Dynamic Implant Fixation Plate

Abstract

Dynamic implant fixation plates and implants configured to accept the disclosed fixation plates can, in some aspects, provide a means to fixate the implant in one or more planes while allowing relative movement in one or more planes. The disclosed fixation plates and corresponding implants can reduce the occurrence of stress shielding and allow increased loading at the implant site. [Selected figure] Figure 2

Description

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims the benefit of U.S. Provisional Application No. 62 / 703,562, filed July 26, 2018, which is incorporated by reference in its entirety. [Technical field]

[0002] The present invention relates to medical implants, and in particular to medical implants using fixation plates. [Background technology]

[0003] Medical implants can be implanted into a fixed location within the body by a variety of means, for example, a bone fusion implant can be anchored to a patient's bone using a bone screw. Summary of the Invention [Means for solving the problem]

[0004] Disclosed herein are dynamic implant fixation plates (hereinafter "fixation plates") which, in some embodiments, can allow for relative movement with respect to the implant after implantation. In some embodiments, the fixation plate can rotate or move relative to the implant and / or patient tissue after implantation. In some embodiments, the fixation plate can allow for axial compression with respect to the implant after implantation. As used herein, the term "tissue" refers to any type of biological, natural or synthetic tissue, including, but not limited to, muscle tissue, epithelial tissue, connective tissue, connective tissue, nerve tissue, and bone structures.

[0005] In the embodiments of the fixation plate presented herein, the fixation plate can be attached with at least one degree of freedom relative to the implant. As used herein, the term "degree of freedom" refers to a direction in which independent movement occurs, even if the movement is slight. Furthermore, the fixation plate can be attached to the first bone and / or the second bone, each attachment having at least one degree of freedom. In some embodiments, the fixation plate can be attached to the implant and / or tissue with one or more degrees of freedom relative to the attachment point. In some embodiments, the fixation plate can be attached to the first bone and / or the second bone with a conical degree of freedom.

[0006] Some embodiments of the fixation plate have screw holes with a concave profile and are attached to the patient's bone using bone screws with screw heads that have a convex profile corresponding to the concave profile of the screw holes when viewed from the end toward the threaded portion of the screw head. The use of a screw head with a convex profile and a screw hole with a concave profile can provide fixation with at least a conical degree of freedom. The bone screw head can be fixed relative to the screw hole of the fixation plate with a clearance fit greater than zero, which in some aspects can provide an amount of translational movement and can prevent binding between the bone screw head and the screw hole of the fixation plate.

[0007] The fixation plate can be attached to the implant using fastening means with at least one degree of freedom. Some embodiments of the fixation plate use fastening means with a clearance fit greater than zero that can provide an amount of translational movement in some aspects and prevent binding between the fixation plate, implant and / or fastening means. Some fastening means that can be used include, but are not limited to, quarter-turn fasteners, screws, etc.

[0008] The fixation plate can be configured for use with bone fusion implants where the implant is fixed to one or more bone structures. With attachment using anchors that allow at least one degree of freedom, the fixation plate does not significantly impede axial compression of the implant where the axis for the implant is in the direction between the first and second bones. Some embodiments use at least a conical degree of freedom that allows for more than purely axial loading.

[0009] The fixation plates disclosed herein can be used in situations where it is desirable to avoid stress shielding the implant. The use of a rigid attachment between the implant and the patient's bone would shield new bone growth and existing bone from stresses that could weaken new bone growth and potentially cause bone loss. The fixation plates disclosed herein transfer load to the implant rather than bearing it, and the elastic modulus and footprint of the implant determine the amount of axial compression that can be tolerated at the implantation site.

[0010] Despite allowing axial movement, the fixation plate disclosed in the present invention can adequately prevent lateral or anterior-posterior movement. When using an implant that provides sufficient axial stability for new bone growth, it can provide adequate stability in non-axial directions to allow new bone growth. [Brief description of the drawings]

[0011] [Figure 1A] FIG. 1 is an isometric perspective view of a single modified rhombic dodecahedral unit cell containing a fully modified rhombic dodecahedral structure along with radial struts with portions of adjacent unit cells. [Figure 1B] FIG. 1 is a side view of a single modified rhombic dodecahedral unit cell showing the interconnection topology when viewed from the side. [Figure 1C] FIG. 13 is a side view of a single modified rhombic dodecahedral unit cell measuring its central void using the longest dimension measurement method. [Figure 1D]FIG. 13 is a side view of a single modified rhombic dodecahedral unit cell with interconnects being measured using the longest dimension metrology method. [Figure 1E] FIG. 13 is a side view of the central void of a modified rhombic dodecahedral unit cell being measured using the longest sphere measurement method. [Figure 1F] FIG. 13 is a cross-sectional view of an interconnect being measured using the longest sphere measurement method. [Figure 1G] FIG. 1 is an isometric view of a single radial dodecahedral rhombic unit cell. [Figure 1H] FIG. 1 is a side view of a single radial dodecahedral rhombic unit cell. [Figure 1I] FIG. 13 is an isometric view of an example of a single node and single strut combination that can be used in a radial dodecahedral rhombus unit cell. [Figure 1J] FIG. 13 is a side view of an example of a single node and single strut combination that can be used in a radial dodecahedral rhombus unit cell. [Figure 1K] FIG. 13 is a side view of a corner of a volume defining the combination boundary of a single node and single strut combination configured for use in a lattice having an elastic modulus of about 3 GPa. [Figure 1L] FIG. 13 is a side view of a corner of a volume defining the combination boundary of a single node and single strut combination configured for use in a lattice having an elastic modulus of about 4 GPa. [Figure 1M] FIG. 13 is a side view of a corner of a volume defining the combination boundary of a single node and single strut combination configured for use in a lattice having an elastic modulus of about 10 GPa. [Figure 1N] FIG. 13 is a side view of the combination of a single node and two adjacent struts viewed from a corner of the volume defining the combination boundary and lateral separation angle. [Figure 1O] FIG. 1 is an isometric view of a sub-unit cell consisting of a single node and four struts. [Figure 1P] FIG. 1 is an isometric view of a stacked configuration of two sub-unit cells, with the upper sub-unit cell inverted on top of the lower sub-unit cell. [Figure 1Q]FIG. 1 is an isometric view of eight sub-unit cells stacked together to form a single unit cell. [Figure 1R] FIG. 2 is a side view of a bone fixation plate, bone screws and implants. [Diagram 2] FIG. 1 is an isometric view of a bone fixation plate, bone screws and implants. [Diagram 3] FIG. 1 is an isometric view of a bone fixation plate and implant. [Figure 4] FIG. 2 is a side view of a bone fixation plate and implant. [Figure 4A] FIG. 1 is a side view of a bone fixation plate and two bone screws with hidden features shown in dashed lines. [Diagram 5] FIG. 2 is a side cross-sectional view of a bone fixation plate and implant. [Figure 6] FIG. 2 is a rear view of the bone fixation plate and implant. [Figure 7] FIG. 13 is a rear view of the implant receiving the bone fixation plate. [Figure 8] FIG. 2 is a side cross-sectional view of a bone fixation plate and implant. [Figure 9] FIG. 1 illustrates an isometric cross-sectional view of an implant configured to receive a bone fixation plate. [Figure 10] FIG. 13 is a top cross-sectional view of an implant configured to receive a bone fixation plate. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0012] In many situations, it is desirable to use implants that allow for bone attachment or osseointegration over time. Furthermore, in many situations, it is desirable to use implants that allow for attachment or osseointegration with living tissue. Examples of implants where attachment or osseointegration to bone is beneficial include, but are not limited to, cervical, lumbar, and thoracic interbody fusion implants, vertebral body replacements, osteotomy wedges, dental implants, bone stems, acetabular cups, craniofacial plating, bone replacements, and fracture plating. In many applications, it is also desirable to apply stress to increase the strength of new bone growth. Wolff's law states that bone adapts to the stress applied to it, such that bone under stress grows stronger and bone not under stress becomes weaker.

[0013] In some aspects, the systems and methods described herein can contemplate implants configured for osseointegration and appropriately stressed new bone growth stimulation. Many of the exemplary implants of the present invention are particularly useful for use in situations where it is desirable to have strong bone attachment and / or bone growth throughout the implant body. Whether bone growth is desired only for bone attachment or only throughout the implant, the present invention incorporates a unique lattice structure that allows for mechanical spacing, a scaffold that supports new bone growth, and an elastic modulus that allows the new bone growth to be loaded with physiological forces. As a result, the present invention provides implants that grow stronger and healthier bone for more secure attachment and / or stronger bone after implant osseointegration.

