U.S. patent application number 11/122092 was filed with the patent office on 2005-10-06 for surgical devices and methods of use.
Invention is credited to Chana, Gursharan.
Application Number | 20050222572 11/122092 |
Document ID | / |
Family ID | 27738829 |
Filed Date | 2005-10-06 |
United States Patent
Application |
20050222572 |
Kind Code |
A1 |
Chana, Gursharan |
October 6, 2005 |
Surgical devices and methods of use
Abstract
A surgical device for holding and rotating an acetabular reaming
head is provided, comprising a shaft having a length which runs
from a first end adapted for holding an acetabular reaming head to
a second end. At least part of the shaft is divergent from the axis
defined by the first and second ends of the shaft, for example the
shaft may include a C-shaped divergent portion. A head held by the
device can therefore access the acetabulum in its true anatomical
position while avoiding encroachment of the shaft on surrounding
body parts.
Inventors: |
Chana, Gursharan; (Sutton
Goldfield, GB) |
Correspondence
Address: |
NEIFELD IP LAW, PC
4813-B EISENHOWER AVENUE
ALEXANDRIA
VA
22304
US
|
Family ID: |
27738829 |
Appl. No.: |
11/122092 |
Filed: |
May 5, 2005 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11122092 |
May 5, 2005 |
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10503788 |
Jan 21, 2005 |
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10503788 |
Jan 21, 2005 |
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PCT/GB03/00557 |
Feb 7, 2003 |
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Current U.S.
Class: |
606/81 |
Current CPC
Class: |
A61F 2/4609 20130101;
A61F 2/34 20130101; A61F 2002/30616 20130101; A61F 2002/4631
20130101; A61F 2/4603 20130101; A61B 17/1666 20130101; A61B 17/1631
20130101 |
Class at
Publication: |
606/081 |
International
Class: |
A61B 017/32 |
Foreign Application Data
Date |
Code |
Application Number |
Feb 8, 2002 |
GB |
0202934.6 |
Mar 5, 2002 |
GB |
0205043.3 |
Aug 23, 2002 |
GB |
0219696.2 |
Claims
1. A surgical tool driver, comprising: a hollow elongated outer
shaft having a first end and a second end, said outer shaft having
a fixed curved portion between said first end and said second end,
said fixed curved portion adapted and arranged along said outer
shaft for bypassing anatomical structures in a patient between said
first and second ends as said driver is positioned for use; a
driven end attachment assembly at one said end of said outer shaft,
said driven end attachment assembly being adapted for attachment to
a rotary drive source; a driving end attachment assembly at the
other said end of said outer shaft, said driving end attachment
assembly adapted for selectively engaging and disengaging a
surgical tool; and a flexible drive shaft disposed in said outer
shaft, one end of said flexible drive shaft being connected to said
driven end attachment assembly, and the other end of said flexible
drive shaft being connected to said driving end attachment
assembly.
2. The surgical tool driver of claim 1, said driving end attachment
assembly including a universal joint drivingly connected to said
flexible drive shaft.
3. The surgical tool driver of claim 2, said driven end attachment
assembly and said driving end attachment assembly disposed in
substantial linear alignment.
4. The surgical tool driver of claim 1, said driven end attachment
assembly and said driving end attachment assembly disposed in
substantial linear alignment.
5. The surgical tool driver of claim 1, said outer shaft having a
collar, and said driven end attachment assembly including a shaft
adapted for attachment to a drive source, said shaft journaled in
bearings in said collar.
6. The surgical tool driver of claim 5, said shaft of said driven
end attachment assembly and said driving end attachment assembly
disposed in substantial linear alignment.
7. The surgical tool driver of claim 5, said shaft of said driven
end attachment assembly having a hollow end, and said flexible
drive shaft being secured in said hollow end.
8. The surgical tool driver of claim 5, said driving end attachment
assembly including a universal joint drivingly connected to said
flexible drive shaft.
9. The surgical tool driver of claim 8, said shaft of said driven
end attachment assembly having a hollow end, and said flexible
drive shaft being secured in said hollow end.
10. The surgical tool driver of claim 9, said shaft of said driven
end attachment assembly and said driving end attachment assembly
disposed in substantial linear alignment.
