Application instruments including surgical guides with a hybrid- fixation glenoid component system in reverse total shoulder prosthesis

Abstract

This invention comprises base plate and glenosphere designs, as well as cutting guides and holder instruments, developed to provide stronger fixation with a more minimally invasive approach to the shoulder in patients undergoing reverse shoulder arthroplasty for any reason. This newly developed technique allows for surgical operation in a more confined space, particularly in challenging cases such as tight shoulders. In addition, it offers advantages such as being usable as an alternative technique in osteoporotic patients with high cortical fixation and in revision surgeries or in cases with reduced bone stock due to various reasons. In standard base plate designs, it is known that fixation is predominantly achieved in the trabecular bone by screws inserted from the reamed peripheral bone surface surrounding the implant. However, in osteoporotic patients, trabecular bone becomes weakened and the bone stock may not provide sufficient support. Furthermore, version differences related to anatomical variations of the glenoid seen among patients may cause problems in component placement and screw insertion if proper preoperative assessment is not performed. Moreover, in classical component design, in order to send the guidewire in the correct direction corresponding to the surface where the central peg will be applied, soft tissue dissection exposing the entire glenoid must be performed. Performing this dissection may pose challenges for the surgeon in tight shoulders, increase the duration of surgery, and carry risks of complications such as instability or injury to neurovascular structures. In addition, in classical component design, the acceptable threshold of contact between the glenoid and base plate is considered to be 80%. If this is not achieved, implant failure may occur after prosthesis application. When the contact surface between the glenoid and base plate falls below 50%, graft application becomes indicated. Although it is a successful method, it is technically demanding, and in cases of graft non-union, alternative options are limited. Another method is the use of augment components for the defective area. This application not only presents high technical difficulty but also requires well-prepared three-dimensional preoperative planning. Custom-made implants are another option and are technically the most laborious and expensive to manufacture. With this invention, compared to previous techniques, the management of glenoid defect and excessive version problems can be achieved by providing higher cortical fixation with anterior-weighted support.

Description

[0001] APPLICATION INSTRUMENTS INCLUDING SURGICAL GUIDES WITH A HYBRIDFIXATION GLENOID COMPONENT SYSTEM IN REVERSE TOTAL SHOULDER PROSTHESIS

[0002] Technical Field:

[0003] The relevant technical field comprises a base plate (100) design that incorporates different application methods and bone integration principles for patients requiring reverse total shoulder arthroplasty due to various reasons. Reverse total shoulder arthroplasty is used as a definitive and successful method in shoulder arthrosis cases impairing joint function, including irreparable proximal humeral fractures, tumors associated with the shoulder region, cuff tear arthropathies, or avascular necrosis. This method aims to restore function to the shoulder by bypassing the anatomical structures responsible for various functions of the joint that cannot be repaired, through a non-anatomical biomechanical working principle. This technique simply consists of a humeral stem applied to the humerus, a liner integrated into this stem, a base plate (100) applied to the glenoid, and a glenoid sphere integrated thereon. Along with this invention, the insertion guide (200), cutting guide (300), glenoid sphere (400), holder (500), plug (600), grasp bolt (800), and mini grasp bolt (900), which are intended to be used for the implementation of the technique, are also included within the scope of the patent. No new developments related to the humeral stem or liner found in previous techniques are introduced within this invention. The invention is designed to be compatible with standard humeral components and liners currently available on the market.

[0004] Background Art:

[0005] The reverse total shoulder arthroplasty procedure, which has become increasingly common in the definitive treatment of current shoulder pathologies, is one of the most important procedures employed by surgeons in cases where other treatment options have been exhausted. This procedure is considered a last-resort approach for fractures and joint disorders, and if unsuccessful, the subsequent interventions can only be regarded as salvage procedures. In this design, by lateralizing the center of rotation, the moment arm of the deltoid muscle is lengthened, allowing for the bypassing of the functional properties of the rotator cuff, thereby compensating for motion loss due to its insufficiency. One of the most common mechanical complications affecting the success of reverse total shoulder arthroplasty is failure due to loosening of the base plate. In the initial system described following the introduction of the reverse shoulder arthroplasty concept, the glenoid sphere was implanted onto the glenoid surface via a single stem and cement. As early versions resulted in failure, glenoid fixation has since become one of the most critical mechanical parameters in reverse total shoulder arthroplasty.

[0006] The most commonly used glenoid base plate systems today include those developed by Grammont, which are based on the application of a circular-shaped glenoid base plate over a hydroxyapatite-coated central cylindrical peg to the glenoid and then fixation with a screw.

[0007] In the content of patent EP2841021 B1 , which includes a glenoid component, base plate, and glenoid sphere, an oval-shaped design conforming to the anatomy of the glenoid surface was used to enhance glenoid fixation.

[0008] In the content of patent US9233003B2, there is a glenoid base plate having a pear-shaped structure with a single central peg through which multiple locked straight screws and unlocked screws in different configurations can be inserted, and a glenoid sphere with a concave shape having flattened borders in the anterior-posterior plane, particularly intended for use in rotator cuff arthropathies.

[0009] In the content of patent US10143558B2, a design comprising a base plate and glenoid sphere in which glenoid fixation is achieved via a central screw instead of a central peg, along with a humeral component and a humeral socket, is described.

[0010] Patent US6228119B1 discloses a glenoid component for total shoulder arthroplasty, incorporating a nail-shaped central peg and supporting the insertion of two divergent screws, along with liner designs integrated into this component.

[0011] Patent US8690952B2 describes a reverse total shoulder arthroplasty design in which a base plate includes two central pegs and a glenoid sphere integrated thereon.

