Implants, systems and methods of using the same

Abstract

Implants, devices, systems and methods for replacing an articulation surface in a joint, for example, a tibial implant with a plate with a superior surface and an inferior surface, a least one post extending away from the inferior surface of the plate, and a keel extending away from the inferior surface of the plate. Methods for implanting and removal the tibial implant are also disclosed.

Description

IMPLANTS, SYSTEMS AND METHODS OF USING THE SAMECROSS-REFERENCE TO RELATED APPLICATION

[0001] This application claims priority benefit under 35 U.S.C. §119(e) of U.S. Provisional Application No. 63 / 551,825, filed February 9, 2024 and entitled Implants, Systems and Methods of Using The Same, which is incorporated herein by reference in its entirety.FIELD OF THE INVENTION

[0002] The present invention relates generally to general surgery, orthopedic implants used for replacing an articulation surface in a joint, such as knee prostheses. More specifically, but not exclusively, the present invention relates to tibial implants or unicompartmental knee implants, and systems for knee replacements and revisions, as well as methods for using the same.BACKGROUND OF THE INVENTION

[0003] Unicompartmental knee arthroplasty may be performed to replace a medial or lateral aspect of the tibial plateau. The tibial component is typically implanted with cement that is relied upon for fixation of the tibial component to bone. Alternatively, press fit components may be used, which do not utilize cement. However, many press fit components experience loosening after implantation. Therefore, a press fit unicompartmental knee arthroplasty tibial component is needed that can be implanted into the minimal space available between the tibia and femur and still achieve solid fixation without the risk of micromotion or loosening after implantation.SUMMARY OF THE INVENTION

[0004] Aspects of the present disclosure provide tibial implants for unicompartmental knee arthroplasty. The present invention also provides for methods for using the tibial implants.

[0005] In one aspect, provided herein is an implant that includes a tibial implant with a plate with a superior surface and an inferior surface, a least one post extending away from the inferior surface of the plate, and a keel extending away from the inferior surface of the plate.

[0006] In another aspect, provided herein is a surgical method for inserting an implant. The method includes inserting a portion of a keel and at least one post of the implant into a prepared bone surface of a patient’s tibia. The method also includes sliding a pivot point ofthe implant along the prepared bone surface until a distal posterior aspect of the keel is seated within a keel opening in the prepared bone surface. In addition, the method includes impacting a superior surface of the implant to fully insert the implant into the patient’s tibia.

[0007] In yet another aspect, provided herein is a method of removing a tibial implant. The method includes cutting posts of the implant. The method also includes using guided instrumentation to free the posts from a bone. The method further includes extracting the posts from the bone.

[0008] These, and other objects, features and advantages of this invention will become apparent from the following detailed description of the various aspects of the invention taken in conjunction with the accompanying drawings.BRIEF DESCRIPTION OF DRAWINGS

[0009] The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate embodiments of the invention and together with the detailed description herein, serve to explain the principles of the invention. The drawings are only for purposes of illustrating preferred embodiments and are not to be construed as limiting the invention. It is emphasized that, in accordance with the standard practice in the industry, various features are not drawn to scale. In fact, the dimensions of the various features may be arbitrarily increased or reduced for clarity of discussion. The foregoing and other objects, features and advantages of the invention are apparent from the following detailed description taken in conjunction with the accompanying drawings in which:

[0010] FIG. 1 is a first perspective view of an embodiment of a tibial implant, in accordance with an aspect of the present disclosure;

[0011] FIG. 2 is a second perspective view of the tibial implant of FIG. 1, in accordance with an aspect of the present disclosure;

[0012] FIG. 3 is a first side view of the tibial implant of FIG. 1, in accordance with an aspect of the present disclosure;

[0013] FIG. 4 is a second side view of the tibial implant of FIG. 1, in accordance with an aspect of the present disclosure;

[0014] FIG. 5 is a first end view of the tibial implant of FIG. 1, in accordance with an aspect of the present disclosure;

[0015] FIG. 6 is a second end view of the tibial implant of FIG. 1, in accordance with an aspect of the present disclosure;

[0016] FIG. 7 is a superior view of the tibial implant of FIG. 1, in accordance with an aspect of the present disclosure;

[0017] FIG. 8 is an inferior view of the tibial implant of FIG. 1, in accordance with an aspect of the present disclosure;

[0018] FIG. 9 is a cross-sectional view of the tibial implant of FIG. 1, taken along line 9- -9 in FIG. 7, in accordance with an aspect of the present disclosure;

[0019] FIG. 10 is a side view of the tibial implant of FIG. 1 with surface coating, in accordance with an aspect of the present disclosure;

[0020] FIG. 11 is a first perspective view of the tibial implant of FIG. 1 with surface coating, in accordance with the present disclosure;

[0021] FIG. 12 is a side view of the tibial implant of FIG. 1 with surface coating and radii of the fins, in accordance with an aspect of the present disclosure;

[0022] FIG. 13A is a side view of the tibial implant of FIG. 10 being inserted into a prepared portion of bone in a first position, in accordance with an aspect of the present disclosure;

[0023] FIG. 13B is a side view of the tibial implant of FIG. 10 being inserted into a prepared portion of bone in a second position, in accordance with an aspect of the present disclosure;

[0024] FIG. 14 is a first perspective view of a tibial implant with an extended surface coating on the inferior side of the tibial implant, in accordance with an aspect of the present disclosure;

[0025] FIG. 15 is a first perspective view of another embodiment of a tibial implant, in accordance with an aspect of the present disclosure;

[0026] FIG. 16 is a second perspective view of the tibial implant of FIG. 15, in accordance with an aspect of the present disclosure;

[0027] FIG. 17 is a first side view of the tibial implant of FIG. 15, in accordance with an aspect of the present disclosure;

[0028] FIG. 18 is a second side view of the tibial implant of FIG. 15, in accordance with an aspect of the present disclosure;

[0029] FIG. 19 is a first end view of the tibial implant of FIG. 15, in accordance with an aspect of the present disclosure;

[0030] FIG. 20 is a second end view of the tibial implant of FIG. 15, in accordance with an aspect of the present disclosure;

[0031] FIG. 21 is a superior view of the tibial implant of FIG. 15, in accordance with an aspect of the present disclosure;

[0032] FIG. 22 is an inferior view of the tibial implant of FIG. 15, in accordance with an aspect of the present disclosure;

[0033] FIG. 23 is the second side view of the tibial implant of FIG. 4 showing the angulation of the posts, in accordance with an aspect of the present disclosure; and

[0034] FIG. 24 is a second side view of an alternative tibial implant showing the angulation of the posts, in accordance with an aspect of the present disclosure.DETAILED DESCRIPTION FOR CARRYING OUT THE INVENTION

[0035] Generally stated, disclosed herein are tibial implants for unicompartmental knee arthroplasty. Further, surgical methods for using the tibial implants are discussed.

