Devices and methods used for shoulder replacement

Abstract

The present invention provides a method and devices for shoulder replacement surgery that spares the rotator cuff. The method utilizes two anterosuperior passages to gain access to the glenohumeral joint, neither of which requires transaction of the rotator cuff. In addition a transhumeral portal created through the second anterosuperior passage for use as a working tunnel. Specialized instruments and implants are provided to work through both the anterosuperior passage as well as the transhumeral portal.

1 . A method for shoulder replacement comprising: creating a portal along a central axis of a neck of a proximal humerus associated with a shoulder of a patient; and implanting an implant in said shoulder without passing a component of said implant through said portal.  
   
   
       2 . The method of  claim 1  wherein said portal, is transhumeral in that it traverses a section of said proximal humerus within said neck of said proximal humerus and is perpendicular to a center of a humeral joint surface.  
   
   
       3 . The method of  claim 1  wherein a rotator cuff associated with said shoulder is not transected during said method.  
   
   
       4 . The method of  claim 3  further comprising forming an anterosuperior passage to access a glenohumeral joint associated with said shoulder.  
   
   
       5 . The method of  claim 4  further comprising exposing said glenohumeral joint via said anterosuperior passage.  
   
   
       6 . The method of  claim 4  further comprising preparing a glenoid surface associated with said shoulder via said anterosuperior passage.  
   
   
       7 . The method of  claim 4  further comprising preparing a humeral surface and a glenoid surface associated with said shoulder via said anterosuperior passage.  
   
   
       8 . The method of  claim 4  wherein said implant is a humeral implant and said humeral implant is inserted into said shoulder via said anterosuperior passage.  
   
   
       9 . The method of  claim 4  wherein said implant is a glenoid implant and said glenoid implant is inserted via said anterosuperior passage.  
   
   
       10 . The method of  claim 4  wherein said implant is a humeral implant and said method further comprises inserting said humeral implant and a glenoid implant via said anterosuperior passage.  
   
   
       11 . The method of  claim 10  further comprising forming a second anterosuperior passage to said glenohumeral joint, wherein said second anterosuperior passage is located in a position that is inferolateral to said first anterosuperior passage and is utilized to gain access to an anterolateral bony cortex of said proximal humerus in line with said central axis of said neck of said proximal humerus.  
   
   
       12 . The method of  claim 11  wherein said second anterosuperior passage to said glenohumeral joint is utilized to create said portal.  
   
   
       13 . The method of  claim 12  further comprising preparing a glenoid surface and a humeral surface associated with said shoulder to receive said implant.  
   
   
       14 . The method of  claim 13  wherein said glenoid surface is prepared to receive a glenoid implant and said humeral surface is prepared to receive a humeral implant.  
   
   
       15 . The method of  claim 14  wherein said implant is a humeral implant that engages said prepared humeral surface.  
   
   
       16 . The method of  claim 15  further comprising implanting a glenoid implant that engages said prepared glenoid surface.  
   
   
       17 . The method of  claim 1  wherein said portal defines a circular opening having a diameter of about 0.1 cm to about 5.0 cm.  
   
   
       18 . The method of  claim 17  wherein said diameter is about 0.1 to 1.0 cm.  
   
   
       19 . The method of  claim 18  wherein said diameter is about 0.5 to about 1.0 cm.  
   
   
       20 . The method of  claim 3  further comprising forming an arthroscopic passage and subsequently performing shoulder joint contracture releases, capsular plication, osteophyte removal, and glenoid exposure via said arthroscopic passage.  
   
   
       21 . The method of  claim 4  further comprising performing shoulder joint contracture releases, capsular plication, osteophyte removal, and glenoid exposure via said anterosuperior passage.  
   
   
       22 . The method of  claim 4  wherein said forming said anterosuperior passage comprises forming an anterosuperior shoulder skin incision, a deltoid interval or deltoid split, forming a superficial passage, and forming a rotator cuff sparing deep passage.  
   
   
       23 . The method of  claim 22  wherein said rotator cuff sparing deep passage creates an opening at natural intervals or longitudinal splits in musculotendinous units of a rotator cuff associated with said shoulder to gain exposure of an articular surface of said glenohumeral joint.  
   
