U.S. patent application number 10/166209 was filed with the patent office on 2003-12-11 for apparatus for and method of providing a hip replacement.
Invention is credited to Penenberg, Brad L..
Application Number | 20030229352 10/166209 |
Document ID | / |
Family ID | 29710615 |
Filed Date | 2003-12-11 |
United States Patent
Application |
20030229352 |
Kind Code |
A1 |
Penenberg, Brad L. |
December 11, 2003 |
Apparatus for and method of providing a hip replacement
Abstract
A short main incision and portal incisions at portal positions
strategically displaced from the main incision are provided in a
patient's hip. One portal incision (acetabular portal) provides for
a disposition of reamers in the patient's acetabulum to shape the
acetabulum. A cannula is inserted through the portal incision to
the acetabulum and the successive reamers of progressive size are
inserted into the acetabulum through the main incision to
progressively size and shape the acetabulum. An approximately
hemispherical acetabular component is then disposed in the prepared
acetabulum to provide for hip rotation relative to the femoral
component. The other portal incision (femoral portal) provides for
insertion into the patient's hip of a member for driving the
femoral stem into a cavity in the patient's femur. The provision of
the short main incision and the portal incision minimizes the
patient's loss of blood, tissue trauma, length of operating time
and patient recovery time.
Inventors: |
Penenberg, Brad L.; (Los
Angeles, CA) |
Correspondence
Address: |
ELLSWORTH R. ROSTON
FULWIDER PATTON LEE & UTECHT, LLP
HOWARD HUGHES CENTER
6060 Center Drive, Tenth Floor
Los Angeles
CA
90045
US
|
Family ID: |
29710615 |
Appl. No.: |
10/166209 |
Filed: |
June 10, 2002 |
Current U.S.
Class: |
606/81 |
Current CPC
Class: |
A61F 2/4607 20130101;
A61F 2/34 20130101; A61F 2/4609 20130101; A61B 17/175 20130101;
A61B 2090/3908 20160201; A61B 2017/0046 20130101; A61F 2002/4635
20130101; A61F 2002/4681 20130101; A61F 2/3662 20130101; A61F
2/4684 20130101; A61B 17/1668 20130101; A61B 17/1746 20130101; A61B
2017/3405 20130101; A61F 2/36 20130101; A61B 17/00234 20130101;
A61B 2090/395 20160201; A61F 2/4657 20130101; A61B 17/92 20130101;
A61B 17/1666 20130101 |
Class at
Publication: |
606/81 |
International
Class: |
A61B 017/00 |
Claims
What is claimed is:
1. In a method of providing a hip replacement in a patient, the
steps of providing a first incision of a limited length,
determining the position of an incision selected from the group
consisting of an acetabulum portal and a femoral portal, making the
portal incision at the determined position, and providing a
positioning of an instrument in the hip through the portal incision
to facilitate the hip replacement.
2. In a method as set forth in claim 1 wherein the selected portal
is the femoral portal and wherein the incision is provided through
the femoral portal position to provide for the insertion of the
instrument into the hip for positioning the femur in a femur
cavity.
3. In a method as set forth in claim 2 wherein a cannula is
disposed in the hip through the femoral portal incision to provide
for a positioning of a femoral stem in a cavity in the femur.
4. In a method as set forth in claim 3 wherein a driver is disposed
through the cannula to provide for the positioning and final
seating of the femoral stem in the cavity in the femur.
5. In a method as set forth in claim 1 wherein the selected portal
is the acetabular portal and wherein the incision is provided
through the acetabular portal position to provide for the
preparation of the acetabulum.
6. In a method as set forth in claim 5 wherein a cannula is
disposed through the acetabular portal incision to provide for the
formation of the acetabulum.
7. In a method as set forth in claim 6 wherein a shaft is disposed
in the cannula and wherein a reamer is disposed in the acetabulum
and the shaft is coupled to the reamer to provide for an operation
of the reamer in shaping the acetabulum.