[0036] In this detailed description and the following claims, the words proximal, distal, anterior, posterior, medial, lateral, superior and inferior are defined by their standard usage for indicating a particular part of a bone or implant according to the relative disposition of the natural bone or directional terms of reference. For example, “proximal” means the portion of a device or implant nearest the torso, while “distal” indicates the portion of the device or implant farthest from the torso. As for directional terms, “anterior” is a direction towards the front side of the body, “posterior” means a direction towards the back side of the body, “medial” means towards the midline of the body, “lateral” is a direction towards the sides or away from the midline of the body, “superior” means a direction above and “inferior” means a direction below another object or structure.

[0037] Similarly, positions or directions may be used herein with reference to anatomical structures or surfaces. For example, as the current implants, devices, systems and methods are described herein with reference to use with the bones of the knee, the bones of the knee and leg may be used to describe the surfaces, positions, directions or orientations of the implants, devices, systems and methods. Further, the implants, devices, systems and methods, and the aspects, components, features and the like thereof, disclosed herein are described with respect to one side of the body for brevity purposes. However, as the human body is relatively symmetrical or mirrored about a line of symmetry (midline), it is hereby expressly contemplated that the implants, devices, systems and methods, and the aspects, components, features and the like thereof, described and / or illustrated herein may be changed, varied, modified, reconfigured or otherwise altered for use or association with another side of the body for a same or similar purpose without departing from the spirit andscope of the invention. For example, the implants, devices, systems and methods, and the aspects, components, features and the like thereof, described herein with respect to the right knee may be mirrored so that they likewise function with the left knee and vice versa. Further, the implants, devices, systems and methods, and the aspects, components, features and the like thereof, disclosed herein are described with respect to the knee for brevity purposes, but it should be understood that the implants, devices, systems and methods may be used with other bones of the body having similar structures, for example the upper extremity, and more specifically, with the bones of the shoulder, elbow, and arm.

[0038] Referring to the drawings, wherein like reference numerals are used to indicate like or analogous components throughout the several views, and with particular reference to FIGS. 1-14, there is illustrated an embodiment of a tibial implant 100. The tibial implant 100 includes a first end 102, a second end 104 opposite the first end 102, a first side 106, a second side 108 opposite the first side 106, a superior surface 110, and an inferior surface 112 opposite the superior surface 110. The first side 106 and the inferior surface 112 are configured to engage a portion of a patient’s tibia. The first side 106 may be, for example, straight or planar to engage the resected bone of the tibia. The second side 108 may be, for example, curved or arched to correspond to the shape of the medial side of the resected tibia. The first end 102 and second end 104 are curved and the curvature of the first end 102 is smaller than the curvature of the second end 104. The tibial implant 100 also includes a plate 120 with two posts 150, 170 and a keel 190 extending away from the inferior surface 112 of the implant 100.

[0039] As shown in FIGS. 1-14, the plate 120 includes a recessed region 122 extending into the plate 120 from the superior surface 110 of the implant 100 towards the inferior surface 112. The recessed region 122 extends into the plate 120 forming an outer rim 123 that surrounds the recessed region 122. The recessed region 122 extends from a position near the first end 102 to a position near the second end 104. The recessed region 122 may include an upper edge 124 extending from the superior surface 110 into the recessed region 122 and positioned near the first end 102. The recessed region 122 may also include a lower edge or first lip 126 extending from the upper edge 124 to a bottom surface of the recessed region 122. The upper edge 124 may be, for example, curved or tapered in a first direction, while the lower edge 126 may be, for example, curved or tapered in a second direction. The first direction and second direction may be opposite each other. The upper edge 124 and the lower edge 126 may extend into the recessed region 122 from the outer rim 123. An innermost region of the upper edge 124 may engage an innermost region of the lower edge126. The recessed region 122 may further include a second lip 128 recessed into the outer rim 123 of the plate 120 from the recessed region 122 towards the second end 104. The first lip 126 and the second lip 128 may be, for example, configured and / or sized and shaped to engage and retain an insert (not shown). The insert may be, for example, a plastic insert, such as, a polyethylene insert or the like.

[0040] With continued reference to FIGS. 1-14, the plate 120 also includes a groove 130 recessed into the first end 102 of the implant 100. The groove 130 is positioned, for example, near a midpoint between the superior surface 110 and the inferior surface 112. The groove 130 also extends, for example, through the first end 102 from the first side 106 to the second side 108 of the implant 100. The first side 106 may also include a porous region 132 extending along at least a portion of the length of the first side 106 between the first end 102 and the second end 104. As shown, the porous region 132 may extend from the first end 102 to the second end 104 along the entire length of the first side 106. In some embodiments, such as the tibial implant 230 shown in FIG. 14, the porous region 132 may be, for example, an extended porous region 132 extending nearly to the superior surface 110 of the implant 100. The extended porous region 132 may be used to provide additional ingrowth into the implant 100 where the tibial prominence is positioned. A porous coating may also fill and / or extend from the inferior recess 134. The inferior recess 134 may be, for example, inset into the inferior surface 112 of the implant 100. The porous coating of the inferior recess 134 may extend to and engage the porous region 132 on the first side 106 of the implant 100. Where the porous region 132 engages the porous coating of the inferior recess 134 may form a rounded edge 140. The rounded edge 140 may assist with preventing sitting up of the implant 100 on the prepared bone comer. The plate 120 may further include a posterior pivot end 136 at the second end 104 of the implant 100. The posterior pivot end 136 may be, for example, a rounded or curved end. The pivot end 136 may be, for example, made of a solid metal to promote sliding and rolling of the implant 100 into plate within a patient’s bone. The pivot end 136 may extend from, for example, a protrusion or rim 138 positioned near the second end 104 of the inferior surface 112 to the second end 104. The protrusion 138 provides an end point for the porous coating extending from the inferior recess 134 of the plate 120, as shown in FIG. 11.

[0041] Referring now to FIGS. 2-6 and 8-14, the first post 150 extends away from the inferior recess 134 of the plate 120 and the inferior surface 112 of the implant 100. The first post 150 may be, for example, positioned near the first end 102. In addition, the first post 150 may be, for example, positioned closer to the first side 106 than the second side 108 ofthe implant 100. The first post 150 includes a stem 152 coupled to and extending from the inferior recess 134 and a head 154 extending away from a second end of the stem 152. The head 154 may be, for example, tapered or angled from the stem 152 to the second end of the first post 150. The first post 150 may also include an opening 156 extending into the head 154 and at least a portion of the stem 152, as shown in FIG. 9. The opening 156 may include an interior threaded portion 158 extending along at least a portion of the interior of the opening 156. The threaded portion 158 may be positioned, for example, within the head 154. The head 154 may further include, for example, an exterior thread 160 extending circumferentially around the exterior surface of the first post 150 from an end of the first post 150 toward the stem 152. The stem 152 may also, for example, be coated with a porous coating 162. The porous coating 162 may extend from the inferior recess 134 towards the head 154, for example, to the exterior thread 160. The porous coating 162 on the posterior side of the first post 150 may be, for example, curved, arced, or tapered to provide an arced or angled posterior surface of the first post 150. In some embodiments, the porous coating 162 on the anterior side of the first post 150 may be, for example, curved, arced or tapered to provide an arced or angled posterior surface of the first post 150.

