Implants, instruments, and surgical methods for ankle arthroplasty

Abstract

The instrument includes a housing having a first end, a second end, and a body disposed therebetween. The housing also includes a first opening disposed at the first end and a second opening disposed at the second end. The first and second openings are disposed about a common longitudinal axis. The instrument also includes a first drive shaft at least partially received in the first opening and extending into the housing, and a second drive shaft at least partially disposed within the housing. The instrument also includes an engagement member at least partially extending from the second opening in the housing.

Description

[Technical Field]

[0001] (CROSS-REFERENCE TO RELATED APPLICATIONS) This application claims the benefit of priority under 35 U.S.C. § 119(e) of U.S. Provisional Application No. 63 / 377,639, filed September 29, 2022, which is incorporated herein by reference in its entirety.

[0002] This disclosure relates to implantable medical devices, instruments, and surgical methods for surgical procedures. This disclosure relates to podiatric and orthopedic implants, instruments, and surgical methods related to procedures involving the foot / ankle and / or surrounding bone / soft tissue. More specifically, this disclosure relates to implants, instrumentations, and surgical methods for ankle arthroplasty. [Background technology]

[0003] Many of the currently available implants, instruments, systems, and surgical methods for procedures involving the foot / ankle do not fully address the needs of patients. Additionally, many of the currently available implants, instruments, systems, and surgical methods for incorporation into procedures involving the foot / ankle, such as ankle arthroplasty, do not consider the anatomical characteristics of the joint and the associated mechanical and kinematic movement patterns / capacities. Summary of the Invention

[0004] The present disclosure relates to implants, instruments, and surgical methods for procedures involving the foot and / or ankle. More particularly, the present disclosure relates to implants, instruments, and surgical methods for ankle arthroplasty.

[0005] One aspect of the present disclosure relates to an instrument. The instrument includes a housing having a first end, a second end, and a body disposed therebetween. The housing also includes a first opening disposed at the first end and a second opening disposed at the second end, the first opening and the second opening being centered about a common longitudinal axis, and at least a portion of the housing body being substantially parallel to the common longitudinal axis. The instrument also includes a first drive shaft at least partially received within the first opening and extending through the housing, at least one end of the first drive shaft terminating in a first gear member. The instrument also includes a second drive shaft at least partially disposed within the housing, a second gear member disposed at a first end of the second drive shaft such that the second gear member engages with the first gear member, and a third gear member disposed at a second end of the second drive shaft opposite the first end of the second drive shaft. The first drive shaft includes a substantially linear shape, and the second drive shaft includes a substantially non-linear shape. The instrument also includes an engagement member extending at least partially from the second opening in the housing, the engagement member positioned to be engaged by the third gear member.

[0006] Another aspect of the disclosure provided herein is an instrument including a housing having a first end and a second end, a first drive shaft at least partially received within the housing, a first gear member disposed on the first end of the first drive shaft, a second gear member disposed on the first end of the housing and engaged with the first gear member, and a drill bit engaged with the second gear member and extending from at least a portion of the housing.

[0007] Yet another aspect of the present disclosure provided herein is an instrument system including an instrument and a tibial trial having at least one aperture. The instrument includes a housing having a first end and a second end, a first drive shaft at least partially received within the housing, a first gear member disposed on the first end of the first drive shaft, a second gear member disposed on the first end of the housing and engaged with the first gear member, and a drill bit engaged with the second gear member and extending from at least a portion of the housing. The drill bit of the instrument is configured to rotatably pass through the at least one aperture.

[0008] A further aspect of the present disclosure provided herein is a method of using the instrument, including obtaining the instrument. The method also includes performing a surgical procedure to place a tibial trial on the tibia and inserting the instrument so that the drill bit is aligned with at least one opening in the tibial trial. The method further includes using a drill to rotate the drill bit and apply a vertical translating force to at least a portion of the instrument to drill at least one opening in the tibia. The method further includes removing the drill bit from the tibia and removing the instrument from the patient.

[0009] These and other objects, features and advantages of the present disclosure will become apparent from the following detailed description of the various aspects of the disclosure taken in conjunction with the accompanying drawings.

[0010] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the present invention and, together with the detailed description, serve to explain the principles of the present invention. It is emphasized that, in accordance with standard industry practice, various features may or may not be drawn to scale. In fact, the dimensions of various features may be arbitrarily increased or decreased for clarity of discussion. The drawings are intended to illustrate embodiments of the presently disclosed invention and are not to be construed as limiting the invention. [Brief explanation of the drawings]

[0011] [Figure 1] FIG. 1 is an elevated front perspective view of a surgical instrument according to the present disclosure; [Figure 2] 2 is an alternative front perspective view of the device of FIG. 1 according to the present disclosure; [Figure 3] FIG. 2 is a front bottom perspective view of the device of FIG. 1 in accordance with the present disclosure; [Figure 4] FIG. 2 is a perspective view of an instrument system including the instrument of FIG. 1 according to the present disclosure; [Figure 5] FIG. 5 is an alternative front perspective view of the tool system of FIG. 4 according to the present disclosure; [Figure 6] FIG. 5 is a perspective view of an instrument of the instrument system of FIG. 4 in accordance with the present disclosure; [Figure 7] FIG. 5 is an alternative perspective view of the tool system of FIG. 4 according to the present disclosure. [Figure 8] 1 is a side view of an instrument system according to the present disclosure; [Figure 9] 9 is an alternative enlarged side view of the system of FIG. 8 according to the present disclosure. [Figure 10] 9 is an alternative side view of the system of FIG. 8 according to the present disclosure. [Figure 11] 9 is an alternative side view of the system of FIG. 8 according to the present disclosure. [Figure 12] 9 is an alternative side view of the system of FIG. 8 according to the present disclosure. [Figure 13] FIG. 9 is an elevated rear perspective view of a portion of the system of FIG. 8 in accordance with the present disclosure. [Figure 14] 9 is an alternative side view of the system of FIG. 8 according to the present disclosure. [Figure 15] FIG. 9 is an alternative elevated rear perspective view of a portion of the system of FIG. 8 according to the present disclosure. [Figure 16] FIG. 9 is a top view of a portion of the system of FIG. 8 in accordance with the present disclosure. [Figure 17] FIG. 1 is a side cross-sectional view of a surgical instrument according to the present disclosure; [Figure 18] FIG. 1 is a side cross-sectional view of a surgical instrument according to the present disclosure; [Figure 19] FIG. 19 is a side cross-sectional view of a portion of the device of FIG. 18 in accordance with the present disclosure. [Figure 20]FIG. 1 is an elevated perspective view of an instrument system according to the present disclosure; [Figure 21] FIG. 21 is a front view of the system of FIG. 20 according to the present disclosure. [Figure 22] FIG. 21 is an alternative front view of the system of FIG. 20 according to the present disclosure. [Figure 23] FIG. 1 is a perspective view of an instrument system according to the present disclosure; [Figure 24] FIG. 1 is a perspective view of an instrument system according to the present disclosure; [Figure 25] FIG. 1 is a side cross-sectional view of a surgical instrument according to the present disclosure; [Figure 26] FIG. 1 is a side cross-sectional view of a surgical instrument according to the present disclosure; [Figure 27] FIG. 1 is an elevated perspective view of a surgical instrument according to the present disclosure; [Figure 28] FIG. 1 is a side view of an instrument system according to the present disclosure; [Figure 29] FIG. 30 is an alternative side view of the instrument system of FIG. 28 according to the present disclosure; [Figure 30] FIG. 30 is an alternative side view of the instrument system of FIG. 28 according to the present disclosure; [Figure 31] FIG. 29 is a perspective view of the instrument system of FIG. 28 in accordance with the present disclosure; [Figure 32] FIG. 30 is a perspective view illustrating an instrument that may be implemented with the system of FIG. 28 in accordance with the present disclosure. [Figure 33] 32 implemented with a portion of the instrument system of FIG. 28 in accordance with the present disclosure; [Figure 34] 33 is a perspective view of an instrument according to the present disclosure implemented with the instrument of FIG. 32 and part of the instrument system of FIG. 28; [Figure 35] FIG. 1 is a perspective view of an instrument system according to the present disclosure; [Figure 36] FIG. 36 is a partially transparent perspective view of the system of FIG. 35 in accordance with the present disclosure; [Figure 37] FIG. 36 is an alternative, partially see-through perspective view of the system of FIG. 35 according to the present disclosure. [Figure 38] 36 is an alternative, partially see-through, cross-sectional view of the system of FIG. 35 according to the present disclosure. [Figure 39] FIG. 1 is an exploded perspective view of a portion of an instrument system according to the present disclosure. [Figure 40] FIG. 40 is a top view of a portion of the instrument system of FIG. 39 in accordance with the present disclosure; [Figure 41] FIG. 1 is a side view of an implant and instrument system according to the present disclosure; [Figure 42] 42 is an alternative side view of the implant of the system of FIG. 41 according to the present disclosure. [Figure 43] FIG. 42 is an alternative side view of the system of FIG. 41 according to the present disclosure. [Figure 44] FIG. 42 is an exploded perspective view of the instrument of the system of FIG. 41 in accordance with the present disclosure; [Figure 45] FIG. 42 is a side view illustrating an alternative embodiment of an implant of the system of FIG. 41 in accordance with the present disclosure. [Figure 46] 45 of the system of FIG. 41 according to the present disclosure. [Figure 47] FIG. 46 is a bottom view of a portion of the implant of the system of FIG. 45 in accordance with the present disclosure. [Figure 48] FIG. 1 is a front view of an implant system according to the present disclosure; [Figure 49] FIG. 49 is an exploded front view schematically illustrating a portion of the system of FIG. 48 in accordance with the present disclosure. [Figure 50] FIG. 49 is an elevated perspective view of a portion of the system of FIG. 48 in accordance with the present disclosure. [Figure 51] FIG. 49 is an alternative front view of the implant system of FIG. 48 according to the present disclosure; [Figure 52] FIG. 1 is a perspective view of an implant and instrument system according to the present disclosure; [Figure 53] FIG. 53 is a perspective view of an implant of the system of FIG. 52 in accordance with the present disclosure; [Figure 54] 54 is an alternative perspective view of the implant of FIG. 53 in the system of FIG. 52 according to the present disclosure. [Figure 55] FIG. 1 is an elevated perspective view of an implant according to the present disclosure; [Figure 56] FIG. 56 is a side view of the implant of FIG. 55 in accordance with the present disclosure. [Figure 57] FIG. 57 is a side view of an alternative embodiment of the implant of FIG. 56 in accordance with the present disclosure; [Figure 58]FIG. 1 is a perspective view of an apparatus according to the present disclosure; [Figure 59] FIG. 59 is a side view of the device of FIG. 58 in accordance with the present disclosure; [Figure 60] FIG. 59 is a perspective view of a portion of the device of FIG. 58 in accordance with the present disclosure; [Figure 61] FIG. 1 is a perspective view of an apparatus according to the present disclosure; [Figure 62] FIG. 1 is a perspective view of an apparatus according to the present disclosure; [Figure 63] FIG. 1 is a perspective view of an apparatus according to the present disclosure; [Figure 64] FIG. 1 is a perspective view of an apparatus according to the present disclosure; [Figure 65] FIG. 1 is a perspective view of an apparatus according to the present disclosure; [Figure 66] FIG. 66 is a perspective view of the device of FIG. 65 in accordance with the present disclosure; [Figure 67] FIG. 1 is an elevated perspective view of an implant according to the present disclosure; [Figure 68] FIG. 1 is a perspective view of an instrument system according to the present disclosure; [Figure 69] FIG. 1 is a side perspective view of an instrument system according to the present disclosure; [Figure 70] FIG. 70 is a perspective view of a portion of the instrument system of FIG. 69 in accordance with the present disclosure; [Figure 71] FIG. 1 is a side cross-sectional view of an implant system according to the present disclosure; [Figure 72] FIG. 1 is a side cross-sectional view of an implant system according to the present disclosure; [Figure 73] FIG. 1 is a side cross-sectional view of an implant system according to the present disclosure; [Figure 74] FIG. 1 is a side cross-sectional view of an implant system according to the present disclosure; [Figure 75] FIG. 1 is a side view of an implant system according to the present disclosure; [Figure 76] FIG. 76 is an exploded view of the implant system of FIG. 75 in accordance with the present disclosure. DETAILED DESCRIPTION OF THE INVENTION