8. In a method as set forth in claim 7 wherein reamers of
progressive size are disposed in the acetabulum and the shaft is
coupled to the reamer in the acetabulum and the reamer is rotated
to shape and size the acetabulum.
9. In a method as set forth in claim 4 wherein a rasp is disposed
in the cannula to smooth the walls of the femur cavity before the
femoral stem is driven into the femoral cavity.
10. In a method as set forth in claim 8 wherein the selected portal
is the femoral portal and wherein the incision is provided through
the femoral portal position to provide for the insertion of the
instrument into the hip for positioning the femur in a femur cavity
and wherein a cannula is disposed in the hip through the femoral
portal incision to provide for a positioning of a femoral stem in a
cavity in the femur and wherein a driver is disposed through the
cannula to provide for the positioning of the femoral stem in the
cavity in the femur.
11. In a method as set forth in claim 10 wherein a rasp is disposed
in the cannula to smooth the walls of the femur cavity before the
femoral stem is driven into the femoral cavity.
12. In a method as set forth in claim 10 wherein the first incision
is a main incision and wherein the femoral portal incision is
disposed on one side of the main incision and wherein the
acetabular portal incision is disposed on the other side of the
main incision.
13. In a method of providing a hip replacement in a patient, the
steps of providing a first incision of a limited length in the
patient's hip, providing a portal incision in the patient's hip at
a particular disposition displaced from the main incision,
inserting a cannula into the patient's hip through the portal
incision to a position providing for an act by a surgeon to
facilitate the hip replacement in the patient, and disposing a tool
through the cannula to the position providing for the act by the
surgeon to facilitate the hip replacement in the patient.
14. In a method as set forth in claim 13 wherein a member is
disposed in abutting relationship with a femoral stem to provide a
locus for determining the positioning of the portal incision when
the portal incision is a femoral portal incision and wherein the
femoral portal incision is made at the position determined for the
femoral portal incision.
15. In a method as set forth in claim 13 wherein a member is
disposed in the acetabulum to provide a locus for determining the
positioning of the portal incision when the portal incision is an
acetabular portal incision.
16. In a method as set forth in claim 15 wherein a cannula is
disposed to extend from the acetabular portal incision into the hip
to the position of the acetabulum in the hip bone.
17. In a method as set forth in claim 16 wherein a reamer is
disposed at the position of the acetabulum in the hip bone and
wherein a rotary drive member is disposed in the cannula and is
coupled to the reamer to obtain, when operated, a shaping of the
acetabulum.
18. In a method as set forth in claim 17, the step of sequentially
reaming the acetabulum with reamers of progressive size by coupling
the rotary drive member to the reamers of the progressive-size and
rotating the shaft to rotate the reamers.
19. In a method as set forth in claim 13 wherein the locus for the
portal incision is determined to provide for the positioning of the
femoral stem in the femur cavity.
20. In a method as set forth in claim 13 wherein the locus for the
portal incision is determined to provide for the shaping and sizing
of the acetabulum in the hip bone.
21. In a method as set forth in claim 19 wherein the cannula is
extended from the femoral portal incision through the hip to the
femoral stem which is positioned relative to the femur cavity to be
driven into the femur cavity.
22. In a method as set forth in claim 21 wherein a drive member is
extended through the cannula to the femoral stem and wherein forces
are imposed against the drive member to drive the femoral stem into
the femur cavity.
23. In a method as set forth in claim 20 the cannula is extended
from the acetabular portal incision through the hip to the
acetabulum to provide for the shaping and sizing of the
acetabulum.
24. In a method as set forth in claim 23 wherein a rotatable drive
member is extended through the cannula and wherein a reamer is
disposed in the acetabulum and wherein the drive member is coupled
to the reamer and is rotated to provide for a reaming of the
acetabulum by the reamer.
25. In a method as set forth in claim 24 wherein progressively
sized reamers are disposed in the acetabulum and are coupled to the
drive member and are rotated by the drive member to shape and size
the acetabulum.
