(19)
(11)EP 3 277 219 B1

(12)EUROPEAN PATENT SPECIFICATION

(45)Mention of the grant of the patent:
29.07.2020 Bulletin 2020/31

(21)Application number: 16774133.9

(22)Date of filing:  30.03.2016
(51)International Patent Classification (IPC): 
A61F 2/02(2006.01)
A61L 27/00(2006.01)
A61F 2/28(2006.01)
A61F 2/30(2006.01)
A61F 2/38(2006.01)
(86)International application number:
PCT/US2016/025080
(87)International publication number:
WO 2016/161025 (06.10.2016 Gazette  2016/40)

(54)

HYDROGEL IMPLANTS WITH POROUS MATERIALS

HYDROGELIMPLANTATE MIT PORÖSEN MATERIALIEN

IMPLANTS À BASE D'HYDROGEL COMPORTANT DES MATÉRIAUX POREUX


(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: 31.03.2015 US 201562141059 P

(43)Date of publication of application:
07.02.2018 Bulletin 2018/06

(73)Proprietor: Cartiva, Inc.
Alpharetta, GA 30005 (US)

(72)Inventors:
  • PATRICK, Timothy J.
    Alpharetta, GA 3005 (US)
  • RAMEY, Carribeth B.
    Alpharetta, GA 3005 (US)
  • TUDOR, Letitia
    Alpharetta, GA 3005 (US)
  • AXELROD, Michael A.
    Alpharetta, GA 3005 (US)

(74)Representative: Zimmermann & Partner Patentanwälte mbB 
Postfach 330 920
80069 München
80069 München (DE)


(56)References cited: : 
WO-A2-2007/022188
US-A- 4 158 684
US-A1- 2001 039 455
US-A1- 2008 051 889
US-A1- 2014 324 169
WO-A2-2009/052208
US-A- 5 458 643
US-A1- 2006 224 244
US-A1- 2013 006 368
US-B2- 8 334 044
  
      
    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

    PRIORITY APPLICATIONS



    [0001] The present application claims priority benefit of U.S. Provisional Patent App. No. 62/141,059, filed on March 31, 2015.

    BACKGROUND


    Field



    [0002] This disclosure relates generally to implants, and, more specifically, to hydrogel joint implants and various tools, devices, systems, and methods related thereto.

    Description of Related Art



    [0003] Implants can be used to replace deteriorated or otherwise damaged cartilage within a joint. Such devices can be used to treat osteoarthritis, rheumatoid arthritis, other inflammatory diseases, generalized joint pain, joints damaged in an accident, while damaged participating in athletics, joints damaged due to repetitive use, and/or other joint diseases.
    For example, document US 2006/0224244 A1 relates to a hydrogel implant for replacing a portion of a skeletal joint.

    SUMMARY



    [0004] In some embodiments, an implant configured for implantation in a joint comprises, or alternatively consists essentially of, a first portion, a second portion, and a third portion. The first portion comprises a hydrogel. The second portion comprises a porous material (e.g., ceramic, metal, plastic) and the hydrogel in pores of the porous material. The third portion comprises the porous material. The second portion is between the first portion and the second portion. The first portion is free or substantially free of the porous material. The third portion is free or substantially free of the hydrogel.

    [0005] The hydrogel may comprise polyvinyl alcohol (PVA). The hydrogel may comprise water. The hydrogel may comprise saline. The porous material may comprise an oxide material. The porous material may comprise at least one of aluminum, alumina, zirconia, titanium, titania, stainless steel, PEEK, and steatite. The porous material may have a porosity between 17.7 pores per cm (45 ppi) and 31.5 pores per cm (80 ppi). Pores of the porous material may have a dimension between 100 µm and 500 µm. The first portion may comprise a contoured surface. The first portion may comprise an annular flange. The third portion may comprise threads. The implant may be load bearing and non-biodegradable. The implant may be configured to be placed in at least one of a toe, finger, ankle, knee, shoulder, hip, or other joint. A lateral dimension of the first portion may be between 6 mm and 10 mm. A lateral dimension of the first portion may be between 5% and 15% larger than a lateral dimension of the third portion. A ratio of a lateral dimension of the first portion to a lateral dimension of the third portion may be between 1.05 and 1.3.

    [0006] In some embodiments, a method of treatment comprises, or alternatively consists essentially of, aligning an implant deployment tool with a recess in a bone, the recess comprising an opening facing a joint, and deploying the implant out of the implant deployment tool, through the opening, and at least partially in the recess

    [0007] After deployment, the implant may be 1 mm to 3 mm proud. The method may further comprise radially compressing the first portion of the implant in the implant deployment tool. The method may further comprise forming the recess. Forming the recess may comprise using a drill bit. Deploying the implant may comprise urging the implant through an interior of the implant deployment tool using a plunger. Deploying the implant may be manual. Deploying the implant may be mechanically assisted. Deploying the implant may comprise screwing the implant into the recess.

    [0008] In some embodiments, a method of manufacturing the implant comprises, or alternatively consists essentially of, positioning hydrogel material in a well of a mold, positioning porous material in an upper portion of the well and protruding from the well, and freezing and thawing the hydrogel material at least once.

    [0009] Positioning the porous material may comprise anchoring the porous material.

    [0010] In some embodiments, a method of manufacturing the implant comprises, or alternatively consists essentially of, aligning a well of a second mold portion with a well of a first mold portion, the well of the first mold portion comprising a porous material, positioning hydrogel material in the well of the second mold portion and partially in the well of the first mold portion, and freezing and thawing the hydrogel material at least once.

    [0011] The method may further comprise positioning the porous material in the well of the first mold portion. Positioning the hydrogel material may be through a closable port, and further comprising closing the closable port. The method may comprising forming flash between the first mold portion and the second mold portion. The method may further comprise removing the flash. The porous material may comprise a disc shape.

    [0012] In some embodiments, an implant system configured for implantation in a joint comprises, or alternatively consists essentially of, a first part and a second part. The first part comprises an implant. The implant comprises, or alternatively consists essentially of, a first portion comprising a hydrogel, a second portion comprising a porous material and the hydrogel in pores of the porous material, and a third portion comprising the porous material. The first portion is free of or lacks the porous material. The third portion is free of or lacks the hydrogel. The second part comprises sidewalls, a bottom, a cavity at least partially defined by the sidewalls and the bottom, and an anchoring element. The cavity is configured to at least partially receive the implant. One of the porous material and the sidewalls of the second part comprises a detent and the other of the porous material and the sidewalls of the second part comprises a groove configured to interact with the detent when the implant is at least partially in the cavity of the second part.

    [0013] The porous material may comprise a toroidal shape. The porous material may comprise a detent extending radially inward. The anchoring element may selected from the group consisting of a barb, and anchor, and a hole in the bottom of the second part and a screw configured to extend through the hole in the bottom of the second part. The anchor may comprise an insert, a finger extending radially outwardly and towards a top of the implant system, a wire threaded through holes in the bottom of the second part, and a knot configured to be tightened upon pulling of ends of the wire.

    [0014] In some embodiments, an implant system configured for implantation in a joint comprises, or alternatively consists essentially of, a first part and a second part. The first part comprises an implant comprising a first portion comprising a hydrogel, a second portion comprising a porous material and the hydrogel in pores of the porous material, and a third portion comprising the porous material. The first portion is free of or lacks the porous material. The third portion is free of or lacks the hydrogel. The second part comprises sidewalls, a bottom, and a cavity at least partially defined by the sidewalls and the bottom. The cavity is configured to at least partially receive the implant.

    [0015] One of the porous material and the sidewalls of the second part may comprise a detent and the other of the porous material and the sidewalls of the second part may comprise a groove configured to interact with the detent when the implant is at least partially in the cavity of the second part. The second part may further comprise an anchoring element. The anchoring element may comprise a barb. The anchoring element may comprise an anchor comprising an insert, a finger extending radially outwardly and towards a top of the implant system, a wire threaded through holes in the bottom of the second part, and a knot configured to be tightened upon pulling of ends of the wire. The ends of the wire may form a loop. The anchoring element may comprise a hole in the bottom of the second part and a screw configured to extend through the hole in the bottom of the second part. The anchoring element may comprise a hole in the sidewalls of the second part and a second screw configured to extend through the hole in the sidewalls of the second part.

    [0016] In some embodiments, an implant system configured for implantation in a joint comprises a first portion comprising a hydrogel, a second portion comprising a porous material and the hydrogel in pores of the porous material, and a third portion comprising the porous material. The first portion is free of or lacks the porous material. The third portion is free of or lacks the hydrogel. The third portion is configured to contact bone. Pores of the porous material are configured to allow bone infiltration.

    [0017] The first portion may comprise a contoured surface. The contoured surface may be customized for a particular subject based on scan data. The scan data may comprise at least one of computerized tomography, computerized axial tomography, positron emission tomography, and magnetic resonance imaging. The porous material may comprise at least one of aluminum, titanium, and stainless steel. The porous material may comprise titanium mesh. The porous material may comprise printed titanium. The porous material may comprise at least one of alumina, zirconia, titania, and steatite. The porous material may comprise PEEK. The porous material may have a porosity between 45 ppi and 80 ppi. Pores of the porous material may have a dimension between 100 µm and 500 µm. The first portion may comprise a hemispherical shape. The first portion may comprise a wedge shape.

    [0018] In some embodiments, an implant system configured for implantation in a joint comprises an implant comprising a first portion comprising a hydrogel, a second portion comprising a porous material and the hydrogel in pores of the porous material, and a third portion comprising the porous material. The first portion is free of or lacks the porous material. The third portion is free of or lacks the hydrogel.

    [0019] The second portion may be between the first portion and the second portion. The hydrogel may comprise polyvinyl alcohol (PVA). The hydrogel may comprise water. The hydrogel may comprise saline. The porous material may comprise an oxide ceramic. The porous material may comprise at least one of aluminum, titanium, and stainless steel. The porous material may comprise titanium mesh. The porous material may comprise printed titanium. The porous material may comprise PEEK. The porous material may comprise at least one of alumina, zirconia, titania, and steatite. The porous material may have a porosity between 17.7 pores per cm (45 ppi) and 31.5 pores per cm (80 ppi). Pores of the porous material may have a dimension between 100 µm and 500 µm. The first portion may comprise an annular flange. The third portion may comprise threads.

    [0020] The first portion may comprise a contoured surface. The contoured surface may be customized for a particular subject based on scan data. The scan data may comprise at least one of computerized tomography, computerized axial tomography, positron emission tomography, and magnetic resonance imaging.

    [0021] The first portion may comprise a hemispherical shape. The second portion may comprise a hemispherical shape. The third portion may comprise a cylindrical shape. The first portion may comprise a wedge shape. The third portion may comprise a wedge shape. The porous material may comprise a disc shape. The porous material may comprise a toroidal shape. The porous material may comprise a detent extending radially inward. The porous material may comprise an aperture through a sidewall of the porous material. The hydrogel may at least partially extend through the aperture. The porous material may comprise a finger extending radially outwardly and towards a top of the implant system. The porous material may comprise a barb.

    [0022] The implant may be load bearing. The implant may be non-biodegradable. The implant system may be configured to be placed in at least one of a toe, finger, ankle, knee, shoulder, hip, or other joint. A lateral dimension of the first portion may be between 6 mm and 10 mm. A lateral dimension of the first portion may be between 5% and 15% larger than a lateral dimension of the third portion. A ratio of a lateral dimension of the first portion to a lateral dimension of the third portion may be between 1.05 and 1.3.

    [0023] The implant system may further comprise a second part comprising sidewalls, a bottom, and a cavity at least partially defined by the sidewalls and the bottom. The cavity may be configured to at least partially receive the implant. The porous material may comprise a groove extending radially inward and the second part may comprise a detent extending radially inward from the sidewalls of the second part. The detent may be configured to interact with the groove when the implant is at least partially in the cavity of the second part. The porous material may comprise a detent extending radially outward and the second part may comprise a groove extending radially outward into the sidewalls of the second part. The detent may be configured to interact with the groove when the implant is at least partially in the cavity of the second part.

