(19)
(11)EP 3 096 714 B1

(12)EUROPEAN PATENT SPECIFICATION

(45)Mention of the grant of the patent:
13.05.2020 Bulletin 2020/20

(21)Application number: 14828635.4

(22)Date of filing:  26.12.2014
(51)Int. Cl.: 
A61F 2/40  (2006.01)
A61F 2/46  (2006.01)
(86)International application number:
PCT/US2014/072443
(87)International publication number:
WO 2015/112307 (30.07.2015 Gazette  2015/30)

(54)

STEMLESS HUMERAL ANCHOR

SHAFTFREIER SCHULTERANKER

ANCRE HUMÉRALE SANS TIGE


(84)Designated Contracting States:
AL AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HR HU IE IS IT LI LT LU LV MC MK MT NL NO PL PT RO RS SE SI SK SM TR

(30)Priority: 24.01.2014 US 201461931500 P

(43)Date of publication of application:
30.11.2016 Bulletin 2016/48

(60)Divisional application:
20166599.9

(73)Proprietor: Tornier, Inc.
Bloomington, MN 55437 (US)

(72)Inventor:
  • HODOREK, Brian C.
    Bloomington, MN 55437 (US)

(74)Representative: Lavoix 
62, rue de Bonnel
69448 Lyon Cedex 03
69448 Lyon Cedex 03 (FR)


(56)References cited: : 
US-A1- 2010 114 326
US-A1- 2013 261 629
US-A1- 2013 190 882
  
      
    Note: Within nine months from the publication of the mention of the grant of the European patent, any person may give notice to the European Patent Office of opposition to the European patent granted. Notice of opposition shall be filed in a written reasoned statement. It shall not be deemed to have been filed until the opposition fee has been paid. (Art. 99(1) European Patent Convention).


    Description


    [0001] The present invention related to a stemless humeral shoulder assembly.

    BACKGROUND


    Field



    [0002] The present disclosure relates to a stemless humeral component of a shoulder joint prosthesis.

    Description of the Related Art



    [0003] In a shoulder joint, the head of the humerus interacts with the glenoid cavity of the scapula in a manner similar to a "ball and socket" joint. Over time, it may become necessary to replace the shoulder joint with a prosthetic shoulder joint including a humeral component.

    [0004] Traditionally, the humeral component is a single body implant having a humeral head and a stem. The stem is configured to be inserted into an intramedullary canal of the humerus. In certain cases, insertion of the stem disadvantageously requires bone to be removed to fit the stem to the canal due to patient-to-patient anatomical variation. Another disadvantage of this approach is that integration of the stem into the bone through a natural process of bone ingrowth can make it difficult to remove the humeral component if it becomes necessary to replace the humeral component with another device.

    [0005] A stemless humeral component may be used to address some of the disadvantages of conventional humeral components. Stemless humeral components can decrease the amount of bone loss in preparing the humerus to receive the component and decrease the complexity of the joint replacement procedure.

    [0006] Stemless humeral component designs can be more challenging to secure to the humerus. Conventional stemless designs rely on bone ingrowth for strength. While such designs perform well over time, there is a risk in the early days and weeks after surgery where such ingrowth has not yet occurred that the stemless humeral component will be dislodged from the humerus. Dislodgement may also occur due to excessive wear, forces applied thereto during a revision surgery or other high load conditions. An example of such a stemless humeral component is provided by US2013/0190882 which discloses a chassis in a central recess of which can be coupled a post of a prosthetic humeral head. In order to secure the chassis to the humerus, three bone anchors are inserted through apertures that are formed through a collar surrounding the proximal end of the central recess. Another example of such a stemless humeral component is provided by US2013/0261629 which can be considered as the closest prior art for the present invention. US2013/0261629 discloses a base member having both spaced apart arms, which project from a proximal end of the base member, to be disposed at a bone surface, to a distal end of the base member, to be embedded in bone, and a central recess, which is configured to receive a mounting member of a joint interface.

    SUMMARY



    [0007] Accordingly, there is a need for a stemless humeral component or prosthesis designed to preserve bone in initial implantation while enhancing initial pull-out resistance. Preferably enhanced initial dislodgement resistance will also provide excellent long term fixation.

    [0008] For this purpose, the invention is a stemless humeral shoulder assembly as defined in claim 1. The present disclosure relates to various embodiments of a stemless humeral shoulder assembly that can minimize bone loss and provide excellent initial pull-out resistance and long term fixation. Advantageously, the humeral shoulder assemblies described herein provide adequate compression, increase rotational and longitudinal stability, and encourage bone ingrowth.

    [0009] Certain aspects of the disclosure are directed toward a prosthesis mounting system having a base member adapted to be driven into bone. The base member can include a central portion having a lumen extending along a longitudinal axis and a peripheral portion connected to the central portion. Further, the prosthetic mounting system can include an anchor having an inner passage sized to be advanced along the longitudinal axis of the base member. The anchor can have at least one thread surrounding the inner passage. When the anchor is coupled with the base member, the thread extends outward of the central portion of the base member.

    [0010] In one embodiment, a stemless humeral shoulder assembly is provided. The assembly includes a base member and an anchor member. The base member has a distal end that can be embedded in bone and a proximal end that can be disposed at a bone surface. The base member has a plurality of spaced apart arms projecting from the proximal end to the distal end. The anchor member is advanceable into the base member to a position disposed within the arms. The anchor member is configured to project circumferentially into the arms and into a space between the arms. The anchor member is exposed between the arms when advanced into the base member. The assembly includes a recess projecting distally from a proximal end of the anchor member to within the base member. The recess is configured to receive a mounting member of an anatomical or reverse joint interface.

    [0011] Certain aspects of the disclosure are directed toward methods for treating a shoulder joint. The methods can include accessing a humeral head, driving a base member into the humeral head, and advancing an anchor member into the base member. When the anchor member is advanced into the base member, a lateral projection of the anchor member can be disposed through the base member and can be embedded in bone adjacent to the base member. In certain aspects, the methods can also include securing a joint interface to the base member and/or the anchor member.

    [0012] As described above, in certain aspects the stemless humeral component can be modular to provide more options for the surgeon during a revision surgery. For example, the modular humeral component can include a stemless fixation component adapted to be secured in the head of the humerus and a spherical head removably attached to the fixation component. During the revision surgery, the modular approach can make it easier to convert an anatomic shoulder prosthesis to a reverse shoulder prosthesis.

    [0013] In any of the above-mentioned aspects, the anchor member can include a helical structure advanceable to engage corresponding surfaces of the arms. In certain aspects, the anchor can include a cylindrical sleeve and the helical structure can include at least one thread (e.g., one thread, two threads, three threads, or four threads) projecting laterally therefrom.

    [0014] Any feature, structure, or step disclosed herein can be replaced with or combined with any other feature, structure, or step disclosed herein, or omitted. Further, for purposes of summarizing the disclosure, certain aspects, advantages, and features of the inventions have been described herein. It is to be understood that not necessarily any or all such advantages are achieved in accordance with any particular embodiment of the inventions disclosed herein. No aspects of this disclosure are essential or indispensable.

    BRIEF DESCRIPTION OF THE DRAWINGS



    [0015] These and other features, aspects and advantages are described below with reference to the drawings, which are intended to illustrate but not to limit the inventions. In the drawings, like reference characters denote corresponding features consistently throughout similar embodiments. The following is a brief description of each of the drawings.

    Figure 1A is a perspective view of one embodiment of a stemless humeral shoulder assembly shown mounted in a humerus;

    Figure 1B is a cross-sectional view of Figure 1A, showing the stemless humeral shoulder assembly disposed in the humeral head;

    Figure 2 is a perspective view of the stemless humeral shoulder assembly of Figures 1A and 1B;

    Figure 3 is an exploded view of the stemless humeral shoulder assembly of Figure 2;

    Figure 4 is a top view of the base member of the shoulder assembly of Figure 2;

    Figure 5 is a first side view the base member of Figure 4;

    Figure 6 is a second side view of the base member of Figure 4;

    Figure 6A is a cross-section of the base member shown in Figure 6 through line 6A-6A in Figure 4;

    Figure 7 is a top perspective view of an anchor member of the shoulder assembly of Figure 2;

    Figure 8 is a side view of the anchor member of Figure 7;

    Figure 9 is a bottom view of the anchor member of Figure 7;

    Figures 10A-10H illustrate steps of various methods of implantation of the stemless humeral shoulder assembly of Figure 2;

    Figure 11 is a top perspective view of another embodiment of a stemless humeral shoulder assembly;

    Figure 12 is a top perspective view of a base member of the stemless humeral shoulder assembly of Figure 11;

    Figure 13 is a top view of the base member of Figure 12;

    Figure 13A is a side view of the base member of Figure 12;

    Figure 14 is a top perspective view of an anchor member of the stemless humeral shoulder assembly of Figure 11;

    Figure 15 is a top view of the anchor member of Figure 14;

    Figures 16A-16C illustrate steps of various methods of implantation of the stemless humeral shoulder assembly of Figure 11;

    Figure 17 is a top perspective view of another embodiment of a stemless humeral shoulder assembly;

    Figure 18 is a top perspective view of a base member of the stemless humeral shoulder assembly of Figure 17;

    Figure 19 is a top view of the base member of Figure 18;

    Figure 20 is a side view of the base member of Figure 18;

    Figure 21 is a bottom view of the base member of Figure 18;

    Figure 22 is a cross-sectional view of the base member of Figure 19 along line 22-22;

    Figure 23 is a top perspective view of an anchor member of the stemless humeral shoulder assembly of Figure 17;

    Figures 24A-24B illustrate tool and component combinations that can be provided in various methods of implantation of the stemless humeral shoulder assembly of Figure 17;

    Figure 25 illustrates an adaptor or centering pin that can be used to align a driver with a base member, as discussed herein;

    Figure 26 illustrates the performance of various embodiments of stemless humeral shoulder assemblies;

    Figure 27 is a cross-sectional view of another embodiment of a shoulder assembly having a locking device disposed between a base member and an anchor member thereof to reduce or eliminate disengagement of the anchor member from the base member;

    Figure 27A is an enlarged view of the locking device shown in Figure 27 taken through line 27A-27A;

    Figure 28 is a top perspective view of an anchor member assembly of the shoulder assembly of Figure 27;

    Figure 29 is a side view of a shoulder assembly having another embodiment of a locking device;

    Figure 30 is a side view of an anchor member of the shoulder assembly of Figure 29;

    Figure 31 is a top view of a shoulder assembly having another embodiment of a locking device; and

    Figure 32 is a bottom perspective view of a tool for actuating a locking structure of the locking device of the shoulder assembly of Figure 31 from a disengaged configuration to an engaged configuration.


    DETAILED DESCRIPTION



    [0016] While the present description sets forth specific details of various embodiments, it will be appreciated that the description is illustrative only and should not be construed in any way as limiting. Furthermore, various applications of such embodiments and modifications thereto, which may occur to those who are skilled in the art, are also encompassed by the general concepts described herein. Each and every feature described herein, and each and every combination of two or more of such features, is included within the scope of the present invention provided that the features included in such a combination are not mutually inconsistent.

