Patient specific glenoid guide

[0001] This application claims the benefit of U.S. Provisional Application No. 61/552,079, filed on Oct. 27, 2011. The entire disclosure of the above application is incorporated herein by reference.

[0002] This application is related to the following concurrently filed United States patent applications, each of which is incorporated herein by reference: “Patient-Specific Glenoid Guides”; “Patient-Specific Glenoid Guide and Implants”; nd “Methods for Patient-Specific Shoulder Arthroplasty”.

[0003] The present disclosure relates to a glenoid guide and, more particularly, relates to a patient-specific glenoid guide for use in establishing a reference on a glenoid.

[0004] This section provides background information related to the present disclosure that is not necessarily prior art.

[0005] Various guide tools have been proposed for assisting surgeons during surgical procedures. For instance, a cutting guide can be used during implantation of a prosthetic device.

[0006] In the case of a prosthetic knee, for example, a femoral cutting guide can be fixed at a known position relative to the femur. The cutting guide can include one or more surfaces that are consequently fixed at a known position relative to the femur. A cutting tool, such as a reciprocating blade can be operated while sliding along the guide surface of the cutting guide such that the femur can be cut (e.g., resected) at predetermined locations to predetermined dimensions. These anatomical cuts can form surfaces against which the femoral prosthetic device can seat.

[0007] Also, in some embodiments, the cutting guide can be used to guide the formation of holes or other features that can receive a referencing object (e.g., a pin, etc.) in a bone. Once the referencing object is fixed to the bone, another object (e.g., a cutting guide, etc.) can be attached to the referencing object for further use in a predetermined position.

[0008] A patient-specific guide tool for guiding an object toward a glenoid face of a scapula of a patient for implantation of a shoulder prosthetic device is disclosed. The guide tool includes a guide portion that includes a guide surface. The guide surface is configured to guide movement of the object toward the glenoid face. Furthermore, the guide tool includes a patient-specific portion that is operably coupled to the glenoid portion. The patient-specific portion includes at least one patient-specific surface that is three-dimensionally contoured and that is configured to nest and closely conform to a corresponding surface of the scapula to thereby position the guide surface at a predetermined position relative to the glenoid face.

[0009] A method of guiding an object toward a glenoid face of a scapula of a patient for implantation of a shoulder prosthetic device is also disclosed. The method includes preoperatively imaging at least a portion of the scapula to produce an image of the portion of the scapula. The method also includes providing a patient-specific guide tool having a guide portion and a patient-specific portion. The guide portion includes a guide surface. The patient-specific portion is operably coupled to the glenoid portion. The patient-specific portion includes at least one patient-specific surface that is configured according to the image. Moreover, the method includes nesting the patient-specific surface of the guide tool to the at least a portion of the scapula to thereby position the guide surface at a predetermined position relative to the glenoid face.

[0010] Still further, a patient-specific glenoid guide tool for guiding an object toward a glenoid face of a scapula of a patient is disclosed for implantation of a shoulder prosthetic device. The guide tool includes a guide portion that includes an opening with a curved axis. The opening defines a guide surface, and the guide surface is configured to guide movement of the object toward the glenoid face. Moreover, the guide tool includes a patient-specific portion that is operably coupled to the glenoid portion. The patient-specific portion includes at least one patient-specific surface that is three-dimensionally contoured, and that is configured to nest and closely conform to a corresponding surface of the scapula to thereby position the guide surface at a predetermined position relative to the glenoid face. The patient-specific surface is configured to nest and closely conform to at least one of an anterior surface of an acromion of the scapula, an inferior surface of an acromion of the scapula, a posterior surface of an acromion of the scapula, a scapular spine, and the glenoid face.

[0011] Further areas of applicability of the present teachings will become apparent from the description provided hereinafter. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present teachings.

[0026] The following description is merely exemplary in nature and is in no way intended to limit the present teachings, applications, or uses.

[0027] The present teachings generally provide patient-specific surgical instruments that include, for example, alignment guides, drill guides, templates, cutting/resection guides for use in shoulder joint replacement, shoulder resurfacing procedures and other procedures related to the shoulder joint or the various bones of the shoulder joint, including the glenoid and adjacent shoulder bones. The present teachings can be applied to anatomic shoulder replacement and reverse shoulder replacement. The patient-specific instruments can be used either with conventional implant components or with patient-specific implant components and/or bone grafts that are prepared using computer-assisted image methods according to the present teachings. Computer modeling for obtaining three dimensional images of the patient's anatomy using MRI or CT scans of the patient's anatomy, the patient-specific prosthesis components and the patient-specific guides, templates and other instruments, can be designed using various CAD programs and/or software available, for example, by Materialise USA, of Plymouth, Mich. The present teachings also provide algorithms for use with related CAD programs.

