PLACING A GUIDE PIN

RELATED APPLICATIONS

[0001] This application claims the benefit of priority to U.S. Patent

Application Serial No. 14/673,230, filed March 30, 2015, the content of which is incorporated herein by reference in its entirety.

OVERVIEW

[0002] To better illustrate the instrument disclosed herein, a non-limiting list of examples is provided here:

[0003] In Example 1, an acetabular guide system for placing a guide pin near an acetabulum, can be provided that includes a patient specific acetabular guide including an interior surface and an exterior surface, the exterior surface can be configured to have a geometry to register within the acetabulum of a specific patient, a first drill insert can be configured to be received by the patient specific acetabular guide at a first location, the first drill insert can have a first longitudinal bore that can be configured to be received concentrically in a guide bore of the patient specific acetabular guide, the guide bore can extend exterior to the interior surface, a second drill insert can be configured to be fixed to a boney portion exterior to the acetabulum at a second location a predetermined distance from the first location, the second drill insert can form a second longitudinal bore, and a selectively removable alignment pin can be configured to be received by at least one of the first longitudinal bore and the second longitudinal bore.

[0004] In Example 2, the acetabular guide system of Example 1 is optionally configured such that the second drill insert can include a proximal portion and a distal portion, the distal portion including at least one anti- withdrawal feature.

[0005] In Example 3, the acetabular guide of Example 2 is optionally configured such that the at least one anti -withdrawal feature includes at least one of a thread and a fin extending from an exterior surface of the distal portion. [0006] In Example 4, the acetabular guide of Example 2 is optionally configured such that the proximal portion is engageable by a driver, the driver being configured to rotate the proximal portion thereby driving the distal portion into the boney portion exterior to the acetabulum.

[0007] In Example 5, the acetabular guide system of Example 4 further includes a coupling mechanism configured to couple the alignment pin to the driver.

[0008] In Example 6, the acetabular guide system of Example 5 is optionally configured such that the driver is rotated via the coupling mechanism around the alignment pin to a predetermined location relative to the acetabulum.

[0009] In Example 7, the acetabular guide system of Example 6 is optionally configured such that the driver drives the second drill insert into bone at the second location associated with the predetermined location.

[0010] In Example 8, the acetabular guide system of Example 7 is optionally configured such that the alignment pin is configured to be selectively removed from the first drill insert and assembled to the second drill insert.

[0011] In Example 9, a method of placing a guide pin near an

acetabulum with an acetabular guide system can be provided, that includes providing a patient specific acetabular guide including forming an exterior surface of the patient specific acetabular guide to have a geometry to register within the acetabulum of a specific patient, providing a first drill insert having a first longitudinal bore configured to be received concentrically in a guide bore of the patient specific acetabular guide, the guide bore extending exterior to an interior surface of the patient specific acetabular guide to align the first drill insert at a first location, providing a second drill insert having a second longitudinal bore and configured to be fixed to a boney portion at a second location a predefined distance from the first location, and providing a selectively removable alignment pin configured to be received by at least one of the first longitudinal bore or the second longitudinal bore.

[0012] In Example 10, the method of example 9 is optionally configured such that forming the exterior surface of the patient specific acetabular guide configured to have a geometry to register within the acetabulum of a specific patient includes acquiring images of the specific patient and designing the exterior surface of the patient specific acetabular guide to have a mating surface with the acetabulum of the specific patient.

[0013] In Example 11, the method of Example 9 or Example 10 is optionally configured such that providing the second drill insert includes providing a proximal portion and providing at least one anti -withdrawal feature on a distal portion.

[0014] In Example 12, the method of Example 11 further includes engaging the proximal portion in order to drive the distal portion into the boney portion at the second location and assembling the alignment pin into the second drill insert.

[0015] In Example 13, the method of Example 12 further includes selectively removing the alignment pin from the second drill insert while maintaining the second drill insert in the boney portion.

[0016] In Example 14, the method of any of Examples 11-13 further includes coupling the alignment pin to a driver configured to drive the second drill insert into the boney portion at the second location at the predefined distance from the first location.

[0017] In Example 15, the method of Example 14 further includes driving, via the driver, the second drill insert into the boney portion at the second location.

[0018] In Example 16, the method of Example 15 further includes selectively removing the alignment pin from the first drill insert and positioning the alignment pin into the second drill insert.

[0019] In Example 17, a method for implanting an acetabular implant can be provided that includes forming a patient specific acetabular guide having an exterior surface with a geometry formed to register within an acetabulum of a specific patient, connecting a first drill insert to the patient specific acetabular guide at a first location relative to the acetabulum, the first drill insert having a first longitudinal bore configured to be received concentrically in a guide bore of the patient specific acetabular guide, the guide bore extending exterior to the interior surface to align the first drill insert at a first location, fixing an alignment pin to a first portion of bone at the first location, the alignment pin being received by the first longitudinal bore, removing the patient specific acetabular guide and the first drill insert, coupling a driver to the alignment pin, driving, using the driver, a second drill insert, having a second longitudinal bore, into a second portion of bone at a second location, the second location being at a predetermined distance from the first location, and selectively removing the alignment pin from the first drill insert.

[0020] In Example 18, the method of Example 17 further includes fixing the alignment pin to the second portion of bone at the second location, the alignment pin being received by the second longitudinal bore.

[0021] In Example 19, the method of Example 18 further includes selectively removing the alignment pin from the second drill insert.

[0022] In Example 20, the method of Example 19 further includes reaming the acetabulum after removing the alignment pin from the first drill insert.

[0023] In Example 21, the method of Example 20 further includes inserting the alignment pin, after reaming the acetabulum, through the second longitudinal bore of the second drill insert.

[0024] In Example 22, the method of Example 21 further includes implanting an acetabular implant into the reamed acetabulum based on an axis defined by the alignment pin.

[0025] In Example 23, the apparatus, system, or method of any one or any combination of Examples 1-22 can optionally be configured such that all elements or options recited are available to use or select from.

[0026] These and other examples and features of the present devices, systems, and methods will be set forth in part in the following Detailed

Description. This overview is intended to provide a summary of subject matter of the present patent application. It is not intended to provide an exclusive or exhaustive removal of the invention. The detailed description is included to provide further information about the present patent application.