    [0024] The second part further may comprise an anchoring element. The anchoring element may comprise a barb. The barb may comprise a plurality of barbs. The plurality of barbs may be vertically stacked. The anchoring element may comprise an anchor comprising an insert, a finger extending radially outwardly and towards a top of the implant system, a wire threaded through holes in the bottom of the second part, and a knot configured to be tightened upon pulling of ends of the wire. The ends of the wire may form a loop. The anchoring element may comprise a hole in the bottom of the second part and a screw configured to extend through the hole in the bottom of the second part. The anchoring element may comprises a plurality of holes in the bottom of the second part and a plurality of screws configured to extend through the plurality of holes in the bottom of the second part. The anchoring element may comprise a hole in the sidewalls of the second part and a second screw configured to extend through the hole in the sidewalls of the second part. The anchoring element may comprise a plurality of holes in the sidewalls of the second part and a plurality of second screws configured to extend through the plurality of holes in the sidewalls of the second part.

    [0025] In some embodiments, a method of treatment comprises, or alternatively consists essentially of, aligning an implant deployment tool with a recess in a bone and deploying the implant out of the implant deployment tool, through the opening, and at least partially in the recess. The recess comprises an opening facing a joint.

    [0026] After deployment, the implant may be 1 mm to 3 mm proud. The method may further comprise radially compressing the first portion of the implant in the implant deployment tool. The method may further comprise forming the recess. Forming the recess may comprise using a drill bit. Deploying the implant may comprise urging the implant through an interior of the implant deployment tool using a plunger. Deploying the implant may be manual. Deploying the implant may be mechanically assisted. Deploying the implant may comprise screwing the implant into the recess.

    [0027] In some embodiments, a method of manufacturing the implant comprises positioning hydrogel material in a well of a mold, positioning porous material in an upper portion of the well and protruding from the well, and freezing and thawing the hydrogel material at least once. Positioning the porous material may comprise anchoring the porous material.

    [0028] In some embodiments, a method of manufacturing the implant comprises aligning a well of a second mold portion with a well of a first mold portion. The well of the first mold portion comprises a porous material. The method further comprises positioning hydrogel material in the well of the second mold portion and partially in the well of the first mold portion and freezing and thawing the hydrogel material at least once. The method may further comprising positioning the porous material in the well of the first mold portion. Positioning the hydrogel material may be through a closable port. The method may further comprise closing the closable port.

    [0029] The method may comprising forming flash between the first mold portion and the second mold portion. The method may further comprise removing the flash. The porous material may comprises a disc shape. The porous material may comprises a toroidal shape.

    BRIEF DESCRIPTION OF THE DRAWINGS



    [0030] Certain features, aspects, and advantages of the disclosure are described with reference to drawings, which are intended to illustrate, but not to limit, the various inventions disclosed herein. It is to be understood that the attached drawings are for the purpose of illustrating concepts and embodiments of the disclosure and may not be to scale.

    Figure 1A schematically illustrates an example implant;

    Figure 1B schematically illustrates an example implant;

    Figure 1C schematically illustrates an example implant;

    Figure 2 is a photo of an example implant;

    Figures 3A and 3B schematically illustrate an example method of positioning an example implant;

    Figure 3C schematically illustrates an example method of positioning the example implant of Figure 1B;

    Figure 4 schematically illustrates an example method of manufacturing example implants;

    Figures 5A-5C schematically illustrate an example method of manufacturing example implants;

    Figure 6 schematically illustrates another example implant

    Figure 7A schematically illustrates an example implant;

    Figure 7B schematically illustrates an example method of positioning an example implant;

    Figure 7C schematically illustrates an example method of positioning an example implant;

    Figure 8A schematically illustrates an example implant;

    Figure 8B schematically illustrates an example method of positioning an example implant;

    Figure 8C schematically illustrates an example method of positioning an example implant;

    Figure 9A is a side view of an example implant;

    Figure 9B is a cross-sectional view of the implant of Figure 9A;

    Figures 9C and 9D are top and side perspective exploded views of the implant of Figure 9A;

    Figure 9E is a cross-sectional view of an example implant;

    Figure 10A is a side view of an example implant;

    Figure 10B is a cross-sectional view of the implant of Figure 10A;

    Figures 10C-10E are top and side perspective exploded views of the implant of Figure 10A;

    Figure 10F is a cross-sectional view of an example implant;

    Figure 11A is a side view of an example implant;

    Figure 11B is a cross-sectional view of the implant of Figure 11A;

    Figure 11C is a top and side perspective view of the implant of Figure 11A;

    Figure 11D is a top and side perspective exploded view of the implant of Figure 11A;

    Figure 11E is a cross-sectional view of an example implant;

    Figure 12A is a side cross-sectional view of an example implant;

    Figure 12B is a side cross-sectional view of an example implant;

    Figure 12C is a side cross-sectional view of an example implant;

    Figure 12D is a side cross-sectional view of example implants;

    Figure 13A is a top and side perspective view of an example implant; and

    Figure 13B is plan view of an example device for manufacturing example implants.


    DETAILED DESCRIPTION



    [0031] The discussion and the figures illustrated and referenced herein describe various embodiments of a cartilage implant, as well as various tools, systems, and methods related thereto. A number of these devices and associated treatment methods are particularly well suited to replace deteriorated or otherwise damaged cartilage within a joint. Such implants are configured to remain within the patient's joint on a long-term basis (e.g., for most or all of the life of the patient or subject), and as such, are configured, in some embodiments, to replace native cartilage. In some embodiments, an implant is configured to be substantially non-biodegradable and/or non-erodable. In some embodiments, an implant is configured to remain within the patient's joint or other portion of the anatomy for a minimum of 10 to 100 years (e.g., about 10 years, about 20 years, about 25 years, about 30 years, about 35 years, about 40 years, about 45 years, about 50 years, about 55 years, about 60 years, about 65 years, about 70 years, about 75 years, about 80 years, about 85 years, about 90 years, about 95 years, about 100 years, duration ranges between the foregoing values, etc.) without losing structural and/or physical properties and/or without losing ability to function as a cartilage replacement component or device. In some embodiments, an implant is configured to remain within the anatomy for greater than 100 years without losing structural and/or physical properties and/or without losing ability to function as a cartilage replacement component. Certain implants described herein can be used to treat osteoarthritis, rheumatoid arthritis, other inflammatory diseases, generalized joint pain, joints damaged in an accident, joints damaged while participating in athletics, joints damaged due to repetitive use, and/or other joint diseases. However, the various devices, systems, methods, and other features of the embodiments disclosed herein may be utilized or applied to other types of apparatuses, systems, procedures, and/or methods, including arrangements that have non-medical benefits or applications.

    [0032] Certain embodiments described herein may be advantageous because they include one, several, or all of the following benefits: (i) improved osseointegration compared to implants having a hydrogel surface; (ii) improved coupling of disparate implant materials; (iii) improved cavity wall apposition compared to substantially cylindrical implants; (iv) reduced implant height; (v) reduced depth of a bone cavity configured to receive an implant; (vi) improved structural stability; and/or (vii) increased manufacturing flexibility.

    [0033] Figure 1A schematically illustrates an example implant 100. The implant 100 comprises, or alternatively consists essentially of, a first portion 102, a second portion 104, and a third portion 106. The first portion 102 and the second portion 104 of the implant 100, as well as other implants disclosed herein (as is the case for each implant feature unless described otherwise), comprises, or alternatively consists essentially of, a hydrogel (e.g., a hydrogel or other formulation comprising polyvinyl alcohol (PVA) hydrogel). The third portion 106 comprises, or alternatively consists essentially of, a porous material (e.g., a material or section comprising porous ceramic material (e.g., oxide-ceramic), metal (e.g., titanium (e.g., titanium mesh, printed titanium), stainless steel (e.g., stainless steel wool)), plastic (e.g., polyaryl ether ketone (PAEK) (e.g., polyether ether ketone (PEEK))), other biocompatible materials, combinations thereof, and the like).

    [0034] The first portion 102 and the second portion 104 of the implant 100 can comprise one or more other materials, either in addition to or in lieu of PVA, such as, for example, other hydrogels, other polymeric materials, additives, and/or the like. As discussed herein, the second portion 104 comprises porous material. In some embodiments, the PVA content of a hydrogel is about 40% by weight. The PVA content of hydrogel in an implant 100 can be less than or more than about 40% by weight (e.g., about 10%, about 15%, about 20%, about 25%, about 30%, about 32%, about 34%, about 36%, about 37%, about 38%, about 39%, about 41%, about 42%, about 43%, about 44%, about 46%, about 48%, about 50%, about 55%, about 60%, about 65%, about 70%, less than about 10%, more than about 70%, ranges between such values, etc.), as desired or required.

    [0035] The hydrogel of the implant 100, as well as other implants disclosed herein, can comprise water, saline, other liquids, combinations thereof, and/or the like. In some embodiments, saline may be preferred over water, because, under certain circumstances, saline can help maintain osmotic balance with surrounding anatomical tissues following implantation. The exact composition of hydrogel in an implant 100 (e.g., PVA or other hydrogel materials, water, saline or other liquids, other additives, etc.) can be selected so as to provide the implant 100 with the desired or required strength, load bearing capacity, compressibility, flexibility, longevity, durability, resilience, coefficient of friction, and/or other properties and characteristics. Thus, in some embodiments, any hydrogel portion of the implants disclosed herein consist essentially of saline and PVA. In some embodiments, such hydrogel portions of the implants do not comprise any additional additives (e.g., growth factors, surface or other coatings, etc.). In addition, according to some embodiments, the hydrogel portions of any of the implant configurations disclosed herein comprises a consistent concentration (e.g., no concentration gradients), density and/or other chemical and/or physical properties throughout.

    [0036] In some embodiments, the implant 100, as well as other implants disclosed herein, is configured for drug delivery and/or is seeded with growth factors and/or cells. In some embodiments, the implant 100 comprises one or more of the following: chondrocytes, growth factors, bone morphogenetic proteins, collagen, hyaluronic acid, nucleic acids, and stem cells. Such factors and/or any other materials included in the implant 100 and selectively delivered to an implant site can help facilitate and/or promote the long-term fixation of the implant 100 at the joint or other target area of the anatomy.

    [0037] In some embodiments, the hydrogel comprises PVA and/or any other polymeric material. In some embodiments, the content of PVA in the hydrogel is between about 35% and about 45% by weight (e.g., about 35%, about 36%, about 37%, about 38%, about 39%, about 40%, about 41%, about 42%, about 43%, about 44%, about 45%, ranges between such values, etc.). In some embodiments, the content of PVA in the hydrogel is greater than about 45% by weight (e.g., about 45%, about 50%, about 55%, about 60%, about 65%, about 70%, greater than about 70%, ranges between such values, etc.) or less than about 35% by weight (e.g., about 5%, about 10%, about 15%, about 20%, about 25%, about 30%, about 35%, ranges between such values, less than about 5%, etc.). In some embodiments, the content of PVA or other component in the hydrogel is about 40% by weight.

    [0038] In some embodiments, the implant 100 is load bearing and generally non-biodegradable (e.g., non-bioerodable). In some embodiments, the implant 100 is configured for placement in at least one of a toe, finger, ankle, knee, shoulder, hip, or any other joint. In some embodiments, a transition between the upper surface and the sidewalls is generally curved or otherwise smooth.

    [0039] In some embodiments, the first portion 102 of the implant may have a lateral dimension (e.g., diameter) between about 6 mm and about 10 mm (e.g., about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, ranges between such values, etc.), as measured in an uncompressed state. Lateral dimensions smaller than about 6 mm (e.g., between about 2 mm and about 6 mm) and larger than about 10 mm (e.g., between about 10 mm and about 14 mm) are also possible for use in subjects with small or large bones, respectively, and/or for use in joints with small or large bones, respectively.

    [0040] The third portion 106 of the implant can comprise a porous material, such as, for example, a porous ceramic (e.g., oxide-ceramic), metal (e.g., titanium (e.g., titanium mesh, printed titanium), stainless steel (e.g., stainless steel wool)), plastic (e.g., polyaryl ether ketone (PAEK) (e.g., polyether ether ketone (PEEK))), other biocompatible materials, combinations thereof, and the like). The third portion 106 may be free or substantially free from the hydrogel of the first portion 102. In some embodiments, the third portion 106 is substantially rigid or non-deformable. In some embodiments, the third portion 106 is at least partially deformable. The pores and/or other openings of the third portion 106 may promote osseointegration of the implant 100 in a bone. Compared to an implant consisting essentially of hydrogel, an implant comprising one or more porous materials (e.g., porous ceramic, metal, plastic, etc.) may have a reduced height because the porous ceramic and/or other porous material may provide structural stability and/or because the porous ceramic or other porous material may provide better osseointegration such that less contact with bone provides at least as much osseointegration.