[0028] The patient-specific instruments and any associated patient-specific implants and bone grafts can be generally designed and formed using computer modeling based on 3-D anatomic image(s) generated from X-rays, MRI, CT, ultrasound or other medical scans. Specifically, an anatomical feature (e.g., a scapula with or without surrounding soft tissue) can be imaged to detect certain features of the anatomy (e.g., dimensions, curvature of surfaces, etc.). Then, patient-specific instruments can be formed according to these measurements.

[0029] The patient-specific instrument can have a three-dimensional engagement surface that is complementary and made to conformingly contact the anatomical surface. Thus, the patient-specific instruments can be configured to fit at only one position to the anatomical surface. The patient-specific instruments can include custom-made guiding formations, such as, for example, guiding bores or cannulated guiding posts or cannulated guiding extensions or receptacles that can be used for supporting or guiding other instruments, such as drill guides, reamers, cutters, cutting guides and cutting blocks or for inserting pins or other fasteners according to a surgeon-approved pre-operative plan.

[0030] In various embodiments, the patient-specific instruments can also include one or more patient-specific alignment guides for receiving and guiding a tool, such as a drill or pin or guide wire at corresponding patient-specific orientations relative to a selected anatomic axis for the specific patient. The patient-specific instruments can include guiding or orientation formations and features for guiding the implantation of patient-specific or off-the-shelf implants associated with the surgical procedure. The geometry, shape and orientation of the various features of the patient-specific instruments, as well as various patient-specific implants and bone grafts, if used, can be determined during the pre-operative planning stage of the procedure in connection with the computer-assisted modeling of the patient's anatomy. During the pre-operative planning stage, patient-specific instruments, custom, semi-custom or non custom implants and other non custom tools, can be selected and the patient-specific components can be manufactured for a specific-patient with input from a surgeon or other professional associated with the surgical procedure.

[0031] In the following discussion, the terms “patient-specific”, “custom-made” or “customized” are defined to apply to components, including tools, implants, portions or combinations thereof, which include certain geometric features, including surfaces, curves, or other lines, and which are made to closely conform as mirror-images or negatives or complementary surfaces of corresponding geometric features or anatomic landmarks of a patient's anatomy obtained or gathered during a pre-operative planning stage based on 3-D computer images of the corresponding anatomy reconstructed from image scans of the patient by computer imaging methods. Further, patient-specific guiding features, such as, guiding apertures, guiding slots, guiding members or other holes or openings that are included in alignment guides, drill guides, cutting guides, rasps or other instruments or in implants are defined as features that are made to have positions, orientations, dimensions, shapes and/or define cutting planes and axes specific to the particular patient's anatomy including various anatomic or mechanical axes based on the computer-assisted pre-operative plan associated with the patient.

[0032] The prepared patient-specific alignment guides can be configured to mate in alignment with natural anatomic landmarks by orienting and placing the corresponding alignment guide intra-operatively on top of the bone to mate with corresponding landmarks. The anatomic landmarks function as passive fiducial identifiers or fiducial markers for positioning of the various alignment guides, drill guides or other patient-specific instruments.

[0033] The various patient-specific alignment guides can be made of any biocompatible material, including, polymer, ceramic, metal or combinations thereof. The patient-specific alignment guides can be disposable and can be combined or used with reusable and non patient-specific cutting and guiding components.

[0034] More specifically, the present teachings provide various embodiments of patient-specific glenoid guides. The glenoid guides of the present teachings can have patient-specific engagement surfaces that reference various portions of the shoulder joint and include drill guides, guiding bores or sleeves or other guiding formations that can accurately position a guide wire for later glenoid preparation and implantation procedures and for alignment purposes, including implant position control, implant version control, implant inclination control.

[0035] In the following, when of portion of a glenoid guide is described as “referencing” a portion of the anatomy, it will be understood that the referencing portion of the glenoid guide is a patient-specific portion mirroring or negative to the corresponding referenced anatomic portion.

