include a glenoid implant disposed at or adjacent the first end. The glenoid implant retaining mechanism may include a release configuration for disengaging the glenoid baseplate and a retaining configuration for engaging and retaining the glenoid baseplate. The instrument may include a rotation guide. The rotation guide may include a circumferential body. The circumferential body may include an inner periphery, an outer periphery, and an orientation mechanism. The orientation mechanism may be located outside the inner periphery, e.g., within a thickness of the circumferential body, or adjacent to or on the outer periphery. The orientation mechanism may be configured to align with a location corresponding to the augmented portion of the glenoid baseplate. The location corresponding to the augmented location of the glenoid baseplate may be the same location as the augmented location on the periphery of the glenoid baseplate. The location corresponding to the augmented location of the glenoid baseplate may be at an angular offset from the augmented portion, the offset may be determined preoperatively. The inner periphery may be configured to be disposed around the glenoid implant retaining mechanism when the glenoid implant retaining mechanism is in the retaining configuration. The instrument may include a baseplate inserter.

[0013] In one or more variations, the access gap can be located from the outer periphery to the inner periphery to allow passage of the elongate body of the instrument transversely to the longitudinal axis of the elongate body.

[0014] In one or more variations, the orientation feature comprises an open channel disposed on the periphery. The orientation feature can comprise a distal protrusion configured to engage a guidewire. The distal protrusion can comprise an open channel facing away from the peripheral body. In one or more variations, the distal protrusion comprises a sealed opening.

[0015] The inner periphery may be configured to be slidable over the glenoid implant retaining mechanism when the glenoid implant retaining mechanism is in the released configuration. The inner periphery may be secured to the glenoid implant retaining mechanism when the glenoid implant retaining mechanism is in the retained configuration.

[0016] In one or more variations, the inner periphery of the rotation guide comprises a contour configured to match an outer shape of the glenoid implant retention feature. A proximal surface of the inner periphery of the rotation guide can comprise a distally-facing conical surface. A distal portion of the inner periphery can comprise a lip configured to be positioned over a distal edge (e.g., a distally-facing edge) of the glenoid implant retention feature.

[0017] In one or more variations, the inner circumference of the rotation guide can include serrations configured to engage an outer surface of the glenoid implant retention mechanism. The serrations can be, for example, a continuous peripheral edge of serrations disposed continuously around a central space of the rotation guide. The inner circumference of the rotation guide includes a continuous circumference. The serrations can extend continuously and along the entire continuous circumference.

[0018] In one or more variations, the inner periphery is configured to be positioned anywhere over a continuous range of positions on the glenoid implant retention feature.

[0019] In one or more variations, the rotation guide has a sleeve with a collet portion. The sleeve and collet portion are disposed proximally of the peripheral body. The collet portion of the sleeve is configured to engage an outer surface of the elongate body distal from the glenoid implant retention mechanism. The rotation guide may also include a clamping ring. The clamping ring may be provided with internal threads. The sleeve may have external threads, e.g., a threaded outer surface, configured to engage with the clamping ring. The collet portion may have an outer tapered surface. In use, advancing the clamping ring along the external threads, e.g., the tapered surface, creates a frictional engagement between an inner surface of the collet portion of the sleeve and the elongate body of the instrument. The internal threads of the clamping ring engage with the external threads as the clamping ring is advanced due to engagement between the internal threads and the external threads, It is configured to create an enhanced force, and possibly compression, of the collet portion of the sleeve against the exterior surface of the elongate body.

[0020] In another embodiment, an instrument for implanting a glenoid baseplate is provided. The instrument includes an elongate body having a first end, a second end, and disposed therebetween. The instrument includes an expandable glenoid implant retention mechanism disposed at or adjacent the first end. The expandable glenoid implant retention mechanism includes an expandable retention end portion for expanding into engagement with the glenoid baseplate in an expanded state. The instrument includes a rotation guide including a perimeter body. The perimeter body includes an inner surface, an outer surface, and an orientation mechanism disposed adjacent to or on the outer surface. The inner surface is configured to constrain rotation of the rotation guide about the glenoid implant retention mechanism when the glenoid implant retention mechanism is expanded.

[0021] In at least one variation, a lip is disposed on a distal portion of the rotation guide to constrain proximal-distal movement of the rotation guide relative to the glenoid implant retention mechanism. In use, the instrument may be advanced in a lateral-medial direction. Thus, proximal-distal may correspond to lateral-medial in use.

[0022] In another embodiment, a method is provided for aligning a rotationally asymmetric glenoid component to a patient's glenoid. The patient's glenoid is exposed. A pin is placed in or adjacent to the glenoid of the scapula. The rotationally asymmetric glenoid component is coupled to a glenoid component inserter. A rotation guide is coupled to the glenoid component inserter. After coupling the rotation guide to the glenoid component inserter, the rotation guide is rotationally positioned to align the rotation guide with the augmented portion of the rotationally asymmetric glenoid component. The rotationally asymmetric glenoid component is advanced onto the glenoid by referencing an orientation feature of the rotation guide to anatomical structures at or adjacent to the glenoid to align the rotationally asymmetric glenoid component relative to the glenoid in a prescribed rotational orientation for the patient. The rotationally asymmetric glenoid component is secured to the glenoid in the prescribed rotational orientation for the patient.

[0023] Various embodiments are depicted in the accompanying drawings for purposes of illustration and should not be construed as limiting the scope of the embodiments. Furthermore, various features of different disclosed embodiments may be combined to form additional embodiments that are part of the present disclosure. [Brief description of the drawings]

[0024] [Figure 1] 1 is a schematic diagram of a human shoulder. [Diagram 2] FIG. 2 is a perspective view of the glenoid implant in an assembled configuration. [Diagram 3] FIG. 3 is an exploded view of the glenoid implant shown in FIG. 2. [Figure 4] FIG. 3 is a side cross-sectional view of the glenoid implant shown in FIG. 2. [Diagram 5] FIG. 2 is a side view of the base plate and anchor member of the glenoid implant. [Figure 5A] 1 shows a base plate fixed to the glenoid region of the scapula. [Figure 5B] 1 shows the glenosphere attached to a baseplate in the glenoid region of the scapula. [Figure 5C] A base plate having a thickness on a portion of its periphery is shown. [Figure 5D] 13 illustrates an embodiment of a base plate that includes rotational position indicator marks to aid the surgeon in positioning the base plate. [Figure 6] FIG. 13 is a perspective view of an inserter that can be used as a handling tool and to press the glenosphere onto the glenoid baseplate. [Figure 7] FIG. 7 is an exploded view of the inserter illustrated in FIG. [Figure 8] FIG. 7 is a side view showing an actuator configured to operate a retainer disposed at the tip of the inserter of FIG. 6. [Figure 9] FIG. 9 is a cross-sectional view of the inserter of FIG. 6 taken at section 9-9 shown in FIG. 8. [Figure 10]10 is a cross-sectional view similar to FIG. 9 illustrating how a glenosphere component can be held at the distal portion of the inserter of FIG. 6. [Figure 10A] FIG. 7 is a side view of a deflectable tip that can also provide a hold for handling such as the inserter of FIG. [Figure 10B] FIG. 7 is a schematic diagram showing a cross-section of the deflectable tip of the inserter of FIG. 6 with a distal portion of the surgical wire positioned proximally thereto and with its distal end positioned adjacent to the glenosphere. [Figure 10C] 7 illustrates deflection of the tip of the inserter of FIG. 6 following engagement of the tip with the opening of the glenosphere. [Figure 10D] 7 illustrates at least partial recovery of deflection (e.g., expansion) of the tip of the inserter of FIG. 6 after the tip has advanced through the opening of the glenosphere. [Figure 10E] 7 illustrates the deflectable tip of the inserter of FIG. 6 engaging the glenosphere and a surgical wire positioned within or distal to the impaction tip. [Figure 10F] 7 shows the surgical wire being withdrawn from the deflectable tip of the inserter of FIG. 6 immediately prior to crimping. [Figure 10G] FIG. 6 illustrates how the inserter applies an impaction load to the glenosphere, bonding it to the base plate. [Figure 10H] 13 shows removal of the inserter from the surgical site after impaction. [Figure 11] 1 illustrates an embodiment of a handling tool that includes an elongate body that can be combined with and / or separated from an outer elongate body or other impaction load delivery structure. [Figure 12] 13 illustrates another embodiment of a handling tool that can include a separator that is coupled to a threaded surface of the elongate body to disengage the glenosphere from the elongate body. [Figure 13] FIG. 1 illustrates a perspective view of one embodiment of a base plate inserter with a rotation guide used to insert the base plate into the glenoid cavity. [Figure 13A] FIG. 14 is an exploded view of one embodiment of the base plate inserter of FIG. 13 including a rotation guide configured to rotationally align the base plate. [Figure 14] FIG. 2 is a perspective view of one embodiment of a rotation guide. [Figure 14A] FIG. 15 is a top view of the rotation guide of FIG. 14. [Figure 14B] 14B is a cross-sectional view of the rotation guide of FIG. 14 taken at section 14B-14B of FIG. 14A. [Figure 14C] 14C is a cross-sectional view of the rotation guide of FIG. 14 taken at section 14C-14C of FIG. 14A. [Figure 14D] 15 illustrates a step of coupling the base plate inserter of FIG. 13 to the rotation guide of FIG. 14. [Figure 14E] 15 illustrates a step of coupling the base plate inserter of FIG. 13 to the rotation guide of FIG. 14. [Figure 14F] 15 illustrates a step of coupling the base plate inserter of FIG. 13 to the rotation guide of FIG. 14. [Figure 15] FIG. 13 is a perspective view of another embodiment of a rotation guide. [Figure 16A] FIG. 16 is a top view of the rotation guide of FIG. [Figure 16B] 16A taken at section 16A-16A. FIG. [Figure 17] FIG. 13 is a perspective view of a base plate inserter with an alternative embodiment of a rotation guide. [Figure 17A] FIG. 18 is a longitudinal cross-sectional view of the baseplate inserter of FIG. [Figure 17B] FIG. 18 is a proximal end view of the baseplate inserter of FIG. 17. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0025] Although the present description sets forth specific details of various embodiments, it will be understood that the description is illustrative only and should not be construed as limiting in any way. Moreover, various applications of such embodiments and modifications thereof that may occur to those skilled in the art are also encompassed by the general concepts described herein. Any and all features described herein, and any and all combinations of two or more of such features, are included within the scope of the present invention, provided that the features included in such combinations are not mutually inconsistent.

[0026] FIG. 1 illustrates a human shoulder joint, also called the glenohumeral joint. The glenoid cavity is the articular surface of the shoulder joint that is located on the scapula. The glenoid cavity articulates with the humeral head, allowing arm movement at the glenohumeral joint. A total shoulder arthroplasty replaces the articular surface of the glenohumeral joint with an artificial articular surface that replicates the naturally occurring concave and convex surfaces of the body. Generally, in a total shoulder arthroplasty, a glenohumeral arthroplasty is provided with a glenohumeral arthroplasty component having a surface that replaces the natural humeral head, and a glenoid arthroplasty component is provided with a surface that replaces the cartilage in the glenoid cavity. In a typical reverse total shoulder arthroplasty, a glenohumeral arthroplasty component having a convex, e.g., spherical, configuration is coupled to the scapula at or within the glenoid cavity, and a complementary concave arthroplasty structure is placed on the humerus. Thus, a reverse total shoulder arthroplasty reverses the naturally occurring concave and convex orientation of the glenohumeral joint.

