Knee joint forming method and instrument

Abstract

To provide, e.g., a stem provisional assembly that can be configured to be moveable in vivo to position a stem provisional assembly within a bone recess.SOLUTION: According to one example, a provisional system for a knee arthroplasty is disclosed. The system can include any one or combination of a first provisional component 212, a second provisional component 154, a stem provisional assembly 124 and a fastener 214. The first provisional component can be configured to be disposed on a resected bone surface. The second provisional component can be configured to be disposed in a first recess beneath the resected bone surface. The stem provisional assembly can be configured to be disposed in a second recess, and is configured to be engageable in vivo to position the first provisional component on the resected bone surface. The fastener can be configured to couple the first provisional component, the second provisional component and the stem provisional assembly together as an assembly.SELECTED DRAWING: Figure 19

Description

Technical Field

[0001] [Cross - Reference to Related Applications] This application claims the benefit of priority of U.S. Provisional Patent Application No. 62 / 572,210, filed on October 13, 2017, the benefit of whose priority is claimed hereby and which is incorporated herein by reference in its entirety.

[0002] The content of this application relates to orthopedic instruments, systems, methods, and techniques. In particular, this application relates to instruments, systems, methods, and techniques that can be used in revision knee arthroplasty.

Background Art

[0003] Arthroplasty procedures and prostheses are commonly utilized to repair and / or replace damaged bone and tissue in the human body. For example, knee arthroplasty can be used to restore natural knee joint function by repairing damaged or diseased articular surfaces of the femur and / or tibia. The knee joint is incised to expose the bone containing the joint. Cut guides and other instruments are used to guide the removal of the articular surface to be replaced. Prostheses are used to reproduce the articular surface. An artificial knee joint can include a femoral component implanted at the distal end of the femur, and the femoral component articulates with a tibial support component and a tibial component implanted at the proximal end of the tibia to reproduce healthy natural knee function. Various types of arthroplasty are known, including total knee arthroplasty in which all of the articular compartments of the joint are repaired with artificial components and revision knee arthroplasty in which a physician removes a previously implanted artificial knee joint and replaces it with a new artificial knee joint.

Summary of the Invention

[0004] This disclosure generally relates to surgical instruments, systems, methods, and techniques for knee arthroplasty, such as revision knee arthroplasty. The inventors recognize that, in particular, provisional components, instrument designs, systems, and processes can simplify knee surgery, reduce its cost, and / or improve its efficiency. For example, the present application discloses a provisional system that can be coupled together to better conform to a patient's anatomy and adjusted in vivo. In particular, it discloses a stem provisional assembly that can be configured to move in vivo to position the stem provisional assembly within a bone recess.

[0005] To reduce the cost and number of components, the stem provisional assembly can comprise a system that can include a plurality of adapters and a plurality of stem extensions. Each of the plurality of adapters can have a longitudinal axis extending between a proximal end and a distal end. The plurality of adapters can include at least a first adapter having a longitudinal axis without offset and at least a second adapter having a longitudinal axis with a predetermined amount of offset. Each of the plurality of stem extensions can be configured to interchangeably couple with the plurality of adapters. Each of the plurality of stem extensions can have a different longitudinal dimension between a proximal end and a distal end.

[0006] In another form that saves time, reduces cost, and simplifies the procedure, a system of provisional components that can be assembled in vivo and then removed is disclosed. In particular, after being assembled in vivo, the assembly can be removed from the patient's body while maintaining the position of each component relative to one another. This allows a permanent implant to be more easily and timely generated based on the provisional assembly without the need to document or detail the position of the individual provisional components. The entire provisional assembly with each component in its desired relative position to the others can be maintained as a simple reference. These and other forms of the present application will be discussed in further detail hereinafter. It should be apparent to those skilled in the art that the present application includes various other inventive concepts that simplify knee surgery, reduce cost, and improve efficiency.

[0007] To illustrate the devices, systems, and methods disclosed herein further, the following non-limiting examples are presented.

[0008] In Example 1, a provisional system for knee arthroplasty is disclosed. The system can include a first provisional component having a proximal surface and a distal surface opposite the proximal surface, with one of the distal and proximal surfaces configured to be disposed on a bone resection surface. The system can include a second provisional component configured to be disposed in a first recess below the bone resection surface. The second provisional component is configured to mimic at least one of the shapes of a sleeve component, a cone component, or a keel component of an implant. The system can include a stem provisional assembly configured to be disposed in a second recess, the stem provisional assembly being configured to engage in vivo to position the first provisional component on the bone resection surface. The system can include a fastener configured to couple the first provisional component, the second provisional component, and the stem provisional assembly together as one assembly, the fastener including a passageway allowing access from an adjacent portion of the first provisional component to the stem provisional assembly.

[0009] In Example 2, the system of Example 1 can optionally further include a handle configured to temporarily engage the second provisional component to the stem provisional assembly. When temporarily engaged with the handle, the second provisional component and the stem provisional assembly can be inserted into the first and second recesses of the bone, respectively.

[0010] In Example 3, the system of either or both of Examples 1-2, or a combination thereof, can optionally further include a driver or a plurality of drivers configured for at least one of engaging the fastener to thread the fastener into a threaded recess of the stem provisional assembly and passing through the passageway of the fastener to engage the stem provisional assembly, the engagement between the driver and the stem provisional assembly rotating the stem provisional assembly in vivo to position the first provisional component on the resection surface.

[0011] In Example 4, the system of any one or any combination of Examples 1 to 3 can be such that the first provisional component can optionally include a first taper and a second taper, the second provisional component includes a third taper and a fourth taper, and the stem provisional assembly includes a fifth taper. The first taper is configured to engage with the third taper, the second taper is configured to engage with the fifth taper, and the fourth taper is configured to engage with the fifth taper when the fastener joins the first provisional component, the second provisional component, and the stem provisional assembly together as an assembly.

[0012] In Example 5, the system of Example 4 can be such that the first taper and the fifth taper optionally include an outer taper, and the second taper, the third taper, and the fourth taper can include an inner taper.

[0013] In Example 6, the system of any one or any combination of Examples 1 to 5 can be such that the fastener, the first provisional component, the second provisional component, and the stem provisional assembly can optionally be removed together from the bone as an assembly while maintaining the positions of the respective components relative to each other.

[0014] In Example 7, the system of any one or any combination of Examples 1 to 6 can be such that the stem provisional assembly optionally includes a plurality of adapters each having a longitudinal axis extending between a proximal end and a distal end, the plurality of adapters including at least a first adapter having a longitudinal axis without offset and at least a second adapter having a longitudinal axis with a predetermined amount of offset, and a plurality of stem extensions each configured to be interchangeably coupled to the plurality of adapters, the plurality of stem extensions each having a different longitudinal dimension between a proximal end and a distal end.

[0015] In Example 8, the system of Example 7 can be such that at least the second adapter can optionally include two adapters, one adapter having a first amount of offset and the other adapter having a second amount of offset different from the first amount of offset.

[0016] In Example 9, the system of any one or any combination of Examples 1 to 6 is such that the stem provisional assembly is optionally one subsystem comprising a plurality of monolithic integral assemblies, and each of the plurality of monolithic integral assemblies includes an adapter portion and a stem extension portion.

[0017] In Example 10, the system of any one or any combination of Examples 1 to 9 can be such that the first provisional component optionally comprises a femur component having an elongated slot configured to receive a pin therein, and the elongated slot is configured to permit proximal-distal movement of the femur component with respect to the pin.

[0018] In Example 11, the system of any one or any combination of Examples 1 to 10 can be such that the second provisional component optionally comprises a broach configured to remove bone to create a first recess.

[0019] In Example 12, a tibia or femur provisional system for total knee arthroplasty is disclosed. The system can include a first provisional component having a proximal surface and a distal surface opposite the proximal surface, and one of the proximal surface or the distal surface is configured to be disposed on an excision surface of a bone including the tibia or the femur. The system can include a second provisional component configured to be disposed in a first recess below the excision surface, and the second provisional component is a provisional one for mimicking at least one shape of a sleeve component, a cone component, or a keel component of an implant. The system can include a stem provisional assembly configured to be disposed in a second recess of the tibia or the femur, and the stem provisional assembly is configured to be engageable in vivo to reposition the first provisional component on the excision surface. The system can include a fastener configured to couple the first provisional component, the second provisional component, and the stem provisional assembly together as one assembly.

[0020] In Example 13, the system of Example 12 can be such that the fastener optionally includes a passageway that allows access to engage the stem provisional assembly.

[0021] In Example 14, the system of Example 12 can optionally further comprise a driver or a plurality of drivers configured to perform at least one of engaging a fastener to thread the fastener into the threaded recess of the stem sub-assembly and passing through the passage of the fastener to engage the stem sub-assembly, and the engagement between the driver and the stem sub-assembly rotates the stem sub-assembly in vivo.

[0022] In Example 15, the system of any one of Examples 12 to 14 or any combination thereof can be removed from the tibia as an assembly with the fastener, the first provisional component, the second provisional component, and the stem sub-assembly optionally maintaining their respective positions relative to each other.

[0023] In Example 16, the system of any one of Examples 12 to 15 or any combination thereof can comprise a system including a plurality of adapters, wherein the stem sub-assembly optionally has a longitudinal axis extending between a proximal end and a distal end, the plurality of adapters including at least a first adapter having a longitudinal axis without offset and at least a second adapter having a longitudinal axis with a predetermined amount of offset, and a plurality of stem extensions configured to be interchangeably coupled to the plurality of adapters, the plurality of stem extensions each having a different longitudinal dimension between a proximal end and a distal end.

[0024] In Example 17, the system of any one of Examples 12 to 15 or any combination thereof can optionally have the stem sub-assembly be one subsystem comprising a plurality of monolithic integrated assemblies, each of the plurality of monolithic integrated assemblies including an adapter portion and a stem extension portion.

