fig1 - 4 and 7 show generally the preferred embodiment of the tibial trial prosthesis of the present invention designated by the numeral 10 in fig7 . trial tibial prosthesis 10 is comprised of tray 11 , stem or plug 12 , and plastic insert 13 . the entire trial prosthesis 10 can be rotated after assembly and surgical placement on the patient &# 39 ; s distal tibia 9 ( see arrow 15 in fig1 .) fig1 - 2 show trial tray or plate 11 . tray 11 includes an upper surface 16 and a lower surface 17 . a shoulder portion 19 extends partially about the periphery 18 at the posterior of tray 11 . a central v - shaped slot 20 is provided for allowing a fin punch 43 to be used to make surgical cuts in the proximal tibia corresponding to fins that are a permanent part of the final tibial prosthesis to be implanted . in fig1 , the surgeon uses mallet 44 to drive fin punch 43 . the fin punch 43 is used after the tibial trial prosthesis 10 has been finally correctly oriented using the method of the present invention . central opening 42 receives plug 12 . shoulders 37 , 39 extend beyond the periphery of opening 42 . plug 12 has proximal 36 and distal 35 ends . a plurality of openings 21 can be provided in tray 11 for drilling holes that will determine the position of bone screws that hold the final tibial prosthesis to proximal tibia 9 . a preferred embodiment of the fin punch will be described more full hereinafter . a pair of spaced apart appendages 22 , 23 extend away from the periphery 18 of tray 11 . the appendages 22 , 23 ( see fig1 - 2 ) have angled openings 24 , 25 for receiving bone spikes 26 ( see fig1 ). the openings 24 , 25 are circular in cross section to conform to the outer surface of bone spikes 26 . each opening 24 , 25 forms an acute angle with bottom surface 17 of tray 11 . this allows the surgeon to pin the trial prosthesis 10 to the patient &# 39 ; s proximal tibia 9 after rotation has been accomplished using the lever 14 to determine the best fit of tray 11 on proximal tibia 9 . bone spikes 26 placed through the angled openings 22 , 23 fix the position of the tray 11 with respect to the patient &# 39 ; s proximal tibia 9 during punching of the v - shaped opening in the patient &# 39 ; s proximal tibia using a fin punch 43 ( see fig1 ). in fig3 - 4 , plastic trial insert 13 is shown . the insert 13 has a pair of concavities 28 , 29 that define articulating surfaces that fit and articulate with condylar portions of a femoral trial prosthesis 45 mounted on the distal end 7 of the patient &# 39 ; s femur 6 as shown in fig9 . a horizontal slot 30 extends from the periphery 18 of insert 13 toward the center thereof . slot 30 is generally parallel to the generally flat underside 13a of insert 13 , generally parallel thereto slot 13 is positioned in between underside 13 and articulating surfaces 28 , 29 as shown . as shown in fig4 the slot 30 terminates before reaching the anterior side 31 of insert 13 . a pair of annular shoulders 32 , 33 retain the lever tab 34 at one end of line 14 , and more particularly the tab end 34 thereof so that rotation of the lever 14 also rotates the insert 13 , the tray 11 , and the plug or stem 12 to which tray 11 is affixed . in fig1 , the entire assembly of tray 11 , insert 13 , and stem 12 are seen being rotated as illustrated by the curved arrow 15 . tab 34 can be used to engage and manipulate insert 13 . thus , lever 14 and its tab 34 can be used to aid in removal of insert 13 from tray 11 , or in attaching insert 13 to tray 11 . in fig6 a and 6b , the trial stem 12 provides a distal end 35 that is shaped to conform to the transverse cross section of opening 42 ( see fig6 a ) and proximal end 36 . the proximal end 36 has a pair of spaced apart shoulders 37 , 39 that extend away from the central longitudinal axis of the stem . shoulders 37 , 39 define a means of engaging the stem 12 at top surface of the tray 11 upon assembly when the surgeon is building a trial prosthesis . the shoulders 37 , 39 extend beyond the outer surface 41 of stem 12 and thus beyond the central opening 42 in tray 11 . the slot 38 between shoulders 37 , 39 allows the fin punch to fit between the shoulder 37 , 38 . slot 38 is positioned between the laterally extending shoulders 37 , 39 . the slot 38 extends only about halfway along the length of the trial stem , terminating at surface 40 . in fig8 the trial femoral prosthesis 45 is shown affixed to the patient &# 39 ; s distal femur 7 . the distal femur is surgically prepared with anterior and posterior flat cuts that are parallel , a distal cut that is perpendicular to the anterior and posterior cuts , and chamfer cuts ( anterior and posterior ) that extend diagonally respectively between the distal cut and the anterior and posterior cuts . such a surgical preparation of the distal femur 7 to receive a femoral prosthesis , or trial femoral prosthesis is known in the art . the trial femoral prosthesis 45 of the present invention has a pair