[0012] In this detailed description and the claims that follow, the terms proximal, distal, anterior or plantar, posterior or dorsal, medial, lateral, superior, and inferior are defined according to standard usage to designate specific portions or locations of a bone or implant, following reference terms that indicate the relative placement or orientation of natural bone. For example, "proximal" refers to the portion of the device or implant closest to the body, and "distal" refers to the portion of the device or implant farthest from the body. As terms relating to direction, "anterior" means toward the front of the body, "posterior" means toward the back of the body, "medial" means toward the midline of the body, "lateral" means toward the side of the body or away from the midline of the body, "superior" means toward above another object or structure, and "inferior" means toward below another object or structure. Additionally, with respect to the foot specifically, the term "dorsal" refers to the top of the foot and the term "plantar" refers to the bottom of the foot.

[0013] Similarly, positions or orientations may be used herein with reference to anatomical structures or surfaces. For example, as current implants, devices, instrumentation, and methods are described herein with reference to use with the bones of the foot, the bones of the foot, ankle, and lower leg may be used to describe the surfaces, positions, directions, or orientations of implants, devices, instrumentation, and methods. Additionally, the implants, devices, instrumentation, and methods disclosed herein, and their aspects, components, features, etc., are described with reference to one side of the body for simplicity. However, because the human body is relatively symmetrical or mirrored about a line of symmetry (the midline), it is expressly contemplated herein that the implants, devices, instrumentation, and methods described and / or illustrated herein, as well as their aspects, components, features, etc., may be changed, varied, modified, reconfigured, or otherwise altered for use with or in association with another side of the body for the same or similar purposes without departing from the spirit and scope of the present invention. For example, implants, devices, instrumentation, and methods described herein with respect to the right foot, as well as their aspects, components, features, etc., can be mirrored to function similarly on the left foot. Furthermore, while the implants, devices, instrumentation, and methods disclosed herein, as well as their aspects, components, features, etc., are described with respect to the foot for simplicity, it should be understood that the implants, devices, instrumentation, and methods may be used with other bones of the body having similar structures.

[0014] The presently disclosed instruments, implants, systems, assemblies, and related methods for maintaining, correcting, and / or resurfacing joint surfaces are disclosed in U.S. Patent No. 10,117,749, published November 6, 2018, entitled "Subtalar Joint Implant," European Patent No. 3,756,626, published December 30, 2020, entitled "Subtalar Joint Implant," European Patent Application No. 15,770,960.1A, filed July 15, 2020, entitled "Subtalar Joint Implant," European Patent Application No. 15,770,960.1B, filed March 1, 2021, entitled "Methods for Performing Arthroplasty of the Subtalar Joint," and European Patent Application No. 15,770,960.1C, filed March 1, 2021, entitled "Methods for Performing Arthroplasty of the Subtalar Joint." U.S. Provisional Patent Application No. 63 / 155100, filed March 30, 2021, entitled "Methods for Performing Subtalar Joint," U.S. Provisional Patent Application No. 63 / 167965, filed April 24, 2019, entitled "Implants and Methods of Use and Assembly," International Application No. PCT / US2019 / 29009, filed December 12, 2019, entitled "Implant System and Methods of Use," International Application No. PCT / US2019 / 64741, filed December 13, 2019, entitled "Patient Specific Instrumentation and Methods of and / or International Application No. PCT / US2019 / 66336, filed December 13, 2019, entitled "Patient-Specific Device and Method of Use," and / orand Methods of Use and Assembly,” and / or International Application No. PCT / US2019 / 66408, filed December 13, 2019, entitled “Alignment Instruments and Methods for Use in Total Ankle Replacement,” and / or International Application No. PCT / US2019 / 66149, filed December 13, 2019, entitled “Joint Replacement Alignment Guides, Systems, and Methods of Use and Assembly,” and / or International Application No. PCT / US2019 / 66393, filed September 11, 2019, entitled “Resection Guides, Sweeping Reamers, and Methods for Use in Total Ankle Replacement,” and / or No. 62 / 898,615, filed December 13, 2019, entitled "Resection Guide, Sweeping Reamer, and Method of Use in Total Ankle Replacement," and / or U.S. Provisional Patent Application No. 62 / 898,615, filed December 13, 2019, entitled "Distractors Having Attachable Paddles, Impaction Devices,No. PCT / US2019 / 66398, entitled "Distractor with Attachable Paddle, Impaction Device, and Methods for Use in Total Ankle Replacement," and / or International Application No. PCT / US2019 / 65025, filed December 6, 2019, entitled "Trial Insert Assembly," and / or Provisional Patent Application No. 62 / 899460, filed September 12, 2019, entitled "Total Ankle Replacement Surgical Method," and / or Provisional Patent Application No. 62 / 899460, filed December 13, 2019, entitled "Instruments, Guides,The present invention may be similar to, or may include at least one feature or aspect of, the implants, systems, assemblies, and related methods disclosed in International Application No. PCT / US2019 / 66404, entitled "Instruments, Guides, and Related Methods for Total Ankle Replacement," which are incorporated herein by reference in their entirety. Similarly, the presently disclosed instruments, implants, systems, assemblies, and related methods for maintaining, correcting, and / or resurfacing joint surfaces may be disclosed in International Application No. PCT / US2019 / 29009, filed April 24, 2019, and entitled "Implants and Methods of Use and Assembly," International Application No. PCT / US2019 / 64741, filed December 12, 2019, and entitled "Implant System and Methods of Use," International Application No. PCT / US2019 / 66336, filed December 13, 2019, and entitled "Patient Specific Instrumentation and Methods of Use," and / or International Application No. PCT / US2019 / 66336, filed December 13, 2019, and entitled "Joint Replacement Alignment Guides, System, and Methods of Use and Assembly." International Application No. PCT / US2019 / 66408, filed December 13, 2019, entitled "Joint Replacement Alignment Guides, Systems, and Methods of Use and Assembly," and / or International Application No. PCT / US2019 / 66149, filed December 13, 2019, entitled "Alignment Instruments and Methods for Use in Total Ankle Replacement," and / or International Application No. PCT / US2019 / 66149, filed December 13, 2019, entitled "Joint Replacement Alignment Guides, Systems, and Methods of Use and Assembly," and / orNo. PCT / US2019 / 66393, filed September 11, 2019, entitled "Joint Replacement Alignment Guides, Systems, and Methods of Use and Assembly," and / or U.S. Provisional Patent Application No. 62 / 898,615, filed September 11, 2019, entitled "Resection Guides, Sweeping Reamers, and Methods for Use in Total Ankle Replacement," and / or International Application No. PCT / US2019 / 66398, filed December 13, 2019, entitled "Distractors Having Attachable Paddles, Impaction Devices, and Methods for Use in Total Ankle Replacement," and / or International Application No. PCT / US2019 / 66398, filed December 6, 2019, entitled "Trial Insert No. PCT / US2019 / 65025, filed September 12, 2019, entitled "Trial Insert Assembly," and / or Provisional Patent Application No. 62 / 899460, filed December 13, 2019, entitled "Total Ankle Replacement Surgical Method," and / or Provisional Patent Application No. 62 / 899460, filed December 13, 2019, entitled "Instruments, Guides,No. PCT / US2019 / 66404, entitled "Instruments, Guides, and Related Methods for Total Ankle Replacement," and / or U.S. Patent Application No. 16 / 672,505, filed November 3, 2019, entitled "Talus Formational And Implantation Method," and / or International Application No. PCT / US2021 / 046920, entitled "Whole Talus Implant and Method," and / or "Implant for Focal Talus Defects and The implant may include one or more devices (e.g., one or more insertion devices and / or implantation devices) disclosed in International Application No. PCT / US2021 / 047117, entitled "Implant and Method for Localized Talus Defects," which is incorporated herein by reference in its entirety.