BRIEF DESCRIPTION OF THE DRAWINGS

[0027] The present teachings will become more fully understood from the detailed description and the accompanying drawings, wherein:

[0028] FIG. 1 A is a front isometric view of a patient-specific acetabular guide according to the present teachings;

[0029] FIG. IB is side isometric view of the patient-specific acetabular guide of FIG. 1A; [0030] FIG. 1C is a perspective view of alternative drill inserts according to the present teachings;

[0031] Fig. 2A is top isometric view of the patient-specific acetabular guide with an insertion handle, according to the present teachings;

[0032] Fig. 2B is side plan view of the patient-specific acetabular guide with an insertion handle, according to the present teachings;

[0033] FIG. 3 A is an isometric environmental view of the patient- specific acetabular guide of FIG. 1 ;

[0034] FIG. 3B is an isometric environmental view of the patient- specific acetabular guide of FIG. 1 with an inserter attached;

[0035] FIG. 4 is another isometric environmental view of the patient- specific acetabular guide of FIG. 1 and an alignment pin;

[0036] FIG. 5 is an isometric environmental view of an acetabular implant;

[0037] FIGs. 6A-6B are an isometric environmental view of acetabulum and an alternative drill insert and alignment pin;

[0038] FIG. 7 is an isometric environment view of acetabulum and tool and the alternative drill insert and alignment pin of FIGs. 6A-6B

[0039] FIG.8 is an isometric environment view of the patient-specific acetabular guide of FIG.1 including a drill insert;

[0040] FIGs.9- 10 are isometric environmental views of FIG. 8 including a tool and coupler; and

[0041] FIGs. 11 A-l IB are isometric environmental views of FIG. 8 illustrating a removal and reassembly of an alignment pin.

[0042] Corresponding reference numerals indicate corresponding parts throughout the several views of the drawings.

DETAILED DESCRIPTION

[0043] The following description is merely exemplary in nature and is in no way intended to limit the present teachings, applications, or uses.

[0044] The present teachings generally provide patient-specific acetabular alignment guides, inserters and/or other associated instruments for use in orthopedic surgery, such as, for example, in joint replacement or revision surgery for the hip. The patient-specific alignment guides and associated instruments can be used either with conventional or with patient-specific implant components prepared with computer-assisted imaging methods based on medical scan of the specific patient.

[0045] The present teachings provide various instruments and methods for generally preparing the acetabulum of a patient to receive an acetabular implant, such as, for example, an acetabular cup along an alignment axis. The alignment axis, various patient-specific guides, and other associated instruments can be designed during a pre-operative plan using a three-dimensional reconstruction of the patient's relevant anatomy, such as the pelvis or portions thereof. The three-dimensional reconstruction can be based on medical images.

[0046] The present teachings provide, for example, a patient-specific acetabular guide that can be used for preparing an acetabulum of a patient to receive an acetabular implant, such as an acetabular cup. The acetabular guide has a dome-shaped body with a peripheral annular rim and an outer three- dimensional surface configured to match an acetabulum of a specific patient's hip joint from three-dimensional medical images of the patient's hip joint during a preoperative plan for the patient. A patient-specific registration guide can be permanently or removably attached to the peripheral rim. The patient-specific registration guide has a longitudinal bore defining a patient-specific alignment axis with an alignment orientation configured for guiding an acetabular implant for the patient during the preoperative plan of the patient. The registration guide has a patient-specific undersurface configured to mate with a corresponding portion of a periacetabular surface and/or acetabular rim surface of the acetabulum of the patient.

[0047] An acetabular guide system for placing a guide pin near an acetabulum, includes a patient specific acetabular guide including an interior surface and an exterior surface, the exterior surface being configured to have a geometry to register within the acetabulum of a specific patient, a first drill insert configured to be received by the guide at a first location, the first drill insert having a first longitudinal bore configured to be received concentrically in a guide bore of the guide, the guide bore extending exterior to the interior surface, a second drill insert configured to be fixed to a boney portion exterior to the acetabulum at a second location a predetermined distance from the first location, the second drill insert forming a second longitudinal bore, and a selectively removable alignment pin configured to be received by at least one of the first longitudinal bore and the second longitudinal bore.

[0048] In other features, a method of placing a guide pin near an acetabulum with an acetabular guide system includes providing a patient specific acetabular guide including forming an exterior surface of the patient specific acetabular guide to have a geometry to register within the acetabulum of a specific patient, providing a first drill insert having a first longitudinal bore configured to be received concentrically in a guide bore of the patient specific acetabular guide, the guide bore extending exterior to an interior surface of the patient specific acetabular guide to align the first drill insert at a first location, providing a second drill insert having a second longitudinal bore and configured to be fixed to a boney portion at a second location a predefined distance from the first location, and providing a selectively removable alignment pin configured to be received by at least one of the first longitudinal bore or the second

longitudinal bore.

[0049] In yet other features, a method for implanting an acetabular implant includes forming a patient specific acetabular guide having an exterior surface with a geometry formed to register within an acetabulum of a specific patient, connecting a first drill insert to the patient specific acetabular guide at a first location relative to the acetabulum, the first drill insert having a first longitudinal bore configured to be received concentrically in a guide bore of the patient specific acetabular guide, the guide bore extending exterior to the interior surface to align the first drill insert at a first location, fixing an alignment pin to a first portion of bone at the first location, the alignment pin being received by the first longitudinal bore, removing the patient specific acetabular guide and the first drill insert, coupling a driver to the alignment pin, driving, using the driver, a second drill insert, having a second longitudinal bore, into a second portion of bone at a second location, the second location being at a predetermined distance from the first location, and selectively removing the alignment pin from the first drill insert.

[0050] As described in U.S. Patent No. 8,092,465, issued January 1,

2012, and U.S. Patent Application Publication No. 2012/0226283, filed February 21, 2012, 2014/0276873, filed March 11, 2014, all of which are incorporated by reference herein, during a preoperative planning stage, imaging data of relevant anatomy of a patient may be obtained at a facility, including a doctor's office. The imaging data may include, for example, a detailed scan of a pelvis, hip, knee, ankle, or other joint or relevant portion of the patient's anatomy. The imaging data may be obtained using an MRI, CT, and X-Ray, ultrasound or any other imaging systems. The imaging data obtained may be used to construct a three-dimensional computer image of the joint or other portion of the anatomy of the patient and prepare an initial preoperative plan that may include bone or joint preparation, such as planning for resections, milling, reaming, broaching, as well as implant selection and fitting, design of patient-specific guides, templates, tools and alignment protocols for the surgical procedure. Additionally, physical modes of the patient's joint and associated bones may be prepared for visualization and trialing of the guides and implants prior to the surgical procedure.

