`
`SYSTEM AND METHOD FOR ROBOTIC SURGERY
`
`CROSS-REFERENCE TO RELATED APPLICATIONS
`
`[0001]
`
`This application is a continuation of U.S. patent application Ser. No. 15/787,936, filed
`
`on October 19, 2017. U.S. patent application Ser. No. 15/787,936 is a continuation of U.S.
`
`patent application Ser. No. 14/958,967, filed December 4, 2015. U.S. patent application Ser. No.
`
`14/958,967 is a continuation of U.S. patent application Ser. No. 14/725,070, filed May 29, 2015.
`
`U.S. patent application Ser. No. 14/725,070 is a continuation of U.S. patent application Ser. No.
`
`14/451,562 filed August 5, 2014. U.S. patent application Ser. No. 14/451,562 is a continuation
`
`of U.S. patent application Ser. No. 13/407,968 filed Feb. 29, 2012. U.S. patent application Ser.
`
`No. 13/407,968 is a continuation of U.S. patent application Ser. No. 13/407,448 filed Feb. 28,
`
`2012. U.S. patent application Ser. No. 13/407,448 is a continuation of U.S. patent application
`
`Ser. No. 13/221,033 filed Aug. 30, 2011. U.S. patent application Ser. No. 13/221,033 is a
`
`continuation of U.S. patent application Ser. No. 12/795,935 filed Jun. 8, 2010. U.S. patent
`
`application Ser. No. 12/795,935 is a continuation of U.S. patent application Ser. No. 11/684,103
`
`filed Mar. 9, 2007, now U.S. Pat. No. 7,828,852. U.S. patent application Ser. No. 11/684,103 is a
`
`continuation of U.S. patent application Ser. No. 10/681,526 filed Oct. 8, 2003, now U.S. Pat. No.
`
`7,635,390. U.S. patent application Ser. No. 10/681,526 is a continuation of U.S. patent
`
`application Ser. No. 10/191,751 filed Jul. 8, 2002, now U.S. Pat. No. 7,104,996. U.S. patent
`
`application Ser. No. 10/191,751 is a continuation-in-part of U.S. patent application Ser. No.
`
`09/976,396 filed Oct. 11, 2001, now U.S. Pat. No. 6,770,078. U.S. patent application Ser. No.
`
`10/191,751 is also a continuation-in-part of U.S. patent application Ser. No. 09/941,185 filed
`
`Aug. 28, 2001, now U.S. Pat. No. 6,702,821.
`
`[0002]
`
`U.S. patent application Ser. No. 14/451,562 is also a continuation of U.S. patent
`
`application Serial No. 13/859,509,filed April 9, 2013. U.S. patent application Serial No.
`
`
`
`13/859,509 is a continuation of U.S. patent application Serial No. 10/888,783, filed July 9, 2004.
`
`U.S. patent application Serial No. 10/888,783 is a continuation of U.S. patent application Serial
`
`No. 10/191,751 filed July 8, 2002 (now U.S. Patent No. 7,104,996); which is a continuation-in-
`
`part of each of the following: U.S. patent application Serial No. 09/976,396 filed October 11,
`
`2001 (now U.S. Patent No. 6,770,078); and U.S. patent application Serial No. 09/941,185 filed
`
`August 28, 2001 (now U.S. Patent No. 6,702,821).
`
`BACKGROUND OF THE INVENTION
`
`[0003]
`
`The present invention relates to a new and improved method of performing surgery,
`
`and instruments, implants, and other surgical implements that can be used in surgery. The
`
`surgery may be of any desired type. The surgery may be performed on joints in a patient’s body.
`
`The surgery may be performed on any desired joint in a patient’s body. Regardless of the type of
`
`surgery to be performed,a limited incision may advantageously be utilized.
`
`[0004]
`
`In some embodiments, this specification relates to limited incision partial or total
`
`knee joint replacements and revisions andis the result of a continuation of work which was
`
`previously performed in conjunction with the subject matter of U.S. Patent No. 5,514,143. This
`
`specification also contains subject matter which relates to U.S. Patent Nos. 5,163,949; 5,269,785;
`
`5,549,683; 5,662,710; 5,667,520; 5,961,499; 6,059,817; and 6,099,531. Althoughthis
`
`specification refers to knee joints, it should be understood that the subject matter of this
`
`application is also applicable to joints in many different portions of a patient’s body, for example
`
`a shoulder, spine, arm, hand, hip or foot of a patient.