[0042] The first post 150 may also include at least one fin 164 extending away from an exterior surface of the first post 150. The at least one fin 160 extends from a portion of the head 154 and then along the entire length of the stem 152. For example, the at least one fin 164 may extend from the exterior thread 160 to the inferior surface 112 of the implant 100. The at least one fin 164 may be, for example, angled or tapered from the stem 152 toward an exterior surface of the at least one fin 164. The at least one fin 164 may be, for example, angled or pointed to form a leading edge that encourages penetration of the fin 164 into bone. The at least one fin 164 may include, for example, a sharp edge along the entire length of the at least one fin 164. The at least one fin 164 may be, for example, three fins 164 positioned around the circumference of the stem 152. The three fins 164 may be positioned on, for example, the anterior side, the medial side, and the lateral side of the first post 150. The anterior fin 164 may be, for example, positioned an equal distance between the medial fin 164 and the lateral fin 164. The fins 164 may be, for example, curved from a first end near the exterior thread 160 of the head 154 to a second end of the stem 152 coupled to the plate 120. The fins 164 may be, for example, curved as shown in FIG. 12, wherein fins 164 have a curvature of R5. The at least one fin 164 may help improve resistance to pull-out. In an alternative embodiment, the at least one fins 164 may be tapered along the axis of the respective post 150 to increase press as a function of the insertion depth.

[0043] With continued reference to FIGS. 2-6 and 8-14, a second post 170 extends away from the inferior recess 134 of the plate 120 and the inferior surface 112 of the implant 100. The second post 170 may be, for example, positioned between the first end 102 and the second end 104 of the implant 100. In addition, the second post 170 may be, for example, positioned closer to the second side 108 than the first side 106 of the implant 100. The second post 170 includes a stem 172 coupled to and extending from the inferior recess 134 and a head 174 extending away from a second end of the stem 172. The head 174 may be, for example, tapered or angled from the stem 172 to the second end of the second post 170. The second post 170 may also include an opening 176 extending into the head 174 and at least a portion of the stem 172. The opening 176 may include an interior threaded portion 178 extending along at least a portion of the interior of the opening 176. The threaded portion 178 may be positioned, for example, within the head 174. The head 174 may further include, for example, an exterior thread 180 extending circumferentially around the exterior surface of the second post 170 from an end of the second post 170 toward the stem 172. The stem 172 may also, for example, be coated with a porous coating 182. The porous coating 182 may extend from the inferior recess 134 towards the head 174, for example, to the exterior thread 180. The porous coating 182 on the posterior side of the second post 170 may be, for example, curved, arced, or tapered to provide an arced or angled posterior surface of the second post 170. In some embodiments, the porous coating 182 on the anterior side of the second post 170 may be, for example, curved, arced or tapered to provide an arced or angled posterior surface of the second post 170.

[0044] The second post 170 may also include at least one fin 184 extending away from an exterior surface of the second post 170. The at least one fin 184 extends from a portion of the head 174 and then along the entire length of the stem 172. For example, the at least one fin 184 may extend from the exterior thread 160 of the second post 170 to the inferior surface 112 of the plate 120. The at least one fin 184 may be, for example, angled or tapered from the stem 172 toward an exterior surface of the at least one fin 184. The at least one fin 184 may be, for example, angled or pointed to form a leading edge that encourages penetration of the fin 184 into bone. The at least one fin 184 may include, for example, a sharp edge along the entire length of the at least one fin 184. The at least one fin 184 may be, for example, three fins 184 positioned around the circumference of the stem 172. The three fins 184 may be positioned on, for example, the anterior side, the medial side, and the lateral side of the second post 170. The anterior fin 184 may be, for example, positioned an equal distance between the medial fin 184 and the lateral fin 184. The fins 184 may be, for example, curvedfrom a first end near the exterior thread 180 of the head 174 to a second end of the stem 172 coupled to the plate 120. The fins 184 may be, for example, curved as shown in FIG. 12, wherein fins 184 have a curvature of R4. The at least one fin 184 may help improve resistance to pull-out. In an alternative embodiment, the at least one fins 184 may be tapered along the axis of the respective post 170 to increase press as a function of the insertion depth.

[0045] As shown in FIGS. 2-4, 6, and 8-14, the implant 100 also includes a keel 190. The keel 190 includes a first end, anterior end, or leading edge 192 and a second end, posterior end, or trailing edge 194. The keel 190 also includes a distal posterior aspect 196 that is positioned near the second end 104. The second end 194 also includes a recess 198 inset into a portion of the keel 190 at the second end 194. The keel 190 further includes a band member 200. The band member 200 may be, for example, a solid metal portion surrounding the exterior surface of the keel 190. The band member 200 may assist with insertion of the implant 100 into a patient. The band member 200 may have, for example, a tapered periphery which may assist with implant insertion. In some embodiments, the edge of the band member 200 is not, for example, sharp to the touch.

[0046] As shown in FIGS. 3-4, the keel 190 also includes a first protrusion 202 on the first side of the keel 190 and a second protrusion 212 on a second side of the keel 190. The first protrusion 202 may extend from the first end 192 of the keel 190 to a first proximal posterior aspect 204 near the second end 104 of the implant 100. The first proximal posterior aspect 204 tapers into the inferior surface 112 of the implant 100. The first protrusion 202 may be coupled to the interior recess 134 near the protrusion 138. The first protrusion 202 extends from a first end 192 to a second end 194, for example, the protrusion 202 may be angled between the first end 192 and the second end 194. A first porous region 206 may be positioned inferior to the first protrusion 202 and a second porous region 208 may be, for example, positioned superior to the first protrusion 202. The second porous region 208 may have, for example, a width or thickness larger than the width or thickness of the first porous region 206. In addition, the keel 190 includes at least one first fin 210 coupled to and extending from the keel 190. The at least one fin 210 may be, for example, four fins. The at least one fin 210 extends from the inferior surface 112 of the implant 100 to a position near the first protrusion 202. The fins 210 may also each include a radius of curvature. For example, the two most posterior fins 210 have radii of R3 and R2 respectively. In addition, the distal posterior aspect 196 is positioned more anterior than the first and second proximal posterior aspects 204, 214. Said another way the proximal posterior aspects 204, 214 are positioned more posterior than the distal posterior aspect 196. Thus, the proximal posterioraspects 204, 214 couple to the inferior surface 112 of the plate 120 at a position more posterior on the plate 120 than where the distal posterior aspect 196 extends. Further, the proximal posterior aspects 204, 214 extend to a position closer to the second end 104 than the distal posterior aspect 196.