[0025] In Example 18, a method for revision knee arthroplasty can optionally include shaping the patient's bone to create one or more recesses therein, selecting a stem mock-up assembly, placing the stem mock-up assembly within the one or more recesses, and assembling the stem mock-up assembly in vivo with both a first mock component configured to mimic the shape of one of a tibial tray implant or a femoral implant and at least one of a sleeve component, a cone component, or a keel component of the implant.

[0026] In Example 19, the method of Example 18 can optionally further include temporarily coupling together a handle configured to fit over and insert into a post extension, the second mock component, and the stem mock-up assembly, and inserting the stem mock-up assembly and the second mock component together into the one or more recesses.

[0027] In Example 20, the method of Example 18 or 19 or a combination thereof can optionally further include identifying the axis of the bone and measuring whether an offset configuration of the stem mock-up assembly is desirable.

[0028] In Example 21, selecting the stem mock-up assembly in the method of any one or any combination of Examples 18 to 20 can optionally be selecting a monolithic mock stem having an adapter portion and a stem extension, or selecting an adapter from a plurality of adapters each having a longitudinal axis extending between a proximal end and a distal end, the plurality of adapters including at least a first adapter having at least a longitudinally axis without offset and a second adapter having a longitudinally axis with a predetermined amount of offset, and selecting a stem extension from a plurality of stem extensions each configured to couple with a respective one of the plurality of adapters, the plurality of stem extensions each having a different longitudinal dimension between a proximal end and a distal end.

[0029] In Example 22, the method of any one or any combination of Examples 18 to 21 may optionally include the step of assembling in vivo the stem provisional assembly with both a first provisional component configured to mimic the shape of one of the tibial tray implant or the femoral implant and a second provisional component configured to mimic the shape of at least one of the sleeve component or the keel component of the implant, engaging a fastener to thread the fastener into the threaded recess of the stem provisional assembly, and / or passing a tool through the passage of the fastener to engage the stem provisional assembly distal to the threaded recess.

[0030] In Example 23, the method of any one or any combination of Examples 18 to 22 may further optionally include engaging the stem provisional assembly in vivo to position the first provisional component at a desired location on the bone resection surface.

[0031] In Example 24, the method of any one or any combination of Examples 18 to 23 may further include removing at least the first provisional component, the second provisional component, and the stem provisional assembly together from the bone and one or more recesses while maintaining their respective positions relative to each other.

[0032] In Example 25, the method of Example 24 may optionally further include constructing an implant assembly based on the positions of the first provisional component, the second provisional component, and the stem provisional assembly.

[0033] In Example 26, the system of any one or any combination of Examples 1 to 17 may further optionally include a multi-purpose handle configured to couple with one or more of the second provisional component and the offset broach, the multi-purpose handle having a cannula shaft and including a slap hammer configured to be movable along and fixable to the shaft of the handle.

[0034] In Example 27, in the system of Example 26, the offset broach has a cutting surface only along its first side surface, the second side surface opposite the first surface is configured to receive and border a reamer, and the offset broach is configured to offset the first recess with respect to the second recess.

[0035] In Example 28, the method of any one or any combination of Examples 18 to 25 may further optionally include coupling a multi-purpose handle to one or more of the second temporary component and the offset broach, and using the movement of the slap hammer of the multi-purpose handle to extract the offset broach from the bone.

[0036] In Example 29, in the method of Example 28, the offset broach has a cutting surface only along its first side surface, the second side surface opposite the first side surface is configured to receive and border a reamer, and the offset broach is configured to offset the first portion of one or more recesses with respect to the second portion of one or more recesses.

[0037] In Example 30, the system of any one or any combination of Examples 1 to 17 and 26 to 27 may optionally further include a drill guide configured to be attachable to the stem temporary assembly and to pre-drill the bone before broaching for the sleeve component or the cone component.

[0038] In Example 31, the method of any one or any combination of Examples 18 to 25 and 28 to 29 may optionally include shaping the patient's bone to create one or more recesses therein by coupling a drill guide to the stem temporary assembly, the drill guide having a plurality of openings configured to receive a drill and guide the drill into the bone, and broaching the bone.

[0039] In Example 32, the system of any one or any combination of Examples 1 to 17, 26 to 27, and 30 can optionally further include an angled reamer having a distal nose portion and a cutting portion having a back angle taper with a decreasing diameter measured distally-proximally along the longitudinal axis of the angled reamer.

[0040] In Example 33, the method of any one or any combination of Examples 18 to 25, 28 to 29, and 31 can optionally include reaming the bone with an angled reamer having a distal nose portion and a cutting portion having a back angle taper with a decreasing diameter measured distally-proximally along the longitudinal axis of the angled reamer to create one or more depressions therein.

[0041] In Example 34, the system of any one or any combination of Examples 1 to 17, 26 to 27, 30, and 32 can optionally further include a tibial cut guide assembly configured to guide a resection to form a resection surface, the tibial cut guide assembly having a boom arm and a body coupled to the boom arm by a collar, the collar including an opening configured to allow the boom arm to be removed from the collar without changing the position of the body relative to the bone.

[0042] The method of any one or any combination of Examples 18 to 25, 28 to 29, 31, and 33 can optionally further include resected the bone with the tibial cut guide assembly to form a resection surface, the resection including positioning the body of the tibial cut guide assembly adjacent to the proximal portion of the tibia with the boom arm, pinning the body to the proximal portion, and removing the boom arm without removing the body from the pinned position in the proximal portion.

[0043] In Example 36, the system of any one or any combination of Examples 1 to 17, 26 to 27, 30, 32, and 34 can further optionally include a stem implant configured to have one or more slots along the distal portion to allow the stem implant to bend in any direction.

[0044] In Example 37, the assembly can optionally include a fastener having a threaded portion and a head portion, and a component having a hole. The hole can optionally include a corresponding threaded portion configured to engage the threaded portion of the fastener, a pocket portion within the hole adjacent to the corresponding threaded portion and configured to receive the fastener when the threaded portion of the fastener is disengaged from the corresponding threaded portion, and a restriction portion disposed adjacent to the pocket portion and configured to have a diameter substantially equal to or smaller than the head portion of the fastener to hold the fastener within the pocket when the threaded portion of the fastener is disengaged from the corresponding threaded portion.

[0045] In Example 38, the pocket portion of the assembly of Example 37 can optionally have a diameter larger than the diameter of the head portion.

[0046] In Example 39, the assembly of Example 37 or 38 or a combination thereof can optionally have a chamfered surface such that one or more of the restriction portion and the head portion of the fastener act as a chamfered surface to facilitate insertion of the head portion beyond the restriction portion.

[0047] In Example 40, the devices, systems, and methods of any one or any combination of Examples 1 to 39 can optionally be configured such that all elements or options mentioned are usable or selectable.

[0048] These and other examples and features of the apparatus and system of the present invention are described in part in the following detailed description of implementing the invention. This summary is for the purpose of presenting non-limiting examples of the content of the present invention and is not intended to be an exclusive or exhaustive description. The following description is included to provide further information about the apparatus and method of the present invention.

[0049] The drawings are not necessarily to scale, and like reference numerals refer to like components throughout the drawings. Like reference numerals with different suffixes can represent different examples of the same component. The drawings illustrate, schematically and by way of example and not limitation, various examples discussed in this application.

Brief Description of the Drawings

[0050]

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DETAILED DESCRIPTION OF THE INVENTION

[0051] The present application relates to provisional prostheses, tools, systems and methods.

[0052] As described above, the provisional prostheses, instruments, systems and methods can simplify knee surgery, reduce its cost, and / or improve its efficiency. All instruments, components, systems, methods and techniques described herein can be used on the femur and tibia and are similarly applicable.

[0053] As used herein, "proximal" and "distal" shall be interpreted generally anatomically. "Proximal" generally means the direction towards the patient's torso, and "distal" means the opposite direction of proximal, i.e., the direction away from the patient's torso. The use of "proximal" and "distal" shall be interpreted assuming that the knee joint is extended and the patient is standing. "Proximal" and "distal" are intended to be distinguished from "front" and "back". As used herein, "front" and "back" shall be interpreted generally anatomically. Thus, "back" means the posterior part of the patient, e.g., the back of the knee. Similarly, "front" means the anterior part of the patient, e.g., the front of the knee. Thus, "back" means the opposite direction of "front". "Medial" and "lateral" shall be interpreted generally anatomically. Accordingly, "medial" means the opposite direction of "lateral".

[0054] Figure 1 is a cross-sectional view of the tibia 10 and the reamer 14. Only the proximal portion 12 of the tibia 10 is shown in Figure 1. The reamer 14 is inserted into the tibia 10 and can be configured to have a flute groove or a sharp edge to remove bone and create a recess 16 therein. The recess 16 can, in some cases, be formed at least in part by an existing body structure of the patient, such as, for example, the intramedullary canal. In some cases, it is desirable to insert the reamer so as to follow the intramedullary canal to create the recess 16 and / or to align the trial components and the implant components with respect to the mechanical and anatomical axes of the tibia 10. The tibia 10 may be the subject of a revision knee arthroplasty. In this case, prior to the reaming shown in Figure 1, the tibia 10 has a tibial implant component implanted therein, and the implant is removed as part of the revision knee arthroplasty. As further discussed below, as shown, the proximal portion 12 may have a disease or other undesirable bone that needs to be removed as part of the revision knee arthroplasty before a new implant is placed in the proximal portion 12.

[0055] Figure 2 is a perspective view of the reamer 14, the tibial sizing block 18, and the coupler 20. The coupler 20 can engage the tibial sizing block 18 and can be configured to receive the reamer 14. In this way, the tibial sizing block 18 can be coupled to the reamer 14 via the coupler 20. The embodiment of Figure 2 shows that the coupler 20 can be configured so as not to give an offset to the tibial sizing block 18 with respect to the reamer 14. The reamer 14 can position the tibial sizing block 18 on the proximal surface 22 of the tibia 10 via the coupler 20. An appropriately sized tibial sizing block 18 can be selected, such that a desired coverage amount of the proximal surface 22 can be obtained with little or no overhang. When the tibial sizing block 18 is properly positioned on the proximal surface 22 and is substantially aligned with the mechanical and anatomical axes of the tibia 10 as indicated by the reamer 14, an assembly in which the tibial sizing block 18 has no offset may be desirable. Once the appropriate size and position have been measured, the desired markings of the proximal tibia can be made, leaving the reamer 14 in the tibia 10 and removing the tibial sizing block 18 and the coupler 20.