   
       24 . The method of  claim 23  further comprising holding open said longitudinal splits with a rotator cuff interval self-retaining retractor.  
   
   
       25 . The method of  claim 1  wherein said portal is created along said central axis of said humeral neck from an anterolateral cortex of said proximal humerus to a center of a humeral head of said implant.  
   
   
       26 . The method of  claim 25  wherein said creating of said portal is performed by at least one instrument selected from the group consisting of a radiographic guidance system, a guide pin, a specialized transhumeral portal guide, a handled transhumeral portal guide protective sheath, a radiolucent guide attachment, and a cannulated drill bit.  
   
   
       27 . The method of  claim 1  further comprising preparing a proximal surface and a glenoid surface associated with a glenohumeral joint via at least one instrument selected from the group consisting of a transhumeral surgical instruments, protective guards and guides.  
   
   
       28 . The method of  claim 27  wherein said transhumeral surgical instruments are selected from the group consisting of transhumeral humeral head reamer, transhumeral glenoid reamers, transhumeral drills, a transhumeral burr, a transhumeral glenoid keel punch, a transhumeral irrigation and suction catheter, a transhumeral cementation catheter, a transhumeral keel glenoid cement pressurizer, a transhumeral peg glenoid cement pressurizer, a transhumeral glenoid screwdriver, a transhumeral glenoid impactor, a transhumeral glenoid insertor, and a transhumeral multiple peg glenoid insertor.  
   
   
       29 . The method of  claim 27  wherein said protective guards and guides are selected from the group consisting of a transhumeral protective sheath, a glenoid sizer and centering hole guide, a glenoid surface protective guard, a humeral head surface protective guard, a keel glenoid drill guide, a peg glenoid drill guide, a transhumeral glenoid drill guide sleeve, a transhumeral glenoid screw guide sleeve, and a multiple peg glenoid insertor guide.  
   
   
       30 . The method of  claim 28  wherein implanting utilizes at least one of said transhumeral surgical instruments, and insertion of said implant wherein a component of said implant inserted is through said first anterosuperior passage.  
   
   
       31 . The method of  claim 11  wherein said humeral implant comprises a first component and a removably attached second component.  
   
   
       32 . The method of  claim 31  wherein said first component comprises a humeral surface and said second component comprises a removably attached stem.  
   
   
       33 . The method of  claim 32  wherein one of said first and second components is inserted via said anterosuperior passage.  
   
   
       34 . The method of  claim 33  wherein the other of said first and second components is inserted through said portal via said second anterosuperior passage.  
   
   
       35 . The method of  claim 32  wherein said first and second humeral implant components are inserted into said shoulder via said first anterosuperior passage.  
   
   
       36 . The method of  claim 9  wherein said glenoid implant comprises an ingrowth shell and a wear-resistant surface, wherein said ingrowth shell further comprises a hemispherical shell surrounded by an outer flat surface.  
   
   
       37 . The method of  claim 36  wherein said ingrowth shell further comprises a central cannulation and a peripheral cannulation for accommodating attachment screws, wherein said cannulations may be selected from the group consisting of smooth and threaded.  
   
   
       38 . The method of  claim 37  wherein said ingrowth shell has a thickness of from about 0.1 to about 10 mm.  
   
   
       39 . The method of  claim 38  wherein said ingrowth shell has a thickness of from about 0.1 to 2.0 mm.  
   
   
       40 . The method of  claim 36  wherein said ingrowth shell further comprises an in-growth material or covering an entire surface of a convex side for promotion of bone growth and adhesion to said glenoid.  
   
   
       41 . The method of  claim 40  wherein said ingrowth material is selected from the group consisting of autologous or allograft osteogenitor cells or tissues, bone morphogenic proteins, hydroxyapaptite coating, trabecular metal, porous metal, porous metal coating, titanium, and tantalum.  
   
   
       42 . The method of  claim 37  wherein said screws are selected from the group consisting of a compression screw and a fixed angle screw.  
   
   
       43 . The method of  claim 42  wherein said wear-resistant surface is 0.1 to 15 mm thick above a glenoid bony surface and said flat outer surface of said ingrowth shell.  
   