[0047] With continued reference to FIGS. 3-4, the second protrusion 212 may extend from the first end 192 of the keel 190 to a second proximal posterior aspect 214 near the second end 104 of the implant 100. The second proximal posterior aspect 214 may taper into the inferior surface 112 of the implant 100. The second protrusion 212 may be coupled to the interior recess 134 near the protrusion 138. The second protrusion 212 extends from a first end 192 to a second end 194, for example, the protrusion 212 may be angled between the first end 192 and the second end 194. A first porous region 216 may be positioned inferior to the second protrusion 212 and a second porous region 218 may be, for example, positioned superior to the second protrusion 212. The second porous region 218 may have, for example, a width or thickness larger than the width or thickness of the first porous region 216. In addition, the keel 190 includes at least one second fin 220 coupled to and extending from the keel 190. The at least one second fin 220 may be, for example, four fins. The at least one second fin 220 extends from the inferior surface 112 of the implant 100 to a position near the second protrusion 212. The second fins 220 may also each include a radius of curvature. For example, the two most posterior second fins 220 have radii of R3 and R2 respectively.

[0048] Referring now to FIGS. 2 and 8, the first post 150 may be, for example, spaced apart from the second post 170 along a longitudinal axis extending between the first end 102 and the second end 104 of the implant 100. The first post 150 and the second post 170 may also be offset from each other along a lateral axis extending between the first side 106 and the second side 108. The first post 150 may be, for example, an anterior post 150, while the second post 170 may be, for example, a posterior post 170. In addition, the first post 150 may be, for example, a lateral post 150 and the second post 170 may be, for example, a medial post 170. The posts 150, 170 may extend from the plate 120 at, for example, divergent angles. The divergent angle of the posts 150, 170 may allow for an optimized balance between the ease of preparation, an optimal hooking effect, and press-fit. The optimal angle for hooking may be, for example, adjusted as the distance from the pivot point changes. The posts 150, 170 may be, for example, parallel with each other or non-parallel with each other. When posts 150, 170 are parallel with each other, the posts 150, 170 may extend from the plate 120 at an angle relative to the first end 102 of the implant 100. The angle may be, for example, approximately 7 degrees to 13 degrees. Alternatively, when theposts 150, 170 are non-parallel with each other, the first post 150 angle may remain the same as for the parallel posts, while the second post 170 may have, for example, an angle of approximately 13 degrees to 25 degrees from the first end 102 of the implant 100. In a more preferred embodiment, the angle of the second post 170 in a non-parallel embodiment is approximately 20 degrees. The first post 150 may be, for example, aligned with the length of the keel 190, while the second post 170 may be, for example, positioned adjacent to the length of the keel 190.

[0049] Referring now to FIG. 12, the fins 164, 184, 210, 220 and the posterior aspect of the keel 190 may each have, for example, a radius of curvature. The radii of curvature Rl, R2, R3, R4, R5 each arc about a common pivot point and thus, are concentric radii. As the implant 100 is inserted into resected bone portion 240 the fins 164, 184, 210, 220 arc about the pivot point 136. The radius of curvature Rl of the posterior aspect of the keel 190 may be, for example, smaller than the radii of curvature R2, R3, R4, R5 for each of the fins 164, 184, 210, 220. The fins 210, 220 of the keel 190 may have radii R2, R3 that are smaller than the radii R4, R5 of the fins 164, 184 of the posts 150, 170. The keel 190 may have four fins 210, 220 on each side with radii of curvature R2, R3 that increase from the posterior most fin 210, 220 to the anterior most fin 210, 220. In addition, the radii R4 of the fins 164 of the first post 150 may be, for example, smaller than the radii R5 of the fins 184 of the second post 170.

[0050] Referring now to FIGS. 10-14, the implant 100 is shown with the porous coating 162, 182, 206, 208, 216, 218 applied to the recessed region 122 of the plate 120, the first post 150, the second post 170, and the keel 190. The posts 150, 170 and keel 190 also include fins 164, 184, 210, 220 extending from the plate 120 down at least a portion of the length of the posts 150, 170 and keel 190. The fins 164, 184, 210, 220 may be, for example, curved to assist the implant 100 to pivot and hook into place during insertion, as well as to lock the implant 100 in place under the bone. The posts 150, 170 may be, for example, straight from the first ends to the second ends of the posts 150, 170. In addition, the posts 150, 170 may be, for example, angled relative to the inferior surface 112 of the plate 120, as shown in FIGS. 3-4 and 23. For example, both posts 150, 170 may be angled at an angle y relative to the anterior end of the implant 100. The angle y may be, for example, approximately 7-13 degrees. The angle of the posts 150, 170 may assist with insertion of the implant 100 with the least resistance during pivoting and hooking into place.

[0051] It is also contemplated in an alternative embodiment that the posts 150, 170 may have different angles as the posts 150, 170 extend from the plate 120. For example, as shownin FIG. 24, the implant 350 may include a first post 150 and a second post 352. The second post 352 may be positioned at a different angle 5, than the first post 150, which may be positioned at angle y, as shown in FIG. 23. The angle y of the first post 150 may be, for example, approximately 7-13 degrees, while the angle 5 of the second post 170 may be, for example, approximately 13-25 degrees and more specifically approximately 20 degrees. When the second post 352 has a larger angle than the first post 150, additional clearance is provided for the drill bits during preparation of the tibial bone. The larger angle of the second post 352 may, for example, make it easier for the surgeon to drill the second post opening into the tibial bone without contacting the femur. In the alternative embodiment the farther posterior the post 170 is positioned, the larger the angle of least resistance along the hooking arc. In yet another alternative embodiment the posts 150, 170 may be, for example, curved. Further, the second end or posterior aspect 194 of the keel 190 may be, for example, shaped with an arc for hooking the implant 100 into position in the patient’s bone. It is also contemplated that the fins 164, 184, 210, 220 may have, for example, a curve that is not exactly circular and may vary as a function of the amount of sliding that occurs. When the fins 164, 184, 210, 220 are curved in a non-circular configuration, the pivot point or posterior pivot end 136 may move and the device hooking into place will utilize rolling and sliding to position the implant 100 within the patient’s bone.