[0051] Computer modeling for obtaining three-dimensional computer images of the relevant patient's anatomy may be provided by various computer aided drafting (CAD) programs, applications and/or software commercially available from various vendors or developers, such as, for example, from by Object Research Systems or ORS, Montreal, Canada. The computer modeling program or other application may be configured and used to plan a preoperative surgical plan, including planning various bone preparation procedures, to select or design/modify implants and design patient-specific guides and tools. The patient-specific guides and tools may include patient-specific prosthesis components, and patient-specific tools, including reaming, broaching, milling, drilling or cutting tools, alignment guides, templates and other patient-specific instruments.

[0052] The preoperative plan may be stored in any computer storage medium, in a computer file form or any other computer or digital representation, including three-dimensional graphical files or digital data sets. The preoperative plan, in a digital form associated with interactive software or other application, may be made available via a hard medium, a web-based or mobile or cloud service, or a portable device that may have access to a cellular network. The plan may be provided via the various systems or media to the surgeon or other medical practitioner, for review. Using the interactive software or application, the surgeon may review the plan, and manipulate the position of images of various implant components relative to an image of the anatomy. The surgeon may modify the plan and send it to the manufacturer with recommendations or changes. The interactive review process may be repeated until a final, approved plan, is sent to a manufacturing facility for preparing actual physical

components. In various embodiments, physical and digital patient-specific bone models, guides, and instruments may be provided preoperatively to the surgeon for trialing and marking.

[0053] After the surgical plan is approved by the surgeon, patient- specific implants and associated tools, including, for example, alignment guides, cutting/milling/reaming/broaching or other tools for the surgical preparation of the joint or other anatomy portion of the specific patient may be designed using a CAD program or other three-dimensional modeling software, such as the software provided by Object Research Systems or ORS, Montreal, Canada, for example, according to the preoperative surgical plan. Patient-specific guides and other instruments may be manufactured by various stereolithography methods, selective laser sintering, fused deposition modeling, or other rapid prototyping methods, and/or computer controlled machining. In some embodiments, computer instructions of tool paths for machining the patient-specific guides and/or implants may be generated and stored in a tool path data file. The tool path data may be provided as input to a CNC mill or other automated machining system, and the tools and implants may be machined from polymer, ceramic, metal or other suitable material depending on the use, and sterilized. The sterilized tools and implants may be shipped to the surgeon or medical facility for use during the surgical procedure.

[0054] Patient-specific implants, guides, templates, tools or portions thereof are defined herein as those constructed by a preoperative plan for a specific patient from three-dimensional images of the specific patient's anatomy reconstructed from preoperative image scans of the patient. The patient-specific components are constructed to closely conform and mate or match substantially to a surface of the patient's anatomy. The mating or matching is generally as a negative mold, negative surface, or inverse or mirror surface of corresponding surface portions of the patient's anatomy. The anatomical surfaces may include bone surfaces with or without associated soft tissue, such as articular cartilage, depending on the particular procedure, implant and tool use. Minute irregularities, such as those that would not affect placement of the guide, of the patient's joint surfaces need not be mirrored.

[0055] As discussed above, patient-specific alignment guides and implants are generally configured to match the anatomy of a specific patient and fit/register to the patient in only one position on a corresponding surface of the specific patient because anatomic features that are unique to each patient may function as landmarks and may guide placement of the alignment guide or implant in only one position without the need of intraoperative image navigation, patient marking, or other intraoperative guidance. The patient-specific alignment guides are generally configured and manufactured using computer modeling based on the 3-D anatomic image of the patient and have an engagement surface that is made to conformingly contact and match, as discussed above, to a corresponding surface of a three-dimensional image/model of the patient's bone surface (with or without cartilage or other soft tissue), by the computer methods discussed above.

[0056] Generally, the patient specific guide has an exterior surface that directly contacts a selected portion of a selected region of a specific patient's anatomy. For example, a patient specific guide can include an exterior surface (e.g. an external dome surface of an acetabular guide) that directly contacts about 80% of the patient's anatomy (e.g. a specific patient's acetabulum) when properly positioned, including about 90% contact, and about 98% contact. The exterior surface of the patient matched guide may, therefore, substantially mate with the selected portion of the anatomy. It is understood, however, that certain exterior portions of a patient specific guide may not have substantial contact with the patient, while other portions are designed to ensure contact even when other portions are not contacting the patient. Thus, a patient matched guide may have portions that are substantially patient matched and have or may achieve the selected amount of contact with the patient.

[0057] The patient-specific alignment guides may include one or more custom-made guiding formations, such as, for example, guiding bores or cannulated guiding posts or cannulated guiding extensions or receptacles that may be used for supporting or guiding other instruments, such as drill guides, reamers, cutters, cutting guides and cutting blocks or for inserting pins or other fasteners according to a surgeon-approved pre-operative plan. The patient- specific alignment guides may be used in minimally invasive surgery, and also in surgery with multiple minimally-invasive incisions. Various alignment guides and pre-operative planning procedures are disclosed in U.S. Patent No.

8,092,465, issued January 10, 2012; U.S. Patent No. 8,070,752, issued December 6, 2011 ; U.S. Patent No. 8, 133,234, issued March 13, 2012; U.S. Publication No. 2009/0024131, published January 22, 2009; U.S. Publication No.

2008/0114370 dated May 15, 2008, now U.S. Patent No. 8,298,237, issued October 30, 2012; U.S. Publication No. 2011/0224674, published November 15, 2011 ; U.S. Publication No. 2011/0184419, published July 28, 2011; and U.S. Publication No. 2012/0226283, published September 6, 2012, all patents and applications are incorporated herein by reference.