[0014] Exemplary embodiments of the invention presented herein may comprise a lattice in whole or in part. Lattice as used herein refers to a three-dimensional material having one or more interconnected openings through which fluid can communicate from one location to another. A three-dimensional material means a material that fills a three-dimensional space (i.e., has height, width and length). A lattice can be constructed by many means to construct a material with interconnected openings, including repeating various geometric shapes or repeating random shapes. An opening in a lattice is any area within the boundary of the three-dimensional material that is free of material. Thus, within the three-dimensional boundary of the lattice, there is a volume of material and a volume that is free of that material.

[0015] The material that provides the lattice structure is referred to as the primary material. The lattice structure does not necessarily provide structural support for any purpose, but rather refers to the configuration of openings and interconnects that make up the lattice. The openings in the lattice can be empty, filled with a gaseous fluid, filled with a liquid fluid, filled with a solid, or partially filled with a fluid and / or solid. Interconnects relative to the openings refer to areas that are free of the primary material and that connect at least two locations to one another. The interconnects can be configured to allow fluid to pass from one location to another.

[0016] A lattice can be defined by a volume density, which means the ratio between the primary material volume and the void volume, expressed as a percentage for a given three-dimensional material. The void volume is the difference between the volume of the three-dimensional material boundary and the primary material volume. The void volume can consist of the volume of the openings, the interconnects and / or the volume of other materials present. For example, a lattice with a 30% volume density consists of 30% by volume of primary material and 70% by volume of voids for a given volume. A lattice with a 90% volume density consists of 90% by volume of primary material and 10% by volume of voids for a given volume. In three-dimensional materials with a volume density of less than 50%, the volume of the primary material is less than the void volume. When volume density refers to the void volume, the voids do not have to remain void, but can be filled in whole or in part with a fluid or solid before, during or after embedding.

[0017] A lattice consisting of a repeating geometric pattern can be described using the properties of a repeating unit cell. A unit cell in a repeating geometric lattice is a three-dimensional shape that can be repeated to form a lattice. A repeating unit cell can refer to a number of identical unit cells that are repeated in a lattice structure or lattice pattern over all or a portion of the lattice structure. Each unit cell consists of a volume of primary material and a volume of void space, or in other words, a spot volume density. The spot volume density can cover as few partial unit cells, or multiple unit cells as possible. In many situations, the spot volume density corresponds to the volume density of the material, but there are situations where it is desirable to locally increase or decrease the spot volume density.

[0018] The unit cells can be configured in many volumetric shapes, including various types of structures. The unit cells can be bounded by defined spatial volumes that limit the size of lattice structures or other types of structures within the unit cells. In some embodiments, the unit cells can be bounded by volumetric shapes, including, but not limited to, a cubic volume, a rectangular volume, a hexahedral volume, or an amorphous volume. The spatial volume of the unit cells can be defined based on a number of faces that meet at corners. In examples where the volume of the unit cells is a cube, a rectangular volume, or a hexahedral volume, the volume of the unit cells can have six faces and eight corners, and the corners are defined where three faces meet. The unit cells can be interconnected in some or all areas, not interconnected in some or all areas, uniformly sized in some or all areas, or not uniformly sized in some or all areas. In some embodiments described herein that use repeating geometric patterns, the unit cells can be defined by a number of struts that define the edges of the unit cells and are connected at nodes around the unit cells. Unit cells so defined may share some struts between more than one unit cell, such that two adjacent unit cells may share a common planar wall defined by struts common to both lattices. In some embodiments described herein that use repeating geometric patterns, a unit cell may be defined by a node and a number of struts extending radially from the node.

[0019] This application describes example embodiments using volumetric density, but other metrics may also be used, including but not limited to lattice size, strut size, or stiffness. Strut size can be defined in a number of ways, including but not limited to strut length and strut diameter.

[0020] Repeating geometric patterns can provide predictable properties and are therefore useful for use in lattice structures included in implants. Many repeating geometric shapes can be used as unit cells of a lattice, including, but not limited to, rhombic dodecahedrons, diamonds, dodecahedrons, squares, pentagons, hexagons, octagons, sctet struts, truncated octagons, diagonal struts, other known geometric structures, and rounded, reinforced, weakened, or simplified versions of each geometric shape.

[0021] A lattice may also be included in an implant as a structural or non-structural component. A lattice used for structural applications may be referred to herein as a structural lattice, a load-bearing lattice, or a stress-applying lattice. In some embodiments, a structural lattice, a load-bearing lattice, or a stress-applying lattice may simply be referred to as a lattice. Repeating geometric unit cells, particularly rhombic dodecahedrons, are theoretically suitable for use in structural lattices due to their strength-to-weight ratio. To improve the practical strength and fatigue resistance of rhombic dodecahedral lattices, the present invention, in some embodiments, includes modified struts made of triangular segments rather than using struts with rectangular or circular cross sections. Some embodiments described herein modify the angles that define the rhombic faces in a rhombic dodecahedron to change the elastic modulus and fatigue resistance of the lattice. The use of triangular segments results in a lattice with highly predictable print properties that approximate theoretical strength values ​​for a rhombic dodecahedral lattice.

[0022] In structural lattice applications, the strength and modulus of the lattice can be approximated by the volume density. When the volume density increases, the strength and modulus increase. Compared to other porous structures, the lattices of the present invention have higher strength and modulus for a given volume density due to the ability to utilize the high strength-to-weight benefits of the rhombic dodecahedral lattice, modified rhombic dodecahedral lattice, or radial dodecahedral rhombic unit cells.

[0023] The term "elastic modulus" as used herein can refer to either the elastic modulus of a material or the effective elastic modulus of a material volume. The elastic modulus quantifies a material or volume of a material's resistance to elastic deformation in response to a stress. A volume of material can have its own elastic modulus and an effective elastic modulus for the entire volume of the material. The effective elastic modulus can be determined by compressing the material volume and treating it as a homogenous material for purposes of calculating the effective elastic modulus. The term "elastic modulus" as used herein can refer to both or either the elastic modulus of a material or the effective elastic modulus of a material volume.

[0024] When configured to provide support for bone or tissue growth, the lattice can be referred to as a scaffold. The lattice can be configured to provide support for bone or tissue growth by controlling the size of the openings and interconnects disposed within the three-dimensional material. When used on the surface of an implant, the scaffold can provide an osseointegrated surface that allows adjacent bone to attach to the implant. The scaffold can also be configured to provide pathways through which bone can grow beyond mere surface attachment. A scaffold intended for surface attachment is referred to herein as a surface scaffold. A surface scaffold can be one or more unit cells that reach deep but do not extend throughout the entire volume of the implant. A scaffold intended for growth support beyond mere surface attachment is referred to herein as a bulk scaffold. A scaffold can also be included in an implant as a structural or non-structural component. A scaffold used for structural applications can be referred to herein as a structural, load-bearing, or stress-imparting scaffold. In some cases, a structural, load-bearing, or stress-imparting scaffold can simply be referred to as a scaffold. In some cases, use of the term "scaffolds" may refer to materials that are configured to provide bone or tissue growth support, but are not lattices.

[0025] The scaffolds described herein can be used to promote attachment or growth in various types of tissue found in living organisms. As discussed above, some embodiments of the scaffolds are configured to promote bone attachment and growth. The scaffolds can also be configured to promote attachment or growth in other areas of tissue, such as fibrous compositions. In some embodiments, the scaffolds can be configured to promote attachment or growth in multiple types of tissue. Some embodiments of the scaffolds can be configured to be implanted adjacent to or abutting living tissue. Adjacent to living tissue includes situations where other layers, materials, or coatings are disposed between the scaffold and any living tissue.

[0026] In some embodiments, the present invention uses bulk scaffolds with larger openings and interconnections than previously known. Osteon (bone units) can range in diameter from about 100 μm, and it is theorized that osteon bundles produce the strongest form of new bone growth. Bone is considered fully solid when it has a diameter greater than 3 mm, and therefore osteon bundles with diameters approximately equal to half that value are theorized to produce greater strength when grown within a scaffold. It is also theorized that osteons grow in irregular shapes, and the cross-sectional area of ​​the osteon can predict its strength. A cylindrical osteon growth with a diameter of 3 mm has a cross-sectional area of ​​about 7 square millimeters, and a cylindrical osteon growth with a diameter of 1.5 mm has a cross-sectional area of ​​about 1.8 square millimeters. Irregularly shaped osteons with a cross-sectional area of ​​at least 1.8 square millimeters can produce significant strength advantages when grown within a scaffold.