11. A driver for an acetabular reamer, comprising: a hollow
elongated outer shaft having a first end and a second end, said
outer shaft having a fixed curved portion between said first end
and said second end, said fixed curved portion adapted and arranged
along said outer shaft for bypassing anatomical structures in a
patient between said first and second ends as said driver is
positioned for use; a driven end attachment assembly at one said
end of said outer shaft, said driven end attachment assembly being
adapted for attachment to a rotary drive source; a driving end
attachment assembly at the other said end of said outer shaft, said
driving end attachment assembly adapted for selectively engaging
and disengaging an acetabular reamer; and a flexible drive shaft
disposed in said outer shaft, one end of said flexible drive shaft
being connected to said driven end attachment assembly, and the
other end of said flexible drive shaft being connected to said
driving end attachment assembly.
12. The driver of claim 11, said driven end attachment assembly and
said driving end attachment assembly being in substantially linear
alignment.
13. The driver of claim 12, said driving end attachment assembly
including a universal joint connected to said flexible drive
shaft.
14. The driver of claim 11, said driving end attachment assembly
including a universal joint connected to said flexible drive
shaft.
15. The driver of claim 11, said driven end attachment assembly
including a shaft, and said outer shaft having a collar for
rotatably receiving said shaft of said driven end attachment
assembly.
16. The driver of claim 15, said shaft of said driven end
attachment assembly having a hollow end, and said flexible drive
shaft having an end thereof secured in said hollow end.
17. The driver of claim 16, said shaft of said driven end
attachment assembly being in substantially linear alignment with
said driving end attachment assembly.
18. The driver of claim 16, said driving end attachment assembly
having a hollow receiver, and said flexible drive shaft having an
end thereof secured in said hollow receiver.
19. A method for surgically preparing a bone, comprising steps of:
providing a surgical tool driver with a driven end attachment
assembling and a driving end attachment assembly, and a curved
shaft assembly there between, said curved shaft assembly including
a rigid hollow outer shaft and a flexible drive shaft in said outer
shaft, said flexible drive shaft connected to said driven end
attachment assembling and said driving end attachment assembly,
providing a surgical tool for machining a surface of the bone;
attaching the surgical tool to the driving end attachment assembly;
connecting the driven end attachment assembly to a rotary drive
source; inserting the surgical tool through a surgical wound;
positioning the surgical tool against a bone surface while
positioning the curved portion of the shaft assembly around
intervening anatomy; and driving the tool to machine the bone
surface.
20. The method of claim 19, including providing an acetabular
reamer as said surgical tool, and machining a depression in an
acetabulum of sufficient depth for receiving an acetabular cup.
21. A surgical tool driver, comprising: a hollow elongated outer
shaft having a first end and a second end, said outer shaft having
means for bypassing anatomical structures in a patient, including a
fixed curved portion along said outer shaft for bypassing
anatomical structures in a patient between said first and second
ends as said driver is positioned for use; a driven end attachment
assembly at one said end of said outer shaft, said driven end
attachment assembly including means for attachment to a rotary
drive source; a driving end attachment assembly at the other said
end of said outer shaft, said driving end attachment assembly
including means for selectively engaging and disengaging a surgical
tool; and a flexible drive shaft disposed in said outer shaft, one
end of said flexible drive shaft being connected to said driven end
attachment assembly, and the other end of said flexible drive shaft
being connected to said driving end attachment assembly.
22. A surgical tool driver, comprising: a hollow elongated outer
shaft having a first end and a second end, said outer shaft having
a fixed curved portion between said first end and said second end,
said fixed curved portion adapted and arranged along said outer
shaft for bypassing anatomical structures in a patient between said
first and second ends as said driver is positioned for use; a
driven end attachment assembly at one said end of said outer shaft,
said driven end attachment assembly being adapted for attachment to
a rotary drive source; a driving end attachment assembly at the
other said end of said outer shaft, said driving end attachment
assembly adapted for selectively engaging and disengaging a
surgical tool; a flexible drive shaft disposed in said outer shaft,
one end of said flexible drive shaft being connected to said driven
end attachment assembly, and the other end of said flexible drive
shaft being connected to said driving end attachment assembly: and
said driving end attachment assembly including a universal joint
drivingly connected to said flexible drive shaft.
23. The surgical tool driver of claim 2, said driven end attachment
assembly and said driving end attachment assembly disposed in
substantial linear alignment.
24. The surgical tool driver of claim 1, said driven end attachment
assembly and said driving end attachment assembly disposed in
substantial linear alignment.
