1. A system for performing a total knee arthroplasty, the system comprising:
a reference block configured for attachment to a distal surface of the femur and connection with a distal femoral cut guide configured to resect the distal medial and lateral condyles, the reference block setting a position of the resections on the distal medial and lateral condyles when attached to the femur; and
a plurality of shims, each shim attachable to or integral with the reference block, each shim configured for contact with the distal surface of at least one of the medial and lateral condyles of the femur, wherein a particular shim is selected for use from the plurality of shims based on matching at least one of the medial and lateral thicknesses of the selected shim with a determined wear of cartilage on at least one of the distal medial and lateral condyles.
2. The system of claim 1, wherein the plurality of shims can comprise both medial side shims and lateral side shims, and wherein the medial side shims and lateral side shims can comprise separate components from one another and each of the medial side shims and each of the lateral side shims can be configured for attachment to one of a medial side or a lateral side of the reference block.
3. The system of claim 1, wherein at least one of the plurality of shims has a medial thickness that differs from a lateral thickness for that particular shim.
4. The system of claim 1, wherein the reference block includes four reference blocks, the plurality of shims includes four shims, and each of the shims and a corresponding one of the four reference blocks are monolithic to form four one-piece shim block assemblies.
5. The system of claim 4, wherein the plurality of shims comprises:
a first shim having a first medial thickness equal to a first lateral thickness and configured for use on a femur having little to no wear on the distal medial and lateral condyles;
a second shim having a second medial thickness equal to a second lateral thickness and greater than the first medial thickness of the first shim, the second shim configured for use on a femur having cartilage wear on one or both the distal medial and lateral condyles;
a third shim having a third medial thickness less than a third lateral thickness and generally equal to the first medial thickness of the first shim, the third shim configured for use on a femur having cartilage wear on a distal lateral condyle; and
a fourth shim having a fourth medial thickness greater than a fourth lateral thickness and greater than the first medial thickness of the first shim, the fourth shim configured for use on a femur having cartilage wear on a distal medial condyle.
6. The system of claim 5, wherein the second medial and lateral thicknesses of the second shim are about 2 mm greater than the first medial and lateral thicknesses of the first shim.
7. The system of claim 5, wherein the third lateral thickness of the third shim is about 2 mm greater than the third medial thickness of the third shim, and the fourth medial thickness of the fourth shim is about 2 mm greater than the fourth lateral thickness of the fourth shim.
8. The system of claim 1, wherein the plurality of shims includes at least three shims and each shim is removably attachable to the reference block.
9. The system of claim 8, wherein the plurality of shims comprises:
a first shim having a first medial thickness equal to a first lateral thickness and configured for use on a femur having little to no wear on the distal medial and lateral condyles;
a second shim having a second medial thickness equal to a second lateral thickness and greater than the first medial thickness of the first shim, the second shim configured for use on a femur having cartilage wear on both the distal and medial lateral condyles; and
a third shim having a third medial thickness less than a third lateral thickness and generally equal to the first medial thickness of the first shim, the third shim configured for use on a femur having cartilage wear on a distal lateral condyle.
10. The system of claim 9, wherein the third shim is configured for use on a femur having cartilage wear on a distal medial condyle by rotating the shim 180 degrees such that the medial portion of the shim is configured for placement on the lateral condyle of the distal femur and the lateral portion of the shim is configured for placement on the medial condyle of the distal femur.
11. The system of claim 9, wherein the second medial and lateral thicknesses of the second shim are about 2 mm greater than the first medial and lateral thicknesses of the first shim, and the third medial thickness of the third shim is about 2 mm less than the third lateral shim.
12. The system of claim 1, further comprising one or more spacers insertable on a bone contacting side of a cut block configured to resect a posterior portion of the distal femur after resecting the distal medial and lateral condyles.
13. The system of claim 12, wherein the one or more spacers comprises a first spacer having a thickness of about 1 mm and a second spacer having a thickness of about 2 mm.
14. A system for performing a total knee arthroplasty, the system comprising:
a plurality of shim blocks configured for attachment to a distal surface of the femur and for use with a distal femoral cut guide, each of the shim blocks configured to set a location of bone resections on the distal medial and lateral condyles made using the distal femoral cut guide when the shim block is attached to the femur, each of the shim blocks comprising:
a bone contacting side;
an opposing non-bone contacting side;
a medial portion;
a lateral portion; and
at least one opening extending from the bone contacting side to the non-bone contacting side and configured to receive an intramedullary rod, wherein at least one of the plurality of shim blocks has a medial thickness on the medial portion different from a lateral thickness on the lateral portion for that particular shim block, and a particular shim block is selected for use in the total knee arthroplasty based on a determined wear of cartilage on the distal medial and lateral condyles.