[0056] Figures 3 and 3A show another assembly of the reamer 14, the tibial sizing device 18, and the offset coupler 24. The offset coupler 24 can include a distal portion 26 and a proximal portion 28.

[0057] The distal portion 26 can engage the tibial sizing device 18 in the same manner as the coupler 20 of FIG. 2. However, the proximal portion 28 can be configured as a dial so as to be movable relative to the distal portion 26. Since the position of the reamer 14 is fixed relative to the tibia 10 while the tibial sizing device 18 is not fixed to the tibia 10, the movement of the proximal portion 28 relative to the distal portion 26 can move the position of the tibial sizing device 18 on the proximal surface 22 of the tibia 10. The proximal portion 28 can be rotated relative to the distal portion 26 until the desired position of the tibial sizing device 18 is obtained. Indicators 29A, 29B can be attached to the distal portion 26 and the proximal portion 28, respectively. The indicators 29A, 29B can be used to indicate the position of the tibial sizing device 18 relative to the reamer 14.

[0058] As can be seen from the embodiment of FIG. 3, the proximal portion 28 can have a plurality of through holes 30A, 30B configured to receive the reamer 14. The plurality of through holes 30A, 30B can include a first through hole 30A and a second through hole 30B. In particular, the plurality of through holes 30A and 30B have parallel longitudinal axes and can communicate with each other. The through holes 30A and 30B can be configured to provide a variable offset degree to the offset coupler 24 and the tibial sizing device 18 relative to the reamer 14. For example, the first through hole 30A can provide a 3 mm offset to the offset coupler 24 and the tibial sizing device 18 relative to the reamer 14, and the second through hole 30B can provide a 6 mm offset to the offset coupler 24 and the tibial sizing device 18 relative to the reamer 14.

[0059] Figures 4-6B show a multi-purpose handle 50. The handle 50 can also be used in the instruments, systems, and methods of FIGS. 10A-11D. As shown in FIG. 4, the tool 50 can include a distal tip 52, a pin 54, a collar 56, a shaft 58, a proximal end portion 60, and a slap hammer 62.

[0060] The handle 50 extends along the longitudinal axis L from the distal tip 52 to the proximal end portion 60. The distal tip 52 can be connected to the shaft 58. The shaft 58 can be connected to the proximal end portion 60. In fact, the shaft 58 can form the proximal end portion 60. The pin 54 can be disposed along the shaft 58 and can be connected to the collar 56. The collar 56 can be disposed around the shaft 58 and can be movable proximally-distally (along the longitudinal axis L) relative to the shaft. The slap hammer 62 can be movably connected to the proximal end portion 60. The slap hammer 62 can be configured such that a user can grip and move it proximally-distally (along the longitudinal axis L and the shaft 58).

[0061] The distal tip 52 can be configured to have one or more features 64 (FIG. 4), such as protrusions, that engage with various other instruments, such as the offset broach 66 of FIG. 5. The pin 54 can be movable generally along the longitudinal axis L of the tool 50 (extendable and retractable). In the extended position, the pin 54 can engage an instrument attached to the distal tip 52, such as the offset broach of FIG. 5. The pin 54 can be biased to the extended position shown in FIG. 4 by a spring (not shown in FIG. 4, shown in FIGS. 10A - 10D and 11B) or other means. The collar 56 can be coupled to the pin 54 and can act as a mechanism for retracting the pin 54 if desired.

[0062] FIG. 5 shows an offset broach 66 attached to the distal tip 52 at the proximal portion 67. The proximal portion 67 of the offset broach 66 can be engaged by the pin 54 in a position that locks the offset broach 66. The offset broach 66 includes a distal portion 68 configured as a cutting surface 69 along only one of its faces 70. This cutting surface 69 can be tapered and have teeth or other types of cutting edges and / or surfaces.

[0063] As shown in FIG. 5A, the offset burr 66 and the handle 50 can be cannulated to receive the reamer 14 therein. In particular, the handle 50 can be cannulated along the longitudinal axis L (FIG. 4) such that at least a portion of the distal tip 52, the shaft 58, and / or the proximal portion 60 (FIG. 4) is cannulated. The offset burr 66 can similarly be cannulated between the distal portion 68 and the proximal portion 67. As shown in FIG. 5A, such a cannula structure allows the handle 60 and the offset burr 66 to be inserted over the reamer 14 from proximal to distal. Once positioned to receive the reamer 14, the offset burr 66 becomes distal and contacts the proximal end 12 of the tibia 10 with controlled movement to remove bone. This can create a recess such as recess 72 in FIG. 5A.

[0064] Figures 6A and 6B are cross-sectional views of the handle 50, offset burr 66, and reamer 14. The reamer 14 is received into the cannula-style handle 50 and the offset burr 66. Figure 6B shows the movement of the slap hammer 62 along the shaft 58 and proximal end portion 60 from the position of Figure 6A. The movement of the slap hammer 62 can be generally proximally-distally controlled movement along a longitudinal axis L (Figure 4) that can be substantially aligned with the longitudinal axis of the reamer 14. The slap hammer 62 can be configured to impact an enlarged surface 74 of the proximal shaft 58 of the collar 56 as shown in Figure 6B. This impact action applies a proximally-distally force to the offset burr 66 through the distal tip 52 along the shaft 58. This force can contact the cutting surface 69 of the offset burr 66 against the bone to create the recess 72. In addition or alternatively, the slap hammer 62 can be configured to be used to pull the offset burr 66 out of the bone. In some embodiments, the offset burr 66 can be pressed into the bone through the handle 50 using a tool for striking the proximal end portion 60 rather than using pressing via the slap hammer 62. In some embodiments, the slap hammer 62 can be configured to be locked to the proximal edge portion 60 or the enlarged surface 74 so that the slap hammer 62 does not move along the proximal end portion 60 and the shaft 58. The slap hammer 62 can be released when movement is desired as described above.

[0065] As described above, since the slap hammer 62 is coupled to the shaft 58 and the proximal end portion 60, the movement of the slap hammer 62 and the force generated thereby are along the longitudinal axis L of the handle 50. Since the handle 50 and the offset burr 66 can be cannula-style to receive the reamer 14, alignment between the longitudinal axis L of the handle 50 and the longitudinal axis of the reamer 14 is facilitated. The impact force from the slap hammer 62 can be directed in a desired direction (e.g., proximally-distally) using the reamer 14 as a guide to create the recess 72. Impact forces that deviate from the center in a tangential direction relative to the direction of the longitudinal axis can be avoided or minimized, thereby protecting the bone preparation.

[0066] Figures 7A and 7B show an angled reamer 100 that can be used in addition to or in place of the offset broach 66 (Figs. 5 - 6B). Fig. 7A shows an angled reamer 100 that can be used to remove bone from the proximal portion 12 of the tibia 10 to create the recess 72. The angled reamer 100 can have a back - angled taper portion to minimize the risk of over - reaming the bone. Fig. 7B is a cross - sectional view of the angled reamer 100 within the tibia 10. As shown in Figs. 7B and 7C, the angled reamer 100 can include a distal nose portion 102, a cutting portion 104, and a proximal shaft portion 106. The cutting portion 104 can include a first taper section 108 and a second taper section 110.

[0067] The distal nose portion 102 can extend longitudinally to the cutting portion 104. The distal nose portion 102 can be configured with reference to the recess 16 of the tibia 10. The recess 16 can be the intramedullary canal of the tibia 10 and / or can be a recess formed by the reamer 14. The distal nose portion 102 can include a rounded blunt tip 114. The longitudinal length of the distal nose portion 102 can vary depending on the embodiment.

[0068] The cutting portion 104 can have an enlarged diameter compared to the distal nose portion 102 and the proximal shaft portion 106. The first taper section 108 can be disposed distally of the second taper section 110 and can be connected to the distal nose portion 102. The nose portion 104 can have a length of about 15 mm to about 70 mm measured from the rounded blunt tip 114 to the start of the first taper section 108. The rounded blunt tip 114 can have a diameter of about 6 mm to about 16 mm and can have a radius of 5 mm, depending on the various embodiments.

[0069] The first tapered section 108 can be the leading portion in the surgery, and the second tapered section 110 can be the subsequent portion. As shown in FIG. 7C, the first tapered section 108 can have a first taper angle α (or a leading angle) of about 10 degrees to 40 degrees measured from the surface of the tapered section 108 to the longitudinal axis A. The length of the first tapered section 108 along the longitudinal axis A can be about 11 mm to about 24 mm. The second tapered section 110 can have an angle of about 4 degrees to about 16 degrees measured from the surface of the tapered section 108 to the longitudinal axis A. The length of the second tapered section 110 along the longitudinal axis A can be about 20 mm to about 60 mm.

[0070] The first taper angle α can be different from the second taper angle β of the second tapered section 110 measured from the longitudinal axis. The second taper angle β can be in the opposite direction to the first taper angle α. In other words, the second tapered section 110 can have a back taper with respect to the first tapered section 108. In some embodiments, the longitudinal length of the first tapered section 108 is different from the length of the second tapered section 110.

[0071] In another embodiment, the tapered reamer 100 can be configured to have only the second tapered section 110 without the first tapered section 108. The second tapered section 110 can be disposed proximal to the first tapered section 108 and connected to the proximal shaft portion 106. As shown in FIGS. 7B and 7C, the second tapered section 110 can be separated from the first tapered section 108 by a region 109 in some embodiments. The region 109 can include a region having the maximum cross-sectional diameter of the tapered reamer 100 and can be substantially flat (i.e., having a plane parallel to the longitudinal axis A in FIG. 7C). This region 109 can include a sharp transition portion (e.g., a ridge line) between the first tapered section 108 and the second tapered section 110 in some embodiments. In embodiments where the region 109 is flat, the region 109 can have a length of several millimeters with respect to the longitudinal axis A (FIG. 7C) in other examples. The region 109 can have a diameter of about 16 mm to about 60 mm.