[0058] Referring to FIGS. 1 A-3B, the present teachings provide a patient-specific acetabular guide 100 and an acetabular guide inserter 300. The acetabular guide 100 can be used in connection with various other instruments to generally provide a patient-specific alignment axis A. The patient-specific alignment axis A is used to insert an alignment pin 230 and generally to orient, insert, and implant an acetabular implant or acetabular cup 250 in an acetabulum (or acetabulum cavity) 82 of the patient, to facilitate guided reaming of the acetabulum 82, and generally guide any instruments and procedures relative to the alignment axis A or the alignment pin 230. The alignment axis A is determined during the preoperative plan from the three-dimensional image of the hip joint of the patient as the axis along which the acetabular implant 250 is to be inserted. The alignment axis A is generally perpendicular to the acetabulum 82 and corresponding acetabular engagement surface 252 of the acetabular implant 250. More specifically, with reference to FIG. 3B, the orientation (i.e., angles) of the alignment axis A can be selected and specified relative the axial plane (AP), sagittal plane (SP) and anterior pelvic plane (APP) of the pelvis 80. The coronal plane is a vertical plane that is orthogonal to the axial and sagittal planes (not shown). The anterior pelvic plane (APP) is defined as a plane passing through the two anterior iliac spines and the pubic symphysis of the pelvis 80 of the patient. The APP may deviate from being parallel to the coronal plane when viewed in the weight-bearing profile of the patient (standing). Additionally, the APP plane may have a different orientation in the supine position. The deviation varies from patient to patient, such that the anterior pelvic plane cannot be relied on by the surgeon without additional information to guide the acetabular implant and avoid impingement during motion. The angle between the anterior pelvic plane and the coronal plane can be referenced as a pelvic tilt and is zero when the anterior pelvic plane is parallel to the coronal plane. The present teachings determine a patient-specific axis for inserting an acetabular implant. The patient- specific alignment axis is physically and uniquely identified by the orientation of an alignment pin 230 inserted into the bone using the patient-specific acetabular guide and landmark registration incorporated into the acetabular guide during the preoperative plan. Specifically, the preoperative plan that is based on images of the hip joint of the patient can accurately determine the orientation of the alignment axis A and fix it intraoperatively via the patient-specific acetabular guide 100 on the pelvis 80 of the patient to guide the surgeon during the surgical procedure.

[0059] The patient-specific acetabular guide 100 can engage and register to the acetabulum 82 of the specific patient in a unique (only one) position and can provide an accurate alignment axis A relative to the planned orientation of an acetabular implant 250 (Fig. 4). The patient-specific acetabular guide 100 can also provide secure fitting and rotational stability in a design that is lightweight and has compact size and small bulk.

[0060] FIGS. 1 A-3B illustrate a patient-specific acetabular guide 100 that has a dome-shaped body 102 with a three dimensional patient-specific undersurface or outer surface 104 configured to contact and engage the acetabulum 82. The outer surface 104 is designed and/or formed to match as a negative of a corresponding surface of the acetabulum 82 from the three- dimensional image of the patient's hip joint. Thus, the outer surface 104 is formed to mate closely, such as to contact about 85% to about 100% of the acetabulum 82 when positioned in the acetabulum 82. Thus, the outer surface 104 of the guide 100 includes a surface that may mirror or match the acetabulum 82.

[0061] The dome-shaped body 102 of the patient-specific acetabular guide 100 can have one or more openings in the form of windows 106 that reduce the weight of the patient-specific acetabular guide 100 and provide improved visualization of the underlying anatomy. The dome-shaped body 102 can also include additional holes or other apertures 109 for drilling holes in the acetabulum 82 and corresponding to holes 254 for fixation screws of the acetabular implant 250. The dome-shaped body 102 of the patient-specific acetabular guide 100 is bounded by a guide rim 108 in the form of a closed- contour peripheral annular surface that may have uneven, irregular, jagged or wavy shape that follows a corresponding shape of an acetabular rim 84 (and periacetabular surface) around the acetabulum 82 of the patient.

[0062] Additionally, the patient-specific acetabular guide 100 can include one or more registration hooks, which may also be referred to as extensions or flanges, 110 that extend from the guide rim 108 along a three- dimensional curved surface around the acetabular rim 84 at different and spaced- apart positions. The registration hooks 110 are configured to provide additional registration locations for the patient-specific acetabular guide 100 by replicating corresponding underlying surface portions or landmarks of the acetabular rim 84 in a patient-specific manner. Specifically, each registration hook 110 can have a curved (three-dimensional) undersurface 112 that is patient-specific and negative of the surface of the acetabular rim 84 at specific locations selected as landmark locations during the preoperative plan for the patient. Each registration hook 110 can include a hole 114 for receiving a fixation pin or other fixation element (not shown) for attaching the patient-specific acetabular guide 100 to the pelvis of the patient. In addition, the registration hooks 110 may include a reinforcing ridge or rib. Selected reinforcing ribs include those illustrated and described in U.S. Pat. App. No. 13/790,770, filed on March 8, 2013, incorporated herein by reference.

[0063] The patient-specific acetabular guide 100 can include a removable or non-removable registration and alignment guide 120 (referenced as registration guide 120, for short) that has a longitudinal bore 124 along the patient-specific alignment orientation A. A removable drill insert 122 with a longitudinal bore 126 that can be received concentrically in the bore 124 of the registration guide 120. The wall of the bore 124 of the registration guide 120 can define a taper that engages a complementary taper 127 of an end of the removable drill insert 122. The complementary tapers can ensure appropriate and selected alignment of the bore 124 and the insert bore 126. Thus, the bore 124 and the insert bore 126 can be concentric and coextensive.

[0064] The drill insert 122 can provide stability and wear resistance during the insertion of an alignment pin 230. The alignment pin 230 can be inserted along the alignment axis A and further have a longitudinal axis that then extends along the alignment axis A. The alignment pin 230 can include a drill tip 231 that can drill into the bone of or near the acetabulum 82. The alignment pin 230 is received into the concentric bores 124, 126 of the registration guide 120 and the drill insert 122. Accordingly, the alignment pin 230 is oriented along the alignment axis A.

[0065] The drill insert 122 can be formed of a tough and/or strong material. For example, the drill insert 122 can be metallic and reusable, while the registration guide 120 and the acetabular guide 100 are patient-specific and can be made of a softer material, such as a polymer material, and can be disposable. The tough material of the drill insert 122 can engage the alignment pin 230 without deformation and/or wear to protect the registration guide 120 from damage due to engaging the alignment pin 230. Further, during insertion of the pin 230, the drill insert 122 is generally formed to not wear enough to allow movement of the pin 230 from the alignment axis A.