[0036] Referring initially to FIG. 1, a patient-specific glenoid guide 10 (i.e., patient-specific guide tool) is illustrated according to exemplary embodiments of the present disclosure. As will be discussed, the guide 10 can include one or more patient-specific surfaces that engage corresponding surfaces of a patient's scapula. For instance, in the embodiments of FIGS. 3 and 4, patient-specific surfaces of the guide 10 can reference the glenoid face and can straddle the scapular spine. Once engaged with the scapular spine, guide surface(s) of the guide can be positioned, oriented, and located relative to the scapula. As such, the guide surface(s) can be used to guide a cutting tool (e.g., a drill bit) toward the scapula and/or the guide surface(s) can be used to guide a referencing object (e.g., a referencing pin) into the scapula. The guide 10 can also be shaped and dimensioned so as to avoid interference with surrounding soft tissue.

[0037] Generally, the guide 10 can include a guide portion 12, a patient-specific portion 14, and a shoulder 16 that is disposed therebetween. The guide portion 12, the patient-specific portion 14, and shoulder 16 can be integrally connected so as to be monolithic. Also, the guide 10 can be substantially L-shaped. Moreover, the guide 10 can be made from biocompatible metal and/or polymer.

[0038] The guide portion 12 can be generally frusto-conic in shape and can project partially from the shoulder 16 to have a length L3. The guide portion 12 can include a first axial end 18 (i.e., glenoid engaging surface) and a second axial end 20. The guide portion 12 can also include a transverse (radial) surface 24 that extends between the first and second axial ends 18, 20. The transverse surface 24 can be tapered in the radial direction.

[0039] Moreover, the guide portion 12 can include an opening 26 that extends between and is defined through the first and second axial ends 18, 20. In the illustrated embodiments, the opening 26 can be a groove or slot that is also defined through and open on the transverse surface 24. In additional embodiments, the opening 26 can be a through hole that is defined only through the first and second axial ends 18, 20. The opening 26 can have a substantially straight axis X. As will be discussed, an inner surface 28 of the opening 26 can be a guide surface that guides a cutting tool, such as a drill bit, or a referencing object, such as a referencing pin toward a glenoid of a patient.

[0040] Moreover, the patient-specific portion 14 can include a first member 30 and a second member 32 that extend from the shoulder 16 and that are spaced apart from each other at a distance D. In the embodiments illustrated, the members 30, 32 are posts that are axially straight and substantially parallel to each other. In additional embodiments, the members 30, 32 can be axially curved. The members 30, 32 can each have a respective length L1. The members 30, 32 can terminate at a respective end 35, 37.

[0041] The ends 35, 37 can be tapered and, in some embodiments, sharpened so as to enable the ends 35, 37 to penetrate through soft tissue. The members 30, 32 can also include respective patient-specific surfaces 34, 36. The surfaces 34, 36 can be recessed and can be three-dimensionally curved as will be described in greater detail below. The patient-specific surfaces 34, 36 can face each other.

[0042] The shoulder 16 can curve between the guide portion 12 and the patient-specific portion 14 at any suitable radius. In additional embodiments, the shoulder 16 extends linearly between the guide portion 12 and patient-specific portion 14. Also, the shoulder 16 can include an inner surface 38. Furthermore, the shoulder 16 can extend along a length L2 before the members 30, 32 branch apart away from the shoulder 16. Additionally, the shoulder 16 can be curved such that the members 30, 32 are disposed at an angle 8 relative to the axis X of the opening 26.

[0043] As shown in FIGS. 3 and 4, the guide 10 can be configured for engaging, mating, and nesting with a scapula 42 of a patient. Specifically, the members 30, 32 can cooperatively straddle the scapular spine 47 such that the patient-specific surface 34 nests to a superior surface 45 of the spine 47 and the patient-specific surface 36 nests to an inferior surface 49 of the spine 47. Positioned as such, the shoulder 16 can curve about and avoid interference with soft tissue (e.g., rotator cuff, etc.), and the first axial end 18 can abut against a glenoid face 46 of the patient to orient the opening 26 at a predetermined orientation and location relative to the glenoid face 46. In some embodiments, the first axial end 18 can also have a patient-specific convex surface that also nests with the glenoid face 46 for further mating the guide 10 to the scapula 42. Likewise, in some embodiments, the inner surface 38 of the shoulder portion 16 can include a patient-specific surface that is configured to nest against the rim of the glenoid face 46 and/or other surrounding tissue. Once nested against the scapula 42, the guide 10 can be constrained against rotational and translation movement about three orthogonal axes.