   
       44 . The method of  claim 36  wherein said wear-resistant surface is 4 to 7 mm thick above said glenoid bony surface and said flat outer surface of said ingrowth shell.  
   
   
       45 . The method of  claim 42  wherein said compression screw and said fixed angle screw may be inserted via said anterosuperior passage or via said portal.  
   
   
       46 . The method of  claim 32  wherein said humeral surface has a spherical shape.  
   
   
       47 . The method of  claim 32  wherein said humeral surface has a central spherical shape and a peripheral elliptical shape.  
   
   
       48 . The method of  claim 32  wherein said humeral surface and said removably attached stem are mated together.  
   
   
       49 . The method of  claim 1  wherein matter or bone removed from said neck of said proximal humerus to create said portal is not reimplanted within said portal.  
   
   
       50 . A humeral implant comprising a first component removably attached to a second component.  
   
   
       51 . The humeral implant of  claim 50  wherein said first component is a humeral surface and said second component is a removably attachable stem.  
   
   
       52 . The implant of  claim 51  wherein said humeral surface has a coronal radius of curvature and an axial radius of curvature.  
   
   
       53 . The implant of  claim 52  wherein said coronial radius of curvature has a range of from 10 to 50 mm.  
   
   
       54 . The implant of  claim 52  wherein said axial radius of curvature has a range of from 10 to 50 mm.  
   
   
       55 . The implant of  claim 52  wherein said humeral surface has a depth with a range of from 5 to 40 mm.  
   
   
       56 . The implant of  claim 52  wherein said humeral surface has a thickness with a range of from 0.1 to 10 mm.  
   
   
       57 . The implant of  claim 52  wherein a ratio of a depth of said humeral surface to said coronal radius of curvature is from about 0.7 to about 0.9.  
   
   
       58 . The implant of  claim 52  wherein said humeral surface is spherically or elliptically shaped.  
   
   
       59 . The implant of  claim 52  wherein said humeral surface is made of a material selected from the group consisting of cobalt chrome alloy, ceramic, metal, and magnet materials.  
   
   
       60 . The implant of  claim 52  wherein said humeral surface further comprises fins or spikes on a concave undersurface of said humeral surface.  
   
   
       61 . The implant of  claim 52  further comprising a concave undersurface for bony ingrowth material.  
   
   
       62 . The implant of  claim 52  wherein said humeral surface has a smooth articulating surface.  
   
   
       63 . The implant of  claim 52  wherein said attachable stem has a diameter with a range of from 0.1 to 5.0 cm.  
   
   
       64 . The implant of  claim 63  wherein said attachable stem is made of a material selected from the group consisting of titanium, stainless steel, tantalum, porous metal and trabecular metal.  
   
   
       65 . The implant of  claim 64  wherein said removably attached stem further comprises a smooth, textured or threaded surface.  
   
   
       66 . The implant of  claim 65  wherein said removably attached stem is round, square, or triangular.  
   
   
       67 . The implant of  claim 66  wherein said removably attached stem further comprises fins.  
   
   
       68 . The implant of  claim 66  wherein said removably attached stem further comprises a bony ingrowth surface.  
   
   
       69 . The implant of  claim 51  wherein said removably attached stem has variable length wherein said stem extends from a lateral cortex of said humerus to a center of a head of said humerus.  
   
   
       70 . The implant of  claim 51  wherein said humeral surface connects to said removably attached stem.  
   
   
       71 . The implant of  claim 70  wherein said humeral surface connects to said removably attached stem by a technique selected from the group consisting of morse taper, and a screw.  
   
   
       72 . A glenoid implant comprising an ingrowth shell, a wear-resistant surface removably attached to said shell and at least one fixation screw.  
   
   
       73 . The implant of  claim 72  wherein said wear-resistant surface comprises a superior-inferior axis and an anterior-posterior axis.  
   
   
       74 . The implant of  claim 73  wherein said superior-inferior axis of said wear-resistant surface has a range of from 20 to 60 mm.  
   
   
       75 . The implant of  claim 74  wherein said anterior-posterior axis of said wear-resistant surface defines an upper half and a lower half.  
   