`
`
`
`[0005] Duringatotal or partial knee replacementor revision, an incision is made in a knee
`
`portion of a leg of the patient to obtain access to the knee joint. The incision 1s relatively long to
`
`enable instrumentation, such as a femoral alignment guide, anterior resection guide, distal
`
`resection guide, femoral cutting guide, and femoral anterior, posterior and chamfer resection
`
`guide to be positioned relative to a distal end portion of the femur. In addition, the incision must
`
`be relatively large to enable a tibial resection guide to be positioned relative to the proximal end
`
`portion of the tibia.
`
`
`
`[0006]
`
`With knownproceduresoftotal or partial knee replacement, the incision in the knee
`
`portion of the patient is made with the leg of the patient extended (straight) while the patientis
`
`lying on his or her back. Atthis time, the extended leg of the patient is disposed along andrests
`
`on a patient support surface. After the incision has been madein the kneeportion of the leg of
`
`the patient, the leg is flexed and a foot connected with the leg movesalong the patient support
`
`surface. The knee portion of the flexed leg of the patient is disposed above the patient support
`
`surface. This results in the soft tissue in the knee being compressed against the back of the knee
`
`joint. This makesit very difficult to access posterior soft tissue to remove bonespurs(ostified),
`
`meniscus, posterior capsule, ligaments in the back of the joint, and/or any residual soft tissue or
`
`connective tissue that is blocking furtherflexion.
`
`[0007]
`
`After the incision has been made and while the leg is flexed with the foot above the
`
`patient support surface, the surgeon cannot view arteries, nerves and veins whicharesitting just
`
`posterior to the knee capsule. Therefore, a surgeon maybe very reluctant, or at least very
`
`careful, of inserting instruments into the back of the knee joint to removetissue. This may result
`
`in osteophytes, bone spurs and similar types of posterior soft tissue beingleft in place.
`
`[0008]
`
`With knowntechniques, the patella is commonly everted from its normal position.
`
`Whenthe patella is everted, the inner side of the patella is exposed and faces outward away from
`
`end portions of the femur and tibia. The outer side of the everted patella faces inward toward the
`
`end portions of the femur andthe tibia. Moving the everted patella to one side of end portions of
`
`the femurandtibia tends to increase the size of the incision which must be made in the knee
`
`portion of the patient’s leg.
`
`[0009]
`
`After implants have been positioned in the knee portion ofthe patient’s leg, it 1s
`
`commonto check for flexion and extension balancing of ligaments by flexing and extending the
`
`knee portion with the foot above the support surface. Ifthe ligaments are too tight medially or
`
`laterally, they can be released to obtain the desired tension. However, the checking of ligament
`
`balance by flexing and extendingthe leg of the patient, ignores rotational balancing of ligaments.
`
`Since the femoral implant is movable relative to the tibial implant, the stability of the knee joint
`
`is dependent upon balancing of the ligaments in flexion, extension, and rotation.
`
`
`
`SUMMARYOF THE INVENTION
`
`[0010]
`
`The present invention relates to a new and improved method and apparatus for use in
`
`performing any desired type of surgery on a joint in a patient's body. The joint may
`
`advantageously be a knee joint. However, the method and apparatus may be usedin association
`
`with surgery on other joints in a patient's body. There are many different features of the present
`
`invention which may usedeither together or separately in association with many different types
`
`of surgery. Although features of the present invention may be used with many different surgical
`
`procedures, the invention is described herein in conjunction with surgery on a joint in a patient’s
`
`body.
`
`[0011]
`
`Oneof the features of the present invention relates to the making of a limited incision.
`
`The limited incision may be in any desired portion of a patient’s body. For example, the limited
`
`incision may be in a knee portion of a leg of a patient. The limited incision may be made while a
`
`lowerportion of the leg of the patient is extending downward from the upper portion of the leg of
`
`the patient. At this time, a foot connected with the lower portion of the leg of the patient may be
`
`below a surface on whichthe patient is supported. The limited incision may be made while the
`
`lower portion of the leg of the patient is suspended from the upper portion of the leg or while the
`
`lower portion of the leg and/or the foot of the patient are held by a support device. After the
`
`incision has been made, any one of manysurgical procedures may be undertaken.