[0044] With the guide 10 positioned as such, the surface 28 of the opening 26 can guide an object toward the glenoid face 46. For instance, the surface 28 can guide a drill bit (not specifically shown) toward the glenoid face 46 to form a hole therein. Specifically, the drill bit can be inserted into the opening 26 at the second axial end 20, moved toward the first axial end 18, and cut (drill) into the glenoid face 46 while the surface 28 maintains the drill bit substantially coaxial with the opening 26. Then, as shown in FIG. 5, a referencing object 54 (e.g., a pin, etc.) can be received in the newly-formed hole and fixed to the glenoid face 46. The guide 10 can then be removed by the scapula 42 by sliding the members 30, 32 off of the scapular spine 47. In some embodiments, the guide 10 can move parallel to the axis X away from the glenoid face 46. In additional embodiments, the guide 10 can move transverse to the axis X, for instance, such that the referencing object 54 moves through the portion of the opening 26 defined in the transverse surface 24.

[0045] With the referencing object 54 in place in the glenoid face 46, a cutting tool 53 (e.g., a bur, a rasp, a reamer, etc.) can be coupled to the glenoid face 46. Specifically, a hole 55 of the cutting tool 53 can receive the referencing object 54, and the referencing object 54 can guide the cutting tool 53 axially toward the glenoid face 46. The cutting tool 53 can be actuated (e.g., rotated) via an actuator 57 (e.g., an electric motor, etc.) to remove tissue from the glenoid face 46.

[0046] Referring now to FIGS. 2-5, surgical procedures employing the guide 10 will be described in greater detail. For purposes of discussion, it will be assumed that the surgical procedure relates to the implantation of a shoulder prosthetic device that is operable to restore and repair the shoulder joint. The prosthetic device can include a humeral portion, a scapular portion, and a bearing in some embodiments. It will be appreciated that the prosthetic can be either an anatomic or reverse shoulder prosthetic device. Also, the guide 10 can be used during open surgical procedures or during arthroscopic surgical procedures as will be discussed.

[0047] Initially, the patient's anatomy can be imaged and measured using one or more MRI scans, CT scans, etc. Specifically, the dimensions, shape, and other features of the patient's scapula 42 can be determined from these images. Also the prosthetic joint and the surgical procedure can be planned according to these measurements. More specifically, the amount of wear, damaged tissue, etc. on the patient's glenoid face 46 can be measured in this manner. Also, an appropriate size and orientation of the prosthetic shoulder joint (relative to the scapula 42) can be selected for repairing the joint. Moreover, the surgeon can plan how much tissue should be removed, for example, from the glenoid face 46 for implantation of the prosthesis. The size, type, and other characteristics of the tool 53 (FIG. 5) necessary for removing the glenoid tissue can also be determined from this analysis. Moreover, the trajectory of the referencing object 54 relative to the glenoid face 46 for properly locating the tool 53 relative to the glenoid face 46 can be determined.

[0048] Additionally, the patient-specific guide 10 can be planned and constructed according to the data obtained from the images. The guide 10 can be constructed using known rapid-prototyping or other techniques. Specifically, the patient specific surfaces 34, 36 can be constructed according to the measurements of the superior and inferior surfaces 45, 49 of the scapula 42 such that the surfaces 34, 36 can mate and nest with each other. Likewise, the guide 10 can be constructed such that the lengths L1, L2, L3, the distance D, the angle θ, and/or other dimensions of the guide 10 enable the members 30, 32 to nest with the scapular spine 47 while the first axial end 18 abuts against the glenoid face 46.

[0049] Once the guide 10 is constructed, the surgeon can make one or more incisions 56 (FIG. 2) adjacent the shoulder joint. Then, assuming that this is an open-shoulder procedure, the humerus 40 of the joint can be separated from the scapula 42 to thereby expose the glenoid face 46. Then, the surgeon can mate the guide 10 to the scapula 42 by advancing the first and second members 30, 32 in a medial direction over the scapular spine 47 as shown in FIGS. 3 and 4. The ends 35, 37 of the members 30, 32 can penetrate through soft tissue during advancement over the spine 47. Moreover, in some embodiments, the members 30, 32 can resiliently deflect away from each other slightly during advancement over the spine 47, and the members 30, 32 can recover to a neutral position (e.g., as shown in FIG. 1) when the patient-specific surfaces 34, 36 reach the corresponding surfaces 45, 49 of the scapular spine 47.