    [0041] The third portion 106 is illustrated in Figure 1A as a disc, although other shapes of the third portion 106 are also possible. In some embodiments, the third portion 106 may be toroidal, wedge-shaped, etc., for example as described in further detail herein. In some embodiments, the third portion 106 is substantially rigid, semirigid, and/or non-deformable. In some embodiments, the second portion 104 comprises the hydrogel of the first portion 102 within pores of the porous material of the third portion 106. According to some embodiments, the diameter or other lateral dimension of the second portion 104 and/or third portion 106 is smaller than the diameter or other lateral dimension of the first portion 102 of the implant. As discussed herein, this can permit the implant 100 to be radially compressed (e.g., during delivery into a target anatomical site of a subject), especially in embodiments where the first portion 102 is more readily radially compressible than the second portion 104 and/or the third portion 106 (e.g., because of the material(s) included in each portion). For example, in some embodiments, the diameter or other lateral dimension of the second portion 104 and/or third portion 106 is between about 70% and about 95% (e.g., about 70%, about 75%, about 80%, about 85%, about 90%, about 95%, ranges between the foregoing percentages, etc.) of the diameter or other lateral dimension of the first portion 102.

    [0042] According to some embodiments, the second portion 104 and the third portion 106 may comprise an oxide ceramic, for example oxide ceramics from CeramTec of Laurens, South Carolina, as provided in Tables 1 and 2, although other materials and combinations of materials are also possible (e.g., non-oxide ceramics, non-ceramics).
    Table 1
    PropertyUnitsAlumina (92%)Alumina (94%)Alumina (96%)Alumina (99.5%) IAlumina (99.5%) II
    Density g/cm3 3.65 3.6 3.7 3.9 3.9
    Hardness HV 0.5 1300 1200 1350 1700 1700
    Flexural Strength MPa (kPSI) 240 (34.8) 290 (42) 296 (43) 310 (45) 310 (45)
    Fracture Toughness MPa×m1/2 5 3 4 4 4
    Young's Modulus GPa (×106 PSI) 300 (44) 289 (42) 303 (44) 372 (54) 376 (54)
    Shear Modulus GPa (×106 PSI) 120 (17) 121 (17.5) 127 (18.5) 152 (22) 152 (22)
    Polsson -- 0.24 0.21 0.21 0.21 0.21
    Thermal Expansion (300 °C) × 10-6/°C 7.0 6.6 6.5 6.8 6.7
    Thermal Expansion (700 °C) × 10-6/°C 7.3 7.6 7.6 7.9 7.8
    Thermal Expansion (1,000 °C) × 10-6/°C 7.5 8.2 8.1 8.3 8.2
    Thermal Conductivity at 25 °C W/mK 21.0 21.0 24.0 30.0 30.0
    Volume Resistivity ohm×cm >1014 >1014 >1014 >1014 >1014
    Specific Heat J/gK 0.96 0.8 1.1 0.8 0.8
    Dielectric Strength V/mil -- 200 210 230 220
    Dielectric Constant at 1 MHz -- -- 9.0 9.3 9.8 9.8
    Dissipation Factor at 1 MHz -- 9.0×10-4 3.0×10-4 3.0×10-4 1.0×10-4 1.0×10-4
    Loss Factor at 1 MHz -- -- 3.0×10-3 3.0×10-3 1.0×10-3 1.0×10-3
    Table 2
    PropertyUnitsToughened AluminaZirconiaTitaniaSteatite ISteatite II
    Density g/cm3 4.0 6.0 4.0 2.7 2.8
    Hardness HV 0.5 1600 1150 800 450 420
    Flexural Strength MPa (kPSI) 448 (65) 752 (109) 138 (20) 131 (19) 145 (21)
    Fracture Toughness MPa×m1/2 4 10 3 -- --
    Young's Modulus GPa (× 106 PSI) -- 186 (27) 227 (33) 108 (16) 112 (16)
    Shear Modulus GPa (× 106 PSI) -- 80 (11.6) 90 (13.0) 43 (6.3) 45 (6.5)
    Polsson -- -- 0.33 0.27 0.23 0.25
    Thermal Expansion (300 °C) × 10-6/°C 7.9 -- 8.3 8.2 6.9
    Thermal Expansion (700 °C) × 10-6/°C 8.5 10.0 9.0 8.9 7.8
    Thermal Expansion (1,000 °C) × 10-6/°C 9.6 11.0 9.0 9.4 8.0
    Thermal Conductivity at 25 °C W/mK 25.0 2.7 11.9 5.5 5.9
    Volume Resistivity ohm×cm 9.0×1013 -- >1012 >1014 >1014
    Specific Heat J/gK 0.96 0.4 0.7 1.1 1.1
    Dielectric Strength V/mil -- -- 100 210 230
    Dielectric Constant at 1 MHz -- -- 28 85 5.8 6.1
    Dissipation Factor at 1 MHz -- 9.0×10-4 -- 5.0×10-4 1.9×10-3 8.0×10-4
    Loss Factor at 1 MHz -- -- -- -- 1.1×10-2 5.0×10-3


    [0043] According to some embodiments, the second portion 104 and the third portion 106 may comprise a metal, for example titanium mesh, printed titanium, stainless steel, etc. According to some embodiments, the second portion 104 and the third portion 106 may comprise a plastic, for example PAEK, PEEK, etc.

    [0044] In some embodiments, the porous material can have a porosity between about 17.7 pores per cm (45 pores per inch and (ppi)) ab ana out about 31.5 pores per cm (80 ppi) (e.g., about 17.7 pores per cm (45 ppi), about 19.7 pores per cm (50 ppi), about 21.7 pores per cm (55 ppi), about 23.6 pores per cm (60 ppi), about 25.6 pores per cm (65 ppi), about 27.6 pores per cm (70 ppi), about 29.5 pores per cm (75 ppi), about 31.1 pores per cm (80 ppi) ranges between such values, etc.). The pores of the porous material may have a diameter or other dimension between about 100 micrometers (microns; µm) and about 500 µm (e.g., about 100 µm, about 150 µm, about 200 µm, about 250 µm, about 300 µm, about 350 µm, about 400 µm, about 450 µm, about 500 µm, ranges between such values, etc.), as desired or required.

    [0045] In some embodiments, pores of the porous material in the second portion 104 are different than pores of the porous material in the third portion 106. For example, the pores of the porous material in the second portion 104 may be configured to allow hydrogel infiltration while the pores of the porous material in the third portion 106 may be configured to allow osseointegration. In some embodiments, the porous material in the second portion 104 is different than the porous material in the third portion 106. For example, the porous material in the second portion 104 may comprise a first material having a property and the porous material in the third portion 106 may comprise a second material having a property different than the property of the first material. The property may comprise, for example, the material itself (e.g., whether ceramic, metal, plastic, etc.), porosity, pore size, dimensions, deformability, etc.

    [0046] Overlap of hydrogel material of the first portion 102 and porous material of the third portion 106 in the second portion 104, for example by the hydrogel material filling pores of the porous material, may securely anchor the first portion 102 to the third portion 106, for example compared to an implant in which a surface of a hydrogel material is adhered to a surface of another material. In some embodiments, a ratio of a height of the second portion 104 to a height of the third portion 106 is between about 1:5 and about 5:1 (e.g., about 1:5, about 1:4, about 1:3, about 1:2, about 1:1, about 2:1, about 3:1, about 4:1, about 5:1, ranges between such values, etc.). In some embodiments, a ratio of a height of the second portion 104 to a height of the ceramic material (e.g., a height of the second portion 104 and a height of the third portion 106) is between about 1:5 and about 1:1.1 (e.g., about 1:5, about 1:4, about 1:3, about 1:2, about 1:1.5, about 1:1.4, about 1:1.3, about 1:1.2, about 1:1.1, ranges between such values, etc.). In some embodiments, a ratio of a height of the third portion 106 to a height of the ceramic material (e.g., a height of the second portion 104 and a height of the third portion 106) is between about 1:5 and about 1:1.1 (e.g., about 1:5, about 1:4, about 1:3, about 1:2, about 1:1.5, about 1:1.4, about 1:1.3, about 1:1.2, about 1:1.1, ranges between such values, etc.).

    [0047] Compared to an implant consisting essentially of hydrogel, an implant comprising porous material (e.g., porous ceramic, metal, plastic, etc.) may have a reduced height. For example, compared to implants consisting only or essentially of a hydrogel material, such hybrid implants can have a height that is reduced by between about 5% and about 30% (e.g., about 5%, about 10%, about 15%, about 20%, about 25%, about 30%, ranges between the foregoing percentages, etc.). In some embodiments, the third portion 106 of the implant 100 may provide improved or enhanced structural stability to the implant 100. Such improved or enhanced structural stability may be beneficial for use with large bones, although use with small bones is also possible.

    [0048] Although the implant 100 is schematically illustrated as a cylindrical plug, other shapes of the implant 100 are also possible. For example, an upper surface of the first portion 102 may be contoured to abut particular anatomy (e.g., planar (e.g., flat), non-planar (e.g., curved, concave, convex, undulating, fluted)). The implant 100 can include a generally circular or oval cross-sectional shape. In some embodiments, the implant 100 is generally shaped like a cylinder or a mushroom. The overall shape of any of the implants disclosed herein can vary depending on the specific application or use. For example, the shape of at least part of a portion 102, 104, 106 can be generally polygonal (e.g., rectangular, round, hexagonal), irregular, and/or the like.

    [0049] A molding process, for example as described herein with respect to Figures 4 and/or with respect to Figures 5A-5C, may be used to form particular shape of an implant 100.

    [0050] In some embodiments, means for treating a joint (e.g., the implant 100) comprises, or alternatively consists essentially of, means for providing a lubricious surface (e.g., the first portion 102) and means for promoting osseointegration (e.g., the third portion 106).

    [0051] Figure 1B schematically illustrates an example implant 150. The implant 150 comprises, or alternatively consists essentially of, a first portion 152, a second portion, and a third portion 156. The first portion 152 and the second portion of the implant 150 comprises, or alternatively consists essentially of, a hydrogel (e.g., a hydrogel or other formulation comprising PVA hydrogel). The second portion is not illustrated due to the opacity of the hydrogel material of the first portion 152. The third portion 156 comprises, or alternatively consists essentially of, a porous material (e.g., a material or section comprising porous ceramic material (e.g., oxide-ceramic), metal (e.g., titanium (e.g., titanium mesh, printed titanium), stainless steel (e.g., stainless steel wool)), plastic (e.g., polyaryl ether ketone (PAEK) (e.g., polyether ether ketone (PEEK))), other biocompatible materials, combinations thereof, and the like). The first portion 152, or the hydrogel material, comprises a contoured upper surface 162. The upper surface 162 may be rounded at the edges and then flat (e.g., as illustrated in Figure 1B), contoured to correspond to an opposing surface, etc. The hydrogel material of the implant 150 also includes a taper 164 towards the porous material of the third portion 156. Other shapes, surface contours, and combinations thereof are also possible.

    [0052] Figure 1C schematically illustrates an example implant 180. The implant 180 comprises, or alternatively consists essentially of, a first portion 182, a second portion 184, and a third portion 186. The third portion 186 comprises threads 188, which can allow the implant to be screwed into bone and/or a hole in bone. The implant 180 may take the shape of a screw. The threads 188 may comprise a same material as the third portion 186 (e.g., porous material) or a different material than the third portion 186 (e.g., a non-porous ceramic, metal, plastic, etc.). Aspects of orthopedic screws, dental implants, etc. such as coatings, surface features, etc. may be integrated into the threads 188 and/or the third portion 186. In some embodiments, the second portion 184 may comprise threads. Threads in the second portion 184 may help, for example, to anchor the hydrogel material to the porous material and/or inhibit relative longitudinal movement therebetween. Threads of the second portion 184 may be the same or different than the threads 188 of the third portion 186.