    [0017] Figure 1A shows a humeral shoulder assembly 100 that has been implanted in an exposed face F of a humerus H. The assembly 100 has a recess 104 in which further components of a prosthetic shoulder joint can be secured. The configuration of the assembly including the recess 104 enable the humerus H and a corresponding scapula to be fitted with either an anatomical shoulder or a reverse shoulder configuration either initially or as part of a revision procedure. Figure 1B shows that in certain applications, the shoulder assembly 100 can be fully retained within a head h of the humerus H. In other words, the distal-most portion of the assembly 100 is disposed in the humeral head h. The assembly 100 does not have members that protrude beyond the head h into the intramedullary canal. This arrangement is less invasive and simplifies the procedure compared to a procedure involving a humeral component with a stem, as discussed elsewhere herein.

    [0018] Figures 2-9 elaborate on advantageous structures and variations of the shoulder assembly 100 that can be employed in the stemless approach of Figures 1A-1B. Methods of using the shoulder assembly 100 are discussed below in connection with Figures 10A-10H. Shoulder assemblies capable of being at least partly delivered over a guide wire are discussed below in connection with Figures 11-16C. Figures 17-24B illustrate shoulder assemblies where a joint interface mounting platform or recess is disposed on a base member and an anchor member is provided primarily or solely for bone securement function. Figure 25 shows an adaptor that can be used in connection with several embodiments and methods of applying shoulder assemblies. Figure 26 illustrates the performance of certain embodiments compared to a prior art design. While incremental differences in these embodiments and methods are discussed below, it is to be understood that features of each embodiment can be combined with features of the other embodiments, as appropriate.

    I. ASSEMBLIES HAVING REINFORCED BONE ENGAGING ANCHOR MEMBERS



    [0019] Figure 2 and 3 show more detail of components of the shoulder assembly 100 that among other features and advantages provides an anchor member with an inwardly positioned cylindrical member that reinforces outwardly positioned helical structures as discussed below.

    [0020] The assembly 100 has a base member 108 and an anchor member 112. Figure 3 shows that the base member 108 and anchor member 112 are separable components that can be applied to the patient separately, e.g., assembled in multiple steps within the bone as discussed below. The base member 108 has a distal end 120 and a proximal end 124. The distal end 120 is configured to be embedded in the head of a humerus. The proximal end 124 is configured to be disposed adjacent to a face of the humerus or another bone surface. The base member 108 has a plurality of spaced apart arms 128 projecting from the proximal end 124 to the distal end 120. The base member 108 also has a central portion, e.g., a cylindrical member 130, that forms part of the recess 104, as discussed in more detail below. In the illustrated embodiment, the arms 128 are equally spaced about the cylindrical member 130. The arms 128 can be spaced apart by about 120 degrees. The base member 108 and the other base members discussed below can have three arms. The base member 108 and the other base members discussed below can have one or a plurality of arms 128. In various embodiments, the base member 108 and the other base members discussed below can have two, three, four, five, or six arms. The arms 128 preferably are thin in the circumferential direction such that large gaps are provided between the arms.

    [0021] Figures 3 and 4 show the proximal end 124 of the base member 108 in more detail. In particular, the proximal end 124 can include a peripheral member 140 disposed about the outer periphery of the proximal end 124. The peripheral member 140 can be coupled with proximal ends 144 of the arms 128 (see Figures 5-6A) to provide a unitary structure. In one embodiment, the peripheral member 140 comprises an annular structure 145 that is tapered such that a convex surface 146 is provided between proximal and distal portions of the peripheral member 140. The convex surface 146 extends from a bone engaging side of the peripheral member 140 to a proximal side of the peripheral member 140. The proximal side of the peripheral member 140 is disposed adjacent to but may be spaced from another joint component, such as a portion of an assembly including an anatomical or reverse shoulder joint humeral interface.

    [0022] In one embodiment, the proximal end 124 can include a plurality of guide members 148 that can be coupled with the peripheral member 140. The guide members 148 can include plate-like projections extending radially inwardly from an arcuate segment of the peripheral member 140. The guide members 148 can be coupled with, attached to or a monolithic extension of an inner edge of the peripheral member 140. In one embodiment, the base member 108 includes three guide members 148. The guide members 148 can include an angled or lead surface 152 that is angled relative to a transverse plane of the proximal end 124. As used in this context, a transverse plane of the proximal end 124 is a plane that extends perpendicular to a longitudinal axis A (see Figures 5 and 6A) of the cylindrical member 130. The angle of the lead surface 152 is selected to match the angle of a distal face of a helical structure of the anchor member 112 as discussed further below in connection with Figure 6A and 8.

    [0023] In one embodiment, each of the guide members 148 includes a flat surface 156. Each of the flat surfaces 156 can be disposed on a transverse plane of the proximal end 124. The flat surfaces 156 can extend between an outer portion 160 coupled with the peripheral member 140 and an inner portion 168 disposed adjacent to the cylindrical member 130. In the illustrated embodiment, each inner portion 168 of three guide members 148 is spaced from the cylindrical member 130 by a corresponding gap 172. The gaps 172 partly define an annular volume (projecting distally into the page in Figure 4) in which a cylindrical portion of the anchor member can be disposed, as discussed further below.

    [0024] Figure 3 shows that the flat surface 156 can be disposed at an elevation distal of (or below) the proximal-most aspect of the peripheral member 140. The distance between the proximal-most aspect of the peripheral member 140 and the flat surface 156 can provide a space into which at least a portion of the anchor member 112 can be recessed. In one embodiment, a proximal end 180 of the cylindrical member 130 is disposed at about the same elevation of the proximal-most aspect of the peripheral member 140. In some embodiments, an outside surface of the cylindrical member 130 and an inside surface of the peripheral member 140 define side surfaces of an annular space into which a proximal portion of the anchor member 112 can be received. Figure 2 shows that the annular space bounded by the outside surface of the cylindrical member 130 and the inside surface of the peripheral member 140 provides a substantially flush, e.g., stepless, profile or transition from the inner and proximal-most aspect of the peripheral member 140 to an outer periphery 182A of the anchor member 112 and from an inner periphery 182B of the anchor member to the proximal end 180 of the cylindrical member 130. The flush profile enables other components of a shoulder joint to be drawn down adjacent to but preferably spaced from the assembly 100.

    [0025] Figure 4 shows that the guide members 148 generally are spaced apart by arcuate openings 192. The openings 192 extend from a lower end of one of the angled surfaces 152 to an end of an adjacent guide member 148. As discussed further below, the openings 192 permit laterally extending portions of the anchor member 112 to be advanced into the base member 108. In certain embodiments, the laterally extending projections include one or more, e.g., three, threads that can be advanced through the openings to engage with the base member 108 at a position distal of the guide members 148. Figure 4 shows that the arms 128 are disposed distal of but accessible through the openings 192. The arms 128 are located at a circumferential position between the angled surface 152 of a first guide member 148 and a non-angled surface of a second guide member 148, where the second guide member is adjacent to the first guide member. Preferably, the circumferential position of the arms 128 is closer to the circumferential position of the non-angled surface of the second guide member 148 as shown. In this context, the circumferential position is determined by projecting these structures to the plane upon which the non-angled surface 148 is disposed. Figure 6A shows that a proximal portion of the arms 128 is located distal of the distal-most aspect of the angled surface 152.

    [0026] Figure 6A shows one of the arms 128 in more detail. In some embodiments, the arms 128 are each identical. In other embodiments, the arms differ from each other. For example, in the single thread configurations of Figures 11 and 17 the arms differ from each other in having slots advanced distally from a first arm to a next arm in the direction of rotation of an anchor member to accommodate the path of the helical member or thread, as discussed below in connection with those embodiments. The arms 128 have a plurality of slots 202, e.g., three slots disposed between proximal and distal ends thereof. Figure 6A shows that the proximal-most slot 202 can be different from the two slots 202 disposed distal thereof in that the proximal-most slot 202 is bounded by a lower surface 218A discussed below but not by a corresponding upper edge formed in the arm 128. As noted above, the arm 128 is coupled with the peripheral member 140 at a proximal end 144 of the arm 128. In one embodiment, a unitary structure is provided. In such a structure, a continuous structure can be provided from within the peripheral member 140 to within a proximal portion of the arm 128 so that there are no welds or joining lines or boundaries in this area. Such an arrangement simplifies the structure and eliminates potential areas for concentration of stress and potentially failure.

    [0027] An outer edge 210 of the arms 128 provides a continuously arcuate sloping surface in one embodiment. The sloping surface can facilitate insertion of the base member 108 into an exposed humeral face F as discussed above and further below in connection with Figures 10A-10H. An inner edge 214 of the arm 128 can include one or a plurality of, e.g., three, laterally extending faces or surfaces 218A, 218B, 218C.

    [0028] The angle of the surfaces 152, 218A, 218B, 218C can be configured to facilitate advancement of a lateral extent of the anchor member 112 along a helical path. For example, initial advancement of a lateral portion of the anchor member 112 can cause a leading edge surface of the anchor member 112 to slide along the surface 152 shown in Figure 6A. Continued advancement can cause the leading edge surface of the anchor member 112 to approach and then slide across the surface 218A shown in Figure 6A. Continued advancement can cause the leading edge surface of the anchor member 112 to approach and then slide across a surface 218B of an arm 128 disposed adjacent to and on a first side of the arm 128 shown in Figure 6A. Continued advancement can cause the leading edge surface of the anchor member 112 to approach and then slide across a surface 218C of an arm 128 disposed adjacent to and on a second side of the arm 128 shown in Figure 6A. Once the anchor member 112 slides across the surface 218C of each arm 128, the anchor member 112 can continue to rotate an additional 5-15 degrees to further compress the entire construct into the bones. Advancement is complete when a proximal face of the threads 340 (see Figure 8) contacts an upper surface 222B, 222C of the slots 202 (see Figure 6A).

    [0029] At least some of the surfaces 218A, 218B, 218C can be disposed in laterally projecting recesses or channels of the arms 128. For example, the surface 218B extends laterally outwardly from the inner edge 214 of the arms 128. A corresponding surface 222B can extend outwardly from the inner edge 214 adjacent to the surface 218B. The surfaces 218B, 222B can be substantially parallel along their length. The surfaces 218B, 222B can be spaced apart by a short distal-proximal distance. The short distal-proximal distance can be about the same as the thickness of lateral protrusions (e.g., threads) of the anchor member 112 discussed below. In these embodiments both of the surfaces 218B, 222B play a role in guiding the advancement of the anchor member 112. The face 222B can have an angled surface similar to that of the surface 218B. For example, the angle of the face 222B can be the same angle as that of the face 218B.

