Appeal No. 2005-1675 Page 10
Application No. 09/523,503
surface 19 of the distal femur 13, and to make an anterior femoral cut or resection 21 to
remove a thickness or amount of bone from the anterior aspect or surface 23 of the
distal femur 13. The instrumentation 11 includes a resection guide 113 for guiding the
bone resection tool 15 to perform an anterior femoral resection 21 of the end of the
distal femur 13 and a distal femoral resection 19 of the end of the distal femur 13. The
instrumentation 11 further includes an anterior feeler gauge 91 for contacting a portion
of the anterior aspect 23 of the distal femur 13 to indicate the anterior-to-posterior size
of the distal femur.
White teaches (column 8, line 58, to column 10, line 27) the following method
The preferred method of sizing the end of a distal femur 13, of performing
an anterior femoral resection 21 of the distal femur 13, and of performing a distal
femoral resection 19 of the distal femur 13 starts with standard preoperative
planning to estimate the size of the prosthesis to be implanted by, for example,
comparing lateral radiographs of the distal femur 13 with implant templates, etc.
The template size that most closely matches the profile of the distal femur 13 on
the anterior and posterior aspect is normally chosen. In order to maintain proper
quadriceps tension in flexion and extension, the patellar flange should not be
radically shifted either anteriorly or posteriorly. The knee joint can then be
exposed using a long anterior skin incision and medical parapatellar incision or
the like. Any osteophytes should be removed from the intercondylar notch area of
the distal aspect 19 of the distal femur 13 with a rongeur or the like to provide a
clear view of the wails and roof of the intercondylar notch. An intramedullary
cavity 135 can then be prepared in the distal aspect 19 of the distal femur 13,
preferably with an entry point in the deepest point of the patellar groove just
anterior to the cortical roof of the intercondylar notch. The intramedullary cavity
135 can be started with a pilot point drill and then finished with an intramedullary
reamer or combination intramedullary reamer and intramedullary rod. In any
event, the intramedullary rod 37 is then implanted into the intramedullary cavity
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