WO2025265022A1

WO2025265022A1 - Instruments, systems and methods of using the same

Info

Publication number: WO2025265022A1
Application number: PCT/US2025/034535
Authority: WO
Inventors: Brian C. Hodorek; Robert A. Hodorek; Alec E. CUNNINGHAM; Russell M. Parrott; Colton D. MYERS; Matthew J. Purdy; MD Michael P. AST; MD Charles M. LAWRIE; MD Vivek M. SHAH; MD Alexander P. SAH
Original assignee: Ignite Orthomotion LLC
Current assignee: Ignite Orthomotion LLC
Priority date: 2024-06-20
Filing date: 2025-06-20
Publication date: 2025-12-26
Anticipated expiration: 2026-12-20

Abstract

Devices, instruments, systems and methods for replacing an articulation surface in a joint, for example, unicompartmental knee implants. A femoral resection system including a femoral cut guide and a spacer removably coupled to the femoral cut guide. A tibial resection guide for preparing a patient's tibia for insertion of a tibial implant. Methods for preparing the femur and tibia for implanting unicompartmental knee implants are also disclosed.

Description

INSTRUMENTS, SYSTEMS AND METHODS OF USING THE SAME

CROSS-REFERENCE TO RELATED APPLICATION

[0001] This application claims priority benefit under 35 U.S.C. §119(e) of U.S. Provisional Application No. 63/661,984 filed June 20, 2024 and entitled Instruments, Systems and Method of Using The Same, which is incorporated herein by reference in its entirety.

FIELD OF THE INVENTION

[0002] The present invention relates generally to general surgery, orthopedic instruments used for replacing an articulation surface in a joint, such as knee prostheses. More specifically, but not exclusively, the present invention relates to femoral instruments, tibial instruments, or unicompartmental knee instruments, and systems for knee replacements and revisions, as well as methods for using the same.

BACKGROUND OF THE INVENTION

[0003] Unicompartmental knee arthroplasties are performed to replace a single femoral condyle and a medial or lateral aspect of the tibial plateau. Robotic systems have been developed to augment the surgeon’s capabilities in performing unicompartmental knee arthroplasties. However, there are some constraints experienced by the robotic systems including the need for certain steps to be completed by complementary manual instrumentation and the manual instrumentation often being different from the instrumentation used in a fully manual procedure. In robotic partial knee procedures, all femur cuts are generally performed by the robot using guided sagittal saws. Once the cuts are complete, a guide may then be placed onto the cut surface allowing for the guidance of a drill to prepare for the posts. Since most manual finishing guides use the posterior femur as a reference and this feature has been removed by the robot, the surgeons have difficultly manually preparing the femur for the posts. Thus, a means of converting manual instrumentation to be used during a robotic procedure is needed.

[0004] In addition, in the preparation of the tibia, there is a vertical cut that is required that cannot currently be made with the guided sagittal saw using the robot. After the medial/lateral cut is made with the robot, the vertical cut is currently made free-handed with a hand-held reciprocating saw. Since the vertical cut is made free-handed, there is a lack of guidance of the sagittal saw and some of the benefits of a navigated procedure are negated. Thus, a robotic procedure for making the vertical cut is needed to protect the surgeon from creating crisscrossing cut which could be stress risers and possibly cause a tibia fracture. Therefore, instrumentation for unicompartmental knee arthroplasty that can be used during robotic procedures to remove the need for manual steps is needed to improve the outcome of the unicompartmental knee arthroplasty.

SUMMARY OF THE INVENTION

[0005] Aspects of the present disclosure provide femoral instruments, tibial instruments, and/or instrumentation for unicompartmental knee arthroplasty. The present invention also provides for methods for using the femoral instruments, tibial instruments, and/or unicompartmental knee instrumentation.

[0006] In one aspect, provided herein is a femoral cut guide system including a cut guide with a base plate extending from a first end to a second end and a guide plate coupled to and extending from a superior surface of the base plate, and a spacer removably coupled to the cut guide.

[0007] In another aspect, provided herein is a femoral cut guide with a base plate extending from a first end to a second end and a guide plate coupled to and extending from a superior surface of the base plate.

[0008] In yet another aspect, provided herein is a spacer including a base and an engagement portion extending from a first end of the base. The engagement portion including a tab extending away from a first end of the engagement portion and a through hole extending through the engagement portion and on three sides of the tab.

[0009] In still another aspect, provided herein is a tibial resection guide including a plate and a pin guide extending away from a corner of the plate.

[0010] These, and other objects, features and advantages of this invention will become apparent from the following detailed description of the various aspects of the invention taken in conjunction with the accompanying drawings.

BRIEF DESCRIPTION OF DRAWINGS

[0011] The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate embodiments of the invention and together with the detailed description herein, serve to explain the principles of the invention. The drawings are only for purposes of illustrating preferred embodiments and are not to be construed as limiting the invention. It is emphasized that, in accordance with the standard practice in the industry, various features are not drawn to scale. In fact, the dimensions of the various features may be arbitrarily increased or reduced for clarity of discussion. The foregoing and other objects, features and advantages of the invention are apparent from the following detailed description taken in conjunction with the accompanying drawings in which: [0012] FIG. 1 is a first perspective view of an embodiment of a femoral cut guide system, in accordance with an aspect of the present disclosure;

[0013] FIG. 2 is a second perspective view of the femoral cut guide system of FIG. 1, in accordance with an aspect of the present disclosure;

[0014] FIG. 3 is a first end view of the femoral cut guide system of FIG. 1, in accordance with an aspect of the present disclosure;

[0015] FIG. 4 is a second end view of the femoral cut guide system of FIG. 1, in accordance with an aspect of the present disclosure;

[0016] FIG. 5 is a superior view of the femoral cut guide system of FIG. 1, in accordance with an aspect of the present disclosure;

[0017] FIG. 6 is an inferior view of the femoral cut guide system of FIG. 1, in accordance with an aspect of the present disclosure;

[0018] FIG. 7 is a first side view of the femoral cut guide system of FIG. 1, in accordance with an aspect of the present disclosure;

[0019] FIG. 8 is a second side view of the femoral cut guide system of FIG. 1, in accordance with an aspect of the present disclosure;

[0020] FIG. 9 is a first perspective view of an embodiment of a femoral cut guide of the system of FIG. 1, in accordance with an aspect of the present disclosure;

[0021] FIG. 10 is a second perspective view of the femoral cut guide of FIG. 9, in accordance with an aspect of the present disclosure;

[0022] FIG. 11 is a first end view of the femoral cut guide of FIG. 9, in accordance with an aspect of the present disclosure;

[0023] FIG. 12 is a second end view of the femoral cut guide of FIG. 9, in accordance with an aspect of the present disclosure;

[0024] FIG. 13 is a superior view of the femoral cut guide of FIG. 9, in accordance with an aspect of the present disclosure;

[0025] FIG. 14 is an inferior view of the femoral cut guide of FIG. 9, in accordance with an aspect of the present disclosure;

[0026] FIG. 15 is a first side view of the femoral cut guide of FIG. 9, in accordance with an aspect of the present disclosure;