`
`[0012]
`
`It is believed that in certain circumstances, it may be desired to have a main incision
`
`of limited length and a secondary incision of even smaller length. The secondary incision may
`
`be a portal or stab wound. A cutting tool may be movedthrough the secondary incision. An
`
`implant may be moved through the main incision.
`
`[0013]
`
`Once the incision has been made,a patella in a knee portion of the patient may be
`
`offset to one side of its normal position. Whenthe patella is offset, an inner side of the patella
`
`faces inward toward the end portions of a femur andtibia. If desired, the patella can be cut and
`
`realigned in situ, with minimal or no subluxation. Additionally, the cutting and/or realignment
`
`can be done while the knee is in flexion, which is the natural position, rather than extension.
`
`
`
`[0014]
`
`Although any one of many known surgical procedures may be undertaken through the
`
`limited incision, down sized instrumentation for use in the making of cuts in a femur and/ortibia
`
`may be movedthroughor part way through the incision. The down sized instrumentation may
`
`be smaller than implants to be positioned in the knee portion of the patient. The down sized
`
`instrumentation may have opposite ends which are spaced apart by a distance whichis less than
`
`the distance between lateral and medial epicondyles on a femurortibia in the leg of the patient.
`
`[0015]
`
`It is contemplated that the down sized instrumentation may havecutting tool guide
`
`surfaces of reduced length. The length of the cutting tool guide surfaces may be less than the
`
`length of a cut to be made ona bone. A cut on a bonein the patient may be completed using
`
`previously cut surfaces as a guide for the cutting tool.
`
`[0016]
`
`It is contemplated that at least some,if not all, cuts on a bone may be madeusing
`
`light or other electromagnetic radiation, such as infrared radiation, directed onto the bone as a
`
`guide. Thelight directed onto the bone may be in the form of a three dimensional image. The
`
`light directed onto the bone may be a beam along which a cutting or milling tool is moved into
`
`engagement with the bone.
`
`[0017]
`
`There are several different orders in which cuts may be made on bonesin the knee
`
`portion of the leg of the patient. It is believed that it may be advantageous to makethe patellar
`
`and tibial cuts before making the femoralcuts.
`
`[0018]
`
`There are many different reasons to check ligament balancing in a knee portion of the
`
`leg of a patient. Ligament balancing may be checked while the knee portion of the leg of the
`
`patient is flexed and the foot of the patient is below the support surface on which the patientis
`
`disposed. Flexion and extension balancing of ligaments may be checked by varying the extent of
`
`flexion of the knee portion of the leg of the patient. In addition, rotational stability of the
`
`ligaments may be checkedby rotating the lower portion of the leg of the patient aboutits central
`
`axis. Balancing of ligaments may also be checked by moving the foot of the patient sideways,
`
`
`
`rotating the lower portion of the leg of the patient, and/or moving the foot anteriorly or
`
`posteriorly.
`
`[0019]
`
`It is believed that it may be advantageousto utilize an endoscope or a similar
`
`apparatus to examineportions of the patient’s body which are spaced from the incision. It is also
`
`contemplated that images of the knee portion ofthe patient’s leg may be obtained by using any
`
`one of many known image generating devices other than an endoscope. The images may be
`
`obtained while the patient’s leg is stationary or in motion. The images maybe obtainedto assist
`
`a surgeon in conducting any desired type of surgery.
`
`[0020]
`
`Balancing ofthe ligaments in the knee portion of a patient’s leg may be facilitated by
`
`the positioning of one or more transducers between tendons, ligaments, and/or bones in the knee
`
`portion. One transducer maybe positioned relative to a medial side of a knee joint. Another
`
`transducer may be positionedrelative to a lateral side of the knee joint. During bendingofthe
`
`knee joint, the output from the transducers will vary as a function of variations in tension forces
`
`in the ligaments. This enables the tension forces in ligaments in opposite sides of the knee
`
`portion to be comparedto facilitate balancing of the ligaments.
`
`[0021]
`
`Patellar tracking may be checkedby the positioning of one or more transducers
`
`between the patella and the distal end portion of the femur. If desired, one transducer may be
`
`placed between a medial portion of the patella and the distal end portion of the femur. A second
`
`transducer may be placed betweena lateral portion of the patella and the distal end portion of the
`
`femur. Output signals from a transducer will vary as a function of variations in force transmitted
`
`between the patella and femur during bending oftheleg.