[0012] Patent US10188408B2 discloses designs of a base plate with a fin-shaped peg and application instruments developed for use in reverse total shoulder arthroplasty. The literature indicates that a peg designed with a conical structure and hydroxyapatite coating provides sufficient initial stability. When the correct technique is applied regarding the peg structure and application method, there is no significant mechanical superiority between them However, in patients with existing glenoid bone defects, it is considered necessary to increase the length of the central peg in combination with the use of a metal augment or bone graft When the positioning of the inserted screws is examined, no difference has been observed between parallel and divergent orientations. However, the length and number of screws used are noted to increase implant stability.

[0013] Regardless of the component design and working mechanics, the application technique is also observed as an important factor in the survival of the implants. The importance of preoperative planning and the surgeon’s experience in improving the implant application approach has been emphasized in many studies. At this stage, the importance of the surgical guides developed for the purpose of standardizing the technique emerges.

[0014] Patent US10426493B2 can be given as an example of guide designs developed to optimize orientation for the application of the base plate to the glenoid surface.

[0015] In the content of patent US10188408B2, a glenoid surface preparation set design developed for the implantation of the total shoulder prosthesis glenoid component is described.

[0016] Another perspective is related to the fixation methods that enable the integration of the glenoid sphere onto the base plate. Upon the report that loosening occurred with joint movements in implants operating with a mechanism that fixes the glenoid sphere onto the base plate via a threaded structure, this approach has largely been abandoned. Currently, the integration of the base plate and the glenoid sphere is mostly achieved by the 'Morse Taper' method.

[0017] In the content of the patent examining the base plate and glenoid sphere design numbered EP3598957B1 , a base plate supporting the insertion of one central peg and four divergent angled locked screws, and a glenoid sphere integrated onto it by means of screwing, along with the application instruments for these components, are described.

[0018] In the content of patent US20170172764A1 , which includes reverse total arthroplasty implant designs including glenoid and humeral components, it is seen that the integration between the humeral socket applied onto the humeral stem and the adapter component applied onto the base plate is achieved by the orthopedic 'Morse taper' method.

[0019] Technical Problems Aimed to Be Solved by the Invention:

[0020] The present invention relates to the glenoid components of a reverse total shoulder prosthesis system that supports an alternative and more robust fixation for base plate application in patients with total bone loss due to revision requirements that may arise from posterior glenoid bone loss as in arthrosis, central bone erosion as in rheumatoid arthritis, trabecular bone loss due to osteoporosis, tumor or radiotherapy, or infection or mechanical complications.

[0021] Unlike the state of the art, the main principle in this invention is to achieve a more rigid fixation through anterior cortical-weighted anchorage from the glenoid to the scapula.

[0022] Another objective of the invention is to allow modifications aimed at increasing joint stability and function on other components of the implant, which is expected to provide more rigid fixation, without concerns related to implant failure.

[0023] Another objective of the invention is to reduce the risk of anterior shoulder dislocation by preserving the posterior capsule with less tissue dissection due to the anterior approach surgical application method.

[0024] Another objective of the invention is to eliminate the need for the beach chair position, which is more challenging and risky in patient positioning, especially for patients with short necks, since the implant can be applied from an anterior plane similar to the Latarjet approach.

[0025] Another objective of the invention is to provide ease of application in narrow or tight shoulders and a more minimal approach since it utilizes anterior-referenced insertion and cutting guides along with application instruments.

[0026] Description of the Figures:

[0027] Figure 1 : Annotated examination of the Base Plate (100) (Right) component from different perspectives Figure 2: Annotated examination of the Insertion Guide (200) (Right) instrument from different perspectives

[0028] Figure 3: Annotated examination of the Cutting Guide (300) (Right) instrument from different perspectives

[0029] Figure 4: Annotated examination of the Glenoid Sphere (400) (Right) component from different perspectives

[0030] Figure 5: Annotated examination of the Holder (500) instrument from different perspectives

[0031] Figure 6: Annotated examination of the Plug (600) component from different perspectives

[0032] Figure 7: Annotated examination of the Mini Plug (700) component from different perspectives

[0033] Figure 8: Annotated examination of the Grasp Bolt (800) instrument from different perspectives

[0034] Figure 9: Annotated examination of the Mini Grasp Bolt (900) instrument from different perspectives

[0035] Figure 10: Maximum screw configuration deliverable through the angled holes (142, 152) and plate holes (144, 154) on the Base Plate (100)

[0036] Figure 11 : Method of removing the Glenoid Sphere (400) of the Holder (500) from the Base Plate (100)