[0027] Many skilled in the art have shown that pores or openings having a diameter or width of 300-900 μm, with pore sides of 600 μm being ideal, produce the best scaffolding for bone ingrowth. However, some embodiments of the present invention have diameters or widths on the order of 1.0-15.0 times the known range of 300 μm-900 μm, resulting in a pore width of 0.07 mm for bone ingrowth. 2 ~145mm 2In some embodiments, pores or openings having a diameter or width between and including 100 μm and 300 μm may be useful. Some embodiments include openings and interconnects having diameters on the order of 1.0 to 5.0 times the known range. The use of openings and interconnects that are significantly larger than previously known allows for the formation of entire osteons and solid bone tissue throughout the bulk scaffold, allowing for vascularization of new load-bearing bone growth. In some embodiments, the pores are 3 mm or about 7 mm in diameter. 2 In other embodiments, the pores may have a cross-sectional area of ​​about 1.5 mm or about 1.75 mm in diameter. 2 The use of only small diameter openings and interconnects as known in the prior art is theorized to limit the penetration of new bone growth into the bulk scaffold because the small diameter openings limit the vascularization ability throughout the bulk scaffold.

[0028] A related structure to lattices is closed cell materials. Closed cell materials are similar to lattices in that they have openings that are confined within the boundaries of a three-dimensional material, but closed cell materials generally lack interconnections between locations through openings or other pores. Closed cell structures can be achieved using a number of methods, for example, by filling some cells or using solid walls between struts of unit cells. Closed cell structures can also be referred to as cytoplasmic structures. It is possible to have materials that are lattices in some parts and closed cell materials in other parts. It is possible to have closed cell materials that are lattices for only some interconnections between openings, and vice versa. Although this disclosure focuses on lattices, the structures and methods described herein can be easily adapted for use with closed cell structures within the inventive concept.

[0029] The lattices used in the present invention can be produced from a wide range of materials and processes. When used as a scaffold for bone growth, the lattices are desirably made of a biocompatible material that allows bone attachment, either directly to the material or by applying a bioactive surface treatment. In one embodiment, the scaffold is composed of an implantable metal. Implantable metals include, but are not limited to, zirconium, stainless steel (316 and 316L), tantalum, nitinol, cobalt, chromium alloys, titanium and tungsten, and alloys thereof. Scaffolds composed of implantable metals can be produced using additive metal fabrication or 3D printing processes. Suitable production processes include, but are not limited to, direct metal laser sintering, selective laser sintering, selective laser melting, electron beam melting, additive object manufacturing, and directed energy deposition.

[0030] In another embodiment, the lattice of the present invention is comprised of an implantable metal having a bioactive coating. Bioactive coatings include, but are not limited to, coatings that promote bone growth, anti-thrombogenic coatings, anti-bacterial coatings, hydrophobic or hydrophilic coatings, hemophobic, super-hemophobic or hemophilic coatings. Coatings that promote bone growth include, but are not limited to, calcium phosphate, hydroxyapatite ("HA"), silicate glass, stem cell derivatives, bone morphogenetic proteins, titanium plasma spray, titanium beads, and titanium mesh. Anti-thrombogenic coatings include, but are not limited to, low molecular weight fluoro-oligomers. Anti-bacterial coatings include, but are not limited to, silver, organosilane compounds, iodine, and silicon nitride. Super-hemophobic coatings include fluorinated nanotubes.

[0031] In another embodiment, the lattice is made from a titanium alloy, optionally with a bioactive coating. In particular, Ti6Al4V ELI forging (American Society for Testing and Materials ("ASTM") F136) is a titanium alloy that is particularly suitable as a scaffold. While Ti6Al4V ELI forgings are industry standard titanium alloys used for medical purposes, other titanium alloys, including but not limited to unalloyed titanium (ASTM F67), Ti6Al4V standard grades (ASTM F1472), Ti6Al7Nb forgings (ASTM 1295), Ti5Al2.5Fe forgings (BSI / ISO Part 10), CP and Ti6Al4V standard grade powder (ASTM F1580), Ti6Al3Nb13Zr forgings (ASTM 1713), low modulus Ti-24Nb-41Zr-8Sn and Ti-12Mo6Zr2Fe forgings (ASTM 1813), may be suitable for various embodiments of the present invention.

[0032] Titanium alloys are suitable materials for scaffolding because they are biocompatible and allow bone attachment. Various surface treatments can be applied to titanium alloys to increase or decrease the level of bone attachment. Bone attaches to uniformly polished titanium, but surface textured titanium allows for greater bone attachment. Methods to improve bone attachment to titanium can be produced by forging or milling processes, sandblasting, acid etching, and the use of bioactive coatings. Titanium parts produced by additive metal fabrication or 3D printing processes such as direct metal laser sintering can be treated with an acid bath to reduce surface stress risers, normalize the surface topography, and improve surface oxides while maintaining surface roughness and porosity to promote bone attachment.

[0033] Additionally, titanium or other alloys can be treated with heparin, heparin sulfate (HS), glycosaminoglycans (GAGs), chondroitin-4-sulfate (C4S), chondroitin-6-sulfate (C6S), hyaluronic acid (HY), and other proteoglycans in the presence or absence of aqueous calcium solutions. Such treatments can occur while the material is in a prefabricated form (often a powder) or subsequently during the fabrication of the construct.

[0034] Although various structures, materials, surface treatments and coatings have been described, it is believed that a lattice using a repeating modified rhombic dodecahedron (hereinafter "MRDD") unit cell can provide a favorable combination of stiffness, strength, fatigue resistance, and conditions for bone growth. In some embodiments, the repeating MRDD lattice is comprised of titanium or a titanium alloy. A general rhombic dodecahedron (hereinafter "RDD"), by definition, has 12 sides that are rhombic in shape. When repeated in a lattice, the RDD unit cell is comprised of 24 struts that meet at 14 vertices. The 24 struts define 12 planar faces of the structure, and at the center of each planar face is an opening or interconnection that allows flow from the interior of the unit cell to the exterior of the unit cell.

[0035] An embodiment of an MRDD unit cell B10 for use in the present invention is shown in Figures 1A-1E. Figure 1A is an isometric perspective view of a single MRDD unit cell B10, including a complete MRDD structure with radial struts with portions of adjacent unit cells. Figure 1B is a side view of a single MRDD unit cell B10, showing the interconnection topology when viewed from the side. The top or bottom view of the MRDD unit cell B10 is nearly identical to the side view shown in Figure 1B. The MRDD unit cell B10 differs in structural features and design methods from the general RDD shape. The general RDD consists of 12 faces, each of which is an identical rhombus with an acute angle of 70.5° and an obtuse angle of 109.5°. The shape of the rhombus faces in the general RDD does not change even if the size of the unit cell or the diameter of the struts change, i.e., the struts are indexed based on their axes and each passes through the center or apex of the 14 nodes.

[0036] In some embodiments of the MRDD, each node is contained within a fixed volume that defines its boundaries and provides a fixed point in space for the ends of the struts. The fixed volume that contains the MRDD or a sub-unit cell of the MRDD can be of various shapes, including, but not limited to, a cubic volume, a rectangular volume, a hexahedral volume, or an amorphous volume. Some embodiments use a fixed volume that can have six faces and eight corners, where the corners are defined where three faces meet. The orientation of the struts can be based on the center of the nodal face at the base end and the corner closest to the nodal face at the end of the volume. Each node is preferably an octahedron, more specifically a square bipyramid (i.e., a pyramid and an inverted pyramid joined by a horizontal plane). Each node that is centered in a rectangular volume is more preferably oriented such that it has a square plane parallel to the faces of the rectangular volume, six vertices, and each of the six vertices is positioned as close as possible to each of the six faces of the rectangular volume. Centered with respect to node location within a volume means positioning the nodes approximately equal distances from opposing walls of the volume. In some embodiments, the nodes can have a volume density of 100 percent, and in other embodiments, the nodes can have a volume density of less than 100 percent. Each face of the square bipyramid can be triangular, and each face provides a connection point for the struts.

[0037] The strut may further be an octahedron with six substantially similar elongated faces and two end elongated portions. The elongated faces may be isosceles triangles having a first interior angle of angle A and a second interior angle of angle B, where angle B is greater than angle A. The end faces may be substantially similar isosceles triangles having a first interior angle of angle C and a second interior angle of angle D, where angle D is greater than angle C. Preferably, angle C is greater than angle A.

[0038] The strut direction of each strut is a line or vector that defines the orientation of the strut and can be orthogonal or non-orthogonal to the planar plane of each nodal face. In the MRDD and radial dodecahedral rhomboid structures described herein, the strut direction can be determined using a line connecting the center of the strut end faces, the center of mass along the strut, or the outer edge or outer surface of the elongated portion of the strut. When a line connecting the centers of the strut end faces is used to define the strut direction, the line is approximately parallel to the bottom surface or bottom edge of the strut. When a line extending along the center of mass of the strut is used to define the strut direction, the line can be approximately non-parallel to the bottom surface or bottom edge of the strut. The octahedral nodes of the MRDD can be scaled to increase or decrease the volume density by changing the origin and size of the strut. However, the ends of the struts are locked at the corners of a fixed volume formed around each node, which causes the angle to each nodal face to change as the volume density changes. As the volumetric density of the MRDD unit cell changes, the dimensions of the fixed volume formed around each node do not change. In Figure 1A, dashed lines are drawn between the corners of the MRDD unit cell B10 to show the boundary-defining cube B11. In the MRDD unit cell in Figure 1A, the height B12, width B13, and depth B14 of the unit cell are approximately equal to the area defined by the cube of B11.

