Knee instruments and methods

Abstract

Knee arthroplasty instrument systems directly reference and align with the anterior distal femoral cortex and the mechanical axis of the leg. The anterior femoral resection is aligned in the same plane as the anterior distal femoral cortex. The center of the femoral head, the medial/lateral center of the distal femur, the medial/lateral center of the proximal tibia, and the second toe, medial/lateral center of the ankle, or anterior tibial spine are all aligned to the mechanical axis of the leg. Methods of using the instrument systems are disclosed.

1 . A method for cutting a femur during knee joint replacement surgery, the method comprising:
 before any cuts are made to the femur:   placing an instrument base comprising a length, a width, and a posterior surface on a distal anterior surface of the femur with the posterior surface of the instrument base in contact with the distal anterior surface of the femur and the length of the instrument base extending along a superior-inferior direction relative to the femur;   stabilizing the instrument base against the distal anterior surface of the femur while, in an anterior view of the femur:   an inferior portion of a femoral extension rod coupled to the instrument base is centered over a distal medial-lateral width of the femur; and   a superior portion of the femoral extension rod is centered over a head of the femur, such that the femoral extension rod is aligned with a femoral mechanical axis of the femur;   coupling a cut guide comprising an anterior resection slot to the instrument base via an interconnection configured to:   align the anterior resection slot to be coplanar with the posterior surface of the instrument base; and   constrain the cut guide to slide relative to the instrument base straight along the femoral mechanical axis in the anterior view of the femur;   sliding the cut guide along the femoral mechanical axis to abut an unresected distal aspect of at least one distal condyle of the femur; and   guiding a cutter along the anterior resection slot to produce an anterior femoral cut that is coplanar with the posterior surface of the instrument base.   
     
     
         2 . The method of  claim 1 , wherein the posterior surface of the instrument base comprises a plurality of protruding frictional elements configured to stabilize the instrument base against the distal anterior surface of the femur. 
     
     
         3 . The method of  claim 1 , wherein the instrument base comprises one or more apertures configured to receive one or more fasteners therethrough to stabilize the instrument base against the distal anterior surface of the femur. 
     
     
         4 . The method of  claim 1 , comprising centering the width of the instrument base with respect to a distal medial-lateral width of the femur. 
     
     
         5 . The method of  claim 1 , wherein the instrument base comprises a femoral riser protruding anteriorly and superiorly from the instrument base, wherein:
 the femoral extension rod is coupled to the femoral riser and protrudes superiorly from the femoral riser; and   the interconnection is coupled to the femoral riser and protrudes inferiorly from the femoral riser.   
     
     
         6 . The method of  claim 5 , wherein the instrument base is stabilized against the distal anterior surface of the femur while, in an anterior view of the femur, the femoral riser and a distal end of the instrument base are aligned with the femoral mechanical axis. 
     
     
         7 . The method of  claim 1 , wherein the cut guide comprises one or more posterior resection slots, the method further comprising:
 guiding the cutter along the one or more posterior resection slots to produce at least one posterior femoral cut that is offset posteriorly from the anterior femoral cut.   
     
     
         8 . The method of  claim 7 , wherein the cut guide comprises an anterior femoral cut guide and a posterior femoral cut guide, the method further comprising:
 adjusting a position of the posterior femoral cut guide relative to the anterior femoral cut guide to vary a distance between the posterior femoral cut and the anterior femoral cut to match a femoral implant interior anterior/posterior dimension.   
     
     
         9 . The method of  claim 8 , wherein adjusting the position of the posterior femoral cut guide relative to the anterior femoral cut guide comprises:
 adjusting a position of at least one of the posterior femoral cut guide and the anterior femoral cut guide along rails.   
     
     
         10 . The method of  claim 8 , comprising fixing the anterior femoral cut guide and the posterior femoral cut guide to the femur. 
     
     
         11 . The method of  claim 7 , comprising placing the knee in 90 degrees of flexion prior to making the anterior femoral cut and the posterior femoral cut. 
     