[0015] Implants, instruments, systems, and surgical methods are shown and described with reference to the drawings included herein. It should be understood that one or more of the implants, instruments, systems, and / or surgical methods shown and described herein can be practiced with one or more of the various other implants, instruments, systems, and surgical methods shown and described herein. For example, various instruments and / or surgical methods can be practiced to implant one or more of the various implants / implant systems shown and described herein. Furthermore, it should be understood that the implants, instruments, systems, and surgical methods shown herein, and their components, can be duplicated, eliminated, or otherwise combined / modified. For example, the drive shaft of an instrument can be practiced in combination with the power source of another instrument system to implant one or more of the implants and / or implant systems shown and described herein.

[0016] 1-7, an instrument 100 and components configured to be implemented with and / or removably coupled to the instrument 100 are shown, according to an exemplary embodiment. The instrument 100 is shown to include an outer shaft 102. The outer shaft 102 is integral with or coupled to a housing 106 at an end of the outer shaft 102. The outer shaft 102 may have a substantially cylindrical shape and is shown to receive at least a portion of a drive shaft 104 at least partially therein and therethrough. The drive shaft 102 is shown to include a worm 105 located at or near its distal end and may further be configured to couple to a power source or other instrument at an end opposite the worm 105. In some embodiments, other gear configurations may be implemented in place of or in addition to the worm 105, such as a miter gear and / or a series of spur gears (or other mechanisms configured to accommodate substantially orthogonal angles). The worm 105 is shown as being at least partially disposed within the housing 106 such that the worm 105 is disposed adjacent to the spur gear 107 (such that the worm 105 and spur gear 107 collectively form a worm gear). The spur gear 107 can engage with the worm 105, and rotation of the drive shaft 104 (and thus rotation of the worm 105) actuates the spur gear 107 through engagement with the worm 105. The instrument 100 is further shown to include a drill bit 108 that may be integral with and / or coupled to a surface of the spur gear 107 (e.g., at an angle of about 90 degrees from the teeth / engagement elements of the spur gear 107). The drill bit 108 is shown extending through and disposed above an opening in the housing 106, but can be actuated by rotation of the drive shaft 104. As shown at least in FIGS. 2-3, at least a portion of worm 105 and spur gear 107 are disposed adjacent an opening in housing 106 or extend at least partially outside housing 106.

[0017] 4-5 , the instrument is shown implemented with a tibial trial instrument 110. The tibial trial 110 may have one or more shapes, components, and / or dimensions the same and / or similar to those incorporated herein by reference. The tibial trial 110 is shown including a central opening 112 configured to receive at least a portion of a drill bit 108 so that a distal portion of the patient's tibia may be drilled with the tibial trial 110 in place (e.g., positioned adjacent the tibia). The instrument 100 may be removably coupled to one or more modular components 114 (the drill bits 108 are also removably coupled to the modular components 114) to extend the drill bit 108 proximally so that more proximal portions of the tibia may be drilled while the instrument 100 remains stationary. The modular components 114 may be coupled in stages by a physician so that the instrument 100 can be used to drill more proximal regions of the tibia in stages.

[0018] 8-11 , an instrument system including a distractor 116 and an instrument 100 is shown. As shown, the instrument 100 is positioned within a portion of the distractor 116 such that a physician can use the distractor 116 to apply a vertical upward force to the drill bit 108 while drilling the distal tibia from outside the tibial footprint. For example, in some embodiments, the distractor 116 can be configured to apply an upward or downward force and / or manipulate components at its distal end when actuated by the physician. In some embodiments, a power source (e.g., a powered driver) can be coupled to the instrument 100 and / or the distractor 116 to transmit power to the instrument 100 and thus rotate the drive shaft 104. In some embodiments, the distractor 116 can be implemented with both the instrument 100 and the tibial trial 110.

[0019] 12-16, an instrument system is shown that includes a distractor 118. Similar to the distractor 116, the distractor 118 may be configured to receive power via coupling with a power source and / or translate power to the drill bit 108. The distractor 118 and other components shown in FIGS. 12-16 may also be implemented in combination with one or more components (e.g., the tibial trial 110) shown in FIGS. 1-11. The distractor 118 is shown removably coupled to an engagement element 120 that includes a paddle 122 configured to contact the patient's talus and a ratchet instrument 119 (e.g., including a ratchet 124 integral with or removably coupled to the drill bit 108) configured to be positioned adjacent the patient's distal tibia. The ratchet 119 is shown to include the drill bit 108 disposed on an upper surface thereof. Additionally, the ratchet 119 is shown positioned adjacent the tibial trial 110 so that the drill bit 108 can extend through the opening 112 and contact the distal tibia. The distractor 118 and other components of FIGS. 12-16 may be implemented without a power source, i.e., the ratchet 119 is configured to accommodate unpowered drilling of the distal tibia when used in a typical ratcheting action (e.g., moving along an arcuate path in a single plane).

[0020] Referring now to FIG. 17 , an instrument 126 according to an exemplary embodiment is shown. The instrument 126 includes a substantially C-shaped (or U-shaped) housing 130, as shown. The instrument 126 further includes openings at both a first end and a second end of the housing 130, the first end being shown to at least partially receive a shaft 134 (e.g., a drive shaft) therein. The shaft 134 is shown terminating at least one end in a miter gear 132, and the end opposite the miter gear 132 may be coupleable to a power source (in some embodiments, the miter gear 132 may be replaced and / or supplemented with an additional gear). The housing 130 is further shown to include three additional shafts 134. Two of the shafts 134 terminate in spur gears 132 at both ends. The third of the shafts 134 terminates in the miter gear 132 at a first end and in a worm gear 129 at a second end. The worm gear 129 is positioned adjacent an opening in the second end of the housing 130. The instrument 126 is further shown to include a drill bit 128 (which may be the same as and / or similar to the drill bit 108) positioned at least partially within the housing 130 and extending partially through the second opening such that a bottom portion of the drill bit 128 may engage the worm gear 129. Thus, by applying a force (e.g., by coupling to a power source) to a shaft 134 extending from the first opening in the housing 130, the first shaft 134 (and corresponding miter gear 132) can be rotated, which contacts one of the spur gears 132 and drives rotation of the second shaft 134. The rotation of the second shaft 134 and corresponding spur gear 132 drives rotation of the third shaft 134 through engagement with the adjacent spur gear 132. Rotation of the third shaft 134 and its spur gear in turn drives rotation of the fourth shaft 134 (with worm gear 129) and, consequently, rotation of the drill bit 128. Additionally, the instrument 126 and its housing 130 may be modified to allow for the application of a force (e.g., impaction, etc.) to the instrument in the direction of drilling.