[0037] REFERENCE NUMBERS THAT GIVEN IN THE FIGURE

[0038] 100. Base Plate

[0039] 110. Main Body

[0040] 111. Glenoid Sphere Groove

[0041] 112. Slide Plug Slot

[0042] 120. Central Wedge

[0043] 121. Fixation Surface

[0044] 122. Osteointegration Holes

[0045] 123. Sharp Edges

[0046] 130. Stopper

[0047] 131. Cylinder

[0048] 132. Osteointegration Holes

[0049] 140. Lower Plate

[0050] 141. Body Connection

[0051] 142. Lower Angled Hole

[0052] 143. Stabilization Surface 144. Lower Plate Hole

[0053] 145. Suture Hole

[0054] 150. Upper Plate

[0055] 151 . Body Connection

[0056] 152. Upper Angled Hole

[0057] 153. Stabilization Surface

[0058] 154. Upper Plate Hole

[0059] 155. Suture Hole

[0060] 200. Insertion Guide

[0061] 210. Curved Body

[0062] 220. Hook

[0063] 221. Pin Notch

[0064] 230. Pin Guide Handle

[0065] 231 . Lower Pin Hole

[0066] 240. Intermediate Pin Inserter

[0067] 241. Intermediate Pin Hole

[0068] 250. Upper Pin Inserter

[0069] 251. Upper Pin Hole

[0070] 260. Depth Determiner

[0071] 261. Console

[0072] 262. Limiting Extension

[0073] 263. Height Probe

[0074] 300. Cutting Guide

[0075] 310. Front Body

[0076] 311 . Front Cutting Notch

[0077] 312. Transverse Cutting Notch

[0078] 313. Front Fixation Hole

[0079] 320. Side Body

[0080] 321. Side Cutting Notch

[0081] 322. Transverse Cutting Notch

[0082] 323. Angled Side Fixation Hole

[0083] 330. Transverse Cutting Separator

[0084] 340. Lower Pin Guide

[0085] 341. Lower Fixation Hole

[0086] 350. Upper Pin Guide 351. Upper Fixation Hole

[0087] 400. Glenoid Sphere

[0088] 410. Head

[0089] 411. Articular Surface

[0090] 412. Component Surface

[0091] 413. Extraction Notch

[0092] 420. Slide

[0093] 421. Slide Body

[0094] 422. Wedge

[0095] 500. Holder

[0096] 510. Clamp

[0097] 511. Slide

[0098] 512. Ramp

[0099] 520. Adapter

[0100] 521. Block

[0101] 522. Fixation Hole

[0102] 530. Cassette

[0103] 531. Mini Fixation Hole

[0104] 532. Mini Fixation Hole

[0105] 540. Handle

[0106] 541. Impact Arm

[0107] 542. Rod

[0108] 543. Grip

[0109] 600. Plug

[0110] 610. Screw Head

[0111] 611 . Screw Slot

[0112] 620. Screw Body

[0113] 621. Screw Threads

[0114] 622. Thread End Notch

[0115] 700. Mini Plug

[0116] 710. Screw Head

[0117] 711. Screw Slot

[0118] 720. Screw Body 721 . Screw Threads

[0119] 722. Thread End Notch

[0120] 800. Grasp Bolt

[0121] 810. Screw Head

[0122] 811 . Screw Slot

[0123] 820. Screw Body

[0124] 821. Straight Body

[0125] 822. Screw Threads

[0126] 823. Thread Start Notch

[0127] 824. Thread End Notch

[0128] 900. Mini Grasp Bolt

[0129] 910. Screw Head

[0130] 911 . Screw Slot

[0131] 920. Screw Body

[0132] 921. Straight Body

[0133] 922. Screw Threads

[0134] 923. Thread Start Notch

[0135] 924. Thread End Notch

[0136] Description of the Invention:

[0137] Within the scope of the present invention, there are components including the base plate (100), which operates based on the principle of cortical fixation on the glenoid (Figure 1); the glenoid sphere (400), applied onto the base plate (100) (Figure 4); and the components ensuring its fixation, namely the plug (600) (Figure 6) and the mini plug (700) (Figure 7); as well as the holder (500) (Figure 5), the insertion guide (200) (Figure 2), the cutting guide (300) (Figure 3), the grasp bolt (800) (Figure 8), and the mini grasp bolt (900) (Figure 9). The visuals related to the invention are described from the right shoulder perspective, and the mirror images of these designs in the sagittal plane represent the visuals of the left shoulder. After performing the surgical approach through the determined incision and reaching the glenoid, the insertion guide (200) (Figure 2) is placed onto the glenoid. The design of this component has been developed to enable inferior positioning of the base plate (100) and fixation through anterior glenoid cortex by referencing both the anterior and inferior cortices. While the hook (220) on the Insertion guide (200) provides support and compression on the glenoid through its contact with the posterior cortex, the intermediate pin inserter (240) supports pin insertion through contact, resting, or compression on the anterior glenoid. Pin insertion through the Intermediate pin inserter (240) is provided through the Intermediate pin hole (241 ). Although the hook (220) component is shown as a fixed structure in this model, it may also be described as articulated or latch-type to increase posterior cortical fixation, considering different glenoid anatomies and sizes. In patients without bone defects in the anterior glenoid, compression is achieved in the anterior-posterior plane, and there may be no or minimal contact with the inferior cortex. In the presence of an anterior glenoid defect, since the component anchored to the posterior cortex with the aid of the hook (220) does not receive anterior support and thus cannot achieve compression, it is positioned by resting on the inferior cortex. In this case, the pin sent through the lower pin hole (231 ) within the pin guide handle (230) engages with the pin notch (221) on the hook (220), achieving initial fixation. The depth determiner (260) on the insertion guide (200) targets the deepest point on the cartilage surface of an intact glenoid, while the height probe (263) is inserted into the cartilage base, forming a reference point for lateral cutting. The limiting extension (262), which is a part of the depth determiner (260), provides orientation regarding the glenoid version by resting on the anterior cortex of the glenoid after the height probe (263) is inserted. The console (261 ), which connects the depth determiner (260) to the curved body (210), also supports deepening of the lateral cutting level by allowing flexibility over the limiting extension (262) onto the height probe (263). The upper pin inserter (250) determines the height of the anterior cutting level responsible for flattening the anterior surface by referencing the anterior superior cortex of the glenoid neck, and through the upper pin hole (251) on it, a third pin can also be inserted to fix the insertion guide (200). In the determination of the positions of the two pins belonging to the pin inserters (240, 250), inspiration is taken from the latarjet procedure. For this reason, the Insertion guide (200) also has the capability to be used in latarjet procedures for defective glenoid approaches. After the insertion of at least two pins, the insertion guide (200) is removed.