`
`[0022]
`
`The articular surface on the patella may be repaired. The defective original articular
`
`surface on the patella may be removed bycutting the patella while an innerside of the patella
`
`faces toward a distal end portion of a femur. Thestep of cutting the patella may be performed
`
`while the patella is disposed in situ and is urged toward the distal end portion of the femur by
`
`connective tissue. An implant may then be positioned onthe patella.
`
`
`
`[0023]
`
`It is contemplated that the size of the incision in the knee or other portion of the
`
`patient may be minimized by conducting surgery through a cannula. The cannula may be
`
`expandable. To facilitate moving of an implant through the cannula, the implant may be formed
`
`in two or more portions. The portions of the implant may be interconnected whenthe portions of
`
`the implant have been positioned in the patient’s body. Although the implants disclosed herein
`
`are associated with a patient’s knee, it should be understoodthat the implants may be positioned
`
`at any desired location in a patient’s body.
`
`[0024]
`
`An implant may be positioned in a recess formed in a bone in a patient. The implant
`
`may contain biological resurfacing and/or bone growth promoting materials. The implant may
`
`contain mesenchymalcells and/or tissue inductive factors. Alternatively, the implant may be
`
`formed of one or more materials which do not enable bone to grow into the implant.
`
`[0025]
`
`In accordance with one of the features of the present invention, body tissue may be
`
`moved or stretched by a device which is expandable. The expandable device may be
`
`biodegradable so that it can be left in a patient’s body. The expandable device may be expanded
`
`to move and/orstretch body tissue and increase a range of motion of a joint. The expandable
`
`device may be used to stretch body tissue in which anincision is to be made.
`
`[0026]
`
`An improved drape system is provided to maintain a sterile field between a surgeon
`
`and a patient during movementof the surgeonrelative to the patient. The improved drape
`
`system includes a drape which extends between the surgeon and a drapefor the patient. During
`
`surgery on a knee portion of a leg of a patient, the drape system extends beneath a foot portion of
`
`the leg of a patient. It is contemplated that the drape system will be utilized during many
`
`different types of operations other than surgery on a leg ofa patient.
`
`[0027]
`
`An implant may be movable relative to both a femuranda tibia in a leg of a patient
`
`during bending of the leg. The implant may include a single member whichis disposed between
`
`and engaged by endportions of both the femur and tibia. Alternatively, the implant may include
`
`a plurality of members which are disposed in engagement with each other. If desired, one of the
`
`membersofthe plurality of members may be secured to a bone and engaged by a member which
`
`
`
`is not secured to a bone. The implant may be securedto soft tissue in the knee portion of the
`
`patient’s leg.
`
`[0028]
`
`There are many different features to the present invention. It is contemplated that
`
`these features may be used togetheror separately. It is also contemplated that the features may
`
`be utilized in association with joints in a patient’s body other than a knee joint. For example,
`
`features of the present invention may be usedin association with surgery on vertebral joints or
`
`glenoid joints. However, it is believed that many of the features may be advantageously utilized
`
`together during the performanceof surgery on a patient’s knee. However, the invention should
`
`not be limited to any particular combination of features or to surgery on any particular joint in a
`
`patient’s body. It is contemplated that features of the present invention will be used in
`
`association with surgery whichis not performed on a joint in a patient’s body.