[0027] FIG. 16 is a second side view of the femoral cut guide system of FIG. 9, in accordance with an aspect of the present disclosure;

[0028] FIG. 17 is a first perspective view of an embodiment of a spacer of the system of FIG. 1, in accordance with an aspect of the present disclosure; [0029] FIG. 18 is a second perspective view of the spacer of FIG. 17, in accordance with an aspect of the present disclosure;

[0030] FIG. 19 is a first end view of the spacer of FIG. 17, in accordance with an aspect of the present disclosure;

[0031] FIG. 20 is a second end view of the spacer of FIG. 17, in accordance with an aspect of the present disclosure;

[0032] FIG. 21 is a superior view of the spacer of FIG. 17, in accordance with an aspect of the present disclosure;

[0033] FIG. 22 is an inferior view of the spacer of FIG. 17, in accordance with an aspect of the present disclosure;

[0034] FIG. 23 is a first side view of the spacer of FIG. 17, in accordance with an aspect of the present disclosure;

[0035] FIG. 24 is a second side view of the spacer of FIG. 17, in accordance with an aspect of the present disclosure;

[0036] FIG. 25 is a side view of three overlapping femoral cut guides of FIG. 9 and the spacer of FIG. 17, in accordance with an aspect of the present disclosure;

[0037] FIG. 26 is a first perspective view of the three femoral cut guides of FIG. 25, in accordance with an aspect of the present disclosure;

[0038] FIG. 27 is a second perspective view of the three femoral cut guides of FIG. 25, in accordance with an aspect of the present disclosure;

[0039] FIG. 28 is an exploded side view of the femoral cut guides and spacer of FIG. 25, in accordance with an aspect of the present disclosure;

[0040] FIG. 29 is a first side view the femoral cut guide of FIG. 9 positioned on a femur, in accordance with an aspect of the present disclosure;

[0041] FIG. 30 is a first perspective view of the femoral cut guide and femur of FIG. 29, in accordance with an aspect of the present disclosure;

[0042] FIG. 31 is a first side view of the femoral cut guide system of FIG. 1 positioned on a femur with the spacer positioned within the femoral cut guide after resection of the bone, in accordance with an aspect of the present disclosure;

[0043] FIG. 32 is a first perspective view of FIG. 31 with the femoral cut guide system positioned on the femur, in accordance with an aspect of the present disclosure;

[0044] FIG. 33 is a second perspective view of FIG. 31 with the femoral cut guide system positioned on the femur, in accordance with an aspect of the present disclosure;

[0045] FIG. 34 is a first perspective view of an embodiment of a tibial resection guide, in accordance with an aspect of the present disclosure; [0046] FIG. 35 is a second perspective view of the tibial resection guide of FIG. 34, in accordance with an aspect of the present disclosure;

[0047] FIG. 36 is a first end view of the tibial resection guide of FIG. 34, in accordance with an aspect of the present disclosure;

[0048] FIG. 37 is a second end view of the tibial resection guide of FIG. 34, in accordance with an aspect of the present disclosure;

[0049] FIG. 38 is a superior view of the tibial resection guide of FIG. 34, in accordance with an aspect of the present disclosure;

[0050] FIG. 39 is an inferior view of the tibial resection guide of FIG. 34, in accordance with an aspect of the present disclosure;

[0051] FIG. 40 is a first side view of the tibial resection guide of FIG. 34, in accordance with an aspect of the present disclosure;

[0052] FIG. 41 is a second side view of the tibial resection guide of FIG. 34, in accordance with an aspect of the present disclosure;

[0053] FIG. 42 is a first end view of a tibia with a first cut, in accordance with an aspect of the present disclosure;

[0054] FIG. 43 is a first perspective view of the tibia of FIG. 42, in accordance with an aspect of the present disclosure;

[0055] FIG. 44 is a perspective view of a portion of the tibia of FIG. 42 with the tibial resection guide of FIG. 34 inserted into the first cut, in accordance with an aspect of the present disclosure;

[0056] FIG. 45 is a perspective view of the portion of the tibia of FIG. 44 with a pin inserted into the tibial resection guide of FIG. 34, in accordance with an aspect of the present disclosure; [0057] FIG. 46 is a perspective view of the portion of the tibia of FIG. 44 with a saw cutting a portion of the tibia with the tibial resection guide of FIG. 34, in accordance with an aspect of the present disclosure;

[0058] FIG. 47 is a perspective view of the portion of the tibia of FIG. 44 after removal of the resected portion of the tibia, in accordance with an aspect of the present disclosure; and [0059] FIG. 48 is a perspective view of the portion of the tibia of FIG. 44 after removal of the tibial resection guide of FIG. 34 and the pin, in accordance with an aspect of the present disclosure. DETAILED DESCRIPTION FOR CARRYING OUT THE INVENTION

[0060] Generally stated, disclosed herein are femoral instruments, tibial instruments, and other instrumentation for unicompartmental knee arthroplasty. Further, surgical methods for using the femoral instruments, tibial instruments, and other instrumentation are discussed. [0061] In this detailed description and the following claims, the words proximal, distal, anterior, posterior, medial, lateral, superior and inferior are defined by their standard usage for indicating a particular part of a bone or implant according to the relative disposition of the natural bone or directional terms of reference. For example, “proximal” means the portion of a device or implant nearest the torso, while “distal” indicates the portion of the device or implant farthest from the torso. As for directional terms, “anterior” is a direction towards the front side of the body, “posterior” means a direction towards the back side of the body, “medial” means towards the midline of the body, “lateral” is a direction towards the sides or away from the midline of the body, “superior” means a direction above and “inferior” means a direction below another object or structure.

[0062] Similarly, positions or directions may be used herein with reference to anatomical structures or surfaces. For example, as the current devices, instruments, systems and methods are described herein with reference to use with the bones of the knee, the bones of the knee and leg may be used to describe the surfaces, positions, directions or orientations of the devices, instruments, systems and methods. Further, the devices, instruments, systems and methods, and the aspects, components, features and the like thereof, disclosed herein are described with respect to one side of the body for brevity purposes. However, as the human body is relatively symmetrical or mirrored about a line of symmetry (midline), it is hereby expressly contemplated that the devices, instruments, systems and methods, and the aspects, components, features and the like thereof, described and/or illustrated herein may be changed, varied, modified, reconfigured or otherwise altered for use or association with another side of the body for a same or similar purpose without departing from the spirit and scope of the invention. For example, the devices, instruments, systems and methods, and the aspects, components, features and the like thereof, described herein with respect to the right knee may be mirrored so that they likewise function with the left knee and vice versa. Further, the devices, instruments, systems and methods, and the aspects, components, features and the like thereof, disclosed herein are described with respect to the knee for brevity purposes, but it should be understood that the devices, instruments, systems and methods may be used with other bones of the body having similar structures, for example the upper extremity, and more specifically, with the bones of the shoulder, elbow, and arm. [0063] Referring to the drawings, wherein like reference numerals are used to indicate like or analogous components throughout the several views, and with particular reference to FIGS. 1- 48, there is illustrated femoral and tibial instruments 150, 300, 500 for unicompartmental knee arthroplasty.