26. In a method as set forth in claim 26 wherein a hemispherical
member is disposed in the acetabulum after the shaping and sizing
of the acetabulum to provide for a pivotal relationship between the
hemispherical member and the acetabulum.
27. In a method of providing a hip replacement in a patient, the
steps of providing a main incision in a patient, providing an
instrument which includes a positioning member at one end and a
looped portion extending from the positioning member to a marker
member at the other end, disposing the positioning member in the
patient with the looped portion extending from the hip through the
main incision to a position outside of the hip and with the marker
member pointing toward the patient's skin at the patient's hip from
the position outside of the hip; and marking with the marker member
the position on the patient's skin at which the marker member
contacts the patient's skin.
28. In a method as set forth in claim 27, the step of making a
portal incision at the marked position at which the marker member
contacts the patient's skin.
29. In a method as set forth in claim 27 wherein the marked
position indicates a portal position at which an acetabular
incision is to be made through which a driver for a reamer is to be
inserted to form the acetabulum in the patient's hip bone.
30. In a method as set forth in claim 29 wherein a reamer is
inserted into the patient's hip through the main incision and is
coupled to the driver to provide a reaming action on the acetabulum
in accordance with the rotation of the driver.
31. In a method as set forth in claim 27 wherein the marked
position indicates a portal position at which a femoral incision is
to be made through which a member is to be inserted to drive a
femoral stem into a cavity in the patient's femur.
32. In a method as set forth in claim 27 wherein the positioning
member has a substantially hemispherical shape and wherein the
hemispherical member is disposed in the patient's acetabulum when
the instrument is used to mark the portal position.
33. In a method as set forth in claim 27 wherein the positioning
member constitute a finger and wherein the finger is disposed in
abutting relationship to the femoral stem when the instrument is
used to mark the portal position.
34. In a method as set forth in claim 27, the step of using the
main incision and the portal incision to provide for the
positioning of a member for facilitating the hip replacement.
35. A method as set forth in claim 33 wherein the portal incision
is an acetabular portal incision and wherein the main incision and
the acetabular portal position are used to provide for the
disposition of a reamer in the acetabulum for facilitating the hip
replacement.
36. In a method as set forth in claim 34 wherein the portal
incision is a femoral incision and wherein the main incision and
the femoral portal incision are used to provide for the positioning
of a drive member to drive the femoral stem into a cavity in the
femur for facilitating the hip replacement.
37. In combination for use in providing for a hip replacement in a
patient a first member positionable in the hip of the patient, a
positioning member extending at one end from the positioning member
to a position outside of the patient's hip at a second end, and a
marker member at the opposite end of the looped portion and
disposed to mark a portal position on the patient's hip.
38. In a combination as set forth in claim 37 wherein the first
member has a hemispherical shape to fit in the acetabulum of the
patient.
39. In a combination as set forth in claim 37 wherein the marker
member is disposed on the positioning portion at an acute angle
relative to the skin of the patient to mark the skin at the
position of the contact of the marker member with the skin and
wherein the positioning member has a boxed configuration and
wherein the marker member is attached to the looped portion at the
second end of the looped portion.
40. In a combination as set forth in claim 37 wherein the first
member has a shape to abut the femoral stem of the patient.
41. In a combination as set forth in claim 38 wherein the marker
member is disposed on the positioning member at an acute angle
relative to the skin of the patient to mark the skin at the
position of the contact of the marker member with the skin and
wherein the marker member is attached to the looped portion at the
second end of the looped portion.
42. In a combination as set forth in claim 40, the marker member is
disposed on the positioning portion at an acute angle relative to
the skin of the patient to mark the skin at the position of the
contact of the marker member with the skin and wherein the marker
member is attached to the looped portion at the second end of the
looped portion.
43. In a combination as set forth in claim 39 wherein the marker
member includes a stylus and wherein the positioning member has a
looped configuration.