   
       76 . The implant of  claim 75  wherein said lower half of said anterior-posterior axis of said wear-resistant surface has a range of from 15 to 50 mm.  
   
   
       77 . The implant of  claim 76  wherein said upper half of said anterior-posterior axis of said wear-resistant surface has a range of 10 to 50 mm.  
   
   
       78 . The implant of  claim 77  wherein a ratio of said upper half to said lower half of said wear-resistant surface is approximately 0.8 to 1.0.  
   
   
       79 . The implant of  claim 78  wherein a ratio of said lower half of said anterior-posterior axis to said superior-inferior dimension is approximately 0.7 to 1.0.  
   
   
       80 . The implant of  claim 79  wherein a ratio of said upper half of said anterior-posterior axis to said superior-inferior axis is approximately 0.6 to 1.0.  
   
   
       81 . The implant of  claim 84  wherein a superior half of said implant is smaller than an inferior half of said implant.  
   
   
       82 . The implant of  claim 81  wherein said implant has a central thickness with a range of from about 0.1 to about 50 mm and a peripheral thickness with a range from about 0.1 to 50 mm.  
   
   
       83 . The implant of  claim 82  wherein said thickness may vary across said superior-inferior axis or across the anterior-posterior axis.  
   
   
       84 . The implant of  claim 83  wherein said implant has a superior-inferior radius of curvature that is larger than a coronal radius of curvature of a humeral surface of a humerus with which said implant will articulate.  
   
   
       85 . The implant of  claim 84  wherein said implant has an anterior-posterior radius of curvature that is larger than said axial radius of curvature of said humeral surface with which said implant will articulate.  
   
   
       86 . The implant of  claim 72  wherein said ingrowth shell comprises a flat surface and a cannulated convex surface.  
   
   
       87 . The implant of  claim 86  wherein said flat surface mates with a glenoid surface of a scapula and said convex surface mates with a reamed concave surface of a glenoid.  
   
   
       88 . The implant of  claim 72  wherein said ingrowth shell comprises a material selected from the group consisting of metal, titanium, stainless steel, tantalum, porous metal, trabecular metal, and a ceramic.  
   
   
       89 . The implant of  claim 72  wherein said ingrowth shell comprises an ingrowth material to promote bone growth and adhesion of said shell to a glenoid surface.  
   
   
       90 . The implant of  claim 72  wherein said wear-resistant surface is 0.1 to 15 mm thick.  
   
   
       91 . The implant of  claim 90  wherein said wear-resistant surface is 4 to 7 mm thick.  
   
   
       92 . The implant of  claim 91  wherein said wear-resistant is selected from the group consisting of plastic, polyethylene, ceramic, metal, and magnetic material.  
   
   
       93 . The implant of  claim 92  wherein said wear-resistant surface mates with said ingrowth shell.  
   
   
       94 . A transhumeral portal guide comprising a bullet shaped guide with a central cannulation and a peripheral longitudinal cannulation.  
   
   
       95 . The guide of  claim 94  further comprising a transhumeral portal guide protective sheath with a handle, wherein said transhumeral portal guide interfits with a transhumeral portal guide protective sheath.  
   
   
       96 . The guide of  claim 95  wherein said handle has a radiolucent guide attachment connected thereto.  
   
   
       97 . The guide of  claim 96  wherein said guide attachment comprises a radiolucent arm connected to a guiding end.  
   
   
       98 . The guide of  claim 97  wherein said arm is connected to said handle of said transhumeral portal humeral guide protective sheath.  
   
   
       99 . The guide of  claim 98  wherein said guide attachment comprises a radioopaque linear marker within said arm.  
   
   
       100 . A transhumeral humeral reamer comprising a working head and a removably attached shaft, wherein said shaft has a diameter ranging from 0.1 to 5.0 cm.  
   
   
       101 . A transhumeral glenoid reamer comprising a reaming surface and a removably attached shaft, wherein said shaft has a diameter ranging from 0.1 to 5.0 cm.  
   
   
       102 . The reamer of  claim 101  wherein said reaming surface and said shaft are cannulated.  
   
   
       103 . A shoulder structure comprising a humerus portal tube wherein said tube has a diameter ranging from 0.1 to 5.0 cm.  
   