[0064] Referring now to FIGS. 1-33, a femoral cut guide system 100 is shown. The cut guide system 100 includes a femoral cut guide 150 and a spacer or converter 300. The spacer 300 engages the femoral cut guide 150 to assist with use of the cut guide 150 during robotic surgery.

[0065] With specific reference to FIGS. 9-16 the cut guide 150 is shown. The cut guide 150 includes a superior end 152, an inferior end 154 opposite the superior end 152, a first end 156, a second end 158 opposite the first end 156, a first side 160, and a second side 162 opposite the first side 160. The cut guide 150 includes a base plate 170 and a guide plate 190 extending away from a superior surface of the base plate 170. The base plate 170 may be positioned at the inferior end 154 of the cut guide 150. The guide plate 190 extends from the base plate 170 to the superior end 152 of the cut guide 150.

[0066] The base plate 170 includes a first portion 172 extending from a first end 156 toward a second end 158 and a second portion 182 extending from the first portion 172 to the second end 158. The first portion 172 may include a top member 174, a bottom member 176, and a side member 178 connecting the top member 174 and the bottom member 176. The top member 174 extends from the first end 156 at an angle relative to the inferior end 154 of the cut guide 150 toward the second end 158. The bottom member 176 may have a planar inferior end or surface and an angled superior end or surface, for example, forming a wedge portion. The side member 178 may be positioned, for example, connecting the top member 174 and bottom member 176 on a second side 162 of the cut guide 150.

[0067] The first portion 172 also includes a slot or cutting slot 180 extending into the first portion 172 from the first side 160 between the top member 174 and the bottom member 176 toward the second side 162, as shown in at least FIGS. 9-13 and 15-16. The second portion 182 extends from the first portion 172, for example, at the widest portion of the wedge of the bottom member 176 to the second end 158. The slot 180 extends into the first portion 172 of the base plate 170 at an angle relative to the inferior end 154. The second portion 182 may also include a channel or alignment slot 188 extending into the second portion 182 from the second end 158, as shown in at least FIGS. 9, 10, 13, and 14. The slot 188 extends from the second end 158 towards the first end 156. The slot 188 may form, for example, two leg portions 189.

[0068] With continued reference to FIGS. 9-12 and 15-16, the guide plate 190 includes a first portion 192 coupled to and extending away from the base plate 170, a second portion 210 coupled to and extending from the first portion 192, and a third portion 240 coupled to and extending from the second portion 210. The first portion 192 and the third portion 240 may be positioned, for example, generally perpendicular to the inferior surface 154 of the base plate 170. The second portion 210 may be positioned, for example, between and extend out from the first portion 192 and the third portion 240. The second portion 210 may extend from the surfaces of the first portion 192 and third portion 240 facing the first end 156. The second portion 210 may extend, for example, at an angle relative to the surfaces of the first and third portions 192, 240 facing the first end 156. The third portion 240 extends away from the superior end of the second portion 210 to the superior end 152 of the cut guide 150.

[0069] As shown in FIGS. 9-11 and 13-16, the first portion 192 of the guide plate 190 includes a protrusion 193 extending away from the first surface of the first portion 192 towards the first end 156 of the cut guide 150. The protrusion 193 may, for example, extend away from a middle or central portion of the first portion 192 along a longitudinal axis of the guide plate 190. In addition, the first portion 192 of the guide plate 190 includes a coupling member 194 extending from the protrusion 193 towards the first end 156 of the cut guide 150. The coupling member 194 may, for example, extend beyond the first end 156 of the cut guide 150. The coupling member 194 may have, for example, a cylindrical shape, hexagonal prism shape, or the like. The coupling member 194 may be, for example, configured to couple to an insertion handle. The coupling member 194 may also include, for example, grooves 195 inset into the superior and inferior surfaces of the coupling member 194.

[0070] The first portion 192 also includes a first insertion guide 196 extending through the first portion 192 and the protrusion 193 from the surface facing the first end 156 of the cut guide 150 to the surface facing the second end 158 of the cut guide 150. The first insertion guide 196 may be positioned, for example, inferior to the coupling member 194. The coupling member 194 may be positioned, for example, superior to the first insertion guide 196. The coupling member 194 may extend perpendicularly from the protrusion 193. The first insertion guide 196 may extend, for example, at an angle away from the coupling member 194 toward the inferior end 154 of the cut guide 150. The first insertion guide 196 includes a through hole 198 extending through the entire protrusion 193 and the first portion 192. The first insertion guide 196 also includes at least one channel 200 extending through the protrusion 193 and first portion 192 of the first insertion guide 196. The at least one channel 200 may be, for example, three channels 200 evenly spaced around the circumference of the through hole 198 of the first insertion guide 196. It is also contemplated that the channels 200 may be, for example, unequally spaced around the through hole 198 of the first insertion guide 196. The first portion 192 may also include a groove 204 inset into the second side 162 of the cut guide 150, as shown in at least FIGS. 10-12.

[0071] The second portion 210 of the guide plate 190 includes a top member 212, a bottom member 214, and a side member 216 connecting the top member 212 and the bottom member 214. The first end of the top member 212 is coupled to and extends from the inferior end of the third portion 240. The first end of the bottom member 214 is coupled to and extends from the superior end of the first portion 192. The top member 212 and the bottom member 214 extend away from the first end 156 of the guide plate 190. The top member 212 and bottom member 214 extend, for example, at an angle from the first surface of the guide plate 190 facing the first end 156. The side member 216 couples the second side of the top member 212 to the second side of the bottom member 214. The second portion 210 includes a slot 218 extending between the top member 212 and the bottom member 214. The slot 218 extends into the second portion 210 from the first side 160 towards the second side 162 until engagement with the side member 216.

[0072] The second portion 210 also includes a second insertion guide 220 extending through the top member 212 and the bottom member 214 to engage the third portion 240. The slot 218 may, for example, bisect the second insertion guide 220. The second insertion guide 220 may extend, for example, at an angle away from the third portion 240 toward the inferior end 154 of the cut guide 150. The second insertion guide 220 includes a through hole 222 extending through the bottom member 214, the top member 212, and the third portion 240. The second insertion guide 220 also includes at least one channel 224 extending through the bottom member 214, the top member 212, and the third portion 240. The at least one channel 224 may be, for example, three channels 224 evenly spaced around the circumference of the through hole 222. It is also contemplated that the channels 224 may be, for example, unequally spaced around the through hole 222 of the second insertion guide 220.