    [0030] In one embodiment, each of the faces 218A, 218B, 218C has a length as measured radially away from the axis A that differs from the length of the other faces. The distal-most face 218C can have the shortest length. The proximal-most face 218A can have the longest length. A face 218B disposed between the distal- and proximal-most faces 218C, 218A can have an intermediate length. These lengths can correspond to the tapered profile of the base member 108, e.g., with the arms 128 having a generally convex shape from proximal to distal as viewed from the side. The lengths of the faces 218A, 218B, 218C can correspond to the profile of the lateral projection of the anchor member 112, which is some embodiments may be tapered.

    [0031] In one embodiment, the proximal-most face 218A does not have a corresponding face on the arm 128 disposed proximal thereof. A lower surface of the guide member 148 disposed adjacent to but clockwise of the arm 128 can abut a proximal side of a thread while a distal side of the thread advances along the face 218A. In this sense, each of the faces 218A, 218B, 218C has a corresponding surface that together guide a thread of the anchor member 112 as discussed further below.

    [0032] In the embodiment of Figures 1-10H, each arm has a plurality of, e.g., three faces 218A, 218B, 218C. The face 218A of each of the arms 128 is disposed at the same elevation as the corresponding face 218A of adjacent arms 128. The face 218B of each of the arms 128 is disposed at the same elevation as the corresponding face 218B of adjacent arms 128. The face 218C of each of the arms 128 is disposed at the same elevation as the corresponding face 218C of adjacent arms 128. This construction defines a plurality of helical paths on the base 108 for guiding helical members, as appropriate for certain embodiments. Other embodiments have different helical paths, such as a single path as discussed below in connection with the embodiments of Figures 11 and 17. Rather, a plurality of spaced-apart surfaces reside on and/or define the helical path. In one right-hand configuration, a first helical path is defined by a face 218A of a first arm 128, a face 218B of a second arm 128 adjacent to but disposed clockwise of (as defined above) the first arm, and a face 218C of a third arm 128 adjacent to but disposed counter-clockwise of (as defined above) the first arm. In one embodiment, the first helical path also includes the lead surface 152 disposed above and circumferentially between the first and third arms 128. A second helical path can extend from a surface 152 to the second arm 128 to a face 218C of the first arm 128. A third helical path can extend from a surface 152 of the third arm 128 to a face 218C of the second arm 128. Each of the surfaces on the helical paths can have substantially the same angle relative to a transverse plane of the base 108. In some embodiments, the angle of the faces 218A, 218B, 218C can be different.

    [0033] In other embodiments of the base member 108, three left-handed helical paths can be provided, each one commencing with an oppositely oriented surface similar to the surfaces 152 and traversing counter-clockwise to a face 218A below and on the arm 128 immediately counter-clockwise of the oppositely oriented surface, then to the face 218B on the next arm 128 and then to the face 218C on the next arm 128. In this context, the "next arm 128" is the arm circumferentially spaced from and immediately counter-clockwise of the arm from which the path extends.

    [0034] Unlike a conventional mating screw structure, only very small segments of the helical path involve contact between the faces 218A, 218B, 218C and a mating structure. This arrangement enhances the surface area of the anchor thread contacting bone when the assembly 100 is disposed in the bone.

    [0035] Figure 5 shows that a gap 232A is provided between the inner edge 214 and the cylindrical member 130 below the face 218A. A gap 232B is provided between the inner edge 214 and the cylindrical member 130 below the face 218B. A gap 232C is provided between the inner edge 214 and the cylindrical member 130 below the face 218C. The gap 232C is substantially the same width as the gaps 232A, 232B. In one embodiment, the gaps 232A, 232B, 232C are substantially the same as the gap 172. The gaps 172, 232A, 232B, 232C define part of a cylindrical space configured to receive part of the anchor member 112 as discussed further below. The gap 232C enables a distal portion of the anchor member 112 to be advanced distal of the face 218C.

    [0036] Figure 6A shows that in some embodiments, the cylindrical member 130 has a threaded recess 250 formed in a lower portion thereof. The threaded recess 250 enables a component to be advanced into engagement with the base member 108. The component can be another component of a prosthetic joint or can be a tool used in placement of one or more components of the shoulder assembly 100. The recess 250 can engage a guide tool 432 (see Figure 25) in one technique, discussed in more detail in connection with Figure 10F.

    [0037] Figures 2 and 7-9 illustrate features of the anchor member 112 which, as discussed above, is advanceable into the base member 108 to a position disposed within the arms 128. The anchor member 112 includes a proximal face 300, a helical structure 304 disposed distally of the proximal face 300, and a cylindrical sleeve 308 configured to be disposed around the recess 104. In some embodiments, the sleeve 308 is configured to be advanced over and receive the cylindrical member 130 as discussed further below.

    [0038] The proximal face 300 comprises the proximal side of a disc structure 312 disposed at the proximal end of the anchor member 112. The disc structure 312 is configured to be disposed in a space partly bounded by the flat surfaces 156, the inner face of the peripheral member 140, and the outer face at the proximal end 180 of the cylinder member 130 of the base member 108 (see Figure 3). The disc structure 312 can have a thickness (proximal-to-distal distance) substantially the same as the distance from the flat surfaces 156 to the proximal most aspect of the peripheral member 140. The anchor member 112 is configured such that regions 320 (Figure 9) of the distal surface of the disc structure 312 are advanced into a position to abut the flat surfaces 156 of the base member 108 when the shoulder assembly 100 is assembled.

    [0039] Figures 8 and 9 show the helical structure 304 in more detail. In one embodiment, the helical structure 304 includes three spaced apart helical protrusions 332A, 332B, 332C. In this embodiment, the anchor member 112 has a triple lead configuration. Other embodiments can have a single lead (as in the embodiments discussed in connection with Figures 11 and 17 below), a double lead, or a quadruple lead configuration. Distal ends of the three helical protrusions 332A, 332B, 332C can be seen in Figure 9. Each of these helical protrusions 332A, 332B, 332C has progressively larger diameter from a distal end to a proximal end thereof in the illustrated embodiment. The larger size toward the proximal end enables the helical protrusions to project farther laterally into the faces 218A, 218B, 218C of the arms 128. The smaller size toward the distal end enables the disruption of bone toward the distal end to be minimized. The helical protrusions can be threads in some embodiment.

    [0040] Figure 8 shows distal and proximal faces 336, 340 of one of the helical protrusions. The distal face 336 is configured to be advanced along one or guided by one of the helical paths described above. The distal face 336 is angled relative to a transverse (e.g., perpendicular) cross-sectional plane of the anchor member 112, which angle may be selected to match the lead surface 152, as discussed above. For example, the distal face 336 can slide along the lead surface 152, one of the faces 218A, one of the faces 218B, and one of the faces 218C. The proximal face 340 can slide along or be guided by the surface 228B (Figure 6A) or another distally-oriented face disposed in one of the arms 128 or on a lower surface of the guide member 148.

    [0041] Figure 8 shows that a spiral or helical surface 342 extends between adjacent helical protrusions 332A, 332B, 332C. The spiral surface 342 can extend from the base of a distal surface 336 of the helical protrusion 332B to the base of the proximal surface of the helical protrusion 332C. The spiral surface 342 has a proximal to distal dimension that is about the same as the proximal-distal dimension of the side surface 214 between the surfaces 218A, 228B (See Figure 6A). The proximal to distal dimension of the spiral surface 342 is about 50 % larger than and in some cases twice as large as the proximal to distal dimension of the helical protrusions 332A, 332B, 332C.

    [0042] Figure 2 shows that the anchor member 112 projects into the arms 128 and into a space between the arms when the anchor member and the base member are assembled. The anchor member 112 is exposed between the arms 128 when advanced into the base member 108. More specifically, a plurality of elongate segments 352 of the helical protrusions 332A, 332B, 332C are not covered by the faces 218A, 218B, 218C, 222B of the arms 128 but rather are located in an open area between the arms. The exposed segments 352 create areas of engagement with the bone that vastly increase the initial pull-out force of the assembly 100 when initially placed. This improved initial pullout force greatly reduces the chance of dislodgement, as discussed below in connection with Figure 26.

    [0043] Some additional unique features of the assembly 100 include helical surfaces in the anchor member 112 that mate only in very small and spaced apart areas of the base member 108 while exposing a majority of the helical surface to allow the exposed areas to be disposed directly in the bone for direct contact therewith. In some embodiments, a portion of the helical surface is disposed within the arms 128 and not exposed but a majority of the helical surface is exposed to be embedded in bone. The percentage of the surface area of the exposed segments 352 to the total area of the helical protrusions 332A, 332B, 332C is between about 80 and 98% in some embodiments. The percentage of the area of the exposed segments 352 to the total area of the helical protrusions 332A, 332B, 332C is between about 85 and 95% in some embodiments. The percentage of the area of the exposed segments 352 to the total area of the helical protrusions 332A, 332B, 332C is about 91% in some embodiments. Similarly, the ratio of the length of the exposed segments 352 to the total length of the helical protrusions 332A, 332B, 332C is between about 0.8 and about 0.98, e.g., between about 0.85 and about 0.95, e.g., about 0.9 in various embodiments. It may be desirable to further enhance engagement of the assembly 100 and other assemblies herein by increasing the ratios and percentages discussed in this section. Higher percentages and ratios can be provided by decreasing the distance between threads such that each thread has more turns. The percentage and ratios discussed in this passage are also applicable to the other embodiments discussed below.

    [0044] Also, the structure provided herein enables the threads to extend a large distance from the center of the recess 104. For example, the lateral extent, e.g., radius of the helical protrusions 332A, 332B, 332C can be at least 50% of the lateral extent, e.g., radius of the peripheral member 140, for example, at least about 50% and/or less than or equal to about 75%. In some embodiments, the lateral extent of at least one of the helical protrusions 332A, 332B, 332C can be at least about 50%, such as between about 50% and about 55%, of the diameter of the peripheral member 140. In some embodiments, the lateral extent of at least one of the helical protrusions 332A, 332B, 333C can be at least about 60%, such as between about 60% and about 65%, of the diameter of the peripheral member 140. In some embodiments, the lateral extent of the helical protrusions 332A, 332B, 333C can be at least about 70%, such as between about 70% and about 75%, of the diameter of the peripheral member 140. In certain embodiments, as shown in Figure 8, the diameter of each of the helical protrusions 332A, 332B, 332C can vary from the proximal face 300 to the distal end 310 of the anchor 112. For example, the diameter of a portion of the helical protrusions 332A, 332B, 332C near the proximal face 300 can be greater than the diameter of a portion of the helical protrusions 332A, 332B, 332C near the distal end 310. The percentage can be measured against any portion of the protrusions 332A, 332B, 332C. In some embodiments, the lateral extent of the helical protrusion 332C can be between about 50% and 55% of the diameter of the peripheral member 140, while the lateral extent of the helical protrusion 332A can be between about 70% and 75% of the diameter of the peripheral member 140.

    [0045] Figure 7 shows that the proximal face 300 of the anchor member 112 can include a driver interface 364 to facilitate advancing the anchor member 112 into the base member 108. The driver interface 364 can take any suitable form, for example, as three spaced apart recesses. The recesses can be cylindrical recesses extending into the disc member 312.