[0027] 2-4 show a glenoid component assembly or implant 100 configured to be implanted in a patient's glenoid cavity, i.e., in reverse anatomical configuration. The glenoid implant 100 includes an anchor member 104 for securing the implant 100 to the scapula, a base plate 108, and a locking structure 112 configured to prevent rotation of the anchor member relative to the base plate. The reverse glenoid implant assembly 100 also includes a glenosphere 116 that provides a convex (e.g., spherical) articular surface. The glenosphere 116 is configured to couple to a concave surface of or on the humerus (not shown) to provide motion of the patient's glenoid joint. The glenoid implant 100 and corresponding humeral component provide a replacement for the natural glenohumeral joint.

[0028] As used herein, the terms "distal" and "proximal" are used to refer to the orientation of the glenoid implant as shown in Figures 2-4. As shown in Figure 3, the longitudinal axis 120 of the glenoid implant 100 extends through the central longitudinal axis 124 of the anchor member 104 (shown in Figure 4). The end of the glenoid implant 100 having the glenosphere 116 is referred to as the proximal end along the longitudinal axis 120, and the end having the anchor member 104 is referred to as the distal end along the longitudinal axis 120. In other words, if an element is closer to the central opening 128 of the glenosphere 116 (shown in Figure 4) than another element, then that element is more proximal than that other element, and if an element is closer to the distal tip 132 of the anchor member 104 (shown in Figure 4) than another element, then that element is more distal than that other element. The cavity 127 of the glenosphere 116 is located just distal to the opening 128. The cavity 127 may be considered to extend distally to the glenosphere 116. At several points below, reference may be made to anatomical locations: during use when the implant is delivered into the patient's scapula, the distal tip 132 of the anchor member 104 is more medial to the patient, while the articular surface of the glenosphere 116 is more lateral to the patient.

[0029] 3 and 4 show that the base plate 108 is oriented substantially perpendicular to the longitudinal axis 120 of the glenoid implant 100. In FIG. 4, the base plate 108 is shown coupled to the anchor member 104. FIG. 5 shows only the anchor member 104. The base plate 108 also has a proximal end 136 and a distal end 140. The proximal end 136 includes a proximal face 144 and the distal end 140 includes a distal face 148. The proximal face 144 may be substantially parallel to the distal face 148. The base plate 108 may also include a bone-engaging surface 152. The thickness of the base plate 108 defined between the proximal face 144 and the bone-engaging surface 152 may be oriented substantially perpendicular to the longitudinal axis 120 of the glenoid implant 100. In FIG. 4, the base plate 108 is shown coupled to the anchor member 104. In FIG. 5, only the anchor member 104 is shown. The base plate 108 also has a proximal end 136 and a distal end 140. The proximal face 144 may be substantially parallel to the distal face 148. The base plate 108 may also include a bone-engaging surface 152. The depth may correspond to the amount that the base plate 108 extends over the bone surface when it is implanted in the scapula. The thickness may range between about 2 mm and about 12 mm, such as between about 4 mm and about 9 mm, for example, about 6 mm. Thicknesses of about 3 mm, 5 mm, 7 mm, 8 mm, 10 mm, and 11 mm are also contemplated. The bone-engaging surface 152 may be oriented outward in some embodiments. The bone-engaging surface 152 may be substantially parallel to the proximal surface 144 and / or the distal surface 148.

[0030] 2-4 illustrate the case where the base plate 108 is rotationally symmetric about a central axis, e.g., axis 120, of the reverse glenoid implant assembly 100. As a result, the base plate 108 can be placed in any rotational position about axis 120 and then coupled to the scapula. FIG. 5C illustrates a more complex case of a base plate 108A that is asymmetric with respect to axis 120 of a reverse glenoid implant assembly that can be incorporated. The bone engaging surface 152 can be angled to form a wedge or other non-parallel structure that can help increase bone erosion in the glenoid. The bone engaging surface 152 can be patient specific. The base plate 108A can be configured with one or more medial extensions to compensate or fill in worn areas of the scapula, which can reduce, minimize, or eliminate the need to ream bone to prepare the surface. Thus, the base plate 108A can help preserve bone stock.

[0031] The base plate 108 also has a peripheral surface 156 that extends between the proximal surface 144 of the base plate 108 and the bone-engaging surface 152 of the base plate 108. The surface 156 is disposed laterally with respect to the center of the implant 100, and the surface 156 is also disposed laterally of the central surface of the patient when the implant 100 is applied to the patient. The peripheral surface 156 can have a circular profile when viewed in a cross-sectional plane extending parallel to the proximal surface 144. The diameter of the circular profile can be between about 20 mm and about 40 mm, such as between about 25 mm and about 35 mm, such as about 30 mm. In some embodiments, the outer surface 156 of the base plate 108 is configured to form part of a friction locking engagement, such as a Morse taper. In one embodiment, the outer surface 156 of the base plate 108 is tronconical. As used herein, the term "tronconical" means a shape or surface that is or resembles a truncated cone. In some embodiments, the outer surface 156 is configured to gradually increase in perimeter in a direction from the proximal surface 144 toward the bone-engaging surface 152. The surface 156 is configured to mate with the inner surface 248 that is tapered or tron-conical, or is otherwise configured to create high friction with the base plate 108. A portion, such as a majority, of the thickness of the base plate 108 may be received within the cavity 127 when the surfaces 156, 248 are engaged, in some cases.

[0032] 5A and 5B show a base plate 158 and a glenosphere 116 implanted in the scapula. The base plate 158 can be secured to the scapula by anchor members 104 and a number of screws extending through circumferential holes 192 (e.g., one, two, three, four or more such holes). The holes 192 can be formed with an internal member that can pivot within the base plate 108 to help direct the circumferential screws. After the base plate 158 is secured to the scapula, the glenosphere 116 can be attached thereto. The glenosphere 116 is placed against the base plate 158. A handling tool such as an inserter (which may optionally be an impactor), as described below, can be used to initially engage the faces 156, 248 with one another. A driver D (see FIG. 5B) can then be used to advance the set screw 256 (see FIGS. 3 and 4). In some embodiments, the set screw 256 has a blind hole. In some embodiments, the set screw 256 is attached to a handling tool such as may be included in the inserter 300, inserter 300A, or inserter 300B, which are described further below. The set screw 256 has a lumen from the proximal end to the distal end to allow access by the control member. The set screw 256 can be accessed by passing through the central opening 128 and across the proximal (or outer) portion of the cavity 127 in the glenosphere 116. FIG. 4 illustrates how advancement of the set screw 256 can significantly enhance the frictional engagement between the inner surface 248 of the glenosphere 116 and the peripheral surface 156 of the base plate 158. The set screw 256 also secures the base plate 108 against rotation that could loosen the connection between the scapula and the reverse glenoid implant assembly 100. FIG. 3 illustrates how the set screw 256 can be coupled to the glenosphere 116, for example, via a compression washer 260 and a threaded member 264. The set screw 256, compression washer 260, and threaded member 264 can collectively be the locking structure 112. Other locking structures can be used to connect the set screw 256 to the base plate 108. Although the set screw 256 is shown as solid with a blind recess on the proximal side, the screw 256 may incorporate a lumen that extends through the screw from the proximal end to the distal end.

[0033] FIG. 5B illustrates how the glenosphere 116 may be secured to the base plate 158, however, due to the presence of soft tissue within the patient, proper handling of the glenosphere 116 is critical to making the procedure easier and in some cases more successful. An inserter may be used as an impactor, and may itself be referred to herein as an impactor. These instruments are examples of handling tools that facilitate such handling, as described and claimed below. After the glenosphere 116 engages the scapula, the articular surface of the humerus assembly may be placed thereon to provide shoulder joint movement.

[0034] FIG. 5C illustrates that the base plate 108A has a bone-engaging surface that provides, for example, a partial wedge shape resulting from a varying medial-lateral thickness. The base plate 108A can compensate for bone loss, thereby augmenting the bone of the scapula. The base plate 108A has an augmentation portion 150A that has a non-uniform thickness. The augmentation portion 150A can be formed by any suitable method, for example, additive manufacturing that produces a porous metal structure. The augmentation portion 150A has a first thickness t1 along a first peripheral side of the base plate 108A and a second thickness t2 along a second peripheral side of the base plate. The second thickness is greater than the first thickness. The second thickness can be provided by gradually thickening the augmentation portion 150A in an outward direction (e.g., downward direction in FIG. 5C). In the illustrated embodiment, the thickness of the augmentation portion 150A increases linearly from a central section of the base plate 108A toward the first peripheral side of the base plate 108A. In the illustrated embodiment, a distal surface 148A is provided that engages a surface of the scapula, e.g., the glenoid cavity. The surface 148A has a first peripheral portion 146A that is parallel to the proximal surface 144A of the base plate 108A. The surface 148A has a second peripheral portion 149A that is disposed at an angle relative to the proximal surface 144A. The angle between the second peripheral portion 149A and the proximal surface 144A can be selected based on the amount of bone to be replaced or supplemented by the augmentation portion 150A. The first peripheral portion 146A of the surface 148A can be located closer to the proximal surface 144A than the second peripheral portion 149A of the surface 148A. The augmentation portion 150A provides a partial wedge, e.g., a half-wedge configuration. The augmentation portion 150A is intended to compensate for bone degeneration and / or disease at a location below the glenoid implant that includes the base plate 108A.

[0035] The base plate 108A may be used in the event of uneven wear or disease. The base plate 108A may be advantageously used to preserve bone in the unworn or less worn area that would be disposed beneath the first peripheral portion 146A. This area does not need to be reamed or otherwise removed to accommodate the base plate 108A. The entire distal portion of the base plate 108A may be made of a porous structure, such as a porous titanium structure, as described herein. The porous titanium structure can be formed by additive manufacturing. The augmented portion 150A can be made of a porous structure, for example titanium formed by additive manufacturing.

[0036] The base plate 108A must be precisely positioned relative to the scapula by rotation about axis 120 prior to securing the base plate 108A to the scapula. For example, the thicker portions of the base plate 108A should match the more worn portions of the scapula that the base plate is configured to augment.

[0037] FIG. 5D illustrates a variation of the base plate 108B that can be precisely inserted using an inserter instrument as disclosed below in connection with FIGS. 13-13A. The base plate 108B includes a porous layer mark 110 disposed on the porous layer portion of the second peripheral portion 149A. In some embodiments, the porous layer mark 110 can include a groove formed in the porous portion of the base plate 108B. In some embodiments, the porous layer mark 110 can include a surface level mark formed on the porous portion of the base plate 108B that provides only a visual indication. In some embodiments, the porous layer mark 110 can include a protrusion or boss that protrudes radially from the surface of the porous portion of the base plate 108B, thereby providing both a visual and a tactile indication. The surgeon can visually align the porous layer mark 110 with the more worn portion of the glenoid prior to securing the base plate 108B to the glenoid. FIG. 5D shows that the base plate 108B can also have a tapered layer mark 112, or the base plate 108B can have a tapered layer mark 112 as an alternative. The tapered layer mark 112 can be formed on the tapered surface of the base plate 108B, for example, on a cone configured circumferentially to form a Morse taper with a glenosphere. The tapered layer mark 112 can include a groove formed on the tapered portion of the base plate 108B. In some embodiments, the tapered layer mark 112 can include a surface level mark formed on the tapered portion of the base plate 108B. In some embodiments, the tapered layer mark 112 can include a protrusion or boss that protrudes radially from the surface of the tapered portion of the base plate 108B.