25. The surgical tool driver of claim 1, said outer shaft having a
collar, and said driven end attachment assembly including a shaft
adapted for attachment to a drive source, said shaft journaled in
bearings in said collar.
26. The surgical tool driver of claim 5, said shaft of said driven
end attachment assembly and said driving end attachment assembly
disposed in substantial linear alignment.
27. The surgical tool driver of claim 5, said shaft of said driven
end attachment assembly having a hollow end, and said flexible
drive shaft being secured in said hollow end.
28. A surgical tool driver, comprising: a hollow elongated outer
shaft having a first end and a second end, said outer shaft having
a fixed curved portion between said first end and said second end,
said fixed curved portion adapted and arranged along said outer
shaft for bypassing anatomical structures in a patient between said
first and second ends as said driver is positioned for use; a
driven end attachment assembly at one said end of said outer shaft,
said driven end attachment assembly being adapted for attachment to
a rotary drive source; a driving end attachment assembly at the
other said end of said outer shaft, said driving end attachment
assembly adapted for selectively engaging and disengaging a
surgical tool; a flexible drive shaft disposed in said outer shaft,
one end of said flexible drive shaft being connected to said driven
end attachment assembly, and the other end of said flexible drive
shaft being connected to said driving end attachment assembly; said
outer shaft having a collar, and said driven end attachment
assembly including a shaft adapted for attachment to a drive
source, said shaft journaled in bearings in said collar; and said
driving end attachment assembly including a universal joint
drivingly connected to said flexible drive shaft.
29. The surgical tool driver of claim 8, said shaft of said driven
end attachment assembly having a hollow end, and said flexible
drive shaft being secured in said hollow end.
30. The surgical tool driver of claim 9, said shaft of said driven
end attachment assembly and said driving end attachment assembly
disposed in substantial linear alignment.
31. A driver for an acetabular reamer, comprising: a hollow
elongated outer shaft having a first end and a second end, said
outer shaft having means for bypassing anatomical structures in a
patient, including a fixed curved portion along said outer shaft
for bypassing anatomical structures in a patient between said first
and second ends as said driver is positioned for use; a driven end
attachment assembly at one said end of said outer shaft, said
driven end attachment assembly including means for attachment to a
rotary drive source; a driving end attachment assembly at the other
said end of said outer shaft, said driving end attachment assembly
including means for selectively engaging and disengaging an
acetabular reamer; and a flexible drive shaft disposed in said
outer shaft, one end of said flexible drive shaft being connected
to said driven end attachment assembly, and the other end of said
flexible drive shaft being connected to said driving end attachment
assembly.
32. The driver of claim 14, said driven end attachment assembly and
said driving end attachment assembly being in substantially linear
alignment.
33. (canceled)
34. A driver for an acetabular reamer, comprising: a hollow
elongated outer shaft having a first end and a second end, said
outer shaft having a fixed curved portion between said first end
and said second end, said fixed curved portion adapted and arranged
along said outer shaft for bypassing anatomical structures in a
patient between said first and second ends as said driver is
positioned for use; a driven end attachment assembly at one said
end of said outer shaft, said driven end attachment assembly being
adapted for attachment to a rotary drive source; a driving end
attachment assembly at the other said end of said outer shaft, said
driving end attachment assembly adapted for selectively engaging
and disengaging an acetabular reamer, a flexible drive shaft
disposed in said outer shaft, one end of said flexible drive shaft
being connected to said driven end attachment assembly, and the
other end of said flexible drive shaft being connected to said
driving end attachment assembly; and said driving end attachment
assembly including a universal joint connected to said flexible
drive shaft.
35. The driver of claim 14, said driven end attachment assembly
including a shaft, and said outer shaft having a collar for
rotatably receiving said shaft of said driven end attachment
assembly.
36. The driver of claim 15, said shaft of said driven end
attachment assembly having a hollow end, and said flexible drive
shaft having an end thereof secured in said hollow end.
37. The driver of claim 16, said shaft of said driven end
attachment assembly being in substantially linear alignment with
said driving end attachment assembly.
38. The driver of claim 16, said driving end attachment assembly
having a hollow receiver, and said flexible drive shaft having an
end thereof secured in said hollow receiver.