    [0046] Figures 10A-10H illustrate methods of implanting the humeral shoulder assembly 100 into the humerus H. Prior to the step illustrated by Figure 10A, surgical access has been provided to the humerus H and the humerus has been prepared. Preparing the humerus H can include cutting off a joint-facing portion of the humeral head h. The joint facing portion can be further prepared, for example by providing a countersunk region CS in the exposed face F. The countersunk region CS enhances a low profile application of the assembly 100 as discussed further below. A pin 400 is placed in a central region of the countersunk region CS. Figure 10B shows that the pin 400 may be used to guide a reamer to create a well at the base of the pin. Figure 10C shows the well having received a tool 404 that has been advanced into the face F to modify the well to receive the base member 108. For example, the tool 404 has a plurality of, e.g., three, radial projections 406 to create channels radiating from the well as shown in Figure 10D. Preferably the projections 406 have an edge profile similar to that of the arms 128, e.g., with a convex edge from proximal to distal when viewed from the side similar to the edge 210.

    [0047] Figures 10D show the expose humeral face F with the pin 400 and tool 404 removed so that a created recess CR in the face F is shown. The recess CR is configured to permit the base 108 to be advanced with ease into the face F of the humeral head h as shown in Figure 10E. More specifically, the recess CR is shaped to match the shape of a portion of the base member 108 that projects distally. For example, Figure 4 shows that the arms 128 can be equally spaced about the base member 108, e.g., outer ends thereof coupled with the peripheral member 140 can be spaced circumferentially by about 120 degrees. The arms 128 can be thin at radially outer portions thereof and can be joined adjacent to the distal end 120 of the base member 108. Accordingly, the radial projections of the recess CR created by the radial projections 406 of the tool 404 can be narrow and spaced apart by the same amount as the arms 128, e.g., about 120 degrees apart.

    [0048] Although the projection 406 and corresponding projections of the recess CR are generally straight, radial projections, the projections 406 could be curved and/or can extend away from a central region to in a non-radial direction matching the shape and orientation of any projections of the base member 108.

    [0049] Preferably, the insertion of the base member 108 into the recess CR can be achieved with ease, e.g., without an impactor or any other tools, but rather by hand force. The base member 108 advantageously is symmetrical about the axis A (see Figures 4 and 5). This allows the surgeon to insert the base member 108 in any orientation provided that the arms 128 and the projections in the recess CR are aligned. Other configurations have a preferred orientation, as discussed further below.

    [0050] Figures 10E-10F show that the countersunk region CS is configured to receive the peripheral member 140 in a recessed position. For example, the countersunk region CS has a bone recessed area, which is recessed by about the proximal-distal dimension 416 (shown in Figure 6) of the peripheral member 140. By recessing the base member 108, the base member and/or the humeral shoulder assembly 100 can positioned as desired relative to the face F of the humeral head h, e.g., with a small gap or flush mounted. Flush-mount enables a joint interface coupled with the assembly 100 to be positioned close to the face F, e.g., with little to no gap therein. Consistent and accurate positioning of the assembly 100 and joint interface can be important factors in properly locating the prosthetic joint interface.

    [0051] Figure 10F shows that after the base member 108 has been inserted into the face F of the humerus a subsequent step can involve coupling the guide tool 432 with the base member. Figure 25 shows details of one embodiment of the guide tool 432. The guide tool 432 preferably includes a guide body 436 disposed at a proximal portion thereof. The guide body 436 projects outside and proximally of the base member 108 and is configured to guide the anchor member 112 to be advanced thereover. In one form, the guide body 436 is a cylindrical member. A distal portion 440 of the guide tool 432 is configured to be coupled with the base member 108. In particular, a threaded distal portion 444 is configured to mate with the threads in the threaded recess 250 (see Figure 6A). A tapered portion 448 facilitates insertion of the guide tool 432 into the cylindrical member 130 of the base member 108. More particularly as shown in Figure 6A, the cylindrical member 130 can be tapered on an inside surface thereof, such that the recess formed in the member 130 is narrower at the distal end than at the proximal end thereof. Stated another way, a wall surrounding the recess in the cylindrical member 130 is closer to the axis A near the threads 250 than near the proximal end of the recess. Similarly, the outside surface of the tapered portion 448 is closer to a central longitudinal axis B of the guide tool 432 than is a proximal portion of the tapered portion 448. The tapers match such that if the guide tool 432 is inserted into the cylindrical member 130 with the axis A, B offset, the surface 448 and the inside surface of the recess in the cylindrical member 130 match to align these axes before the threads 444 and the threads in the recess 250.

    [0052] Figure 10G shows the anchor member 112 engaged with the base member 108. This configuration results from advancement of the anchor member 112 over the guide tool 432 in one method. In one embodiment, a method step includes coupling a driver with the driver interface 364 on the proximal face 300 of the anchor member 112. The driver can take any suitable form, e.g., can include a plurality of protrusions configured to mate with recesses of the driver interface 364. The driver can be configured to snap into or onto the anchor member 112 at the driver interface 364. Embodiments of a driver are discussed below in connection with Figures 16B and 24B. Preferably, the driver has a ratchet mechanism such that the surgeon can continuously hold the tool and need not release the handle to re-grip it to apply additional turns to the anchor member 112. However, one advantage of the three thread design of the anchor member 112 is that less rotation of the anchor member is required as compared to a two thread design or a one thread design to fully seat the anchor member in the base member 108.

    [0053] In one method, the surgeon observes the face F of the humerus and advances the anchor member 112 until some fluid is observed to emerge from the recess CR and / or around the assembly 100. The emergence of fluid suggests that the anchor member 112 is fully seated in the bone in a way providing excellent initial bone retention. Such retention provides enhanced pull-out force.

    [0054] Figure 26 illustrates the initial pull-out force 1510 for Embodiment A, a variant of the shoulder assembly 100 in which the anchor member 112 has a single continuous thread. Portions of the helical structure 304 project into the open area defined between the arms 128 and engage the bone thereby increasing the initial pull-out force of the assembly 100 when initially placed. As shown in Figure 26, the peak force corresponding to the initial pull out force 1510 of Embodiment A is at least ten times greater than the peak force corresponding to the initial pull out force 1500 of the prior art design having a base member and no anchor thread.

    [0055] As discussed above, the assembly 100 enables a variety of joint interface components. The surgeon can couple an anatomical joint interface with the assembly 100, e.g., by positioning an anchor portion of the anatomical joint interface in the recess 104. In some cases, a reverse shoulder configuration is better for the patient. The surgeon can dispose an anchor portion of a reverse configuration shoulder joint interface in the recess 104. Figure 10H shows an adaptor 464 coupled with the recess 104. The adaptor 464 can be seated with a concave socket portion 468 that can be coupled with a convex head implanted in the scapula in the reverse shoulder configuration.

    [0056] The methods described above, e.g., in connection with Figures 10A-10H, can include additional steps and employ additional tools as discussed below. The shoulder assembly 100 also can be adapted to be compatible with other methods herein, e.g., having a guidewire passage suitable for employing over-the-wire methods discussed below.

    [0057] The assembly 100 and the methods described above can be modified by incorporation of structures and methods discussed in connection with the embodiments below.

    II. ASSEMBLIES HAVING GUIDEWIRE DELIVERY CAPABILITY



    [0058] Figure 11-16C show a stemless shoulder assembly 500 and methods similar to the shoulder assembly 100 and methods discussed above except as described differently below. The assembly 500 is configured to allow a guidewire to be used to advance components thereof into a prepared humeral face F, providing for an efficient and accurate procedure. The assembly 500 includes a recess 504, a base member 508, and an anchor member 512. As discussed more below, a thread or other helical protrusion 532 extends from the anchor member 512 into engagement with the base member 508 and into an open area where it can engage bone. In this embodiment, the anchor member 512 has a single lead configuration. Other embodiments can have a multiple lead configuration, e.g., including a double lead, a triple lead, or a quadruple lead configuration.

    [0059] Figures 12, 13 and 13A show features of the base member 508 that facilitate delivery of the base member and/or the anchor member 512 over a guidewire. For example, the base member 508 has a plurality of arms 528A, 528B, 528C that extend between a distal and a proximal end 520, 524 of the base member 508. The arms 528A, B, C are coupled with a sleeve 530 disposed adjacent to the distal end 520 of the base member 508. The sleeve 530 has an opening at a proximal end 534 thereof extending into a lumen 538. The lumen 538 extends from the opening at the proximal end 534 to an opening at the distal end 520 of the sleeve 530. The lumen 538 is accessible through an open space 542 disposed between the arms 528A, B, C and between the proximal end 534 of the sleeve 530 and the proximal end 524 of the base member 508. The space 542 provides access to the lumen 538 by a direct path, e.g., a path perpendicular to the plane of the proximal end 524 of the base member 508.

    [0060] Figure 12 shows that the base member 508 includes a guide surface 548 and a lead surface 552 in some embodiments. The guide and lead surfaces 548, 552 can be regions of a continuous guide member and can be a continuous expanse without a change in orientation between them. The guide surface 548 can be substantially flat, e.g., disposed on a plane that is perpendicular to a longitudinal axis C of the lumen 538. The lead surface 552 can be angled to match the pitch of the helical protrusion 532 (see Figure 14) on the anchor member 512. The guide member or the guide and lead surfaces 548, 552 can be disposed adjacent to a periphery of the base member 508, e.g., between a peripheral member 540 and the axis C. In one embodiment, the guide and lead surfaces 548, 552 are coupled at outer edges thereof with an inner edge of the peripheral member 540. In one embodiment, a circumferential gap 544 is provided between ends of the guide and lead surfaces 548, 552. The gap 544 is configured to permit the helical protrusion 532 (see Figure 14) to be advanced along the lead surface 548 to a top laterally extending surface 560A of the first arm 528A, which is disposed beneath the gap 544.

    [0061] Figure 13A show the path from the lead surface 552 to the top surface 560A through the gap 544 is a first segment of a helical path about the axis C. A second segment of the helical path extends from the top laterally extending surface 560A to a top laterally extending surface 560B on the arm 528B. A third segment of the path extends from the top laterally extending surface 560B to a top laterally extending surface 560C of the arm 528C. A fourth segment of the path extends from the top laterally extending surface 560C to a laterally extending surface 564A of the arm 528A below the surface 560A. The laterally extending surface 564A is a mid-level surface on the arm 528A. The helical path through the base 508 extends in the same manner across a plurality of mid-level surface corresponding to the surface 564A and a plurality of surfaces at a lower level of the arms to a distal end point on or adjacent to or at a laterally extending surface 568C. The helical path described above accommodates a single helical protrusion, e.g., thread, of the anchor member 512. An advantage of this design is that only a single thread must traverse a gap in the proximal surface of the base portion 508. Also, the thread is much longer than the thread of the anchor member 112 and is generally at a shallower angle and so may be advanceable along the helical path with less torque than is required for the anchor member 112.