[0038] In one variation, the porous layer mark 110 is provided without the tapered layer mark 112. This variation is advantageous in that the surface area and finish of the tapered layer is maintained. In another variation, the tapered layer mark 112 is provided without the porous layer mark 110. This variation is advantageous in that the formation of screw holes in the porous layer has little or no effect on the tapered layer mark 112. Providing both the porous layer mark 110 and the tapered layer mark 112 can provide longer marks for improved visibility and accuracy.

[0039] While it is advantageous to provide marks directly on the implant, one approach, described further below in connection with Figures 13-17B, is to provide an instrument with a rotational guide 604 that controls the position of the base plate 108A (or other rotationally asymmetric base plate) relative to the guide wire 742, without the need for positioning marks on the base plate.

[0040] I. Glenosphere Inserter Instrument 6-10 show an inserter 300 that can be conveniently used to handle glenospheres 116. The inserter 300 is one example of a handling tool disclosed herein. The inserter 300 can include a handle assembly 304 that includes a handle member 306 disposed at a proximal end 308 of the inserter 300. In the context of the inserter 300, "proximal" and proximal direction refer to where the handle member 306 is located or to the direction of the handle member 306. and the "distal" or distal direction of the inserter 300 is the direction toward the impaction tip 400 (described below). The inserter 300 includes a distal end 312. A longitudinal axis 314 extends along the inserter 300 from the proximal end 308, including the distal end 312. The proximal end 308 provides for handling by the surgeon and application of an impaction force or load, for example, with a strike plate 440 (described below). The distal end 312 couples with the glenosphere 116, for example, by engaging the glenosphere in a hands-free manner and holding it against the impaction tip 400. For example, the inserter 300 can generate a proximal force on the glenosphere 116 to press the glenosphere against the impaction tip 400. The impaction tip 400 can provide a counter force that holds the glenosphere 116 in place between the impaction tip 400 and the tip of the inserter 300, as described below.

[0041] The handle assembly 304 may include an outer elongate body 320 extending from a proximal end 322 to a distal end 324 thereof. The outer elongate body 320 may include a lumen 326 extending along a longitudinal axis 314 between the proximal end 322 and the distal end 324. The lumen 326 may vary in size with a smaller diameter portion for slidably supporting the elongate shaft of the inner elongate body 340 and a larger diameter portion for slidably supporting an enlarged portion at its proximal end. The larger diameter portion of the lumen 326 may also allow for a spring or other compression member to be positioned therein between the outer elongate body 320 and the inner elongate body 340. The handle assembly 304 may include a strike plate 440. The strike plate 440 may be integrally formed with the outer elongate body 320. The strike plate 440 may be removably attached to the outer elongate body 320. The strike plate 440 can be configured to provide access to the lumen 326, as described further below.

[0042] The handle assembly 304 can include a distal portion 328 configured to mate with the impaction tip 400. The impaction tip 400 can be removably attached to the distal portion 328 of the elongate outer body 320. In one example, the distal portion 328 includes a recessed distal opening 330 configured to receive a proximal protrusion 331 of the impaction tip 400. Engagement of the proximal protrusion 331 with the recessed distal opening 330 can be by any suitable structure, such as threads 332. The proximal protrusion 331 can be connected to the recessed distal opening 330 by a bayonet connection or by a snap fit, such as using a C-ring or other flexible connector.

[0043] In one example, the distal portion 328 of the outer elongate body 320 includes an enlarged profile. For example, the diameter of the distal end 324 of the outer elongate body 320 may be greater than the outer diameter of the outer elongate body 320 at a location proximal to the distal end 324. The mid-span of the outer elongate body 320 may be of reduced profile compared to the distal end 324. The mid-span of the outer elongate body 320 may be of reduced profile compared to the proximal end 322. The mid-span of the outer elongate body 320 may be of reduced profile compared to both the proximal end 322 and the distal end 324. Due to the reduced profile of the mid-span, the inserter 300 may be inserted through a small incision in the area within the dashed box A (see FIG. 8 ). The inserter 300 may be enlarged at or toward the distal end 324 to provide good engagement with the glenosphere 116. The inserter 300 can flare in a direction toward the proximal end 322 to allow a surgeon to comfortably grip the handle member 306. The side profile of the inserter 300 includes a continuous concave curve, as seen in Figures 7-10. The continuous concave curvature allows soft tissue to be moved away from the inserter 300 in a less traumatic manner.

[0044] 7 and 9-10H show that the inserter 300 can have an inner elongate body 340, which can comprise a unitary or monolithic body or can include an assembly. The inner elongate body 340 can include a proximal end 342 and a distal end 344. The inner elongate body 340 can include a lumen 346 extending therethrough, for example, from the proximal end 342 to the distal end 344. The inner elongate body 340 can be centered about a longitudinal axis 314. The lumen 346 can be centered about the longitudinal axis 314. The lumen 346 can provide direct access between the proximal end 308 and the distal end 312 of the inserter 300. The lumen 346 can be used to deliver a surgical wire or other control member, as described further below. A surgical wire is one example of a control member that can be separate or separable from other components of the inserter 300. Variations of the inserter can include an integral control member that can move the inner elongate body 340 into and out of engagement with the glenosphere.

[0045] The inner elongate body 340 may also include an enlarged portion 348 at or adjacent the proximal end 342. The enlarged portion 348 may include a distally facing surface 349. The outer elongate body 320 may include a proximally facing surface 321 therein, for example, disposed in the region of the handle member 306. An enlarged portion of the lumen 326 in the region of the handle member 306 may allow the enlarged portion 348 to slide therein. The enlarged portion may extend proximally from the proximal facing surface 321 of the outer elongate body 320.

[0046] In some cases, the position of the enlarged portion 348 is controlled at least in part by the action of a compression spring 380 or other spring member. The compression spring 380 or other spring or resilient member may be configured to exert a traction force (e.g., a proximal force) on the inner elongate body 340, such as on the distal facing surface 349. The compression spring 380 may be compressed between the proximal facing surface 321 of the outer elongate body 320 and the distal facing surface 349 of the inner elongate body 340. As the enlarged portion 348 moves forward, the distal facing surface 349 acts on a first end 384 of the compression spring 380, causing the first end 384 of the compression spring 380 to move and compress the spring against the proximal facing surface 321 of the outer elongate body 320. The proximal facing surface 321 is in contact with a second end 388 of the compression spring 380. As a result, strain energy is stored in the compression spring 380. This strain energy can be released when the compression spring 380 is restored once the enlarged portion 348 and the remainder of the inner elongate body 340 have moved proximally within the lumen 326 of the outer elongate body 320. A traction force can be applied by the inner elongate body 340 to the glenosphere 116 and toward the handle member 306 when the glenosphere is coupled to the inner elongate body 340, for example, when coupled with a deflectable tip 350 disposed at its distal end 344.

[0047] The lumen 346 can provide access to a space 352 proximate the deflectable tip 350. In one example, the space 352 allows the deflectable tip 350 to deflect when the space 352 is unoccupied. When the space 352 is occupied, deflection of the deflectable tip 350 is limited, reduced, or eliminated. The space 352 can constitute a distal portion of the lumen 346, for example, a region within the inserter 300 that is aligned with the lumen 346 along the longitudinal axis 314. The space 352 can be accessed by advancing a control member or device through the strike plate 440 at the opening 444. The opening 444 can be aligned with the lumen 346 to provide access from the strike plate 440 to the distal end 344 of the inner elongate body 340. As described further below, the opening 444 and lumen 346 can be configured to receive a surgical wire 460 (or other control member) to occupy the space 352 or leave the space 352 open and control the deflection of the deflectable tip 350 during various stages of use of the inserter 300.

[0048] As described above, the inner elongate body 340 is movable within the lumen 326 of the outer elongate body 320. Devices can be provided to facilitate this movement. For example, an actuator 362 can be provided that can be accessed from outside the outer elongate body 320 to move the inner elongate body 340 between positions or along a range of positions. The actuator 362 can include an inner portion 364 that extends through the outer elongate body 320 and into the lumen 326. The inner portion 364 can extend to an inner end 366 that engages the inner elongate body 340, for example, the enlarged portion 348. The inner end 366 can be a threaded end that can be threaded into a threaded hole in the enlarged portion 348. The inner end 366 can be secured to the enlarged portion 348 by adhesive or other techniques such as an interference fit. The actuator 362 can include an outer end 368 configured to be finger actuated. The outer end 368 can include an enlarged profile compared to the inner portion 364. The outer end 368 may include a knurled surface to enhance finger grip during use.

[0049] The inserter 300 can have a control that provides a clear, tactile indication of the position of the actuator 362. The indication of the position of the actuator 362 can indicate to a user the position or state of the deflectable tip 350 that can be used to grab, hold, or latch the glenosphere 116. In one example, a slot 370 is provided on a side 371 of the outer elongate body 320. The slot 370 can be elongate in a direction corresponding to the longitudinal axis 314 of the inserter 300. The slot 370 can have a width transverse to the elongate direction of the slot 370 sufficient to allow the actuator 362 to pass therethrough. The slot 370 can have a first position 372 and a second position 374 disposed proximally along the longitudinal axis 314 of the inserter 300, e.g., proximal to the first position 372. For example, the slot 370 can have an elongated oval configuration with a first location 372 at a distal end of the oval and a second location 374 at a proximal end of the oval. The slot 370 can have a third location 376 disposed longitudinally between the first location 372 and the second location 374. The third location 376 can be circumferentially displaced from the first location 372, the second location 374. The third location 376 can be circumferentially offset from the slot 370 or from another track disposed between the locations 372, 374. The third location 376 can provide a hands-free, spring-loaded location, for example, where the deflectable tip 350 extends to engage the glenosphere 116. As described further below, the inner elongate body 340 can be released from the third position 376 towards the second position 374 after engaging the glenosphere 116 and retracting the glenosphere into engagement with the impaction tip 400.

[0050] Although the inserter 300 is shown with one circumferentially displaced position, e.g., third position 376, multiple circumferentially offset positions can be provided corresponding to different degrees of extension of the deflectable tip 350 from the tip of the outer elongate body 320. When multiple circumferentially displaced positions are provided, one can be circumferentially displaced in a first direction and another can be provided in a second direction different from the first direction, e.g., opposite to the first direction.