[0072] The second tapered section 110 can have a decreasing diameter when measured in the distal-proximal direction from the region 109 to the proximal shaft portion 106 along the longitudinal axis A (FIG. 7C). Conversely, the first tapered section 108 can have an increasing diameter when measured in the distal-proximal direction along the longitudinal axis A from the nose portion 102 to the region 109.

[0073] FIGS. 8A, 8B, and 8C show a cannulated reamer 120 that can be used to prepare the tibia or femur for a trial stem housing and / or to remove initial bone to receive a cone / sleeve broach or a tibial keel broach. FIG. 8A shows the cannulated reamer 120 that can be used to remove bone from the proximal portion 12 of the tibia 10 to create the recess 72. FIGS. 8B and 8C are cross-sectional views of the cannulated reamer 120 within the tibia 10. The cannulated reamer 120 can include a cutting portion 122 and a shaft portion 123. FIGS. 8B and 8C also show a stem mock-up assembly 124 disposed within the recesses 72 and 16 of the tibia 10. The stem mock-up assembly 124 can include a post extension 126, an adapter 128, and a stem extension 130. According to another embodiment, the stem mock-up assembly 124 can include a post extension 126 and a monolithic trial stem (shown later).

[0074] As shown in FIGS. 8B and 8C, the passage 132 can be formed by the connecting portion 122 and the shaft portion 123. This passage 132 can be configured to receive the post extension 126 of the stem mock-up assembly 124. The post extension 126 can be configured to guide the cutting portion 122 of the cannulated reamer 120 into the tibia 10 to form the recess 72.

[0075] The post extension 126 can be partially disposed within the recess 72 and can extend proximally to a position above the tibia 10 as shown in FIG. 8C. The post extension 126 can be removably coupled to the adapter 128, for example, by a threaded portion 133 as shown in FIG. 8C. The cannula reamer 120 can also be positioned to cover the proximal portion 134 of the adapter 128 within the recess 72.

[0076] The adapter 128 can be positioned within the recess 72 and can have a proximal portion 134 and a distal portion 136 disposed distally of the post extension 126. FIGS. 8B and 8C show a stem mock-up 124 that can have an offset O provided by the adapter 128. In particular, the post extension 126 and the proximal portion 134 of the adapter 128 can define a first longitudinal axis L1 that is offset by a distance O from a second longitudinal axis L2 defined by the stem extension 130 and the distal portion 136 of the adapter 128. The offset O, when measured between the axis L1 and the axis L2, can be in one or more directions such as proximal, distal, medial, or lateral.

[0077] The stem extension 128 can be positioned within the recess 16 and can be removably coupled to the distal portion 136 of the adapter 128, for example, by a threaded portion 137 (FIG. 8C). The stem extension 128 extends distally of the adapter 126 along the recess 16.

[0078] Figures 9A and 9B show a drill guide 140 that can be used in preparation for broaching a cone or sleeve implant in addition to the cannula reamer 120 (Figs. 8A - 8C). In particular, the drill guide 140 can be configured to pre-perforate bone in a desired shape and area prior to broaching the sleeve component or cone component. Pre-perforating the bone using the drill guide 140 can reduce the risk of bone fracture during broaching. Fig. 9A shows a drill guide 140 attached to the post extension 126 of the stem mock-up assembly 124 (Fig. 9B) to direct one or more drills 142 to remove bone from the proximal portion 12 of the tibia 10 to create a recess 72 (this recess can be larger than the recess created by the cannula reamer 120 and can be proximal to the recesses created by the offset broach 66 (Figs. 4 - 6B) and / or the angled reamer 100 (Figs. 7A and 7B)). The drill guide 140 can be used to direct one or more drills 142 along a desired path to fracture the bone along the perimeter or specified area to create the recess 72.

[0079] The drill guide 140 can include a coupling 144 and a body 146. The body 146 can include a plurality of openings 148 (Fig. 9A) configured to receive one or more drills 142. Fig. 9B is a cross-sectional view of the drill guide 140 showing a portion of the body 146 having two openings 148 and the coupling 144. The coupling 144 has an opening and is configured to receive and rest on the post extension 126. The coupling 144 can be connected to the body 146 and hold the body 146 above the tibia 10.

[0080] Figure 9B shows a drill guide 140 attached to a post extender 126 proximal to the tibia 10 and the recess 72. As shown in Figure 9B, the drill guide 140 can be configured to direct one or more drills 142 distally into the tibia 10 in front of, behind, medial and / or lateral to the stem mock-up 124. The tips of the one or more drills 142 can be positioned adjacent to but spaced from the adapter 128. Each of the one or more drills 142 can include an enlarged diameter section 150 to limit the distal travel of the one or more drills 142 and avoid contact with the adapter 128.

[0081] Figures 10A - 10E show the multi-purpose handle 50 illustrated and described in connection with FIGS. 4 - 6B above. Accordingly, the details of the handle 50 will not be discussed. Figures 10A - 10E show the features discussed above, including the distal tip 52 and the pin 54. Figures 10A - 10D further show a biasing element 152 configured to position the pin 54 in an extended position. Figures 10A - 10B also show one or more features 64 (e.g., protrusions) configured to engage other instruments, such as the offset broach 66 of FIG. 5 and the second mock component 154 of FIGS. 10A - 10E.

[0082] Figures 10A and 10B show the handle 50 removed from the second mock component 154, and FIGS. 10C - 10E show the handle 50 engaged with the second mock component 154.

[0083] As shown in FIGS. 10A and 10B, the second mock component 154 includes a recess 156, a proximal surface 157 (FIG. 10A), and a side outer surface 158. As shown in FIG. 10A, the recess 156 can include a passageway 160 configured to allow one or more features 64 to pass therethrough. The second mock component 154 can further include one or more lips 162 formed by a portion of the proximal surface 157 and designed to capture one or more features 64 when the handle 50 is rotated (e.g., a quarter turn) about the longitudinal axis L.

[0084] As shown in FIGS. 10C - 10D, when one or more feature portions 64 are captured under one or more lips 162, the pin 54 can extend distally into the second recess 164. Such an arrangement can fix the second provisional component 154 to the handle 50 because the pin 54 suppresses the rotation of the second provisional component 154 about the longitudinal axis L (FIG. 10A).

[0085] The second provisional component 154 can be configured to mimic at least one of the shapes of the sleeve component or the cone component of the implant (e.g., having a size and shape along the outer side surface 158). In particular, the second provisional component 154 can be configured to mimic the shape and size of the sleeve component of the implant (it can have a shape and size). FIG. 21 showing another embodiment shows a provisional component configured to mimic the keel component of the implant.

[0086] As will be discussed and shown later, the recess 156 can include a through - hole from the proximal surface 157 to the distal surface 166 (FIGS. 10A - 10C). The outer side surface 158 can extend from the proximal surface 157 to the distal surface 166. According to one embodiment, the second provisional component 154 can be configured as a broach. Thus, the outer side surface 158 can include a plurality of cutting edges 168 (FIGS. 10C and 10D) that can be used with the handle 50 to at least partially create a recess in the tibia.

[0087] One or more of the portions of the outer side surface 158 and the recess 156 can, according to one embodiment, be tapered along their longitudinal length. Thus, the cross - sectional area of the distal portion of the second provisional component 154 can be different from and / or vary from the cross - sectional area of the proximal portion.

[0088] FIG. 11A shows an assembly 170 of the handle 50 together with the second provisional component 154 and the stem sub - assembly 124. FIG. 11B is an enlarged view of a portion of the assembly 170 including portions of the handle 50 and the stem sub - assembly 124.

[0089] Figures 11A and 11B show a second provisional component 154 engaged with a handle 50. The second provisional component 154 can be configured to receive a portion of the stem subassembly 124 therein. In particular, portions of the post extension 126 and the adapter 128 can be disposed within a recess 156 of the second provisional component 154. The adapter 128 can extend distally from the second provisional component 154. The post extension 126 extends proximally to the second provisional component 154 and is received within the handle 50. In particular, the handle 50 can be cannula-shaped to receive the post extension 126 therein.

[0090] As shown in FIG. 11B, the post extension 126 can have a flare section 172 with a tapered outer surface 174 that seats against and is in contact with a first tapered inner surface 176 that forms a portion of the recess 156 of the second provisional component 154 when the post extension 126 is threaded to fix to the adapter 128. Further, the adapter 128 can include a tapered outer surface 178 configured to seat against and be in contact with a second tapered inner surface 180 that forms a portion of the recess 156 of the second provisional component 154 when the post extension 126 is threaded to fix to the adapter 128. The taper used by one or more of the post extension 126, the second provisional component 154, and the stem subassembly 124 can be self-retaining (e.g., a Morse taper or the like) in some embodiments. According to another embodiment, the taper used by one or more of the post extension 126, the second provisional component 154, and the stem subassembly 124 can be self-releasing.

[0091] Figures 11C to 11E show a method 184 of placing the assembly 170 of Figures 11A to 11B on the tibia 10. In particular, the assembly 170 is generated by the process described with reference to Figures 10A to 11B. The method 184 can include coupling the second provisional component 154 to the handle 50, and can further include coupling the stem provisional assembly 124 (Figures 11C and 11D) to the second provisional component 154 via the tapered surface and screw connection between the post extension and the adapter discussed with reference to Figure 11B. The coupling of the components to form the assembly 170 according to the method 184 can be performed in vivo or outside the knee joint.

[0092] As shown in Figures 11C to 11D, the method 184 can include inserting the stem provisional assembly 124 and the second provisional component 154 into one or more recesses (e.g., the recesses 72 and 16 of Figures 8B and 8C). Thereby, the stem extension 130 can extend along the recess 16 (Figures 8B and 8C), and the second provisional component 154 can be inserted into the recess 72 (Figures 8B and 8C). The handle 50 can be configured to facilitate the insertion of the stem provisional assembly 124 and the second provisional component 154.