    [0062] Figures 14 and 15 show further details of the anchor member 512. In particular, the anchor member 512 has a proximal face 600 having a tapered annular surface. The proximal face 600 can include a driver interface 604 that can take any suitable form, such as any of those described above. For example, driver interface 604 can include a plurality of recesses. Figure 15 shows that the recess 504 can extend from the proximal face 600 to a distal end having an aperture 608 formed therein. The aperture 608 can be configured to receive a guidewire such that the anchor member 512 can be advanced over a wire, as discussed further below.

    [0063] Figures 16A-C illustrate various methods of implanting the shoulder assembly 500. The method can include compatible steps of any of the methods discussed above in connection with Figures 10A-10H, including initial preparation of a humeral head with a recess to receive a guidewire 650. The guidewire 650 can take any suitable form and is sometimes known as a Kirschner wire or K-wire. The guidewire 650 is placed into a recess extending distally into a face of a humeral head. Once in place, the base member 508 is advanced over the proximal end 654 of the guidewire 650, e.g., an opening at the distal end of the lumen 538 is advanced over the proximal end 654 of the guidewire 650. The lumen 538 is sized so that the base member 508 can easily slide along the length of the guidewire 650 to a position corresponding to the position of the base member 108 in Figure 10E.

    [0064] Thereafter, the base member 508 is advanced into the bone. For example, if a recess have been formed that has a profile similar to that of the base member 508, the base member can be urged into the recess with low force, e.g., with hand force and without impactors or with light force from the impactor. In some methods, the gap 544 is oriented with respect to the anatomy. For example, the gap 544 can be disposed at a lower elevation (caudad) compared to the position of the guide surface 548.

    [0065] Figure 16B illustrates further step in which a cannulated driver 662 is advanced over the guidewire 650. The cannulated driver 662 preferably has an interface configured to mate with the driver interface 604 on the anchor member 512. The driver 662 can have a plurality of prongs extending distally therefrom to engage recesses in the face 600 of the anchor member 512. In one step, the surgeon couples the driver 662 with the anchor member 512. Once so coupled, the driver 662 and the anchor member 512 are advanced over the guidewire 650. An initial step of advancing the driver 662 and the anchor member 512 over the guidewire 650 includes inserting the proximal end 654 of the guidewire 650 into the aperture 608 in the anchor member 512. Continued advancement of the driver 662 and the anchor member 512 causes the guidewire 650 to be advanced through the driver 662 and out of a proximal end 668 thereof.

    [0066] Once the driver 662 and the anchor member 512 are adjacent to the proximal portion of the base member 508, the distal portion of the helical protrusion 532 is placed against the guide surface 548 and/or the lead surface 552 and through the gap 544 and from there along the helical path discussed above. Once fully advanced, the cannulated driver 662 can be removed leaving the shoulder assembly 500 in place as shown in Figure 16C. Thereafter the guidewire 650 is removed to allow subsequent steps to proceed, including attachment of a joint interface as discussed above.

    [0067] Among the additional advantages of the shoulder assembly 500 is providing a single sleeve-like structure in the anchor member 512 rather than co-axial sleeve one in each of the base and anchor members. In particular, in the assembly 500 only the anchor member 512 includes a cylindrical structure. The cylindrical structure of the assembly 500 reinforces the helical protrusion 532 and also comprises the recess 504. This provides a simpler construction having fewer components. Also, there is no chance for multiple cylinders to be slid over each other to become misaligned, leading to binding or increased torque requirements for advancing the anchor member 512 into the base member 508.

    III. ASSEMBLIES HAVING REINFORCED BASE MEMBERS



    [0068] Figures 17-24B illustrate an embodiment of a humeral shoulder assembly 1000 in which distally projecting arms are more rigid by virtue of being coupled to each other and directly to a cylinder member at intermediate positions. This structure retains the direct bone engagement of exposed threads while making the arms more rigid.

    [0069] Figure 17 illustrates the assembly 1000 having a base member 1008 and an anchor member 1012. The base member 1008 and the anchor member 1012 are separable components that can be applied to the patient separately, e.g., assembled in multiple steps within the bone in techniques similar to those discussed above.

    [0070] Figures 18-22 illustrate various views of the base member 1008. The base member 1008 has a distal end 1020 configured to be embedded in bone and a proximal portion 1024 to be disposed adjacent to the face F of the humerus H or another bone surface.

    [0071] As shown in Figure 20, the base member 1008 can have a plurality of spaced apart arms 1028 projecting from the proximal portion 1024 to the distal end 1020 of the base member 1008. Each arm 1028 can define an outer edge 1210 having an arcuate sloping surface. The sloping surface can facilitate insertion of the base member 1008 into an exposed humeral face F as discussed above in connection with Figures 10A-10H. Further, each arm can define an inner edge 1214. The inner edge 1214 of a distal portion 1046 of each of the arms can be connected to form the distal end 1020 of the base member 1008 (see Figure 21).

    [0072] The inner edge 1214 of each arm 1028 can include one or more laterally extending recesses 1218A, 1218B, 1218C. The number of laterally extending recesses can vary between different arms 1028. For example, as shown in Figure 20, a first arm can include a first recess 1218A and a second recess 1218B, while a second arm can include only one recess 1218C. The recesses 1218A, 1218B of the first arm can be longitudinally displaced from the recess 1218C of the second arm to accommodate a helical structure 1304 of the anchor member 1012 (see Figure 17). Additionally, the outermost edge of each of the laterally extending recesses 1218A, 1218B, 1218C can be equidistant from the longitudinal axis of the base member 1008 to accommodate an anchor member 1012 having a substantially constant outer diameter along the helical structure 1304 (see Figure 17).

    [0073] The base member 1008 can also include a central portion (e.g., a cylindrical member 1030). As shown in Figure 22, the cylindrical member 1030 can include an open proximal end 1034 and a closed distal end 1032. The proximal end 1034 can define the proximal-most point of the base member 1008. In certain aspects, the proximal end 1034 can include an annular groove 1076 (Figure 18) for receiving a c-ring that may be present to prevent loosening between the anchor member 1012 and the base member 1008. A c-ring can be part of a locking device, as discussed further in connection with Figures 27-27A below. Further, a threaded recess 1250 can be formed in the distal portion of the cylindrical member 1030. The threaded recess 1250 enables a component to be advanced into a secure position of engagement with the base 1008. The component can be part of a prosthetic joint interface or can be a tool used in placement of the shoulder assembly 1000. For example, as shown in Figure 24A, the recess 1250 can engage a guide tool 432 (Figure 25). The guide tool 432 can extend the length of the cylindrical member 1030 to facilitate insertion of the anchor member 1012 into the base member 1008.

    [0074] Figure 20 shows that the outer wall of the cylindrical member 1030 can define a helical channel 1050 (e.g., groove or opening). The outer wall of the cylindrical member 1030 can connect to the inner edge 1214 of the arms 1028, such that portions of the helical channel 1050 can align with each of the laterally extending recesses 1218A, 1218B, 1218C to form a pathway for the helical structure 1304 of the anchor member 1112 (see Figure 17).

    [0075] Figure 19 illustrates that the proximal portion 1024 of the base member 1008 can include a peripheral member 1040 disposed about the outer periphery of the proximal portion 1024. The peripheral member 1040 can be coupled with the proximal ends of the arms 1028 (see Figure 22) to provide a unitary structure. As shown in Figure 19, the proximal portion 1024 can include a guide member 1048 that can be connected to the peripheral member 1040. The guide member 1048 can be partially recessed from the proximal face of the peripheral member 1040 to provide a space into which a proximal disc structure 1312 of the anchor member 1012 can be positioned (see Figure 17). Further, the guide member 1048 can include a plate-like projection extending radially inwardly from the peripheral member 1040 to a proximal portion of the cylindrical member 1030. For instance, the guide member 1048 can extend continuously from the inner edge of the peripheral member 1040 to the cylindrical member 1030 around at least about 50% of an inner diameter of the peripheral member 1040. In an arcuate segment, the guide member 1048 can extend discontinuously from the inner edge of the peripheral member 1040 to the cylindrical member 1030. For example, a gap 1072 can be defined adjacent to but radially inward of an arcuate segment of the guide member 1048 that is disposed between the peripheral portion 1040 and the gap 1072. The gap 1072 facilitates insertion of the anchor member 1012 into the base member 1008.

    [0076] As shown in Figure 20, the proximal end 1034 of the cylindrical member 1030 can be elevated above the proximal-most aspect of the peripheral member 1040. When the anchor member 1012 is connected to the base member 1008 (see Figure 17), the proximal disc structure 1312 can fill the annular space bounded by the outside surface of the cylindrical member 1030 and the inside surface of the peripheral member 1040 to create a tapered, annular surface from proximal end 1034 of the cylindrical member 1030 to the peripheral member 1040. This structure avoids inflection points in the side profile of the assembly 1000, which is advantageous in reducing or eliminating gaps between the assembly 1000 and another component of a shoulder joint assembly coupled therewith.

    [0077] Figure 23 illustrates features of the anchor member 1012, which has a proximal disc structure 1312. The proximal disc structure 1312 can define a central opening 1316 that can surround the proximal end 1034 of the cylindrical member 1030 when the shoulder assembly 1000 is assembled. Further, the proximal disc structure 1312 can include a driver interface 1364 (e.g. a plurality of openings) for engaging a driving tool 450 (see Figure 24B). Rotating the driving tool 450 can advance the anchor member 1012 to rotationally engage the base member 1008.

    [0078] The anchor member 1012 can also include a continuous helical structure 1304 disposed distally of the proximal disc structure 1312. In this embodiment, the anchor member 1012 has a single helical structure 1304. Other embodiments can have a multiple helices, e.g., including a double helix, a triple helix, or a quadruple helix configuration. The inner edge of the helical structure 1304 can define the innermost edge of the anchor member 1012 distal of the disc structure 1312 in that the anchor member 1012 does not include a central body structure. In at least this sense, the anchor member 1012 has an open helix construction. The helical structure 1304 defines a substantially constant inner diameter and a substantially constant outer diameter in one embodiment.

    [0079] When the shoulder assembly 1000 is assembled, the disc structure 1312 can abut the guide member 1048 of the base member 1008 and the helical structure 1304 can be disposed in the helical groove 1350 and the laterally extending recesses 1218A, 1218B, 1218C of the base member 1008 (see Figure 17). Portions of the helical structure 1304 project into the open area defined between the arms 1028 and engage the bone, thereby increasing the initial pull-out force of the assembly 1000 when initially placed. As shown in Figure 26, the peak force corresponding to the initial pull out force 1520 of the shoulder assembly 1000 is at least five times greater than the peak force corresponding to the initial pull out force 1500 of the prior art.

    [0080] Figures 24A-24B illustrate tools that can be used to implant the shoulder assembly 1000 and corresponding methods. The method of using the tools can include compatible steps of any of the methods discussed above in connection with Figures 10A-10H including creating a recess CR in the humeral head (see Figure 10D). Once the recess CR is created, the base member 1008 can be inserted into the face F of the humerus head h (similar to Figure 10E). Preferably, the insertion of the base member 1008 can be achieved without an impactor or any other tools, but rather just inserted by hand force.