44. In a combination as set forth in claim 39 wherein the
positioning member has a looped configuration and wherein the
marker member is disposed on the positioning member at an acute
angle relative to the skin of the patient to mark the skin of the
patient and wherein the marker member is attached to the looped
portion at the second end of the looped portion and wherein the
marker member is a stylus.
Description
[0001] This invention relates to a method of providing a
replacement for a patient's hip with a minimal loss of blood,
minimal tissue trauma and a minimal length of operating time and
patient recovery time. The invention also relates to a tool which
is need in the method constituting this invention.
BACKGROUND OF A PREFERRED EMBODIMENT OF THE INVENTION
[0002] Great progress has been made in the field of hip
replacements. Considering that hip replacements may not even have
existed a generation ago, hip replacements, particularly among the
elderly, are now relatively common. In spite of the considerable
progress which has been made, hip replacement operations are still
relatively crude. For example, an incision of a relatively great
length still has to be made in a patient's hip as one of the first
steps in a hip replacement operation. The incision may be as long
as approximately eight inches (8") to approximately twelve inches
(12"). Such a large incision has caused patients to lose large
amounts of blood and to suffer significant trauma. It has caused
the length of the operation and the patient recovery time to be
relatively long.
BRIEF DESCRIPTION OF A PREFERRED EMBODIMENT OF THE INVENTION
[0003] A minimal length main incision (e.g., approximately
1{fraction (1/2)}"-3" long) and two portal incisions (each
significantly less than 1" long) strategically displaced from the
main incisions are provided in a patient's hip. A cannula is
inserted through the portal incision to the acetabulum and a shaft
is inserted through the cannula. A reamer is disposed through the
main incision in the acetabulum and coupled to the shaft to ream
the acetabulum when the shaft is rotated. Reamers of progressive
size are then coupled to the shaft to progressively shape and size
a socket in the acetabulum. An approximately hemispherical
acetabular component is then disposed in the acetabulum to provide
for hip rotation relative to the femur. The other portal (femoral
portal) incision provides for a preparation of an insertion of a
member into the patient's hip for preparing a femoral canal and
then driving the femoral stem into a cavity in the patient's
femur.
[0004] The provision of the main incision and the portal incisions
minimizes the patient's loss of blood, tissue trauma, length of
operating time and patient recovery time.
BRIEF DESCRIPTION OF THE DRAWINGS
[0005] In the drawings:
[0006] FIG. 1 is a fragmentary schematic side elevational view of a
patient's hip and shows a main incision and portal incisions made
in the patient's hip as an initial step in providing for a
replacement of the patient's hip;
[0007] FIG. 2 is a side elevational view of a tool used by a
surgeon to determine the positioning of the portal incisions in the
patient's hip after the formation of the main incision in the
patient's hip;
[0008] FIG. 3 is an enlarged fragmentary sectional view of a
patient's hip and shows the formation of the main incision in the
patient's hip;
[0009] FIG. 4 is an enlarged fragmentary sectional view similar to
that shown in FIG. 3 and shows the approximate positioning of the
main incision in relation to a hip bone and a femur in the
patient;
[0010] FIG. 5 is an enlarged fragmentary sectional view similar to
that shown in FIG. 4 and shows the positioning of the tool of FIG.