[0138] The cutting guide (300) (Figure 3) is applied in such a way that it aligns with the fixation holes over the existing pins. On the cutting guide (300), there is a level difference between the surfaces of the upper pin guide (350) and the lower pin guide (340) where contact is made with the anterior glenoid. Due to the fact that the glenoid morphometry is predominantly pear-shaped and less frequently inverted comma or oval-shaped, the inferior surface of the anterior glenoid cortex is positioned more anteriorly in the natural glenoid. In patients with anterior glenoid defects, it is expected that cortical contact may not be achieved on the lower pin guide (340), resulting in a gap. After positioning the cutting guide via at least two pins inserted through the three fixation holes located on the front body (310), it is preferred to insert an additional pin through the angled lateral fixation hole (323) located on the side body (320), which supports pin insertion at a 45-degree angle to the axial plane. The pin inserted through the angled lateral fixation hole (323) provides anchorage to the posterolateral cortex and supports stabilization of the guide during the cutting process. However, the pins inserted through the angled lateral fixation hole (323) and the lower fixation hole (341) on the lower pin guide (340) may interfere respectively during lateral and anterior cuts. In this case, it is preferred that the pins inserted through the angled lateral fixation hole (323) during the lateral cut and through the lower fixation hole (341) during the anterior cut be removed for the cuts to be performed, and reinserted afterward if needed. Another alternative is to proceed with the cuts through the cutting notches even in the presence of the pins. However, since the orientation of the angled lateral fixation hole (323) extends posteriorly as it progresses from lateral to medial in the coronal plane, the cut is mostly completed. After the cutting guide (300) is removed, the remaining bone fragments can be cleaned with the aid of an osteotome or rongeur. The cuts are performed using a fine cutting motor through the cutting guide (300). There is no specific instruction for the order of the cuts; however, after performing the lateral cut using the front cutting notch (311) and the anterior cut using the side cutting notch (321), a transverse cut can be performed in the coronal plane using the transverse cutting notch (312, 322). The front cutting notch (311), located near the upper part, is divided by the transverse cutting notch (312), and is responsible for shaving the cartilage layer on the glenoid articular surface during the lateral cut. During this cut, considering the inferior placement principle of the base plate (100), it is sufficient to reach up to the upper limit of the front cutting notch (311). In larger glenoid anatomies, a transverse cut in the anteroposterior direction from the upper edge of the cutting guide (300) can be used to limit the upper extent of the lateral cut, thereby preserving bone stock. The side cutting notch (321 ) supports performing the anterior cut in patients without anterior glenoid defects. During this cut, the pin inserted through the lower fixation hole (341) within the lower pin guide (340) remains in the cutting area and may obstruct the fine blades of the cutting motor. Pin insertion through the lower fixation hole (341 ) is an optional step; the two pins inserted through the upper fixation hole (351 ) and the front fixation hole (313) are sufficient for single-plane stabilization. The transverse cutting notch (312, 322) is located within both elements of the cutting guide (300), namely the front body (310) and the side body (320). The transverse cutting notch (312, 322) is divided into two layers in the coronal and sagittal planes by the transverse cut separator (330). In the upper segment of the transverse cutting notch (312, 322) divided by the transverse cut separator (330), the upper part of the cut is performed using a fine saw motor, while the lower part is cut in the lower segment. After these cuts, the bone segment in between can be released with the aid of an osteotome and removed in block form using an auxiliary instrument such as a towel clamp. If it is observed that a sufficient amount of bone has not been removed, the remaining bone pieces can be cleaned with the cutting motor using a standard-sized cutting saw. During this procedure, care should be taken to preserve the posterior cortex of the scapula located beneath the spinous process. It is expected that the transverse cut will extend beyond the posterior of the glenoid neck region; however, if the posterior cortex of the scapular body, to which the central wedge (120) on the base plate (100) extends, remains intact, the risk of implant-related fractures will be reduced.

[0139] Following the completion of the cuts, the pins are removed and the base plate (100) is placed onto the glenoid in the appropriate position either alone or with the aid of the holder (500) (Figure 5). Here, the definition of the appropriate position involves advancing the central wedge (120) by impaction into the transverse cut and placing the posterior surface of the main body (110) of the base plate (100) onto the lateral cut. In this application, the posterior surfaces of the lower plate (140) and the upper plate (150) components may contact the anterior glenoid cut surface or be positioned parallel to it. The engagement surface (121) part of the central wedge (120) is hydroxyapatite-coated for final fixation, and the sharp edges (123) on the posterior and medial surfaces of the component are designed in a smooth structure to allow advancement of the component by impaction. In order to fully advance the central wedge (120) and ensure compression after application, hammering can be applied onto the body connection (141 , 151) surfaces on the lower plate (140) or the upper plate (150). The stopper (130) component is designed in an appropriate axis and position to prevent the central wedge (120) from excessive posterior movement or rotation, thus avoiding potential issues such as sinking or version in the component. The cylinder (131 ) part of this component provides contact and sliding with the anterior cortex of the scapula. The osteointegration holes (122, 132) are partially located on the central wedge (120) and partially on the stopper (130). The purpose of these holes is to enhance the final fixation by filling them with graft material obtained from the cuts made before or after the application of the component, thereby enabling osteointegration with the anterior cortex. The lower plate (140) and the upper plate (150) are components designed to provide corticotrabecular fixation and reinforcement after placement of the component. The angled holes (142, 152) are located on the body connection (141 , 151) components and consist of a large-diameter threaded section near the surface, followed by a narrowdiameter smooth groove. The angled holes (142, 152) have an angle of 60 degrees in the axial plane relative to their own axis. Through these holes, either a standard locking screw with retention on the proximal threads can be inserted, or, following hole creation with a flexible drill motor, a non-locking screw can also be inserted at a 15-degree angle in any axis. After inserting a non-locking screw, a mini plug (700) can be applied onto the threaded section to prevent screw backing and to fill the hole. The fixation surfaces (143,