    [0053] Figure 2 illustrates one embodiment of an implant 200 comprising a hydrogel section and a porous material section. Similar to the implant 100 discussed above, the illustrated implant 200 comprises a first hydrogel portion 202, a second overlap portion 204, and a third porous material portion 206. In the depicted arrangement, the third portion 206 is substantially free from the hydrogel of the first portion 202, as highlighted by the dotted line 208 between the second portion 204 and the third portion 206. More or less overlap in the second portion 204 is also possible, for example by using less hydrogel material and/or less porous material, by adjusting height of the implant 200, etc. In some embodiments, a ratio of a height of the second portion 204 (e.g., measured at an average of the hydrogel level) to a height of the implant 200 is between about 5% and about 40% (e.g., about 5%, about 10%, about 15%, about 20%, about 25%, about 30%, about 35%, about 40%, ranges between such values, etc.). In some embodiments, a ratio of a height of the second portion 204 to a height of the first portion 202 is between about 15% and about 75% (e.g., about 15%, about 25%, about 35%, about 45%, about 55%, about 65%, about 75%, ranges between such values, etc.). In some embodiments, a ratio of a height of the second portion 204 to a height of the third portion 206 is between about 10% and about 90% (e.g., about 10%, about 20%, about 30%, about 40%, about 50%, about 60%, about 70%, about 80%, about 90%, ranges between such values, etc.).

    [0054] Figures 3A and 3B schematically illustrate an example method of positioning an example implant 300. Similar to the implants 100, 200, the implant 300 comprises a first hydrogel portion 302, a second overlap portion 304, and a third porous material portion 306.

    [0055] According to some embodiments, the bone portion 308 in which the implant 300 will be positioned has been drilled to form a hole or aperture or recess or cavity or crater or pit or pocket 310. In some embodiments, the lateral dimension (e.g., diameter) of the hole 310 is less than the lateral dimension (e.g., diameter) of the third portion 306, which is rigid. In some embodiments, a lateral dimension and/or cross-sectional area of the hole 310 is about 5% to about 15% (e.g., about 5%, about 6%, about 7%, about 8%, about 9%, about 10%, about 11%, about 12%, about 13%, about 14%, about 15%, ranges between such values, etc.) wider or otherwise larger than the lateral dimension and/or cross-sectional area of the third portion 306. The lateral dimension (e.g., diameter) of the hole 310 may be smaller than the lateral dimension (e.g., diameter) of the first portion 302, which may flex radially inwardly. Although illustrated as a cylindrical hole 310, other shapes are also possible (e.g., trapezoidal tapering inwards towards the upper surface). In some embodiments, a lateral dimension and/or cross-sectional area of the hole 310 is about 5% to about 15% (e.g., about 5%, about 6%, about 7%, about 8%, about 9%, about 10%, about 11%, about 12%, about 13%, about 14%, about 15%, ranges between such values, etc.) narrower or otherwise smaller than the lateral dimension and/or cross-sectional area of the first portion 302. The hole 310 may be coated or otherwise treated prior to positioning of the implant 300.

    [0056] As a result of the shape of the implant 300 and the corresponding implant site (e.g., in the hole 310), the implant 300 may be inwardly radially compressed in order to insert the implant 300 in the hole 310. A delivery system or introducer 312 and/or other delivery tools can be used to facilitate positioning of the implant 300. Radially inward compressive forces may facilitate delivery of an implant 300 that is at least partially radially oversized relative to the hole 310, as discussed further herein. The degree to which the implant 300 can be compressed (e.g., circumferentially, radially inwardly, etc.) may depend on one or more factors, properties, characteristics and/or other considerations of the first portion 302, such as, for example, implant size, water content, ingredients and other components, strength, elasticity, surrounding temperature, method of manufacturing, and/or the like. Although described herein as generally rigid, the second portion 304 and the third portion 306 may also have some degree of compressibility. Radial compression of an implant 300 can affect the overall height, the shape and/or contours of outer surfaces (e.g., top or articulating surface, base or bottom surface, sides, etc.), and/or one or more other properties or characteristics of the implant 300. In some embodiments, radial compression of an implant 300 causes the height of the implant 300 to increase (e.g., relative to the height of the implant 300 when not radially compressed). Consequently, careful consideration may be given to the design of the implant 300 based on, among other things, the expected level of radial compression that may occur once the implant 300 has been properly secured in the hole 310, prior to implantation. Otherwise, in some embodiments, upon implantation, an implant 300 may not properly align with adjacent cartilage or other tissue surfaces in a joint or other anatomical location.

    [0057] According to some embodiments, the implant 300 is loaded into a delivery system 312; only the distal end of the delivery system 312 is illustrated in Figure 3A. The delivery system 312 can comprise an outer body 314 and a plunger or pusher member 316. The outer body 314 may be cylindrical or may taper radially inwardly towards the distal end of the delivery system 312. In the illustrated embodiment, the plunger 316 abuts the first portion 302 of the implant 300. The delivery system 312 can be aligned with the hole 310, and then a user such as a surgeon can depress the plunger 316. The plunger 316 is translatable along the longitudinal axis of the delivery system 312 to push the implant 300 out of the distal end of the delivery system 312 into the hole 310. Depression of the plunger 316 and/or deployment of the implant 300 may be manual, mechanically assisted, combinations thereof, and the like.

    [0058] Figure 3B illustrates the implant 300 in the bone portion 308. The hole 310 preferably has a depth that is greater than or equal to the height of the second portion 304 and the third portion 306 such that the part of the implant 300 prolapsing from the bone portion 308, the load-bearing surface, comprises hydrogel and is free or substantially free of the relatively more rigid porous material. In some embodiments, an upper surface of the implant 300 is about 1 millimeter (mm) to about 3 mm above an upper surface of the bone portion 308 (e.g., the bone of the bone portion, remaining cartilage, etc.), also termed "proud," designated in Figure 3B by the measurement p, which can provide a desired contour of the damaged joint surface. In some embodiments, such a raised or otherwise protruding configuration can assist in creating a smoother transition between the exposed surface of the implant 300 and adjacent native surfaces.

    [0059] The first portion 302 may have a larger lateral dimension (e.g., diameter) than the third portion 306 to create a "mushroom" shape, as illustrated in Figure 3B, as well as in Figures 1A-2 and other examples herein. In some embodiments, for any of the implants disclosed herein, a ratio of a lateral dimension (e.g., diameter) and/or cross-sectional area of the first portion 302 or a portion thereof to a lateral dimension (e.g., diameter) and/or cross-sectional area of the third portion 306 or a portion thereof is between about 1 and about 1.3 (e.g., greater than or equal to about 1.05, about 1.06, about 1.07, about 1.08, about 1.09, about 1.1, about 1.11, about 1.12, about 1.13, about 1.14, about 1.15, about 1.16, about 1.17, about 1.18, about 1.19, about 1.2, about 1.21, about 1.22, about 1.23, about 1.24, about 1.25, about 1.26, about 1.27, about 1.28, about 1.29, about 1.3, ranges between such values, etc.). In other embodiments, the ratio is between about 1 and 1.05 (e.g., greater than or equal to about 1.01, about 1.02, about 1.03, about 1.04, about 1.05, ranges between such values, etc.), or greater than about 1.3 (e.g., greater than or equal to about 1.3, about 1.35, about 1.4, about 1.45, about 1.5, about 1.55, about 1.6, etc.), as desired or required.

    [0060] The smaller third portion 306 can slide into the hole 310 of the bone portion 308, although preferably making contact with the sidewalls or perimeter of the hole 310, and the larger first portion 302 can be wedged into the hole 310 of the bone portion 308 due to its flexibility. Referring again to Figure 3A, the implant 300 may be held in the delivery system 312 by radial compression of the implant 300. The substantially rigid porous material of the second portion 304 and the third portion 306 might not be susceptible to radial compression. The larger first portion 302 can be radially compressed or wedged into the outer body 314 due to its flexibility while the smaller third portion 306 may slide within the outer body 314.

    [0061] Figure 3C schematically illustrates an example method of positioning the example implant 150 of Figure 1B. The implant 150 in a bone portion 358, for example by the method of Figures 3A and 3B or another method. The third portion 156 makes contact with the perimeter of the hole in the bone portion 358. The hydrogel material of the second portion and usually the first portion 152 is radially compressed in the hole in the bone portion 358. Figure 3C illustrates a radially compressed segment 366 and an uncompressed segment 368. The uncompressed segment 368 is over the surface of the bone portion 358. Referring again to Figure 3B, the segment of the first portion 302 that is proud may be radially larger than the segment of the first portion 302 that is in the hole 310 in the bone portion 308.

    [0062] Figure 4 schematically illustrates an example method of manufacturing example implants 400. A mold 408 comprises a plurality of wells or cavities or recesses or holes 410. Bottoms of the wells 410 may be contoured, for example for a specific anatomy location in which an implant 400 will be placed, and/or other factors or considerations. For example, an implant 400 can be configured to generally or specifically match the slopes, contours, and/or other features of the existing cartilaginous and/or bone tissue (e.g., planar (e.g., flat), non-planar (e.g., curved, concave, convex, undulating, fluted)), a recess or hole or cavity created in the bone, and/or the like. Accordingly, the function of a rehabilitated joint or other targeted anatomical region being treated can be improved. The bottom surfaces of the implants 400 in the mold 408 will be the upper load bearing surfaces of the implants 400 in use. In some embodiments, the mold 408 further comprises a plurality of anchors 412 configured to inhibit or prevent third portions 406 from sinking into first portions 402 during the manufacturing process. The anchors 412 may comprise wire, clamps, releasable adhesive, combinations thereof, and the like. Hydrogel material of the first portion 402 fills pores of the porous material of the third portion 406 in the second portion 404. The upper surface of the hydrogel may be generally planar, although other shapes are also possible. A mold configured to make one implant 400 at a time is also possible.

    [0063] Figures 5A-5C schematically illustrate an example method of manufacturing example implants 500. As shown in Figure 5A, in some embodiments, a first mold portion 508 comprises a plurality of wells or cavities or recesses or holes 510. The first mold portion 508 may be the same or different than the mold 408. In contrast to the method of Figure 4, the implants 400 are made "upside down" in that the bottom surfaces of the implants 500 in the mold 508 will not be the upper load bearing surfaces of the implants 500 in use. Porous material 505, for example in the shape of discs, grommets, etc., are inserted into the wells 510. Since the porous material 505 are substantially rigid, they will not conform to any contours at bottoms of the wells 510. The fit of the porous ceramic 505 in the mold 508 is preferably tight enough that hydrogel material subsequently inserted into the wells 510 is inhibited or prevented from flowing to bottoms of the wells 510.

    [0064] As shown in Figure 5B, a second mold portion 512 comprises a plurality of wells 514 configured to be aligned with the plurality of wells 510 of the first mold portion 508. Bottoms of the wells 514 (or tops of the wells 514 in the orientation of Figure 5B) may be contoured, for example for a specific anatomical location in which an implant 500 will be placed, and/or other factors or considerations. For example, an implant 500 can be configured to generally or specifically match the slopes, contours, and/or other features of the existing cartilaginous and/or bone tissue (e.g., planar (e.g., flat), non-planar (e.g., curved, concave, convex, undulating, fluted)), a recess or hole or cavity created in the bone, and/or the like. The upper surfaces of the implants 500 will be the upper load bearing surfaces of the implants 500 in use.

    [0065] As shown in Figure 5C, the second mold portion 512 is aligned with the first mold portion 508. Hydrogel material can then be inserted into the wells 510, 512, for example through closable port or holes or apertures 516. The hydrogel material fills some but preferably not all of the pores of the porous material 505. Porous material 505 free or substantially free of hydrogel material form the third portions 506, porous material 505 having pores at least partially filled or filled by hydrogel material form the second portions 504, and hydrogel material free or substantially free of porous material 505 form the first portions 502.

    [0066] The first mold portion 508 and the second mold portion 512 meet at intersection 518. Similar to blow molding processes, any spacing between the mold portions 508, 512 may result in flashing. The molds 508, 512 may be configured to reduce or minimize flashing, for example by being precisely corresponding, tightly joined, etc. The molds 508, 512 may be configured to not reduce flashing, for example by using a flash removal process or by allowing the implants 500 to have flashing.