[0052] As shown in FIG. 13A-13B, the posterior post 170 may have a length that is determined at least in part by a minimum initial seating depth when the device is inserted prior to impaction. The post 170 includes a minimum length of, for example, approximately 6 mm. The length is determined when the inferior surface 112 of the implant 100 is positioned at an angle P relative to the top surface of the resected bone 240. The angle P may be, for example, approximately 8 degrees to 15 degrees. The angle P is measured during insertion of the implant 100 when the first porous regions, slip-fit region, scratch fit region, or light press fit region 206, 216 of the keel 190 are inserted into the prepared keel area 242 up to the protrusions 202, 212. Further, the angle P is generally determined by the angle between the pivot point 136 and the distal aspect of the anterior post 150. The first porous regions 206, 216 allow the implant 100 to be positioned or nest into the proper position within the resected bone portion 240 before being impacted into place within the bone portion 240. Specifically, FIG. 13 A illustrates the tibial implant 100 inserted in a first insertion position at an angle P to the bone portion 240 and where the first regions 206, 216 of the keel 190 are inserted into the prepared keel area 242. While FIG. 13B illustrates the tibial implant 100 inserted into a second insertion position at an angle a and where the second regions 208,218 of the keel 190 have begun to be inserted into the prepared keel area 242. The angle P may be, for example, larger than the angle a. In addition, the posts 150, 170 may have, for example, only the non-porous portions inserted into the first and second post openings 244, 246, respectively, in the first position of FIG. 13 A. While the posts 150, 170 may have, for example, the non-porous portions and a portion of the porous stems 152, 172 inserted into the first and second post openings 244, 245, respectively.

[0053] Referring now to FIGS. 15-22, the tibial implant 250 is shown. The tibial implant 250 is similar to the implants 100, 230 with a similar plate 120 and alternative posts 260, 280 and keel 300. The plate 120 will not be described again here for brevity’s sake. The posts 260, 280 may have, for example, different angles as the posts 260, 280 extend from the plate 120. When the posts 260, 280 have different angles, the posts 260, 280 may be, for example, optimized to improve insertion of the implant 250.

[0054] Referring now to FIGS. 16-20 and 22, the first post 260 may extend away from the inferior recess 134 of the plate 120 and the inferior surface 112 of the implant 100. The first post 260 may be, for example, positioned near the first end 102. In addition, the first post 260 may be, for example, positioned closer to the first side 106 than the second side 108 of the implant 250. The first post 260 includes a stem 262 coupled to and extending from the inferior recess 134 and a head 264 extending away from a second end of the stem 262. The head 264 may be, for example, tapered or curved from the stem 262 to the second end of the first post 260. The head 264 may also include, for example, an exterior thread 266 extending circumferentially around at least a portion of the exterior surface of the first post 260 from an end of the first post 260 toward the stem 262. The head 264 may be, for example, solid and tapered into a rounded tip. The stem 262 may also, for example, be coated with a porous coating 268. The porous coating 268 may extend from the inferior recess 134 towards the head 264, for example, to the exterior thread 266. The porous coating 268 may be uniform around the entire circumference of the first post 260.

[0055] The first post 260 may also include at least one fin 270 extending away from an exterior surface of the first post 260. The at least one fin 270 extends, for example, along the entire length of the stem 262. For example, the at least one fin 270 may extend from the exterior thread 266 to the inferior surface 112 of the implant 100. The at least one fin 270 may extend, for example, straight along the stem 262. The at least one fin 270 may be, for example, angled or pointed to form a leading edge that encourages penetration of the at least one fin 270 into bone. The at least one fin 270 may include, for example, a sharp edge along the exterior surface of the at least one fin 270. The at least one fin 270 may be, for example,three fins 270 positioned around the circumference of the stem 262. The three fins 270 may be positioned on, for example, the anterior side, the medial side, and the lateral side of the first post 260. The anterior fin 270 may be, for example, positioned an equal distance between the medial fin 270 and the lateral fin 270. The medial and lateral fins 270 may have, for example, their exterior surface angled towards the second end 104 of the implant 250. The at least one fin 270 may also include a plurality of serrations 272 along the entire length of the at least one fin 270. The at least one fin 270 may help improve resistance to pull-out.

[0056] With continued reference to FIGS. 16-20 and 22, the second post 280 may extend away from the inferior recess 134 of the plate 120 and the inferior surface 112 of the implant 100. The second post 280 may be, for example, positioned between the first post 260 and the second end 104 of the implant 250. In addition, the second post 280 may be, for example, positioned closer to the second side 108 than the first side 106 of the implant 250. The second post 280 includes a stem 282 coupled to and extending from the inferior recess 134 and a head 284 extending away from a second end of the stem 282. The head 284 may be, for example, tapered or curved from the stem 282 to the second end of the second post 280. The head 284 may also include, for example, an exterior thread 286 extending circumferentially around at least a portion of the exterior surface of the second post 280 from an end of the second post 280 toward the stem 282. The head 284 may be, for example, solid and tapered into a rounded tip. The stem 282 may also, for example, be coated with a porous coating 288. The porous coating 288 may extend from the inferior recess 134 towards the head 284, for example, to the exterior thread 286. The porous coating 288 may be uniform around the entire circumference of the second post 280.

[0057] The second post 280 may also include at least one fin 290 extending away from an exterior surface of the second post 280. The at least one fin 290 extends, for example, along the entire length of the stem 282. For example, the at least one fin 290 may extend from the exterior thread 286 to the inferior surface 112 of the implant 100. The at least one fin 290 may extend, for example, straight along the stem 282. The at least one fin 290 may be, for example, angled or pointed to form a leading edge that encourages penetration of the at least one fin 290 into bone. The at least one fin 290 may include, for example, a sharp edge along the exterior surface of the at least one fin 290. The at least one fin 290 may be, for example, three fins 290 positioned around the circumference of the stem 282. The three fins 290 may be positioned on, for example, the anterior side, the medial side, and the lateral side of the second post 280. The anterior fin 290 may be, for example, positioned an equal distance between the medial fin 290 and the lateral fin 290. The medial and lateral fins 290 may have,for example, their exterior surface angled towards the second end 104 of the implant 250. The at least one fin 290 may also include a plurality of serrations 292 along the entire length of the at least one fin 290. The at least one fin 290 may help improve resistance to pull-out.

[0058] The first post 260 may be, for example, longer than the second post 280. The first post 260 may be, for example, an anterior and medial post, while the second post 280 may be, for example, a posterior and lateral post. The first post 260 may be, for example, aligned with a longitudinal axis of the keel 300 extending between the first end 102 and the second end 104. Further, the second post 280 may have, for example, the anterior fin 290 aligned with the anterior end of the keel 300.

[0059] The keel 300, as shown in FIGS. 16-20 and 22, may include a first end, anterior end, or leading edge 302 and a second end, posterior end, or trailing edge 304. The keel 300 also includes a distal posterior aspect 306 that is positioned near the second end 104. The second end 304 also includes a recess 308 inset into a portion of the keel 300 at the second end 304. The keel 300 further includes a band member 310. The band member 310 may be, for example, a solid metal portion surrounding the exterior surface of the keel 300. The band member 310 may assist with insertion of the implant 250 into a patient. The band member 310 may have, for example, a tapered periphery which may assist with implant insertion. In some embodiments, the edge of the band member 310 is not, for example, sharp to the touch.