2 in the patient's hip to determine the position of the portal
incision for providing an acetabular shaping of the hip bone;
[0011] FIG. 6 is an enlarged fragmentary sectional view similar to
that shown in FIG. 5 and shows partial insertion of a cannula into
the patient's hip through the portal incision to provide for an
acetabular shaping in the patient's hip;
[0012] FIG. 7 is a fragmentary sectional view similar to that shown
in FIGS. 5 and 6 and shows the positioning of a reamer through the
cannula and the operation of the reamer to form the acetabulum in
the patient's hip bone;
[0013] FIG. 8 is an enlarged fragmentary sectional view similar to
that shown in FIGS. 5-8 and schematically shows the use of reamers
of progressively increased size to shape the acetabulum in the
patient's hip;
[0014] FIG. 9 is an enlarged fragmentary sectional view of one of
the reamers shown in FIGS. 5-8;
[0015] FIG. 10 is an enlarged fragmentary sectional view similar to
that shown in FIG. 7 and shows a reamer which is large in
comparison to the reamer shown in FIG. 7;
[0016] FIG. 11 is a fragmentary sectional view similar to that
shown in FIGS. 5 and 6 and shows the insertion of an approximately
hemispherical acetabular component into the acetabulum of the
patient's hip to provide the pivotable relationship between the
femoral ball and the acetabulum in the patient's hip bone;
[0017] FIG. 12 is an enlarged fragmentary sectional view similar to
that shown in FIG. 4 and shows the positioning relative to a
femoral stem of a tool similar to that shown in FIG. 2 to determine
the positioning of the portal for the femoral incision for
obtaining the disposition of a femoral stem in a cavity in the
patient's femur;
[0018] FIG. 13 is an enlarged fragmentary sectional view similar to
that shown in FIG. 12 and shows the positioning of a cannula
through the portal incision and the positioning of a rasp through
the cannula to provide for the smoothing of the walls of the femur
cavity;
[0019] FIG. 14 is an enlarged fragmentary sectional view similar to
that shown in FIG. 13 and shows how the femoral stem becomes
disposed in the femur cavity; and
[0020] FIG. 15 is an enlarged fragmentary sectional view similar to
that shown in FIGS. 13 and 14 and shows the proper disposition of
the femoral stem in the femur cavity.
DETAILED DESCRIPTION OF A PREFERRED EMBODIMENT OF THE INVENTION
[0021] FIGS. 1-15 show progressive steps in performing a method
constituting a preferred embodiment of the invention and also show
apparatus included in the patentable features of the preferred
embodiment of this invention. FIG. 1 schematically shows a
patient's hip 10 and also shows a main incision 12 and a pair of
portal incisions 14 and 16. The main incision 12 may be as short as
approximately one inch (1") long. The incision 14 may be an
acetabular portal incision, may be on one side of the main incision
and may be significantly less than one half inch ({fraction
(1/2)}") in length. The incision 16 may be a femoral incision, may
be on the other side of the main incision 12 from the acetabular
incision 14 and may also be significantly less than one half inch
({fraction (1/2)}") in length. The portal incisions 14 and 16 may
be of the same approximate length.
[0022] A tool generally indicated at 18 is shown in FIG. 2. The
tool 18 may illustratively be used to locate the position of the
portal incision 14. The tool 18 includes a positioning member 20
which may preferably have a hemispherical configuration to fit in
an acetabulum 22 (FIG. 4) when the position of the acetabular
portal incision 14 is being determined. A looped extension portion
24 extends from the positioning member 20. The portion 24 is
preferably looped to extend through the main incision 12 to a
position external to the patient's hip 10 and then to extend to a
position approximating the position of the acetabular portal
incision 14. It will be appreciated that the looped portion 24 may
have a different configuration than that shown in FIG. 2 provided
that the right end in FIG. 2 has a position corresponding
substantially to that shown in FIG. 2. A marker member 26 such as a
stylus attached to the looped portion at the right end of the
looped portion 24 in FIG. 2. The marker member 26 is retained by a
holder 28. As will be seen, the holder 28 and the marker member 26
have a substantially identical axial relationship with the
positioning member 20.
[0023] A first step in the performance of applicant's method is
shown in FIG. 3. In this step, a cutter 30 is used to provide the
main incision 12. This incision is preferably made anterior to,
directly over or posterior to the greater trochanter. It will
accordingly be appreciated that the positioning of the main
incision 12 is somewhat discretionary. FIG. 4 is a somewhat
schematic view showing the approximate positioning of the main
incision 12 relative to the positioning of the patient's hip bone
32 and femur 34.