`
`BRIEF DESCRIPTION OF THE DRAWINGS
`
`[0029]
`
`The foregoing and other features of the invention will become more apparent upon a
`
`consideration of the following description taken in connection with the accompanying drawings
`
`wherein:
`
`[0030]
`
`Fig. 1 is a schematic illustration depicting extended and flexed positions of a patient’s
`
`leg during performance of knee surgery in a known manner;
`
`[0031]
`
`Fig. 2 is a schematic illustration depicting the mannerin which a leg support is used
`
`to support an upper portion of a leg of a patient above a support surface on whichthepatientis
`
`disposed in a supine orientation during performance of knee surgery;
`
`[0032]
`
`Fig. 3 is a schematic illustration depicting the patient’s leg after a portion of a drape
`
`system has been positioned overthe patient, the leg being shownin a flexed condition with the
`
`foot below the patient support surface and with an upperportion of the leg supported by the leg
`
`support of Fig. 2;
`
`
`
`[0033]
`
`Fig. 4 is a schematic illustration of the patient’s leg of Figs. 2 and 3 in an extended
`
`condition and of the drape system which extends between a surgeon and the patient;
`
`[0034]
`
`Fig. 5 is a schematic illustration depicting the manner in which the drape system of
`
`Fig. 4 maintainsa sterile field during movementof the surgeonrelative to the patient;
`
`[0035]
`
`Fig. 6 is a schematic illustration depicting the manner in which an incision is made in
`
`the knee portion of the leg of the patient when the leg is in the position illustrated in Figs. 2
`
`and 3;
`
`[0036]
`
`Fig. 7 is a schematic illustration depicting the mannerin whichthe incision is
`
`expanded anda patella is everted with the leg of the patient extended;
`
`[0037]
`
`Fig. 8 is a schematic illustration depicting the manner in whicha drill is utilized to
`
`form a passage in a femurin the upperportion of the leg of the patient with the leg in the
`
`position illustrated in Figs. 2 and 3 and the patella offset from its normal position;
`
`[0038]
`
`Fig. 9 is a schematic illustration of the positioning of a femoral alignment guide in the
`
`hole formedby the drill of Fig. 8 with the leg of the patient in the position illustrated in Figs. 2
`
`and 3;
`
`[0039]
`
`Fig. 10 is a schematic illustration depicting the position of an anterior resection guide
`
`and a stylusrelative to the femoral alignment guide of Fig. 9 before an anterior femurcut has
`
`been made with the leg of the patient in the position illustrated in Figs. 2 and 3;
`
`[0040]
`
`Fig. 11 is a schematic illustration, taken generally along the line 11-11 of Fig. 10,
`
`furtherillustrating the relationship of the anterior resection guide andstylusto the distal end
`
`portion of the femur;
`
`[0041]
`
`Fig. 12 is a schematic illustration further illustrating the relationship of the anterior
`
`resection guide andstylus to the distal end portion of the femur;
`
`
`
`[0042]
`
`Fig. 13 is a schematic illustration depicting the manner in whicha cutting toolis
`
`moved along a guide surface on the anterior resection guide during making of an anterior femur
`
`cut with the leg of the patient in the position illustrated in Figs. 2 and 3;
`
`[0043]
`
`Fig. 14 is a schematic illustration depicting the relationship of the femoral alignment
`
`guide to the femur after making of the anterior femur cut of Fig. 13, the anterior resection guide
`
`and stylus being removed from the femoral alignment guide, andthe leg of the patient being in
`
`the position illustrated in Figs. 2 and 3;
`
`[0044]
`
`Fig. 15 is a schematic illustration of the anterior femur cut and femoral alignment
`
`guide of Fig. 14;
`
`[0045]
`
`Fig. 16 is a schematic illustration depicting the manner in which the femoral
`
`alignment guideis utilized to position a distal resection guide relative to the distal end portion of
`
`the femur after making of the anterior femur cut and with the leg of the patient in the position
`
`illustrated in Figs. 2 and 3;
`
`[0046]
`
`Fig. 17 is a schematic illustration depicting the manner in which a distal femurcutis
`
`made with a cutting tool after the femoral alignment guide has been removed,the leg of the
`
`patient being in the position illustrated in Figs. 2 and 3;
`
`[0047]
`
`Fig. 18 is a schematic illustration depicting the relationship of the cutting tool and
`
`distal resection guide of Fig. 17 to the femur;
`
`[0048]
`
`Fig. 19 is a schematic illustration depicting the manner in which a femoral cutting
`