[0039] In some embodiments, the support direction of the support can intersect the center of the node and the corner of the rectangular parallelepiped volume closest to the node surface to which the support is fixed. In some embodiments, the support direction of the support can intersect the corner of the rectangular parallelepiped volume closest to the node surface to which the support is fixed. In some embodiments, a reference plane defined by the faces of a rectangular parallelepiped or hexahedron is used to describe the support direction of the support. When the support direction of the support is defined based on the reference plane, it can be between 0° and 90° from the reference plane. When the support direction of the support is defined based on the reference plane, it is preferably between 8° and 30° from the reference plane.

[0040] By indexing the strut directions to the variable nodal plane at one end and the fixed points at the end, the resulting MRDD unit cell allows the diamond shaped faces to have smaller acute angles and larger obtuse angles than a general RDD. The diamond shaped faces of the MRDD can have two nearly identical opposed acute angles and two nearly identical opposed obtuse angles. In some embodiments, the acute angles are less than 70.5° and the obtuse angles are greater than 109.5°. In some embodiments, the acute angles are between 0° and 55° and the obtuse angles are between 125° and 180°. In some embodiments, the acute angles are between 8° and 60° and the obtuse angles are between 120° and 172°. The reduction in the acute angles increases fatigue resistance to loads directed from the obtuse corners to the more obtuse corners. The reduction in the acute angles and the increase in the obtuse angles further increase the shear strength of the MRDD and increase fatigue resistance. By varying the diamond corner angle from that of the general RDD, the shear load passes more nearly in the axial direction of some of the struts, increasing the shear strength. By varying the diamond corner angle from that of the general RDD, it also reduces the overall deflection caused by compressive loads and increases the fatigue strength by resisting deflection under load.

[0041] When positioned toward the center of the lattice structure, the twelve interconnects in a unit cell connect to twelve different adjacent unit cells, resulting in a continuous path through the lattice. The size of the central void and interconnects in the MRDD can be defined using the longest dimension method described above. Using the longest dimension method, the central void can be defined by taking a measurement of the longest dimension shown in FIG. 1C. In FIG. 1C, the longest dimension is labeled as distance AA. Distance AA can be taken in a vertical or horizontal direction (where the direction is relative to the plane of the drawing) and is approximately the same in this example. The interconnects can be defined by the longest measurement when viewed from the side, top, or bottom of the unit cell. In FIG. 1D, the longest dimension is labeled as distance AB. Distance AB can be taken in a vertical or horizontal direction (where the direction is relative to the plane of the drawing). Although the view in FIG. 1D is a side view, in this example the unit cell looks approximately the same when viewed from the top or bottom.

[0042] The size of the central cavity and the interconnect can alternatively be defined by the largest sphere method described herein. Using this largest sphere method, the central cavity can be defined by the diameter of the largest sphere that can fit into the central cavity without intersecting the support. In FIG. 1E, an example of using the largest sphere method to define the size of the central cavity with a sphere having a diameter of BA. The interconnect is approximately diamond-shaped, and its size can alternatively be defined by the size of the length and width of three circles drawn within the aperture. A first circle BB1 ​​drawn in a plane that defines the sides is drawn at the center of the aperture and is the largest diameter circle that can fit into the support without intersecting. A second circle BB2 and a third circle BB3 are drawn tangent to the first circle BB1 ​​and are also the largest diameter circle that can fit into the support without intersecting. The diameter of the first circle BB1 ​​is the width of the interconnect, and the sum of all three diameters of circles BB1, BB2, and BB3 represents the length of the interconnect. Using this measurement method eliminates the sharp corners of the diamond shaped openings from the size determination. In some cases, it is beneficial to exclude the sharp corners of the diamond shaped openings from the calculated size of the interconnects due to additive manufacturing process limitations. For example, if the SLS machine has a resolution of 12 μm that is accurate to within 5 μm, the sharp corners may be rounded by the SLS machine and may not be available for bone ingrowth. When designing a lattice to be manufactured with less accurate additive process equipment, it may be beneficial to use this measurement system to better approximate the size of the interconnects.

[0043] Using alternative measurement methods in some examples, the width of the interconnect is about 600 μm and the length of the interconnect is about 300 μm. The use of a 600 μm length and a 300 μm width provides an opening in a known pore size for bone growth and also provides a surface area of ​​approximately 1.8 square millimeters, allowing high strength bone growth to form. Alternative embodiments can include interconnects having a cross-sectional area of ​​1.0 to 15.0 times the cross-sectional area of ​​a pore having a diameter of 300 μm. Other embodiments can include interconnects having a cross-sectional area of ​​1.0 to 15.0 times the cross-sectional area of ​​a pore having a diameter of 900 μm.

[0044] The MRDD unit cell further has the advantage of providing at least two sets of generally uniform pore or aperture sizes in the lattice structure. In some embodiments, the first set of pores has a width of about 200 μm to 900 μm, and the second set of pores has a width of about 1 to 15 times the width of the first set of pores. In some embodiments, the first set of pores can be configured to promote osteoblast growth and the second set of pores can be configured to promote osteon growth. The pores sized to promote osteoblast growth can have a width including values ​​between about 100 μm to 900 μm. In some embodiments, the pores sized to promote osteoblast growth can have a width greater than 900 μm. The pores sized to promote osteon growth can have a width including values ​​between about 100 μm to 13.5 mm. In some embodiments, the pores sized to promote osteon growth can have a width greater than 13.5 mm.

[0045] In some embodiments, it is beneficial to include a number of substantially uniform larger pores and a number of substantially uniform smaller pores, where the number of larger pores is selected based on a ratio to the number of smaller pores. For example, some embodiments have one large pore for every 1-25 small pores in the lattice structure. Some embodiments have one large pore for every 8-12 small pores. In some embodiments, the number of large and small pores can be selected based on a percentage of the total number of pores in the lattice structure. For example, some embodiments can include 4 percent to 50 percent of the total number of pores as large pores and 50 percent to 96 percent of the total number of pores as small pores. More preferably, some embodiments can include 8 percent to 13 percent of the total number of pores as large pores and 87 percent to 92 percent of the total number of pores as small pores. It is believed that the disclosed lattice composed of two substantially uniform sets of pores of different sizes provides a lattice structure that simultaneously promotes the growth of osteoblasts and osteons.

[0046] The MRDD unit cell can be further defined by the size of the interconnects when viewed from the side, top, or bottom of the unit cell. The MRDD unit cell has the same appearance when viewed from the side, top, or bottom as measured in a side view showing the other side. When viewed from the side as in FIG. 1D, the MRDD unit cell shows four interconnects that are apparently diamond shaped with near right angles. Although the area at each interconnect is smaller when viewed from the side rather than perpendicular to the planar direction of each interconnect, the area when viewed from the side can represent the area available for bone growth in that direction. In some embodiments, it is desirable to index the unit cell and lattice properties based on the area of ​​the interconnects when viewed from the top, bottom, or side.

[0047] In some embodiments of the grid structures described herein, the central void is larger than the length or width of the interconnects. The size of each interconnect may be approximately the same in a repeating MRDD structure, so that the resulting grid may consist of at least two distinctly sized openings. In some embodiments, the diameter of the central void is preferably about twice the length of the interconnects. In some embodiments, the diameter of the central void is preferably about four times the length of the interconnects.

[0048] In some embodiments, the ratio between the diameter of the central void and the length or width of the interconnects can be varied to produce structural lattices of particular strength. In these embodiments, the ratio between the diameter of the central void and the length or width of the interconnects has an increasing relationship as the structural lattice strength increases.

[0049] Additionally, lattices using repeating radial dodecahedral rhombic (hereinafter "RDDR") unit cells can exhibit a favorable combination of stiffness, strength, fatigue resistance, and conditions for bone ingrowth. In some embodiments, the repeating RDDR lattices are made of titanium or titanium alloys. FIG. 1G is an isometric view of a single RDDR unit cell B20 that includes a complete RDDR structure. FIG. 1H is a side view of a single RDDR unit cell B20, showing the interconnect configuration when viewed from the side. The top or bottom view of the RDDR unit cell B20 is nearly identical to the side view shown in FIG. 1H.