39. A method for surgically preparing a bone, comprising steps of:
providing a surgical tool driver with a driven end attachment
assembling and a driving end attachment assembly, and a curved
shaft assembly there between, said curved shaft assembly including
a rigid hollow outer shaft and a flexible drive shaft in said outer
shaft, said flexible drive shaft connected to said driven end
attachment assembling and said driving end attachment assembly;
providing a surgical tool for machining a surface of the bone;
attaching the surgical tool to the driving end attachment assembly;
connecting the driven end attachment assembly to a rotary drive
source; inserting the surgical tool through a surgical wound;
positioning the surgical tool against a bone surface while
positioning the curved portion of the shaft assembly around
intervening anatomy; and driving the tool to machine the bone
surface.
40. The method of claim 19, including providing an acetabular
reamer as said surgical tool, and machining a depression in an
acetabulum of sufficient depth for receiving an acetabular cup.
41. An apparatus to practice a method for surgically preparing a
bone, comprising: means for providing a surgical tool driver with a
driven end attachment assembling and a driving end attachment
assembly, and a curved shaft assembly there between, said curved
shaft assembly including a rigid hollow outer shaft and a flexible
drive shaft in said outer shaft, said flexible drive shaft
connected to said driven end attachment assembling and said driving
end attachment assembly; means for providing a surgical tool for
machining a surface of the bone; means for attaching the surgical
tool to the driving end attachment assembly; means for connecting
the driven end attachment assembly to a rotary drive source; means
for inserting the surgical tool through a surgical wound; means for
positioning the surgical tool against a bone surface while
positioning the curved portion of the shaft assembly around
intervening anatomy; and means for driving the tool to machine the
bone surface.
Description
FIELD OF THE INVENTION
[0001] The present invention relates to improved surgical devices
and their uses, in particular a surgical reaming device for use in
the removal of bone tissue and methods for its use. The improved
reaming device is particularly for use in reducing invasion when
carrying out hip replacement and hip resurfacing surgery.
SUMMARY OF THE INVENTION
[0002] Procedures for replacement of all or part of a patient's
joint have been in existence for a number of years. The current
procedures generally require large incisions to be made through the
skin and underlying tissue of the patient to allow the surgeon to
access and see the joint while the surgery is being carried
out.
[0003] For example to carry out hip replacement or hip resurfacing
surgery an incision approximately 25-30 cm must be made through the
skin and underlying tissue. Such an incision allows good visibility
of the joint and the surgery can therefore be carried out using the
naked eye.
[0004] Furthermore current surgical devices such as reaming
devices, impactors and pushers used in surgery such as hip
replacement and hip resurfacing require good access to the joint
which is provided by a large incision.
[0005] Reaming devices generally comprise a rotating cutting
portion situated at the end of an elongate drive shaft and
connected to a power source.
[0006] Reaming devices are used in hip replacement and hip
resurfacing surgery to remove bone tissue from the acetabulum
before a prosthetic acetabular cup is fitted. Pushers and impactors
are used in the fitting of prosthetic joint components such as
acetabular cups to the acetabulum.
[0007] Posterior access to a hip joint is usual during surgery and,
as a result to obtain sufficient access to the joint a large amount
of muscle tissue must be divided, cut through or separated from the
bone to which it is anchored. This division or separation of the
muscle allows the femoral head to be moved away from the acetabulum
to allow access to the acetabulum, for example with a reaming
device, or to allow removal of the femoral head. The division or
separation of muscle is essential in the current methods for
resurfacing a hip joint where the femoral head is not removed and
access to the joint is therefore reduced.
[0008] Muscles such as the gluteus maximus and gluteus medius are
usually cut through, divided or separated from the bone to which
they are attached during hip surgery as are the tensor fascia lata
and the ilio-tibial tract.
[0009] Although the muscles do repair themselves following surgery
the recovery period, in and out of hospital, and the amount of
physiotherapy required is extensive. It is also possible that the
muscles may never regain the strength they had before surgery.
Furthermore cutting through muscles can lead to a significant loss
of blood and the patient may require a blood transfusion.
[0010] Therefore there remains a need for surgical devices and
associated methods for their use that reduce the size of the
incision required, the amount of muscle tissue cut through or
separated from the bone to which it was attached and the access
required to a joint to perform surgery.
[0011] Accordingly from a first aspect the present invention
provides a surgical device suitable for use in hip surgery
comprising a shaft having a first end and a second end, with the
shaft being adapted at the first end to be connected to a head,
wherein at least part of the length of the shaft is divergent from
the axis formed between the first end and the second end of the
shaft.