[0140] 153) on the plates (140, 150) are important as they include the plate holes (144, 154) and the suture holes (145, 155). The lower plate hole (144) on the lower plate (140) and the upper plate hole (154) on the upper plate (150) correspond to the positions of the pins sent through the intermediate pin hole (241 ) and the upper pin hole (251) of the positioning guide (200) and the pins inserted through the lower fixation hole (341) and the upper fixation hole (351 ) of the cutting guide (300), designed inspired by the Latarjet procedure screw application. Therefore, after placement of the base plate (100) component, drilling through the plate holes (144, 154) enlarges the corresponding pin holes and allows fixation with locking screws without creating new holes. Screwing through the plate holes (144,

[0141] 154) is the preferred screw application method, which helps preserve bone stock by avoiding the creation of new holes. However, when this screw application method is used, insertion of a locking screw in its own axis through the angled holes (142, 152) is not possible. If sufficient fixation is deemed not to have been achieved after screwing through the plate holes (144, 154), non-locking screws can be inserted at an angle through the angled holes (142, 152) using a flexible drill for freehand drilling. In applications performed with non-locking screws, a mini plug (700) is applied to the threaded sections of the angled holes (142, 152) to fill the holes and prevent screw backing. (Figure 10) The suture holes (145, 155), located on both plates, are recesses angled at 45 degrees in the sagittal plane that support techniques such as capsular repair or soft tissue reinforcement if needed after fixation. On the main body (110), there are two parts named the glenoid sphere groove (111 ) and the slide plug slot (112). The slide (420) of the glenoid sphere (400) is inserted through the glenoid sphere groove (111 ) to combine the components. Then, the fixation of the components is ensured with the plug (600) applied to the slide plug slot (112).

[0142] The glenoid sphere (400) consists of two components: the head (410) and the slide (420). The head (410) component forms the surface that constitutes the joint element in reverse shoulder arthroplasty. While the head (410) has a 1 / 3 spherical structure in the standard design, it may also have different forms such as 1 / 2, 2 / 3, or 1 / 4 sphere in more lateralized or medialized designs. The partial spherical part of the head (410) component is referred to as the joint surface (411 ), while the part where it connects to the base plate (100) is defined as the component surface (412). The removal notch (413) is located on the same side as the component surface (412) and facilitates the removal of the glenoid sphere (400), which is applied via the slide (420) through the glenoid sphere groove (111 ), with the holder (500) apparatus if needed. The slide (420) is a component designed to support the advantages aimed with the implementation of this invention. There is no restriction against using the ‘Morse taper’ method, which is the most commonly used and proven technique for combining components in total or partial arthroplasties, in the design of these implants. The reason for preferring the application technique with the slide (420) is that it enables easier implantation with less retraction and tissue dissection in tight shoulders and limited anterior approaches, in line with one of the objectives of the invention. With this approach, the posterior capsule can be preserved while interfering less with the anterior capsule. In the standard design, the slide (420) is centrally positioned, but it can be placed superiorly to enable inferior positioning of the component. The slide (420) consists of two parts: the slide body (421 ) and the wedge (422). The slide body (421) enables advancement and engagement through the glenoid sphere groove (111), while the wedge (422) provides three-point fixation with its inclined structure. It is preferred that the cross-section of the slide body (421) be in an isosceles trapezoid shape. It is also preferred that the end of the glenoid sphere groove (111 ) on the base plate (100) have a concave structure that accommodates the inclined edge of the wedge (422). After the slide (420) component is inserted into the glenoid sphere groove (111), fixation is achieved by means of the plug (600) component applied to the slide plug slot (112) on the base plate (100).

[0143] The holder (500) apparatus has the function of both impaction and removal of the base plate (100). For impacting the base plate (100) in position, the clamp (510) belonging to the holder (500) is first placed into the glenoid sphere groove (111) through the slide (511) part. The clamp (510) component has a structure similar to the slide (420) on the glenoid sphere (400) and provides engagement from the same area. The holder (500) apparatus also plays a role in the removal of the glenoid sphere (400) in cases where removal of the components is required. (Figure 11 ) After the removal of the plug (600) component, which acts as a barrier by being inserted into the slide plug slot (112) in front of the slide (420), the glenoid sphere (400) is expected to be removed by sliding it through the glenoid sphere groove (111 ). In the case where this removal cannot be achieved, the tip of the slide (511) part of the holder (500) is hooked into the removal notch (413) on the glenoid sphere (400), and by means of a lever effect, the slide (420) is advanced within the glenoid sphere groove (111 ) to enable removal. The ramp (512) ensures the connection of the slide (511 ) part with the adapter (520) and the cassette (530) components. The adapter (520) component consists of two parts: the block (521 ) and the fixation hole (522). Fixation is achieved during impaction and removal by means of the engagement of the fixation element (800), which is inserted through the fixation hole (522), into the slide plug slot (112) on the base plate (100) via threading. Another method of achieving or supporting fixation is through the cassette (530). Fixation can be supported with the fixation element (800) by means of the mini grasp bolts (900) inserted through the two mini grasp bolt holes (531 , 532) located on the cassette (530), or, in the event that engagement cannot be achieved, they may be used alone as an alternative method to secure engagement. The handle (540) component connects to the cassette (530) and allows the operator to hold the apparatus and to reach the relevant area easily thanks to its curved structure. The handle (540), depending on its function, consists of three parts: the impact bar (541 ), the shaft (542), and the grip (543); the impact bar (541) is the part located closest to the cassette (530). The impact bar (541) is thickened and its related surfaces are flattened in order to withstand hammer blows during impaction or removal. The shaft (542) section is of sufficient length and curved to allow for tissue retraction and access to the relevant area. The grip (543) section has a cylindrical design flattened on opposite sides to provide the operator with a firm grasp. The grip (543) may also preferably be made of wood in order to ensure better handling.