[0051] As described in more detail below, the positions 372, 374, 376 provide different control positions for the inserter 300. In one example, the first position 372 is the fully advanced position of the actuator 362 of the inserter 300. When the actuator 362 is in the first position 372, the distal portion 328 is fully extended from the impaction tip 400 of the inserter 300. Movement of the actuator 362 to the first position 372 moves the enlarged portion 348 of the inner elongate body 340 in a distal direction. Such movement moves the distal facing surface 349 towards the proximal facing surface 321 within the lumen 326. This movement may cause the compression spring 380 to compress between the proximal facing surface 321 of the outer elongate body 320 and the distal facing surface 349 of the inner elongate body 340. The actuator 362 may be moved from the first position 372 to the third position 372. 3. When in the third position 376, some, but not all, of the strain energy stored in the compression spring 380 is released; however, the remaining strain energy in the compression spring 380 provides a continued traction load toward the proximal end 308 of the inserter 300. Before or after delivery of the glenosphere, the actuator 362 can be disposed in a second position 374 where any strain energy that may be stored in the compression spring 380 can be substantially released as the enlarged portion 348 and remaining inner elongate body 340 move toward the proximal end 308 of the inserter 300.

[0052] In one embodiment, an inserter inner assembly 382 can be provided that includes the inner elongate body 340, the deflectable tip 350, and the enlarged portion 348. These components can be integrally formed, for example as a monolith. Some or all of these components can be separate components that can be assembled together.

[0053] In some embodiments, an inserter outer assembly 442 can be provided that includes the outer elongate body 320, the handle member 304, and the impaction tip 400. In some embodiments, the outer assembly 442 can include a strike plate 440.

[0054] The impaction tip 400 can include a distal portion 404 and a proximal portion. The distal portion 404 can be flat or can have a curvature configured to accommodate one or more sizes of glenospheres 116.

[0055] 10-10F illustrate the inserter 300 and how it can be used as a handling tool to handle and deliver the glenosphere 116 to a base plate attached to the glenoid surface. FIG. 10 illustrates the components of the inserter 300 assembled and in a configuration to hold the glenosphere 116. FIG. 10 also illustrates the separately implanted base plate 108 (see FIG. 5A). The base plate 108 can be secured to the scapula using anchors 104 and one or more perimeter screws, or by other techniques. The glenosphere 116 can be secured to the base plate 108A or base plate 108B. The base plates disclosed herein can be positioned using the instruments described in connection with FIGS. 13-17B. The description of the method of use of the inserter 300 generally refers to the base plate 108, but the same or similar methods can be applied to the base plate 108A or base plate 108B. Although reference may be made only to the base plate 108, the same description applies to rotationally asymmetric base plates unless otherwise stated. The glenosphere 116 may be temporarily but securely held by the inserter 300 in the manner illustrated in Figures 10A-10F.

[0056] FIG. 10A shows a partial view of a distal portion of the inner elongate body 340. Although the discussion of the use of the inner elongate body 340 in these methods is in the context of the inserter 300, the elongate body may also be present in other handling tools that may not include the outer elongate body 320, as shown, for example, in FIGS. 11-12. However, some aspects of these methods also apply to the embodiment of FIGS. 11-12. The inner elongate body 340 has an adjacent deflectable tip 350, for example, extending proximally from the distal end 344 of the inner elongate body 340. The deflectable tip 350 can have any suitable structure to make it flexible. For example, the deflectable tip 350 can include one or more, for example two, slots 500. FIG. 10A shows that the slot(s) 500 can extend from the distal end 504 to the proximal end 508 of the slot(s) in the deflectable tip 350. The slot(s) 500 deflect the distal end 504 toward the longitudinal axis 314 of the inserter 300. The proximal end 508 can include a radius, e.g., a radius, to facilitate elastic deflection of the distal end 504.

[0057] The deflectable tip 350 can include an enlarged portion 512 disposed at the distal end 344. The enlarged portion 512 can be used to deflect the deflectable tip 350, as described in more detail below. The contour, e.g., diameter, of the deflectable tip 350 can be different from the contour of a portion of the inner elongate body 340 disposed proximal to the deflectable tip 350. For example, the inner elongate body 340 can have an outer diameter at the proximal section and at a tapered portion between the proximal section and the deflectable tip 350. The portion of the deflectable tip 350 along the slot 500, e.g., the portion between the proximal end 508 and the enlarged portion 512, can have a smaller diameter than the diameter of the tapered portion of the inner elongate body 340. The smaller diameter of the deflectable tip 350 provides a gap between the deflectable tip 350 and the inner circumference of the central opening 128 of the glenosphere 116. This gap allows the deflectable tip 350 to slide within the opening 128 in an undeflected or minimally deflected state.

[0058] 10B illustrates the deflectable tip 350 of the inner elongate body 340 and also illustrates the impaction tip 400 in schematic form. The outer elongate body 320 and other components of the outer assembly 442, which may include the handle member 304 and the strike plate 440, have been removed to simplify the drawing. However, these components are typically present, as described further below. The enlarged portion 512 of the deflectable tip 350 can be advanced relative to the impaction tip 400 such that the enlarged portion 512 is exposed at the distal end 312 of the inserter 300. This can be accomplished by any suitable technique, such as advancing the actuator 362 within the slot 370 to or toward the first position 372. As the actuator 362 moves toward the first position 372 of the slot 370, the enlarged portion 512 can be advanced sufficiently against the distal face of the impaction tip 400 to allow the enlarged portion 512 to engage the glenosphere 116. For example, the distal face of the enlarged portion 512 can be advanced toward the surface of the glenosphere 116 around the opening 128. The open state of the lumen 346 in the vicinity of the deflectable tip 350 allows the tip to deflect.

[0059] The actuator 362 can be positioned within the slot 370 to a position where it is held or locked in place. Such a position can be any position where the surgeon does not need to continue to hold the actuator 362 and the inner elongate body 340 advances relative to the outer elongate body 320. As discussed above, some embodiments can have a compression spring 380 that stores strain energy as the inner elongate body 340 advances. To do so, a force may be required to hold the actuator 362 in a distal position corresponding to the position of the inner elongate body 340 shown in FIG. 10B. For example, the actuator 362 can be moved circumferentially to a third position 376 such that the circumferential surface of the slot 370 can apply a force against the spring force of the compression spring 380. This allows the surgeon to release the actuator 362 and focus on other aspects of the method of press-fitting the glenosphere 116.

[0060] In one technique, arrow A1 indicates movement of the surgical wire 460 within the lumen 346 to a position proximal to the deflectable tip 350. In one example, the distal end of the surgical wire 460 may be positioned just proximal to the proximal end 508 of the slot 500. Once the surgical wire is positioned adjacent to the deflectable tip 350, the surgical wire 460 may be ready to be moved to a position within or distal to the deflectable tip 350.

[0061] 10C illustrates arrow A2, which corresponds to a distal movement or force applied to the inserter 300 as the enlarged portion 512 contacts the surface of the glenosphere 116 around the opening 128. The force movement corresponding to arrow A2 deflects the distal end 504 within and proximal to the enlarged portion 512 toward the longitudinal axis 314. The deflection of the enlarged portion 512 may be facilitated by an angled or chamfered surface on the distal face of the enlarged portion 512. The movement of the enlarged portion 512 is illustrated by arrow A3. Arrow A3 illustrates a load being applied to the enlarged portion 512. The load may result in strain energy being stored in the deflectable tip 350. The strain energy may be stored until the enlarged portion 512 is disposed distal to the opening 128 and within the cavity in the glenosphere 116 (see FIG. 4).

[0062] FIG. 10D illustrates the deflectable tip 350 returning toward an undeflected position or configuration. Arrow A5 illustrates the movement of the deflectable tip 350 corresponding to the release of strain energy from the deflectable tip 350. As described above, the undeflected state or configuration of the deflectable tip 350 may occur when the enlarged portion 512 is positioned beyond (e.g., distal to) the opening 128 of the glenosphere 116. In this position, the portion of the deflectable tip 350 having a smaller diameter is aligned with the opening 128. A gap may be provided that allows the deflectable tip 350 to be completely undeflected. In some embodiments, the gap may be minimal or negative such that the deflectable tip 350 is somewhat deflected toward the longitudinal axis 314 when the enlarged portion 512 is positioned within the cavity of the glenosphere 116.

[0063] 10D illustrates arrow A4, which corresponds to moving the surgical wire 460 distally within the lumen 326 of the outer elongate body 320. Moving the surgical wire 460 according to arrow A4 can include moving the distal end of the surgical wire 460 from proximal to the proximal end 508 of the slot 500 to a position at or distal to the enlarged portion 512. If the clearance between the outer diameter of the deflectable tip 350 proximal to the enlarged portion 512 and the surface of the glenosphere 116 around the opening 128 is negligible or negative (e.g., the deflectable tip 350 is somewhat deflected when the enlarged portion 512 is within the cavity of the glenosphere 116), the advancement of the surgical wire 460 can cause some compression of the outer surface of the deflectable tip 350 adjacent the enlarged portion 512, thereby gripping the periphery of the opening 128.

[0064] FIG. 10E shows the surgical wire 460 fully advanced through the enlarged portion 512 to a position within the cavity of the glenosphere 116. FIG. 10 shows that the distal end of the surgical wire 460 can be distal to the assembly including the glenosphere 116. For example, the distal end of the surgical wire 460 can extend through the deflectable tip 350, the compression washer 260, and the threaded member 264 that fastens the compression washer to the interior of the glenosphere 116. The surgical wire 460 can also be inserted into the set screw if it is preassembled to the glenosphere 116. The surgical wire 460 can be advanced into a blind hole or lumen that extends from the proximal end to the distal end of the set screw 256.

[0065] In the advanced position or configuration, the surgeon can control the glenosphere 116 from the proximal end 308 of the inserter 300, for example, by grasping the handle member 306 of the actuator 362. In a step between those shown in FIGS. 10D and 10E, the surgical wire 460 may be advanced distally, as in FIG. 10E, while the impaction tip 400 may be spaced proximally from the glenosphere 116, as in FIG. 10D. To move the impaction tip 400 into contact with the convex surface of the glenosphere 116, the actuator 362 can be moved from the third position 376 of the slot 370 back toward the second position 374 of the slot. Movement from the third position 376 to the second position 374 results in the movement indicated by arrow A6, as shown in FIG. 10E, resulting in a contact between the distal surface of the impaction tip 400 and the glenosphere 116, as shown in FIG. 10D. The compression spring 380 can cause the gap between the convex articular surface of the sphere 116 to close so that these surfaces come into contact. The compression spring 380 can release the strain energy so that the closure of the gap can occur automatically, for example without continued movement by the surgeon. Of course, in another embodiment, the inserter 300 can be configured without a spring so that the movement of the actuator 362 can be caused by the action of the surgeon's finger. Releasing the strain energy from the compression spring 380 applies a continuous force (also in the direction of arrow A6) to the interface between the distal surface of the impaction tip 400 and the convex articular surface of the glenosphere 116. This allows the glenosphere 116 to engage the inner elongate body 340 and provide active control of the attitude, position and orientation of the glenosphere 116 while the actuator 362 is in the third position 376 of the slot 370.

[0066] The control provided by the configuration of FIG. 10E allows the surgeon to move the glenosphere 116 through the incision in the patient's skin toward the base plate 108, which is placed on or adjacent to the glenoid cavity (see FIG. 5A). In the case of the rotationally asymmetric base plate 108A, 108B, the base plate is positioned such that the augmentation portion is fixed to the worn portion of the scapula, for example according to a preoperative plan. The glenosphere 116 can be placed on the base plate 108 such that the mating tapered surface 156 of the base plate 108 and the mating tapered surface 248 of the glenosphere 116 can contact each other. Initially, the tapered surfaces are in loose contact with each other, and the surgeon can remove or reposition the glenosphere 116 on the base plate 108, or even remove the first glenosphere 116 and place another, e.g., a different size, glenosphere 116.