`guide is positioned on the distal end portion of the femur with the leg of the patient in the
`
`position illustrated in Figs. 2 and 3;
`
`[0049]
`
`Fig. 20 is a schematic illustration further depicting the relationship of the femoral
`
`cutting guide to the distal end portion of the femur;
`
`10
`
`
`
`[0050]
`
`Fig. 21 is a schematic illustration depicting the relationship ofa tibial resection guide
`
`to the proximal end portion ofa tibia in the lower portion of the patient’s leg after making the
`
`femoral cuts and with the leg of the patient in the position illustrated in Figs. 2 and 3;
`
`[0051]
`
`Fig. 22 is a schematic illustration of the distal end portion of the femur and the
`
`proximal end portion ofthe tibia after making the femoral andtibial cuts with the leg of the
`
`patient in the position illustrated in Figs. 2 and 3 and the patella offset to one side of the incision;
`
`[0052]
`
`Fig. 23 is a schematic illustration further depicting the femoral andtibial cuts of
`
`Fig 22;
`
`[0053]
`
`Fig. 24 is a schematic illustration depicting the manner in which force is applied
`
`against the bottom of the patient’s foot by a surgeon’s knee with the leg of the patient in the
`
`position illustrated in Figs. 2 and 3;
`
`[0054]
`
`Fig. 25 is a schematic illustration depicting the various directions in which the lower
`
`portion of the patient’s leg can be movedrelative to the upper portion of the patient’s leg to
`
`expose portions of the boneat the incision in the knee portion of the patient’s leg and to check
`
`ligament balancing;
`
`[0055]
`
`Fig. 26 is a schematic illustration depicting the manner in whicha tibial punch 1s
`
`positioned relative to a tibial base plate with the leg of the patient in the position illustrated in
`
`Figs. 2 and 3;
`
`[0056]
`
`Fig. 27 is a schematic illustration depicting completed preparation of the tibia for a
`
`tibial tray implant with the leg of the patient in the position illustrated in Figs. 2 and 3;
`
`[0057]
`
`Fig. 28 is a schematic illustration depicting positioning ofa tibial bearing insert in the
`
`tibial tray of Fig. 27 with the leg of the patient in the position illustrated in Figs. 2 and 3;
`
`11
`
`
`
`[0058]
`
`Fig. 29 is a schematic illustration depicting femoral andtibial implants with the leg of
`
`the patient in the position illustrated in Figs. 2 and 3;
`
`[0059]
`
`Fig. 30 is a schematic illustration of an apparatus which may beutilized to move the
`
`lower portion of a patient’s leg relative to the upper portion of a patient’s leg when the patient’s
`
`leg is in the position illustrated in Figs. 2 and 3;
`
`[0060]
`
`Fig. 31 is a schematic illustration depicting the manner in whicha distal resection
`
`guide is connected with a patient’s femur by pins which extend through the guide and through
`
`skin in the upperportion of the patient’s leg into the femur with the leg of the patient in the
`
`position illustrated in Figs. 2 and 3;
`
`[0061]
`
`Fig. 32 is a schematic illustration depicting the manner in which an endoscope may
`
`be inserted through an incision in a patient’s knee to inspect portions of the patient’s knee which
`
`are remote from the incision with the leg of the patient in the position illustrated in Figs. 2 and 3;
`
`[0062]
`
`Fig. 33 is a schematic illustration similar to Fig. 32, depicting the manner in which
`
`the endoscope maybe inserted through the incision in the patient’s knee with the leg of the
`
`patient extended;
`
`[0063]
`
`Fig. 34 is a schematic illustration depicting the manner in which an imaging apparatus
`
`may be utilized to generate images of a portion of the patient’s leg and the manner in which a
`
`robot may be utilized to position cutting tools or other devices relative to the patient’s leg with
`
`the patient’s leg in the position illustrated in Figs. 2 and 3;
`
`[0064]
`
`Fig. 35 is a schematic illustration depicting the relationship ofa cut line to a patella in
`
`a knee of the leg of the patient with the leg in the position illustrated in Figs. 2 and 3 and with the
`
`patella in the normal position;
`
`12
`
`
`
`[0065]
`
`Fig. 36 is a schematic illustration depicting the manner in whicha cutting toolis
`
`movedrelative to a guide memberto cut the patella of Fig. 35 while the patella is disposed in
`
`situ;
`
`[0066]
`
`Fig. 37 is a schematic illustration depicting the manner in whicha tibial alignment
`
`shaft and a tibial resection guide are positioned relative to a tibia in a lowerportion of a leg of
`
`the patient with the leg of the patient in the position illustrated in Figs. 2 and 3;