    [0067] One or more of the mold portions described with respect to Figures 4 and 5A-5C, and modifications thereof, may be tailored to, or designed or customized for, a specific subject's anatomy. For example, a surface of a bone and/or an opposing bone may be scanned (e.g., via computerized tomography (CT), computerized axial tomography (CAT), positron emission tomography (PET), magnetic resonance imaging (MRI), combinations thereof, etc.), which can be used to make a mold (e.g., via 3D printing, CAD-CAM milling, etc.) to match specific anatomical features of a specific patient or subject. For example, with reference to Figure 4, the bottom of the well 410 may be customized such that hydrogel of the first portion 402 takes a certain shape. For another example, with reference to Figures 5A-5C, the bottom of the well 514 may be customized such that hydrogel of the first portion 402 takes a certain shape. Other parts of the molds may also be modified (e.g., sides of the wells 410, 514, wells 510, etc.). A custom implant can be advantageous, for example, when the anatomy has been damaged or otherwise includes unique characteristics.

    [0068] In some embodiments, a scan may reveal that a plurality of implants may be used for treatment. For example, compared to one implant, a plurality of implants may be better able to treat a large defect, be better provide a load bearing surface to key points, and/or provide better access to a physician. The scan can be used to select locations and/or sizes for a plurality of implants. For example, taking a knee joint as an example, a user may select in a scan a portion of a lateral condyle for a first implant and a portion of a medial condyle for a second implant. If the implant would provide an advantage if the portion is a little more anterior, a little more posterior, a little more medial, a little more lateral, etc., the implant can be customized to that particular location using the scan, which may result in, for example, different load bearing surface features, different dimensions, different protrusion amounts, combinations thereof, and the like.

    [0069] Any of the implant embodiments disclosed herein, or equivalents thereof, can be manufactured using freeze/thaw cycling and/or any other appropriate production method. For example, a hydrogel formulation comprising water, saline, PVA (and/or other hydrogel materials), other polymeric materials, other additives and/or the like can be cooled, heated, and/or otherwise treated as part of a freeze/thaw manufacturing process. In some embodiments, a hydrogel solution comprising saline and about 40% PVA by weight is heated to approximately 121 °C under elevated pressure conditions (e.g., to effect dissolution of the polymer). For example, such a solution can be autoclaved to facilitate complete or substantially complete dissolution of the PVA in the saline, water, and/or other liquid. Next, the temperature and/or pressure of the solution can be lowered to permit entrapped air and/or other gases to escape. In some embodiments, after the autoclaving or similar step, the solution is generally maintained at a temperature of approximately 95 °C and atmospheric pressure for a predetermined time period. The solution can then be transferred (e.g., pumped, poured, etc.) into a mold or mold portions (e.g., as described with respect to Figures 4 and 5C) where, once set, form at least part of the shape of the implant.

    [0070] The molded implant can be removed either after initial formation or after undergoing additional treatment (e.g., freeze/thaw cycling, other heat and/or pressure treatment, etc.). The molded implant may optionally be cut, altered, or otherwise processed after molding. In some embodiments, flashing may be excised and discarded as part of a subsequent reshaping step.

    [0071] In some embodiments, due in part to the remaining production steps, accommodation of any changes in size (e.g., expansion, contraction, etc.) that may occur or are likely to occur to the implant can be considered during manufacturing by properly sizing and otherwise designing the mold or mold portions. The amount of contraction or expansion of the implant can be based on one or more factors or conditions, such as, for example, the number of freeze/thaw cycles, the temperature and/or pressure ranges associated with the remaining steps, and/or the like.

    [0072] Other methods can also be used to form the implants described herein. For example, an implant can be formed, at least in part, using an injection molding process and/or any other molding or casting procedure. In such injection or transfer molding techniques, once the hydrogel or other implant solution has been prepared, it can be loaded into an injection cylinder or other container of a molding press. The solution can then be forcibly transferred into a closed mold assembly using a pneumatic or hydraulic ram or any other electromechanical device, system, or method. In some embodiments, the hydrogel and/or other solution or implant component is injected into a corresponding closed mold assembly through a standard runner and gate system. Injection molding of implants can provide one or more benefits relative to open mold assemblies. For instance, an implant formed as part of an injection molding technique may be or may essentially be in a final shape immediately after the injection molding step has been completed such that the manufacturing process may be free or may be substantially free of steps such as post-mold cutting, reshaping, resizing, and/or processing.

    [0073] Regardless of how the implant is molded or otherwise shaped or manufactured, the implant can be subsequently subjected to one or more freeze/thaw cycles, as desired or required. In some embodiments, the implant, while in a cavity of a mold, is cooled using a total of four freeze/thaw cycles in which the temperature is sequentially varied between about -20 °C and about 20 °C. In some embodiments, the number of freeze/thaw cycles, the temperature fluctuation, and/or other details can be different than disclosed herein, in accordance with a specific production protocol and/or implant design.

    [0074] Following freeze/thaw cycling, the implant can be at least partially removed (e.g., including fully removed) from the mold and placed in one or more saline and/or other fluid (e.g., other liquid) baths where the implant can be subjected to additional cooling and/or other treatment procedures (e.g., to further stabilize the physical properties of the implant). In some embodiments, the implant undergoes an additional eight freeze/thaw cycles while in saline. In some embodiments, such follow-up cooling procedures can be either different (e.g., more or fewer freeze/thaw cycles, different type of bath, etc.) or altogether eliminated from the production process, as desired or required.

    [0075] When the cooling (e.g., freeze/thaw cycling) and/or other manufacturing processes have been completed, the implants can be inspected for any manufacturing flaws or other defects. At least some of the implants can be subjected to selective testing for physical and other characteristics, in accordance with the original design goals and/or target parameters. The implant may be cut or otherwise processed to remove any excess portions (e.g., flash). In some embodiments, one or more completed implant is packaged in hermetically sealed plastic trays or other containers comprising foil or other types of lids or covering members. A volume of saline and/or other liquid can be included within such trays or other containers to provide hydration of the implant(s) during storage and/or any other steps preceding use. In some embodiments, the implant tray or other container is terminally sterilized using e-beam exposure between about 25 kilogray (kGy) and about 40 kGy.

    [0076] Additional details related to implants comprising hydrogels, including methods of manufacturing and use, can be found in U.S. Patent No. 5,981,826, U.S. Patent No. 6,231,605, and PCT Patent Application Publication No. WO 2012/162552.

    [0077] Figure 6 schematically illustrates another example implant 600. Similar to the implant 100, the implant 600 comprises a first hydrogel portion 602, a second overlap portion 604, and a third porous portion (e.g., comprising porous material) 606. In some embodiments, the implant 600 comprises an outer contour or rim or flange 608. As described with respect to Figure 5C, the use of a two-part mold may result in flashing where the mold portions 508, 512 meet at intersection 518. The outer contour 608 may comprise unremoved flashing. The outer contour 608 may increase apposition of the first portion 602 in a hole, which can help to anchor the implant 600 in the hole.

    [0078] Figure 7A schematically illustrates an example implant 700. Similar to the implant 100, the implant 700 comprises a first hydrogel portion 702, a second overlap portion 704, and a third porous portion (e.g., comprising porous material) 706. The implant 700 comprises outer sidewalls having an angle to the longitudinal axis of the implant 700. In some embodiments, the implant 700 comprises a frustoconical shape. In some embodiments, the implant 700 comprises a pyramid shape. In some embodiments, the porous material in the second portion 704 and the third portion 706 comprises a disc shape, for example as described with respect to the implant 100. In some embodiments, the porous material in the second portion 704 and the third portion 706 comprises a frustoconical or pyramid shape, for example as shown in Figure 7A. The shape of the porous material and the shape of the hydrogel may be the same (e.g., as illustrated in Figure 7A) or different (e.g., comprising a disc-shaped porous material).

    [0079] Implant dimensions, shapes, angles, tooling used to make non-cylindrical bone apertures, tooling to deploy non-cylindrical implants, potential advantages, etc. may be the same as or similar to (e.g., including appropriate modification to include porous material as understood from the present application) the hydrogel implants comprising wedge shapes are described in U.S. Patent No. 9,155,543.

    [0080] In some embodiments, the porous material may be selected based on bone infiltration characteristics and/or dimensions of the third portion 706. In certain such embodiments, the height and/or shape of the second portion 704 may be at least partially based on a porosity of the porous material. For example, if the porous material is more porous, then hydrogel infiltration into the porous material will be greater, so less porous material may be used. Conversely, if the porous material is less porous, then hydrogel infiltration into the porous material will be less, so more porous material may be used.

    [0081] Figure 7B schematically illustrates an example method of positioning an example implant 700. More specifically, Figure 7B illustrates the implant 700 in a bone portion 708. According to some embodiments, the bone portion 708 in which the implant 700 will be positioned has been drilled to form a hole or aperture or recess or cavity or crater or pit or pocket 710. The hole 710 comprises a shape corresponding to the shape of the implant 700. For example, the hole 710 may be frustoconical, pyramidal, etc. As described in further detail in U.S. Patent No. 9,155,543, a cylindrical pilot hole may be formed in the bone segment, then a secondary tool may be used to shape the hole 710 such that the hole 710 can take a wide variety of shapes. In some embodiments, the lateral dimension (e.g., diameter) of the top of the hole 710 is greater than the lateral dimension (e.g., diameter) of the bottom of the third portion 706, which is rigid. In some embodiments, a lateral dimension and/or cross-sectional area of the top of the hole 710 is about 5% to about 15% (e.g., about 5%, about 6%, about 7%, about 8%, about 9%, about 10%, about 11%, about 12%, about 13%, about 14%, about 15%, ranges between such values, etc.) wider or otherwise larger than the lateral dimension and/or cross-sectional area of the bottom of the third portion 706. The lateral dimension (e.g., diameter) of the hole 710 may be smaller than the lateral dimension (e.g., diameter) of the bottom of the first portion 702, which may flex radially inwardly. In some embodiments, a lateral dimension and/or cross-sectional area of the top of the hole 710 is about 5% to about 15% (e.g., about 5%, about 6%, about 7%, about 8%, about 9%, about 10%, about 11%, about 12%, about 13%, about 14%, about 15%, ranges between such values, etc.) narrower or otherwise smaller than the lateral dimension and/or cross-sectional area of the bottom of the first portion 702. The hole 710 may be coated or otherwise treated prior to positioning of the implant 700.

    [0082] The hole 710 preferably has a depth that is greater than or equal to the height of the second portion 704 and the third portion 706 such that the part of the implant 700 prolapsing from the bone portion 708, the load-bearing surface, comprises hydrogel and is free or substantially free of the relatively more rigid porous material. In some embodiments, an upper surface of the implant 700 is about 1 millimeter (mm) to about 7 mm above an upper surface of the bone portion 708 (e.g., the bone of the bone portion, remaining cartilage, etc.), which can provide a desired contour of the damaged joint surface. In some embodiments, such a raised or otherwise protruding configuration can assist in creating a smoother transition between the exposed surface of the implant 700 and adjacent native surfaces.

    [0083] As a result of the shape of the implant 700 and the corresponding implant site (e.g., in the hole 710), the implant 700 may be inwardly radially compressed in order to insert the implant 700 in the hole 710. A delivery system or introducer and/or other delivery tools can be used to facilitate positioning of the implant 700. Radially inward compressive forces may facilitate delivery of the implant 700 that is at radially oversized relative to the top of the hole 710. The degree to which the implant 700 can be compressed (e.g., circumferentially, radially inwardly, etc.) may depend on one or more factors, properties, characteristics and/or other considerations of the first portion 702, such as, for example, implant size, water content, ingredients and other components, strength, elasticity, surrounding temperature, method of manufacturing, and/or the like. Although described herein as generally rigid, the second portion 704 and the third portion 706 may also have some degree of compressibility. Radial compression of an implant 700 can affect the overall height, the shape and/or contours of outer surfaces (e.g., top or articulating surface, base or bottom surface, sides, etc.), and/or one or more other properties or characteristics of the implant 700. In some embodiments, radial compression of an implant 700 causes the height of the implant 700 to increase (e.g., relative to the height of the implant 700 when not radially compressed). Consequently, careful consideration may be given to the design of the implant 700 based on, among other things, the expected level of radial compression that may occur once the implant 700 has been properly secured in the hole 710, prior to implantation. Otherwise, in some embodiments, upon implantation, an implant 700 may not properly align with adjacent cartilage or other tissue surfaces in a joint or other anatomical location.