[0021] 18-19, an instrument 136 according to an exemplary embodiment is shown. The instrument 136 includes a substantially C-shaped (or U-shaped) housing 130, as shown in FIG. 17. The instrument 136 further includes openings at both a first end and a second end of the housing 130. The first end is shown to at least partially receive a shaft 140 (e.g., a drive shaft) therein. The shaft 140 is shown terminating at least one end in a miter gear 132, and the end opposite the miter gear 132 may be connectable to a power source. The housing 130 is further shown to include three additional shafts 140. Two of the shafts 140 terminate at one end in a coupling 138. One of the shafts 140 terminates at both ends in a coupling 138. The tool 126 is shown as including a drill bit 128 (which may be the same as and / or similar to the drill bit 108) disposed at least partially within the housing 130 and extending partially through the second opening such that a bottom portion of the drill bit 128 may engage the worm gear 129. The tool 126 includes shafts 140 terminating at one end in a coupling 138, with the first shaft 140 terminating at one end in a spur gear 132 that engages the shaft 140 protruding from the housing 130, and the second shaft 140 terminating in a worm gear 129 adjacent the second opening in the housing. The tool 126 is thus shown as including a drill bit 128 (which may be the same as and / or similar to the drill bit 108) disposed at least partially within the housing 130 and extending partially through the second opening such that a bottom portion of the drill bit 128 may engage the worm gear 129. Thus, by applying a force (e.g., by coupling to a power source) to the shaft 134 extending from the first opening in the housing 130, the first shaft 134 (and corresponding miter gear 132) can be rotated, which in turn contacts one of the spur gears 132 to drive rotation of the second shaft 134. Rotation of the second shaft 134 and corresponding spur gear 132, through engagement with the adjacent spur gear 132, drives rotation of the third shaft 134. Rotation of the third shaft 134 and its spur gear 132 then drives rotation of the fourth shaft 134 (with worm gear 129) and, consequently, the drill bit 128. Additionally, the instrument 126 and its housing 130 may be modified so that a force (e.g., impaction, etc.) can be applied to the instrument in the direction of drilling.

[0022] 20-21 , an instrument system 142 (“system 142”) is shown in accordance with an exemplary embodiment. System 142 is shown to include an instrument 126 removably coupled to a power source 144. Power source 144 may be configured to apply a force to at least a portion of instrument 126, e.g., shaft 134, thereby rotating shaft 134 and actuating other components of instrument 126 (including drill bit 128). Similarly, system 142 may be modified to include instrument 136 as previously shown and described herein, with power source 144 implemented in the same or similar manner. Referring to FIG. 22 , system 142 has been modified to include instrument 146 (which may include one or more of the same / similar components, shape, or other features / attributes as instruments 126, 136). Instrument 146 is shown to include a keel punch 148 instead of the drill bit 128 relative to instruments 126, 136. Further, power source 144 is shown to be an impact driver (e.g., a hammer drill, etc.) configured to drive keel punch 148 into the distal tibia. However, in example systems 142 (and instruments 126, 136, etc. described herein), power source 144 may be configured to apply a rotational force, torque, etc. configured to rotate a shaft / drive shaft or other element. Referring to FIGS. 23-24 , instruments 150, 152 are shown in a system similar to that shown in FIG. 22 . However, as shown in FIGS. 23-24 , instruments 150, 152 (which may be the same as and / or similar to instruments 126, 136, 146) may receive a manually applied force at their end (e.g., impact force from a mallet or a constant force applied to handle 154, etc.) to drive drill bit 128 into the distal tibia, while power source 144 simultaneously applies a force to the instrument to rotate drill bit 128.

[0023] Referring now to FIG. 25 , an instrument 156 is shown according to an exemplary embodiment. The instrument 156 is shown to have a shape the same as and / or similar to that of the instrument 126 and / or the instrument 136 previously shown and described herein. The instrument 156 is shown to include a housing 160. The housing 160 includes openings at opposite ends thereof. As shown, the first and second openings of the housing 160 are configured about a common longitudinal axis. It should be understood that such an arrangement of the first and second openings of the housing 160 may be a feature of other instruments shown and described herein, such as the instruments 126 and 136. However, such an arrangement of the first and second openings of the housing may be about independent longitudinal axes. A shaft 138 is shown extending into the housing 160 through one of the aforementioned openings. A first end of the shaft 138 terminates in the miter gear 132. A second end of the shaft 138 is configured to couple to a power source. The miter gear 132 of the shaft 138 is shown positioned adjacent to the additional miter gear 132. The additional miter gear 132 is positioned at the end of a flexible shaft 158. The flexible shaft 158 ​​is shown to extend around the interior geometry of a housing 160 and terminate at an opposite end from the miter gear 132 in a worm gear 162. The worm gear 162 is positioned adjacent to the bottom of the drill bit 128, such that rotation of the shaft 138 drives rotation of the flexible shaft 158, and thus the worm gear 162, to rotate the drill bit 128.

[0024] 26-27, an instrument 163 is shown according to an exemplary embodiment. The instrument 163 is shown to have a shape that may be the same as and / or similar to the shapes of the instrument 156, the instrument 126, and / or the instrument 136 previously shown and described herein. The instrument 163 is shown to include a housing 164. The housing 164 includes openings at opposite ends thereof. As shown, the first and second openings in the housing 164 are configured about a common longitudinal axis. It should be understood that such an arrangement of the first and second openings in the housing 164 may be a feature of other instruments shown and described herein, such as the instruments 126 and 136. However, such an arrangement of the first and second openings in the housing may be about independent longitudinal axes. A shaft 138 is shown extending into the housing 164 through one of the openings. A first end of the shaft 138 terminates in the miter gear 132. A second end of the shaft 138 is configured to couple to a power source. The miter gear 132 of the shaft 138 is shown disposed adjacent to the additional miter gear 132. The additional miter gear 132 is disposed at the end of a flexible shaft 160. The flexible shaft 160 is shown extending around the interior shape of the housing 164 and terminating in a worm gear 162 at an end opposite the miter gear 132. In some embodiments, the flexible shaft 166 may be the same as the flexible shaft 158 ​​or may differ from the flexible shaft 158 ​​in that the flexible shaft 166 may be configured to accommodate a U-shaped housing, while the flexible shaft 158 ​​may be configured to accommodate a C-shaped housing. The worm gear 162 is disposed adjacent to the bottom of the drill bit 128, and is configured such that rotation of the shaft 138 drives rotation of the flexible shaft 166, and thus the worm gear 162, to rotate the drill bit 128.

[0025] 28-31 , an instrument 168 is shown according to an exemplary embodiment. The instrument 168 is shown to include a housing 170 having a substantially non-linear cylindrical shape as shown. The instrument 168 is further shown to include a drive shaft 174. The drive shaft 174 may be coupled to or integral with a flexible shaft 176. The flexible shaft 176 terminates in a drill bit 172 at an end opposite the drive shaft 174. The drive shaft 174 may be connectable to a power source, as described above with reference to similar components herein. In some embodiments, the flexible shaft 176 may be flexible in particular directions and / or orientations, for example, within a range (e.g., angle) that facilitates manipulation specific to the anatomy involved in a particular procedure. The housing 170 is configured to receive at least a portion of the drive shaft 174, flexible shaft 176, and / or drill bit 172 therein and can guide these components into and through an anterior window between the tibia and the talus, with the drill bit 172 exiting the housing and contacting (or positioned adjacent to) a portion of the distal tibia. In some embodiments, the instrument 168 can be implemented in combination with the tibial trial 110, where the housing 170 is manipulated by the physician to be positioned adjacent to or partially within the opening 112. Referring to FIGS. 31-34 , an instrument 178 and an instrument 182 are shown that can be implemented in combination with the instrument 168. The instrument 178 can be configured to releasably couple with the tibial trial 110, such that the instrument 168 (and its housing 170) can be guided along a path 180 defined by an elongated recess in the instrument 178 (corresponding to the shape of the instrument and housing 168, 170). Instrument 182 may be configured to removably couple with instrument 178 and can support instrument 168 and its components as they advance along pathway 180 and drill holes in the distal tibia.