[0066] In some embodiments, the drill insert 122 includes a proximal portion 125 and a distal portion 129. The distal portion 129 may include one of a plurality of bone engaging fins 127a and a plurality of threads, such as self- taping threads, 127b as illustrated in FIG. 1C. It is understood that while only fins and threads are described herein, the drill insert 122 may include any suitable fixation and/or anti -withdrawal feature. Each of the fins 127a and threads 127b are configured to be drilled into the bone at or near the acetabulum 82 and resist withdrawal of the drill insert 122 from the bone. It is understood, however, that multiple drill inserts or pin guides may be provided. Those with the fin 127a or the thread 127b may not directly engage the guide 100, as discussed herein.

[0067] Briefly turning reference to Figs 7 and 8, a tool, such as a driver

500 includes a handle 504, a shaft 508, and a socket portion 512. The socket portion 512 is configured to engage the proximal portion 125 of the drill insert 122. For example, the socket portion 512 includes a distal opening 516. The distal opening 516 is configured to receive the proximal portion 125 of the drill insert 122, such as within an interior wall of the socket portion 512. The interior wall may form a hexagonal engagement, or other appropriate engagement. [0068] As will be described below, the socket portion 512 may engage the proximal portion and drive or move the insert 122 along the axis A, such as with the handle 504. As the engaging portion engages the proximal portion 125, the drill insert 122 is pushed, causing the fins 127a to engage the bone and drive the distal portion 129 into the bone. It is understood that while drill insert 122 is shown with the fins 127a, the principles herein apply to a drill insert that includes the threads 127b, or any suitable anti -withdrawal feature.

[0069] The shaft 508 is configured to provide a sufficient length between the handle 504 and the socket portion 512. For example, the shaft 508 may provide a length long enough for a surgeon to operate the driver 500 without having to enter a patient's anatomy. It is understood the shaft 508 may be of any suitable length.

[0070] The handle 504 is configured to receive a surgeons hand for operation of the driver 500. In use, the surgeon may rotate the handle relative to the axis A, thereby causing the socketed portion 512 to engage the proximal portion 125 and drive the distal portion 129 into the bone, as described above. Also, a hammer or other tool may be used to impact or turn the driver 500.

[0071] As illustrated in FIG. 7, the driver 500 includes a through bore

520. The through bore 520 passes concentrically through the handle 504, the shaft 508, and the socket portion 512. Further, the through bore 520 may be concentric and coextensive with the insert bore 126 of the drill insert 122 when engaging the drill insert 122. In this manner, the alignment pin 230 may pass through the driver 500 and through the drill insert 122. After the surgeon drills the drill insert 122 into the bone, the driver 500 may be removed along the axis A, leaving the alignment pin 230 assembled in the drill insert 122.

[0072] FIG. 8 illustrates an alignment pin 230 assembled in a drill insert

122. In some implementations, the drill insert 122 may include the fins 127a or the threads 127b disposed on the distal portion 129 of the drill insert 122 as described with respect to FIG. 1C. The fins 127a may be received concentrically in the bore 124 of the registration guide 120. Thus, any other suitable anti- withdrawal feature, or no anti -withdrawal feature as illustrated in FIG. 8, may be used with the guide 100.

[0073] The registration guide 120 may have an undersurface portion that is a patient-specific undersurface 128 that can hook around or snap-on or otherwise engage and contact the guide rim 108 at a pre-defined marked location determined during the preoperative plan of the patient. The registration guide 120 that includes the patient-specific undersurface 128 matches the surface of the acetabular rim 84 and/or periacetabular area of the pelvis 80 of the patient at a corresponding location.

[0074] The bore 124 of the registration guide 120 and the bore 126 of the drill insert 122 can have an open (i.e., non-continuous) periphery defining a longitudinal slit 133. The slit 133 may be configured to allow the patient-specific acetabular guide 100 to be removed from the pelvis 80 of the patient without removing the alignment pin 230 that is inserted into the pelvis 80 and defines the alignment axis A. In other words, the patient-specific acetabular guide 100 can be also removed by side or lateral motion relative to the slit 133 and the longitudinal axis A and not necessarily by only motion along the alignment axis A or along the alignment pin 230.

[0075] The patient-specific acetabular guide 100 can include a first post 130 and, optionally, a second post 132 (shown in phantom). Both of the posts

130, 132 may extend from an interior surface 105 (opposite to outer surface 104) of the dome-shaped body 102 of the patient-specific acetabular guide 100. The post 130, as discussed herein, assists with placement and alignment of the guide 100. Further, it is understood that the second post 132 is optional and need not be included with the guide 100.

[0076] The first post 130 may, optionally, define a bore that passes through the dome-shaped body 102 of the acetabular guide for optional fixation to the acetabulum 82 using a pin or other fastener. The bore is not necessary, however, and the post 130 can be a closed hollow post or a solid post. The first post 130 can be centrally located and perpendicular relative to a tangent to the dome-shaped body 102 of the patient-specific acetabular guide 100 and the underlying surface of the acetabulum 82. The optional second post 132, if included, can be offset relative to the first post 130 in a radial direction relative to the periphery of the guide rim 108. The second post 132 can be shorter in height relative to the first post 130. The posts 130, 132 can be used to insert the patient-specific acetabular guide 100 using an acetabular guide inserter, such as the acetabular guide inserter 300 shown in FIG. 2-3B. [0077] The post 130 can be an insertion and alignment post that extends from and is formed with the guide 100. It is further understood, however, that the insertion post 130 can be interconnected with the guide 100 in any appropriate manner, such as with an adhesive or other fixation mechanism. Regardless, the post 130 may be formed to include a non-circular or non-cylindrical shape. For example, the post 130 can include a trapezoidal, oval, oblong or other selected shape. The non-circular shape can be viewed in cross-section of the post 130 and/or along an axis extending along a height of the post 130.