[0067] 10F illustrates that the surgical wire 460 may be removed, as indicated by arrow A6, immediately prior to initial fixation of the glenosphere 116 to the base plate 108. In this position, the surgeon may maintain initial contact between the tapered surface of the base plate 108 and the glenosphere 116 by applying a distally (or inwardly) directed force to the convex surface of the glenosphere 116 via the outer elongate body 320 and the impaction tip 400. Once the surgical wire 460 has been withdrawn from the deflectable tip 350, the inserter 300 may be impacted at the strike plate 440. The surgical wire 460 may be fully withdrawn from the inserter 300, for example, out of its opening 444.

[0068] In FIG. 10G, application of an impaction force is indicated by arrow A8. The applied force may be generated by an impactor striking the strike plate 440. The force may be transmitted through the outer elongate body 320 to the impaction tip 400. As discussed above, the inner elongate body 340 is slidable within the outer elongate body 320. The slidable coupling and compression spring 380 substantially isolate the inner elongate body 340 from loads applied to the strike plate 440. As a result, there may be some distal displacement of the impaction tip 400 relative to the enlarged portion 512 upon application of an impaction force. In some cases, an impaction load on the strike plate 440 may engage the glenosphere with a glenoid base plate (e.g., any of the base plates 108, 108A, 108B) while simultaneously disengaging the retention portion from the glenosphere. This movement is facilitated by the length of the slot 370 in the side 371 of the handle member 306 and the movement of the actuator 362 therein. As the impaction tip 400 moves relative to the enlarged portion 512, the deflectable tip 350 is allowed to deflect toward the longitudinal axis 314, as shown by arrow A9. Deflection toward the longitudinal axis 314 reduces the profile of the enlarged portion 512 such that the enlarged portion 512 is smaller than the opening 128 of the glenosphere 116.

[0069] FIG. 10H illustrates the removal of the inserter 300 from the surgical incision indicated by arrow A10. A surgeon can grasp the handle member 306 and pull the entire inserter 300 out of the incision in which it was placed.

[0070] The reverse glenoid implant assembly 100 is first assembled after the glenosphere 116 is press-fit onto the base plate 108. When fully assembling the reverse glenoid implant assembly 100, a driver can be used to advance the set screw 256, as illustrated in FIG 5B. The set screw 256 can be advanced after removing the inserter 300 from the surgical incision.

[0071] FIG. 11 illustrates another handling tool in which an elongated body 340A can hold and control a glenosphere 116 and can be used separate from a device or structure that applies an impaction load. The elongated body 340A is similar to the inner elongated body 340, except as otherwise described below. The elongated body 340A includes a deflectable tip 350 that can be flexible by a slot 500. The elongated body 340A can have an outer surface 550 that can be exposed during use. The elongated body 340A can be used to advance the glenosphere 116 through an incision and onto the base plate 108. Control of the glenosphere 116 on the elongated body 340A can be similar to the control described above in connection with the inserter 300. For example, a surgical wire 460 can be advanced through a control lumen 554 of the elongated body 340A to a position within the deflectable tip 350 to prevent deflection toward the longitudinal axis of the elongated body 340A. In other embodiments, the deflectable tip 350 can apply sufficient control force to the glenosphere 116 without the use of a surgical wire 460. In some cases, the deflectable tip 350 can be deflected toward the longitudinal axis of the elongate body 340A by advancing the surgical wire 460 or another control member into the control lumen 554. In another approach, a press-fit device can be advanced over the outer surface 550 of the elongate body 340A, for example, after the elongate body is placed through the incision and the glenosphere 116 is placed on the base plate 108. The press-fit device can push the glenosphere 116 out of the deflectable tip 350 of the elongate body 340A in a manner similar to that described above. The elongate body 340A can be combined with a press-fit member to form an inserter assembly 300A together with the press-fit member.

[0072] FIG. 12 illustrates another example of a glenoid handling tool, which can include an inserter assembly 300B including an elongated body 340B similar to the inner elongated body 340. The elongated body 340B can include similar structures, such as a deflectable tip 350. The elongated body 340B can include a control lumen extending from its proximal end to its distal end. The elongated body 340B can include a threaded surface 560 disposed adjacent its distal end. The inserter assembly 300B can also include a separator 564 disposed at the distal end of the inserter assembly 300B. The separator 564 can have a threaded passage therein such that rotation of the separator 564 about the longitudinal axis of the elongated body 340B can advance rotation of the separator 564. Such rotation can cause the distal surface of the separator 564 to engage the convex articular surface of the glenosphere 116. Engagement of these surfaces can provide relative motion between the elongate body 340B and the glenosphere 116, causing the distal end of the elongate body 340B to disengage from the glenosphere 116. The elongate body 340B can include a deflectable tip 350, such that advancement of the separator 564 can deflect the enlarged portion 512 toward the longitudinal axis of the elongate body 340B, causing the enlarged portion 512 to disengage from the glenosphere 116.

[0073] II. Baseplate Inserter Instrument As discussed above, part of the treatment of shoulder joint conditions may include implanting a baseplate 108, 108A, 108B into the glenoid cavity. FIGS. 13-17B show an embodiment of a baseplate inserter that can be used to precisely and conveniently implant the baseplate. The following examples illustrate embodiments and modifications.

[0074] 13 illustrates a glenoid cavity 601 into which and / or onto which a base plate 108A is implanted. The glenoid cavity 601 can have an opening formed therein to receive the anchor member 104. In some techniques, the base plate 108A and the anchor member 104 can be delivered together by a base plate inserter 600. The anchor member 104 can be a unit with the base plate 108A or can be a separate, separately movable component.

[0075] 13 and 13A show that the baseplate inserter 600 can include separable components. The baseplate inserter 600 can include a rotation guide 604 that can be applied to the components of the baseplate inserter 600 to aid in the placement of the rotationally asymmetric baseplate 108A. The rotation guide 604 can include a portion that fastens to the baseplate inserter 600 and a portion that guides the orientation of the baseplate 108A relative to the glenoid fossa 601. The baseplate inserter 600 can include an outer shell 612, an inner shell 616, and an inner shaft assembly 620. The inner shaft assembly 620 can be removably inserted and positioned in a lumen 662 of the inner shell 616, for example. The inner shaft assembly 620 can be used to control the position of the anchor member 104 and / or the baseplate 108A. The inner shell 616 can be slidably positioned within the outer shell 612. The inner shell 616 can have a first position and a second position within the outer shell 612. The first position allows the first end 656 of the medial shell 616 to be positioned closer to the first end 636 of the outer shell 612 than the position of the first end 656 when the medial shell 616 is in the second position. The second position is shown in FIG. 14D below. The first position is described in more detail below in connection with FIG. 14D. The medial shell 616 can be configured to actuate the glenoid implant retention mechanism 644 into a retaining configuration when the medial shell 616 is in the first position.

[0076] FIG. 13A shows further details of the outer shell 612. The outer shell 612 includes an elongated body 632 extending between a first end 636 and a second end 640. The outer shell 612 includes a glenoid implant retention feature 644 disposed on or at the first end 636 of the elongated body 632. The glenoid implant retention feature 644 of FIG. 13A includes a protrusion or projection and a slotted ring configuration that can be biased from a release configuration to a retention configuration. The release configuration is for disengaging the base plate 108A. The retention configuration is for securely retaining the base plate 108A. The protrusions of the glenoid implant retention feature 644 can be angled away from each other and can be configured to be received in channels angled from either side of the base plates 108, 108A, 108B. The prongs of the glenoid implant retaining mechanism 644 may be attached to an expandable retaining end that may expand, e.g., deflect, to engage the prongs with corresponding channels in the base plate 108A. The rotation guide 604 may be used with other inserter structures that may not include the prong and channel engagement provided by the glenoid implant retaining mechanism 644 to retain and control the position of the base plates 108, 108A, 108B.

[0077] 13A shows further details of the inner shell 616. The inner shell 616 includes an elongate body 652 extending between a first end 656 and a second end 660. The elongate body 652 includes a lumen 662 disposed therethrough. The lumen 662 may extend from the first end 656 to the second end 660. The lumen 662 may thereby allow for the passage of a distal portion of the inner shaft assembly 620. The elongate body 652 may have a shell interface 664 disposed on an outer surface thereof. Shell Interface 664 may include any feature configured to axially secure the inner shell 616 to the outer shell 612. The shell interface 664 may include threads that engage with corresponding threads formed or disposed on an interior surface, e.g., within a lumen, of the elongate body 632. The second end 660 may include an enlarged body or other handle structure configured to facilitate rotation of the inner shell 616 to engage the shell interface 664 disposed on the exterior surface of the elongate body 652 with a corresponding feature inside the elongate body 632.

[0078] The inner shaft assembly 620 can include an elongated body 672 extending between a first end 676 and a second end 680. The elongated body 672 can include an inner shaft 684 configured to be disposed within the lumen 662 of the inner shell 616. The inner shaft assembly 620 can have a torque interface 688 at its end disposed at the first end 676. The second end 680 can include an enlarged portion forming a handle. The torque interface 688 can include a hexagonal head for engaging a corresponding hexagonal recess in the anchor member 104.

[0079] 13A illustrates the assembly of the base plate inserter 600. The rotation guide 604 can be advanced over a portion of the elongated body 632 disposed adjacent the first end 636, as shown by arrow B1. As described further below, the rotation guide 604 can include an access gap 724 to allow the elongated body 632 to pass therethrough. The rotation guide 604 can pass transversely to the longitudinal axis of the elongated body 632. The elongated body 632 can pass through the access gap 724 in a direction transverse to the longitudinal axis of the elongated body 632. In one technique, the inner shell 616 can then be advanced into the outer shell 612, as shown by arrow B2. The outer shell 612 can be moved over the first end 656 of the inner shell 616 in the direction opposite to arrow B2. Full advancement of the first end 656, as shown by arrow B2, may actuate the glenoid implant retention mechanism 644 from a released configuration to a retained configuration, as described further below. The shell interface 664 may retain the first end 656 within the glenoid implant retention mechanism 644 for retaining the baseplate 108, as described further below.

[0080] The inner shaft assembly 620 can be positioned within the lumen 662. Once the inner shaft assembly 620 is fully advanced within the lumen 662 along arrow B3, the torque interface 688 can be advanced out of the first end 656 of the inner shell 616. The torque interface 688 can engage the anchor member 104, the base plate 108A, or both the anchor member 104 and the base plate 108A. In one embodiment, the glenoid implant retention mechanism 644 can be actuated into a retention configuration that holds the base plate 108A in place while allowing the inner shaft assembly 620 to rotate freely within the lumen 662, allowing the anchor member 104 to rotate relative to the lumen 662 for embodiments in which the anchor member 104 can be threaded and advanced into the scapula inside the glenoid cavity 601. The free relative rotation can allow for full seating of the anchor member 104 and proper rotational orientation of the base plates 108A, 108B, as described below.