[0024] FIG. 5 shows the hip bone 32 and the acetabulum 22 in the
hip bone. FIG. 5 also shows the disposition of the tool 18 with the
positioning member 20 in the acetabulum 22. In this disposition,
the marker member 26 abuts the patient's skin 36 in the region of
the patient's hip and causes a mark 38 to be produced on the
patient's skin. This mark indicates the position to be provided for
the acetabular portal incision 12. FIG. 6 illustrates the
positioning of a cannula 40 so that it extends through the
acetabular incision 12 at the mark 38 in the direction toward the
axis of the positioning member 20.
[0025] FIG. 7 shows a shaft 42 extending through the cannula 40 and
coupled to a reamer 44 which is disposed in the acetabulum 22. A
motor 46 drives the shaft in one rotary direction to operate the
reamer 44. The rotary movement of the shaft 42 is indicated at 48.
As will be appreciated, the acetabulum 22 is sequentially reamed by
reamers 44 of progressively increasing size. This is illustrated at
44a in FIG. 7 and at 44a and 44b in FIG. 8. It may also be seen by
comparing the size of the reamers 44a and 44b respectively in FIGS.
7 and 10 and also in FIG. 8. When the acetabulum 22 has the desired
shape, size and smoothness, a hemispherical shell (acetabular
component or a trial component) 45 (FIG. 11) is introduced into the
acetabulum 22 to provide a pivotal relationship with the femoral
head. This may be accomplished by applying a mallet 50 to the shaft
extending thru the cannula 40 as illustrated schematically at 50 in
FIG. 11.
[0026] FIGS. 12-15 relate to the formation of the femoral portal
incision 16 and the use of this incision in connection with the
disposition of the femoral stem 52 in a cavity 54 (FIG. 15) in the
femur 34. As shown in FIG. 12, a tool generally indicated at 56 is
provided to determine the position of the femoral portal incision
16. The tool 56 is similar in a number of respects to the tool 18.
For example, the tool 56 may include an extension portion 58 and a
marker member 60 respectively corresponding in configuration to the
extension portion 24 and the marker member 26 in FIG. 2. The
dimensions of the extension portion 58 may be different from those
of the extension portion 24. The tool 56 may also be provided with
a drive member 62 at the end opposite the marker member 60. The
drive member 62 may have a finger configuration. The marker member
60 and the drive member 62 preferably are disposed on the same
axis. When the drive member 62 is inserted into the main incision
12 and is disposed against the femoral stem 52, the marker member
60 makes a mark 63 a long scalpel blade may be passed thru this
portal locator sleeve to indicate the position of the femoral
portal incision 16 as shown in FIG. 12. A relatively long scalpel
blade may then be passed through this portal locator sleeve.
[0027] A cannula 64 (FIG. 13) is then inserted through the femoral
portal incision 16 to a position adjacent the femoral stem 32. If
soft tissues permit, a cannula need not always be used. A rasp 66
or, a reamer, a drill or a tamp is passed through the cannula 64
into the cavity 54 in the femur 34 and is operated to prepare the
walls of the cavity to receive the femur. In the claims, the term
"rasp" is intended to include a reamer, drill or tamp or other
suitable component. The rasp 66, or, a reamer, a drill or a tamp is
then withdrawn from the cannula 64 and a drive member 68 (FIG. 14)
is inserted through the cannula to abut the femoral stem. This is
shown in FIG. 14. A mallet 70 in FIG. 15 is then applied against
the drive member 68 to move the femoral stem 52 into the cavity 54
in the femur 34. This is shown in FIG. 15.
[0028] Although this invention has been disclosed and illustrated
with reference to particular preferred embodiments, the principles
involved are susceptible for use in numerous other embodiments
which will be apparent to persons of ordinary skill in the art. The
invention is, therefore, to be limited only as indicated by the
scope of the appended claims.
* * * * *