[0078] The post 130 can include a post alignment axis 130a that can have a specific orientation relative to the guide 100, and particularly to the alignment axis A through the registration guide 120. The post alignment axis 130a may be used to align the guide 100 relative to a selected portion of the anatomy, including an anatomical landmark, as discussed further herein. The anatomical landmark can be predetermined in the patient image, such as during planning the procedure. Accordingly, the post 130, including a post alignment axis 130a can assist in rotationally aligning the guide 100 relative to the acetabulum 82 in the pelvis 80. Moreover, the non-circular shape of the post 130 can assist in holding and engaging the guide 100 relative to a selected insertion instrument 300 (Fig. 2A and 2B), as discussed further herein. Moreover, the post 130 can include an external geometry that tapers towards a base 131 of the post 130 near the internal surface 105 of the guide 100. Again, the taper of the post 130 can assist in engagement and fixation of the guide relative to the insertion instrument 300, as discussed further herein.

[0079] With particular reference to FIGS. 2 A and 2B, the inserter 300 can engage the first post 130 near a first end 302 that defines an internal bore or capture area 304 that is complementarily shaped and/or mates with an upper or top portion 133 of the post 130. As discussed above, the shape of the central post 130 can define the post alignment axis 130a. The complimentary internal bore 304 of the inserter instrument 300 can also define an inserter bore axis that mates or aligns with the post alignment axis 130a once the inserter 300 engages the post 130. Accordingly, the instrument 300 engages and may couple to the post 130 in a selected and keyed manner. In the keyed manner the inserter 300 engages the post 130 in a selected single orientation and position, which also allows the inserter 300 to be positioned at a single orientation and position relative to the guide 100. The inserter 300, therefore, can be interconnected with the guide 100 and a selected single orientation and position to allow for manipulating the guide relative to the pelvis 80.

[0080] The first end 302 of the shaft 306 can further include a taper that engages the external taper of the post 130. A female taper of the receiving bore 304 coupling with the external taper of the post 130 can assist in holding and fixing the post 130, and the guide 100, relative to the inserter handle 300. It is understood, however, that additional attachment mechanisms can also be provided such as an interference fit, a snap fit, a screw or bolt that engages the post 130 relative to the handle 300, or other appropriate connection mechanisms.

[0081] Additionally, the inserter 300 can include a shaft 306 that extends to a handle 308. The handle 308 can be grasped by a user to manipulate the inserter 300 relative to the guide 100 for engaging the post 130. Once the inserter 300 is coupled to the post 130 the inserter can then further translate and rotate the guide 100 relative to the pelvis 80 once the handle 300 is engaged on the post 130.

[0082] Additionally, the inserter 300 can include an alignment portion, such, as a jig or alignment rod 310, which may be coupled to and/or formed with the shaft 306 at an engagement or coupling region 312. The alignment portion can be viewed exterior to soft tissue of the patient by a user during insertion and positioning the guide 100 from. Thus, the user can know an alignment of the guide 100 by viewing the alignment portion as the inserter 300 engages the post 130 in a single location and orientation.

[0083] The coupling region 312 can include an internal thread to engage an external thread of the alignment jig or rod 310. Additionally, however, further connection mechanisms can be provided such as a slotted aperture which allows the alignment jig or rod to directly contact a pre-defined portion of anatomy or soft tissue. Alternatively, the alignment portion, such as the alignment jig 310, may be permanently fixed or manufactured with the shaft 306 as a single piece. Nevertheless, the alignment jig 310 can extend from the shaft 306 along an alignment portion or jig axis 310a. The alignment portion axis 310a of the alignment jig 310 can be formed to align with the post alignment axis 130a of the post 130. Because the post 130 engages the internal bore 304 in the shaft 306 in a single selected and predetermined location and orientation, the shaft 306 will engage and align with the post 130 in a substantially single orientation and position. Thus, the alignment jig 310, which defines the alignment axis 310a, is aligned with the axis 130a of the post 130. It is understood, however, that the alignment jig 310 is not required and that the handle 300 engaging the post 130 can provide appropriate fixation and alignment for a user, for purposes as discussed further herein.

[0084] With reference to FIGS. 3 A and 3B, the guide 100 can be positioned in the acetabulum 82 of the pelvis 80 in a selected manner. As discussed above, the central post 130 defines the post alignment axis 130a. As the inserter 300 is aligned with the axis 130a, due to the engagement of the bore 304 with the post 130, the handle 300 can be visually viewed from exterior to the patient. Additionally, the alignment jig 310 can also be positioned on a portion of the shaft 306 such that it is also exterior to the patient when the guide 100 is positioned near or within the acetabulum 82. It is understood, that when viewed from an exterior of the patient, a user, such as a surgeon, can have a clear view of the alignment jig 310 and/or a portion of the inserter 300 while positioning the guide 100 within the acetabulum 82.

[0085] The post alignment axis 130a can be extended exterior to the guide 100 to allow for alignment with a portion of the pelvis, such as an anatomical landmark 400, which can include the Anterior Superior Iliac Spine (ASIS), due to positioning of the guide 100 within the acetabulum 82. The anatomical landmark can be predetermined, such as during planning of the procedure. The alignment axis A through the registration guide 120 can also be selected during a pre-planning process. The design of the guide 100 can then be based on the predetermined landmark and the predetermined location of the alignment axis A. The guide 100 can then be manufactured to have the post 130 with the post alignment axis 130a formed relative to the alignment axis A such that alignment of the post alignment axis 130a with the predetermined landmark will place the alignment axis A at the predetermined location and orientation.

[0086] Accordingly, the position of axis A relative to the acetabulum 82 can be pre-determined and can be positioned relative to the pelvis 80 due to registration of the guide 100 within the acetabulum 82. As discussed above, the guide 100 registers within the acetabulum 82 (i.e., by substantial matching or contact of the exterior surface 104 of the guide 100 with the acetabulum 82) in substantially only a single location and orientation. Accordingly, the handle 300 can be used to position and rotate the guide 100 in the direction of Arrow 410. The inserter 300 can be used to sweep an arc of a selected length in either or both directions of arrow 410. The alignment jig 310 that defines the jig axis 310a that is aligned with the post alignment axis 130a can all be designed to ensure that registration of the guide 100 occurs when the alignment axis A is at the selected pre-planned position within the patient. Accordingly, via moving the handle 300, illustrated in FIGS. 2 A and 2B, the surgeon can clearly view the alignment jig 310 relative to various landmarks of the patient, such as the ASIS 400, such as from exterior to soft tissue of the patient.