[0060] As shown in FIGS. 17-18, the keel 300 also includes a first protrusion 312 on the first side of the keel 300 and a second protrusion 322 on a second side of the keel 300. The first protrusion 312 may extend from the first end 302 of the keel 300 to a first proximal posterior aspect 314 near the second end 104 of the implant 250. The first proximal posterior aspect 314 tapers into the inferior surface 112 of the implant 250. The first protrusion 312 may be coupled to the interior recess 134 near the protrusion 138. The first protrusion 312 extends from a first end 302 to a second end 304, for example, the protrusion 312 may be angled between the first end 302 and the second end 304. A first porous region 316 may be positioned inferior to the first protrusion 312 and a second porous region 318 may be, for example, positioned superior to the first protrusion 312. The second porous region 318 may have, for example, a width or thickness larger than the width or thickness of the first porous region 316. In addition, the keel 300 includes at least one first fin 320 coupled to and extending from the keel 300. The at least one fin 320 may be, for example, three fins. The at least one fin 320 extends from the inferior surface 112 of the implant 250 to a position near the first protrusion 312. The fins 320 may extend straight from the plate 120. In an embodiment, the fins 320 may be, for example, straight, but the angle of one or more of thefins 320 changes as the fin 320 gets closer to the natural insertion pivot point of the implant 250. The angle of least resistance for insertion of the implant 250 may change relative to the theoretical insertion pivot point 136. In addition, the distal posterior aspect 306 is positioned more anterior than the first and second proximal posterior aspects 314, 324. Said another way the proximal posterior aspects 314, 324 are positioned more posterior than the distal posterior aspect 306. Thus, the proximal posterior aspects 314, 324 couple to the inferior surface 112 of the plate 120 at a position more posterior on the plate 120 than where the distal posterior aspect 306 extends. Further, the proximal posterior aspects 314, 324 extend to a position closer to the second end 104 than the distal posterior aspect 306. The posterior aspect may include a plurality of serrations 332 extending between the distal posterior aspect 306 and the proximal posterior aspects 314, 324. The plurality of serrations 332 extend from the posterior end of the keel 300 toward the second end 104 of the implant 250. The serrations 332 provide additional engagement mechanisms during insertion of the implant 250 into a patient’s bone.

[0061] With continued reference to FIGS. 17-18, the second protrusion 322 may extend from the first end 302 of the keel 300 to a second proximal posterior aspect 324 near the second end 104 of the implant 250. The second proximal posterior aspect 324 may taper into the inferior surface 112 of the implant 250. The second protrusion 322 may be coupled to the interior recess 134 near the protrusion 138. The second protrusion 322 extends from a first end 302 to a second end 304, for example, the protrusion 322 may be angled between the first end 302 and the second end 304. A first porous region 326 may be positioned inferior to the second protrusion 322 and a second porous region 328 may be, for example, positioned superior to the second protrusion 322. The second porous region 328 may have, for example, a width or thickness larger than the width or thickness of the first porous region 326. In addition, the keel 300 includes at least one second fin 330 coupled to and extending from the keel 300. The at least one second fin 330 may be, for example, three fins. The at least one second fin 330 extends from the inferior surface 112 of the implant 250 to a position near the second protrusion 322. The fins 330 may extend straight from the plate 120. In an embodiment, the fins 330 may be, for example, straight, but the angle of one or more of the fins 330 changes as the fin 330 gets closer to the natural insertion pivot point of the implant 250. The angle of least resistance for insertion of the implant 250 may change relative to the theoretical insertion pivot point 136.

[0062] A method of inserting a tibial implant 100, 230, 250 may include preparing the tibial bone. Preparing the tibial bone may include performing a resection of a portion of thetibia and forming openings for the posts 150, 170, 260, 280 and the keel 190, 300. The openings for the posts 150, 170, 260, 280 may be formed in an anatomically advantageous position to provide limited exposure and allow improved drill and / or preparation instrument access. The method also includes inserting the distal posterior aspect 196 of the keel 190, 300 into the prepared keel area 242 of the resected bone portion 240, as shown in FIG. 13. In addition, the posts 150, 260, 170, 280 may be aligned with the prepared first post opening 244 and second post opening 246, respectively. After the keel 190, 300 and posts 150, 170, 260, 280 are aligned and / or partially inserted into the openings 242, 244, 246, an impaction device may be used to complete inserting the implant 100, 230, 250 into the resected bone portion 240. The impaction device may aid in impacting the implant 100, 230, 250 to optimize hooking.

[0063] If a revision surgery is necessary, then the posts 150, 170, 260, 280, 352 can be separated from the plate to ease extraction. The surgeon may cut off the posts 150, 170, 260, 280, 352. Then, if the posts 150, 170 include threaded portions 158, 178, as included in implant 100, a pin may be threaded into the exposed post openings 156, 176. Next, the surgeon may use the pin as a guide for the punch or cannulated trephine. Once the punch frees the posts 150, 170, 260, 280, 352, the posts 150, 170, 260, 280, 352 can be pulled out of or extracted from the patient’s tibia. The posts 150, 170, 260, 280, 352 can be, for example, pulled out by pulling on the pins that are threaded into the posts 150, 170, 260, 280, 352.

[0064] As may be recognized by those of ordinary skill in the art based on the teachings herein, numerous changes and modifications may be made to the above-described and other embodiments of the present disclosure without departing from the scope of the disclosure. The components of the implants, devices, and / or systems as disclosed in the specification, including the accompanying abstract and drawings, may be replaced by alternative component(s) or feature(s), such as those disclosed in another embodiment, which serve the same, equivalent or similar purpose as known by those skilled in the art to achieve the same, equivalent or similar results by such alternative component(s) or feature(s) to provide a similar function for the intended purpose. In addition, the implants, devices, and / or systems may include more or fewer components or features than the embodiments as described and illustrated herein. Accordingly, this detailed description of the currently-preferred embodiments is to be taken in an illustrative, as opposed to limiting of the disclosure.

[0065] The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. As used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless thecontext clearly indicates otherwise. It will be further understood that the terms “comprise” (and any form of comprise, such as “comprises” and “comprising”), “have” (and any form of have, such as “has”, and “having”), “include” (and any form of include, such as “includes” and “including”), and “contain” (and any form of contain, such as “contains” and “containing”) are open-ended linking verbs. As a result, a method or device that “comprises,” “has,” “includes,” or “contains” one or more steps or elements possesses those one or more steps or elements, but is not limited to possessing only those one or more steps or elements. Likewise, a step of a method or an element of a device that “comprises,” “has,” “includes,” or “contains” one or more features possesses those one or more features, but is not limited to possessing only those one or more features. Furthermore, a device or structure that is configured in a certain way is configured in at least that way, but may also be configured in ways that are not listed.

[0066] The invention has been described with reference to the preferred embodiments. It will be understood that the operational embodiments described herein are exemplary of a plurality of possible arrangements to provide the same general features, characteristics, and general system operation. Modifications and alterations will occur to others upon a reading and understanding of the preceding detailed description. It is intended that the invention be construed as including all such modifications and alterations.

Claims

CLAIMSHaving thus described the preferred embodiments, the invention is now claimed to be:

1. An implant, comprising: a plate with a superior surface and an inferior surface; at least one post extending away from the inferior surface of the plate; and a keel extending away from the inferior surface of the plate.