[0081] 14-14F illustrate an example of a rotation guide 604 and its use. The rotation guide 604 can include a peripheral body 704. The peripheral body 704 can be disposed on a portion of the base plate inserter 600, for example, about a distal portion of the elongate body 632 of the outer shell 612. The peripheral body 704 can have an access gap 724 that can allow access to a central space of the rotation guide 604. The peripheral body 704 can have an inner periphery 708 that surrounds the central space. The peripheral body 704 can have an outer periphery 724 disposed about the inner periphery 708. 712. The peripheral body 704 can extend between the inner periphery 708 and the outer periphery 712. The peripheral body 704 can extend from the inner periphery 708 to the outer periphery 712.

[0082] The orientation feature 716 can be disposed on the outer periphery 712. The orientation feature 716 can be configured to align with a corresponding location of the augmented portion of the base plate 108A. As described further below, the inner periphery 708 can be removably disposed about the first end 636 of the elongated body 632, such as about the glenoid implant retaining feature 644. The inner periphery 708 can be intra-operatively disposed about the first end 636 of the elongated body 632, such as about the glenoid implant retaining feature 644. When so disposed, the inner periphery 708 can engage with the glenoid implant retaining feature 644 when the glenoid implant retaining feature is in the retaining configuration. The inner periphery 708 can engage with an outer surface of the glenoid implant retaining feature 644 while a protrusion of the glenoid implant retaining feature 644 secures the base plate 108A. The inner periphery 708 can engage with the first end 636 of the elongate body 632, for example, in association with an inserter that engages with a base plate without the need for any prong connection. When the orientation feature 716 is aligned with or positioned at a preoperatively defined angular offset from the augmentation portion of the base plate 108A, the surgeon can more easily and more precisely control the rotational position of the augmentation portion.

[0083] The orienting feature 716 can include an open channel 732 disposed on or away from the outer periphery 712 of the peripheral body 704. FIG. 14A shows that the open channel 732 can be configured to at least partially or completely receive a guidewire 742. The open channel 732 can have a depth, measured radially (vertically in FIG. 14A), equal to or greater than the diameter of the guidewire 742. As such, the guidewire 742 can be received within the open channel 732. The guidewire 742 can be surrounded by the orienting feature 716 at other than the radially outermost position of the rotating guide 604, which can be open. The rotating guide 604 viewed from the side (such as in FIG. 14A) can provide an open sight field of view in the inward direction. FIG. 14B shows that the orienting feature 716 can have a distal protrusion 736 configured to engage the guidewire 742. The distal protrusion 736 can extend below the inside of the peripheral body 704. The open channel 732 can extend from a medial-lateral location within the thickness of the peripheral body 704 to a medial-lateral location disposed on the inside of the interior of the peripheral body 704 .

[0084] 14B and 14C show additional features of the inner periphery 708 of the rotation guide 604. The inner periphery 708 can include a contour 710 configured to match a contour of the first end 636 of the elongate body 632, e.g., a contour adjacent to or a contour of the glenoid implant retaining feature 644 of the base plate inserter 600. The contour 710 can surround an edge of the first end 636 adjacent the elongate body 632, e.g., an edge adjacent to or an edge of the glenoid implant retaining feature 644. The inner periphery 708 can have a proximal surface 758. In one embodiment, the proximal surface 758 includes a distally facing conical surface 762. In one embodiment, the proximal surface 758 includes a conical surface 762. The inner periphery 708 can include a distal portion 766 configured to limit medial-lateral movement of the rotation guide 604. The distal portion 766 may include a lip 774 configured to be disposed over a distal edge of the first end 636 of the elongate body 632, such as a distal edge of a split ring of the glenoid implant retention mechanism 644. The contour 710 may have a cylindrical portion disposed between the lip 774 and the conical surface 762.

[0085] 14D-14F show operation of the baseplate inserter 600 in more detail. The inner shell 616 can be advanced within the lumen of the elongate body 632 of the outer shell 612 until the first end 656 of the inner shell 616 is adjacent the first end 636 of the elongate body 632. 14D shows the base plate inserter 600 in a release configuration. In this configuration, the projections of the glenoid implant retention feature 644 can be moved by hand in a direction opposite to arrow B5 due to the split ring configuration, allowing the projections to slide into corresponding recesses in the proximal face of the base plate 108A. The projections can disengage from the inner circumferential surface 708 of the rotation guide 604 during such movement.

[0086] After the base plate 108A is held on the projections of the glenoid implant retention feature 644, the rotation guide 604 can be moved into position. Preoperative planning may determine that the guide pin may be placed on the scapula at the 12 o'clock position and the augmented portion of the base plate 108A at the 3 o'clock position, as shown in FIG. 13. Accordingly, the surgeon can move the peripheral body 704 relative to the augmented portion of the base plate 108A such that when the augmented portion of the base plate 108A is at the 3 o'clock position, the orientation feature 716 is at the 12 o'clock position. Other positions may be provided according to preoperative planning. The rotation guide 604 allows any rotational position about the axis 120 required for a particular patient according to preoperative planning.

[0087] After a preoperatively determined relative rotational position is provided between the peripheral body 704 and the first end 636 of the elongated body 632 of the baseplate inserter 600, the inner shell 616 can be advanced according to arrow B2 until the first end 656 is disposed within the first end 636, for example, at or distal to the conical surface 637 within the first end 636, which is the first position of the inner shell 616. Distal movement of the first end 656 contacts the constricted interior space of the first end 636, causing movement according to arrow B5. The inner shell 616 resists radial inward deflection, thus preventing the glenoid implant retention feature 644 from moving in the direction opposite to arrow B5 when the first end 656 is disposed within the first end 636. This provides the glenoid implant retention configuration of the baseplate inserter 600.

[0088] 14E and 14F illustrate this mechanism in further detail. The elongated body 632 is shown generally with the conical surface 637 spaced apart from the conical surface 762 of the profile 710. This configuration corresponds to a released configuration in which both sides of the first end 636 can move towards each other. FIG. 14F shows the elongated body 632 actuated with the first end 636, and specifically the conical surface 637, biased outwardly into contact with the conical surface 762 of the peripheral body 704. The outward movement of the conical surface 637 can be accomplished by any configuration, including moving the inner shell 616 downwardly into the distal region of the outer shell 612. FIG. 14F illustrates the retaining configuration of the baseplate inserter 600.

[0089] 15-16B show a rotation guide 604A similar to the rotation guide 604 except as described below. The rotation guide 604A includes a peripheral body 704A disposed between an inner periphery 708A and an outer periphery 712A. The peripheral body 704A may be continuous, for example, lacking an access gap at the outer periphery 712A or the inner periphery 708A. The central opening is configured to advance beyond the proximal or distal end of the elongated body 632 of the base plate inserter 600. The rotation guide 604A may be assembled onto the second end 640 of the elongated body 632 along arrow B2 before the inner shell 616 advances along arrow B2. The central opening in the peripheral body 704A may have a larger diameter or lateral dimension than the proximal portion of the elongated body 632.

[0090] The rotation guide 604A includes an orientation feature 716A that includes a distal protrusion 736A. The distal protrusion 736A is similar to the distal protrusion 736, except as described below. The distal protrusion 736A includes a sealed opening 750. The sealed opening 750 is similar to the open channel 732 in that the sealed opening is adapted to receive a guidewire 742, as shown in FIG. 16A. The guidewire 742 is completely surrounded radially by the sealed opening 750. The open channel 732 is advantageous in that the rotation guide 604 can be side-loaded onto the guidewire 742. The sealed opening 750 is advantageous in that the guidewire 742 is retained within the sealed opening 750 when advancing the rotation guide 604A over the guidewire 742 or by advancing the guidewire 742 through the sealed opening 750.

[0091] The inner periphery 708A of the rotation guide 604A also includes sawtooth 782 configured to engage an outer surface of the first end 636 of the elongate body 632 adjacent the glenoid implant retaining feature 644. The sawtooth 782 can engage and grip the outer periphery of the first end 636 adjacent the retaining feature 644. The sawtooth 782 can grip the outer periphery at any rotational position of the rotation guide 604A relative to the outer surface of the baseplate inserter 600 adjacent the glenoid implant retaining feature 644. FIG. 16B shows that the sawtooth 782 can extend to the inner end of the inner periphery 708A of the rotation guide 604A. The conical inner surface of the rotation guide 604A can engage the conical surface 637 of the baseplate inserter 600.

[0092] 17-17B show another embodiment in which a rotation guide 604B is provided that engages or grips the base plate inserter 600 in a different manner. The rotation guide 604B comprises a slotted guide body 800 and a clamping ring 832. The slotted guide body 800 includes an alignment foot 804 and an alignment guide body 808. The alignment foot 804 is an example of an orientation feature. The alignment guide body 808 includes a sleeve 812 having a slot 816 formed therealong. The slot 816 extends from the perimeter body 824 to the outer end of the alignment guide body 808. The slot 816 allows the alignment guide body 808 to expand around the base plate inserter 600 to allow the inserter to fit therein. In some variations, the rotation guide 604B need not be advanced over the second end 640 of the elongate body 632 to allow for expansion of the slot 816 to allow for insertion of the elongate body 632 therein. The peripheral body 824 has an inner circumference that may be similar to the inner circumference 708 and may have a contour similar to the contour 710. The sleeve 812 of the alignment guide body 808 may include a collet portion 820 disposed proximally of the peripheral body 824. The collet portion 820 of the sleeve 812 may be configured to engage an outer surface of the elongate body 632 away from the first end 636, for example, away from the glenoid implant retention feature 644.

[0093] 17A shows a rotation guide 604B mounted around the periphery of the base plate inserter 600. The alignment guide body 808 can be mounted around the periphery of the base plate inserter 600 by advancing the elongated body 632 through the slot 816. The alignment guide body 808 can be mounted around the periphery of the base plate inserter 600 by advancing the alignment guide body 808 along arrow B2 over the second end 640 of the elongated body 632 prior to inserting the inner shell 616 into the outer shell 612. The periphery body 824 can then be advanced over the first end 636 of the elongated body 632 or over the first end 636, for example, over a slotted ring of the glenoid implant retention feature 644. The inner periphery of the periphery body 824 can be disposed around the first end 636 as shown. The peripheral body 824 can be disposed proximate and radially outward from an outer surface of the first end 636 of the elongated body 632. The peripheral body 824 can have a profile that includes a conical surface and a cylindrical surface. The conical surface can be formed by arranging the first end 636 of the elongated body 632 in a circular arc. The peripheral body 824 may rest on a conical surface 637 of the first end 636. The cylindrical surface may be disposed radially outward of the cylindrical surface of the first end 636. In one modified embodiment, the peripheral body 824 may include a lip such as in the rotation guide 604.

[0094] The clamping ring 832 can engage the alignment guide body 808 to secure the rotation guide 604B to the base plate inserter 600. The alignment guide body 808 can extend proximally from the peripheral body 824 to a proximal end (sometimes referred to as an outer end) of the slotted guide body 800. The alignment guide body 808 can include a collet portion 820 and a threaded outer surface 840 disposed on the sleeve 812. The threaded outer surface 840 can be configured to engage with the clamping ring 848. The clamping ring 832 can include internal threads 836 configured to engage with the threaded outer surface 840. The clamping ring 832 can include a tapered surface 848, and the collet portion 820 of the sleeve 812 can include a corresponding tapered surface. As the clamping ring 832 is advanced along the tapered surface of the collet portion 820 of the sleeve 812, frictional engagement occurs between the inner surface of the collet portion 820 of the sleeve 812 and the elongated body 632 of the base plate inserter 600. Specifically, the tapered surface 848 can bring the sleeve 812 into contact with the elongated body 632 and increase the normal force on the elongated body 632. The clamping ring 832 can be advanced by engaging the internal threads 836 of the clamping ring 832 with a threaded outer surface 840 disposed on the sleeve 812. The collet portion 820 is disposed proximal to the threaded interface. In a modified embodiment, the collet portion 820 is disposed distal to the threaded interface. In this modified embodiment, the clamping ring 832 includes a tapered portion disposed distal to the internal threads 836.