`
`[0067]
`
`Fig. 38 is an enlarged fragmentary view ofa portion of Fig. 37 andillustrating the
`
`construction of the tibial resection guide;
`
`[0068]
`
`Fig. 39 is a schematic illustration depicting the relationship between an expandable
`
`cannula and an incision in the knee portion of one leg of the patient with the leg of the patient in
`
`the position illustrated in Figs. 2 and 3;
`
`[0069]
`
`Fig. 40 is a schematic illustration depicting the relationship between two separate
`
`portions of an implant which are interconnected within the patient’s body;
`
`[0070]
`
`Fig. 41 is a schematic illustration depicting the relationship of transducersto a flexed
`
`knee joint of a patient whenthe leg of the patientis in the position illustrated in Figs. 2 and 3;
`
`[0071]
`
`Fig. 42 is a schematic illustration, generally similar to Fig. 41, illustrating the
`
`relationship of the transducers to the knee joint whenthe leg of the patient is extended;
`
`[0072]
`
`Fig. 43 is a schematic illustration of a distal end portion of a femurin a leg of a
`
`patient with the leg in the position illustrated in Figs. 2 and 3 andillustrating the relationship of
`
`an implant to a recess in the end portion of the femur;
`
`[0073]
`
`Fig. 44 is a schematic sectional view depicting the manner in which a cutting tool is
`
`used to form a recess in the end portion of the femur of Fig. 43 with the leg of the patient in the
`
`position illustrated in Figs. 2 and 3;
`
`13
`
`
`
`[0074]
`
`Fig. 45 is a schematic sectional view, taken generally along the line 45-45 of Fig. 43
`
`furtherillustrating the relationship of the implant to the recess;
`
`[0075]
`
`Fig. 46 is a schematic end view of a proximal endportion of a tibia in a leg of a
`
`patient, with the leg in the position illustrated in Figs. 2 and 3, illustrating the relationship of an
`
`implant to a recess in the end portion ofthe tibia;
`
`[0076]
`
`Fig. 47 is a schematic sectional view depicting the manner in which a cutting tool is
`
`used to form the recess in the end portion ofthetibia of Fig. 46;
`
`[0077]
`
`Fig. 48 is a schematic sectional view, taken generally along the line 48-48 of Fig. 46,
`
`furtherillustrating the relationship of the implant to the recess;
`
`[0078]
`
`Fig. 49 is a schematic sectional view illustrating the relationship of another implant to
`
`a recess in a bone in a patient’s body;
`
`[0079]
`
`Fig. 50 is a schematic illustration depicting the relationship between a tibial implant
`
`and a tibia in the leg of the patient;
`
`[0080]
`
`Fig. 51 is a schematic illustration depicting the relationship of expandable devicesto
`
`the knee portion of a patient’s leg;
`
`[0081]
`
`Fig. 52 is a schematic illustration depicting the manner in which an expandable
`
`device may be positioned relative to a knee portion of a patient’s leg with the patient’s leg in the
`
`position illustrated in Figs. 2 and 3;
`
`[0082]
`
`Fig. 53 is a schematic illustration depicting the manner in which a femoral cutting
`
`guide may be mounted on a distal end of a femurin a patient’s leg with the patient’s leg in the
`
`position illustrated in Figs. 2 and 3;
`
`14
`
`
`
`[0083]
`
`Fig. 54 is a schematic illustration of the manner in which a femoral cutting guide may
`
`be mounted onaside surface of a femurin a patient’s leg with the patient’s leg in the position
`
`illustrated in Figs. 2 and 3;
`
`[0084]
`
`Fig. 55 is a schematic illustration depicting the manner in whichlightis directed onto
`
`a distal end portion of a femur with the patient’s leg in the position illustrated in Figs. 2 and 3;
`
`[0085]
`
`Fig. 56 is a schematic illustration depicting the manner in whichlight is used to guide
`
`movementofa cutting tool relative to a distal end portion of a femur with the patient’s leg in the
`
`position illustrated in Figs. 2 and 3;
`
`[0086]
`
`Fig. 57 is a schematic illustration depicting the manner in whicha cutting toolis
`
`movedrelative to a secondary incision with a knee portion of a patient’s leg in the position
`
`illustrated in Figs. 2 and 3;
`
`[0087]
`
`Fig. 58 is schematic illustration depicting the relationship of transducersto a patella
`
`and distal end portion of a femur with the patient’s leg in the position illustrated in Figs. 2 and 3;
`
`[0088]
`
`Fig. 59 is a schematic illustration depicting the relationship between a movable
`
`implant, a distal end portion of a femur, and a proximal end portion of a tibia in a knee portion of
`
`a leg of a patient;
`
`[0089]
`