[0073] In addition, the second portion 210 includes a first screw guide 230 extending through the second portion 210 from the first side to the second side. The first screw guide 230 is positioned superior to the groove 204. The first screw guide 230 may include a first through hole 232 extending through the second portion 210. The first through hole 232 may be positioned, for example, adjacent to the slot 218 and superior to the opening for the slot 218 on the second surface of the second portion 210 facing the second end 158 of the cut guide 150. The first through hole 232 of the first screw guide 230 may be, for example, configured or sized and shaped to receive a fastener, screw, or the like to secure the cut guide 150 to the femur. [0074] With continued reference to FIGS. 9-12 and 15-16, the third portion 240 is shown. The third portion 240 includes screw guides 242, 246 extending away from the first surface of the third portion 240 facing the first end 156 of the cut guide 150 at various angles. The screw guides 242, 246 may include, for example, a first screw guide 242 positioned on a first side 160 of the third portion 240 and a second screw guide 246 positioned at the superior end 152 of the third portion 240. The first screw guide 242 may include a first through hole 244 extending through the third portion 240 from the first surface to the second surface. The second screw guide 246 may include a second through hole 248 extending through the third portion 240 from the first surface to the second surface. The screw guides 342, 346 may be, for example, configured or sized and shaped to receive a fastener, screw, or the like to secure the cut guide 150 to the femur. The third portion 240 may also include a cutout 258 extending into the superior end 152. The cutout 258 may have a curved interior surface. The cutout 258 may be, for example, positioned adjacent to the second screw guide 246. The third portion 240 also includes a protrusion 250 extending between the first or front surface of the third portion 240 and the top member 212 of the second portion 210.

[0075] Referring now to FIGS. 17-24, the spacer 300 is shown. The spacer 300 includes a superior end or top surface 302, an inferior end or bottom surface 304 opposite the superior end 302, a first end 306, a second end 308 opposite the first end 306, a first side 310, and a second side 312 opposite the first side 310. The spacer 300 includes a base or wedge portion 320 and an engagement member or extension 340 extending from the first end 326 of the base 320. [0076] The base 320 includes a top surface 322 and a bottom surface 324 opposite the top surface 322. The bottom surface 324 may be, for example, flat or planar. The top surface 322 may be, for example, angled or slopped from the first end 326 to the second end 328 relative to the bottom surface 324. The base 320 also includes a first side 330 and a second side 332 opposite the first side 330. Each side 330, 332 may include, for example, a recess or curve inset into the base 320 between the first end 326 and the second end 328. The base 320 also includes an alignment member or protrusion 334 extending away from the bottom surface 324 of the base 320. The protrusion 334 may be positioned, for example, near the second end 328 of the base 320. The protrusion 334 may be, for example, oval shaped with a length extending along a longitudinal axis of the spacer 300. The protrusion 334 may be shaped, for example, to engage the alignment slot 188 of the cut guide 150. The thickness of the protrusion 334 may be, for example, smaller than the thickness of the second end 328 of the base 320.

[0077] The engagement portion or extension portion 340 includes a top surface 342 and a bottom surface 344 opposite the top surface 342. The top and bottom surfaces 322, 324 may each be planar or flat. The engagement portion 340 may also include a first end 346 and a second end 348 opposite the first end 346. The second end 348 of the engagement portion 340 may be coupled to the first end 326 of the base 320. The engagement portion 340 further includes a first side 350 and a second side 352 opposite the first side 350. The sides 350, 352 may extend from the first end 326 of the base 320 parallel to each other. The engagement portion 340 also includes a tab or deformable member 354 coupled to and extending from the first end 346 of the engagement portion 340. The engagement portion 340 may also include a through hole 356 extending through the engagement portion 340 from the top surface 342 to the bottom surface 344. The through hole 356 may extend around three sides of the tab 354. The through hole 356 may, for example, extend along the first side 350, the second side 352, and the second end 348 of the tab 354.

[0078] As shown in FIGS. 1-4, 7, and 8, the engagement portion 340 of the spacer 300 may be inserted into the slot 180 of the cut guide 150. Once inserted the tab 354 of the spacer 300 may engage the slot 180 of the cut guide 150. In addition, the bottom surface 324 of the spacer 300 may be positioned on and slide relative to the top surface of the base plate 170 of the cut guide 150. Further, the protrusion 334 of the spacer 300 may be positioned to engage the alignment slot 188 of the cut guide 150.

[0079] Referring now to FIGS. 25-28, different size cut guides 150 are shown. The different sizes may include a first cut guide 150, a second cut guide 370, and a third cut guide 390. The second cut guide 370 may be the smallest, the first cut guide 150 may be larger than the second cut guide 370, and the third cut guide 390 may be larger than the first cut guide 150 and the second cut guide 370. Each cut guide 150, 370, 390 includes a base plate 170 and a guide plate 190 as described in greater detail above and which will not be described again here in detail for brevity’s sake. The second cut guide 370 may include a protrusion 372 that is larger than the protrusion 193 of cut guide 150. A coupling member 374 may extend away from the protrusion 372 and may be the same or similar to the coupling member 194. The first insertion guide 376 may extend through the protrusion 372 and the first portion 192. The second insertion guide 378 may also extend through the protrusion 372 and the second portion 210.

[0080] The third cut guide 390 may include a protrusion 382 that is smaller than the protrusion 193 of cut guide 150. A coupling member 394 may extend away from the protrusion 392 and may be the same or similar to the coupling member 194. The first insertion guide 396 may extend through the protrusion 392 and the first portion 192. The second insertion guide 398 may also extend through the second portion 210 and the third portion 240. The second insertion guide 398 may create a recess 400 extending into the end of the second portion 210.

[0081] Referring now to FIGS. 29-33, the cut guide 150 is positioned on a resected portion of the femur 410. Alternatively, cut guides 370, 390 could be positioned on the resected portion of the femur 410. Then, fasteners or screws are inserted through one or more of the screw guides 230, 242, 246. Next, a posterior cut 412 of the femur 410 made be made, as shown in FIG. 31. Once the posterior cut 412 is made, then the spacer 300 may be attached to the posterior aspect of the cut guide 150, 370, 390 to rest against the posterior cut 412. The spacer 300 aligns the robotic cut with the cut plane that the manual guide would have made. The cut guide 150, 370, 390 can then be used to drill or punch through the femur 410. For example, drill bits may be inserted through the insertion guides 196, 220, 376, 378, 396, 398 for drilling openings into the femur 410. Then, fin punches (not shown) may be inserted through the insertion guides 196, 220, 376, 378, 396, 398 and the fin punches may be impacted until fully seated within the cut guide 150, 370, 390 forming openings in the femur. One or more of the fin punches may be left in the femur to provide stability for the cut guide 150, 370, 390. Then, additional drilling, punching, and/or cutting may be performed using the cut guide 150, 370, 390.

[0082] Referring now to FIGS. 34-48, the tibial resection guide or cut guide 500 is shown. The resection guide 500 may include a superior end 502, an inferior end 504 opposite the superior end 502, a first end 506, a second end 508 opposite the first end 506, a first side 510, and a second side 512 opposite the first side 510. The resection guide 500 may include a flange or plate 520 and a pin guide or cut guide 540 extending away from the first end 526 of the plate 520. The plate 520 has a thickness smaller than the pin guide 540. In addition, the width and length of the plate 520 are larger than the width and length of the pin guide 540.