[0050] The RDDR unit cell B20, as used herein, is a three-dimensional shape consisting of a central node with radial struts and mirror-image struts forming 12 diamond-shaped structures. The node is preferably an octahedron, more specifically a square bipyramid (i.e., a pyramid joined at a horizontal plane and an inverted pyramid). Each face of the node is triangular, and attached to each face is a strut consisting of six triangular facets and two end faces. The central axis of each strut can be orthogonal or non-orthogonal to the planar surface of each node face. This central axis can follow the centroid of the strut. The RDDR is further characterized by a central node with one strut attached to each face, resulting in a square bipyramid node with eight struts attached.

[0051] Examples of node and strut combinations are shown in Figures 1I-1M. Figure 1I is an isometric view of a single node B30 with a single strut B31 attached. The node B30 is a square bipyramid oriented with two apexes facing the top and bottom surfaces of a volume B32 that defines the boundaries of the node B30 and any attached struts B31. The node B30 is oriented such that a horizontal corner is positioned at a point closest to a side of the volume B32. The struts B31 extend from the face of the node B30 to the corners of the volume B32 that define the boundaries of the node B30 and any attached struts B31. In Figure 1I, the central axis of the struts is angled 45° above the horizontal plane and the planar face of the node is angled 45° above the horizontal plane.

[0052] FIG. 1I shows a detail of octahedral strut B31, with dashed lines indicating hidden edges of the strut. Strut B31 is an octahedron having an elongated portion with six generally similar elongated faces and two end faces. Elongated faces B31a, B31b, B31c, B31d, B31e, and B31f of strut B31 define the exterior of the elongated, somewhat cylindrical surface of the strut. Each of elongated faces B31a, B31b, B31c, B31d, B31e, and B31f is an isosceles triangle having a first interior angle (angle A) and a second interior angle (angle B), with angle B being greater than angle A. The pillar B31 further has two end faces B31f and B31g, which are substantially the same as each other and have a first interior angle (angle C) and a second interior angle (angle D), forming an isosceles triangle with angle D being greater than angle C. Comparing the interior angles of the elongated faces B31a, B31b, B31c, B31d, B31e, and B31f with the interior angles of the end faces B31f and B31g, angle C is greater than angle A.

[0053] FIG. 1J is a side view of node B30 and strut B31 bounded by volume B32. In this side view, the height of node B30 compared to the height of cube B32 can be easily compared. FIGS. 1K-1M are side views of node and strut combinations viewed from the corners of the volume rather than the walls or faces, which have been modified from FIGS. 1I-1J to change the volume density of the resulting unit cell. In FIG. 1K, the height of node B130 is increased relative to the height of volume B132. Because the ends of strut B131 are fixed at the corners of volume B132, strut B131 must change its angle to the node surface to which it is attached so that it is non-orthogonal. A node B130 and strut B131 combination with strut B131 angled from the horizontal plane of about 20.6° would be appropriate for a lattice structure having an elastic modulus of about 3 GPa.

[0054] In FIG. 1L, the height of the nodes B230 relative to the height of the cubes B232 is increased from the ratio in FIG. 1K to produce a combination of nodes B230 and struts B231 suitable for a lattice structure with an elastic modulus of about 4 GPa. As the height of the nodes B230 increases, the angle between the struts B231 and the horizontal plane decreases to about 18.8°. As the height of the nodes B230 increases, the size of the nodes also increases, which increases the size of the struts B231. The ends of the struts B231 are fixed to the corners of the volume B232, while the size of the ends increases to accommodate the increased size of the node faces, maintaining a nearly uniform strut diameter along the length. As the size of the nodes and struts increases, the volume density increases as well as the elastic modulus. In FIG. 1M, the height of node B330 relative to the height of cube B332 is increased from the ratio in FIG. 1M to create a combination of node B330 and strut B331 suitable for a lattice structure with an elastic modulus of about 10 GPa. In this configuration, the angle between strut B331 and the horizontal plane is reduced to about 12.4° and the volume density is increased from the previous example. The single node and strut example can be replicated and / or mirrored to create unit cells of appropriate size and properties. For example, the angle between the strut and the horizontal plane can be increased to 25.8° to create a lattice with a volume density of 12.3 percent and an elastic modulus of about 300 MPa. Although a single node and strut is shown in the example for clarity, multiple struts can be attached to each node to create an appropriate unit cell.

[0055] Adjacent struts extending from adjacent node faces at the upper or lower halves of the node have a lateral separation angle defined by the angle from the horizontal plane and the angle between the strut directions of the adjacent struts. In MRDD and RDDR structures, adjacent struts have outer edges or faces of the elongated portions that extend closest to the associated adjacent strut. The lateral separation angles described herein generally refer to the angle between the outer edges or faces of the elongated portions of the struts that extend closest to the associated adjacent struts. In some embodiments, the lateral separation angle defined by a line extending between the center of the strut end face and a line defined by the center of mass of the strut can be used in conjunction with similar calculations for the adjacent struts.

[0056] The lateral separation angle is the angle between the closest face or edge of a strut to an adjacent strut. The lateral separation angle can be measured as the smallest angle in a plane containing the edges of both struts between the closest edge of a strut to the closest edge of an adjacent strut. The lateral separation angle can also be measured as the smallest angle in a plane perpendicular to the two strut faces between the closest face of a strut to the closest face of an adjacent strut. In embodiments where there are no defined strut edges or faces, the lateral separation angle can be measured as the angle between the closest portion of one strut to the closest portion of an adjacent strut. For a unit cell in a cubic volume, as the strut angle from the horizontal plane decreases, the lateral separation angle approaches 90°. For a unit cell in a cubic volume, as the strut angle from the horizontal plane increases, the lateral separation angle approaches 180°. In some embodiments, it is preferred to have a lateral separation angle greater than 109.5°. In some embodiments, it is preferred to have a lateral separation angle less than 109.5°. In some embodiments, it is preferred to have a lateral separation angle between and including about 108° and about 156°. In some embodiments, it is more preferred to have a lateral separation angle between and including about 111° and about 156°. In some embodiments, it is more preferred to have a lateral separation angle between and including about 108° and about 120°. In some embodiments, it is more preferred to have a lateral separation angle between and including about 111° and about 120°. In some embodiments, it is more preferred to have a lateral separation angle between and including about 128° and about 156°. 1N is a side view from a corner of a cube B432 of a single node B430 to which two adjacent struts B431 and B434 are attached and a lateral separation angle B443 is identified. The lateral separation angle B443, as measured from the nearest edge of the strut to the nearest edge of the adjacent strut, is approximately 116°.

[0057] In some embodiments, a unit cell is composed of multiple sub-unit cells that are secured together. Figure 1O is an isometric view of an exemplary sub-unit cell consisting of a single node and four posts. Figure A16 is an isometric view of two sub-unit cells in a stacked configuration with the top sub-unit cell flipped over and secured on top of the bottom sub-unit cell. Figure 1Q is an isometric view of eight sub-unit cells stacked together to form a single RDDR unit cell.

[0058] In FIG. 1O, node B530 is a square bipyramid with two vertices oriented to face the top and bottom of cubic volume B532. In some embodiments, volume B532 can be a rectangular volume, a hexahedral volume, an irregular volume, or a volume with one or more non-orthogonal sides. Apex refers to the point where the four top sides meet and the point where the four bottom sides meet. Node B530 is oriented with its horizontal vertex facing the side of cubic volume B532. Support B531 is fixed at its base end to the bottom side of the face of node B530 and extends at its distal end to the nearest corner of cubic volume B532. The distal end of support B531 can remain fixed to cubic volume B532 even when node B530 is resized to adjust the sub-unit cell properties.

[0059] The base end of the support B534 is fixed to the node B530 on the lower side of the node B530 opposite to the side to which the support B531 is fixed. The support B534 extends at its end to the nearest corner of the cubic volume B532. The support B535 is fixed at its base end to a face of the upper node B530 oriented approximately 90° laterally from the face of the node B530 fixed to the support B531. The support B535 extends at its end to the nearest corner of the cubic volume B532. The base end of the support B536 is fixed to the node B530 on the upper side of the node B530 opposite to the face to which the support B535 is fixed. The support B536 extends at its end to the nearest corner of the cubic volume B532.

[0060] In some embodiments, the pillars B531 and B534-B536 are octahedrons with triangular faces. The pillar faces that are fixed to the faces of the nodes 530 can be approximately the same size and orientation as the faces of the nodes 530. The pillar faces that are fixed to the nearest corners of the cube B532 can be approximately the same size as the pillar faces that are fixed to the nodes 530 and oriented in a substantially parallel plane. The remaining six faces can be six approximately similar isosceles triangles having a first interior angle and a second interior angle that is greater than the first interior angle. The six approximately similar isosceles triangles can be fixed along their long edges to adjacent inverted approximately similar isosceles triangles to form an approximately cylindrical shape with triangular ends.

[0061] When forming the sub-unit cell B540, it may be beneficial to add eight nodes B538 at each corner of the cube B532 that is secured to the supports B531 and B534-B536. When replicating the sub-unit cell B540, the eight nodes B538 attached to each support end combine with the eight nodes B538 from adjacent sub-unit cells to form nodes located between the supports of adjacent sub-unit cells.