[0050] Next, a drill bit (not specifically shown) can be received in the opening 26 of the guide 10, and the surface 28 can guide the drill bit axially toward the glenoid face 46 to form a hole for the referencing object 54 (FIG. 5). The referencing object 54 can be inserted into this hole of the glenoid face 46 to be fixed to the scapula 42. Subsequently, the tool 53 can be positioned over the referencing object 54, and the actuator 57 can drivingly rotate the tool 53 as it advances toward the glenoid face 46. As such, the tool 53 can remove the predetermined amount of tissue from the glenoid face 46 to prepare the glenoid face for implantation of a prosthetic device (not specifically shown). After the glenoid face 46 is fully prepared, the scapular portion of a prosthetic device can be implanted on the scapula 42 in a known manner. Also, the humerus 40 can be resected in a known manner, and a humeral portion of the prosthetic device can be implanted thereon. Then, the artificial joint can be assembled, and the incision 56 (FIG. 2) can be repaired.

[0051] Thus, it will be appreciated that the guide 10 and its method of use can significantly aid the surgeon during these and/or other procedures. Because of the patient-specific surfaces 34, 36, the guide 10 can be tailored for the specific patient, thereby allowing the procedure to be tailored for the specific patient. Accordingly, the prosthetic joint can be very effective in repairing the patient's mobility, etc.

[0052] Referring now to FIGS. 6-8, additional embodiments of a glenoid guide 110 are illustrated according to the teachings of the present disclosure. Components that correspond with those of FIGS. 1-5 are indicated with corresponding reference numbers increased by 100.

[0053] In some embodiments, the guide 110 can be a monolithic body with integrally connected components. Also, the guide 110 can be made from biocompatible metal, polymer, etc.

[0054] The guide 110 can include a block-shaped guide portion 112. The guide portion 112 can include a patient-specific surface 170 that is configured to engage and nest with the glenoid face 146 (FIGS. 7 and 8). For instance, the patient-specific surface 170 can engage and nest with an anterior rim of the glenoid face 146. In additional embodiments, the patient-specific surface 170 can engage and nest with a superior, inferior, and/or posterior portion of the rim of the glenoid face 146.

[0055] Also, the guide portion 112 can also include at least one tube 164a, 164b that includes an opening 126a, 126b (FIG. 8) extending therethrough. The tubes 164a, 164b can project from the guide portion 112, opposite the patient-specific surface 170. In the embodiments illustrated, there are two tubes 164a, 164b, and the openings 126a, 126b are holes that extend therethrough. The inner surfaces 128a, 128b can act as guide surfaces for guiding a drill bit, a referencing object, etc. toward the glenoid face 146. The tubes 164a, 164b also include respective slot-shaped windows 165a, 165b extending transversely therethrough. The windows 165a, 165b can allow the user to view the drill bit, referencing object, etc. moving through the openings 126a, 126b.

[0056] The openings 126a, 126b can be disposed at an angle α relative to each other. In some embodiments, the opening 126a can be configured for use during implantation of a normal shoulder prosthetic device whereas the opening 126b can be configured for use during implantation of a reverse shoulder prosthetic device. Thus, the guide 110 can be versatile and usable for both procedures. Moreover, one or both tubes 164a, 164b can include lettering or other symbols thereon that distinguish the tubes 164a, 164b from each other, that identify the patient associated with the guide 110, etc.

[0057] The guide 110 can further include a handle 168. In the embodiments illustrated, the handle 168 projects from one side of the guide portion 112 and the tubes 164a, 164b and tapers so as to have a generally triangular shape. The handle 164a can be used to grasp the guide 110 and to manipulate the guide 110 when mating the guide 110 against the scapula 142. For instance, the surgeon can apply pressure to the handle 168 medially toward the glenoid face 146 when mating the guide 110 against the scapula 142.

[0058] As shown in FIGS. 7 and 8, the guide 110 can further include a notch 166 that extends through the guide portion 112. The notch 166 can extend in the lateral-medial direction and can be disposed inferiorly relative to the handle 168 when the guide 110 is mated to the scapula 142. The notch 166 can provide exposure to the glenoid face 146 when the guide 110 is mated to the scapula 142 to ensure that the guide 110 is seated correctly against the scapula 142.

[0059] Furthermore, the guide 110 can include an arm 160 that projects away from the tube 164a or other portion of the guide 110. The arm 160 can be curved. In additional embodiments, the arm 160 can be axially straight.

[0060] Also, the guide 110 can include a patient-specific portion 114 (i.e., an acromion engaging portion) that is configured to engage and mate to the patient's acromion 148. The acromion-engaging portion 114 can include a head 162 that is fixed to the arm 160, on an end that is opposite the tube 164a. The head 162 can include a recessed patient-specific surface 134 that is the negative of the patient's acromion 148. Thus, the head 162 can be generally saddle-shaped, and the patient-specific surface 134 can mesh with the anterior, inferior, and posterior surfaces of the acromion 148 (FIGS. 7 and 8). Thus, the patient-specific surface 134 and the patient-specific surface 170 of the guide portion 112 can cooperate to closely mesh with the scapula 142 and constrain the guide 110 against relative movement.