[0093] Figure 12 shows a second assembly 186 composed of the post extension 126, the second provisional component 154, and the stem extension 130, as described previously. Figure 12 further shows a second adapter 188 that is substantially offset-free along its longitudinal length. Thus, the second adapter 188 has one longitudinal axis of the second adapter 188 that extends throughout the length of the second adapter 188.

[0094] Figure 13 shows a cutting instrument 190, such as a saw, used to remove a portion of bone in an excision to generate an excision plane that includes the proximal plane 22 of the tibia 10. As shown in Figure 13, the proximal plane 157 of the second provisional component 154 can be used to set the excision height of the proximal plane 22. In particular, the tibia 12 can be excised substantially horizontally using the proximal plane 157 with the blade of the cutting instrument 190 above the proximal plane 157 such that the proximal plane 157 guides the removal of the bone.

[0095] Figures 14A - 14C show a cut guide assembly 192 that can be used with the cutting instrument 190 (FIG. 13). The cut guide assembly 192 can be used in addition to or in place of the resection method of FIG. 13. As shown in FIG. 14B, the cut guide assembly 192 can include a first collar 194, a first arm 196, a second collar 198, a second arm 200, and a body 202.

[0096] As shown in FIG. 14B, the cut guide assembly 192 can be assembled proximal to the second provisional component 154. The first collar 194 can include a boom configured to couple to the post extension 126 or the reamer 14. The first collar 194 can be releasably locked to the post extension 126 or the reamer 14, for example, by turning the knob 204. The first arm 196 can be connected to the first collar 194 and can project from the first collar, including in the forward direction. The second collar 198 can be configured to receive the first arm 196. The second collar 198 can be movable along the length of the first arm 196 and can be releasably locked to the first arm, for example, by turning the second knob 206. As shown in FIG. 14C, the second collar 198 can have an opening 199 along a portion thereof. The opening 199 can facilitate removal (along the reamer 14) of the components of the cut guide assembly 192, including the first collar 194 and the first arm 196, without the need to remove the body 202 from the bone. In particular, the opening 199 can be sized such that the first arm 196 can pass through when not engaged by the second knob 206. Thus, the first arm 196 and the first arm 194 can be removed without changing the position of the body 202 relative to the bone.

[0097] Looking again at FIG. 14B, the second arm 200 can be connected to the second collar 198 and extends distally generally for connection to the body 202. The body 202 can be disposed adjacent to the front and proximal portion 12 of the anterior portion of the tibia 10. The body 202 can be positioned relative to the tibia 10 using the first collar 194 and the second collar 198. The body 202 can be configured to have a plurality of slots 208 and pinholes therein. The physician can select one or more of the plurality of slots 208 to guide the cutting instrument 190 (FIG. 13) when performing an excision to remove bone to create the proximal surface 22. In some embodiments, the plurality of slots 208 can be spaced at mutually set intervals (e.g., 5 mm increments).

[0098] FIG. 15 is an enlarged view of a portion of an assembly 210 including a tibial tray provisional component 212, a fastener 214, a second provisional component 154, and a stem provisional assembly 124 (FIGS. 11A-11E). FIG. 18 shows the assembly 210 with the tibial tray provisional component 212 attached over the proximal surface 22 of the tibia 10. In FIG. 18, the fastener 214 can be threaded to engage the stem provisional assembly 124 (e.g., FIGS. 11A-11E) to couple the tibial tray provisional component 212, the second provisional component 154 (FIG. 15), and the stem provisional assembly 124 together.

[0099] FIG. 15 shows the tibial tray provisional component 212 and the fastener 214 removed from the second provisional component 154. The tibial tray provisional component can have an opening 216 configured to receive the fastener 214 and can have a distally extending protrusion 218 configured to couple with the second provisional component 154 as shown later in FIG. 19.

[0100] FIG. 16 shows a driver 220 configured to engage various components of the assembly 210 (FIGS. 15 and 18) including the fastener 214 and the stem provisional assembly 124 (e.g., FIGS. 11A-11E). The driver 220 includes a first head portion 222, a handle 223, and a second head portion 224.

[0101] As shown in FIG. 17, the first head portion 222 of the driver 220 can be configured to engage with and cooperate with the fastener 214 to rotate the fastener 214 to threadedly engage with the adapter 128 (e.g., FIGS. 11A-11E) for threadedly coupling the fastener 214 to the adapter 128. The second head portion 224 is disposed opposite the first head portion 222 across the handle 223 and can have a size different from that of the first head portion 222. In particular, the second head portion 224 can be made smaller than the first head portion 222 so as to be configured to access a portion of the distal adapter 128 where the first head portion 222 engages, as will be described later with reference to FIG. 19.

[0102] As described above, FIG. 19 is a cross-sectional view of an assembly 210 that can include the tibial tray provisional component 212, the fastener 214, the second provisional component 154, and the stem provisional assembly 124. The stem provisional assembly 124 can include the adapter 128 and the stem extension 130. Similarly, but for the femoral assembly, FIGS. 26 and 26A are shown.

[0103] As shown in FIG. 19, the fastener 214 can pass through the opening 216 and be received at least partially within the protrusion 218 that extends distally of the tibial tray provisional component 212. The fastener 214 can extend into the threaded hole 225 of the adapter 128 and can have a threaded portion configured to engage the threaded portion of the threaded hole 225. The second provisional component 154 can be disposed around the protrusion 218 that extends in the distal direction of the tibial tray provisional component 212. The proximal portion 134 of the adapter 128 is received within the recess 156 of the second provisional component 154. The adapter 128 and the stem extension 130 can extend distally of the tibial tray provisional component 212 and the second provisional component 154. The adapter 128 can be configured to provide an offset along its longitudinal length, as described with reference to FIGS. 8B and 8C.

[0104] The fastener 214 can be threadedly coupled to the proximal portion 134 of the adapter 128 within the threaded hole 225. The protrusion 218 extending distally of the tibial tray provisional component 212 can have a tapered outer surface 226 that is tapered such that it seats against and abuts a first tapered inner surface 176 that forms part of the recess 156 of the second provisional component 154 when the fastener 214 is threadedly secured to the adapter 128. Further, the adapter 128 can include a tapered outer surface 178 configured to seat against and abut a second tapered inner surface 180 that forms part of the recess 156 of the second provisional component 154 when the fastener 214 is threadedly secured to the adapter 128. The taper utilized by one or more of the distally extending protrusion 218, the second provisional component 154, and the stem provisional assembly 124 can, according to some embodiments, be a self - retaining type (e.g., a Morse taper or the like). According to another embodiment, the taper utilized by one or more of the distally extending protrusion 218, the second provisional component 154, and the stem provisional assembly 124 can be a self - releasing type.

[0105] As shown in FIG. 19, the fastener 214 can include a passage 228 therein. The passage 228 can extend the entire longitudinal length of the fastener 214, can comprise a through - hole, and can be formed by a proximal portion 230, a central portion 232, and a distal portion 234. The central portion 232 of the fastener 214 forming the passage 228 can comprise a first engagement feature 236. The proximal portion 232 can be threaded along the passage 228 (which can have a female thread portion) to couple with a second fastener for locking to a tibial support component (not shown). The distal portion 234 can include a male thread portion 238 configured to mate with the threaded hole 225.

[0106] The first engagement feature 236 can be configured such that the first head portion 222 of the driver 220 (FIG. 16) engages therewith. Such engagement facilitates rotation of the fastener 214 to couple or decouple the fastener 214 to / from the adapter 128 by a threaded connection.

[0107] Furthermore, the adapter 128 can include a second engagement feature 240 disposed within the adapter 128 that communicates with the tapped hole distally of the tapped hole 225. The second engagement feature 240 can be configured such that the second head portion 224 of the driver 220 (FIG. 16) engages therewith. Such engagement can facilitate movement of the tibial tray provisional component 212 as shown in FIGS. 23A and 23B when it is desirable to change the position of the tibial tray provisional component 212. This allows the tibial tray provisional component 212 or the femur provisional component 268 of FIG. 26A to better conform around the tibia (or femur as shown in FIGS. 27 and 28 in the case of the femur provisional component) as shown in FIGS. 23A and 23B. The engagement between the stem provisional assembly 124 and the driver 220 is shown in FIGS. 22A and 22B. Such engagement allows the stem provisional assembly 124 to be rotated within the body, and this rotation is shown in FIGS. 22A and 22B.

[0108] The second engagement feature 240 can be sized small enough so that the shaft and the second head portion 224 pass through the passage 228 including the first engagement feature 236 of the fastener 214 and the tapped hole 225 to access the second engagement feature 240, and thus can be accessed by the driver 220. Accordingly, the engagement to facilitate positioning of the tibial tray provisional component 212 and / or coupling or removal of the fastener 214 to the adapter 128 via the threaded connection can be performed with most of the driver 220 disposed proximally to the tibial tray provisional component 212 (i.e., one of the positions shown in FIG. 17).

[0109] For engagement to facilitate positioning and / or coupling or removal of the fastener 214 to the adapter 128 via the threaded connection, reference is made to FIGS. 17 - 23B. This can be achieved by the tibial tray provisional components 212 disposed on the resected proximal surface 22 of the tibia 10 and the second provisional component 154 and the stem provisional assembly 124 disposed within one or more recesses as shown in FIGS. 17, 23A and 23B. In the case of the femur, the femur provisional component 268 (FIG. 26A) can be positioned within the body, the femur provisional component 268 is disposed on the resected distal surface of the femur, and the second provisional component 154 and the stem provisional assembly 124 are disposed within one or more recesses of the femur.