[0087] Rotating the guide 100 can move the post alignment axis 130a of the central post 130 relative to the pelvis 80. For example, as illustrated in FIG. 3B, the post alignment axis 130a of the post 130 can be positioned to point toward or be aligned with an iliac crest 420 of the pelvis 80. Positioning of the post alignment axis 130a' of the central post 130 aligns the jig axis 310A of the jig 320 with the iliac crest 420 as well. During the procedure, the surgeon can view that the alignment jig 310 is oriented or aligned with the iliac crest 420 and determine that the guide 100 must be rotated anteriorly or towards a pubis 430. The user can then rotate the inserter 300 and the guide 100 as needed, and generally in the direction of one of the arrowheads 410. Thus, the user can determine an appropriate movement of the guide 100 to position the guide 100 relative to a pre-selected landmark, such as the ASIS 400. The alignment jig 310 can assist and/or ensure that the guide 100 is positioned and registered to the acetabulum 82 by allowing the user to view the jig 310, or selected portion of the inserter 300. Again, this assists in rotational alignment of the guide 100 at least because the inserter 300 engages the post 130 in the keyed manner. Accordingly, while the acetabular guide 100 will register within the acetabulum 82 at a selected single location and orientation, the alignment jig 310, viewed by the user, can assist in ensuring that the guide 100 is at a pre-selected or pre-planned location and increase the speed of aligning the guide 100 relative to the pre- planned and selected orientation.

[0088] It is understood that the guide 100 can be oriented relative to any selected anatomical landmark that can be viewed and/or palpated by a user during the procedure. For example, it is understood that the central post 130 can be designed and positioned within the guide 100 such that the post alignment axis 130a is aligned with the iliac crest 420 when the guide 100 is properly registered within the acetabulum 82. Accordingly, aligning the post alignment axis 130a with the ASIS 400 is not required for ensuring that the guide 100 is properly registered with the patient, if a pre-planned or pre-determined orientation of the guide 100 is selected as such that the axis 130A is to be aligned with a different landmark.

[0089] Nevertheless, based upon the pre-planned or pre-determined alignment with the selected landmark, the inserter 300 can be used to rotate the guide 100 relative to the acetabulum 82 during insertion and placement of the guide 100 within the acetabulum 82. Once appropriately registered, the inserter 300 can be removed from the central post 130 and the alignment pin 230 can be passed through the drill insert 122 that has been positioned within the

registration guide 120, as illustrated in FIG. 4. The alignment pin 230, when inserted through the drill insert 122 that is positioned within the registration guide 120 generally extends along the alignment axis A that is pre-planned relative to the guide 100. Again, by positioning the guide 100 registered within the acetabulum 82 the alignment axis A is at the pre-planned and selected position relative to the acetabulum 82. Positioning of the alignment pin 230 through the drill insert 122 that is positioned within the registration guide 120 and drilling it into the pelvis 80 positions the alignment pin 230 along the axis A.

[0090] The positioning of the guide 100, as discussed above, is assisted by positioning the inserter 300 relative to the central post 130 to align the alignment jig 310, or other selected portion of the handle 300, along post alignment axis 130a of the central post 130. The guide 100, therefore, could be properly registered relative to the patient by aligning the alignment jig 300 relative to a selected anatomical landmark, such as the ASIS 400, at least via rotation of the handle 300 and the guide 100, due to coupling with the handle 300. In this way, the inserter 300 may be used to rotationally position the guide 100 for placement of the alignment axis A at the predetermined location and orientation for placement of the pin 230.

[0091] Once the alignment pin 230 is positioned within the pelvis 80, the drill insert 122 can be removed generally along the alignment pin 230 and the guide 100 can be removed longitudinally and/or laterally relative to the alignment pin 230. The alignment pin 230, either directly or indirectly, can then be used to guide various portions of a procedure, such as reaming of the acetabulum 82 and/or positioning the acetabular implant 250, as illustrated in FIG. 5. The acetabular implant 250 can be positioned in the acetabulum with reference to the alignment axis A by aligning the acetabular implant 250, having the central axis A, with the alignment pin 230. Accordingly, as illustrated in FIG. 5, the acetabular implant 250 can be positioned aligned with the alignment axis A that has been pre-planned and determined relative to the pelvis 80.

[0092] In various embodiments, the pin 230 may be positioned with the guide 100 and the drill insert 122 at a selected position (e.g. patient specific position) and maintained at the selected position for the remainder of the procedure. In various embodiments, however, the pin 230 may be removed and the drill insert or guide 122 may be maintained in the anatomy for an entire or remainder of the procedure. Further, as discussed herein, a first drill insert may be placed over the pin 230 and a second drill insert or guide may be placed at a second location. The second drill insert or guide may then be maintained in the anatomy for the remainder of the procedure while the guide 100 and the first drill insert 122 are removed.

[0093] Thus, additionally or alternatively, the alignment pin 230 may be selectively removable during selected procedures, such as a reaming of the acetabulum 82. As illustrated in FIG. 8, the drill insert 122 includes bone engaging fins 127a disposed on the distal portion 129. (It is noted that the drill insert 122 may alternatively include the self-tapping threads 127b, or other suitable anti -withdrawal features). As descried above, a surgeon may use a tool, such as the driver 500, to drive the drill insert 122 into bone at or near the acetabulum 82.

[0094] As described above, the fins 127a, and alternatively, the threads

127b, prevent withdrawal of the drill insert 122 from the bone. Accordingly, the alignment pin 230 may be selectively removed along the axis A without losing a reference to the alignment axis A. In other words, the drill insert 122 remains in the bone and provides a reference to the axis A after the alignment pin 230 has been removed. By removing the alignment pin 230, as needed or desired by the surgeon, the surgeon may ream, or perform other operative procedures unobstructed by the alignment pin 230. [0095] In yet another embodiment, the alignment pin 230 may be removed and assembled in an alternative drill insert 122 at a predefined area of bone near to the acetabulum 82, but at a location different from that defined by the drill insert 122 connected to the guide 100. As illustrated in FIG. 9, a coupling mechanism 600 may couple an alignment pin 230 to the driver 500.

[0096] The alignment pin 230 may be assembled to a first drill insert 122 according to any of the methods described above. In some scenarios, a surgeon may require an unobstructed workspace to ream the acetabulum 82 or perform other operational procedures. Accordingly, the surgeon may remove the alignment pin 230 from the first drill insert 122 as described above. Additionally or alternatively, the surgeon may relocate the alignment pin 230 to a

preoperatively defined location so as to continue to guide various portions of a procedure, such as reaming of the acetabulum 82 and/or positioning the acetabular implant 250.