15. The system of claim 14, wherein the plurality of shim blocks comprises:
a first shim block having a first medial thickness equal to a first lateral thickness and configured for use on a femur having little to no wear on the distal medial and lateral condyles;
a second shim block having a second medial thickness equal to a second lateral thickness and greater than the first medial thickness of the first shim block, the second shim block configured for use on a femur having cartilage wear on both the distal medial and lateral condyles;
a third shim block having a third medial thickness less than a third lateral thickness and generally equal to the first medial thickness of the first shim block, the third shim block configured for use on a femur having cartilage wear on a distal lateral condyle; and
a fourth shim block having a fourth medial thickness greater than a fourth lateral thickness and greater than the first medial thickness of the first shim block, the fourth shim block configured for use on a femur having cartilage wear on a distal medial condyle.
16. The system of claim 15, wherein the second medial and lateral thicknesses of the second shim block are about 2 mm greater than the first medial and lateral thicknesses of the first shim block, the third medial thickness of the third shim block is about 2 mm less than the third lateral thickness of the third shim block, and the fourth medial thickness of the fourth shim block is about 2 mm greater than the fourth lateral thickness of the fourth shim block.
17. The system of claim 14, wherein each of the shim blocks comprises two apertures formed in a top portion of the shim block, and the system further comprises:
a guide tower configured to receive the selected shim block prior to attachment of the shim block to the distal surface of the femur.
18. The system of claim 14, further comprising one or more spacers insertable on a bone contacting side of a cut block configured to resect a posterior portion of the distal femur after resecting the distal medial and lateral condyles.
19. A method of performing a total knee arthroplasty, the method comprising:
determining cartilage wear on distal medial and lateral condyles of a distal femur;
determining a target medial resection thickness and a target lateral resection thickness based on the determined cartilage wear;
selecting a shim block assembly from a plurality of shim block assemblies, each shim block assembly configured for attachment to a distal surface of the femur and for use with a distal femoral cut guide to set a location of bone resections on the distal medial and lateral condyles, each shim block assembly comprising a bone contacting side and the particular shim block assembly selected is based on the determined cartilage wear on the distal medial and lateral condyles;
attaching the shim block assembly to the distal femur;
connecting the distal femoral cut guide to the shim block assembly on the distal femur; and
resecting the distal medial and lateral condyles.
20. The method of claim 19, wherein the shim block assemblies can include both medial side shims and lateral side shims, and wherein the medial side shims and lateral side shims can comprise separate components from one another.
21. The method of claim 19, wherein each shim block has a medial portion and a lateral portion and at least one of the shim block assemblies having a medial thickness on the medial portion different from a lateral thickness on the lateral portion for that particular shim block.
22. The method of claim 19, further comprising:
confirming a thickness of the distal medial resection is about equal to the target medial resection thickness; and
confirming a thickness of the distal lateral resection is about equal to the target lateral resection thickness.
23. The method of claim 19, wherein the plurality of shim block assemblies includes a plurality of shim components and a block assembly, and each shim component is removably attachable to the block assembly to form a two-piece shim block assembly.
24. The method of claim 19, further comprising:
resecting a posterior portion of the distal femur.
25. The method of claim 24, wherein resecting the posterior portion of the distal femur is performed by a cut block, and if a thickness of the distal medial resection is greater than the target medial resection thickness or a thickness of the distal lateral resection is greater than the target lateral resection thickness, the method further comprises:
placing one or more spacers on a bone contacting side of the cut block prior to resecting the posterior portion of the distal femur, the one or more spacers configured to compensate for a difference between the thickness of the distal medial resection and the target medial resection thickness or a difference between the thickness of the distal lateral resection and the target lateral resection thickness.
26. The method of claim 19, wherein the plurality of shim block assemblies comprises:
a first shim block having a first medial thickness equal to a first lateral thickness and configured for use on a femur having little to no wear on the distal medial and lateral condyles;
a second shim block having a second medial thickness equal to a second lateral thickness and greater than the first medial thickness of the first shim block, the second shim block configured for use on a femur having cartilage wear on one or both the distal medial and lateral condyles;
a third shim block having a third medial thickness less than a third lateral thickness and generally equal to the first medial thickness of the first shim block, the third shim block configured for use on a femur having cartilage wear on a distal lateral condyle; and
a fourth shim block having a fourth medial thickness greater than a fourth lateral thickness and greater than the first medial thickness of the first shim block, the fourth shim block configured for use on a femur having cartilage wear on a distal medial condyle.