[0026] 35-38 , an instrument system 184 (“system 184”) is shown in accordance with an exemplary embodiment. System 184 is shown to include a body 186 coupled to the bottom of a tibial trial 188. Body 186 includes at least a portion of a drill bit 190, a drive shaft 192, a worm gear 193, and a spur gear 194. Drive shaft 192 is shown to include worm gear 193 at a first end thereof and may be connectable to a power source at an opposite end. Actuation (e.g., rotation) of drive shaft 192 causes worm gear 193 to engage spur gear 194, which in turn rotates within body 186. Spur gear 194 engages drill bit 190, and rotation of spur gear 194 rotates drill bit 190. The drill bit 190 is configured to be tranatable along a vertical axis (similar to or the same as the axis about which it is rotatable), with at least a portion of the drill bit 190 protruding through an opening in the tibial trial 188. Thus, the system 184 may be positioned adjacent to the distal tibia (e.g., within the anterior window) with the drive shaft 192 coupled to a power source. Actuation of the drive shaft 192 subsequently rotates the drill bit 190, drilling upward into the distal tibia.

[0027] 39-46, a system 196 ("system 196") according to an exemplary embodiment is shown. The system 196 is shown to include a tibial component 198 as well as a drill bit 200 and a modular component 202. The tibial component 198 is shown to include an opening in its central portion through which the drill bit 200 and one or more modular components 202 can be translated or otherwise manipulated. In some aspects, the tibial component may be a component of a tibial trial or tibial implant configured to be coupled to or positioned adjacent to the distal tibia while the distal tibia is drilled through the central opening by the drill bit 200. To reach more proximal portions of the distal tibia, one or more modular components 202 can be coupled together with the drill bit 200 to gradually increase the height of the drilling apparatus and correspondingly access more proximal portions of the distal tibia. In some embodiments, the modular component 202 can include an interface on at least a portion of its surface configured to interface with an instrument 206, thereby facilitating manipulation and drilling. Additionally, in some embodiments, the modular components 202 may be configured to lock together, ultimately forming part of the tibial implant (e.g., a stem portion), and also to lock with the tibial component 198 (thus eliminating the need for removal after drilling). With reference to FIGS. 45-47 , the system 196 is shown with a tibial component 208 configured to be implemented in combination with a drill bit 200 and one or more modular components 202. The tibial component 208 is configured to include an engagement feature (e.g., a keel) configured to occupy a corresponding volume 204 (e.g., formed by a keel punch as shown and described herein).The tibial component 208 is further shown to receive a fastener 210 configured to couple the tibial component 208 with one or more modular components 202 (and in some embodiments, the drill bit 200, which serves as the proximal-most point of the tibial stem). Additionally, the underside of the tibial component 208 may be configured to removably couple with an intermediate component 212 (e.g., a poly component) of an ankle arthroplasty system.

[0028] 48-49, an implant system 214 ("system 214") is shown according to an exemplary embodiment. System 214 is shown to include a tibial component 220. Tibial component 220 is configured to releasably couple (via features disposed on its underside) with an intermediate (e.g., poly) component 222 as a component of a total ankle replacement system. System 214 is further shown to include one or more (as shown, multiple) modular components 218 configured to releasably couple to one another in a stacking configuration. In some embodiments, each of modular components 218 may be identical, while in other configurations, some of modular components 218 may be different from others. Each of modular components 218 is shown to include a first interface on its bottom surface and a second interface on its top surface. The first and second interfaces are opposite each other (e.g., the first interface is male, the second interface is female, etc.). The tibial component 220 is further shown to be matable with at least one of the modular components 218 on its upper surface (opposite the surface mated with the intermediate component 222). In some embodiments, the modular component 218 may be configured for drilling and / or cutting, while in other embodiments, the modular component 218 may be configured for implantation after a drilling operation has formed a volume in the distal tibia corresponding to the shape of the modular component 218. The system 214 is further shown to include a tip 216, which may include a drill bit or other cutting component configured to facilitate the formation of a volume in the distal tibia. In some embodiments, the tip 216 can perform the aforementioned volume formation and remain within the volume while one or more modular components are coupled to it to form a tibial stem of appropriate length for the volume.

[0029] 50-51, an implant system 224 ("system 224") according to an exemplary embodiment is shown. System 224 is shown to include a tibial component 228. Tibial component 228 is configured to detachably couple (via features disposed on its underside) to an intermediate (e.g., poly) component 232 as a component of a total ankle replacement system. System 224 is further shown to include one or more (as shown, multiple) modular components 230 configured to detachably couple to one another in a stacked configuration. In some embodiments, each of modular components 230 may be identical, while in other configurations, some of modular components 230 may be different from others. Each of modular components 230 is shown to include a first interface on its bottom surface and a second interface on its top surface. The first and second interfaces are opposed to one another (e.g., the first interface is male, the second interface is female, etc.). The tibial component 228 is further shown to be matable with at least one of the modular components 230 on its upper surface (opposite the mating with the intermediate component 232). In some embodiments, the modular component 230 is configured to drill and / or cut and may include one or more cutting features 234 the same as or similar to those shown in FIG. 50. The system 224 is further shown to include a tip 226, which may include a drill bit or other cutting component configured to facilitate the formation of a volume in the distal tibia. In some embodiments, the tip 216 performs the formation of the volume described above and can remain within that volume while one or more modular components are mated to it to advance the tip further proximally within the distal tibia.

[0030] 52-54, an implant system 236 is shown in accordance with an exemplary embodiment. The implant system 236 ("system 236") may include one or more components the same as and / or similar to the system 168 shown and described previously herein. The system 236 is shown to include a lateral component 238 and a medial component 240. The medial component 240 includes a tip 242 at its end that may be implemented in drilling or otherwise forming a volume in the distal tibia. In some embodiments, both the lateral component 238 and the medial component 240 may be flexible in a particular plane (e.g., bendable to a substantially 90-degree angle or other bend angle specific to the anatomy adjacent to or involved in a particular procedure, bendable about a particular radius of curvature or range of radii, etc.), but rigid (e.g., non-bendable) in an orthogonal plane. Thus, the lateral component 238 and the medial component 240 may be positioned so that their respective planes of flexibility are aligned, and then inserted into the volume of the distal tibia with the components 238, 240 bent approximately 90 degrees, as shown in FIG. 52 . Then, once positioned in the desired location within the volume, one or both components 238, 240 may be rotated so that their respective planes of flexibility are at an orthogonal angle relative to the other component. Thus, in such an orientation, alignment of the rigid plane of the medial component 240 with the flexible plane of the lateral component may prevent the lateral component 238 from bending about its flexible plane, and vice versa. In some embodiments, one or both of the components 238, 240 may be bendable / flexible about multiple or infinite planes. One or both of the lateral component 238 and the medial component 240 may include a feature at their distal-most end (opposite the tip 242 when implanted, as shown) configured to facilitate coupling with a tibial tray or other similar component of a tibial implant.Additionally, the system 224 may be implemented in combination with other implants and / or implant systems, such as ankle arthroplasty systems.

[0031] 55-57, an implant 244 according to an exemplary embodiment is shown. The implant 244 is shown to be a tibial implant having a keel feature on its upper surface. As shown, the keel feature includes a central element (e.g., a post, etc.) from which each of the keels is incrementally spaced. In some embodiments, the implant 244 may include more or fewer keels than shown, such as two to eight keels. Furthermore, in some embodiments, the keels may be evenly spaced from one another, while in some embodiments, the keels may be at least partially unevenly spaced from one another. In some embodiments, such as shown in FIG. 57, the implant 244 can be implemented in combination with one or more other implant systems / components, such as the implant system 224 and / or its components. Accordingly, in some embodiments, the implant 244 may include one or more coupling features disposed thereon to facilitate coupling with one or more other implant systems and / or its components.

[0032] 58-60, an instrument system 246 ("system 246") according to an exemplary embodiment is shown. System 246 is shown to include a housing 248. The housing contains therein at least a portion of a first gear-shaped member 250 and a second gear-shaped member 256. First gear member 250 is shown to include a drive shaft configured to couple to a power source at a first end and terminate at an opposite second end in a miter gear. The miter gear is configured to engage a complementary miter gear at a first end of a second gear mechanism located on the opposite side of the threaded shaft from the coupling with keel punch 252. Thus, upon actuation of first gear-shaped member 250 (e.g., rotationally driven by a power source), second gear-shaped member 256 rotates, thus moving keel punch 252 (which can translate along the threads of the threaded shaft) upward, so that keel punch 252 protrudes from an opening in the top surface of housing 248 and contacts a distal portion of the tibia when the housing is positioned within the anterior window.