[0061] In additional embodiments, the patient-specific surface 134 can engage only the anterior surface of the acromion 148. In still additional embodiments, the patient-specific surface 134 can be configured to nest with the inferior surface of the acromion 148 only. In further embodiments, the patient-specific surface 134 can be configured to nest with the posterior surface of the acromion 148 only.

[0062] It will be appreciated that the guide 110 can be designed, structured, shaped, dimensioned, and otherwise configured to nest with a particular patient's scapula 142 in order to locate at least one of the openings 126a, 162b in a predetermined manner relative to the glenoid face 146. Thus, the guide 110 can be used similarly to the guide 10 discussed above in relation to FIGS. 1-5. However, as mentioned above, the surgeon can choose to use only one of the tubes 164a, 164b for guiding a drill bit, a referencing object, etc., depending on whether a normal or a reverse shoulder prosthetic device is being implanted.

[0063] Referring now to FIGS. 9 and 10, additional embodiments of the guide 210 are illustrated according to exemplary embodiments. In some embodiments, the guide 210 can be used during arthroscopic procedures. The guide 210 can, however, also be used during open shoulder surgical procedures. Also, the guide 210 can nest against both the acromion 248 and the glenoid face 246, similar to the embodiments of FIGS. 6-8. Components that correspond to those of the embodiments of FIGS. 6-8 are indicated by corresponding reference numbers increased by 100.

[0064] As shown in FIG. 9, the guide 210 can include a first rod 276. The rod 276 can be elongate, axially straight, and can have a relatively small diameter in cross section. Accordingly, the rod 276 can extend through a small incision 256 in the patient's skin (e.g., during arthroscopic surgery). In some embodiments, a cannulated instrument (not specifically shown) can extend through the incision 256, and the rod 276 can extend through the cannulated instrument toward the acromion 248.

[0065] The rod 276 can also include the head 262 on one end. Like the embodiments of FIGS. 6-8, the head 262 can be generally saddle-shaped and can include patient specific surfaces that are configured to nest with anterior, inferior, and posterior surfaces of the acromion 248. Moreover, the rod 276 can be coupled to a handle 278 on an end opposite the head 262. The handle 278 can remain outside the patient's body while the head 262 is nested to the acromion 248.

[0066] The guide 210 can further include a second rod 280. On one end, the rod 280 can be coupled to the handle 278 such that the first and second rods 276, 280 are spaced apart at a distance. In some embodiments, the rod 280 can be removably coupled to the handle 278 (e.g., via a threaded attachment, etc.). The second rod 280 can extend through a separate incision 256 in the patient's body.

[0067] As best shown in FIG. 10, the second rod 280 can further include a patient-specific pad 284 on an end opposite the handle 278. The patient-specific pad 284 can be relatively small and disc-shaped and can include a patient-specific surface 285 thereon, which is configured to nest with the glenoid face 246 (e.g., at the superior portion of the glenoid face 246).

[0068] Moreover, the guide 210 can include a branch 290 that is substantially T-shaped and that is moveably (e.g., pivotally) attached to the second rod 280. In some embodiments, the branch 290 can include a patient-specific pad 286 on one end. The patient-specific pad 286 can be relatively small and disc-shaped and can include a patient-specific surface 287 thereon, which is configured to nest with the glenoid face 246 (e.g., at the inferior portion of the glenoid face 246). The branch 290 can further include a tab 286 with a guide tube 292 extending therethrough. The guide tube 292 can guide a drill bit 253, a referencing pin, or other object toward the glenoid face 246, similar to the embodiments discussed above. A scope 274 can extend toward the joint to allow the surgeon to view this procedure.

[0069] The guide tube 292 can be axially curved in some embodiments. This curvature can enable the surgeon to manipulate the drill bit 253 around surrounding tissue (e.g., during an arthroscopic procedure), where the drill bit 253 is flexible to follow the curvature. In other embodiments, the guide tube 292 can be axially straight.