[0083] The plate 520 includes a top surface 522, a bottom surface 524 opposite the top surface 522, a first end 526, a second end 528 opposite the first end 526, a first side 530, and a second side 532 opposite the first side 530. The top surface 522 and the bottom surface 524 are positioned planar to each other. The plate 520 may have, for example, a rectangular shape. [0084] The pin guide 540 couples to and extends from the corner where the first end 526 of the plate 520 engages the second side 532 of the plate 520. The pin guide 540 includes a top surface 542, a bottom surface 544 opposite the top surface 542, a first end 546, a second end 548 opposite the first end 546, a first side 550, and a second side 552 opposite the first side 550. The pin guide 540 includes a base 554 with an extension arm 556 extending away from a top surface of the base 554 on a second side 552 of the pin guide 540. The base 554 has, for example, a cube or rectangular prism shape. The extension arm 556 may be curved between the bottom surface 544 and the second side 552. The pin guide 540 may also include a pin hole 558 extending through the pin guide 540 between the base 554 and the extension arm 556. The pin hole 558 may extend from the first end 546 to the second end 548. The pin hole 558 may be, for example, sized and shaped to receive a pin or drill bit. In addition, the pin guide 540 may include a slot 560 extending from the top surface of the base 554 into the pin hole 558. The slot 560 may be, for example, sized and shaped to receive a cutting instrument, for example, a sagittal or like saw blade.

[0085] In an alternative embodiment, the pin guide 540 may include the base 554, extension arm 556, and the slot 560. In the alternative embodiment, the slot 560 extends through a portion of the base 554 directly adjacent to the extension arm 556 from the top surface 542 towards the bottom surface 544. In this alternative embodiment, the slot 560 has the same width over the entire length from the top surface 542 to the bottom surface 544. The width of the slot 560 may be, for example, the same size or slightly larger than a cutting instrument, for example, a sagittal saw blade or the like.

[0086] Referring now to FIGS. 42-48, a method of resecting the tibia 570 with a robot is shown. A first cut 572 is made into the tibia 570, as shown in FIGS. 42-43. The plate 520 of the tibial resection guide 500 is inserted into the first cut 572, as shown in FIG. 44. Then, in some embodiments, a pin 574 may be inserted into the pin hole 558 of the pin guide 540 and into the tibia 570 to make a rounded cut through the tibia 570, as shown in FIG. 45. In an alternative embodiment, additional pins (not shown) may be used to secure the resection guide 500 to the tibia 570. In yet another alternative embodiment, a clip (not shown) may wrap around and grab the top of the tibia 570. Next, a robot (not shown) may be used with a sagittal saw 576 to make a second cut 578. In some embodiments, where the tibial resection guide 500 includes the slot 560 and does not include the pin hole 558, it is contemplated that after the tibial resection guide 500 is inserted into the first cut 572, then the robot is used to make the second cut 578. The sagittal saw 576 is guided by the extension arm 556 of the pin guide 540 down to the pin 574, as shown in FIG. 46, or in the alternative embodiment down to the most distal end of the slot 560. The resected portion 580 of the tibia 570 may then be removed, as shown in FIG. 47. Finally, the pin 574 and resection guide 500 may be removed from the tibia 570.

[0087] As may be recognized by those of ordinary skill in the art based on the teachings herein, numerous changes and modifications may be made to the above-described and other embodiments of the present disclosure without departing from the scope of the disclosure. The components of the instruments, devices, and/or systems as disclosed in the specification, including the accompanying abstract and drawings, may be replaced by alternative component(s) or feature(s), such as those disclosed in another embodiment, which serve the same, equivalent or similar purpose as known by those skilled in the art to achieve the same, equivalent or similar results by such alternative component(s) or feature(s) to provide a similar function for the intended purpose. In addition, the instruments, devices, and/or systems may include more or fewer components or features than the embodiments as described and illustrated herein. Accordingly, this detailed description of the currently-preferred embodiments is to be taken in an illustrative, as opposed to limiting of the disclosure.

[0088] The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. As used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprise” (and any form of comprise, such as “comprises” and “comprising”), “have” (and any form of have, such as “has”, and “having”), “include” (and any form of include, such as “includes” and “including”), and “contain” (and any form of contain, such as “contains” and “containing”) are open-ended linking verbs. As a result, a method or device that “comprises,” “has,” “includes,” or “contains” one or more steps or elements possesses those one or more steps or elements, but is not limited to possessing only those one or more steps or elements. Likewise, a step of a method or an element of a device that “comprises,” “has,” “includes,” or “contains” one or more features possesses those one or more features, but is not limited to possessing only those one or more features. Furthermore, a device or structure that is configured in a certain way is configured in at least that way, but may also be configured in ways that are not listed.

[0089] The invention has been described with reference to the preferred embodiments. It will be understood that the operational embodiments described herein are exemplary of a plurality of possible arrangements to provide the same general features, characteristics, and general system operation. Modifications and alterations will occur to others upon a reading and understanding of the preceding detailed description. It is intended that the invention be construed as including all such modifications and alterations.

Claims

CLAIMS Having thus described the preferred embodiments, the invention is now claimed to be:

1. A femoral cut guide system, comprising: a cut guide, comprising: a base plate extending from a first end to a second end; and a guide plate coupled to and extending from a superior surface of the base plate; and a spacer removably coupled to the cut guide.

2. The femoral cut guide system of claim 1, wherein the spacer comprises: a base; and an engagement portion extending from a first end of the base and received within a portion of the base plate.

3. The femoral cut guide system of claim 2, wherein the engagement portion comprises: a tab extending away from a first end of the engagement portion; and a through hole extending through the engagement portion and on three sides of the tab.

4. The femoral cut guide system of claim 3, wherein the tab engages a portion of the base plate of the cut guide.

5. The femoral cut guide system of claim 3, wherein the base comprises: an alignment member extending away from a bottom surface of the base.

6. The femoral cut guide system of claim 5, wherein the alignment member of the spacer removably engages a portion of the base plate of the cut guide.

7. The femoral cut guide system of claim 3, wherein a top surface of the engagement portion is aligned with and extends from the top surface of the base.

8. The femoral cut guide system of claim 3, wherein a top surface of the base is angled from a second end to a first end of the base relative to a bottom surface.

9. The femoral cut guide system of claim 3, wherein the base has a wedge shape.

10. The femoral cut guide system of claim 1, wherein the base plate comprises: a first portion extending from the first end toward the second end; and a second portion extending from the second end toward the first end.

11. The femoral cut guide system of claim 10, wherein the first portion comprises: a top member extending from the first end of the base plate at an angle; a bottom member with a top surface extending from the first end of the base plate at an angle and a bottom surface extending from the first end of the base plate to the second end; a side member positioned on a second side of the base plate and extending between the top member and the bottom member; and a slot extending into a first side of the base plate between the top member and the bottom member.

12. The femoral cut guide system of claim 11, wherein the second portion extends from the first portion to the second end of the base plate.

13. The femoral cut guide system of claim 11, wherein the guide plate comprises: a first portion coupled to and extending from the base plate; a second portion coupled to and extending from a first end of the first portion; and a third portion coupled to and extending from a first end of the second portion.