[0097] The coupling mechanism 600 may be formed to releasably couple two or more members, including the pin 230. The coupling mechanism, therefore, may include a first opening 604 configured to receive a portion of the shaft 508 and a second opening 608, a selected and formed distance 610 from the first opening 604, configured to receive a portion of the alignment pin 230. The distance 610 may be determined during the preoperative planning. For example, a distance 610 between the driver 500 and the alignment pin 230 may be selected so as to relocate the alignment pin 230, as will be described in detail below, at a predefined location relative to the acetabulum 82. Thus, the coupling mechanism may also be a patient specific coupling mechanism 600.

[0098] The driver 500 is configured to drive a second drill insert 122a, such as those described above. The alignment pin 230, via the coupling mechanism 600, acts as a guide for placement of the second drill insert 122a. The surgeon then drives the driver 500, such as with pushing, striking, or turning, about the axis A, via the coupling mechanism 600, until a suitable and/or predefined area of bone is selected. Thus, the guide 100 and the first drill insert 122 may be used to place pin 230. Following the positioning of the pin 230, the second drill insert 122a may be placed at a second location that is different than the location of the first drill insert 122. [0099] For example, a second location 650 may be predetermined and/or selected during planning. The second location may be defined by the distance 610 and a selected orientation relative to the anatomy, such as aligned with the PSIS or ASIS. Thus, once the driver 500 is coupled to the pin 230 with the coupling mechanism 600, it may be aligned with the selected anatomy or other portion to be aligned along axis B with the second location 650. The driver 500 may then be used to place the second drill insert 122a at the second location 650.

[00100] As illustrated in FIG. 10, the surgeon then drives the second drill insert 122a into the bone, as described above. It is noted that the second drill insert 122a may include fins 127a, threads 127b, or any other anti -withdrawal feature disposed on the distal portion 129. The surgeon may then remove the driver 500 from the second drill insert 122a as illustrated in FIG. 11 A.

[00101] With additional reference to Fig. 1 IB, the surgeon may remove the alignment pin 230 from the first drill insert 122 and assemble the alignment pin 230 into the second drill insert 122a. In this manner, the alignment pin 230 may be removed from obstruction during operational procedures, such as reaming the acetabulum 82. Further, the alignment pin 230 may provide guidance, either directly or indirectly, while assembled in the second drill insert 122a, according to the predetermined plan, such as based on patient images. If selected, the surgeon may also remove the alignment pin 230 from the second drill insert 122a and reassemble the alignment pin 230 into the first drill insert 122. It is understood, therefore, that the drill inserts may be positioned for receiving the pin 230 as selected by the surgeon

[00102] Further, the pin 230 may also be removed and reassembled into the second drill guide 122a as desired. Thus, the drill guide 122 may be fixed in bone separate from the guide 100 to allow for maintaining a location for placement of the pin 230, regardless of repeated removal and replacement of the pin 230. Also, it is understood that the pin 230 may define a guide axis, such as for reaming or implant placement, regardless of where it is placed. Thus, the pin 230 need not be in the drill insert 122 attached to the guide 100 to provide a guide axis, as discussed above, for performing portions of the procedure.

[00103] Moreover, it may be selected that the axis A defined through the drill insert 122 attached to the guide 100 may never be selected for performing alterations to the acetabulum, such as reaming or implant placement, but axis A may only be defined to guide placement of the second drill insert 122a for defining axis B to assist in the procedure. Thus, axis B may be used by a user, such as a surgeon, in a manner similar to axis A as described above.

[00104] It is understood that the patient-specific guide 100 can be positioned within the acetabulum 82 of the patient in a pre-planned and registered position. The positioning of the patient-specific guide 100 can require axial movement to and/or within the acetabulum 82 and rotational positioning within the acetabulum 82. The inserter 300 may be coupled relative to the central post 130, which is fixed to the acetabular guide 100 at a pre-planned and selected position, such that a post alignment axis 130a of the post 130 can be aligned with a pre-determined landmark. The inserter 300, including the alignment jig 310 or other appropriate alignment portion, can be aligned with a post alignment axis 130a of the central post 130 for viewing by a user. Viewing the alignment axis and/or the alignment jig 310 by the user during insertion of the guide 100 into the acetabulum 82 can allow the user to ensure appropriate positioning of the guide 100 within the acetabulum 82 by aligning the alignment jig 310 with a predetermined landmark, such as the ASIS 410. Thus, the inserter 300 coupled in a keyed manner at a pre-determined orientation relative to the guide 100 can be used to assist in ensuring and placing the patient-specific guide 100 within the acetabulum 82.

[00105] According to various embodiments, when the guide 100 is placed in the acetabulum 82 in the predetermined location and orientation the guide 100 is registered to the acetabulum 82. Generally, the registration occurs and/or is achieved due to the contact of the outer surface 104 with the acetabulum either alone or with the various surfaces of the registration hooks 110 and/or the surface 128. Thus, the guide 100 can be registered to the acetabulum 82 of a specific patient in a specific and predetermined location and orientation.

[00106] Various patient-specific guides, secondary guides, reamers, guide handles, inserters, impactors, support devices, electronic positioners and other instruments can be used in various combinations and based on surgeon preferences or patient and preoperative or intraoperative circumstances for preparing an acetabulum and guiding and implanting an acetabular implant along a preoperatively determined alignment orientation. In this respect, tools and instrumentation providing redundant functionality and of different embodiments may provide to the surgeon in a kit or per surgeon's request.

[00107] For example, adaptors and other instruments described above can be provided and used in various combinations within the scope of the methods described herein.

[00108] The foregoing discussion discloses and describes merely exemplary arrangements of the present teachings. Furthermore, the mixing and matching of features, elements and/or functions between various embodiments is expressly contemplated herein, so that one of ordinary skill in the art would appreciate from this disclosure that features, elements and/or functions of one embodiment may be incorporated into another embodiment as appropriate, unless described otherwise above. Moreover, many modifications may be made to adapt a particular situation or material to the present teachings without departing from the essential scope thereof. One skilled in the art will readily recognize from such discussion, and from the accompanying drawings and claims, that various changes, modifications and variations can be made therein without departing from the spirit and scope of the present teachings as defined in the following claims.