of curved articulating condylar surfaces 46 , 47 . the rear surface 48 of trial femoral prosthesis 45 is sized and shaped to fit the surgically prepared distal femur 7 . trial femoral prosthesis 45 has a pair of flat cutting guide surfaces 49 , 50 that allow the surgeon to form surgical cuts 52 , 53 forming a v - shaped recess in the patient &# 39 ; s distal femur 7 . blade 54 in fig8 is seen resecting the distal femur 7 with cuts 52 , 53 to form recess 51 . the formed recess 51 allows placement of a final femoral prosthesis . in fig9 - 10 , trial tibial prosthesis 10 has been installed by the surgeon on the patient &# 39 ; s proximal tibial 9 . the surgeon has also installed a trial femoral prosthesis 45 on the distal femur 7 . using the method and apparatus of the present invention , the surgeon can determine the best fit for the tibial trial prosthesis 10 in relation to the trial femoral prosthesis 45 . trial femoral prosthesis 45 ( fig8 ) can be drilled at openings 55 , 56 and affixed to the distal femur 7 using bone screws or pegs . these openings 55 , 56 can also define the position of pegs that attach the final femoral prosthesis to the distal femur 6 . in fig1 , the trial prosthesis 10 is shown mounted on the patient &# 39 ; s proximal tibia 9 . lever 14 fits slot 30 of the trial prosthesis insert 13 . using the lever 14 , the surgeon can now rotate the trial prosthesis 10 about its stem portion 12 , as shown by the curved arrows 15 in fig1 . this can be done as the surgeon rotates the knee through its full range of motion to obtain the best fit . the surgeon rotates the lever 14 to place the trial prosthesis 10 in a desired position ( see fig1 ). the surgeon can also rotate the tibia relative to the femur ( see arrow 27 in fig9 ) through a full range of motion . if the surgeon is not satisfied with the fit , the lever 14 can be used to reposition the trial prosthesis 10 , and rotate the knee again through a full range of motion . the lever 14 and its tab 34 can also be used to change inserts 11 , such as a different size or different thickness insert 11 . the procedure can be repeated until the surgeon is completely satisfied with the orientation of trial prosthesis 10 in relation to trial femoral prosthesis 45 . in fig1 and 14 - 17 , there can be seen screw drill guide 57 . the drill guide 57 can be used to install a final tibial prosthesis 64 on the patient &# 39 ; s proximal tibia 9 once the surgeon has decided upon a particular size and shape of tibial implant 64 based upon the use as aforedescribed of the tibial trial prosthesis 10 . drill guide 57 includes a handle 58 for holding and manipulating the drill guide 57 . a guide sleeve 59 is generally cylindrically shaped , and provides a plurality of bores through bone screws can be placed for attaching the final tibial prosthesis 64 to the patient &# 39 ; s proximal tibia 9 . guide sleeve 59 preferably includes four ( 4 ) screw guide bores . a straight bore 60 tracks the central longitudinal axis of guide sleeve 59 . a plurality of angles bores 61 - 63 extend from the upper surface to the lower surface of the guide sleeve 59 , all of the bores 61 - 63 exiting at common opening 65 . in fig1 , there can be seen a drill 66 being guided by the surgeon through one of the bores 60 - 63 of the guide sleeve 59 . the drill 66 is simply placed in the desired bore 60 - 63 and driven into one of the openings 68 of the tibial prosthesis 64 using drill driver 67 . the surgeon inserts a bone screw through the prepared hole then places the final plastic insert 69 on the prosthesis 64 and hammers it into place using mallet 44 , hammering in the direction of arrow 70 . fig1 - 21 illustrate the all poly plastic fin punch of the present invention designated generally by the numeral 71 . in fig1 - 2 , fin punch 71 has a cylindrical section 72 with a pair of blades 73 , 74 joined at vertical plate 93 and extending downwardly with respect to the central axis of the cylindrical section 72 . a horizonal frame section 76 forms a connection between the cylindrical sections 72 and the pair of blades 73 , 74 . a generally u - shaped slot 75 is positioned between the blade member 73 , 74 . the horizontal section 76 has a generally flat upper surface 77 . each of the blades 73 , 74 provides a respective inclined cutting edge 78 , 79 . the cutting edge 78 begins at pointed distal end 80 and extends to horizontal surface 84 of section 76 . the inclined cutting edge 79 begins at pointed distal end 81 of blade 74 and extend to horizontal surface 84 of section 76 . a plurality of notches or stepped portions 85 - 90 can be seen along each of the inclined cutting surfaces 78 , 79 of the blades 73 , 74 . each of the stepped portions 85 , 90 includes a vertical surface 91 and a horizonal surface 92 . the step portions combined with the size of slot 20 of trial tray 11 to limit the depth of cut that is made by the fin punch 71 . the punch 71 only goes down to that particular