[0033] 61-64, an instrument 254 is shown. The instrument 254 is shown to include a keel punch at its distal end. As shown, the keel punch may include various keel sizes and / or keel shapes. For example, the keel punch may include various numbers of keels, e.g., from two to five keels (inclusive), and may further include features (e.g., serrations) on one or more surfaces of the keels. In some embodiments, the keels may be spaced apart relative to a central strut or other structural element. In other embodiments, the keels may abut each other to form a sharp apex at their centers.

[0034] 65-66, an instrument 258 is shown in accordance with an exemplary embodiment. The instrument 258 is shown to include a centrally disposed volume. The volume corresponds to the volume of a keel punch. Additionally, the keel punch, or at least a portion thereof, may be configured to be received within an opening in the instrument 258. In some aspects, the instrument 258 can be implemented in combination with other instruments, instrument systems, implants, or implant systems described above and below herein to position, guide, or otherwise engage a keel punch or other similar instrument (or portion thereof).

[0035] 67 , an exemplary embodiment of implant 260 is shown. Implant 260 is shown to be a centrally located keeled tibial implant. In some aspects, the keel of implant 260 may have a shape corresponding to the shape of a keel punch or other similar instrument included in the system (e.g., instrument 254). Implant 260 may be implemented as part of an implant system in combination with other implant components, such as a tibial implant component configured to mate with implant 260 and / or other implants, such as a talar implant or intermediate component as part of an ankle arthroplasty system.

[0036] Referring now to FIG. 68 , the keel punch 252 is shown removably coupled to an instrument 259. The instrument 259 may be the same as and / or similar to that shown in FIG. 22 previously shown and described herein. The instrument 259 is shown removably coupled (e.g., engaged, etc.) with a power source 144. In some embodiments, the power source 144 may be a drill or other rotating element. However, in some embodiments, such as the embodiment shown in FIG. 68 , the power source 144 may be an impact driver, impact hammer drill, or similar instrument. Furthermore, in embodiments such as FIG. 68 where a keel punch 252 is implemented, the instrument 259 may engage an impact-based power source 144 (as opposed to a rotation-based power source 144) configured to drive or “punch” the keel punch 252 into the distal tibia.

[0037] 69-70 , an instrument system 290 (“system 290”) is shown according to an exemplary embodiment. The system 290 is shown to include a distractor 293. The distractor 293 is modified to receive and / or translate force provided by a power source (e.g., the power source 144 as previously shown and described herein). In some aspects, the distractor 293 may be configured such that actuation of the distractor 293 by a physician manipulates one or more components at its distal end toward one another (e.g., retracting a portion of one component into another). The distractor 293 is shown to include a first shaft 292 extending from between the handles of the distractor 293 at its proximal end, which may be configured to couple and / or engage with a power source. The first shaft 292 is shown to detachably couple to a modulation element 294 disposed substantially between and / or adjacent to the handles of the distractor 293. The modulation element 294 may be configured to convert the force / power provided by the power source (e.g., "decrease" or "increase" gears so that other elements of the system 290 can operate at higher or lower speeds, respectively) and may further be coupled to a drive shaft 296. The drive shaft 296 is shown extending from the distractor 293 in a substantially opposite direction from the first shaft 292. As shown in FIG. 69 , the drive shaft 296 extends at its lower portion toward and is positioned adjacent to / within the anterior window. In some embodiments, the drive shaft 296 may include one or more gears at its distal portion, such as one or more worm gears and / or spur gears (e.g., similar to those shown in FIG. 1 ). The drive shaft 296 is shown extending upward from the end of the drive shaft 296 and coupled to a drill bit 300 positioned adjacent the distal tibia. The distractor 293 is also shown to include a tibial trial 302 disposed on the end opposite the end from which the first shaft 292 extends.Similar to the other tibial trials shown and described herein, the tibial trial 302 may include a central opening configured to receive at least a portion of the drill bit 300 or other instrument when the drill bit 300 or other instrument contacts the distal tibia. Thus, a physician can apply power to the first shaft 292, which applies a force that ultimately reaches the drill bit 300 (via the modulation element 294 and drive shaft 296) to rotate the drill bit 300. As the drill bit 300 rotates, the physician can manipulate the handles of the distractor 293 toward each other, causing the drill bit 300 to engage and drill into the patient's distal tibia.

[0038] 71-73, various embodiments of an implant system 260 are shown, according to an exemplary embodiment. The implant system 260 is shown to include a lower portion 262 (e.g., a tibial baseplate) and an upper portion 264. The upper portion 264 is shown to define a volume corresponding to the shape of the lower portion 262, e.g., an upward projection of the lower portion 262. The implant system 260 is further shown to include at least one resilient element 266 (e.g., multiple components, a ring / washer, etc.) configured to have dampening properties. The at least one resilient element 266 is configured to be disposed between shoulders of the lower portion 262 and a corresponding shape of the upper portion 264 to dampen forces applied to either implant portion and prevent the upper portion 264 from contacting the lower portion 262 (or vice versa). In some embodiments, one or more components of the upper portion 264 can be translatable in response to an applied force such that the resilient element 266 is compressed.

[0039] 74, an implant system 272 is shown according to an exemplary embodiment. The implant system 272 is shown to include a base component 270 (e.g., a tibial baseplate) and a medial component 268. The base component 270 is shown to define a volume corresponding to the shape of the medial component 268, e.g., a lateral projection of the medial component 268. The implant system 272 is further shown to include at least one resilient element 266 (e.g., multiple components, a ring / washer, etc.) configured to have damping properties. The at least one resilient element 266 is configured to be positioned between a shoulder of the projection of the medial component 268 and a corresponding shape of the base piece 270 to dampen forces applied to either implant portion and prevent the medial component 268 from contacting the underlying base component (or vice versa) when either component is translated up or down in response to the applied force. In some embodiments, one or more components of inner component 268 may be translatable in response to an applied force such that resilient element 266 is compressed.

[0040] 75-76 , an implant system 274 is shown according to an exemplary embodiment. The implant system 274, which is a talar implant system, can be implemented in combination with various instrumentation systems and surgical methods, as well as various tibial implant systems, including, but not limited to, those shown, described, and incorporated by reference herein. The implant system 274 is shown to include a talar base 276 and a modular component 278. The modular component 278 is configured to be removably coupled to or positioned adjacent to the talar base 276. In some aspects, the implant system 274 can be provided to a physician with multiple embodiments of the modular component 278. For example, the implant system 274 can include modular components 278 of various sizes or can include various modular components 278 having various geometric shapes and / or other structural features or characteristics. In some aspects, the modular component 278 and / or the talar base 276 can be patient-specific (e.g., custom-made to fit the shape of the patient's anatomy). The components of implant system 274 may also be configured to interface with adjacent anatomical structures and / or surfaces of other implants that may be placed in the patient adjacent to implant system 274. Additionally, in some embodiments, modular component 278 may be configured to rotate internally / externally relative to talar base 276 and / or other components that may be implemented in combination with implant system 274.

[0041] In view of the above-described illustrated embodiments, the present disclosure provides, in one aspect, a drive shaft 104, 134, 158, 166, 192, comprising a housing 106, 130, 160, 164, 186 having a first end and a second end; a first drive shaft 104, 134, 158, 166, 192 at least partially received within the housing 106, 130, 160, 164, 186; and a first gear member 105, 125 disposed on the first end of the first drive shaft 104, 134, 158, 166, 192. 9, 162, 193; a second gear member 107, 194 disposed at a first end of the housing 106, 130, 160, 164, 186 and engaging the first gear member 105, 129, 162, 193; and a drill bit 108, 128, 190 engaged with the second gear member 107, 194 and extending from at least a portion of the housing 106, 130, 160, 164, 186.

[0042] In some embodiments, the first gear member 105,129,162,193 is disposed adjacent to the second gear member 107,194.

[0043] In some embodiments, the housing 106, 130, 160, 164, 186 further includes a first opening disposed at the first end and a second opening disposed at the second end. In some embodiments, the first opening is disposed perpendicular to the second opening. In some embodiments, the first drive shaft 104, 134, 158, 166, 192 extends at least partially through the first opening, and the drill bit 108, 128, 190 extends through the second opening.

[0044] In some embodiments, the first gear member 105,129,162,193 rotatably engages the second gear member 107,194 and the associated drill bit 108,128,190.

[0045] In some embodiments, the instrument 100, 126, 156, 163, 184 of claim 1 further comprises an outer shaft 102 coupled at a first end to the housing 106, 130, 160, 164, 186 and surrounding at least a portion of the first drive shaft 104, 134, 158, 166, 192.

[0046] In some embodiments, the drill bit 108, 128, 190 is integral with or coupled to the top surface of the second gear member 107, 194.