14. The femoral cut guide system of claim 13, wherein the first portion comprises: a protrusion extending from a first end of the first portion; a coupling member extending from the protrusion; and a first insertion guide extending through the protrusion and the first portion.

15. The femoral cut guide system of claim 14, wherein the coupling member is positioned superior to the first insertion guide.

16. The femoral cut guide system of claim 14, wherein the first insertion guide comprises: a through hole extending through the protrusion and the first portion; a plurality of channels extending through the protrusion from an exterior surface to the through hole and through the protrusion and the first portion from a first end to a second end.

17. The femoral cut guide system of claim 16, wherein the plurality of channels is three channels spaced circumferentially around the through hole.

18. The femoral cut guide system of claim 13, wherein the first portion further comprises: a groove inset into a second side of the first portion between the first end and a second end of the first portion.

19. The femoral cut guide system of claim 13, wherein the second portion extends anteriorly out from a first end of the first portion and a second end of the third portion at an angle towards a superior end of the guide plate.

20. The femoral cut guide system of claim 13, wherein the second portion comprises: a bottom member with a first end and a second end, wherein the second end of the bottom member is coupled to a first end of the first portion; a top member with a first end and a second end, wherein the second end of the top member is coupled to a second end of the third portion; and a side member coupled to and extending between the bottom member and the top member on a second side of the guide plate.

21. The femoral cut guide system of claim 20, wherein the second portion further comprises: a slot extending between the top member and the bottom member from a first side of the guide plate to the side member.

22. The femoral cut guide system of claim 21, wherein the second portion further comprises: a second insertion guide extending through the second portion.

23. The femoral cut guide system of claim 22, wherein the second insertion guide extends through the second portion and at least a portion of the third portion.

24. The femoral cut guide system of claim 22, wherein the second insertion guide comprises: a through hole extending through the top member and the bottom member of the second portion; and a plurality of channels extending through the top member and the bottom member of the second portion and into the through hole.

25. The femoral cut guide system of claim 24, wherein the through hole further extends through the third portion from a first end to a second end.

26. The femoral cut guide system of claim 24, wherein the plurality of channels further extends through the third portion from a first end to a second end.

27. The femoral cut guide system of claim 24, wherein the plurality of channels is three channels spaced circumferentially around the through hole.

28. The femoral cut guide system of claim 24, wherein the second portion further comprises: a first screw guide coupled to and extending from the second portion on a second side of the guide plate; and a first through hole extending through the first screw guide.

29. The femoral cut guide system of claim 13, wherein the third portion comprises: at least one screw guide coupled to and extending from a first end of the third portion; and at least one through hole extending through the at least one screw guide and the third portion.

30. The femoral cut guide system of claim 29, wherein the at least one screw guide is two screw guides positioned around an outer edge of the third portion.

31. The femoral cut guide system of claim 30, wherein a first screw guide is positioned on a first side of the third portion, and wherein a second screw guide is positioned on a superior end of the third portion.

32. The femoral cut guide system of claim 31, wherein the third portion further comprises: a cutout extending into the superior end of the third portion, wherein the cutout extends through the third portion from a first end toward a second end.

33. The femoral cut guide system of claim 32, wherein the cutout is positioned between the first screw guide of the third portion and the second screw guide of the third portion.

34. The femoral cut guide system of claim 29, wherein the third portion further comprises: a protrusion extending between a first end of the third portion and a top member of the second portion.

35. A spacer, comprising: a base; and an engagement portion extending from a first end of the base, wherein the engagement portion comprises: a tab extending away from a first end of the engagement portion; and a through hole extending through the engagement portion and on three sides of the tab.

36. The spacer of claim 35, wherein the base comprises: an alignment member extending away from a bottom surface of the base.

37. The spacer of claim 36, wherein a top surface of the engagement portion is aligned with and extends from the top surface of the base.

38. The spacer of claim 36, wherein a top surface of the base is angled from a second end to a first end of the base relative to a bottom surface.

39. The spacer of claim 36, wherein the base has a wedge shape.

40. The spacer of claim 36, wherein the alignment member is positioned on a second end of the base near a midpoint between a first side and a second side.

41. The spacer of claim 36, wherein the alignment member has an oval shape.

42. A cut guide, comprising: a base plate extending from a first end to a second end; and a guide plate coupled to and extending from a superior surface of the base plate.

43. The cut guide of claim 42, wherein the base plate comprises: a first portion extending from the first end toward the second end; and a second portion extending from the second end toward the first end.

44. The cut guide of claim 43, wherein the first portion comprises: a top member extending from the first end of the base plate at an angle; a bottom member with a top surface extending from the first end of the base plate at an angle and a bottom surface extending from the first end of the base plate to the second end; a side member positioned on a second side of the base plate and extending between the top member and the bottom member; and a slot extending into a first side of the base plate between the top member and the bottom member.

45. The cut guide of claim 44, wherein the second portion extends from the first portion to the second end of the base plate.

46. The cut guide of claim 44, wherein the guide plate comprises: a first portion coupled to and extending from the base plate; a second portion coupled to and extending from a first end of the first portion; and a third portion coupled to and extending from a first end of the second portion.

47. The cut guide of claim 46, wherein the first portion comprises: a protrusion extending from a first end of the first portion; a coupling member extending from the protrusion; and a first insertion guide extending through the protrusion and the first portion.

48. The cut guide of claim 47, wherein the coupling member is positioned superior to the first insertion guide.

49. The cut guide of claim 47, wherein the first insertion guide comprises: a through hole extending through the protrusion and the first portion; a plurality of channels extending through the protrusion from an exterior surface to the through hole and through the protrusion and the first portion from a first end to a second end.

50. The cut guide of claim 49, wherein the plurality of channels is three channels spaced circumferentially around the through hole.

51. The cut guide of claim 46, wherein the first portion further comprises: a groove inset into a second side of the first portion between the first end and a second end of the first portion.

52. The cut guide of claim 46, wherein the second portion extends anteriorly out from a first end of the first portion and a second end of the third portion at an angle towards a superior end of the guide plate.

53. The cut guide of claim 46, wherein the second portion comprises: a bottom member with a first end and a second end, wherein the second end of the bottom member is coupled to a first end of the first portion; a top member with a first end and a second end, wherein the second end of the top member is coupled to a second end of the third portion; and a side member coupled to and extending between the bottom member and the top member on a second side of the guide plate.

54. The cut guide of claim 43, wherein the second portion further comprises: a slot extending between the top member and the bottom member from a first side of the guide plate to the side member.

55. The cut guide of claim 54, wherein the second portion further comprises: a second insertion guide extending through the second portion.

56. The cut guide of claim 55, wherein the second insertion guide extends through the second portion and at least a portion of the third portion.

57. The cut guide of claim 55, wherein the second insertion guide comprises: a through hole extending through the top member and the bottom member of the second portion; and a plurality of channels extending through the top member and the bottom member of the second portion and into the through hole.

58. The cut guide of claim 57, wherein the through hole further extends through the third portion from a first end to a second end.

59. The cut guide of claim 57, wherein the plurality of channels further extends through the third portion from a first end to a second end.