    [0084] Interaction between the sidewalls of the hole 710 and the edges of the implant 700 can create a downward force, which can create a more secure implantation (e.g., resisting dislodge forces). Interaction between the sidewalls of the hole 710 and the edges of the implant 700 can create a downward force, which can help the third portion 706 make contact with the bottom of the hole 710, which can improve bone infiltration into the third portion 706.

    [0085] In some embodiments, the third portion and the hole may have nonuniform lateral cross-sections. For example, the bottom of the third portion may have an ellipse shape having a length greater than a width, and the top of the hole may have an oval shape having a length greater than a width. During implantation, the implant may be positioned such that the length and width of the third portion are aligned with the length and width of the hole. The generally rigid third portion may fit through the hole when aligned, but the generally rigid third portion may not fit through the hole when the implant is rotated. For example, after rotation, the length of the third portion may not be able to fit through a width of the hole. If the length of an ellipse compared to a circle in a third portion for an otherwise same implant may increase the area of contact between the bottom of the third portion and the bottom of the hole by about 10% to about 50% (e.g., about 10%, about 20%, about 30%, about 40%, about 50%, ranges between such values, etc.). In some embodiments, the implant may be rotated until sides of the third portion make contact with the hole. Contact between sides of the third portion and sides of the hole may provide increased area for bone infiltration and/or increase downward force.

    [0086] Figure 7C schematically illustrates an example method of positioning an example implant 720. Similar to the implant 700, the implant 720 comprises a first hydrogel portion 722, a second overlap portion 724, and a third porous portion (e.g., comprising porous material) 726. The implant 700 further comprises an anchor 728. The anchor 728 is illustrated as comprising barbs, but implants comprising other types of anchors compatible with the implant 720 and other implants (e.g., the implants 100, 150, 180, 200, 300, 600, 700, and modifications thereof) are described in further detail herein. For example, the porous material may comprise a grommet shape including an eyelet. The eyelet may be in a center of the porous material or elsewhere, including superficial eyelets in lateral sides of the porous material. The anchor may extend through the eyelet. The porous material may comprise a plurality of eyelets, which may be used for a plurality of anchors and/or for securing a single anchor.

    [0087] When the implant 720 is inserted into a hole 740 in a bone segment 732 that comprises a secondary hole 742, the anchor 728 can fit into the secondary hole 742. The anchor 728 can flex inwardly during insertion and then is resistant to retraction. The anchor 728 can maintain a downward force on the third portion 726 against the bottom of the hole 740. The force may be advantageous at least until bone infiltration, which may be complete enough to anchor the implant without the anchor 728 in about six to eight weeks. In some embodiments, the secondary hole 742 can be formed while forming a pilot hole (e.g., using a dual diameter drill bit). In some embodiments, the secondary hole 742 can be formed before or after forming a pilot hole (e.g., using a different drill bit), before or after forming a shape such as a wedge. In some embodiments in which a guide pin is used for procedures like drill bit alignment, the secondary hole 742 may be a result of removal of the guide pin.

    [0088] Figure 8A schematically illustrates an example implant 800. Similar to the implant 100, the implant 800 comprises a first hydrogel portion 802, a second overlap portion 804, and a third porous portion (e.g., comprising porous material) 806. As illustrated in Figure 8A, the porous material comprises a titanium mesh and/or stainless steel wool comprising a bundle of intertwined filaments. The implant 800 comprises a mushroom shape in which the first portion 802 and the second portion 804 are generally hemispherical or dome shaped and the third portion 806 is generally cylindrical. The shape of the porous material in the second portion 802 and the shape of the hydrogel may be the same (e.g., as illustrated in Figure 8A) or different (e.g., the porous material continuing as a cylinder, being disc shaped in the second portion 804, etc.). In some embodiments, the shape of the first portion 802 corresponds to a load bearing surface, for example a condyle.

    [0089] Figure 8B schematically illustrates an example method of positioning an example implant 800. More specifically, Figure 8B illustrates the implant 800 in a bone portion 808. According to some embodiments, the bone portion 808 in which the implant 800 will be positioned has been drilled to form a hole or aperture or recess or cavity or crater or pit or pocket 810. The hole 810 comprises a shape corresponding to the shape of the implant 800. For example, the hole 810 may comprise a generally cylindrical lower portion and a wedge shape or spherical segment shape upper portion. As described in further detail in U.S. Patent No. 9,155,543, a cylindrical pilot hole may be formed in the bone segment, then a secondary tool may be used to shape the hole 810 such that the hole 810 can take a wide variety of shapes. In some embodiments, the lateral dimension (e.g., diameter) of the top of the hole 810 is greater than the lateral dimension (e.g., diameter) of the bottom of the second portion 804, which is relatively rigid. In some embodiments, a lateral dimension and/or cross-sectional area of the top of the hole 810 is about 5% to about 15% (e.g., about 5%, about 6%, about 7%, about 8%, about 9%, about 10%, about 11%, about 12%, about 13%, about 14%, about 15%, ranges between such values, etc.) wider or otherwise larger than the lateral dimension and/or cross-sectional area of the bottom of the second portion 804. The lateral dimension (e.g., diameter) of the hole 810 may be smaller than the lateral dimension (e.g., diameter) of the bottom of the first portion 802, which may flex radially inwardly. In some embodiments, a lateral dimension and/or cross-sectional area of the top of the hole 810 is about 5% to about 15% (e.g., about 5%, about 6%, about 7%, about 8%, about 9%, about 10%, about 11%, about 12%, about 13%, about 14%, about 15%, ranges between such values, etc.) narrower or otherwise smaller than the lateral dimension and/or cross-sectional area of the bottom of the first portion 802. In some embodiments, the lateral dimension (e.g., diameter) of the lower segment of the hole 810 is about the same (e.g., about ±5%, about ±10%, about ±15%, about ±20%, about ±25%) as the lateral dimension (e.g., diameter) of the third portion 806, which is generally rigid but may be flexible or compressible enough to squeeze radially inwardly. In some embodiments, as the third portion 806 is longitudinally compressed, a lateral dimension (e.g., diameter) of the third portion 806 may increase. The hole 810 may be coated or otherwise treated prior to positioning of the implant 800.

    [0090] The hole 810 preferably has a depth that is greater than or equal to the height of the second portion 804 and the third portion 806 such that the part of the implant 800 prolapsing from the bone portion 808, the load-bearing surface, comprises hydrogel and is free or substantially free of the relatively more rigid porous material. In some embodiments, an upper surface of the implant 800 is about 1 millimeter (mm) to about 7 mm above an upper surface of the bone portion 808 (e.g., the bone of the bone portion, remaining cartilage, etc.), which can provide a desired contour of the damaged joint surface. In some embodiments, such a raised or otherwise protruding configuration can assist in creating a smoother transition between the exposed surface of the implant 800 and adjacent native surfaces.

    [0091] As a result of the shape of the implant 800 and the corresponding implant site (e.g., in the hole 810), the implant 800 may be inwardly radially compressed in order to insert the implant 800 in the hole 810. A delivery system or introducer and/or other delivery tools can be used to facilitate positioning of the implant 800. Radially inward compressive forces may facilitate delivery of the implant 800 that is at radially oversized relative to the top of the hole 810. The degree to which the implant 800 can be compressed (e.g., circumferentially, radially inwardly, etc.) may depend on one or more factors, properties, characteristics and/or other considerations of the first portion 802, such as, for example, implant size, water content, ingredients and other components, strength, elasticity, surrounding temperature, method of manufacturing, and/or the like. Although described herein as generally rigid, the second portion 804 and the third portion 806 may also have some degree of compressibility. Radial compression of an implant 800 can affect the overall height, the shape and/or contours of outer surfaces (e.g., top or articulating surface, base or bottom surface, sides, etc.), and/or one or more other properties or characteristics of the implant 800. In some embodiments, radial compression of an implant 800 causes the height of the implant 800 to increase (e.g., relative to the height of the implant 800 when not radially compressed). Consequently, careful consideration may be given to the design of the implant 800 based on, among other things, the expected level of radial compression that may occur once the implant 800 has been properly secured in the hole 810, prior to implantation. Otherwise, in some embodiments, upon implantation, an implant 800 may not properly align with adjacent cartilage or other tissue surfaces in a joint or other anatomical location.

    [0092] Interaction between the sidewalls of the hole 810 and the edges of the implant 810 can create a downward force, which can create a more secure implantation (e.g., resisting dislodge forces). Interaction between the sidewalls of the hole 810 and the edges of the implant 800 can create a downward force, which can help the third portion 806 make contact with the bottom of the hole 810, which can improve bone infiltration into the third portion 806. The sides of the third portion 806 may appose the sidewalls of the lower segment of the hole 810 and contact the bottom of the hole 810, which can provide a large area for bone infiltration.

    [0093] Figure 8C schematically illustrates an example method of positioning an example implant 800. In contrast to Figure 8B, the hole 820 in the bone segment 818 is generally cylindrical throughout. The bottom of the first portion 802 can appose sidewalls of the hole 818. The hole 820 may be easier and/or faster to form than the hole 810 such that the hole 820 may be desired even if sidewall apposition by the third portion 806 is reduced or eliminated and Interaction between the sidewalls of the hole 810 and the edges of the implant 810 do not create a downward force. In some embodiments, a hole comprises a lower cylindrical portion having a first lateral dimension (e.g., diameter) sized to correspond to a lateral dimension (e.g., diameter) of the third portion 806 and an upper cylindrical portion having a second lateral dimension (e.g., diameter) larger than the first lateral dimension, which may be easier to form than the hole 810 and still provide sidewall apposition by the third portion 806.

    [0094] Figure 9A is a side view of an example implant 900. Figure 9B is a cross-sectional view of the implant 900 of Figure 9A. Figures 9C and 9D are top and side perspective exploded views of the implant 900 of Figure 9A. Like several of the implants described herein, the implant 900 comprises, in a first part 901, hydrogel 902 and porous material 904. The hydrogel 902 may infiltrate pores of the porous material 904. As best seen in Figures 9B and 9D, the porous material 904 is generally annular. In some embodiments, the porous material 904 could be a solid disc (e.g., like the porous material of the implant 100).

    [0095] The implant 900 also comprises a second part 908. The second part 908 comprises an annular rim, a bottom, and a barb 910. The rim and the bottom at least partially define a cavity configured to receive the first part 901. In some embodiments, the barb 910 is monolithic (formed from a single piece of material) with the remainder of the second part 908. In some embodiments, the barb 910 is formed separately from the remainder of the second part 908 and coupled to the remainder of the second part 908. The second part 908 may comprise a rigid material such as metal, ceramic, plastic, etc. The second part 908 may be formed, for example, by metal casting, injection molding, milling, printing, combinations thereof, etc.

    [0096] The barb 908 may be inwardly compressible when longitudinally advanced, for example into a hole in a bone site, but configured to catch when longitudinally retracted, for example from a hole in a bone site. The second part 908 may comprise a porous material (e.g., to allow bone infiltration) and/or non-porous material (e.g., the second part 908 being anchored by the barb 908).

    [0097] The second part 908 may be inserted at an implant site (e.g., a hole in a bone site) and the first part 901 may be inserted into the second part 908, and thus also into the implant site. As best seen in Figures 9B-9D, the porous material 904 comprises an annular groove 905 and the second part 908 comprises a detent 912. When the first part 901 is inserted into the second part 908, the porous material 904 and/or the detent 912 can flex until the detent 912 interacts with the groove 905, at which point the first part 901 is inhibited from being dislodged from the second portion 908. The groove 905 may be partially or fully annular. In some embodiments, the second part 908 comprises a plurality of detents 912 (e.g., two detents, three detents, four detents, five detents, six detents, ranges therebetween, or more than six detents). The circumferential spacing between detents 912 may be the same (e.g., spaced by about 360° divided by the number of detents) or may vary between pairs of detents 912.