[0070] As mentioned, the branch 290 can be moveably coupled to the second rod 280. The guide 210 can also include a lever 282 that is mounted to the handle 278 and a linkage 281 that operably couples the lever 282 and the branch 290. The linkage 281 can be a rigid rod that is attached at one end to the lever 282 and that is attached at the opposite end to the branch 290. By manipulating the lever 282, the surgeon can selectively move the branch 290 relative to the second rod 280. In some embodiments, the lever 282 can include a clamp or other retaining device that is operable to selectively fix the branch 290 relative to the second rod 280.

[0071] Thus, to use the guide 210, the surgeon can make the incisions 256 and can insert the first rod 276 into the patient to mate the head 262 to the acromion 248. Then, the surgeon can insert the second rod 280 into the patient. The second rod 280 and branch 290 can be inserted in a collapsed state (e.g., where the branch 290 is positioned substantially parallel to the second rod 280). Once inserted, the surgeon can use the lever 282 to move the second rod 280 and branch 290 to an expanded state (e.g., where the branch 290 is angled away from the second rod 280). This movement can allow both patient specific surfaces 285, 287 to nest against the glenoid face 246, thereby securing the guide tube 292 into the predetermined position relative to the glenoid face 246. Then, the drill bit 253 can be used to form the hole for the referencing pin, and the procedure can be carried out as discussed above. Next, the surgeon can use the lever 282 to collapse the branch 290 against the second rod 280, and the guide 210 can be removed from the patient's body.

[0072] Referring now to FIG. 11, additional embodiments of the guide 310 are illustrated. As will be disclosed, the guide 310 can be a patient-specific guide that nests against the glenoid 346 and the acromion 348. Thus, the guide 310 can include components that especially correspond to the embodiments of FIGS. 6-8. Corresponding components are identified with corresponding reference numbers increased by 200.

[0073] As shown, the guide 310 can include a guide portion 312 that can include one or more patient-specific surfaces for nesting against the glenoid face 346. The guide portion 312 can include a guide tube 326, which can guide a drill bit, a referencing pin, or other object toward a center of the glenoid face 346.

[0074] The guide 310 can further include an arm 360 that extends away from the guide portion 312 and a head 362 that is fixed to an end of the arm 360 opposite the guide portion 312. The head 362 can include patient-specific surfaces 334 that are configured to nest against the acromion 348, similar to the embodiments of FIGS. 6-8.

[0075] In some embodiments, the guide portion 312 and the arm 360 and/or the guide portion 312 and the head 362 can be moveably attached. For instance, in some embodiments, the guide 310 can include a movable coupling 394, such as a pivoting joint, that moveably couples the guide portion 312 and the arm 360. The coupling 394 can be substantially coaxial with the guide tube 326. The coupling 394 can be a ring bearing with an outer race fixed to the guide portion 312, an inner race fixed to the arm 360, and one or more bearings between the races. The coupling 394 could also be of a different type, such as a hinge, etc.

[0076] Because of the coupling 394, the guide 310 can move between a collapsed position and an extended position. In the extended position, the guide 310 can mate against both the glenoid face 346 and the acromion 348 as shown in FIG. 11. In the collapsed position, the arm 360 can rotate toward the guide portion 312 such that the guide 310 is more compact. Accordingly, during use, the surgeon can introduce the guide 310 into the patient's body while the guide 310 is collapsed. After the guide 310 is introduced, the surgeon can selectively and manually move the arm 360 away from the guide portion 312 and nest the head 362 to the acromion 348 and the guide portion 312 to the glenoid face 346. Then, the guide 310 can be used as detailed above. In some embodiments, the guide 310 can further include a retaining device, such as a clamp, etc., which can be used to selectively secure the guide 310 in its extended position.

[0077] Thus, because the guide 310 can selectively move between a collapsed and extended position, the guide 310 can be useful during arthroscopic surgical procedures. For instance, the guide 310 can be configured to collapse to a relatively small size so that the guide 310 can fit into a relatively small cannula to be introduced into the body and can move within the body without interfering with surrounding patient anatomy.

[0078] Referring now to FIG. 12, additional embodiments of a guide 410 are illustrated. Components that correspond to the embodiments of FIGS. 1-5 are indicated with corresponding reference numbers increased by 400.