    [0081] After the base member 108 has been inserted into the recess CR, a subsequent step can involve coupling the guide tool 432 with the base member 1008 (see Figure 24A). As described above, Figure 25 illustrates one embodiment of the guide tool 432. The guide tool 432 can extend the length of the cylindrical member 1030 to guide the anchor member 1112 into the base member 1008. To advance the anchor member 1012 over the guide tool 432, the method can include coupling a driver 450 with the driver interface 1364 (see Figure 24B). The driver 450 can take any suitable form, e.g., can include a plurality of protrusions configured to mate with openings of the driver interface 1364. Preferably, the driver 450 has a ratchet mechanism such that the surgeon can continuously hold the tool and need not release the handle to re-grip it. Once the shoulder assembly 1000 is assembled, the driver 450 and the guide tool 432 can be removed.

    [0082] The methods described above, e.g., in connection with Figures 24A-24B, can include additional steps and employ additional tools as discussed above. The shoulder assembly 1000 and/or the tool 450 also can be adapted to be compatible with other methods, e.g., with over-the-wire methods. For instance, the base member 1008 can have a lumen extending through the distal end 1020 to guide the base member into place. A channel in the tool 450 can be used in guiding the anchor member 1012 into place in the base member 1008.

    IV. LOCKING DEVICES TO REDUCE OR ELIMINATE DISENGAGEMENT OF BASE AND ANCHOR MEMBERS



    [0083] Figures 27-32 show features that can reduce or eliminate disengagement between a base member and an anchor member. These embodiments are illustrated in connection with the shoulder assembly 100, but can be used in connection with any of the embodiments herein. Also, although the features are discussed separately they could be combined in some embodiments.

    [0084] Figures 27 and 27A shows a shoulder assembly 1100 that includes a base member 1108, an anchor member 1112, and a locking device 1118 disposed adjacent to a proximal end 1124 of the base member 1108. The locking device 1118 comprises a C-ring 1122 that is disposed partially in a recess or groove 1126 (See Figure 27A) of the anchor member 1112 and partially in a groove 1130 (see Figure 27A) of the base member 1108. Figure 28 shows a partial assembly in which the C-ring 1122 is coupled with the anchor member 1112 prior to coupling the anchor member 1112 to the base member 1108. In the illustrated embodiment, the C-ring 1122 is disposed in the anchor member 1112 prior to implantation. Figure 27A shows that the cross-sectional shape of the C-ring 1122 facilitates actuation of the C-ring 1122 during assembly. A distal face 1134 of the C-ring 1122 is angled relative to a plane oriented perpendicular to the distal-proximal direction of the assembly 1100. In assembly, the anchor member 1112 is advanced into the base member 1108 until the distal face 1134 engages a proximal portion 1138 (See Figure 27A) of the base member 1108 and is deflected thereby into or deeper into the recess 1126 of the anchor member 1112. This permits the anchor member 1112 to move relative to the base member 1108 until the C-ring 1122 moves to the position of the groove 1130. The resilience of the C-ring 1122 causes the C-ring to return to an un-deflected configuration thereof. Figure 27A shows the final position of the C-ring 1122 with a portion disposed in the groove 1130 and a portion disposed in the groove 1126. In this configuration, the anchor member 1112 is locked into the base member 1108 because further advancement of the anchor member 1112 into the base member 1108 is prevented by contact between a base face 1148 and an anchor face 1120 and because retraction of the anchor member 1112 from the base member 1108 is prevented by the C-ring 1122 in cooperation with grooves 1126 and 1130 (see Figure 27).

    [0085] In other embodiments, the C-ring 1122 can be coupled with the base member 1108 prior to assembly of the anchor member 1112 with the base member 1108. In such embodiments, a surface of the anchor member 1112 can be configured to deflect the C-ring 1122 into or deeper into the groove 1130. In such embodiments, a proximal face of the C-ring 1122 may be angled relative to a plane oriented perpendicular to the distal-proximal direction of the assembly to facilitate deflection of the C-ring. Although a C-ring is illustrated, other structures that can be temporarily deflected into the recess 1126 or the recess 1130 can be used, such as spring loaded or resilient detents or members or other similar structures.

    [0086] Figures 29 and 30 illustrate another embodiment of a shoulder assembly 1200 that has a base member 1208, an anchor member 1212, and a locking device 1218 comprising an interface between the anchor member 1212 and the base member 1208. The locking device 1218 includes a distal projection 1220 disposed on a distal side of a helical protrusion 1232 (see Figure 30). Figure 30 shows that the distal projection 1220 can have a first face 1222 that is oriented generally proximal to distal and a second face 1226 that is disposed at an angle relative to a plane extending perpendicular to the proximal-distal direction of the anchor member 1212.

    [0087] In use, the anchor member 1212 is advanced into the base member 1208 in the same manner as described above in connection with the assembly 100. As the anchor member 1212 approaches the fully engaged position, the second face 1226 of the projection 1220 approaches a first side 1228A of the arm 1228 of the base member 1208. The second face 1226 passes across a lower lateral face of an upper-most slot of the arm 1228. As the second face 1226 crosses the arm 1228 from the first side 1228A, local deformation of at least one of the arm 1228 and the projection 1220 permits further advancement of the second surface 1226 relative to the arm until the first surface is disposed on the second side 1228B of the arm 1228 (see Figure 29). The local deformation is preferably temporary such that the deformed structure(s) return toward their undeformed state(s). Once disposed on the second side 1228B of the arm 1228, the first face 1222 abuts a corresponding surface of the second side 1228B of the arm 1228. In this configuration, the anchor member 1212 is locked into the base member 1208 because further advancement of the anchor member 1212 into the base member 1208 is prevented by contact between an upper surface of the base member 1208 and an anchor face 1224 and because retraction of the anchor member 1212 from the base member 1208 is prevented by contact between the first face 1222 and the second side 1228B of the arm 1228.

    [0088] The locking device 1218 is simple in construction in that a first portion of the interface is disposed on the anchor member 1212 and a second portion of the interface is disposed on the base member 1208 and thus does not require another separable component compared to the shoulder assembly 1100. Also, the locking device 1218 does not require an additional discrete step in the locking of the base member 1208 to the anchor member 1212 because the final step of passing the projection 1220 from the first side 1228A to the second side 1222B is accomplished with the same rotation as is required in connection with the assembly 100, though some additional force may be required to provide the local deformation discussed above.

    [0089] Figures 31 and 32 show another embodiment of a shoulder assembly 1300 that has a base member 1308, an anchor member 1312, and a locking device 1318 comprising at least one, e.g., a plurality of deflectable prongs 1320 that can be deployed to span from one of the anchor member 1312 and the base member 1308 to the other of the anchor and base members. The spanning of the prong(s) 1320 causes a portion of the prong to be engaged with the base member 1308 and another portion to be engaged with the rotatable anchor member 1312 such that rotation of the anchor member in either direction is reduced or eliminated.

    [0090] Figure 31 shows that the prongs 1320 can be disposed on the anchor member 1312 about an inner periphery 1332 of a disc structure 1336 thereof. The base member 1308 can have a cylindrical member 1324, similar to that discussed above in connection with the assembly 100. The cylindrical member 1324 can have a plurality of scallops or recesses 1328 disposed on a side surface thereof. The recesses 1328 can extend entirely around the cylindrical member 1324 in one embodiment to enable the prong(s) 1320 to be engaged at a nearest recess 1328 rather than come precisely to rest at a specific rotational position and recess. In other embodiments, the base and anchor members 1308, 1312 could be provided with the same number or prongs and recesses, wherein the location of the prongs and recesses are provided at an expected fully engaged position of the anchor member 1312 relative to the base member 1308.

    [0091] Figure 31 shows the prong(s) 1320 in a disengaged position. Any suitable technique or tool can be used to deploy the prongs 1320 across a gap between the anchor member 1312 and the base member 1308. Figure 32 illustrates a tool 1400 that can be used to deploy the prongs 1320. The tool 1400 includes a proximal user grip portion 1404, which can be a cylindrical member or any other ergonomic gripping structure. The tool 1400 also includes a plurality of pins 1408 disposed on a distal portion thereof that are configured and positioned to engage driver interfaces 1364 disposed on the proximal face of the disc structure 1336. The pins 1408 can be on an opposite side of the tool 1400 from the grip portion 1404. The tool 1400 also includes a plurality of prong actuators 1412 disposed on the same side of the tool as are the pins 1408. The prong actuators 1412 can each include a first, radially inward side 1416 and a second, radially outward side 1420. An angled surface 1424 is disposed between the sides 1416, 1420. The angled surface 1424 is configured to engage the prongs 1320 and deflect and in some cases deform them as the tool 1400 is advanced. For example, the radially outward side 1420 is configured and positioned to be inserted into a recess 1340 disposed in the proximal faces of the disc 1336 radially outward of the prongs 1320. This initial insertion of the prong actuator 1412 into the recess 1340 can be up to a point where the angled surface 1424 first engages the prong 1320. The radial distance from the first, radially inward side 1416 to the second, radially outward side 1420 is greater than the radial extent of the recess 1340. The radial distance from the first, radially inward side 1416 to the second, radially outward side 1420 spans the recess 1340, the gap between the anchor and base members 1312, 1308 and into the scallop or recess 1328. Further advancement of the tool 1400 causes the angled surface 1424 to engage the prong 1320. Still further advancement of the tool 1400 causes the prong 1320 to be deflected, e.g., bent or otherwise deformed into the recess 1328 of the base member 1308. When so deflected, the prong 1320 spans from the disc structure 1336 of the anchor member 1312 to the recess 1328 of the base member 1308. Because the base member 1308 is fixed in the bone, the coupling of the prong 1320 with the base member 1308 causes the anchor member 1312 also to be fixed relative to the bone. This prevents any backing out or unintended disengagement of the anchor member 1312 from the base member 1308.

    [0092] As illustrated, one embodiment of the locking device 1318 comprises six prongs 1320. In other embodiments, one prong 1320 can be provided. In other embodiments, a plurality of prongs, e.g., two three, four, five, twenty, or more prongs 1320 can be provided. The prongs 1320 could be disposed on the base member 1308 and could be deflected, e.g., bent or otherwise deformed, into a scallop or recess disposed on the anchor member 1312 in other embodiments. In further embodiments, the prong 1320 can be configured as a spanning member that need not be formed as a part of either the base member 1308 or the anchor member 1312 but rather as a separate components installed at the proximal side of the assembly 1300. As discussed above, the various locking devices discussed herein can be combined to provide multiple locking structures.

    [0093] As used herein, the relative terms "proximal" and "distal" shall be defined from the perspective of the humeral shoulder assembly. Thus, distal refers the direction of the end of the humeral shoulder assembly embedded in the humerus, while proximal refers to the direction of the end of the humeral shoulder assembly facing the glenoid cavity.