    [0098] Figure 9E is a cross-sectional view of an example implant 920. The implant 920 shares some features with the implant 900, for example comprising hydrogel 922, porous material 924, and a second part 928. The second part 928 comprises a barb 930 comprising two radially outward protrusions, which may provide better dislodge resistance than a single barb. Converse to the implant 900, in which the porous material 904 comprises a groove 905 and the second part 908 comprises a detent 912, in the implant 920, the porous material 924 comprises a detent 925 and the second part 928 comprises a groove 932. The groove 925 may be partially or fully annular. In some embodiments, the porous material 924 comprises a plurality of detents 925 (e.g., two detents, three detents, four detents, five detents, six detents, ranges therebetween, or more than six detents). The circumferential spacing between detents 925 may be the same (e.g., spaced by about 360° divided by the number of detents) or may vary between pairs of detents 925.

    [0099] Figure 10A is a side view of an example implant 1000. Figure 10B is a cross-sectional view of the implant 1000 of Figure 10A. Figures 10C-10E are top and side perspective exploded views of the implant 1000 of Figure 10A. Like the implant 900, the implant 1000 comprises, in a first part 1001, hydrogel 1002 and porous material 1004. The hydrogel 1002 may infiltrate pores of the porous material 1004. As best seen in Figures 10B and 10E, the porous material 1004 is generally annular. In some embodiments, the porous material 1004 could be a solid disc (e.g., like the porous material of the implant 100).

    [0100] The implant 1000 also comprises a second part 1008. The second part 1008 comprises an annular rim, a bottom, and an anchor 1010. The rim and the bottom at least partially define a cavity configured to receive the first part 1001. The second part 1008 may comprise a rigid material such as metal, ceramic, plastic, etc. The second part 1008 may be formed, for example, by metal casting, injection molding, milling, printing, combinations thereof, etc. The second part 1008 may comprise a porous material (e.g., to allow bone infiltration) and/or non-porous material (e.g., the second part 1008 being anchored by the barb 1008).

    [0101] The anchor 1010 comprises an insert 1022 and radially outwardly extending fingers 1024. The anchor 1010 may be coupled to the second part 1008 by a wire 1026 extending through holes 1009 and forming a knot 1028. The anchor 1010 may be pushed into a hole (e.g., a hole in a bone site). The fingers 1024 may flex radially inwardly during advancement into the hole and flex radially outward to inhibit dislodgement from the hole. Ends of the wire 1026 may optionally form a loop. When ends of the wire 1026 are pulled, the knot 1028 tightens to draw the second part 1008 and the anchor 1010 closer together. The anchor 1010 is inhibited from retracting, so the tightening pushes the second part 1008 into the hole. In some embodiments, the anchor 1010 shares features with the anchors described in U.S. Patent Pub. No. 2015/0351815, which is incorporated herein by reference in its entirety for all purposes.

    [0102] The second part 1008 may be inserted at an implant site (e.g., a hole in a bone site) and tightened, and the first part 1001 may be inserted into the second part 1008, and thus also into the implant site. As best seen in Figures 10B-10E, the porous material 1004 comprises an annular groove 1005 and the second part 1008 comprises a detent 1012. When the first part 1001 is inserted into the second part 1008, the porous material 1004 and/or the detent 1012 can flex until the detent 1012 interacts with the groove 1005, at which point the first part 1001 is inhibited from being dislodged from the second portion 1008. The groove 1005 may be partially or fully annular. In some embodiments, the second part 1008 comprises a plurality of detents 1012 (e.g., two detents, three detents, four detents, five detents, six detents, ranges therebetween, or more than six detents). The circumferential spacing between detents 1012 may be the same (e.g., spaced by about 360° divided by the number of detents) or may vary between pairs of detents 1012.

    [0103] Figure 10F is a cross-sectional view of an example implant 1040. The implant 1040 shares some features with the implant 1000, for example comprising hydrogel 1042, porous material 1044, and a second part 1048. The second part 1048 comprises an anchor 1050 including a loop 1060 proximal to a knot 1058. Converse to the implant 1000, in which the porous material 1004 comprises a groove 1005 and the second part 1008 comprises a detent 1012, in the implant 1040, the porous material 1044 comprises a detent 1045 and the second part 1048 comprises a groove 1052. The groove 1052 may be partially or fully annular. In some embodiments, the porous material 1044 comprises a plurality of detents 1045 (e.g., two detents, three detents, four detents, five detents, six detents, ranges therebetween, or more than six detents). The circumferential spacing between detents 1045 may be the same (e.g., spaced by about 360° divided by the number of detents) or may vary between pairs of detents 1045.

    [0104] Figure 11A is a side view of an example implant 1100. Figure 11B is a cross-sectional view of the implant 1100 of Figure 11A. Figure 11C is a top and side perspective view of the implant 1100 of Figure 11A. Figure 11D is a top and side perspective exploded view of the implant 1100 of Figure 11A. Like the implant 900, the implant 1100 comprises, in a first part 1101, hydrogel 1102 and porous material 1104. The hydrogel 1102 may infiltrate pores of the porous material 1104. As best seen in Figures 11B and 11D, the porous material 1104 is generally annular. In some embodiments, the porous material 1104 could be a solid disc (e.g., like the porous material of the implant 100).

    [0105] The implant 1100 also comprises a second part 1108. The second part 1108 comprises an annular rim and a bottom. The rim and the bottom at least partially define a cavity configured to receive the first part 1101. The second part 1108 may comprise a rigid material such as metal, ceramic, plastic, etc. The second part 1108 may be formed, for example, by metal casting, injection molding, milling, printing, combinations thereof, etc. The second part 1108 may comprise a porous material (e.g., to allow bone infiltration) and/or non-porous material (e.g., the second part 1108 being anchored by the barb 1108).

    [0106] The bottom of the second part 1108 comprises a plurality of holes 1109 configured to receive screws 1110. In some embodiments, the bottom of the second part 1108 comprises one hole 1109, two holes 1109, three holes 1109, four holes 1109 (e.g., as shown in Figure 11D), five holes 1109, six holes 1109, ranges therebetween, or more than six holes.

    [0107] The second part 1108 may be inserted at an implant site (e.g., a hole in a bone site). One or more screws 1010 may be inserted through holes 1109 to tighten the second part 1108 against the hole. The first part 1101 may be inserted into the second part 1108, and thus also into the implant site. As best seen in Figures 11B and 11D, the porous material 1104 comprises an annular groove 1105 and the second part 1108 comprises a detent 1112. When the first part 1101 is inserted into the second part 1108, the porous material 1104 and/or the detent 1112 can flex until the detent 1112 interacts with the groove 1105, at which point the first part 1101 is inhibited from being dislodged from the second portion 1108. The groove 1105 may be partially or fully annular. In some embodiments, the second part 1108 comprises a plurality of detents 1112 (e.g., two detents, three detents, four detents, five detents, six detents, ranges therebetween, or more than six detents). The circumferential spacing between detents 1112 may be the same (e.g., spaced by about 360° divided by the number of detents) or may vary between pairs of detents 1112.

    [0108] Figure 11E is a cross-sectional view of an example implant 1120. The implant 1120 shares some features with the implant 1100, for example comprising hydrogel 1122, porous material 1124, and a second part 1128. Like the implant 1100, the second part 1128 comprises a bottom including holes configured to receive screws 1110 therethrough. The second part 1128 also comprises holes in the sidewalls configured to receive screws 1140 therethrough. Inserting the screws 1140 in the sidewalls of the second part can provide more options for fixation of the second part 1128 at an implant site and/or better fixation than a second part comprising only bottom holes. Converse to the implant 1100, in which the porous material 1104 comprises a groove 1105 and the second part 1108 comprises a detent 1112, in the implant 1120, the porous material 1124 comprises a detent 1125 and the second part 1128 comprises a groove 1132. The groove 1132 may be partially or fully annular. In some embodiments, the porous material 1124 comprises a plurality of detents 1125 (e.g., two detents, three detents, four detents, five detents, six detents, ranges therebetween, or more than six detents). The circumferential spacing between detents 1125 may be the same (e.g., spaced by about 360° divided by the number of detents) or may vary between pairs of detents 1115.

    [0109] Figure 12A is a side cross-sectional view of an example implant 1200. Like the implant 900, the implant 1200 comprises hydrogel 1202 and porous material 1204. The hydrogel 1202 may infiltrate pores of the porous material 1204. The porous material 1204 is generally annular. In some embodiments, the porous material 1204 could be a solid disc (e.g., like the porous material of the implant 100). The porous material 1204 comprises a detent 1206 configured to interact with or "bite" the hydrogel 1202. The detent 1206 may be partially or fully annular. In some embodiments, the porous material 1204 comprises a plurality of detents 1206, for example at a variety of positions along the inner walls of the porous material 1204. In some embodiments, the porous material 1204 may comprise a non-porous material, for example because the bite of the detent 1206 provides sufficient interaction with the hydrogel 1202 to inhibit dislodgement of the hydrogel 1202. The porous material 1204 further comprises a barb 1208. The barb 1208 may be inwardly compressible (e.g., due to being thin and/or porous) when longitudinally advanced, for example into a hole in a bone site, but configured to catch when longitudinally retracted, for example from a hole in a bone site. The barb 1208 may be partially or completely annular. The porous material 1204 may comprise barbs 1208 at different longitudinal positions. In some embodiments, the porous material 1204 may be 3D printed, machined, etc.

    [0110] The height of the porous material 1204 may be at least partially based on the intended use of the implant 1200. For example, if the intended use is a small joint (e.g., in a hand or foot), a larger profile and a less proud hydrogel 1202 generally reduces the chances of dislocation.

    [0111] Figure 12B is a side cross-sectional view of an example implant 1210. Like the implant 1200, the implant 1210 comprises hydrogel 1212 and porous material 1214 comprising a barb 1218. The porous material 1214 comprises a groove into which the hydrogel 1212 can radially outwardly extend to form a detent 1216 or a flange if fully annular. The interaction between the detent 1216 and the porous material 1214 provides sufficient bite that the porous material 1214 may comprise a non-porous material. Depending on the mold, desirability of the detent 1216 extending radially outward of the porous material 1214, etc., the detent 1216 may be trimmed.

    [0112] Figure 12C is a side cross-sectional view of an example implant 1220. Like the implant 1200, the implant 1220 comprises hydrogel 1222 and porous material 1224 comprising a detent 1226. The porous material 1224 lacks or is free of a barb, but the porous material 1224 may interact with sidewalls of a hole at an implant site to allow bone infiltration. The implant 1220 may comprise a hydrogel detent like the implant 1210. Any of the implants 1200, 1210, 1220 may comprise porous material detents, hydrogel detents, or combinations thereof.

    [0113] Figure 12D is a side cross-sectional view of example implants 1230, 1240. The implant 1230 comprises hydrogel 1232 and porous material 1234. The hydrogel 1232 infiltrates the pores of the porous material 1234. The porous material 1234 comprises a detent 1236 configured to engage a groove, for example in a second part and/or in a bone hole at an implant site. The porous material 1234 has a height h1. The hydrogel 1232 is proud over the porous material 1234. The implant 1240 comprises hydrogel 1242 and porous material 1244. The hydrogel 1242 infiltrates the pores of the porous material 1244. The porous material 1244 comprises a detent 1246 configured to engage a groove, for example in a second part and/or in a bone hole at an implant site. The porous material 1244 has a height h2 less than the height h1. The hydrogel 1242 is proud over the porous material 1244. The implant 1240 may provide more hydrogel 1242 to appose sidewalls of a second part and/or a bone hole at an implant site. If the bone stock and/or density is limited, the height of the porous material may be increased, which can provide column strength in the implant. If bone stock and/or density is favorable, the height of the porous material may be reduced, which can allow more hydrogel apposition of sidewalls.

    [0114] With respect to any of the implants described herein in which the porous material comprises metal, the implant may advantageously be visible under x-ray.

    [0115] With respect to any of the implants described herein, comprising porous material allowing fixation due to bone infiltration and/or comprising a fixation device such as a barb, anchor, screw, etc., an overall height can be reduced versus and implant, for example, consisting essentially of hydrogel (e.g., lacking porous material and/or a fixation device), which generally uses interaction between a long bone hole and a large height to provide anti-dislodging force. In some embodiments, an anchored implant can have a height that is less than a height of an equivalent but unanchored implant by about 10% to about 60% (e.g., about 10%, about 20%, about 30%, about 40%, about 50%, about 60%, ranges between such values, etc.). For example, if a hydrogel implant has a diameter of 10 mm and a height of 10 mm, then an implant as described herein may have a diameter of 10 mm and a height of 5 mm such that the height is 50% less.