60. The cut guide of claim 57, wherein the plurality of channels is three channels spaced circumferentially around the through hole.

61. The cut guide of claim 57, wherein the second portion further comprises: a first screw guide coupled to and extending from the second portion on a second side of the guide plate; and a first through hole extending through the first screw guide.

62. The cut guide of claim 46, wherein the third portion comprises: at least one screw guide coupled to and extending from a first end of the third portion; and at least one through hole extending through the at least one screw guide and the third portion.

63. The cut guide of claim 62, wherein the at least one screw guide is two screw guides positioned around an outer edge of the third portion.

64. The cut guide of claim 63, wherein a first screw guide is positioned on a first side of the third portion, and wherein a second screw guide is positioned on a superior end of the third portion.

65. The cut guide of claim 64, wherein the third portion further comprises: a cutout extending into the superior end of the third portion, wherein the cutout extends through the third portion from a first end toward a second end.

66. The cut guide of claim 65, wherein the cutout is positioned between the first screw guide of the third portion and the second screw guide of the third portion.

67. The cut guide of claim 62, wherein the third portion further comprises: a protrusion extending between a first end of the third portion and a top member of the second portion.

68. A tibial resection guide, comprising: a plate; and a pin guide coupled to and extending away from a corner of the plate.

69. The tibial resection guide of claim 68, wherein the resection guide comprises: a base; and an extension arm coupled to and extending from a first side of the base.

70. The tibial resection guide of claim 69, further comprising: a slot extending into the base from a top surface toward a bottom surface.

71. The tibial resection guide of claim 70, wherein the slot extends into the base adjacent to the extension arm.

72. The tibial resection guide of claim 71, wherein the slot extends through the base from a first end to a second end.

73. The tibial resection guide of claim 71, further comprising: a pin hole positioned at a distal most end of the slot and extending through the base from a first end to a second end.

74. The tibial resection guide of claim 69, wherein a top surface of the extension arm extends beyond a top surface of the base in a superior direction of the resection guide.

75. The tibial resection guide of claim 68, wherein the plate has a rectangular shape.

76. A femoral cut guide system, comprising: a cut guide, comprising: a base plate extending from a first end to a second end; and a guide plate coupled to and extending from a superior surface of the base plate; and a spacer removably coupled to the cut guide.

77. The femoral cut guide system of claim 76, wherein the spacer comprises: a base; and an engagement portion extending from a first end of the base and received within a portion of the base plate.

78. The femoral cut guide system of claim 77, wherein the engagement portion comprises: a tab extending away from a first end of the engagement portion; and a through hole extending through the engagement portion and on three sides of the tab.

79. The femoral cut guide system of claim 78, wherein the tab engages a portion of the base plate of the cut guide.

80. The femoral cut guide system of any one of claims 76-79, wherein the base comprises: an alignment member extending away from a bottom surface of the base.

81. The femoral cut guide system of any one of claims 76-80, wherein the alignment member of the spacer removably engages a portion of the base plate of the cut guide.

82. The femoral cut guide system of any one of claims 76-81, wherein a top surface of the engagement portion is aligned with and extends from the top surface of the base.

83. The femoral cut guide system of any one of claims 76-82, wherein a top surface of the base is angled from a second end to a first end of the base relative to a bottom surface.

84. The femoral cut guide system of any one of claims 76-83, wherein the base has a wedge shape.

85. The femoral cut guide system of any one of claims 76-84, wherein the base plate comprises: a first portion extending from the first end toward the second end; and a second portion extending from the second end toward the first end.

86. The femoral cut guide system of any one of claims 76-85, wherein the first portion comprises: a top member extending from the first end of the base plate at an angle; a bottom member with a top surface extending from the first end of the base plate at an angle and a bottom surface extending from the first end of the base plate to the second end; a side member positioned on a second side of the base plate and extending between the top member and the bottom member; and a slot extending into a first side of the base plate between the top member and the bottom member.

87. The femoral cut guide system of any one of claims 76-86, wherein the second portion extends from the first portion to the second end of the base plate.

88. The femoral cut guide system of any one of claims 76-87, wherein the guide plate comprises: a first portion coupled to and extending from the base plate; a second portion coupled to and extending from a first end of the first portion; and a third portion coupled to and extending from a first end of the second portion.

89. The femoral cut guide system of any one of claims 76-88, wherein the first portion comprises: a protrusion extending from a first end of the first portion; a coupling member extending from the protrusion; and a first insertion guide extending through the protrusion and the first portion.

90. The femoral cut guide system of any one of claims 76-89, wherein the coupling member is positioned superior to the first insertion guide.

91. The femoral cut guide system of any one of claims 76-90, wherein the first insertion guide comprises: a through hole extending through the protrusion and the first portion; a plurality of channels extending through the protrusion from an exterior surface to the through hole and through the protrusion and the first portion from a first end to a second end.

92. The femoral cut guide system of any one of claims 76-91, wherein the plurality of channels is three channels spaced circumferentially around the through hole.

93. The femoral cut guide system of any one of claims 76-92, wherein the first portion further comprises: a groove inset into a second side of the first portion between the first end and a second end of the first portion.

94. The femoral cut guide system of any one of claims 76-93, wherein the second portion extends anteriorly out from a first end of the first portion and a second end of the third portion at an angle towards a superior end of the guide plate.

95. The femoral cut guide system of any one of claims 76-94, wherein the second portion comprises: a bottom member with a first end and a second end, wherein the second end of the bottom member is coupled to a first end of the first portion; a top member with a first end and a second end, wherein the second end of the top member is coupled to a second end of the third portion; and a side member coupled to and extending between the bottom member and the top member on a second side of the guide plate.

96. The femoral cut guide system of any one of claims 76-95, wherein the second portion further comprises: a slot extending between the top member and the bottom member from a first side of the guide plate to the side member.

97. The femoral cut guide system of any one of claims 76-96, wherein the second portion further comprises: a second insertion guide extending through the second portion.

98. The femoral cut guide system of any one of claims 76-97, wherein the second insertion guide extends through the second portion and at least a portion of the third portion.

99. The femoral cut guide system of any one of claims 76-98, wherein the second insertion guide comprises: a through hole extending through the top member and the bottom member of the second portion; and a plurality of channels extending through the top member and the bottom member of the second portion and into the through hole.

100. The femoral cut guide system of any one of claims 76-99, wherein the through hole further extends through the third portion from a first end to a second end.

101. The femoral cut guide system of any one of claims 76-100, wherein the plurality of channels further extends through the third portion from a first end to a second end.

102. The femoral cut guide system of any one of claims 76-101, wherein the plurality of channels is three channels spaced circumferentially around the through hole.

103. The femoral cut guide system of any one of claims 76-102, wherein the second portion further comprises: a first screw guide coupled to and extending from the second portion on a second side of the guide plate; and a first through hole extending through the first screw guide.

104. The femoral cut guide system of any one of claims 76-103, wherein the third portion comprises: at least one screw guide coupled to and extending from a first end of the third portion; and at least one through hole extending through the at least one screw guide and the third portion.