[0012] Specifically, a surgical device for holding and rotating an
acetabular reaming head is provided, comprising a shaft having a
length which runs from a first end to a second end, wherein the
first end is adapted for holding an acetabular reaming head, the
first and second ends defining an axis which runs through these two
end points, wherein at least part of the shaft is divergent from
said axis, allowing a head held by the device to access the
acetabulum in its true anatomical position while avoiding
encroachment of the shaft on surrounding body parts.
[0013] Preferably at least part of the length of the shaft is
permanently divergent from the axis which runs through the first
end and the second end of the shaft.
[0014] Preferably the part of the length of the shaft that is
divergent from the axis which runs through the first end and the
second end of the shaft is substantially C-shaped or includes a
substantially C-shaped section.
[0015] Accordingly, in a preferred aspect the invention provides a
surgical device for holding and rotating an acetabular reaming head
comprising a shaft having a length which runs from a first end to a
second end, wherein the first end is adapted for holding an
acetabular reaming head and wherein the shaft includes a
substantially C-shaped portion along its length.
[0016] Preferably, the part of the shaft that is divergent from the
axis forms a C-shape.
[0017] In surgery such as hip resurfacing surgery the provision of
a substantially C-shaped portion or other divergent portion along
the length of the drive shaft allows a reaming head to achieve
access to the acetabulum without fully anteriorly displacing the
femoral head and neck. In hip resurfacing surgery this removes the
need to cut through large amounts of muscle tissue to allow the
femoral head and neck to be displaced out of the acetabulum before
reaming can take place.
[0018] The avoidance of the need to cut through large amounts of
muscle and displace the femoral head and neck results in a much
less invasive approach allowing a smaller incision through the skin
and underlying tissue to be made. The muscle damage to the patient
is greatly reduced therefore meaning that the patient can be
mobilized much earlier than with existing resurfacing surgical
methods, perhaps even on the same day as the surgery takes place.
The amount of rehabilitation time required in hospital is less,
reducing cost and increasing patient throughput. In some cases
rehabilitation centers may be needed by patients but the time and
attention required by patients in these facilities will also be
less than with existing surgical methods.
[0019] In hip replacement surgery the removal of the femoral head
from the femoral neck prior to reaming the acetabulum increases the
access to the acetabulum when compared to resurfacing surgery.
However the use of the surgical device of the present invention
facilitates reaming as it avoids encroachment of the surgical
device on to the femoral shaft. The use of the surgical device of
the present invention therefore provides the same improvements in
hip replacement surgery as it provides in hip resurfacing
surgery.
[0020] The use of the surgical device of the present invention also
allows reaming to take place in the true anatomical position of the
acetabulum.
[0021] The shaft of the surgical device may be any suitable drive
shaft that permits transmission of torque. The shaft may be
selected from known torque transmitting mechanisms and devices such
as a nickel titanium shaft, a flexible round or flat wire wound
cable, a series of gear driven shafts or a series of shafts
interconnected by universal joints.
[0022] Preferably, the shaft of the surgical device is connectable
at the first end to a reaming head and at the second end to a
rotational drive element.
[0023] More preferably the surgical device comprises a rotatable
drive shaft connectable at a first end to a reaming head and
connected at a second end to a rotational drive element.
[0024] Alternatively a rotational drive element can be positioned
adjacent the first end of the shaft so that in use it is located
between the first end of the shaft and the reaming head.
[0025] The rotational drive element may be a manual drive element
such as a handle to turn; alternatively the drive element may be an
electrical power source. Most preferably the rotational drive
element is an air powered or battery powered rotating drive
element. The drive element must. provide high torque at a low speed
for maximum efficiency.
[0026] The rotational drive element may be provided with one or
more gears.
[0027] It is preferred that a section of the shaft adjacent the
first end is straight and a section of the shaft adjacent the
second end is straight, and these straight sections are aligned
with one another.
[0028] In a preferred embodiment the shaft has a substantially
C-shaped portion and the section of the drive shaft between the
substantially C-shaped portion and the first end that is
connectable to the reaming head is straight and of sufficient
length to ensure that eccentric motion of the drive shaft where it
causes rotation of a reaming head is prevented. It is however also
preferred that this section is not so long that this section
encroaches on the femur or femoral shaft when in use.
[0029] Preferably the section of the drive shaft between the
substantially C-shaped portion and the first end that is
connectable to a reaming head and the section of the drive shaft
between the substantially C-shaped portion and the second end are
both straight. It is further preferred that these two sections are
in line with each other as this allows accurate guidance of the
reaming head.