[0079] As shown, the guide 410 can include an arm 414 with a head 462 attached. The head 462 can include one or more patient-specific surfaces 434 that are configured to nest with the patient's acromion (not specifically shown). The guide 410 can further include a guide portion 412. The guide portion 412 can include a cutting surface 496. The cutting surface 496 can be similar to those of known burr-type devices, rasps, or other cutting tools. Also, the cutting surface 496 can be patient-specific and can be configured according to the shape of the patient's glenoid surface and/or according to the amount of tissue that the surgeon aims to remove from the glenoid surface as will be discussed in greater detail below. The guide 410 can be operably coupled to an actuator 497 via a coupling 498. The actuator 497 can be of any type, such as a vibrating motor, etc., and the coupling 498 can be a rigid rod or other type that extends between the actuator 497 and the guide portion 412. Moreover, the guide 410 can include one or more fluid conduits 499 that pump fluids toward the cutting surfaces 496 for facilitating cutting of the glenoid face. In the embodiments illustrated, the fluid conduit 499 can extend toward the actuator 497 and through the coupling 498.

[0080] To use the guide 410, the patient's shoulder joint can be imaged using a CT scan, MRI, etc., and a treatment can be planned therefrom. Specifically, the surgeon can plan out how much tissue to remove from the glenoid face, locations on the glenoid face from which to remove tissue, etc. Then, the guide 410 can be planned and constructed accordingly to enable such tissue removal. Specifically, the size, shape, and relative locations of the head 462, patient-specific surfaces 434, arm 460, and cutting surfaces 496 of the guide 412 can be planned so as to enable tissue removal according to the surgical plan.

[0081] Thus, the guide 410 can allow the surgeon to provide patient-specific cutting of the glenoid face. Also, the guide 410 could be used to prepare the glenoid face for implantation of a patient-specific prosthetic implant. For instance, a bearing (not shown) could include a glenoid-engaging surface that is configured to mate against the glenoid face after the cutting surfaces 496 have prepared the glenoid face. The bearing can include a plurality of small posts with anchoring formations for anchoring into the glenoid face without the need for cement. Also, a patient-specific impacting guide can be employed for implanting such a bearing. The impacting guide could include a bearing engaging end that engages the bearing, an impacting head that the surgeon can impact to drive the bearing into engagement with the glenoid face, and a patient-specific surface that nests to the acromion or other portion of the scapula. Thus, the impacting guide could reference the patient's anatomy to ensure that the impacting guide is in its desired position relative to the anatomy during implantation of the bearing.

[0082] Referring now to FIG. 13, additional embodiments of a guide 510 are illustrated according to exemplary embodiments. Components that are similar to those of FIGS. 1-5 are indicated with corresponding reference numbers increased by 500.

[0083] In the embodiments illustrated, the guide 510 can include a guide portion 512 that is configured to engage the glenoid face. A guide tube 526 can extend from the guide portion 512 and an inner surface of the guide tube 526 can extend continuously through the guide portion 512. The guide portion 512 can be made out of transparent material (e.g., a transparent polymeric material). The guide portion 512 can also include cross hairs or other similar indicia thereon that are visible through the guide portion 512. The cross hairs can intersect the central axis of the guide tube 526.

[0084] In some embodiments, the guide 510 can include three-dimensionally curved, patient-specific surfaces that are configured to nest to the glenoid of the patient. Thus, the guide 510 can be used similar to the embodiments discussed above. The cross hairs on the guide portion 512 can help the surgeon center the guide portion 510 on the glenoid face.

[0085] In additional embodiments, the guide 510 can have standardized surfaces such that the guide 510 can be used for multiple patients. The guide 510 can also be part of a set of similar guides 510 of different sizes, and the surgeon can select an appropriately-sized guide 510 according to the particular size of the glenoid face. Again, the cross hairs on the guide portion 512 can help the surgeon center the guide portion 510 on the glenoid face.

[0086] In summary, the guides 10, 110, 210, 310, 410, 510 discussed above can facilitate implantation of a shoulder prosthesis. The guides 10, 110, 210, 310, 410, 510 can include one or more patient-specific features such that the guide 10, 110, 210, 310, 410, 510 can be tailored for a specific patient, and the associated shoulder prosthesis and/or implantation procedure can be similarly tailored. Thus, the patient's shoulder can be repaired and shoulder joint function can be restored in an effective manner.

[0087] The foregoing discussion discloses and describes merely exemplary arrangements of the present teachings. Furthermore, the mixing and matching of features, elements and/or functions between various embodiments is expressly contemplated herein, so that one of ordinary skill in the art would appreciate from this disclosure that features, elements and/or functions of one embodiment may be incorporated into another embodiment as appropriate, unless described otherwise above. Moreover, many modifications may be made to adapt a particular situation or material to the present teachings without departing from the essential scope thereof. One skilled in the art will readily recognize from such discussion, and from the accompanying drawings and claims, that various changes, modifications and variations can be made therein without departing from the spirit and scope of the present teachings as defined in the following claims.