[0110] As shown in FIGS. 23A and 23B, the position of the tibial tray provisional component 212 on the resected proximal surface 22 of the tibia 10 can be varied (indicated by arrow A1 in FIG. 23A) by actuating a driver 220 (indicated by arrow A2 in FIG. 23A) to engage and rotate its position with respect to the stem provisional assembly 124 as shown in FIGS. 22A and 22B. This allows the positioning of the tibial tray provisional component 212 with respect to the stem provisional assembly 124 on the resected proximal surface 22 to be changed after implantation of the second provisional component 154 and the stem provisional assembly 124. The use of the driver and the stem provisional assembly 124 and / or the use of a femoral sizing cut guide 262 (FIG. 25) on the femur can also be envisioned for the adjustment of the femoral provisional component 268 (FIGS. 26 - 28) on the femur.

[0111] FIG. 20 shows that once the desired relative positions of the various components of the assembly 210 are obtained, the assembly 210 can be removed from the patient together and placed on the work surface 211. In particular, after being assembled and adjusted in vivo, the assembly 210 can be removed from the patient's body while maintaining the positions of the respective components relative to each other. This eliminates the need to document or specify in detail the positions of the individual provisional components, allowing a permanent implant to be generated more easily and in a timely manner based on the provisional assembly. The entire provisional assembly with the desired relative positions of each component with respect to the other components can be maintained for easy reference.

[0112] FIG. 21 shows another assembly 213 that can be assembled to include a stem provisional assembly 124 or other stem provisional assembly as described above, adjusted in position in vivo, and then removed together and placed on the work surface 211. The embodiment of FIG. 21 includes a second provisional component 215 designed to mimic the configuration of a keel implant.

[0113] FIG. 24 shows an assembly 250 of components that can be assembled to include a stem provisional assembly 124 or other stem provisional assembly. Alternatively, a system of a monolithic version (integral adapter portion and stem extension) of the stem provisional assembly can be provided as shown in FIG. 38.

[0114] As shown in the embodiment of FIG. 24, the system 250 can include a plurality of adapters 252 and a plurality of stem extensions 254. The plurality of adapters 252 can include a first adapter 128, a second adapter 188, and a third adapter 256. The plurality of stem extensions 254 can include a stem extension 130 and a second stem extension 258.

[0115] The plurality of adapters 252 can be used interchangeably with the plurality of stem extensions 254 to provide a longitudinally variable offset. For example, the adapter 128 can provide a first amount of offset O1. The second adapter 188 provides substantially no offset. The third adapter 256 can provide a third offset amount O3 that is different from the offset O1 provided by the first adapter 128 and the no-offset provided by the second adapter 188. According to one embodiment, the first offset amount O1 is 3 mm and the offset O3 is 6 mm.

[0116] The plurality of stem extensions 254 allows for a variable longitudinal length. For example, the stem extension 130 can have a longitudinal length of 135 mm, and the stem extension 258 can have a longitudinal length of 175 mm. Various diameters can be provided for each of the plurality of stem extensions 254 as part of the system 250.

[0117] The system 250 can be used interchangeably as a kit with a tibial prosthesis component or a femoral prosthesis component to reduce the overall number of components and thereby reduce the cost and weight of the exemplary systems illustrated herein. According to other embodiments, different systems 250 are possible, for example, additional adapters with different offsets can be provided. According to some embodiments, an integrated stem prosthesis assembly having a stem extension and an adapter as a single component, rather than modular, as shown in FIG. 38, is possible.

[0118] FIG. 25 shows the femur 260 together with the reamer 14, the femoral cutting guide 262, and the offset coupler 24. The offset coupler 24 can have the configuration previously described with reference to FIGS. 3 and 3A. All of the instruments, components, systems, methods, and techniques previously described with reference to FIGS. 1-24 can be used with and equally applied to the femur 260 as well as the tibia 10.

[0119] In FIG. 25, the offset coupler 24 is coupled to the reamer 14 and can be coupled to the femoral cutting guide 262. The offset coupler 24 can be used as previously described in connection with FIGS. 3 and 3A to adjust the position of the femoral cutting guide 262 as desired at the distal end portion 264 of the femur 250. The femoral cutting guide 262 can comprise a 4-in-1 cutting guide having a plurality of slots 256 configured to guide resection of the distal end portion 264 of the femur 250 at various desired angles.

[0120] FIGS. 26 and 26A show an assembly 266 including the femoral provisional component 268, the fastener 270 (FIG. 26A), the second provisional component 154, and the stem provisional assembly 124 as previously illustrated and described. The stem provisional assembly 124 includes the adapter 128 and the stem extension 130.

[0121] The fastener 270 can be configured similarly to the fastener 214 (FIG. 19) described above, but can have different longitudinal lengths and proximal end portions of different configurations since there is no need to couple a support component to the fastener 262. The fastener 262 can include a passageway 228 that provides access to the adapter 128 to enable adjustment of the positioning of the stem provisional assembly 124 as described above.

[0122] As shown in FIGS. 27 and 28, according to some embodiments, the femoral component 268 can include an elongated slot 272. This elongated slot 272 can be configured to receive a pin 273 therein. The elongated slot 272 can be positioned at the end portion 264 of the femur 260 as shown in FIGS. 26 and 27 so as to enable proximal-distal adjustment of the femoral component 268. In particular, when the pin 273 is received in the elongated slot 272 at a predetermined location, medial-lateral movement and internal-external rotation of the femoral component 268 can be suppressed. However, depending on the shape and orientation of the slot 272, adjustment of the proximal-distal position of the femoral component 268 can be enabled. Once the desired position of the femoral component 268 is obtained, a second pin (not shown) can be passed through the opening 274 and into the femur 260. Thereby, the femoral component 268 can be held in the desired position.

[0123] The femoral component 268 can include various slots for making enhancement cuts and can include an intercondylar recess configured to couple with an insert for performing a box cut if desired.

[0124] FIGS. 29-32 show a stem extension implant configured to be insensitive to stem rotation angle. Thereby, the stem extension implant can be bent in any direction. In contrast, known slotted stem implants of the prior art are configured to be direction sensitive, so the implant can be bent in only a limited number of directions.

[0125] FIG. 29 shows another design of the distal portion of a stem extension implant 275 according to one embodiment. The stem extension implant 275 can include a helical passage 276 along a portion of its longitudinal length. Such a configuration can provide additional flexibility to the stem extension implant 275 if it is desired not to depend on a specific rotational orientation in the bone.

[0126] Figure 30 shows another design of the distal portion of the stem extension implant 278. The stem extension implant 278 can include a plurality of gaps 280 spaced from each other along a portion of the longitudinal length of the stem extension implant 278. The plurality of gaps 280 create spaced sections 282 having a cross-sectional area different from that of the plurality of gaps 280. Such a configuration can impart additional flexibility to the stem extension implant 278 if it is desired that it not depend on a particular rotational orientation in the bone.

[0127] Figures 31 and 32 show yet another design of the distal portion of the stem extension implant 284. The stem extension implant 284 can include a plurality of slots 286 therein. These slots 286 can extend along a portion of the longitudinal length of the stem extension implant 284 and can extend to its distal tip 288. The plurality of slots 286 can separate the stem extension implant 284 into a plurality of sections 290 including a central section 292 and a plurality of outer sections 294. Such a configuration can impart additional flexibility to the stem extension implant 284 if desired, while increasing rigidity against bending by contact of 294 with the central core (288 or 292).

[0128] According to other embodiments, instead of having three slots 286 as shown in the figures, more or fewer slots can be had. For example, when using three slots 286, the central section 292 has an approximately triangular shape when viewed in a cross-section perpendicular to the longitudinal axis L, whereas if four slots are used, the central section can have an approximately square shape.

[0129] FIG. 33 shows a method 300 according to one embodiment. Method 300 can utilize the systems, instruments, and components previously described with reference to FIGS. 1-32. According to one embodiment, method 300 can include a preoperative step. This can include imaging the knee joint using a medical imaging method such as computed tomography (CT scan), X-ray, or magnetic resonance imaging (MRI) to obtain image data representing the knee joint. The imaging data can be obtained or collected during the preoperative planning phase based on a two-dimensional or three-dimensional computer image of the corresponding body structure reconstructed from the patient's image scan by a computer imaging method, according to some embodiments. Such imaging can be used to identify diseased bone or tissue of the tibia and / or femur that requires removal and implants that require removal in the case of revision. Imaging can be used to identify one or more axes of the knee joint, such as the mechanical or anatomical axes of the tibia and femur. A model of the joint can be presented to the physician as part of the preoperative plan. The physician can verify the three-dimensional model and provide instructions, in some embodiments, by electronic input.

[0130] In step 304, the joint can be exposed and one or more existing implants can be removed. A preliminary joint assessment can also be performed 306. Thereafter, the tibial joint revision stage of method 300 can be carried out. The physician can identify 308 the mechanical axis of the tibia based on the image data and / or observations and experience. A starter hole can also be generated. The tibial canal (e.g., intramedullary canal, diaphysis, and / or metaphysis) can be prepared 310 using, for example, the reamer 14 previously illustrated and discussed. An assessment 312 of the tibial size and position can be made. If an offset stem mock-up assembly is desired, this or another stem mock-up assembly can be prepared and inserted 314 into one or more recesses of the tibia. Any desired drilling, broaching, or reaming can be performed 316 using, for example, the instruments and / or techniques discussed in connection with FIGS. 5 - 10E. The resection of the proximal tibia can be performed 318 using, for example, the instruments and / or techniques of FIGS. 13 - 14B. The tibial tray provisional component can be attached 320 and assembled as discussed with reference to FIGS. 15 - 23B. A joint assessment 322 can be performed. In some embodiments, the tibial assembly can be removed to generate an implant assembly as discussed with reference to FIGS. 20 and 21.

[0131] Thereafter, the femoral joint revision stage of method 300 can be carried out. The physician can identify 324 the mechanical and / or anatomical axis of the femur based on the image data and / or observations and experience. A starter hole can also be generated. The femoral canal (e.g., intramedullary canal, diaphysis, and / or metaphysis) can be prepared 326 using, for example, the reamer 14 previously illustrated and discussed. An assessment 328 of the femoral size and position can be made. If an offset stem mock-up assembly is desired, this or another stem mock-up assembly can be prepared and inserted 330 into one or more recesses of the tibia. Any desired drilling, broaching, or reaming can be performed 332 using, for example, the instruments and / or techniques discussed in connection with FIGS. 5 - 10E. The resection of the distal femur can be performed 334 using, for example, the instruments and / or techniques of FIGS. 25 - 28. The femoral provisional component can be attached 336 and assembled as discussed with reference to FIGS. 15 - 28.