[0144] The plug (600) (Figure 6) is the component that provides the final fixation of the glenoid sphere (400). It consists of two elements: the screw head (610) and the screw body (620). The hexagonal-shaped screw recess (611) located on the screw head (610) allows the screw to be driven with a hex screwdriver. The screw body (620) is defined by the screw threads (621) and the thread end notch (622). The plug (600), after the glenoid sphere (400) is applied onto the glenoid sphere groove (111 ) on the base plate (100) via the slide (420), is inserted into the slide plug slot (112) through its threads and provides fixation by compression.

[0145] The mini plug (700) (Figure 7) is an optional component used in cases where an unlocked screw is inserted through the angled holes (142, 152) on the base plate (100), or where no application is performed. This component (700), similar to the plug (600), consists of two elements: the screw head (710) and the screw body (720). The hexagonal-shaped screw recess (711 ) located on the screw head (710) allows the screw to be driven with a hex screwdriver. The screw body (720) is defined by the screw threads (721) and the thread end notch (722). A partially spherical indentation is preferred at the base of the screw body (720) to accommodate the curved head of the applied free screw.

[0146] The stabilizer (800) (Figure 8) is an apparatus with a design similar to the plug (600), specialized to perform the extraction function. The stabilizer (800) is applied, just like the plug (600), to the plug recess (112) on the base plate (100). The purpose of this apparatus is to be inserted through the stabilizer hole (522) located on the adapter (520) element of the holder (500) apparatus, in order to connect the holder (500) with the base plate (100). This technique allows the base plate (100) to be inserted by impaction or removed with the help of the holder (500). The stabilizer (800) consists of two elements: the screw head (810) and the screw body (820). The hexagonal-shaped screw recess (811 ) located on the screw head (810) allows the screw to be driven with a hex screwdriver. The screw head (810) remains on the block (521 ) part of the adapter (520) and serves as a support element. The screw body (820) is defined as having the straight body (821), the screw threads (822), the thread start notch (823), and the thread end notch (824). When the stabilizer (800) is inserted, the straight body (821 ) is the portion that remains within the stabilizer hole (522) on the adapter (520). The screw threads (822) are applied to the plug recess (112) on the base plate (100). The thread start notch (823) allows smooth advancement over the threads of the plug recess (112), while the thread end notch (824) serves to prevent restriction of the apparatus's advancement and ensure compression.

[0147] The mini stabilizer (900) (Figure 9) is an apparatus designed to perform the same function as the stabilizer (800), and has similar features to the mini plug component. This apparatus is inserted through the mini stabilizer holes (531 , 532) located on the cassette (530) element of the holder (500) apparatus, and attaches onto the angled holes (142, 152) on the base plate (100). Thus, the components are joined during the impaction or removal of the base plate (100) via the holder (500). For this application to be carried out, the clamp (510) element on the holder (500) must be inserted into the glenoid sphere groove (111) located on the main body (110) of the base plate (100). The mini stabilizer (900) is preferred in cases where the stabilizer (800) cannot be applied or is not considered sufficient on its own, and is used in at least two pieces. The mini stabilizer (900) consists of two elements: the screw head (910) and the screw body (920). The hexagonal-shaped screw recess (911) located on the screw head (910) allows the screw to be driven using a hex screwdriver. The screw body (920) is defined in four parts as the straight body (921 ), the screw threads (922), the thread start notch (923), and the thread end notch (924). The thread start notch (923) enables smooth advancement over the threads of the angled holes (142, 152) on the base plate (100), while the thread end notch (924) is intended to prevent restriction of the apparatus's advancement and ensure compression.

[0148] Industrial Applicability of the Invention:

[0149] The intended application of the invention is in the field of medicine, particularly in the branch of Orthopedics and Traumatology, for patients requiring arthroplasty in shoulder- related disorders. The use of these new models and specially designed incision guides and holder apparatuses can increase precision and accuracy during the surgical process, reduce the risk of complications, enhance surgical success by achieving higher cortical fixation in cases with low bone stock, and ensure the longevity of the implant. This situation enables effective use in difficult cases such as tight shoulders and revision surgeries. This provides an alternative option for surgeons and allows for the expansion of the patient population. The invention has been designed in a manner that allows easy production and distribution by medical device manufacturers, and the development and production of the invention may be cost-effective compared to traditional methods.

Claims

CLAIMS1. A base plate (100), which supports fixation to both cortical and trabecular bone, unlike standard designs, as one of the components of the system providing hybrid fixation to the glenoid articular surface in reverse total shoulder arthroplasty, characterized by comprising,- a pear-shaped main body (110) conforming to the glenoid anatomy in order to ensure high glenoid surface contact and fixation, and- a central wedge (120), a stopper (130), a lower plate (140), and an upper plate (150).

2. The front surface of the main body (110) according to Claim 1 is characterized by the glenoid sphere groove (111 ) having a reverse isosceles trapezoid-shaped cross-section, enabling it to slide into a column in the same cross-section in a raillike manner, and featuring a fixation-enhancing design with a sharp-edged, deepening termination.

3. The slide plug slot (112), which is a cylindrical recess located on the anterior surface of the glenoid sphere groove (111 ) according to Claim 1 , comprises screw threads.

4. The central wedge (120) according to Claim 1 is the main component providing bone fixation and characterized in that it comprises,- the fixation surface (121 ), which is the part placed into the bone after the component is advanced by means of impaction following the cuts,- square cross-section osteointegration holes (122) that will enhance final fixation through spontaneous bone filling or bone grafts that can be applied to the region, and- sharp edges (123), which are smooth-surfaced parts on the medial and posterior regions of the component that enable advancement by means of path creation during the impaction-based placement of the central wedge (120).

5. The main body (110) according to Claim 1 is characterized in that its rear surface and the upper and lower surfaces of the fixation surface (121) are in direct contact with the glenoid and are coated with hydroxyapatite in order to provide bone fixation.