stepped portion or notch 85 - 90 that can be fitted through the slot 20 depending upon the width of the slot 20 . for example , the punch 71 only goes down to the fourth notch for a size &# 34 ; 4 &# 34 ; tibial prep - plate 11 because the slots 20 in the trial plate 11 for a size &# 34 ; 4 &# 34 ; or a given distance wide . they would be provided as wider slots 20 for example on sizes &# 34 ; 5 &# 34 ; and &# 34 ; 6 &# 34 ;. the slot 20 would be smaller for an over all width for a size &# 34 ; 3 &# 34 ; or smaller . this sizing concept also corresponds to the implant design since the fins or blades 73 , 74 get larger in width the larger the size . fig2 - 32 illustrate tibial trial prosthesis 94 that can be used with a tibial prep plate tray 95 . for purposes of the embodiment of fig2 - 32 , prep plate tray 95 can be assumed to have the same configuration and structure as tray 11 described in fig1 and 2 . fig2 - 23 show generally the second embodiment of the tibial trial prosthesis designated generally by the numeral 94 . tibial trial prosthesis 94 includes a prep plate or tray 95 that is attached to trial taper 96 , trial stem coupler 97 or 97a , and trial stem 98 . the trial taper 96 is shown generally in fig2 . trial taper 96 includes a generally cylindrical bushing 99 having an enlarged integral head portion 100 . an assembly bolt 101 can be placed through counterbore 104 of bushing 99 . the counterbore 104 is shaped to retain the head 103 of bolt 101 , allowing only the threaded section 102 to pass therethrough as shown in fig2 . bushing 99 and its enlarged head 100 are coupled to stem 113 that has a frustroconical surface 113a thereon at the lower distal 105 end portion . the proximal 106 end of stem 113 provides a counterbore 107 that is sized and shaped to receive bushing 99 and the threaded portion 102 of bolt 101 . further , the counterbore 107 includes an internally threaded section for engaging the threads 102 of bolt 101 upon assembly . the bolt head 103 can have a hexagonal recess , for example , for accepting an allen wrench that impart torque to the bolt 101 during assembly to stem 113 . as with the trial tray 11 of fig1 - 2 , a central opening 42 can be provided into plate 95 . the opening 92 is sized and shaped to receive a reduced section 110 of stem 113 at proximal end 106 thereof . a thickened 108 section of stem 113 extends between annular shoulder 109 and frustroconical surface 113a . the thickened section 108 can carry a pair of longitudinally extending slots 111 , 112 that receive the blades of fin punch 71 . thus , the trial plate can have a v - shaped slot as with the slot 20 on plate 11 of fig1 - 2 . after the bushing 99 , bolt 101 and stem 113 have been assembled , the slot 20 extends away from stem 113 and the blades of fin punch 71 can pass on opposites sides of the trial taper 96 . a flat surface 114 on stem 113 cooperates with a similar flat surface of trial stem coupler 97 , 98 . in fig2 , 28 , a first trial stem coupler 97 is shown . in fig2 - 32 , a second trial stem coupler 97a is shown that includes an angled bore . in fig2 - 28 , trial stem coupler 99 includes an externally threaded smaller diameter section 115 and a larger diameter cylindrical section 116 that is unthreaded . the section 116 provides a frustroconical bore 118 surrounded by a thick annular side wall 117 and a thin annular side wall 122 . an annular shoulder 120 extends between the thick annular side wall 117 and the thin annular side wall 122 . a transverse bore 119 extends at generally right angles to the frustroconical bore 118 as shown in fig2 . flat surface 121 is positioned at thin annular side wall 122 . the flat surface 121 mates with the flat surface 114 on stem 113 upon assembly of trial taper 96 and coupler 97 . in fig2 - 32 , coupler 97a is shown having an internal inclined frustroconical bore 126 . the coupler 97a includes an externally threaded smaller diameter section 123 , a larger diameter unthreaded cylindrical section 124 surrounded by a thick annular wall 125 and a thin annular wall 130 . as with the coupler 97 , the coupler 97a includes a transverse bore 127 . an annular shoulder 128 extends between the thick annular wall 125 and the thin annular wall 130 . a flat surface 129 at thin annular surface 130 cooperates with a corresponding flat surface 114 on stem 113 upon assembly of trial taper 96 and the trial stem coupler 97a . in fig2 , axis 131 represents a normal axis that is the central longitudinal axis of threaded cylindrical section 123 . the axis 132 is an offset axis that is the central longitudinal axis of inclined frustroconical bore 126 . the angle between the normal axis 131 and the inclined axis 132 can be , for example , between about 3 and 8 degrees . in fig3 - 32 , the trial stem 98 . trial stem 98 includes a lower frustroconically - shaped distal end 133 , a generally cylindrically - shaped elongated section 134 , and a thickened proximal end