     
         12 . The method of  claim 8 , comprising:
 securing the instrument base to the distal anterior surface of the femur;   uncoupling the anterior femoral cut guide and the posterior femoral cut guide from the instrument base while the instrument base is secured to the distal anterior surface of the femur;   coupling a femoral trial component to the anterior femoral cut and the posterior femoral cut while the instrument base is secured to the distal anterior surface of the femur;   moving a tibia of the knee joint through a flexion-extension range of motion relative to the femur of the knee joint while the instrument base is secured to the distal anterior surface of the femur; and   adjusting the anterior femoral cut and the posterior femoral cut.   
     
     
         13 . A method for cutting a femur during knee joint replacement surgery, the method comprising:
 before any cuts are made to the femur:   placing an instrument base comprising a length, a width, and a posterior surface on a distal anterior surface of the femur with the posterior surface of the instrument base in contact with the distal anterior surface of the femur and the length of the instrument base extending along a superior-inferior direction relative to the femur;   stabilizing the instrument base against the distal anterior surface of the femur while, in an anterior view of the femur:   an inferior portion of a femoral extension rod coupled to the instrument base is centered over a distal medial-lateral width of the femur; and   a superior portion of the femoral extension rod is centered over a head of the femur, such that the femoral extension rod is aligned with a femoral mechanical axis of the femur; and   mounting an anterior femoral cut guide and a posterior femoral cut guide to the instrument base to abut an unresected distal aspect of at least one distal condyle, the anterior femoral cut guide having a cutter guide aligned coplanar with the posterior surface of the instrument base;   guiding a cutter along the cutter guide of the anterior femoral cut guide to produce an anterior femoral cut coplanar with the posterior surface of the instrument base, and guiding the cutter along a cutter guide of the posterior femoral cut guide to produce a posterior femoral cut offset posteriorly from the anterior femoral cut;   securing the instrument base to the distal anterior surface of the femur;   coupling a femoral trial component to the anterior femoral cut and the posterior femoral cut while the instrument base is secured to the distal anterior surface of the femur; and   moving a tibia of the knee joint through a flexion-extension range of motion relative to the femur of the knee joint while the instrument base is secured to the distal anterior surface of the femur and the femoral trial component is coupled to the anterior femoral cut and the posterior femoral cut.   
     
     
         14 . The method of  claim 13 , wherein the posterior surface of the instrument base comprises a plurality of protruding frictional elements configured to stabilize the instrument base against the distal anterior surface of the femur. 
     
     
         15 . The method of  claim 13 , wherein the instrument base comprises one or more apertures configured to receive one or more fasteners therethrough to secure the instrument base to the distal anterior surface of the femur. 
     
     
         16 . The method of  claim 13 , wherein the instrument base comprises a femoral riser protruding anteriorly and superiorly from the instrument base, and wherein the femoral extension rod is coupled to the femoral riser and protrudes superiorly from the femoral riser. 
     
     
         17 . The method of  claim 16 , wherein the instrument base is stabilized against the distal anterior surface of the femur while, in an anterior view of the femur:
 the instrument base is centered over the distal medial-lateral width of the femur; and   the femoral riser and a distal end of the instrument base are aligned with the femoral mechanical axis.   
     
     
         18 . The method of  claim 13 , comprising adjusting a position of the posterior femoral cut guide relative to the anterior femoral cut guide to vary a distance between the posterior femoral cut and the anterior femoral cut to match a femoral implant interior anterior/posterior dimension. 
     
     
         19 . The method of  claim 18 , wherein adjusting the position of the posterior femoral cut guide relative to the anterior femoral cut guide comprises:
 adjusting a position of at least one of the posterior femoral cut guide and the anterior femoral cut guide along rails.   
     
     
         20 . The method of  claim 18 , comprising placing the knee in 90 degrees of flexion prior to making the anterior femoral cut and the posterior femoral cut.