`Fig. 60 is a plan view ofa proximal end portion of a tibia depicting the mannerin
`
`which an implant may be inlaid intoatibia;
`
`[0090]
`
`Fig. 61 is a schematic illustration, generally similar to Fig. 59, depicting the
`
`relationship between a movable implant formedby a plurality of members, a distal end portion of
`
`a femur, and a proximal end portion of a tibia in a knee portion ofa leg of a patient;
`
`15
`
`
`
`[0091]
`
`Fig. 62 is a schematic illustration, generally similar to Figs. 59 and 61, depicting the
`
`relationship between an implant formed by a movable memberanda fixed member, a distal end
`
`portion of a femur, and a proximal end portion ofa tibia in a knee portion of a leg of a patient;
`
`[0092]
`
`Fig. 63 is a schematic illustration, generally similar to Fig. 59, depicting the manner
`
`in which an implant is connected with a ligamentin a knee portion of a patient’s leg;
`
`[0093]
`
`Fig. 64 is a schematic illustration, generally similar to Fig. 60, depicting the manner
`
`in which an implant is connected with a joint capsule in a knee portion of a patient’s leg;
`
`[0094]
`
`Fig. 65 is a schematic illustration, generally similar to Fig. 60, depicting the manner
`
`in which a retainer holds moldable implant material in place on a proximal end portion ofa tibia
`
`in the knee portion of a leg of the patient;
`
`[0095]
`
`Fig. 66 is a fragmentary sectional view, taken generally along the line 66-66ofFig.
`
`65 further illustrating the manner in which the retainer holds moldable implant material;
`
`[0096]
`
`Fig. 67 is a schematic illustration depicting the manner in which an implantis
`
`provided in a knee portion of a leg of a patient to correct defects in a joint and in which an
`
`osteotomy wedgeis provided to correct defects in bone alignment;
`
`[0097]
`
`Fig. 68 is a schematic view of the hip region with a guide wire and cannula inserted;
`
`[0098]
`
`Fig. 69 is a schematic view ofthe hip region with an inflatable device inserted;
`
`[0099]
`
`Fig. 70A is a side view of a bone removing instrument according to the present
`
`invention in a retractedstate;
`
`[00100]
`
`Fig. 70B is a perspective view of the bone removing instrument of Fig. 70A in an
`
`expandedstate;
`
`16
`
`
`
`[0100]
`
`Fig. 71 is a schematic view of the hip region with the bone removerof Fig. 70B
`
`inserted and rem
![](/site_media/img/document_icon.png)
Accessing this document will incur an additional charge of $.
After purchase, you can access this document again without charge.
Accept $ ChargeStill Working On It
This document is taking longer than usual to download. This can happen if we need to contact the court directly to obtain the document and their servers are running slowly.
Give it another minute or two to complete, and then try the refresh button.
A few More Minutes ... Still Working
It can take up to 5 minutes for us to download a document if the court servers are running slowly.
Thank you for your continued patience.
![](/site_media/img/error_icon.png)
This document could not be displayed.
We could not find this document within its docket. Please go back to the docket page and check the link. If that does not work, go back to the docket and refresh it to pull the newest information.
![](/site_media/img/error_icon.png)
Your account does not support viewing this document.
You need a Paid Account to view this document. Click here to change your account type.
![](/site_media/img/error_icon.png)
Your account does not support viewing this document.
Set your membership
status to view this document.
With a Docket Alarm membership, you'll
get a whole lot more, including:
- Up-to-date information for this case.
- Email alerts whenever there is an update.
- Full text search for other cases.
- Get email alerts whenever a new case matches your search.
![](/site_media/img/document_icon.png)
One Moment Please
The filing “” is large (MB) and is being downloaded.
Please refresh this page in a few minutes to see if the filing has been downloaded. The filing will also be emailed to you when the download completes.
![](/site_media/img/document_icon.png)
Your document is on its way!
If you do not receive the document in five minutes, contact support at support@docketalarm.com.
![](/site_media/img/error_icon.png)
Sealed Document
We are unable to display this document, it may be under a court ordered seal.
If you have proper credentials to access the file, you may proceed directly to the court's system using your government issued username and password.
Access Government Site