   
       104 . The structure of  claim 103  wherein said sheath is comprised of a metal or a wear-resistant material.  
   
   
       105 . The structure of  claim 104  wherein said sheath is press-fit or screwed into a transhumeral portal.  
   
   
       106 . The structure of  claim 105  wherein said sheath has a wall thickness of about 0.1 to 10 mm.  
   
   
       107 . The structure of  claim 106  wherein said sheath has a wall thickness of from about 0.1 to 3 mm.  
   
   
       108 . The structure of  claim 107  wherein said sheath has a wall thickness of from 0.1 to about 1 mm.  
   
   
       109 . A glenoid surface protective guard comprising a protective surface and a handle wherein said protective surface is shaped similarly to a glenoid surface.  
   
   
       110 . The protective guard of  claim 109  wherein said protective surface is metal.  
   
   
       111 . The protective guard of  claim 110  wherein said protective surface has an elevated peripheral edge.  
   
   
       112 . The protective guard of  claim 111  wherein said protective surface has a thickness with a range of from 0.1 to 2.0 mm.  
   
   
       113 . A humeral head surface protective guard comprising a protective surface.  
   
   
       114 . The protective guard of  claim 113  further comprising a handle.  
   
   
       115 . The protective guard of  claim 113  wherein said protective surface comprises a shell that is centrally cannulated.  
   
   
       116 . The protective guard of  claim 115  wherein said protective surface has a thickness with a range of from 0.1 to 2.0 mm.  
   
   
       117 . A glenoid sizer and centering hole guide comprising a glenoid contacting surface and a removably attached handle.  
   
   
       118 . The sizer and centering hold guide of  claim 117  wherein said glenoid contacting surface further comprises a central hole.  
   
   
       119 . The sizer and centering hole guide of  claim 118  wherein said glenoid contacting surface has a thickness with a range of from 0.1 to 5 mm.  
   
   
       120 . The drill guide of  claim 119  wherein said guiding surface further comprises additional holes, wherein said additional holes are either a) inferior and superior toward a center of said guiding surface, or b) said additional holes are in the periphery of said guiding surface.  
   
   
       121 . The drill guide of  claim 120  wherein said drill guide interfits with a drill.  
   
   
       122 . The drill guide of  claim 120  wherein said guiding surface has a thickness with a range of 0.1 to 5 mm.  
   
   
       123 . The drill guide of  claim 122  further comprising a sleeve wherein said sleeve has a diameter with a range of from 0.1 to 5 mm and said drill guide interfits within said sleeve.  
   
   
       124 . A transhumeral glenoid drill comprising a working surface and a removably attached shaft wherein said shaft has a diameter with a range of from 0.1 to 5 mm.  
   
   
       125 . The drill of  claim 124  wherein said working surface comprises a drill bit.  
   
   
       126 . The drill of  claim 124  wherein said shaft further comprises markings that define a measurement of depth or distance.  
   
   
       127 . A transhumeral burr comprising a high speed working burr surface and a removably attached shaft wherein said shaft has a diameter with a range of from 0.1 to 5 cm.  
   
   
       128 . A glenoid keel punch comprising a working head and a removably attached shaft, wherein said working head further comprises a keel shape with cutting teeth, wherein said shaft has a diameter with a range of from 0.1 to 5 cm.  
   
   
       129 . A transhumeral irrigation and suction catheter comprising a semi-rigid plastic tubing that is removably attached to a fluid pump and a suction device, wherein said tubing has a diameter with a range of from 0.1 to 5 cm.  
   
   
       130 . A transhumeral cementation device comprising a removably attached head, and tubing, wherein said tubing has a diameter ranging from 0.1 to 5.0 cm.  
   
   
       131 . The device of  claim 130  wherein said head further comprises a cannulated tip from which cementation material may be delivered to a surface or hole.  
   
   
       132 . The device of  claim 131  wherein which said tip prevents said cementation material from escaping from said hole.  
   
   
       133 . A transhumeral glenoid impactor comprising a dome-shaped head and a removably attached shaft, wherein said shaft has a diameter ranging from 0.1 to 5 cm.  
   