[0062] FIG. A16 shows a first sub-unit cell B540 secured to a second sub-unit cell B640 to form a quarter-unit cell B560 used in some embodiments. The second sub-unit cell B640 has a square bipyramidal node B630 oriented such that two vertices face the top and bottom of a cubic volume. A support B635 is secured to the underside of the node B630 on the side facing the base end and extends to the nearest corner of the cubic volume at the end. A support B636 is secured to the underside of the node B630 on the side opposite to the side to which the support B635 is secured at the base end. A support B636 extends to the nearest corner of the cubic volume at the end. The strut B636 is fixed at its proximal end to a face of the upper node B630 oriented approximately 90° laterally from the face of the node B630 fixed to the strut B635. The strut B634 extends at its distal end to the nearest corner of the cubic volume. The strut B631 is fixed at its proximal end to the node B630 on the upper side of the node B630 opposite the face to which the strut B634 is fixed. The strut B631 extends at its distal end to the nearest corner of the cubic volume.

[0063] Although the first sub-unit cell B540 is used as a reference point in the embodiment of FIG. A16, the second sub-unit cell B640 or other points can also be used as reference points. After the first sub-unit cell B540 is fixed in place, the second sub-unit cell B640 is replicated to be substantially similar to the first sub-unit cell. This second sub-unit cell B640 is rotated about its central axis before being fixed on top of the first sub-unit cell B540. In FIG. A16, the second sub-unit cell B640 is flipped to obtain the correct rotation, but other rotations about the central axis can achieve the same result. The first sub-unit cell B540 fixed to the second sub-unit cell B640 forms a quarter unit cell B560, which can be replicated and laterally attached to other quarter unit cells to form a complete unit cell.

[0064] Alternatively, a complete unit cell can be built up by laterally fastening a first group of four substantially similar sub-unit cells together to form a square, rectangle, or quadrilateral when viewed from above. A second group of four substantially similar sub-unit cells rotated about their central axes can be laterally fastened to one another to also form a square, rectangle, or quadrilateral when viewed from above. The second group of sub-unit cells can be rotated about their central axes before being laterally fastened to one another or inverted after being fastened to one another to achieve the same result. The second group is then fastened on top of the first group to form a complete unit cell.

[0065] Figure 1Q is an example of a complete unit cell B770 formed by replicating sub-unit cell B540 of Figure 1O. For clarity, cube B532, as well as nodes B530 and struts B531 and B534-B536, which define the boundaries of sub-unit cell B540 are identified. Complete unit cell B770 of Figure 1Q can be formed using the methods described above or variations within the concepts of the present invention.

[0066] Each strut extending from the node for a given unit cell may be of approximately the same length and at approximately the same angle relative to the horizontal plane as it extends radially from the node. At the end of each strut, the struts are mirror symmetric such that the struts extending from the node face form a diamond shaped opening. The struts may be non-orthogonal to the node face, resulting in two shapes of diamonds. In this configuration, a first group of four diamonds extends radially from the node oriented on a vertical plane. The acute angle of the diamonds in the first group is equal to twice the strut angle relative to the horizontal plane, and the obtuse angle is equal to 180 minus the acute angle. Furthermore, in this configuration, a second group of eight diamonds extends radially, and a portion of the second group of eight diamonds is included within the lateral separation angle between adjacent struts that define the first group of four. The acute angle of the second group of diamonds is approximately the same as the lateral separation angle between adjacent struts that define the first group of four diamonds, and the obtuse angle is equal to 180 minus the acute angle. The properties of the scaffold can be described by surface area per volume. For a 1.0 mm x 1.0 mm x 1.0 mm solid cube, the surface area is 6 square mm. When the 1.0 cubic mm structure is made of a lattice structure other than 100 percent volumetric density material, the surface area per volume increases considerably. For scaffolds with low volumetric density, the surface area per volume increases as the volumetric density increases. In some embodiments, a scaffold with a volumetric density of 30.1 percent has a surface area of ​​27.4 square mm per cubic mm. In some embodiments, if the volume density is reduced to 27.0 percent, the lattice will have a surface area of ​​26.0 square mm per cubic mm, and if the volume density is reduced to 24.0 percent, the lattice will have a surface area of ​​24.6 square mm per cubic mm.

[0067] The MRDD and RDDR structures described herein further have the advantage of a particularly high modulus for a given volume density. When used as a lattice or scaffold, an implant can be obtained with an appropriate modulus and low volume density. The low volume density increases the volume of the implant available for bone ingrowth.

[0068] Table 1 below shows a number of exemplary lattice configurations at various lattice design moduli. An estimated actual modulus is provided for each example, which represents the calculated modulus of that lattice after it has gone through the manufacturing process. The lattice structures and implants described herein can be designed to have a designed modulus in some embodiments and an estimated actual modulus in other embodiments. One advantage of the lattice structures disclosed herein is that the estimated actual modulus is closer to the design modulus than has previously been achieved. During testing, one embodiment of the lattice was designed for a 4.0 GPa design modulus. Under testing, this lattice had an actual modulus of 3.1 GPa, achieving an actual modulus within 77 percent of the design modulus.

[0069] For each lattice design modulus, the ratio of design modulus to volume density, surface area to volume density in mm 2 The unit surface area ratio, the ratio of surface area to lattice design modulus, is given.

[0070] [Table 1]

[0071] In some embodiments described herein, the required strut thickness can be calculated from the desired elastic modulus. Using the following equation, the strut thickness required to achieve a particular elastic modulus can be calculated for some MRDD and RDDR structures. Strut Thickness = (-0.0035 (E^2)) + (0.0696 E) + 0.4603

[0072] In the above equation, "E" is the modulus of elasticity. The modulus of elasticity can be selected or calculated using a preselected strut thickness to determine the required strut thickness required to achieve that value. The strut thickness is expressed in mm and represents the strut diameter. This strut thickness can be calculated or selected using a preselected modulus of elasticity to determine the modulus of elasticity for the preselected strut thickness.

[0073] In some embodiments, the unit cells can be elongated in one or more directions to provide a lattice with anisotropic properties. When the unit cells are elongated, they generally decrease the modulus in the direction perpendicular to the elongation direction. The modulus in the elongation direction increases. It is desirable to elongate the cells in the direction perpendicular to the direction of new bone growth that will fit within the interconnects, openings, and central void (if present). By elongating the cells in the direction perpendicular to the desired direction of decreased modulus, the shear strength in the elongation direction can be increased, providing a desirable set of qualities when designing a structural scaffold. Co-varying the overall stiffness of the scaffold can increase or decrease this effect to allow for changes in one or more directions.

[0074] In some embodiments, the sub-unit cells can be engineered by controlling the node height relative to the height of the volume that defines the sub-unit cell. Controlling the node height can affect the final properties and appearance of the lattice structure. Generally, increasing the node height increases the strut thickness, increases the volume density, increases the strength, and increases the elastic modulus of the resulting lattice. When increasing the node height, the node width can be held constant in some embodiments and can be varied in other embodiments.

[0075] In some embodiments, the sub-unit cells can be engineered by controlling the volume of the nodes relative to the volume defining the sub-unit cells. Controlling the volume of the nodes can affect the final properties and appearance of the lattice structure. In general, increasing the volume of the nodes increases the strut thickness, increases the volume density, increases the strength, and increases the elastic modulus of the resulting lattice. When increasing the volume of the nodes, the width or height of the nodes can be held constant in some embodiments.

[0076] Table 2 below shows a number of example lattice configurations at various lattice design moduli. An estimated actual modulus is given for each example, which represents the calculated modulus of that lattice after it has gone through the manufacturing process. The lattice structures and implants described herein can be designed to have a design modulus in some embodiments and an estimated actual modulus in other embodiments. For each lattice design modulus, the estimated lattice modulus, node height, volume density, node volume, ratio of node height to volume density, ratio of node height to lattice design modulus, and ratio of volume density to node volume are given.

[0077] [Table 2]

[0078] Some embodiments of the disclosed lattice structures are particularly useful when provided with a modulus of elasticity in the range of 0.375 GPa to 4.0 GPa, including these values. Some embodiments include lattice structures having a modulus of elasticity in the range of 2.5 GPa to 4.0 GPa, and more preferably, including these values. Some embodiments include lattice structures having a volume density in the range of 5 percent to 40 percent, including these values. Some embodiments include lattice structures having a volume density in the range of 30 percent to 38 percent, including these values.