2. The implant of claim 1, wherein the keel comprises: a first end opposite a second end; a distal posterior aspect positioned at a second end; and at least one proximal posterior aspect positioned at the second end, wherein the at least one proximal posterior aspect extends beyond the distal posterior aspect along a length of the plate extending between a first end and a second end.

3. The implant of claim 2, wherein the at least one proximal posterior aspect comprises: a first proximal posterior aspect positioned on a first side of the keel; and a second proximal posterior aspect positioned on a second side of the keel, wherein the first proximal posterior aspect is opposite the second proximal posterior aspect.

4. The implant of claim 2, wherein a posterior aspect of the keel includes at least one plurality of serrations extending between the distal posterior aspect and the at least one proximal posterior aspect.

5. The implant of claim 3, wherein a recess is positioned between the first proximal posterior aspect and the second proximal posterior aspect.

6. The implant of claim 1, wherein the keel further comprises: a recess extending into the keel from a posterior aspect of the keel.

7. The implant of claim 1, wherein the keel further comprises:a band member extending around an exterior surface of the keel.

8. The implant of claim 1, wherein the band member is solid, wherein a first side of the keel has a porous coating, and wherein a second side of the keel has a porous coating.

9. The implant of claim 1, wherein the keel comprises: a first protrusion extending from a first side of the keel, wherein the first protrusion is angled from a second end to a first end of the keel; and a second protrusion extending from a second side of the keel, wherein the second protrusion is angled from the second end to the first end of the keel.

10. The implant of claim 9, wherein the keel further comprises: a first porous region positioned inferior to the first protrusion on the first side of the keel; a second porous region positioned superior to the first protrusion on the first side of the keel; a third porous region positioned inferior to the second protrusion on the second side of the keel; and a fourth porous region positioned superior to the second protrusion on the second side of the keel.

11. The implant of claim 10, wherein the first porous region of the first side has a first thickness, wherein the second porous region of the first side has a second thickness, and wherein the second thickness is larger than the first thickness; and wherein the third porous region of the second side has a third thickness, wherein the fourth porous region of the second side has a fourth thickness, and wherein the fourth thickness is larger than the third thickness.

12. The implant of claim 1, wherein the keel further comprises: at least one first fin extending away from a first side of the keel and from the inferior surface of the plate; and at least one second fin extending away from a second side of the keel and from the inferior surface of the plate.

13. The implant of claim 12, wherein the at least one first fin extends straight away from the plate; and wherein the at least one second fin extends straight away from the plate.

14. The implant of claim 13, wherein the at least one first fin is at least two first fins and wherein each first fin of the at least two first fins has an angle and the angle changes as the first fins get closer to a posterior end of the implant, wherein the at least one second fin is at least two second fins and wherein each second fin of the at least two second fins has an angle and the angle changes as the second fins get closer to the posterior end of the implant.

15. The implant of claim 12, wherein the at least one first fin curves as it extends away from the plate; and wherein the at least one second fin curves as it extends away from the plate.

16. The implant of claim 12, wherein the plate includes a pivot point at a posterior-inferior end of the implant.

17. The implant of claim 16, wherein the pivot point curves from a posterior end of the implant to the inferior surface of the implant.

18. The implant of claim 16, wherein the at least one first fin is curved concentric about the pivot point, and wherein the at least one second fin is curved concentric about the pivot point.

19. The implant of claim 1, wherein the at least one post extends away from the inferior surface of the plate at an angle.

20. The implant of claim 1, wherein the at least one post comprises: a stem; a head coupled to and extending from the stem; and at least one fin extending away from at least a portion of the stem.

21. The implant of claim 20, wherein the at least one post extends straight from the inferior surface of the implant.

22. The implant of claim 21, wherein the at least one fin of the at least one post is curved as the at least one fin extends from at least the portion of the stem.

23. The implant of claim 20, wherein the at least one post further comprises: a porous coating coupled to and extending from an exterior surface of at least a portion of the stem.

24. The implant of claim 21, wherein the porous coating extending from the stem on a posterior side of the at least one post is curved between the inferior surface of the plate and an end of the stem.

25. The implant of claim 21, wherein the porous coating extending from the stem on an anterior side of the at least one post is curved between the inferior surface of the plate and an end of the stem.

26. The implant of claim 21, wherein the porous coating extending from the stem on an anterior side and a posterior side of the at least one post is curved between the inferior surface of the plate and an end of the stem.

27. The implant of claim 20, wherein the at least one post extends curved from the inferior surface of the implant.

28. The implant of claim 20, wherein the at least one post comprises: an opening extending into the head and at least a portion of the stem, wherein the opening extends into the head from a first end of the at least one post; and a threaded portion positioned in at least a portion of the opening of the at least one post.

29. The implant of claim 20, wherein the at least one post comprises: a first post; and a second post, wherein the first post is positioned offset from the second post.

30. The implant of claim 29, wherein the first post is positioned near a first end of the plate and wherein the second post is positioned between the first post and a second end of the plate.

31. The implant of claim 29, wherein the first post is angled at a first angle from the inferior surface of the plate, wherein the second post is angled at a second angle from the inferior surface of the plate, and wherein the first angle is different than the second angle.

32. The implant of claim 29, wherein the first post is positioned aligned with the keel along a longitudinal axis extending between a first end and a second end of the plate, and wherein the second post is positioned lateral to the keel along the longitudinal axis of the plate.

33. The implant of claim 20, wherein the at least one fin of the at least one post extends along a length of the stem.

34. The implant of claim 33, wherein the at least one fin is curved between a first end and a second end of the stem.

35. The implant of claim 33, wherein the at least one fin extends straight between a first end and a second end of the stem.

36. The implant of claim 33, wherein the at least one fin comprises a plurality of serrations along a length of the at least one fin.

37. The implant of claim 33, wherein the at least one fin is three fins positioned circumferentially around the stem of the implant.

38. The implant of claim 33, wherein the at least one fin comprises: at least one radius of curvature with a first radius; and wherein the keel comprises at least one fin with at least one radius of curvature with a second radius, and wherein the first radius is larger than the second radius.

39. A method of inserting an implant, comprising:inserting a portion of a keel and at least one post of the implant into a prepared bone surface of a patient’s tibia; sliding a pivot point of the implant along the prepared bone surface until a distal posterior aspect of the keel is seated within a keel opening in the prepared bone surface; and impacting a superior surface of the implant to fully insert the implant into the patient’s tibia.

40. The method of claim 39, wherein the keel comprises a first porous region extending from a distal end of the keel and a second porous region extending from the first porous region to an inferior surface of the implant, and wherein the method further comprises: nesting the first porous region into the keel opening in the prepared bone surface to find a proper insertion location.

41. The method of claim 39, wherein the at least one post is curved, and wherein inserting the at least one post of the implant into the prepared bone surface comprises: inserting the at least one curved post into straight holes in the prepared bone surface.