   
       134 . The impactor of  claim 133  wherein said head further comprises a convex surface.  
   
   
       135 . The impactor of  claim 134  wherein said head is plastic or metal.  
   
   
       136 . The impactor of  claim 133  wherein said shaft has a diameter with range of from 0.1 to 5 cm.  
   
   
       137 . A transhumeral screw driver comprising a working head and a removably attached shaft wherein said shaft has a diameter ranging from 0.1 to 5 cm.  
   
   
       138 . The screwdriver of  claim 137  wherein said working head is is shaped to interfit with a screw.  
   
   
       139 . The screwdriver of  claim 138  further comprising a transhumeral screw guide sleeve, wherein said sleeve comprises a passage in which said transhumeral screwdriver interfits.  
   
   
       140 . The screwdriver of  claim 139  wherein said sleeve has a diameter with a range of from 0.1 to 5 cm.  
   
   
       141 . The screwdriver of  claim 140  wherein said sleeve interfits within a transhumeral protective sheath, wherein said transhumeral protective sheath comprises a tube of material, wherein said tube has a diameter ranging from 0.1 to 5.0 cm.  
   
   
       142 . The screwdriver of  claim 141  wherein said sleeve interfits with a transhumeral glenoid drill guide sleeve, wherein said transhumeral glenoid drill guide sleeve has a diameter with a range of from 0.1 to 5 mm and wherein a drill guide interfits within said sleeve.  
   
   
       143 . A rotator interval retractor comprising a first blade dimensioned for interaction with a supraspinatus and a second blade dimensioned for interaction with a subscapularis.  
   
   
       144 . A glenohumeral joint comprising a transhumeral portal along a central axis of a neck of a proximal humerus and an implant.  
   
   
       145 . The glenohumeral joint of  claim 144  wherein said implant is a humeral implant.  
   
   
       146 . The glenohumeral joint of  claim 144  wherein said implant is a glenoid implant.  
   
   
       147 . A repaired humerus bone comprising a modular implant with a humeral suface and a stem, wherein said stem is anchored in the epiphyseal-metaphyseal portion of said humerus bone.  
   
   
       148 . The repaired humerus bone of  claim 147  wherein said stem has a diameter with a range of from 0.1 to 5.0 cm.  
   
   
       149 . The repaired humerus bone of  claim 148  wherein said stem has is linear.  
   
   
       150 . A humeral implant comprising a humeral surface component and no stem.  
   
   
       151 . A repaired glenoid of a scapula comprising a modular implant, and a recess within a glenoid.  
   
   
       152 . The repaired glenoid of  claim 151  wherein said modular implant comprises an ingrowth shell and a wear-resistant surface.  
   
   
       153 . The repaired glenoid of  claim 152  wherein said ingrowth shell interfits within said recess of said glenoid.  
   
   
       154 . The repaired glenoid of  claim 153  wherein said wear-resistant surface interfits within a concavity of said ingrowth shell.  
   
   
       155 . A method of arthroscopic rotator cuff repair comprising the steps of 
 a) inserting an insertional guide into a humerus;    b) extending a bore of said insertional guide into a humerus;    c) inserting a suture pin through a greater tuberosity of said humerus into an anteromedial suprapsinatus rotator cuff footprint;    d) advancing said suture pin out of said rotator cuff and through a superior soft tissue and skin;    e) removing said pin;    f) tying said suture.    
   
   
       156 . A suture pin comprising a tip, a pin shaft, and suture, wherein said tip has a diameter that is larger than said pin shaft, and said suture.  
   
   
       157 . The suture pin of  claim 156  wherein said tip is a trocar tip.  
   
   
       158 . An insertional guide comprising a handle, and a cannulated tip, wherein said cannulated tip further comprises a sharp tip.  
   
   
       159 . The insertional guide of  claim 158  further comprising a protective sheath comprising a handle and a shaft with a blunt end.  
   
   
       160 . The insertional guide of  claim 159  wherein said protective sheath interfits with said insertional guide.  
   
   
       161 . The protective sheath of  claim 160  further comprising an outer sleeve wherein said outer sleeve comprises a longitudinal split that extends beyond a sharp tip of said insertional guide.