[0079] The lattice structures disclosed herein have particularly robust load and fatigue properties for low bulk density and modulus ranges. Some embodiments of the lattice structures have shear and compression yield loads of between and including 300-15000N at static and dynamic loads of up to 5,000,000 cycles at 5Hz. Some embodiments have compressive shear strengths and axial loads of between and including 300-15000N at static and dynamic loads of up to 5,000,000 cycles at 5Hz. Some embodiments have shear strengths and axial loads of between and including 300-15000N at static and dynamic loads of up to 5,000,000 cycles at 5Hz. Some embodiments have torsional yield loads of up to 15Nm.

[0080] In one embodiment, a lattice structure according to the present invention has a volume density of between and including 32 percent and 38 percent, a modulus of elasticity of between and including 2.5 GPa and 4 GPa, and a shear strength and axial load of between and including 300 and 15,000 N at static and dynamic loads up to 5,000,000 cycles at 5 Hz. Some embodiments include a first set of substantially uniform openings having a width of between about 200 μm and 900 μm and a second set of substantially uniform openings having a width of between about 1 and 15 times the width of the openings in the first set, with the number of openings in the second set being in a ratio of between about 1:8 and 1:12 to the number of openings in the first set.

[0081] Structures according to the present disclosure may also be beneficial when used in applications where osseointegration is not required or desired. By including a growth-inhibiting coating or skin on the structure, the lattices described herein may be used to provide structural support without providing a scaffold for bone growth. This may be desirable when used in temporary implants or medical devices that are intended to be removed after a period of time.

[0082] Disclosed herein is a first exemplary embodiment of a fixation plate 10 configured for use with a temporary implant 20. The fixation plate can be configured to work with multiple types of implants, including, but not limited to, bone fusion implants and interbody fusion implants. In some embodiments, the implant 20 is a cervical stand-alone (hereinafter referred to as "CSA") implant. In some embodiments, the implant 20 is a lumbar interbody fusion stand-alone (hereinafter referred to as "ALIF-SA") implant. In some embodiments, the implant 20 is a posterior pathway lumbar interbody fusion (hereinafter referred to as "PLIF") implant. In some embodiments, the implant 20 is a transforaminal lumbar interbody fusion (hereinafter referred to as "TLIF") implant. In some embodiments, the implant 20 is a PLIF or TLIF implant. In some embodiments, the implant 20 is a vertebral body replacement (hereinafter referred to as "VBR") implant. In some embodiments, the implant 20 is an osteotomy wedge. In some embodiments, the implant 20 is an ankle fusion spacer implant. In some embodiments, the implant 20 is configured for tissue attachment, including but not limited to bone structures and connective tissue. In some embodiments, the implant 20 is configured to allow tissue ingrowth, including but not limited to bone structures and connective tissue.

[0083] The fixation plate 10 can be configured to allow movement relative to the implant after implantation and / or relative to the patient tissue after implantation. In some embodiments, the fixation plate can be axially compressible relative to the implant after implantation. In the fixation plate embodiments presented, the fixation plate can be attached to the implant such that the fixation plate has at least one degree of freedom relative to the implant. Additionally, the fixation plate can be attached to the first bone and / or the second bone such that each attachment has at least one degree of freedom. In some embodiments, the fixation plate can be attached to the implant and / or tissue with more than one degree of freedom for each attachment point. In some embodiments, the fixation plate can be attached to the first bone and / or the second bone with a conical degree of freedom.

[0084] Some embodiments of the fixation plate have screw holes with a concave profile and are attached to the patient's bone using bone screws with screw heads that have a convex profile when viewed from the side of the end of the screw head facing the threaded portion, corresponding to the concave profile of the screw hole. The use of convex profile screw heads and concave profile screw holes can result in fixation with at least a conical degree of freedom. The bone screw heads can be fixed relative to the screw holes of the fixation plate with a clearance fit greater than zero, in a sense that this clearance fit provides an amount of translational movement and prevents binding between the bone screw head and the screw holes of the fixation plate. As used herein, clearance fit refers to a condition where there is a positive difference between the dimensions of the mating components. For example, a clearance fit exists when the diameter of the screw head is smaller than the diameter of the corresponding screw hole.

[0085] The fixation plate can be attached with at least one degree of freedom to the implant using fastening means. Some embodiments of the fixation plate use fastening means with a clearance fit between the fixation plate and the implant that is greater than zero. The use of fastening means with a clearance fit can, in some sense, provide an amount of translational movement between the fixation plate, the implant and / or the fastening means and prevent binding. Some fastening means that can be used include, but are not limited to, quarter turn fasteners, screws, etc. The clearance fit for quarter turn fasteners can provide multiple translational directions in the axial and / or radial directions.

[0086] The number of degrees of freedom that occur between two given components can be the result of multiple factors, including but not limited to design freedom, manufacturing tolerance freedom, or clearance fit freedom. This specification focuses on design freedom, and in some embodiments, on intended clearance fit freedom. However, it will be appreciated that manufacturing tolerances can be measured and / or used in the same manner to create a device with the necessary degrees of freedom.

[0087] FIG. 1R is a side view of fixation plate 10 rotatably attached to an implant. Although one bone screw 30 is depicted, fixation plate 10 is configured to use two bone screws. In FIG. 1R, fixation plate 10 is in a locked position relative to implant 20. Locked position, as used herein, refers to locking one element relative to another element in at least one plane, but with freedom of movement in at least one plane. In FIG. 1R, fixation plate 10 is locked in an anterior-posterior direction relative to implant 20, but is free to rotate about an axis in that anterior-posterior direction. Anterior-posterior are shown in the drawings as exemplary orientations used, but are not intended to be limiting in any way with respect to use or configuration. In the drawings used herein, the posterior of implant 20 refers to the end of implant 20 that is configured to receive fixation plate 10. Anterior of implant 20 refers to the end opposite posterior. The portion of implant 20 between the anterior and posterior portions is described as the lateral portion. The top-to-bottom direction of implant 20 is described as the axial or compression direction. The exemplary fixation plate 10 and implant 20 are configured for situations in which the axial and compression directions are approximately the same, but need not be the same or similar.

[0088] FIG. 2 is an isometric view of the fixation plate 10, implant 20, and bone screw 30 in a locked position. The fixation plate 10 can be configured to rotate relative to the implant 20 about its axis in a front-to-back direction. The angle of allowable rotation between the fixation plate 10 and the implant 20 can be limited by interference between the implant 20 and the bone screw 30. The amount of axial compression allowed by the fixation plate 10 can be adjusted based on the placement of the bone screw 30 relative to the implant 20. As the bone screw 30 moves axially away from the implant 20, the amount of allowable axial compression increases up to a certain point. The amount of axial compression can be estimated by the angle of the fixation plate 10 relative to the implant 20 after implantation of a particular length of the fixation plate 10 between the screw holes 11. For example, a fixation plate 10 with a 10 mm spacing between the centers of the screw holes allows for more axial compression when implanted at a 50° angle relative to the implant 20 than when implanted at a 45° angle relative to the implant 20.

[0089] In some embodiments, the fixation plate 10 is oriented relative to the implant 20 based on the orientation of a line drawn between the centers of the screw holes 11 relative to a plane passing through the central axis of the implant 20. In some embodiments, the fixation plate 10 is oriented relative to the implant 20 at an angle between -45° and 45°, inclusive, in the unlocked position. In some embodiments, the fixation plate 10 is oriented relative to the implant 20 at an angle between 10° and 90°, inclusive, in the locked position. In some embodiments, the fixation plate 10 is oriented relative to the implant 20 at an angle between -10° and -90°, inclusive, in the locked position.

[0090] 3 and 4 are additional illustrations showing the relationship between the fixation plate 10 in a locked position and the implant 20. Although only one locked position is illustrated, it will be appreciated that the fixation plate 10 can be rotated more or less relative to the implant 20 in this and other embodiments.

[0091] 4A is a side view of fixation plate 10 and bone screw 30 with hidden features shown in dashed lines. In some embodiments, bone screw 30 can have a screw head 31 with varying diameters that correspond to the varying diameters of screw hole 11. In some embodiments, screw head 31 can have a convex profile when viewed from the end of the screw head that faces threaded portion 32. In some embodiments, screw hole 11 can have a concave profile that corresponds to the convex profile of screw head 31.

[0092] The use of a screw head 31 with a convex profile and a screw hole 11 with a concave profile can result in a fixation with at least 40 conical degrees of freedom. Although the use of a screw head 31 with a convex profile and a screw hole 11 with a concave profile to produce a fixation with conical degrees of freedom has been disclosed herein, it will be appreciated that other methods exist in the prior art to obtain fixation with similar characteristics. In some embodiments, the conical degrees of freedom range from 0° to 90°. In some embodiments, the conical degrees of freedom range from 10° to 70°. In some embodiments, the conical degrees of freedom range from 20° to 40°. In some embodiments, the conical degrees of freedom range from 25° to 35°. In some embodiments, the conical degrees of freedom range from 28° to 32°. In some embodiments, the conical degrees of freedom are approximately 30°.