[0132] Method 300 can further include performing an initial trial and restoration 338 and an excision and box resection 340 for femoral augmentation. Method 300 can also further include a knee correction 342 that can stabilize the knee in flexion and extension and a final trial stage 343. Method 300 can end with the insertion 344 of one or more implants.

[0133] FIG. 34 shows details of another method 350 that can be used as part of method 300 of FIG. 33. Method 350 can include shaping the patient's bone 352 to create one or more recesses in the bone. Method 350 can include assembling a stem mock-up assembly comprising an adapter and a stem extension 354 and placing the stem mock-up assembly within one or more of the recesses 356. Method 350 can also include assembling the stem mock-up assembly in vivo with both a first mock component configured to mimic the shape of one of a tibial tray implant or a femoral implant and a second mock component configured to mimic the shape of at least one of a sleeve component or a keel component of the implant 358. In some embodiments, this assembly can include selecting an adapter from a plurality of adapters, each of the plurality of adapters having a longitudinal axis extending between a proximal end and a distal end, the plurality of adapters including at least a first adapter having a longitudinal axis without offset and at least a second adapter having a longitudinal axis with a predetermined amount of offset, and selecting a stem extension from a plurality of stem extensions each configured to couple with a respective one of the plurality of adapters, the plurality of stem extensions each having a different longitudinal dimension between a proximal end and a distal end. In another embodiment, this assembly can include one or more of threading a fastener into a threaded recess of the stem mock-up assembly to engage a mating member and passing a tool through a passage of the fastener to engage the stem mock-up assembly distal of the threaded recess.

[0134] Method 350 can further include temporarily coupling together the second provisional component and the stem provisional assembly with a handle configured to be placed over and inserted into the post extension, and inserting the stem provisional assembly and the second provisional component together into one or more recesses. According to one embodiment, method 350 can include identifying the axis of the bone and measuring whether an offset configuration is desirable for the stem provisional assembly. According to one embodiment, method 350 can include moving the stem provisional assembly in vivo to position the stem provisional assembly in a desired location within one or more recesses and position the first provisional component at the resection surface of the bone. According to one embodiment, method 350 can include removing at least the tibial tray provisional component, the second provisional component, and the stem provisional assembly together from the bone and one or more recesses while maintaining their respective positions relative to each other. Further, method 350 can include constructing an implant assembly based on the positions of the tibial tray provisional component, the second provisional component, and the stem provisional assembly.

[0135] Figures 35A and 35B show an assembly 400 of a set screw 402, a fastener 402, and a component 404. Component 404 can practically include any orthopedic instrument or device, including, for example, drill guide 140 (Figs. 9A and 9B), offset coupler 24, and femoral cut guide 262 of Fig. 25, and other instruments and devices described herein.

[0136] According to the embodiment of Figs. 35A and 35B, the component can include a hole 406 having a threaded portion 408, a pocket portion 410, and a restriction 412. Fastener 402 can include a set screw having a head portion 414 and a threaded portion 416.

[0137] The hole 406 can be configured such that the threaded portion 408 is adjacent to and in communication with the pocket portion 410, and the pocket portion 410 is adjacent to and in communication with the restricting portion 412. According to some embodiments, the restricting portion 412 can be disposed at or proximate to an opening 418 that communicates with the hole 406. However, this arrangement may be different in other embodiments. The threaded portion 416 of the fastener 402 can be connected to the head portion 414.

[0138] As shown in FIG. 35A, the fastener 402 can be removed from the component 404 such that the threaded portion 408 does not engage the threaded portion 416. The fastener 402, including the threaded portion 416 and the head portion 414, can fit within the pocket portion 410 with a certain amount of space 420 therearound. In particular, the pocket portion 410 can be sized to receive the fastener 402 therein and create a space 420 between the sidewall of the pocket portion 410 and the portions of the surface of the fastener 402 that form the head portion 414 and the threaded portion 416. This space 420 allows a sterilizing solution to access the threaded portion 408, the pocket 410, and the fastener 402 around the head portion 414, for example, through the opening 418.

[0139] Figure 35A shows that the pocket portion 410 can have a diameter larger than that of the head portion so that it can have a certain distance from the head portion 414. However, the restricting portion 412 can have a diameter substantially equal to or slightly smaller than that of the head portion 414. In this case, an interference fit occurs between the restricting portion 412 and the head portion 414. In Figure 35A, the fastener 402 is inserted into the pocket portion 410 through the interference fit. Such insertion can be carried out, for example, by using a flexible material for the components and / or the fastener, applying sufficient force to the fastener 402 for insertion, or applying a temperature difference (causing expansion and / or contraction) between the fastener and the components. To facilitate such insertion, the head portion 414 can include a chamfered surface 422 that can act as an inclined surface to facilitate the insertion of the fastener 402 into the restricting portion 412. In addition or alternatively, the restricting portion 412 can include a chamfered surface 424 that can act as an inclined surface. In an embodiment where both the chamfered surfaces 424 and 422 are utilized, the chamfered surface 422 can have a shape and position such that it initially interacts with the chamfered surface 424 when the fastener 402 is inserted into the pocket portion 410.

[0140] Once captured within the pocket portion 410, the restricting portion 410 can be configured (can have a relative size) relative to the head portion 414 such that, due to the interference fit between the restricting portion 412 and the head portion 414, the fastener 402 cannot return out of the hole 406 beyond the restricting portion 412. Thus, the fastener 402 is non-removable after being inserted into the pocket portion 410 and can be held by the restricting portion 410.

[0141] Figure 35B shows the fastener 402 after being engaged and rotated at the engaging feature 426 of the head portion 414 to engage the threaded portion 416 with the threaded portion 408. Such a threaded engagement can, for example, fasten two parts of the component 404.

[0142] Figures 36A and 36B show another assembly 430 having a configuration very similar to that of the assembly 400 of FIGS. 35A and 35B. Therefore, since the specific features of the assembly 430 include the features discussed with reference to FIGS. 35A and 35B, they will not be described in detail. The embodiments of FIGS. 36A and 36B differ from the embodiments of FIGS. 35A and 35B in that pocket portions 410 and passages 432A and 432B for fluid circulation are provided. These passages 432A and 432B extend substantially transverse to the longitudinal axis of, for example, the holes 406. The passages 432A and 432B facilitate the passage of a sterilizing solution if desired.

[0143] Figures 37A and 37B show two drivers 450A and 450B that can be used in place of the driver 220 of FIG. 16. The driver 450A of FIG. 37A can be configured to engage various components such as the assembly 210 (FIGS. 15 and 18), specifically the fastener 214. Therefore, the driver 450A can include a first head 222 and a handle 223 as described above. The first head 222 of the driver 450A is configured to engage and cooperate with the fastener 214 to rotate the fastener 214 for threadedly engaging the adapter 128 (FIGS. 11A - 11B) for threadedly coupling the fastener 214 to the adapter 128 as shown in FIG. 17. According to the embodiment of FIG. 37A, the first head 222 can have a 5 mm sized hexagonal head.

[0144] The driver 450B of FIG. 37B can include a handle 223 and a second head 224. The driver 450B can be configured to engage the stem sub - assembly 124 as previously described with reference to FIGS. 11A - 11E and FIGS. 22A - 22B. The second head 224 can have a size different from that of the first head 222 (FIG. 37A). In particular, the second head 224 can be made smaller (e.g., a 3 mm hexagonal head) than the first head 222 such that it is configured to access the portion of the distal adapter 128 where the first head 222 engages, as discussed in connection with FIG. 19.

[0145] FIG. 38 shows a system 460 of monolithic components that can be assembled, for example, to include a stem subassembly. This system 460 can be used in place of the modular system of FIG. 24 (separate adapters and stem extensions).

[0146] As shown in FIG. 38, system 460 can utilize a monolithic version of the stem subassembly (i.e., a single component having one adapter portion 462A, 462B, 462C and one stem extension portion 464A and 464B).

[0147] In a reference plane, system 460 can include a plurality of components 466, 468, 470, 472, 474, and 476. Each of the plurality of components 466, 468, 470, 472, 474, and 476 can have one of the plurality of adapter portions 462A, 462B, 462C and one of the plurality of stem extension portions 464A and 464B.

[0148] The plurality of stem extension portions 464A and 464B can be configured to provide various longitudinal lengths. For example, stem extension portion 464A can have a longitudinal length of 135 mm, and stem extension portion 464B can have a longitudinal length of 175 mm. Various diameters of each of the plurality of stem extension portions 464A and 464B can be provided as part of system 460.

[0149] The plurality of adapter portions 462B and 462B can be configured to provide different amounts of offset in the longitudinal direction. For example, adapter portion 462B can provide a first amount of offset O1. Adapter portion 462A has substantially no offset. The third adapter portion 462C can provide a third offset amount O3 different from the offset O1 and no offset provided by adapter portions 462A and 462B. According to one embodiment, the first offset amount O1 is 3 mm and the offset O3 is 6 mm.

[0150] Appendix The above description refers to the accompanying drawings, which form part of the description. The drawings show, by way of example, specific embodiments in which the invention can be practiced. These embodiments are also referred to herein as "examples". These examples can include other elements in addition to the elements illustrated or described. However, the inventor also contemplates examples that include only the elements illustrated and described. Further, the inventor also contemplates examples (or one or more forms thereof) that use any combination or permutation of the elements illustrated or described in connection with a particular example (or one or more forms thereof) or in connection with other examples (or one or more forms thereof) illustrated or described herein.