portion 135 . the proximal end portion provides an internally threaded bore 136 that can form a connection with either the externally threaded section 115 of trial stem coupler 97 or the externally threaded section 123 of trial coupler 97a . upon assembly , the flat annular surface 137 of proximal end portion 135 mates with the flat annular surface 138 of trial coupler 97 or the flat annular surface 139 of trial coupler 97a . the following table lists the parts numbers and parts descriptions as used herein and in the drawings attached hereto . ______________________________________parts listpart number description______________________________________ 6 femur 7 distal femur 8 tibia 9 distal tibia 10 trial prosthesis 11 tray 12 stem 13 insert . sup . 13a underside 14 handle 15 arrow 16 upper surface 17 lower surface 18 periphery 19 raised shoulder portion 20 v - shaped slot 21 opening 22 appendage 23 appendage 24 angled opening 25 angled opening 26 bone spike 27 arrow 28 concavity 29 concavity 30 slot 31 anterior side 32 shoulder 33 shoulder 34 tab 35 distal end 36 proximal end 37 shoulder 38 slot 39 shoulder 40 surface 41 surface 42 opening 43 fin punch 44 mallet 45 trial femoral prosthesis 46 condylar articulating surface 47 condylar articulating surface 48 rear surface 49 cutting guide surface 50 cutting guide surface 51 v - shaped recess 52 surgical cut 53 surgical cut 54 blade 55 opening 56 opening 57 screw drill guide 58 handle 59 guide sleeve 60 straight bore 61 angled bore 62 angled bore 63 angled bore 64 tibial prosthesis 65 common opening 66 drill 67 driver 68 opening 69 plastic insert 70 arrow 71 fin punch 72 cylindrical section 73 blade 74 blade 75 slot 76 horizontal section 77 flat surface 78 inclined cutting edge 79 inclined cutting edge 80 pointed distal end 81 pointed distal end 82 proximal end 83 internally threaded bore 84 horizontal surface 85 stepped portions 86 stepped portions 87 stepped portions 88 stepped portions 89 stepped portions 90 stepped portions 91 vertical surface 92 horizontal surface 93 vertical plate 94 tibial trial prosthesis 95 prep plate tray 96 trial taper 97 trial stem coupler . sup . 97a trial stem coupler 98 trial stem 99 bushing100 head101 bolt102 threads103 head104 counterbore105 distal end106 proximal end107 counterbore108 thickened section109 annular section110 reduced section111 longitudinal slot112 longitudinal slot113 stem . sup . 113a frustroconical surface114 flat surface115 externally threaded section116 cylindrical section117 thick annular side wall118 frustroconical bore119 transverse bore120 annular shoulder121 flat surface122 thin annular side wall123 externally threaded section124 cylindrical section125 thick annular wall126 inclined frustroconical bore127 transverse bore128 annular shoulder129 flat surface130 thin annular wall131 normal axis132 inclined axis133 distal end134 cylindrically - shaped section135 proximal end136 internally threaded bore137 flat annular surface138 flat annular surface139 flat annular surface______________________________________ because many varying and different embodiments may be made within the scope of the inventive concept herein taught , and because many modifications may be made in the embodiments herein detailed in accordance with the descriptive requirement of the law , it is to be understood that the details herein are to be interpreted as illustrative and not in a limiting sense .
the method of implanting a femoral and a tibial knee prosthesis and instruments for surgically implanting the femoral and tibial prosthesis component as disclosed . the method includes the formation of a plurality of surgical cuts on the patient &# 39 ; s distal femur . a trial tibial prosthesis is then fitted to the surgically prepared distal femur . the trial prosthesis has a femoral articulating surface and a non - articulating surface that fits the patient &# 39 ; s distal femur at the surgical cuts . a surgeon then forms a transverse cut on the patient &# 39 ; s proximal tibia . the surgeon places a tibial trial prosthesis on the patient &# 39 ; s proximal tibia , the trial prosthesis including a tibial trial stem that fits the patient &# 39 ; s intramedullary canal , a tibial trial metallic tray or plate , and a plastic trial insert that fits the tibial tray or plate . the plastic insert includes a tibial articulating surface that can articulate with the femoral articulating surface . the respective articulating surfaces are placed in contact and the surgeon then moves the patient &# 39 ; s knee through a full range of motion . during this movement of patient &# 39 ; s knee through a full range of motion , the surgeon uses a lever that is attached to the trial tibial prosthesis to rotate the trial tibial prosthesis about its stem . the surgeon can try different rotational positions of the tibial trial prosthesis each time moving the knee through a full range of motion to ensure proper orientation and an accurate fit .