6. The stopper (130) according to Claim 1 is positioned at an angle with its cylinder (131 ) portion in contact with the anterior cortex of the scapula in order to provide proper version during the impaction-based advancement of the component and to limit the embedding of the implant, and is characterized in that the square crosssection osteointegration holes (132) on it are aligned with, serve the same purpose as, and are a continuation of the osteointegration holes (122) present on the central wedge (120).

7. The lower plate (140) according to Claim 1 is one of the two elements that are connected to the main body (110) via the body connection (141) and in which the fixation to the glenoid bone is reinforced by means of bicortical screws, and is characterized by,- allowing the insertion of an angled, locked or non-locked screw through a single lower angled hole (142) present on it,- allowing the insertion of a bicortical locked screw in the AP orientation onto the glenoid through at least one lower plate hole (144) present on the stabilization surface (143),- supporting the passage of a suture for the purpose of repairing the capsule or other soft tissues through at least one suture hole (145) that may be present on the body connection (141) or the stabilization surface (143).

8. The upper plate (150) according to Claim 1 is the other of the two elements that are connected to the main body (110) via the body connection (151) and in which the fixation to the glenoid bone is reinforced by means of bicortical screws, and is characterized by,- allowing the insertion of an angled, locked or non-locked screw through a single upper angled hole (152) present on it,- allowing the insertion of a bicortical locked screw in the AP orientation onto the glenoid through at least one upper plate hole (154) present on the stabilization surface (153),- supporting the passage of a suture for the purpose of repairing the capsule or other soft tissues through at least one suture hole (155) that may be present on the body connection (151 ) or the stabilization surface (153).

9. The In the reverse total shoulder prosthesis, the insertion guide (200), which is one of the application instruments of the glenoid hybrid fixation system and enables thepositioning of the initially inserted pins according to the anatomical features of the glenoid, is characterized by comprising,- the curved body (210), which enables grasping the glenoid neck starting from the anterior, proceeding to the inferior, and then to the posterior surface,- the hook (220), which is responsible for fixation from the posterior section of the glenoid neck,- the pin guide handle (230), which functions as a handle for holding and positioning the component, and supports pin insertion along its long axis,- the intermediate pin inserter (240), which is a cylindrical element supporting pin insertion from the middle axis of the component body,- the depth determiner (260), which is an apparatus that reaches the lateral surface of the glenoid from the component and determines the depth of the joint surface cutting level,- the upper pin inserter (250), which determines the height of the cutting level responsible for flattening the anterior surface by referencing the anterior superior cortex of the glenoid neck.

10. The connection of the hook (220) with the curved body (210) according to Claim 9 is characterized by being either a fixed structure with static properties or a dynamic structure with articulated or latched features to support the function of compression.

11. The insertion guide (200) according to Claim 9 is characterized in that, after its positioning, the pin inserted through the lower pin hole (231 ) along the long axis of the pin guide handle (230) is placed into the pin notch (221) on the hook (220), thereby supporting the fixation of the component in a stable position prior to the insertion of other pins.

12. The insertion guide (200) according to Claim 9 is characterized by the placement of pins corresponding to the screw positions sent through the plate holes (144, 154) of the base plate (100), being designed inspired by the Latarjet procedure, and comprising the intermediate pin inserter (240), which has a cylindrical structure and includes the intermediate pin hole (241 ) along its circular axis, and the upper pin inserter (250), which also has a cylindrical structure and includes the upper pin hole (251 ) along its circular axis.

13. The depth determiner (260) according to Claim 9 comprises a console (261) that enables connection with the curved body (210), a limiting extension (262) that determines the depth, and a height probe (263) that determines the height.

14. The cutting guide (300), which is one of the application instruments of the glenoid hybrid fixation system in reverse total shoulder prosthesis, provides bone preparation by performing cuts with a fine cutting motor through notches positioned in a total of three planes prior to the implantation of the components, and comprises,- two main elements, the front body (310) according to the anatomical anterior position and the side body (320) according to the lateral position in its functional placement, and- three auxiliary elements, the transverse cutting separator (330), the lower pin guide (340), and the upper pin guide (350).

15. The front body (310) according to Claim 14 comprises the front cutting notch (311), which enables the cutting of the lateral surface of the glenoid, the transverse cutting notch (312), which corresponds to the notch structure allowing transverse cutting on the front body, and the front fixation hole (313), which allows positioning or fixation through the pin placed at the lowest position anteriorly in the functional placement of the instrument.

16. The side body (320) according to Claim 14 comprises the side cutting notch (321), which enables the cutting of the glenoid in the anterior plane in its anatomical position, the transverse cutting notch (322), which is the continuation of the notch structure allowing transverse cutting on the side body, and the angled side fixation hole (323), which supports stabilization in three planes by allowing a 45-degree angled pin to be inserted into the glenoid in the sagittal plane after the instrument is positioned through other pins sent in the anterior-posterior plane.

17. The transverse cutting separator (330) according to Claim 14 is characterized by dividing the integrated structure of the transverse cutting notch (312) on the front body (310) and the transverse cutting notch (322) on the side body (320), which are continuous with each other, into two compartments along the height of the notch in a way that supports the creation of two parallel cuts along the midline using a fine cutting motor.

18. The lower pin guide (340) and the upper pin guide (350), which are elements associated with the front body (310) according to Claim 14, comprise the lower fixation hole (341) and the upper fixation hole (351), which enable the positioning of the cutting guide (300) through the pins inserted into the intermediate and upper pin holes (241 , 251 ) of the insertion guide (200).

19. In reverse total shoulder arthroplasty, the glenoid sphere (400), which is one of the components of the system providing hybrid fixation to the glenoid joint surface, essentially performs the same function as the standard glenoid sphere used in conventional reverse shoulder prostheses, but differs from standard designs in terms of its integration with the base plate (100) component, and comprises two main elements, the head (410) and the slide (420).