27. The method of claim 26, wherein the second medial and lateral thicknesses of the second shim block are about 2 mm greater than the first medial and lateral thicknesses of the first shim block, the third medial thickness of the third shim block is about 2 mm less than the third lateral thickness of the third shim block, and the fourth medial thickness of the fourth shim block is about 2 mm greater than the fourth lateral thickness of the fourth shim block.
The claims below are in addition to those above.
All refrences to claim(s) which appear below refer to the numbering after this setence.
1. An integrated delivery device operable with one hand and for co-delivery of a liquid medicant and a powder medicant onto a tissue or wound comprising at least two integrated medicant expression subunits of
a) a liquid medicant expression subunit and a
b) a powder medicant expression subunit,
a. each expression subunit having an actuator for the medicant contained therein, the actuators are positioned in close proximity to each other at a proximate end of said expression subunits, and
b. delivery cannulas for each of said expression subunits that positioned in close proximity to each other at a distal end of said expression subunits.
2. The integrated delivery device of claim 1, wherein the liquid medicant expression subunit comprises a syringe containing the liquid medicant, and the powder medicant expression subunit comprises a powder delivery pump.
3. The integrated delivery device of claim 2, wherein the liquid medicant comprises a two-part sealant or hemostat, and the syringe comprises a dual barrel syringe with each barrel containing one of different individual components of the two-part sealant or hemostat.
4. The integrated delivery device of claim 3, wherein the powder delivery pump comprises a resiliently compressible bellows and a compartment filled with the powder medicant, said compartment being in fluid communication with the bellows and with the powder medicant delivery cannula.
5. The integrated delivery device of claim 4, wherein the dual barrel syringe comprises two plungers that are connected by a plunger bridge at the proximal end and a handle at the proximal end, wherein the plunger bridge and the resiliently compressible bellows are positioned in close proximity to one another and are synchronously or sequentially operable while being held in one hand.
6. The integrated delivery device of claim 5, wherein the resiliently compressible bellows is mounted onto the plunger bridge or onto the handle.
7. The integrated delivery device of claim 5, wherein the resiliently compressible bellows is mounted between the barrels.
8. The integrated delivery device of claim 5, wherein the plunger bridge and the resiliently compressible bellows are operable with the same finger of one hand while being held in the same one hand.
9. The integrated delivery device of claim 2, wherein the liquid medicant comprises a cross-linkable polymer, and the syringe comprises a single barrel syringe containing a cross-linking initiator andor a cross-linking accelerator that is retained on a porous media that is in fluid communication with said single barrel syringe.
10. The integrated delivery device of claim 9, wherein the cross-linkable polymer comprises an acrylic monomer.
11. A method of treating of the tissue comprising activating the integrated delivery device of claim 1 to deliver the powder medicant and the liquid medicant onto the tissue with no pre-mixing of the powder medicant and the liquid medicant to form a hemostatic or tissue sealing or coating on the tissue.
12. A method of claim 11, wherein the liquid medicant and the powder medicant are delivered within about 10 seconds of each other onto the tissue, and wherein the integrated delivery device is operated with one hand.
13. The method of claim 11, wherein said coating has a tissue interface side and an opposing top side; and wherein the powder medicant is directionally concentrated within the coating layer either at the tissue interface side or at the top side.
14. The method of claim 11, wherein said coating has a tissue interface side and an opposing top side; and wherein the powder medicant is distributed within the coating approximately uniformly as between the tissue interface side and the top side.
15. The method of claim 11, wherein the powder medicant comprises a bioabsorbable powder having at least one of hemostatic, wound treatment, fluid absorption, properties; the liquid medicant comprises a rapidly curable bioabsorbable liquid having hemostatic and or tissue sealing properties; and wherein said powder medicant is a non-curable powder material.
16. The method of claim 11, wherein said powder medicant is in the form of particles with an aspect ratio from about 1 to about 10, and an average particle size from about 90 microns to about 320 microns.
17. The method of claim 11, wherein said powder medicant is oxidized cellulose, oxidized regenerated cellulose, chitosan, starch, gelatin, collagen, or synthetic polymer.
18. The method of claim 11, wherein said powder medicant is oxidized regenerated cellulose.
19. The method of claim 11, wherein said liquid medicant comprises a fibrinogen and an initiator of fibrinogen conversion to fibrin.
20. The method of claim 11, wherein said liquid medicant comprises an acrylic monomer.