[0095] 17A-17B show that the rotation guide 604B can be configured to advance over the guidewire 742 to control the position of the baseplate inserter 600 as the baseplate 108A advances toward the scapula. The alignment foot 804 can be structured similarly to the orientation mechanism 716A and can, for example, protrude beyond the inside of the peripheral body 824. The alignment foot 804 can have a sealing opening 750. The sealing opening 750 can allow the guidewire 742 to slide therein so that the rotation guide 604B can advance along the guidewire 742 toward the scapula. Thus, the guidewire 742 controls one or more degrees of freedom, for example three degrees of freedom, of the rotation guide 604B, the baseplate inserter 600, and the baseplate 108A coupled thereto. The guidewire 742 can control translation in at least two lateral directions and can control the direction of movement along it, for example, limiting the movement of the base plates 108, 108A, 108B to directions along or parallel to the longitudinal axis of the guidewire 742. This control prevents rotation of the plates about axis 120 in a direction that would cause the augmentation to deviate from the preoperative plan. term

[0096] Although certain embodiments are described herein with respect to anatomical or reverse-type components, the implants and methods described herein may be used interchangeably with any joint component, including anatomical and reverse-type components described herein, as the context may dictate.

[0097] As used herein, the relative terms "proximal" and "distal" shall be defined from the perspective of the implant, whereby proximal refers to the direction of the articular component and distal refers to the direction of the base plate when the implant is assembled.

[0098] The terms "first" articular component and "second" articular component are used interchangeably. It should be noted that the terms "first" and "second" openings can be used interchangeably and can be used to refer to either one of the openings in the base plate.

[0099] Unless specifically stated otherwise or understood otherwise within the context in which it is used, conditional language such as "can," "could," "might," or "may" is generally intended to convey that some 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.

[0100] The terms "comprising," "including," "having," and the like are synonymous and are used inclusively and openly and do not exclude additional elements, features, acts, operations, etc. Also, the term "or" is used in its inclusive (and not exclusive) sense, e.g., when used to join a list of elements, the term "or" means one, some or all of the elements in the list.

[0101] As used herein, the terms "approximately," "about," and "substantially" refer to an amount close to the stated amount that still performs a desired function or achieves a desired result. For example, the terms "approximately," "about," and "substantially" may refer to an amount within less than 10% of the stated amount, as the context may dictate. As an example, in certain embodiments, the term "approximately perpendicular" refers to a value, amount, or characteristic that deviates from exactly perpendicular by less than about 10 degrees.

[0102] Although specific embodiments and examples have been described herein, it will be understood by those skilled in the art that many aspects of the glenoid implants shown and described in this disclosure may be combined differently and / or modified to form further embodiments or acceptable examples. All such modifications and variations are intended to be included herein within the scope of the present disclosure. Various designs and approaches are possible. No feature, structure, or step disclosed herein is required or essential.

[0103] Some embodiments have been described in conjunction with the accompanying drawings, although it should be understood that the figures are not drawn to scale. Distances, angles, and the like are merely exemplary and do not necessarily bear precise relationship to the actual dimensions and layout of the illustrated devices. Components may be added, removed, and / or rearranged. Furthermore, any particular feature, aspect, method, property, characteristic, quality, attribute, element, etc. of the disclosures herein in connection with various embodiments may be used in all other embodiments shown herein. Furthermore, it will be appreciated that any method described herein may be implemented using any apparatus suitable for performing the recited steps.

[0104] For purposes of this disclosure, certain aspects, advantages, and novel features are described herein. It will 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 may be embodied or implemented in a manner that achieves one advantage or group of advantages as taught herein, without necessarily achieving other advantages as may be taught or suggested herein.

[0105] Moreover, while exemplary embodiments have been described herein, it will be apparent to those skilled in the art based on this disclosure that It will thus be recognized that the scope of any and all embodiments includes equivalent elements, modifications, omissions, combinations (e.g., of aspects across various embodiments), adaptations, and / or alterations. Limitations in the claims are to be broadly interpreted based on the language employed in the claims and are not limited to the examples described herein or those described during prosecution of the application, where the examples are to be interpreted as non-exclusive. Furthermore, the actions of the disclosed processes and methods can be modified in any manner, including changing the order of the actions and / or inserting additional actions and / or deleting actions. Accordingly, it is intended that the specification and examples be construed as illustrative only, with the true scope and spirit being indicated by the claims and their full scope of equivalents.

[0106] Any of the methods disclosed herein do not have to be performed in the order described. The methods disclosed herein include specific acts performed by a practitioner, but may also include, explicitly or implicitly, third-party direction of those acts. For example, an act such as "inserting a baseplate into the glenoid cavity" includes "instructing the insertion of the baseplate into the glenoid cavity."

Claims

1. 1. An inserter for attaching a glenosphere to a base plate placed in and / or on the scapula of a human, comprising: A handle assembly having a proximal end and a distal end, said handle assembly comprising: an outer elongate body extending between the proximal end and the distal end; an inner elongate body extending between the proximal end and the distal end and slidably disposed within the outer elongate body, the inner elongate body including a lumen disposed therethrough and a deflectable tip disposed at a distal end thereof; an actuator configured to slide the inner elongate body relative to the outer elongate body to extend the deflectable tip from a retracted position; The handle assembly includes: The inserter, wherein the deflectable tip is undeflected within a cavity of the glenosphere and is configured to apply a force to the glenosphere.

2. The inserter of claim 1 , wherein the actuator extends from outside the outer elongate member, through a slot in the outer elongate member, and to an end of the inner elongate body.

3. The inserter of claim 2 , wherein the end of the inner elongate body is enlarged relative to a portion of the inner elongate body distal thereto, and an inner end of the actuator member engages the enlarged end.

4. 2. The inserter of claim 1, wherein an end of the inner elongate body includes an enlarged portion configured to engage a first end of a compression spring, and a second end of the compression spring configured to engage an inner surface of the outer elongate body.

5. The inserter of claim 1 , further comprising an impaction tip removably attached to a distal portion of the outer elongate body.

6. 2. The inserter of claim 1, further comprising a strike plate coupled to the outer elongate body, the strike plate having an opening aligned with the lumen to provide access from the strike plate to the distal end of the inner elongate body.

7. The inserter of claim 6 , wherein the opening in the strike plate is configured to allow for occupation or unoccupation of the lumen adjacent the deflectable tip.

8. 2. The inserter of claim 1, wherein the lumen of the inner elongate body is sized to slidably receive a control member at a first location proximal to the deflectable tip and at a second location interior to or distal to the deflectable tip.

9. The inserter of claim 8 , wherein the control member is separable from the inserter.

10. The inserter of claim 8 , wherein the control member comprises a surgical wire.

11. The inserter of claim 1 , wherein the deflectable tip is configured to be disposed in a low-profile configuration when the lumen is unoccupied.

12. The deflectable tip is maintained in an enlarged profile configuration when the lumen is occupied. The inserter of claim 1 , configured to:

13. A glenosphere inserter, an outer assembly including an outer elongate body, a handle disposed at a proximal portion of the glenosphere inserter, and an impaction tip at a distal portion of the glenosphere inserter; an inner assembly including an inner elongate body and a deflectable distal portion, the inner elongate body being slidably disposed within the outer elongate body; a lumen disposed through the inner elongate body and the deflectable distal portion disposed at a distal end thereof; an actuator configured to slide the inner elongate body relative to the outer elongate body to extend the deflectable distal portion distally from the impaction tip; The glenosphere inserter, wherein the deflectable distal portion is configured to be deflected within a cavity of a glenosphere and to apply a force to the glenosphere toward the handle of the outer assembly.

14. 14. The glenosphere inserter of claim 13, wherein the inner assembly comprises an enlarged proximal portion and a spring member disposed between the enlarged proximal portion and an inner surface of the outer assembly, the spring member configured to apply a pulling force to the glenosphere toward the handle when the glenosphere is coupled with the deflectable distal portion.

15. 1. A glenosphere handling tool, comprising: an elongate body having a proximal end and a distal end; a retainer disposed at the distal end of the elongate body, the retainer comprising: a plurality of wall segments of the elongate body separated from one another by slots, the slots extending from a proximal end of the slot to a distal end of the slot at the distal end of the elongate body; an enlarged periphery at the distal end of the elongate body, the enlarged periphery comprising a proximally-facing edge configured to engage an inner wall surface of a glenosphere; and The holding portion includes: It is equipped with the retainer is configured such that, when the retainer is in a free state, the proximally-facing edge faces a surface of the glenosphere and is capable of contacting the surface of the glenosphere to retain the glenosphere; The glenosphere handling tool, wherein the retaining portion is configured to be deflected at the distal end of the elongate body such that the enlarged periphery has a reduced profile to separate the handling tool from the glenosphere.

16. The glenosphere handling tool of claim 15 , further comprising a control member configurable to cause the holder to hold the glenosphere.

17. The glenosphere handling tool of claim 16 , wherein the control member has a configuration in which the control member is separated from the holding portion.

18. 16. The glenosphere handling tool of claim 15, further comprising a surgical wire, the elongate body comprising a lumen extending between the proximal and distal ends, and the holding portion configured to hold a glenosphere when the surgical wire is disposed within the holding portion.

19. 16. The glenosphere handling tool of claim 15, wherein the elongate body comprises an inner elongate body and further comprises an outer elongate body, the inner elongate body being slidably disposed within the outer elongate body.

20. 20. The glenosphere handling tool of claim 19, wherein the inner elongate body is resiliently biased toward the proximal end of the outer elongate body when the retaining portion of the inner elongate body extends from the outer elongate body.

21. 20. The glenosphere handling tool of claim 19, wherein when the inner elongate body is resiliently biased to apply a retaining force to the glenosphere, that retaining force is transmitted through the glenosphere to an impaction tip, which applies a reaction force opposite to the retaining force.

22. 20. The glenosphere handling tool of claim 19, wherein the outer elongate body comprises a slot, and further comprises an actuator disposed through the slot and engaging the inner elongate body, the actuator being movable along the slot to a first position in which the retainer is exposed at a distal end, a second position in which the retainer is retracted, and a third position disposed between the first position and the second position.

23. 23. The glenosphere handling tool of claim 22, wherein the slot comprises a first portion aligned with a longitudinal axis of the glenosphere handling tool and a second portion transverse to the first portion, the first position and the second position corresponding to positions along the first portion of the slot and the third position corresponding to a position along the second portion of the slot.

24. 20. The glenosphere handling tool of claim 19, further comprising a strike plate disposed at the proximal end of the outer elongate body and an impaction tip disposed at the distal end of the outer elongate body.

25. 25. The glenosphere handling tool of claim 24, wherein application of the impaction load results in proximal movement of the inner elongate body relative to the outer elongate body.