    [0094] Conditional language, such as "can," "could," "might," or "may," unless specifically stated otherwise, or otherwise understood within the context as used, is generally intended to convey that certain embodiments include, while other embodiments do not include, certain features, elements, and/or steps. Thus, such conditional language is not generally intended to imply that features, elements, and/or steps are in any way required for one or more embodiments or that one or more embodiments necessarily include logic for deciding, with or without user input or prompting, whether these features, elements, and/or steps are included or are to be performed in any particular embodiment.

    [0095] The terms "approximately," "about," and "substantially" as used herein represent an amount close to the stated amount that still performs a desired function or achieves a desired result. For example, the terms "approximately", "about", and "substantially" may refer to an amount that is within less than 10% of, within less than 5% of, within less than 1% of, within less than 0.1% of, and within less than 0.01% of the stated amount. As another example, in certain embodiments, the terms "generally parallel" and "substantially parallel" refer to a value, amount, or characteristic that departs from exactly parallel by less than or equal to 15 degrees, 10 degrees, 5 degrees, 3 degrees, 1 degree, 0.1 degree, or otherwise.

    [0096] Some embodiments have been described in connection with the accompanying drawings. However, it should be understood that the figures are not drawn to scale. Distances, angles, etc. are merely illustrative and do not necessarily bear an exact relationship to actual dimensions and layout of the devices illustrated. Components can be added, removed, and/or rearranged. Further, the disclosure herein of any particular feature, aspect, method, property, characteristic, quality, attribute, element, or the like in connection with various embodiments can be used in all other embodiments set forth herein. Additionally, it will be recognized that any methods described herein may be practiced using any device suitable for performing the recited steps.

    [0097] For purposes of this disclosure, certain aspects, advantages, and novel features are described herein. It is to be understood that not necessarily all such advantages may be achieved in accordance with any particular embodiment. Thus, for example, those skilled in the art will recognize that the disclosure may be embodied or carried out in a manner that achieves one advantage or a group of advantages as taught herein without necessarily achieving other advantages as may be taught or suggested herein.

    [0098] Although these inventions have been disclosed in the context of certain preferred embodiments and examples, it will be understood by those skilled in the art that the present inventions extend beyond the specifically disclosed embodiments to other alternative embodiments and/or uses of the inventions and obvious modifications and equivalents thereof. In addition, while several variations of the inventions have been shown and described in detail, other modifications, which are within the scope of these inventions, will be readily apparent to those of skill in the art based upon this disclosure. It is also contemplated that various combination or sub-combinations of the specific features and aspects of the embodiments may be made and still fall within the scope of the inventions. It should be understood that various features and aspects of the disclosed embodiments can be combined with or substituted for one another in order to form varying modes of the disclosed inventions. Further, the actions of the disclosed processes and methods may be modified in any manner, including by reordering actions and/or inserting additional actions and/or deleting actions. Thus, it is intended that the scope of at least some of the present inventions herein disclosed should not be limited by the particular disclosed embodiments described above. The limitations in the claims are to be interpreted broadly based on the language employed in the claims and not limited to the examples described in the present specification or during the prosecution of the application, which examples are to be construed as non-exclusive.


    Claims

    1. A stemless humeral shoulder assembly (100; 500; 1000; 1100; 1200; 1300), comprising:

    a base member (108; 508; 1008; 1108; 1208; 1308) comprising a distal end (120; 520; 1020) configured to be embedded in bone and a proximal end (124; 524; 1024; 1124) to be disposed at a bone surface, the base member having a plurality of spaced apart arms (128; 528A, 528B, 528C; 1028) projecting from the proximal end to the distal end,

    characterized in that the stemless humeral shoulder assembly further comprises:

    an anchor (112; 512; 1012; 1112; 1212; 1312) adapted to be assembled with the base member to a position disposed within the arms, the anchor being configured to project circumferentially into spaced apart engagement areas of the base member and into a space between the arms so as to be exposed between the arms when the anchor is assembled with the base member, and

    a recess (104; 504) configured to receive a mounting member (464) of an anatomical or reverse joint interface, the recess being surrounded by the base member and the anchor and projecting distally from a proximal end of the anchor to within the base member when the anchor is assembled with the base member.


     
    2. The stemless humeral shoulder assembly of Claim 1, wherein the spaced apart engagement areas are provided at the arms (128; 528A, 528B, 528C; 1028), the anchor (112; 512; 1012; 1112; 1212; 1312) being configured to project circumferentially into the arms.
     
    3. The stemless humeral shoulder assembly of Claim 1 or Claim 2, wherein the anchor (112; 512; 1012; 1112; 1212; 1312) comprises a helical structure (304; 1232; 1304) advanceable to engage corresponding surfaces of the arms (128; 528A, 528B, 528C; 1028).
     
    4. The stemless humeral shoulder assembly of Claim 3, wherein the anchor (112; 512; 1012; 1112; 1212; 1312) comprises a proximal face (300; 600) having an aperture providing access to the recess (104; 504) and a distal portion coupled with the helical structure (304; 1232; 1304).
     
    5. The stemless humeral shoulder assembly of Claim 4, wherein the proximal face (300; 600) comprises a driver interface (364; 604; 1364) disposed thereon outward of the aperture.
     
    6. The stemless humeral shoulder assembly of any one of Claims 3 to 5, wherein the anchor (112; 512; 1012; 1112; 1212; 1312) comprises a cylindrical sleeve (308) and the helical structure (304; 1232; 1304) comprises a thread (332A, 332B, 332C; 532) projecting laterally therefrom.
     
    7. The stemless humeral shoulder assembly of Claim 6, wherein the helical structure comprises three threads.
     
    8. The stemless humeral shoulder assembly of any one of Claims 3 to 7, wherein the helical structure (1304) comprises an open helix and the base member (1008) comprises helical mating surfaces disposed on an outer surface of the recess and on an inner surface of the arms.
     
    9. The stemless humeral shoulder assembly of any one of the preceding claims, further comprising a locking device (1118; 1218; 1318) disposed between the anchor (1012; 1112; 1212; 1312) and the base member (1008; 1108; 1208; 1308) to prevent disengagement of the anchor from the base member.
     
    10. The stemless humeral shoulder assembly of Claim 9, wherein the locking device (1118; 1218; 1318) comprises a resilient member configured to reside partially in a groove (1076; 1130) of the base member (1008; 1108; 1208; 1308) and partially in a groove (1126) of the anchor (1012; 1112; 1212; 1312).
     
    11. The stemless humeral shoulder assembly of Claim 10, wherein the resilient member comprises a C-ring.
     
    12. The stemless humeral shoulder assembly of any one of Claims 3 to 11, wherein the anchor (1212) comprises a projection (1220) disposed on the helical structure (1232), the projection comprises a first face (1222) configured to be advanced along with the helical structure in a first direction past a first side (1228A) of one of the arms (1228) and a second face (1226) configured to be disposed adjacent a second side (1228B) of the arm opposite the first side of the arm to prevent the projection and the helical portion from being advanced in a second direction opposite the first direction.
     
    13. The stemless humeral shoulder assembly of any one of the preceding claims, further comprising a prong (1320) disposed on one of the anchor (1312) and the base member (1308) and a scallop (1328) disposed on the other of the anchor and the base member, wherein the prong has a first configuration in which the prong is spaced away from the scallop permitting relative rotation between the anchor and the base member and a second configuration in which the prong is disposed in the scallop and prevents relative rotation between the anchor and the base member.
     
    14. The stemless humeral shoulder assembly of Claim 13, further comprising a plurality of prongs (1320) disposed on the anchor (1312) and a plurality of scallops (1328) disposed on the base member (1308).
     
    15. The stemless humeral shoulder assembly of Claim 14, wherein the plurality of scallops (1328) are disposed continuously around the recess and the plurality of prongs (1320) are spaced apart and disposed around the recess.
     
    16. The stemless humeral shoulder assembly of any one of the preceding claims, wherein the base member (508) and/or the anchor member (512) are configured for delivery over a guidewire (650).
     


    Ansprüche

    1. Schaftlose Humerus-Schulter-Anordnung (100; 500; 1000; 1100; 1200; 1300), umfassend:

    ein Grundelement (108; 508; 1008; 1108; 1208; 1308), umfassend ein distales Ende (120; 520; 1020), das konfiguriert ist, um in einen Knochen eingebettet zu werden, und ein proximales Ende (124; 524; 1024; 1124), das an einer Knochenoberfläche einzurichten ist, wobei das Grundelement eine Vielzahl von beabstandeten Armen (128; 528A, 528B, 528C; 1028) aufweist, die vom proximalen Ende zum distalen Ende ragen,

    dadurch gekennzeichnet, dass die schaftlose Humerus-Schulter-Anordnung ferner umfasst:

    einen Anker (112; 512; 1012; 1112; 1212; 1312), der angepasst ist, um mit dem Grundelement an einer in den Armen eingerichteten Position zusammengefügt zu werden, wobei der Anker konfiguriert ist, um umlaufend in beabstandete Eingriffsbereiche des Grundelements und in einen Raum zwischen den Armen zu ragen, um zwischen den Armen exponiert zu sein, wenn der Anker mit dem Grundelement zusammengefügt wird, und

    eine Vertiefung (104; 504), die konfiguriert ist, um ein Befestigungselement (464) einer Schnittstelle eines anatomischen oder inversen Gelenks aufzunehmen, wobei die Vertiefung von dem Grundelement und dem Anker umschlossen ist und distal von einem proximalen Ende des Ankers in das Grundelement ragt, wenn der Anker mit dem Grundelement zusammengefügt wird.


     
    2. Schaftlose Humerus-Schulter-Anordnung nach Anspruch 1, wobei die beabstandeten Eingriffsbereiche an den Armen (128; 528A, 528B, 528C; 1028) bereitgestellt sind, wobei der Anker (112; 512; 1012; 1112; 1212; 1312) konfiguriert ist, um umlaufend in die Arme zu ragen.
     
    3. Schaftlose Humerus-Schulter-Anordnung nach Anspruch 1 oder Anspruch 2, wobei der Anker (112; 512; 1012; 1112; 1212; 1312) eine wendelförmige Struktur (304; 1232; 1304) umfasst, die vorschiebbar ist, um in entsprechende Oberflächen der Arme (128; 528A, 528B, 528C; 1028) einzugreifen.
     
    4. Schaftlose Humerus-Schulter-Anordnung nach Anspruch 3, wobei der Anker (112; 512; 1012; 1112; 1212; 1312) eine proximale Fläche (300; 600), die eine Öffnung aufweist, die Zugang zu der Vertiefung (104; 504) bereitstellt, und einen mit der wendelförmigen Struktur (304; 1232; 1304) gekoppelten distalen Abschnitt umfasst.
     
    5. Schaftlose Humerus-Schulter-Anordnung nach Anspruch 4, wobei die proximale Fläche (300; 600) eine Antriebsschnittstelle (364; 604; 1364) umfasst, die darauf außerhalb der Öffnung eingerichtet ist.
     
    6. Schaftlose Humerus-Schulter-Anordnung nach einem der Ansprüche 3 bis 5, wobei der Anker (112; 512; 1012; 1112; 1212; 1312) eine zylindrische Manschette (308) umfasst und die wendelförmige Struktur (304; 1232; 1304) einen Gewindegang (332A, 332B, 332C; 532) umfasst, der lateral davon hervorragt.
     