105. The femoral cut guide system of any one of claims 76-104, wherein the at least one screw guide is two screw guides positioned around an outer edge of the third portion.

106. The femoral cut guide system of any one of claims 76-105, wherein a first screw guide is positioned on a first side of the third portion, and wherein a second screw guide is positioned on a superior end of the third portion.

107. The femoral cut guide system of any one of claims 76-106, wherein the third portion further comprises: a cutout extending into the superior end of the third portion, wherein the cutout extends through the third portion from a first end toward a second end.

108. The femoral cut guide system of any one of claims 76-107, wherein the cutout is positioned between the first screw guide of the third portion and the second screw guide of the third portion.

109. The femoral cut guide system of any one of claims 76-108, wherein the third portion further comprises: a protrusion extending between a first end of the third portion and a top member of the second portion.

110. A spacer, comprising: a base; and an engagement portion extending from a first end of the base, wherein the engagement portion comprises: a tab extending away from a first end of the engagement portion; and a through hole extending through the engagement portion and on three sides of the tab.

111. The spacer of claim 110, wherein the base comprises: an alignment member extending away from a bottom surface of the base.

112. The spacer of any one of claims 110-111, wherein a top surface of the engagement portion is aligned with and extends from the top surface of the base.

113. The spacer of any one of claims 110-112, wherein a top surface of the base is angled from a second end to a first end of the base relative to a bottom surface.

114. The spacer of any one of claims 110-113, wherein the base has a wedge shape.

115. The spacer of any one of claims 110-114, wherein the alignment member is positioned on a second end of the base near a midpoint between a first side and a second side.

116. The spacer of any one of claims 110-115, wherein the alignment member has an oval shape.

117. A cut guide, comprising: a base plate extending from a first end to a second end; and a guide plate coupled to and extending from a superior surface of the base plate.

118. The cut guide of claim 117, wherein the base plate comprises: a first portion extending from the first end toward the second end; and a second portion extending from the second end toward the first end.

119. The cut guide of claim 118, wherein the first portion comprises: a top member extending from the first end of the base plate at an angle; a bottom member with a top surface extending from the first end of the base plate at an angle and a bottom surface extending from the first end of the base plate to the second end; a side member positioned on a second side of the base plate and extending between the top member and the bottom member; and a slot extending into a first side of the base plate between the top member and the bottom member.

120. The cut guide of any one of claims 117-119, wherein the second portion extends from the first portion to the second end of the base plate.

121. The cut guide of any one of claims 117-120, wherein the guide plate comprises: a first portion coupled to and extending from the base plate; a second portion coupled to and extending from a first end of the first portion; and a third portion coupled to and extending from a first end of the second portion.

122. The cut guide of any one of claims 117-121, wherein the first portion comprises: a protrusion extending from a first end of the first portion; a coupling member extending from the protrusion; and a first insertion guide extending through the protrusion and the first portion.

123. The cut guide of any one of claims 117-122, wherein the coupling member is positioned superior to the first insertion guide.

124. The cut guide of any one of claims 117-123, wherein the first insertion guide comprises: a through hole extending through the protrusion and the first portion; a plurality of channels extending through the protrusion from an exterior surface to the through hole and through the protrusion and the first portion from a first end to a second end.

125. The cut guide of any one of claims 117-124, wherein the plurality of channels is three channels spaced circumferentially around the through hole.

126. The cut guide of any one of claims 117-125, wherein the first portion further comprises: a groove inset into a second side of the first portion between the first end and a second end of the first portion.

127. The cut guide of any one of claims 117-126, wherein the second portion extends anteriorly out from a first end of the first portion and a second end of the third portion at an angle towards a superior end of the guide plate.

128. The cut guide of any one of claims 117-127, wherein the second portion comprises: a bottom member with a first end and a second end, wherein the second end of the bottom member is coupled to a first end of the first portion; a top member with a first end and a second end, wherein the second end of the top member is coupled to a second end of the third portion; and a side member coupled to and extending between the bottom member and the top member on a second side of the guide plate.

129. The cut guide of any one of claims 117-128, wherein the second portion further comprises: a slot extending between the top member and the bottom member from a first side of the guide plate to the side member.

130. The cut guide of any one of claims 117-129, wherein the second portion further comprises: a second insertion guide extending through the second portion.

131. The cut guide of any one of claims 117-130, wherein the second insertion guide extends through the second portion and at least a portion of the third portion.

132. The cut guide of any one of claims 117-131, wherein the second insertion guide comprises: a through hole extending through the top member and the bottom member of the second portion; and a plurality of channels extending through the top member and the bottom member of the second portion and into the through hole.

133. The cut guide of any one of claims 117-132, wherein the through hole further extends through the third portion from a first end to a second end.

134. The cut guide of any one of claims 117-133, wherein the plurality of channels further extends through the third portion from a first end to a second end.

135. The cut guide of any one of claims 117-134, wherein the plurality of channels is three channels spaced circumferentially around the through hole.

136. The cut guide of any one of claims 117-135, wherein the second portion further comprises: a first screw guide coupled to and extending from the second portion on a second side of the guide plate; and a first through hole extending through the first screw guide.

137. The cut guide of any one of claims 117-136, wherein the third portion comprises: at least one screw guide coupled to and extending from a first end of the third portion; and at least one through hole extending through the at least one screw guide and the third portion.

138. The cut guide of any one of claims 117-137, wherein the at least one screw guide is two screw guides positioned around an outer edge of the third portion.

139. The cut guide of any one of claims 117-138, wherein a first screw guide is positioned on a first side of the third portion, and wherein a second screw guide is positioned on a superior end of the third portion.

140. The cut guide of any one of claims 117-139, wherein the third portion further comprises: a cutout extending into the superior end of the third portion, wherein the cutout extends through the third portion from a first end toward a second end.

141. The cut guide of any one of claims 117-140, wherein the cutout is positioned between the first screw guide of the third portion and the second screw guide of the third portion.

142. The cut guide of any one of claims 117-141, wherein the third portion further comprises: a protrusion extending between a first end of the third portion and a top member of the second portion.

143. A tibial resection guide, comprising: a plate; and a pin guide coupled to and extending away from a corner of the plate.

144. The tibial resection guide of claim 143, wherein the resection guide comprises: a base; and an extension arm coupled to and extending from a first side of the base.

145. The tibial resection guide of any one of claims 143-144, further comprising: a slot extending into the base from a top surface toward a bottom surface.

146. The tibial resection guide of any one of claims 143-145, wherein the slot extends into the base adjacent to the extension arm.

147. The tibial resection guide of any one of claims 143-146, wherein the slot extends through the base from a first end to a second end.

148. The tibial resection guide of any one of claims 143-147, further comprising: a pin hole positioned at a distal most end of the slot and extending through the base from a first end to a second end.

149. The tibial resection guide of any one of claims 143-148, wherein a top surface of the extension arm extends beyond a top surface of the base in a superior direction of the resection guide.

150. The tibial resection guide of any one of claims 143-149, wherein the plate has a rectangular shape.