26. 20. The glenosphere handling tool of claim 19, wherein the outer elongate body comprises a handle at a proximal end, an impaction tip opposite the handle, and a thinned portion disposed between the handle and the impaction tip, the thinned portion having a width smaller than both the handle portion and the impaction tip and comprising a continuous concave curvature in a side view.

27. 25. The glenosphere handling tool of claim 24, wherein the impaction tip is removably mounted in a recess in the outer elongate body.

28. 25. The glenosphere handling tool of claim 24, wherein the impaction tip comprises an opening configured to slidably receive the enlarged periphery at the distal end of the inner elongate body.

29. 16. The glenosphere handling tool of claim 15, further comprising an outer member disposed on an outer surface of the elongate body, the outer member configured to be disposed on a side of the glenosphere opposite the enlarged periphery of the retaining portion when the enlarged periphery has a contour configured to retain a glenosphere.

30. 30. The glenosphere handling tool of claim 29, wherein the outer member is configured to be moved toward the distal end of the elongate body to apply a load to a glenosphere engaged with the retainer and to deflect the distal end of the retainer such that the enlarged periphery has a contour that enables the retainer to be separated from the glenosphere.

31. 31. The glenosphere handling tool of claim 30, wherein the outer member comprises a female threaded portion that engages with a male threaded portion of the elongate body.

32. 1. A method of manipulating glenospheres, comprising: providing a glenosphere having a convex articular surface, a concave interior space, and an opening providing access from said convex articular surface to said concave interior space; extending a tip of an elongate member of a handling tool through the opening while a distal portion of the tip is in a lower profile configuration; actuating the tip of the elongate member such that a proximally facing surface thereof has a contour greater than the opening; applying a proximal and / or outward force to the glenosphere from the tip to hold the glenosphere against the tip of the handling tool; The method comprising:

33. 33. The method of claim 32, wherein actuating the tip of the elongate member includes inserting a surgical wire through a lumen of the elongate member to occupy space in the lumen near the distal end of the tip.

34. 33. The method of claim 32, wherein actuating the tip of the elongate member comprises advancing the control member to a position where the control member occupies a space near the distal portion of the tip to maintain the proximally-facing surface having the contour greater than the opening.

35. 33. The method of claim 32, further comprising applying a pressure force to a strike plate of the handling tool to engage the glenosphere with a glenoid base plate.

36. 36. The method of claim 35, further comprising removing the surgical wire before press-fitting the strike plate.

37. 36. The method of claim 35, wherein the elongated member is an inner member and the press-fit force is applied to an outer member of the handling tool disposed about and slidable relative to the inner member.

38. 38. The method of claim 37, wherein the tip is advanced through the opening by an actuator disposed through a side of the outer member.

39. 39. The method of claim 38, wherein the outer member comprises a slot configured to accommodate movement of the actuator along a longitudinal axis of the handling tool, and further comprising moving the actuator into a distal portion of the slot to load a spring disposed between the inner and outer members.

40. 33. The method of claim 32, further comprising placing an actuator of the handling tool in a spring-loaded position in which the tip of the elongate member is held in a distally advanced position.

41. 41. The method of claim 40, further comprising advancing the actuator distally and circumferentially about the longitudinal axis of the elongate body.

42. 1. An instrument for implanting a glenoid base plate, comprising: an elongate body having a first end, a second end and disposed therebetween; a glenoid implant retention mechanism disposed at or adjacent to the first end, the glenoid implant retention mechanism comprising a release arrangement for disengaging a glenoid baseplate and a retention arrangement for engaging and retaining the glenoid baseplate; A rotating guide comprising a peripheral body, The inner circumference and The outer circumference and an orientation feature disposed adjacent to or on the periphery, the orientation feature configured to align with a location corresponding to an augmented portion of a glenoid baseplate; The rotation guide includes: Equipped with The instrument, wherein the inner periphery is configured to be disposed about the glenoid implant retention mechanism when the glenoid implant retention mechanism is in the holding configuration.

43. 43. The instrument of claim 42, further comprising an access gap disposed from the outer periphery to the inner periphery to allow passage of the elongate body transversely to a longitudinal axis of the elongate body.

44. 43. The apparatus of claim 42, wherein the orientation feature comprises an open channel disposed on the periphery.

45. 43. The instrument of claim 42, wherein the orientation mechanism comprises a distal protrusion configured to engage a guidewire.

46. 46. ​​The instrument of claim 45, wherein the distal projection comprises an open channel facing away from the peripheral body.

47. 46. ​​The instrument of claim 45, wherein the distal projection comprises a sealed opening.

48. 43. The instrument of claim 42, wherein the inner periphery is configured to be slidable over the glenoid implant retention feature when the glenoid implant retention feature is in the released configuration and configured to be secured to the glenoid implant retention feature when the glenoid implant retention feature is in the retained configuration.

49. 43. The instrument of claim 42, wherein the inner periphery of the rotation guide comprises a contour configured to match a contour of the glenoid implant retention mechanism.

50. 43. The instrument of claim 42, wherein the proximal surface of the inner periphery comprises a distally-facing conical surface.

51. 43. The instrument of claim 42, wherein a distal portion of the inner periphery comprises a lip configured to be disposed over a distal edge of the glenoid implant retention feature.

52. The inner periphery of the rotation guide is adapted to engage an outer surface of the glenoid implant retention mechanism.

43. The instrument of claim 42, comprising sawtooth configured.

53. 43. The instrument of claim 42, wherein the inner periphery of the rotation guide comprises a continuous circumference.

54. 43. The instrument of claim 42, wherein the inner periphery is configured to be positioned anywhere over a continuous range of positions on the glenoid implant retention feature.

55. 43. The instrument of claim 42, wherein the rotation guide comprises a sleeve with a collet portion disposed proximally of the peripheral body, the collet portion of the sleeve configured to engage an outer surface of the elongate body away from the glenoid implant retention mechanism.

56. 56. The instrument of claim 55, further comprising a clamping ring having internal threads, the sleeve further comprising external threads configured to engage with the clamping ring, the collet portion comprising an outer tapered surface, and wherein advancing the clamping ring along the outer tapered surface creates frictional engagement between an inner surface of the collet portion of the sleeve and the elongated body of the instrument.

57. 57. The instrument of claim 56, wherein the internal threads of the clamping ring are configured to engage with the external threads as the clamping ring advances due to engagement between the internal threads and the external threads to create an enhanced force of the collet portion of the sleeve against an outer surface of the elongate body.

58. 1. An instrument for implanting a glenoid base plate, comprising: an elongate body having a first end, a second end and disposed therebetween; an expandable glenoid implant retention mechanism disposed at or adjacent to the first end, the expandable glenoid implant retention mechanism comprising an expandable retaining end portion for expanding and engaging a glenoid baseplate in an expanded state; and A rotating guide comprising a peripheral body, The inside and The exterior and an orientation feature disposed adjacent to or on the exterior surface; The rotation guide includes: It is equipped with The instrument, wherein the inner surface is configured to restrain rotation of the rotation guide about the glenoid implant retention feature when the glenoid implant retention feature is expanded.

59. 60. The instrument of claim 58, further comprising a lip disposed on a distal portion of the rotation guide to restrain proximal-distal movement of the rotation guide relative to the glenoid implant retention mechanism.

60. 1. A method of aligning a rotationally asymmetric glenoid component to a glenoid of a particular patient, comprising: exposing the glenoid cavity; inserting a pin at or adjacent to the glenoid cavity of the scapula; coupling the rotationally asymmetric glenoid component to a glenoid component inserter; coupling a rotation guide to the glenoid component inserter; After the rotation guide is attached, the rotation guide is attached to the rotationally asymmetric glenoid component. rotationally positioning the rotation guide to align with the augmented portion of the advancing the rotationally asymmetric glenoid component onto the glenoid by referencing an orientation feature of the rotation guide with respect to anatomical structures at or adjacent to the glenoid to align the rotationally asymmetric glenoid component with respect to the glenoid in a prescribed rotational orientation for a particular patient; fixing the rotationally asymmetric glenoid component in the glenoid in the specified rotational orientation for the particular patient; The method comprising:

61. 61. The method of claim 60, wherein coupling the rotation guide to the glenoid component inserter comprises disposing an inner circumferential contour of the rotation guide around a medial end of the glenoid component inserter.

62. 61. The method of claim 60, wherein coupling the rotation guide to the glenoid component inserter comprises disposing an inner peripheral lip of the rotation guide on an inwardly facing surface of a glenoid implant retention feature of the inserter.

63. 61. The method of claim 60, wherein coupling the rotation guide includes coupling an inner circumferential conical surface of the rotation guide to an outer surface of the inserter.

64. 61. The method of claim 60, wherein coupling the rotation guide comprises disposing serrations disposed on an inner circumference of the rotation guide around the expandable distal portion of the inserter.

65. 61. The method of claim 60, wherein advancing the rotationally asymmetric glenoid component onto the glenoid by referencing an orientation feature of the rotational guide with respect to the anatomical structure comprises moving the rotational guide along a guidewire.

66. 66. The method of claim 65, further comprising advancing the open channel of the orientation mechanism over the guidewire transversely to a longitudinal axis of the guidewire.

67. 66. The method of claim 65, further comprising advancing a sealing opening over an outer end of the guidewire along a longitudinal axis of the guidewire.

68. 61. The method of claim 60, wherein coupling the rotation guide comprises: placing an alignment guide body on an outer surface of the inserter; and engaging an inner surface of the alignment guide body with the outer surface of the inserter to rotatably couple the rotation guide to the inserter.

69. 61. The method of claim 60, further comprising advancing a clamping ring over an outer surface of the alignment guide body to cause a portion of the clamping ring to apply a radial force to a collet portion of the alignment guide body.

70. 1. A glenoid base plate comprising: A plate portion, A proximal end; A distal end. a tapered outer surface disposed between the proximal end and the distal end and centered about an insertion axis of the base plate; a bone-engaging surface disposed distally of the tapered outer surface, the bone-engaging surface being adapted to engage the proximal end the bone engaging surface being asymmetrical with respect to the insertion axis so as to define thicker and thinner regions of the plate portion between the bone engaging surface and the bone engaging surface; The plate portion includes: an orientation mark disposed about a periphery of the plate portion between the proximal end and the distal end, the orientation mark being positioned relative to the thicker portion such that a portion of the glenoid of a particular patient can be aligned with the thicker portion according to a preoperative plan for the particular patient; and The glenoid base plate comprising:

71. The glenoid baseplate of claim 70, further comprising a porous layer disposed between said tapered outer surface and said bone engaging surface.

72. 72. The glenoid baseplate of claim 71, further comprising a porous layer marking disposed about a periphery of the porous layer.

73. 73. The glenoid baseplate of claim 72, wherein the porous layer marks are aligned with the thicker areas of the plate portions.

74. 74. The glenoid baseplate of claim 73, wherein the porous layer markings comprise grooves formed in the porous layer.

75. The glenoid baseplate of claim 70, further comprising tapered layer markings disposed on said tapered outer surface.

76. 75. The glenoid baseplate of claim 74, wherein the taper layer mark is aligned with the thicker area of ​​the plate portion.

77. 77. The glenoid baseplate of claim 76, wherein the tapered layer markings comprise grooves formed in the tapered outer surface.

Images