    7. Schaftlose Humerus-Schulter-Anordnung nach Anspruch 6, wobei die wendelförmige Struktur drei Gewindegänge umfasst.
     
    8. Schaftlose Humerus-Schulter-Anordnung nach einem der Ansprüche 3 bis 7, wobei die wendelförmige Struktur (1304) eine offene Helix umfasst und das Grundelement (1008) dazu passende wendelförmige Oberflächen umfasst, die auf einer äußeren Oberfläche der Vertiefung und auf einer inneren Oberfläche der Arme eingerichtet sind.
     
    9. Schaftlose Humerus-Schulter-Anordnung nach einem der vorstehenden Ansprüche, weiter umfassend eine Arretiervorrichtung (1118; 1218; 1318), die zwischen dem Anker (1012; 1112; 1212; 1312) und dem Grundelement (1008; 1108; 1208; 1308) eingerichtet ist, um ein Lösen des Ankers von dem Grundelement zu verhindern.
     
    10. Schaftlose Humerus-Schulter-Anordnung nach Anspruch 9, wobei die Arretiervorrichtung (1118; 1218; 1318) ein elastisches Element umfasst, das konfiguriert ist, um sich teilweise in einer Rille (1076; 1130) des Grundelements (1008; 1108; 1208; 1308) und teilweise in einer Rille (1126) des Ankers (1012; 1112; 1212; 1312) zu befinden.
     
    11. Schaftlose Humerus-Schulter-Anordnung nach Anspruch 10, wobei das elastische Element einen C-Ring umfasst.
     
    12. Schaftlose Humerus-Schulter-Anordnung nach einem der Ansprüche 3 bis 11, wobei der Anker (1212) einen Vorsprung (1220) umfasst, der auf der wendelförmigen Struktur (1232) eingerichtet ist, der Vorsprung eine erste Fläche (1222), die konfiguriert ist, um zusammen mit der wendelförmigen Struktur in eine erste Richtung vorbei an einer ersten Seite (1228A) eines der Arme (1228) vorgeschoben zu werden, und eine zweite Fläche (1226), die konfiguriert ist, um angrenzend an eine zweite Seite (1228B) des Arms gegenüber der ersten Seite des Arms eingerichtet zu sein, umfasst, um zu verhindern, dass der Vorsprung und der wendelförmige Abschnitt in eine der ersten Richtung entgegengesetzte zweite Richtung vorgeschoben werden.
     
    13. Schaftlose Humerus-Schulter-Anordnung nach einem der vorstehenden Ansprüche, weiter umfassend einen Stift (1320), der auf einem des Ankers (1312) und des Grundelements (1308) eingerichtet ist, und eine Einwölbung (1328), die auf dem anderen des Ankers und des Grundelements eingerichtet ist, wobei der Stift eine erste Konfiguration, in der der Stift von der Einwölbung beabstandet ist, was eine relative Rotation zwischen dem Anker und dem Grundelement gestattet, und eine zweite Konfiguration, in der der Stift in der Einwölbung eingerichtet ist und eine relative Rotation zwischen dem Anker und dem Grundelement verhindert, aufweist.
     
    14. Schaftlose Humerus-Schulter-Anordnung nach Anspruch 13, weiter umfassend eine Vielzahl von Stiften (1320), die auf dem Anker (1312) eingerichtet ist, und eine Vielzahl von Einwölbungen (1328), die auf dem Grundelement (1308) eingerichtet ist.
     
    15. Schaftlose Humerus-Schulter-Anordnung nach Anspruch 14, wobei die Vielzahl von Einwölbungen (1328) durchgängig um die Vertiefung herum eingerichtet ist und die Vielzahl von Stiften (1320) beabstandet und um die Vertiefung herum eingerichtet ist.
     
    16. Schaftlose Humerus-Schulter-Anordnung nach einem der vorstehenden Ansprüche, wobei das Grundelement (508) und/oder das Ankerelement (512) zur Zuführung über einen Führungsdraht (650) konfiguriert sind.
     


    Revendications

    1. Ensemble huméral d'épaule sans tige (100 ; 500 ; 1000 ; 1100 ; 1200 ; 1300) comprenant :

    un élément de base (108 ; 508 ; 1008 ; 1108 ; 1208 ; 1308) comprenant une extrémité distale (120 ; 520 ; 1020) configurée pour être encastrée dans l'os et une extrémité proximale (124 ; 524 ; 1024 ; 1124) à disposer au niveau d'une surface osseuse, l'élément de base ayant une pluralité de bras espacés (128 ; 528A, 528B, 528C ; 1028) faisant saillie de l'extrémité proximale à l'extrémité distale,

    caractérisé en ce que l'ensemble huméral d'épaule sans tige comprend en outre :

    une ancre (112 ; 512 ; 1012 ; 1112 ; 1212 ; 1312) adaptée pour être assemblée avec l'élément de base dans une position disposée à l'intérieur des bras, l'ancre étant configurée pour faire saillie de manière circonférentielle dans des zones de mise en prise espacées de l'élément de base et dans un espace entre les bras afin d'être exposée entre les bras lorsque l'ancre est assemblée avec l'élément de base, et

    un évidement (104 ; 504) configuré pour recevoir un élément de montage (464) d'une interface d'articulation anatomique ou inversée, l'évidement étant entouré par l'élément de base et l'ancre et faisant saillie de manière distale d'une extrémité proximale de l'ancre jusqu'à l'intérieur de l'élément de base lorsque l'ancre est assemblée avec l'élément de base.


     
    2. Ensemble huméral d'épaule sans tige selon la revendication 1, dans lequel les zones de mise en prise espacées sont prévues au niveau des bras (128 ; 528A, 528B, 528C, 1028), l'ancre (112 ; 512 ; 1012 ; 1112 ; 1212 ; 1312) étant configurée pour faire saillie de manière circonférentielle dans les bras.
     
    3. Ensemble huméral d'épaule sans tige selon la revendication 1 ou la revendication 2, dans lequel l'ancre (112 ; 512 ; 1012 ; 1112 ; 1212 ; 1312) comprend une structure hélicoïdale (304 ; 1232 ; 1304) pouvant avancer pour mettre en prise des surfaces correspondantes des bras (128 ; 528A, 528B, 528C ; 1028).
     
    4. Ensemble huméral d'épaule sans tige selon la revendication 3, dans lequel l'ancre (112 ; 512 ; 1012 ; 1112 ; 1212 ; 1312) comprend une face proximale (300 ; 600) ayant une ouverture fournissant l'accès à l'évidement (104 ; 504) et une partie distale couplée avec la structure hélicoïdale (304 ; 1232 ; 1304).
     
    5. Ensemble huméral d'épaule sans tige selon la revendication 4, dans lequel la face proximale (300 ; 600) comprend une interface d'entraînement (364 ; 604 ; 1364) disposée sur cette dernière vers l'extérieur de l'ouverture.
     
    6. Ensemble huméral d'épaule sans tige selon l'une quelconque des revendications 3 à 5, dans lequel l'ancre (112 ; 512 ; 1012 ; 1112 ; 1212 ; 1312) comprend un manchon cylindrique (308) et la structure hélicoïdale (304 ; 1232 ; 1304) comprend un filetage (332A, 332B, 332C ; 532) faisant saillie latéralement de cette dernière.
     
    7. Ensemble huméral d'épaule sans tige selon la revendication 6, dans lequel la structure hélicoïdale comprend trois filetages.
     
    8. Ensemble huméral d'épaule sans tige selon l'une quelconque des revendications 3 à 7, dans lequel la structure hélicoïdale (1304) comprend une hélice ouverte et l'élément de base (1008) comprend des surfaces de couplage hélicoïdales disposées sur une surface externe de l'évidement et sur une surface interne des bras.
     
    9. Ensemble huméral d'épaule sans tige selon l'une quelconque des revendications précédentes, comprenant en outre un dispositif de verrouillage (1118 ; 1218 ; 1318) disposé entre l'ancre (1012 ; 1112 ; 1212 ; 1312) et l'élément de base (1008 ; 1108 ; 1208 ; 1308) pour empêcher le dégagement de l'ancre de l'élément de base.
     
    10. Ensemble huméral d'épaule sans tige selon la revendication 9, dans lequel le dispositif de verrouillage (1118 ; 1218 ; 1318) comprend un élément résilient configuré pour résider partiellement dans une rainure (1076 ; 1130) de l'élément de base (1008 ; 1108 ; 1208 ; 1308) et partiellement dans une rainure (1126) de l'ancre (1012, 1112, 1212, 1312).
     
    11. Ensemble huméral d'épaule sans tige selon la revendication 10, dans lequel l'élément résilient comprend une bague en C.
     
    12. Ensemble huméral d'épaule sans tige selon l'une quelconque des revendications 3 à 11, dans lequel l'ancre (1212) comprend une saillie (1220) disposée sur la structure hélicoïdale (1232), la saillie comprend une première face (1222) configurée pour être avancée conjointement avec la structure hélicoïdale dans une première direction au-delà d'un premier côté (1228A) de l'un des bras (1228) et une seconde face (1226) configurée pour être disposée de manière adjacente à un second côté (1228B) du bras opposé au premier côté du bras pour empêcher l'avancement de la saillie et de la partie hélicoïdale dans une seconde direction opposée à la première direction.
     
    13. Ensemble huméral d'épaule sans tige selon l'une quelconque des revendications précédentes, comprenant en outre une dent (1320) disposée sur l'un parmi l'ancre (1312) et l'élément de base (1308) et une dentelure (1328) disposée sur l'autre parmi l'ancre et l'élément de base, dans lequel la dent a une première configuration dans laquelle la dent est espacée de la dentelure, permettant la rotation relative entre l'ancre et l'élément de base, et une seconde configuration dans laquelle la dent est disposée dans la dentelure et empêche la rotation relative entre l'ancre et l'élément de base.
     
    14. Ensemble huméral d'épaule sans tige selon la revendication 13, comprenant en outre une pluralité de dents (1320) disposées sur l'ancre (1312) et une pluralité de dentelures (1328) disposées sur l'élément de base (1308).
     
    15. Ensemble huméral d'épaule sans tige selon la revendication 14, dans lequel la pluralité de dentelures (1328) sont disposées de manière continue autour de l'évidement et la pluralité de dents (1320) sont espacées et disposées autour de l'évidement.
     
    16. Ensemble huméral d'épaule sans tige selon l'une quelconque des revendications précédentes, dans lequel l'élément de base (508) et/ou l'élément d'ancre (512) sont configurés pour la pose sur un fil-guide (650).
     




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    REFERENCES CITED IN THE DESCRIPTION



    This list of references cited by the applicant is for the reader's convenience only. It does not form part of the European patent document. Even though great care has been taken in compiling the references, errors or omissions cannot be excluded and the EPO disclaims all liability in this regard.

    Patent documents cited in the description