    [0116] Figure 13A is a top and side perspective view of an example implant 1300. The implant 1300 comprises hydrogel 1302 and porous material 1304. The hydrogel 1302 infiltrates pores of the porous material 1304. The porous material 1304 comprises radially outward and upward extending fingers 1306. Similar to the anchor 1010 of the implant 1000 described herein, the fingers 1306 may flex radially inwardly during advancement of the implant 1300 into a bone hole at an implant site and flex radially outward to inhibit dislodgement from the hole. In some embodiments, the fingers 1306 and general structure of the device 1300 share features with the anchors described in U.S. Patent Pub. No. 2015/0351815. The hydrogel 1302 may extend radially outward towards the fingers 1306.

    [0117] Figure 13B is plan view of an example device 1310 for manufacturing example implants such as the implant 1300. In some embodiments, the device 1310 comprises a hydrogel mold. The device 1310 comprises a plurality of radially outwardly extending arms 1312 configured to accommodate hydrogel that can infiltrate cutouts forming the fingers 1306. For example, with reference to Figures 4-5C and 13A, a porous material 1304 comprising a plurality of fingers 1306 can be placed into the device 1310. The device 1310 may be filled with hydrogel 1302, which can infiltrate pores of the porous material 1304 to form the implant 1300.

    [0118] Although several embodiments and examples are disclosed herein, the present application extends beyond the specifically disclosed embodiments to other alternative embodiments and/or uses of the various inventions and modifications, and/or equivalents thereof. It is also contemplated that various combinations or subcombinations of the specific features and aspects of the embodiments may be made and still fall within the scope of the inventions. Accordingly, 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. Thus, the scope of the various inventions disclosed herein should not be limited by any particular embodiments described above. While the embodiments disclosed herein are susceptible to various modifications, and alternative forms, specific examples thereof have been shown in the drawings and are described in detail herein. However, the inventions of the present application are not limited to the particular forms or methods disclosed, but, to the contrary, cover all modifications, equivalents, and alternatives falling within the spirit and scope of the various embodiments described and the appended claims. Further, the disclosure herein of any particular feature, aspect, method, property, characteristic, quality, attribute, element and/or the like in connection with an implementation or embodiment can be used in all other implementations or embodiments set forth herein.

    [0119] In any methods disclosed herein, the acts or operations can be performed in any suitable sequence and are not necessarily limited to any particular disclosed sequence and not be performed in the order recited. Various operations can be described as multiple discrete operations in turn, in a manner that can be helpful in understanding certain embodiments; however, the order of description should not be construed to imply that these operations are order dependent. Additionally, any structures described herein can be embodied as integrated components or as separate components. For purposes of comparing various embodiments, certain aspects and advantages of these embodiments are described. Not necessarily all such aspects or advantages are achieved by any particular embodiment. Thus, for example, embodiments can be carried out in a manner that achieves or optimizes one advantage or group of advantages without necessarily achieving other advantages or groups of advantages.

    [0120] The methods disclosed herein include certain actions taken by a practitioner; however, they can also include any third-party instruction of those actions, either expressly or by implication. For example, actions such as "deploying an implant" include "instructing deployment of an implant." The ranges disclosed herein also encompass any and all overlap, sub-ranges, and combinations thereof. Language such as "up to," "at least," "greater than," "less than," "between," and the like includes the number recited. Numbers preceded by a term such as "about" or "approximately" include the recited numbers and should be interpreted based on the circumstances (e.g., as accurate as reasonably possible under the circumstances, for example ±5%, ±10%, ±15%, etc.). For example, "about 1 mm" includes "1 mm." Phrases preceded by a term such as "substantially" include the recited phrase and should be interpreted based on the circumstances (e.g., as much as reasonably possible under the circumstances). For example, "substantially rigid" includes "rigid" and "substantially parallel" includes "parallel."


    Claims

    1. An implant system configured for implantation in a joint, the implant system comprising:
    an implant (100, 700) comprising:

    a first portion (102, 702) comprising a hydrogel;

    a second portion (104, 704) comprising a porous material and the hydrogel in pores of the porous material;

    a third portion (106, 706) comprising the porous material, the first portion (102, 702) being free of the porous material, the third portion (106, 706) being free of the hydrogel, wherein a lateral dimension of the first portion (102,702) is larger than a lateral dimension of the third portion (106,706).


     
    2. The implant system of Claim 1, wherein the hydrogel comprises polyvinyl alcohol (PVA), and wherein the hydrogel comprises water or saline.
     
    3. The implant system of Claim 1 or 2, wherein the porous material comprises metal.
     
    4. The implant system of any one of Claims 1 to 3, wherein the porous material comprises plastic.
     
    5. The implant system of any one of Claims 1 to 4, wherein the porous material has a porosity between 45 ppi and 80 ppi.
     
    6. The implant system of any one of Claims 1 to 5, wherein pores of the porous material have a dimension between 100 µm and 500 µm.
     
    7. The implant system of any one of Claims 1 to 6, wherein the porous material comprises a disc shape.
     
    8. The implant system of any one of Claims 1 to 7, wherein the implant is load bearing and non-biodegradable.
     
    9. The implant system of any one of Claims 1 to 8, wherein the implant (100,700) is configured to be placed in at least one of a toe, finger, ankle, knee, shoulder, hip, or other joint.
     
    10. The implant system of any one of Claims 1 to 9, wherein a lateral dimension of the first portion (102, 702) is between 5% and 15% larger than a lateral dimension of the third portion (106, 706).
     
    11. The implant system of any one of Claims 1 to 10, wherein the implant (100,700) comprises a frustoconical shape.
     
    12. The implant system of any one of Claims 1 to 10, wherein the implant (100,700) comprises a pyramid shape.
     
    13. The implant system of any one of Claims 1 to 12, wherein a shape of the hydrogel is the same as a shape of the porous material.
     
    14. The implant system of any one of Claims 1 to 13, wherein a shape of the hydrogel is different than a shape of the porous material.
     
    15. The implant system of any one of Claims 1 to 14, wherein the implant (100,700) comprises an anchor (728).
     


    Ansprüche

    1. Implantatsystem, das für die Implantation in einem Gelenk konfiguriert ist, wobei das Implantatsystem Folgendes umfasst:
    ein Implantat (100, 700), umfassend:

    einen ersten Teil (102, 702), der ein Hydrogel umfasst;

    einen zweiten Teil (104, 704), der ein poröses Material und das Hydrogel in Poren des porösen Materials umfasst;

    einen dritten Teil (106, 706), der das poröse Material umfasst, wobei der erste Teil (102, 702) frei vom porösen Material ist, der dritte Teil (106, 706) frei vom Hydrogel ist, wobei eine seitliche Abmessung des ersten Teils (102, 702) größer ist als eine seitliche Abmessung des dritten Teils (106, 706).


     
    2. Implantatsystem nach Anspruch 1, wobei das Hydrogel Polyvinylalkohol (PVA) umfasst, und wobei das Hydrogel Wasser oder Kochsalzlösung umfasst.
     
    3. Implantatsystem nach Anspruch 1 oder 2, wobei das poröse Material Metall umfasst.
     
    4. Implantatsystem nach einem der Ansprüche 1 bis 3, wobei das poröse Material Kunststoff umfasst.
     
    5. Implantatsystem nach einem der Ansprüche 1 bis 4, wobei das poröse Material eine Porosität zwischen 45 ppi und 80 ppi aufweist.
     
    6. Implantatsystem nach einem der Ansprüche 1 bis 5, wobei Poren des porösen Materials eine Abmessung zwischen 100 µm und 500 µm aufweisen.
     
    7. Implantatsystem nach einem der Ansprüche 1 bis 6, wobei das poröse Material eine Scheibenform umfasst.
     
    8. Implantatsystem nach einem der Ansprüche 1 bis 7, wobei das Implantat lasttragend und nicht biologisch abbaubar ist.
     
    9. Implantatsystem nach einem der Ansprüche 1 bis 8, wobei das Implantat (100, 700) konfiguriert ist, um in mindestens eins von einer Zehe, einem Knöchel, einem Knie, einer Schulter, einer Hüfte oder einem anderen Gelenk platziert zu werden.
     
    10. Implantatsystem nach einem der Ansprüche 1 bis 9, wobei eine seitliche Abmessung des ersten Teils (102, 702) zwischen 5 % und 15 % größer ist als eine seitliche Abmessung des dritten Teils (106, 706).
     
    11. Implantatsystem nach einem der Ansprüche 1 bis 10, wobei das Implantat (100, 700) eine Kegelstumpfform aufweist.
     
    12. Implantatsystem nach einem der Ansprüche 1 bis 10, wobei das Implantat (100, 700) eine Pyramidenform aufweist.
     
    13. Implantatsystem nach einem der Ansprüche 1 bis 12, wobei eine Form des Hydrogels die gleiche ist wie eine Form des porösen Materials.
     
    14. Implantatsystem nach einem der Ansprüche 1 bis 13, wobei eine Form des Hydrogels anders ist als eine Form des porösen Materials.
     
    15. Implantatsystem nach einem der Ansprüche 1 bis 14, wobei das Implantat (100, 700) einen Anker (728) umfasst.
     


    Revendications

    1. Système d'implant configuré pour l'implantation dans une articulation, le système d'implant comprenant:
    un implant (100, 700) comprenant:

    une première partie (102, 702) comprenant un hydrogel;

    une seconde partie (104, 704) comprenant un matériau poreux et l'hydrogel dans les pores du matériau poreux;

    une troisième partie (106, 706) comprenant le matériau poreux, la première partie (102, 702) étant exempte de matériau poreux, la troisième partie (106, 706) étant exempte d'hydrogel, dans lequel une dimension latérale de la première partie (102, 702) est plus grande qu'une dimension latérale de la troisième partie (106, 706).


     
    2. Système d'implant selon la revendication 1, dans lequel l'hydrogel comprend du poly(alcool vinylique) (PVA), et dans lequel l'hydrogel comprend de l'eau ou une solution saline.
     
    3. Système d'implant selon la revendication 1 ou 2, dans lequel le matériau poreux comprend un métal.
     
    4. Système d'implant selon l'une quelconque des revendications 1 à 3, dans lequel le matériau poreux comprend une matière plastique.
     
    5. Système d'implant selon l'une quelconque des revendications 1 à 4, dans lequel le matériau poreux a une porosité entre 45 ppi et 80 ppi.
     
    6. Système d'implant selon l'une quelconque des revendications 1 à 5, dans lequel les pores du matériau poreux ont une dimension entre 100 µm et 500 µm.
     
    7. Système d'implant selon l'une quelconque des revendications 1 à 6, dans lequel le matériau poreux comprend une forme de disque.
     
    8. Système d'implant selon l'une quelconque des revendications 1 à 7, dans lequel l'implant est porteur et non biodégradable.
     
    9. Système d'implant selon l'une quelconque des revendications 1 à 8, dans lequel l'implant (100, 700) est configuré pour être placé dans au moins l'un d'un orteil, doigt, cheville, genou, épaule, hanche ou autre articulation.
     
    10. Système d'implant selon l'une quelconque des revendications 1 à 9, dans lequel une dimension latérale de la première partie (102, 702) est entre 5% et 15% plus grande qu'une dimension latérale de la troisième partie (106, 706).
     
    11. Système d'implant selon l'une quelconque des revendications 1 à 10, dans lequel l'implant (100, 700) comprend une forme tronconique.
     
    12. Système d'implant selon l'une quelconque des revendications 1 à 10, dans lequel l'implant (100, 700) comprend une forme pyramidale.
     
    13. Système d'implant selon l'une quelconque des revendications 1 à 12, dans lequel une forme de l'hydrogel est la même qu'une forme du matériau poreux.
     
    14. Système d'implant selon l'une quelconque des revendications 1 à 13, dans lequel une forme de l'hydrogel est différente d'une forme du matériau poreux.
     
    15. Système d'implant selon l'une quelconque des revendications 1 à 14, dans lequel l'implant (100, 700) comprend une ancre (728).
     




    Drawing















































    Cited references

    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