[0151] In this document, the "singular article ("a" or "an")" is used to include one or more, as is common in patent documents, regardless of other instances or uses of "at least one" or "one or more". In this application, "or" is used non-exclusively, and unless otherwise indicated, "A or B" includes "not B but A", "not A but B", and "A and B". In this document, "including" and "in which" are used as ordinary English equivalents of "comprising" and "wherein", respectively. Also, in the claims, "including" and "comprising" are without limitation, and a system, apparatus, item, composition, formulation, or process that includes additional elements in addition to the elements listed before "including" in the claim is also considered to fall within the scope of the claim. Further, in the claims, "first", "second", "third", etc. are used as mere labels and do not impose numerical requirements on the object.

[0152] The above description is illustrative and not restrictive. For example, the above embodiments (or one or more forms thereof) can be used in combination with each other. Those skilled in the art can use other embodiments by verifying the above description. The abstract is presented to enable a reader to quickly confirm the content of the present disclosure in accordance with 37 C.F.R. § 1.72(b). The abstract is submitted on the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above description, various features can be grouped to rationalize the disclosure. It is not to be construed as intending that features which are not claimed and are disclosed are essential to any of the claims. The content of the present invention may fall short of all the features of a particular disclosed embodiment. Accordingly, the claims are incorporated into the embodiments or forms of practicing the invention as examples, and each claim stands on its own as a separate embodiment, and these embodiments can be combined with each other in various combinations or permutations. The scope of the present invention should be determined with reference to the claims, together with the full scope of equivalents to which the claims are entitled. According to aspect (1), an inclined reamer for removing bone to create a recess, comprising: a proximal shaft portion; a distal nose portion; a cutting portion coupled to the proximal shaft portion and the distal nose portion, the cutting portion having a back angle taper with a diameter that decreases in a distal-proximal direction as measured along the longitudinal axis of the inclined reamer; and an inclined reamer. According to aspect (2), the distal nose portion has a blunt tip. According to aspect (3), the cutting portion has a first tapered section having a first angle measured from the longitudinal axis, and the back angle taper is a second tapered section having a second angle measured from the longitudinal axis. According to aspect (4), the first tapered section is separated from the second tapered section by a region having the maximum diameter of the cutting portion. According to aspect (5), the first angle is inverted with respect to the second angle. According to aspect (6), a system for removing bone to create a recess, comprising: a cannula-type reamer having a cutting portion and a shaft portion coupled to the cutting portion; a stem mock-up configured to be inserted into the intramedullary canal of the bone, wherein the cutting portion and the shaft portion are configured to receive at least a post extension of the stem mock-up, and the post extension of the stem mock-up is configured to guide the cutting portion into the bone to form the recess; and a system. According to aspect (7), it further comprises a drill guide configured to be attachable to the stem provisional assembly and configured to pre-drill the bone before bleaching. According to aspect (8), the drill guide is configured to direct one or more drills along a plurality of desired passages, break the bone along a specified area, and form the recess. According to aspect (9), the plurality of desired passages are at an acute angle to the axis of the post extension of the stem provisional assembly. According to aspect (10), the drill guide has a body with a plurality of spaced openings configured to receive the one or more drills. According to aspect (11), the stem provisional assembly includes an adapter configured to be disposed in the recess, the adapter is coupled between the post extension and the stem extension, and the drill guide is configured to limit the travel of the one or more drills adjacent to the adapter. According to aspect (12), it further comprises an inclined reamer having a distal nose portion and a cutting portion, and the cutting portion has a back angle taper with a decreasing diameter measured in the distal-proximal direction along the longitudinal axis of the inclined reamer. According to aspect (13), a first provisional component having a proximal surface and a distal surface opposite to the proximal surface, wherein one of the distal surface and the proximal surface is configured to be disposed on the resection surface of the bone, the first provisional component; A second provisional component configured to be disposed in the recess below the resection surface of the bone, the second provisional component being configured to mimic at least one of the shapes of the sleeve component, the cone component or the keel component of the implant, the second provisional component; A fastener configured to couple the first provisional component, the second provisional component and the stem provisional assembly together as one assembly, the fastener including a passage for accessing the stem provisional assembly from the adjacent first provisional component, the fastener; having. According to aspect (14), it further comprises a handle configured to temporarily engage the second provisional component with the stem provisional assembly, and when temporarily engaged with the handle, the second provisional component and the stem provisional assembly are each insertable into the recess of the bone. According to aspect (15), it further comprises a single or a plurality of drivers, and the single or plurality of drivers Engaging the fastener to screw it into the threaded recessed portion of the stem provisional assembly, and passing through the passage of the fastener to engage with the stem provisional assembly, wherein the engagement between the driver and the stem provisional assembly rotates the stem provisional assembly in vivo and positions the first provisional component on the resection surface, the passing through, is configured to perform at least one of. According to aspect (16), the fastener, the first provisional component, the first provisional component, and the stem provisional assembly can be removed together from the bone as an assembly while maintaining the positions of the respective components relative to each other. According to aspect (17), the first provisional component includes a femur component having an elongated slot configured to receive a pin therein, and the elongated slot is configured to allow proximal-distal movement of the femur component relative to the pin. According to aspect (18), the stem provisional assembly is a plurality of adapters having a longitudinal axis extending between a proximal end and a distal end, the plurality of adapters including at least a first adapter having no offset from the longitudinal axis and at least a second adapter having a certain offset from the longitudinal axis, a plurality of adapters, a plurality of stem extensions each configured to be interchangeably coupled to the plurality of adapters, each of the plurality of stem extensions having a different longitudinal range between a proximal end and a distal end, a plurality of stem extensions, and comprises the second adapter comprises two adapters, one adapter having a first offset amount and the other adapter having a second offset amount different from the first offset amount, a system.

Claims

1. 1. An angled reamer for removing bone to create a recess, comprising: a proximal shaft portion; a non-cutting distal nose portion having a length between 15 mm and 70 mm; a cutting portion coupled to the proximal shaft portion and the distal nose portion, the cutting portion having a back angle taper that decreases in diameter measured in a distal-proximal direction along a longitudinal axis of the bevel reamer; Including, angled reamers.

2. The angled reamer of claim 1 , wherein said distal nose portion has a blunt tip.

3. 2. The angled reamer of claim 1, wherein said cutting portion has a first tapered section having a first angle measured from said longitudinal axis and said back angle taper is a second tapered section having a second angle measured from said longitudinal axis.

4. 4. The angled reamer of claim 3, wherein said first tapered section is separated from said second tapered section by an area having a maximum diameter of said cutting portion.

5. 4. The angled reamer of claim 3, wherein said first angle is inverted relative to said second angle.

6. 1. A system for removing bone to create a recess, comprising:

2. The angled reamer of claim 1 having said distal nose portion and said cutting portion; a cannulated reamer having the cutting portion and a shaft portion coupled to the cutting portion; a stem provisional assembly configured for insertion into an intramedullary canal of the bone, the cutting portion and the shaft portion configured to receive at least a post extension of the stem provisional assembly, the post extension of the stem provisional assembly configured to guide the cutting portion into the interior of the bone to form the recess; Including, the system.

7. The system of claim 6, further comprising a drill guide configured to be attachable to the stem provisional assembly and configured to pre-drill the bone prior to breaching.

8. 8. The system of claim 7, wherein the drill guide is configured to direct one or more drills along a plurality of desired paths to fracture the bone along designated areas and form the recesses.

9. The system of claim 8 , wherein the plurality of desired paths are at an acute angle relative to an axis of the post extension of the stem provisional assembly.

10. The system of claim 8 , wherein the drill guide has a body with a plurality of spaced apart openings configured to receive the one or more drills.

11. 11. The system of claim 10, wherein the stem provisional assembly includes an adaptor configured to be placed in the recess, the adaptor coupled between the post extension and the stem extension, and the drill guide configured to limit a travel of the one or more drills adjacent the adaptor.

12. a first provisional component having a proximal surface and a distal surface opposite the proximal surface, one of the distal surface and the proximal surface configured to be positioned on the resected surface of the bone; a second provisional component configured to be placed in the recess below the resected surface of the bone, the second provisional component configured to mimic a shape of at least one of a sleeve component, a cone component, or a keel component of an implant; and a fastener configured to join the first temporary component, the second temporary component, and the stem temporary assembly together as an assembly, the fastener including a passageway for allowing access to the stem temporary assembly from adjacent first temporary components; The system of claim 6 , further comprising:

13. 13. The system of claim 12, further comprising a handle configured to temporarily engage the second provisional component to the stem provisional assembly, wherein when temporarily engaged with the handle, the second provisional component and the stem provisional assembly are each insertable into the recess of the bone.

14. The system further includes one or more drivers, the one or more drivers comprising: engaging the fastener to thread the fastener into the threaded recess of the stem subassembly; and penetrating the passage of the fastener to engage the stem provisional assembly, where engagement between the driver and the stem provisional assembly rotates the stem provisional assembly in vivo and positions the first provisional component at the resection surface; The system of claim 12 , configured to perform at least one of the following:

15. 13. The system of claim 12, wherein the fastener, the first provisional component, the first provisional component, and the stem provisional assembly are removable together as an assembly from the bone while maintaining the position of each component relative to one another.

16. 13. The system of claim 12, wherein the first provisional component includes a femoral component having an elongated slot configured to receive a pin therein, the elongated slot configured to permit proximal-distal movement of the femoral component relative to the pin.

17. The stem temporary assembly includes: a plurality of adaptors having a longitudinal axis extending between a proximal end and a distal end, the plurality of adaptors including at least a first adaptor having no offset in the longitudinal axis and at least a second adaptor having some offset in the longitudinal axis; a plurality of stem extensions, each configured to interchangeably couple with the plurality of adapters, each of the plurality of stem extensions having a different longitudinal extent between a proximal end and a distal end; Equipped with the second adapter comprises two adapters, one adapter having a first offset amount and the other adapter having a second offset amount different from the first offset amount; The system of claim 6 .

18. The angled reamer of claim 1, wherein the non-cutting distal nose portion has an elongated length for referencing the intramedullary canal of a bone.

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