[0047] In some embodiments, the instrument 100 , 126 , 156 , 163 , 184 further comprises a drill 144 coupled to the second end of the first drive shaft 104 , 134 , 158 , 166 , 192 .

[0048] In some embodiments, the first gear member 105, 129, 162, 193 is integral with the first drive shaft 104, 134, 158, 166, 192.

[0049] In some embodiments, the drill bit 108,128,190 is integral with and / or coupled to the upper surface of the second gear member 107,194.

[0050] In some embodiments, the instrument 100, 126, 156, 163, 184 further comprises one or more modular components 114. The one or more modular components 114 are removably coupled at a first end to the drill bit 108, 128, 190 and at a second end to the second gear member 107, 194.

[0051] In some embodiments, the instrument 100, 126, 156, 163, 184 further comprises a distractor 116. A portion of the distractor 116 engages a portion of the first drive shaft 104, 134, 158, 166, 192 to translate the first drive shaft 104, 134, 158, 166, 192 vertically relative to the distractor 116.

[0052] In some embodiments, the instrument 100, 126, 156, 163, 184 further comprises a second drive shaft 134 having a third gear member 132 disposed at a first end of the second drive shaft 134. The third gear member 132 is rotatably engaged with the first gear member 105, 129, 162, 193.

[0053] In some embodiments, the instrument 100 , 126 , 156 , 163 , 184 further comprises a drill 144 rotatably coupled to the second end of the second drive shaft 134 .

[0054] In another aspect, the present disclosure provides an instrument system including an instrument 100, 126, 156, 163, 184 and a tibial trial 110 having at least one aperture 112. A drill bit 108, 128, 190 of the instrument 100 is configured to rotatably pass through the at least one aperture 112. The instrument 100, 126, 156, 163, 184 includes a housing 106, 130, 160, 164, 186 having a first end and a second end, a first drive shaft 104, 134, 158, 166, 192 at least partially received within the housing 106, 130, 160, 164, 186, and a first gear member 108 disposed on the first end of the first drive shaft 104, 134, 158, 166, 192. a second gear member 107, 194 disposed at a first end of the housing 106, 130, 160, 164, 186 and engaged with the first gear member 105, 129, 162, 193; and a drill bit 108, 128, 190 engaged with the second gear member 107, 194 and extending from at least a portion of the housing 106, 130, 160, 164, 186.

[0055] In some embodiments, the instrument system further comprises a tibial implant. In some embodiments, the at least one opening 112 of the tibial trial 110 corresponds to the location of at least one attachment means of the tibial implant.

[0056] In some embodiments, the at least one opening 112 is two openings 112 .

[0057] In a further aspect, the present disclosure provides a method of using instrument 100, 126, 156, 163, 184, including obtaining instrument 100, 126, 156, 163, 184, performing a surgical procedure to place tibial trial 110 on the tibia, inserting instrument 100, 126, 156, 163, 184 so that drill bit 108, 128, 190 is aligned with at least one opening in tibial trial 110, rotating drill bit 108, 128, 190 using drill 144, applying a vertical translational force to at least a portion of instrument 100, 126, 156, 163, 184 to drill at least one opening in the tibia, and removing drill bit 108, 128, 190 from the tibia and removing instrument 100, 126, 156, 163, 184 from the patient.

[0058] In some embodiments, the instrument 100, 126, 156, 163, 184 includes a housing 106, 130, 160, 164, 186 having a first end and a second end, a first drive shaft 104, 134, 158, 166, 192 at least partially received within the housing 106, 130, 160, 164, 186, and a drive shaft 104, 134, 158, 166, 192 disposed at the first end of the first drive shaft 104, 134, 158, 166, 192. a first gear member 105, 129, 162, 193 disposed at a first end of the housing 106, 130, 160, 164, 186 and engaging the first gear member 105, 129, 162, 193; a second gear member 107, 194 disposed at a first end of the housing 106, 130, 160, 164, 186 and engaging the first gear member 105, 129, 162, 193; and a drill bit 108, 128, 190 engaged with the second gear member 107, 194 and extending from at least a portion of the housing 106, 130, 160, 164, 186.

[0059] In some embodiments, the at least one opening in the tibial trial 110 is two openings, and the at least one opening drilled in the tibia is two openings.

[0060] In some embodiments, a vertical translational force is applied to the instrument 100 , 126 , 156 , 163 , 184 by the distractor 116 .

[0061] In some embodiments, using the drill 144 to rotate the drill bit 108, 128, 190 includes actuating the drill 144 to rotate the first drive shaft 104, 134, 158, 166, 192 and the associated first gear member 105, 129, 162, 193. In some embodiments, the first gear member 105, 129, 162, 193 engages the second gear member 107, 194 to rotate the second gear member 107, 194, which in turn rotates the drill bit 108, 128, 190.

[0062] In some embodiments, the instrument 100, 126, 156, 163, 184 of claim 1 further includes a second drive shaft 134 having a third gear member 132 disposed at a first end of the second drive shaft 134. The third gear member 132 is rotatably engaged with the first gear member 105, 129, 162, 193. In some embodiments, rotating the drill bit 108, 128, 190 using the drill 144 includes actuating the drill 144 to rotate the second drive shaft 134 and the associated third gear member 132. In some embodiments, the third gear member 132 rotates the first drive shaft 104, 134, 158, 166, 192 and the associated first gear member 105, 129, 162, 193. In some embodiments, the first gear member 105, 129, 162, 193 engages the second gear member 107, 194 to rotate the second gear member 107, 194. Rotation of the second gear member 107, 194 rotates the drill bit 108, 128, 190.

[0063] In a further aspect, the present disclosure provides an instrument comprising a housing having a first end, a second end, and a body disposed therebetween. In some embodiments, the housing further comprises a first opening disposed at the first end and a second opening disposed at the second end. In some embodiments, the first opening and the second opening are disposed about a common longitudinal axis. In some embodiments, at least a portion of the body of the housing is disposed substantially parallel to the common longitudinal axis. In some embodiments, the instrument further comprises a first drive shaft at least partially received in the first opening and extending within the housing. In some embodiments, at least one end of the first drive shaft terminates in a first gear member. In some embodiments, the instrument further comprises a second drive shaft at least partially disposed within the housing. In some embodiments, the second drive shaft comprises a second gear member disposed at a first end of the second drive shaft such that the second gear member engages with the first gear member, and a third gear member disposed at a second end of the second drive shaft opposite the first end of the second drive shaft. In some embodiments, the first drive shaft has a substantially linear shape and the second drive shaft has a substantially non-linear shape. In some embodiments, the instrument further comprises an engagement member extending at least partially from the second opening in the housing and positioned such that the engagement member is engaged by the third gear member.

[0064] The terms used herein are for the purpose of describing particular embodiments only and are not intended to be limiting of the invention. As used herein, the singular forms "a," "an," and "the" are intended to include the plural forms as well, unless the context clearly dictates otherwise. Furthermore, it will be further understood that the terms "comprise" (and all forms of "comprise," such as "comprises" and "comprising"), "have" (and all forms of "have," such as "has" and "having"), "include" (and all forms of "include," such as "includes" and "including"), and "contain" (and all forms of "contain," such as "contains" and "containing") are open-ended linking verbs. Consequently, a method or apparatus that "comprises," "has," "includes," or "contains" one or more steps or elements has those one or more steps or elements, but is not limited to having only those one or more steps or elements. Similarly, a method step or apparatus element that "comprises," "has," "includes," or "contains" one or more features has those one or more features, but is not limited to having only those one or more features. Furthermore, an apparatus or structure that is configured in a certain way is configured in at least that way, but may also be configured in ways not recited.

[0065] The present invention has been described with reference to preferred embodiments. It will be understood that the architectural and operational embodiments described herein are illustrative of several possible arrangements for providing the same general features, characteristics, and general system operation. Modifications and changes may occur to others upon reading and understanding the foregoing detailed description. It is intended that the present invention be construed as including all such modifications and changes.

Claims

1. a housing having a first end and a second end; a first drive shaft at least partially received within the housing; a first gear member disposed on a first end of the first drive shaft; a second gear member disposed at the first end of the housing and engaging the first gear member; a drill bit engaged with the second gear member and extending from at least a portion of the housing; Equipped with Equipment.

2. The first gear member is disposed adjacent to the second gear member.

10. The device of claim 1.

3. The housing further comprises: a first opening disposed at the first end; a second opening disposed at the second end; Equipped with the first opening is disposed perpendicular to the second opening; The first drive shaft extends from at least a portion of the first opening. the drill bit extends from the second opening; 10. The device of claim 1.

4. the first gear member rotatably engages the second gear member and the associated drill bit; 10. The device of claim 1.