20. The head (410) according to Claim 19 is the main element forming the joint with the humeral components in reverse total shoulder prosthesis, and characterized in that it comprises,- the articular surface (411 ), which is the part that provides contact with the polyethylene liner on the humeral side,- the component surface (412), which is the part adjacent to the base plate (100) on the glenoidal side,- the extraction notch (413), which is an indentation positioned on the glenoidal side for the removal of the component.21 . The slide (420) according to Claim 19 provides the connection of the glenoid sphere (400) to the base plate (100) through the slide body (421) by engaging with the glenoid sphere groove (111 ) on the base plate (100), and is characterized by stronger fixation and rotational stability through the interlocking inclined edge effect formed by the wedge (422).

22. The holder (500), which is one of the application instruments of the glenoid hybrid fixation system in reverse total shoulder prosthesis, provides the functions of placement, impaction, and removal of the base plate (100), and comprises,- the clamp (510), which connects to the base plate (100) and plays a role in the implantation and removal of the component,- the adapter (520), which provides firm fixation after connection with the component,- the cassette (530), which reinforces the fixation and connects the elements of the instrument to each other,- the handle (540), which provides guidance for implantation after fixation of the component, or for its removal.

23. The clamp (510) according to Claim 22 comprises the slide (511 ), which is characterized by being slidable over the glenoid sphere groove (111) to enable fixation of the base plate (100) or attachable via the extraction notch (413) to enable removal of the glenoid sphere (400), and the ramp (512), which allows connection of the slide (511) with the remaining parts of the instrument and is characterized by a lever arm effect during the removal of the glenoid sphere.

24. The adapter (520) according to Claim 22 comprises the block (521) and a single fixation hole (522) located at its center.

25. The cassette (530) according to Claim 22 comprises two unthreaded mini fixation holes (531 , 532), which support reinforcement of the base plate (100) by providing an additional fixation path through connection with the angled holes (142, 152) via the fixation instruments inserted through them.

26. The handle (540) according to Claim 22 comprises three parts, the impact arm (541 ), which is characterized by a thickened structure and flattened relevant surfaces to withstand hammer blows during impaction or removal, the rod (542), which is characterized by sufficient length and a curved structure to allow tissue retraction and access to the relevant area, and the grip (543), which is characterized by a cylindrical design flattened on opposite sides to provide the operator with a good grasp.

27. In reverse total shoulder arthroplasty, the plug (600), which is one of the components of the system providing hybrid fixation to the glenoid joint surface, ensures fixation after the glenoid sphere (400) is placed onto the base plate (100), and comprises two elements, the screw head (610) and the screw body (620).

28. The screw head (610) according to Claim 27 is characterized by a wedge effect in the fixation following the placement of the glenoid sphere (400), and includes the screw slot (611), which enables the component to be driven with the aid of a screwdriver.

29. The screw body (620) according to Claim 27 comprises the screw threads (621) and the thread end notch (622), and is characterized by the fixation of the component by means of placement into the slide plug slot (112), which is a threaded section on the base plate (100).

30. The mini plug (700), which is one of the components of the system providing hybrid fixation to the glenoid joint surface in reverse total shoulder arthroplasty, is characterized by preventing the screws from backing out when non-locked screws are applied at different angles through the angled holes (142, 152) of the lower and upper plate elements (140, 150) present on the base plate (100), and by preventing the holes from being filled with bone when screws are not applied, and comprises two elements, the screw head (710) and the screw body (720).

31. The screw head (710) according to Claim 30 includes the screw slot (711 ), which enables the component to be driven with the aid of a screwdriver.

32. The screw body (720) according to Claim 30 includes the screw threads (721 ) applied to the threaded section within the angled holes (142, 152) and the thread end notch (722).

33. The grasp bolt (800), which is one of the application instruments of the glenoid hybrid fixation system in reverse total shoulder prosthesis and provides fixation with the holder (500) for the purpose of placement, impaction, or removal of the base plate (100), consists of two main elements, the screw head (810) and the screw body (820).

34. The screw head (810) according to Claim 33 includes the screw slot (811 ) and is characterized by the screw being driven with the aid of a screwdriver.

35. The screw body (820) according to Claim 33 comprises four parts, the straight body (821 ), the screw threads (822), the thread start notch (823), and the thread end notch (824), and is characterized by- the straight body (821 ) passing through the fixation hole (522) present on the holder (500) to engage the instrument,- the screw threads (822) engaging with the slide plug slot (112) present on the base plate (100) to provide fixation,- the thread end notch (824) catching the thread grooves on the slot into which the screw threads (822) are driven,- the thread start notch (823) supporting tightening by increasing thread embedding during the driving of the grasp bolt (800).

36. The mini grasp bolt (900), which is one of the application instruments of the glenoid hybrid fixation system in reverse total shoulder prosthesis and reinforces the fixation with the holder (500) for the purpose of placement, impaction, or removal of the base plate (100), comprises two main elements, the screw head (910) and the screw body (920).

37. The screw head (910) according to Claim 36 includes the screw slot (911 ) and is characterized by the screw being driven with the aid of a screwdriver.

38. The screw body (920) according to Claim 36 comprises four parts, the straight body (921 ), the screw threads (922), the thread start notch (923), and the thread end notch (924), and is characterized by- the straight body (921) passing through the mini fixation holes (531 , 532) present on the cassette (530) element of the holder (500) to engage the instrument,- the screw threads (922) engaging with the angled holes (142, 152) present on the base plate (100) to provide fixation,- the thread end notch (924) catching the thread grooves on the slot into which the screw threads (922) are driven,- the thread start notch (923) supporting tightening by increasing thread embedding during the driving of the mini grasp bolt (900).

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