42. A method of removing a tibial implant, comprising: cutting posts of the implant; using guided instrumentation to free the posts from a bone; and extracting the posts from the bone.

43. An implant, comprising: a plate with a superior surface and an inferior surface; at least one post extending away from the inferior surface of the plate; and a keel extending away from the inferior surface of the plate.

44. The implant of claim 43, wherein the keel comprises: a first end opposite a second end; a distal posterior aspect positioned at a second end; andat least one proximal posterior aspect positioned at the second end, wherein the at least one proximal posterior aspect extends beyond the distal posterior aspect along a length of the plate extending between a first end and a second end.

45. The implant of any one of claims 43-44, wherein the at least one proximal posterior aspect comprises: a first proximal posterior aspect positioned on a first side of the keel; and a second proximal posterior aspect positioned on a second side of the keel, wherein the first proximal posterior aspect is opposite the second proximal posterior aspect.

46. The implant of any one of claims 43-45, wherein a posterior aspect of the keel includes at least one plurality of serrations extending between the distal posterior aspect and the at least one proximal posterior aspect.

47. The implant of any one of claims 43-46, wherein a recess is positioned between the first proximal posterior aspect and the second proximal posterior aspect.

48. The implant of any one of claims 43-47, wherein the keel further comprises: a recess extending into the keel from a posterior aspect of the keel.

49. The implant of any one of claims 43-48, wherein the keel further comprises: a band member extending around an exterior surface of the keel.

50. The implant of any one of claims 43-49, wherein the band member is solid, wherein a first side of the keel has a porous coating, and wherein a second side of the keel has a porous coating.

51. The implant of any one of claims 43-50, wherein the keel comprises: a first protrusion extending from a first side of the keel, wherein the first protrusion is angled from a second end to a first end of the keel; and a second protrusion extending from a second side of the keel, wherein the second protrusion is angled from the second end to the first end of the keel.

52. The implant of any one of claims 43-51, wherein the keel further comprises: a first porous region positioned inferior to the first protrusion on the first side of the keel; a second porous region positioned superior to the first protrusion on the first side of the keel; a third porous region positioned inferior to the second protrusion on the second side of the keel; and a fourth porous region positioned superior to the second protrusion on the second side of the keel.

53. The implant of any one of claims 43-52, wherein the first porous region of the first side has a first thickness, wherein the second porous region of the first side has a second thickness, and wherein the second thickness is larger than the first thickness; and wherein the third porous region of the second side has a third thickness, wherein the fourth porous region of the second side has a fourth thickness, and wherein the fourth thickness is larger than the third thickness.

54. The implant of any one of claims 43-53, wherein the keel further comprises: at least one first fin extending away from a first side of the keel and from the inferior surface of the plate; and at least one second fin extending away from a second side of the keel and from the inferior surface of the plate.

55. The implant of any one of claims 43-54, wherein the at least one first fin extends straight away from the plate; and wherein the at least one second fin extends straight away from the plate.

56. The implant of any one of claims 43-55, wherein the at least one first fin is at least two first fins and wherein each first fin of the at least two first fins has an angle and the angle changes as the first fins get closer to a posterior end of the implant, wherein the at least one second fin is at least two second fins and wherein each second fin of the at least two second fins has an angle and the angle changes as the second fins get closer to the posterior end of the implant.

57. The implant of any one of claims 43-56, wherein the at least one first fin curves as it extends away from the plate; and wherein the at least one second fin curves as it extends away from the plate.

58. The implant of any one of claims 43-57, wherein the plate includes a pivot point at a posterior-inferior end of the implant.

59. The implant of any one of claims 43-58, wherein the pivot point curves from a posterior end of the implant to the inferior surface of the implant.

60. The implant of any one of claims 43-59, wherein the at least one first fin is curved concentric about the pivot point, and wherein the at least one second fin is curved concentric about the pivot point.

61. The implant of any one of claims 43-60, wherein the at least one post extends away from the inferior surface of the plate at an angle.

62. The implant of any one of claims 43-61, wherein the at least one post comprises: a stem; a head coupled to and extending from the stem; and at least one fin extending away from at least a portion of the stem.

63. The implant of any one of claims 43-62, wherein the at least one post extends straight from the inferior surface of the implant.

64. The implant of any one of claims 43-63, wherein the at least one fin of the at least one post is curved as the at least one fin extends from at least the portion of the stem.

65. The implant of any one of claims 43-64, wherein the at least one post further comprises: a porous coating coupled to and extending from an exterior surface of at least a portion of the stem.

66. The implant of any one of claims 43-65, wherein the porous coating extending from the stem on a posterior side of the at least one post is curved between the inferior surface of the plate and an end of the stem.

67. The implant of any one of claims 43-66, wherein the porous coating extending from the stem on an anterior side of the at least one post is curved between the inferior surface of the plate and an end of the stem.

68. The implant of any one of claims 43-67, wherein the porous coating extending from the stem on an anterior side and a posterior side of the at least one post is curved between the inferior surface of the plate and an end of the stem.

69. The implant of any one of claims 43-68, wherein the at least one post extends curved from the inferior surface of the implant.

70. The implant of claim 43-69, wherein the at least one post comprises: an opening extending into the head and at least a portion of the stem, wherein the opening extends into the head from a first end of the at least one post; and a threaded portion positioned in at least a portion of the opening of the at least one post.

71. The implant of any one of claims 43-70, wherein the at least one post comprises: a first post; and a second post, wherein the first post is positioned offset from the second post.

72. The implant of any one of claims 43-71, wherein the first post is positioned near a first end of the plate and wherein the second post is positioned between the first post and a second end of the plate.

73. The implant of any one of claims 43-72, wherein the first post is angled at a first angle from the inferior surface of the plate, wherein the second post is angled at a second angle from the inferior surface of the plate, and wherein the first angle is different than the second angle.

74. The implant of any one of claims 43-73, wherein the first post is positioned aligned with the keel along a longitudinal axis extending between a first end and a second end of the plate, and wherein the second post is positioned lateral to the keel along the longitudinal axis of the plate.

75. The implant of any one of claims 43-74, wherein the at least one fin of the at least one post extends along a length of the stem.

76. The implant of any one of claims 43-75, wherein the at least one fin is curved between a first end and a second end of the stem.

77. The implant of any one of claims 43-76, wherein the at least one fin extends straight between a first end and a second end of the stem.

78. The implant of any one of claims 43-77, wherein the at least one fin comprises a plurality of serrations along a length of the at least one fin.

79. The implant of any one of claims 43-78, wherein the at least one fin is three fins positioned circumferentially around the stem of the implant.

80. The implant of any one of claims 43-79, wherein the at least one fin comprises: at least one radius of curvature with a first radius; and wherein the keel comprises at least one fin with at least one radius of curvature with a second radius, and wherein the first radius is larger than the second radius.

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