5. moreover, an outer shaft coupled to the housing at a first end and surrounding at least a portion of the first drive shaft; Equipped with 10. The device of claim 1.

6. the drill bit is integral with or coupled to an upper surface of the second gear member; 10. The device of claim 1.

7. moreover, a drill coupled to a second end of the first drive shaft; Including, 10. The device of claim 1.

8. the first gear member is integral with the first drive shaft; 10. The device of claim 1.

9. the drill bit is at least one of integral with or coupled to an upper surface of the second gear member; 10. The device of claim 1.

10. moreover, one or more modular components; Equipped with the one or more modular components removably couple to the drill bit at a first end and to the second gear member at a second end; 10. The device of claim 1.

11. moreover, Distractor, Equipped with a portion of the distractor engages a portion of the first drive shaft to translate the first drive shaft relative to the distractor; 10. The device of claim 1.

12. moreover, a second drive shaft having a third gear member; Equipped with the third gear member is disposed at a first end of the second drive shaft and rotatably engages the first gear member; 10. The device of claim 1.

13. moreover, a drill rotatably coupled to the second end of the second drive shaft; Equipped with 13. The device of claim 12.

14. a housing having a first end and a second end; a first drive shaft at least partially received within the housing; a first gear member disposed on a first end of the first drive shaft; a second gear member disposed at the first end of the housing and engaging the first gear member; a drill bit engaged with the second gear member and extending from at least a portion of the housing; and a tibial trial having at least one opening; Equipped with the drill bit of the instrument is configured to rotatably pass through the at least one opening; Instrument system.

15. moreover, tibial implant Equipped with the at least one opening in the tibial trial corresponds to the location of at least one attachment means of the tibial implant; 15. The tool system of claim 14.

16. the at least one opening includes two openings; 15. The tool system of claim 14.

17. A method of using an appliance, comprising: obtaining an instrument; performing a surgical procedure to place a tibial trial on the tibia; inserting the instrument so that a drill bit is aligned with at least one opening in the tibial trial; using a drill to rotate the drill bit; applying a vertical translational force to at least a portion of the instrument to drill at least one opening in the tibia; removing the drill bit from the tibia and removing the instrument from the patient; Including, method.

18. The device comprises: a housing having a first end and a second end; a first drive shaft at least partially received within the housing; a first gear member disposed on a first end of the first drive shaft; a second gear member disposed at the first end of the housing and engaging the first gear member; a drill bit engaged with the second gear member and extending from at least a portion of the housing; Equipped with 18. The method of claim 17.

19. the at least one opening in the tibial trial includes two openings; the at least one opening drilled in the tibia includes two openings; 18. The method of claim 17.

20. the vertical translational force is applied to the instrument by a distractor; 18. The method of claim 17.

21. The step of rotating the drill bit using the drill comprises: operating the drill to rotate the first drive shaft and associated first gear member; Including, the first gear member engages with the second gear member to rotate the second gear member; Rotation of the second gear member rotates the drill bit.

20. The method of claim 18.

22. The device comprises: a second drive shaft having a third gear member, the third gear member being disposed at a first end of the second drive shaft; Furthermore, the third gear member rotatably engages the first gear member; The step of rotating the drill bit using the drill comprises: actuating the drill to rotate the second drive shaft and the associated third gear member; the third gear member rotates the first drive shaft and the coupled first gear member; the first gear member engages with the second gear member to rotate the second gear member; Rotation of the second gear member rotates the drill bit.

20. The method of claim 18.

23. A housing having a first end, a second end, and a body disposed therebetween, the housing further comprising: a first opening disposed at the first end; a second opening disposed at the second end; Equipped with a housing, the first opening and the second opening being disposed about a common longitudinal axis, and at least a portion of the body of the housing being disposed substantially parallel to the common longitudinal axis; a first drive shaft at least partially received within the first opening and extending into the housing, at least one end of the first drive shaft terminating in a first gear member, the first drive shaft having a substantially straight configuration; a second drive shaft at least partially disposed within the housing, a second gear member disposed on a first end of the second drive shaft and engaging the first gear member; a third gear member disposed at a second end of the second drive shaft opposite the first end of the second drive shaft; a second drive shaft having a substantially non-linear shape; an engagement member extending at least partially from the second opening in the housing and positioned to be engaged by the third gear member; Equipped with Equipment.

24. a housing having a first end and a second end; a first drive shaft at least partially received within the housing; a first gear member disposed on a first end of the first drive shaft; a second gear member disposed at the first end of the housing and engaging the first gear member; a drill bit engaged with the second gear member and extending from at least a portion of the housing; Equipped with Equipment.

25. The first gear member is disposed adjacent to the second gear member.

25. The device of claim 24.

26. The housing further comprises: a first opening disposed at the first end; a second opening disposed at the second end; Equipped with the first opening is disposed perpendicular to the second opening; The first drive shaft extends from at least a portion of the first opening. the drill bit extends from the second opening; 26. The device of claim 24 or 25.

27. the first gear member rotatably engages the second gear member and the associated drill bit; 27. An apparatus according to any one of claims 24 to 26.

28. moreover, an outer shaft coupled to the housing at a first end and surrounding at least a portion of the first drive shaft; Equipped with 28. Apparatus according to any one of claims 24 to 27.

29. the drill bit is integral with or coupled to an upper surface of the second gear member; 29. Apparatus according to any one of claims 24 to 28.

30. moreover, a drill coupled to a second end of the first drive shaft; Including, 30. Apparatus according to any one of claims 24 to 29.

31. the first gear member is integral with the first drive shaft; 31. Apparatus according to any one of claims 24 to 30.

32. the drill bit is at least one of integral with or coupled to an upper surface of the second gear member; 32. Apparatus according to any one of claims 24 to 31.

33. moreover, one or more modular components; Equipped with the one or more modular components removably couple to the drill bit at a first end and to the second gear member at a second end; 33. Apparatus according to any one of claims 24 to 32.

34. moreover, Distractor, Equipped with a portion of the distractor engages a portion of the first drive shaft to translate the first drive shaft relative to the distractor; 34. Apparatus according to any one of claims 24 to 33.

35. moreover, a second drive shaft having a third gear member; Equipped with the third gear member is disposed at a first end of the second drive shaft and rotatably engages the first gear member; 35. Apparatus according to any one of claims 24 to 34.

36. moreover, a drill rotatably coupled to the second end of the second drive shaft; Equipped with 26. The device of claim 25.

37. a housing having a first end and a second end; a first drive shaft at least partially received within the housing; a first gear member disposed on a first end of the first drive shaft; a second gear member disposed at the first end of the housing and engaging the first gear member; a drill bit engaged with the second gear member and extending from at least a portion of the housing; and a tibial trial having at least one opening; Equipped with the drill bit of the instrument is configured to rotatably pass through the at least one opening; Instrument system.

38. moreover, tibial implant Equipped with the at least one opening in the tibial trial corresponds to the location of at least one attachment means of the tibial implant; 38. An instrument system according to claim 37.

39. the at least one opening includes two openings; 39. An instrument system according to claim 37 or 38.

40. A method of using an appliance, comprising: obtaining an instrument; performing a surgical procedure to place a tibial trial on the tibia; inserting the instrument so that a drill bit is aligned with at least one opening in the tibial trial; using a drill to rotate the drill bit; applying a vertical translational force to at least a portion of the instrument to drill at least one opening in the tibia; removing the drill bit from the tibia and removing the instrument from the patient; Including, method.

41. The device comprises: a housing having a first end and a second end; a first drive shaft at least partially received within the housing; a first gear member disposed on a first end of the first drive shaft; a second gear member disposed at the first end of the housing and engaging the first gear member; a drill bit engaged with the second gear member and extending from at least a portion of the housing; Equipped with 41. The method of claim 40.

42. the at least one opening in the tibial trial includes two openings; the at least one opening drilled in the tibia includes two openings; 42. The method of claim 40 or 41.

43. the vertical translational force is applied to the instrument by a distractor; 43. The method of any one of claims 40 to 42.

44. The step of rotating the drill bit using the drill comprises: operating the drill to rotate the first drive shaft and associated first gear member; Including, the first gear member engages with the second gear member to rotate the second gear member; Rotation of the second gear member rotates the drill bit.

44. The method of any one of claims 40 to 43.

45. The device comprises: a second drive shaft having a third gear member, the third gear member being disposed at a first end of the second drive shaft; Furthermore, the third gear member rotatably engages the first gear member; The step of rotating the drill bit using the drill comprises: actuating the drill to rotate the second drive shaft and the associated third gear member; the third gear member rotates the first drive shaft and the coupled first gear member; the first gear member engages with the second gear member to rotate the second gear member; Rotation of the second gear member rotates the drill bit.

45. The method of any one of claims 40 to 44.

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