[0093] The use of a screw head 31 having a convex profile and a screw hole 11 having a concave profile can also result in fixation with an infinite number of degrees of freedom. In some embodiments, the bone screw 30 is fixed to the tissue segment such that there is a clearance fit 50 between the screw head 31 and the screw hole 11. This clearance fit 50 allows for any design freedom of the fixation plate 10 relative to the screw head 31 and a certain amount of rotation in the direction of the clearance fit 50. In some embodiments, it is desirable to use a clearance fit 50 between the screw head 31 and the screw hole 11 that is greater than zero to prevent binding.

[0094] In some embodiments, the screw holes 11 are round and smooth on the inside to allow the fixation plate 10 to rotate relative to the bone screws 30. The screw holes 11 can be a single diameter or have a tapered diameter to accept custom shaped bone screws 30. The screw holes 11 and bone screws 30 can optionally be configured with rotation stops to inhibit rotation of the fixation plate 10 relative to the bone screws 30.

[0095] 5 is a side cross-sectional view of the fixation plate 10 and implant 20 in an unlocked position. The fixation plate 10 further includes a cylindrical member 12 configured to fit within an attachment port 22 of the implant 20. In some embodiments, the cylindrical member 12 and attachment port 22 further include a 1 / 4 locking mechanism that uses partial relative rotation of the cylindrical member 12 or attachment port 22 to engage a pin, wedge, or tip against a surface configured to receive the pin, wedge, or tip.

[0096] In the exemplary embodiment, attachment port 22 further includes an outer portion 23 and an inner portion 24. In some embodiments, outer portion 23 is cylindrical and has a smaller diameter than inner portion 24, which is also cylindrical. Outer portion 24 may have one or more circular sectors from which material has been radially removed corresponding to areas of cylindrical member 12 where material has been radially added. Material being added or removed may refer to the design process or process during manufacture of the device, the device from which material is added may refer to a single continuous piece of material, and the device from which material is removed may refer to the device being manufactured.

[0097] 6 is a rear view of the fixation plate 10 and implant 20 in an unlocked position. In some embodiments, the fixation plate 10 may be provided with a tool engagement area 13 for applying torque to the fixation plate 10 during implantation. The fixation plate 10 may be rotated using a tool having an extension that corresponds to the tool engagement area 13.

[0098] 7 is a rear view of an implant 20 configured to receive a fixation plate 10. In an exemplary embodiment, the cylindrical member 12 further includes two pins 14 that project radially in opposite directions. In this embodiment, the implant 20 is configured to receive the two pins 14 in radially opposite extending notches 25 in the outer portion 23 of the attachment port 22. It will be appreciated that the disclosed configuration of pins and notches is merely one way in which the fixation plate 10 can be attached to the implant 20 and placed in an unlocked position and a locked position. For example, fewer or more than two pins 14 can be used, or fewer or more than two notches 25 can be used, the pins 14 can be spaced apart on the cylindrical member 12 at intervals other than about 180°, and the notches 25 can be spaced apart on the outer portion of the attachment port 22 at intervals other than about 180°.

[0099] 8 is a side cross-sectional view of the fixation plate 10 and implant 20 in a locked position. In this locked position, the pins 24 protruding radially from the cylindrical member 12 provide a surface that exceeds the diameter of the outer portion 23 of the attachment port 22. The pins 24 provide a surface that can be smaller than the diameter of the inner portion 24 of the attachment port 22, allowing for unhindered rotation of the fixation plate 10 relative to the implant 20. Although the inner portion 24 is shown as cylindrical with a substantially equal diameter throughout, in some embodiments, the inner portion 24 can be non-cylindrical or have a variable diameter. In some embodiments, the inner portion 24 further includes a variable diameter with at least one area having a diameter smaller than the distance between the ends of the pins 24. In some embodiments, the inner portion 24 further includes at least one area where material has been added to create a localized area having a diameter smaller than the distance between the ends of the pins 24. The use of an area having a diameter smaller than the distance between the ends of the pins 24 can provide a rotational stop for the fixation plate 10 relative to the implant 20.

[0100] Figure 9 is an isometric cross-sectional view of an implant configured to receive a fixation plate. Figure 10 is a top cross-sectional view of an implant configured to receive a fixation plate. These figures provide additional views of an example configuration using attachment port 22, outer portion 23, inner portion 24 and notch 25.

[0101] Thus far described are fixation plates and implants configured to receive the disclosed fixation plates. Although only exemplary embodiments of the invention are shown and described in this disclosure, it is to be understood that the invention is capable of use in various other combinations and environments and is capable of modification or alteration within the scope of the inventive concept as expressed herein.

Claims

1. a bone fusion implant configured for implantation within a body and including at least one side; one or more fasteners configured to secure the bone fusion implant to one or more bone structures within the body, the fasteners having a convex contour; an elongated plate having a plurality of openings configured to allow the one or more fasteners to pass through the elongated plate and having a concave contour to produce a fixation having a conical degree of freedom, the elongated plate is rotatably coupled to a side of the bone fusion implant and configured to rotate relative to the bone fusion implant after implantation in the body to provide axial compression to the bone fusion implant; The amount of axial compression is adjustable based on the placement of the one or more fasteners relative to the elongated plate and the angle of the elongated plate relative to the bone fusion implant.

2. The medical implant system of claim 1 , wherein the plurality of apertures are further configured to rotate about the fastener.

3. 10. The medical implant system of claim 1, wherein the plurality of openings further comprise a smooth annular shaped head having a first diameter, and the fastener further comprises a smooth annular shaped head having a second diameter, the second diameter being smaller than the first diameter.

4. 10. The medical implant system of claim 1, wherein the elongated plate further comprises a quarter turn fastener extending toward the side of the bone fusion implant; The bone fusion implant further comprises an opening in the elongated plate corresponding to the quarter turn fastener.

5. an elongated plate configured for rotatable attachment to a side of the bone fusion implant; a plurality of openings in the elongated plate configured to receive a corresponding plurality of fasteners; A fixation plate for the bone fusion implant, comprising: the plurality of fasteners are configured to secure the bone fusion implant to one or more bone structures within a body; At least one fastener of the plurality of fasteners has a convex profile; each of at least one of the plurality of openings has a concave contour resulting in fixation having a conical degree of freedom; the elongated plate is rotatable to the side of the bone fusion implant to allow axial compression of the bone fusion implant after implantation in the body; The amount of axial compression is adjustable based on the placement of the plurality of fasteners relative to the elongated plate and the angle of the elongated plate relative to the bone fusion implant.

6. The fixation plate of claim 5 , wherein the plurality of apertures includes two or more apertures each configured to receive one of the plurality of fasteners.

7. The fixation plate of claim 6, wherein the angle of the elongated plate relative to the bone fusion implant is between -45° and 45°.

8. The fixation plate of claim 6 , wherein the elongated plate is configured to rotatably attach to the lateral side of the bone fusion implant in a locked position.

9. The fixation plate of claim 8 , wherein the elongated plate is fixed with a degree of freedom in at least one plane relative to the side of the bone fusion implant in the locked position and rotates about an axis in the at least one plane.

10. The fixation plate of claim 9 , wherein the side surface of the bone fusion implant includes a posterior side of the bone fusion implant.

11. The fixation plate of claim 10 , wherein the at least one plane includes a plane in an anterior-posterior direction relative to the bone fusion implant.

12. The fixation plate of claim 8, wherein the angle of the elongated plate relative to the bone fusion implant in the locked position is between −10° and −90°.

13. The fixation plate of claim 8, wherein the angle of the elongated plate relative to the bone fusion implant in the locked position is between 10° and 90°.

14. The fixation plate of claim 6 , wherein at least one of the plurality of apertures is configured to rotate about a corresponding one of the plurality of fasteners.

15. At least one of the plurality of openings has a smooth annular shape having a first diameter; a corresponding one of the plurality of fasteners includes a smooth annular shaped head having a second diameter; The fixation plate of claim 6 , wherein the second diameter is smaller than the first diameter.

16. The fixation plate of claim 6 , wherein the elongated plate is rotatable in at least one degree of freedom relative to the side of the bone fusion implant.

17. The at least one degree of freedom may be in the range of 0° to 90°, in the range of 10° to 70°, or in the range of 20° 40°, 25° to 35°, 28° to 32°, or about 30°. The fixation plate of claim 16 .

18. The fixation plate of claim 16 , wherein the at least one degree of freedom includes a conical degree of freedom.

19. The fixation plate of claim 6 , wherein the elongated plate includes a member configured to fit within an attachment port of the bone fusion implant.

20. The fixation plate of claim 19 , wherein the member includes a locking mechanism configured to engage an attachment port of the bone fusion implant.

21. The fixation plate of claim 6 , wherein the elongated plate includes a tool engagement area.

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