[0030] A protective sleeve may, preferably, surround the drive
shaft. In one embodiment, the drive shaft is held to the protective
sleeve; for example with a series of bearings, which keep the drive
shaft from riding on the inside of the housing. Preferably the
drive shaft is rotatable and rotates within the sleeve. The
protective sleeve is preferably made from metal, most preferably
stainless steel. The protective sleeve is preferably made from
cannulated material. The protective sleeve shields the drive shaft
from body tissue during use and also shields the body tissue from
damage by the rotating drive shaft.
[0031] The protective sleeve may comprise two or more sleeve
members that are separable from each other, e.g. to allow cleaning.
Such sleeve members may be connected by any suitable means. For
example, the drive shaft may include at one end a capture mechanism
adapted to receive an end of each of the housing members and align
them in the correct position, and at its other end a ring adapted
to interact with a catch in one of the housing members so as to
retain the housing members in a connected formation.
[0032] The surgical device is preferably provided with a handle,
suitable for manipulation by a surgeon. The handle may be provided
as part of the shaft at the end furthest from the reaming head. In
a preferred embodiment the handle is formed as part of the sleeve
in which the drive shaft rotates.
[0033] The surgical device may be adapted at the first end of the
shaft to connect to a reaming head by the provision of any suitable
connecting means.
[0034] The surgical device may be adapted so that the reaming head
may be connected to the sleeve of the drive shaft by any suitable
connecting means.
[0035] One preferred connecting means is the provision of one or
more spring-biased pins and corresponding apertures, one part of
the connecting means being provided on each of a neck extending
from a base of a reaming head and the sleeve of the drive shaft.
Another preferred connecting means is a bayonet mechanism,
preferably with the bayonet fitting being provided on the end of
the drive shaft. An alternative connecting means is a ball and cage
mechanism.
[0036] The use of a simple connecting means allows the reaming head
to be easily removed from the surgical device, e.g. for cleaning or
for exchange of the head for a different sized head.
[0037] The present invention also provides, in a second aspect, a
surgical instrument for acetabular reaming comprising a surgical
device of the first aspect, as defined above, and an acetabular
reaming head; wherein the acetabular reaming head is attached to
the first end of the surgical device.
[0038] The reaming head can be any suitable reaming head depending
on the use and the patient; a cheese grater type of reaming head is
most preferred.
[0039] This type of reaming head collects reamed material within
the reaming head. Generally a number of reaming heads will be used
in succession beginning with a small size and increasing in size
until a sufficient amount of material has been removed for an
acetabular cup to be fitted.
[0040] The reaming head may be connected to the surgical device, in
particular to the sleeve of the drive shaft, by any suitable
connecting means, such as those discussed above.
[0041] The base of the reaming head may suitably be detachable from
the cutting portion of the reaming head to enable the reaming head
to be emptied after use. The base of the reaming head may be
attached to the cutting portion by any conventional means.
[0042] The use of a simple connecting means allows the instrument
to be easily taken apart, e.g. for cleaning.
[0043] Accordingly, in one embodiment a surgical instrument
suitable for acetabular reaming is provided comprising a shaft
having a first and a second end, with the shaft being connected at
the first end to a head, and with the first and second ends
defining an axis which runs through these two end points, wherein
at least part of the shaft is divergent from said axis, allowing
the head to access the acetabulum in its true anatomical position
while avoiding encroachment of the shaft on surrounding body
parts.
[0044] Preferably, the part of the shaft that is divergent from the
axis is substantially C-shaped or includes a substantially C-shaped
section.
[0045] The surgical instrument provided may be a reaming instrument
comprising a shaft connected at a first end to a reaming head, with
at least part of the length of the shaft being divergent from the
axis formed between the first end and the second end of the shaft,
and with the reaming head being connected to a rotational drive
element.
[0046] It is preferred that the shaft of the reaming instrument
includes a substantially C-shaped portion along its length.
[0047] Preferably, the reaming instrument comprises a rotatable
drive shaft connected at a first end to the reaming head and
connected at a second end to a rotational drive element.
[0048] In a third aspect the invention provides a kit for
performing hip surgery on a patient, comprising a surgical device
in accordance with the fast aspect described above; and one or more
acetabular reaming heads having selected sizes, each operable with
the first end of the surgical device for shaping the acetabular
cavity of the patient.
[0049] The kit is preferably adapted to perform hip re-surfacing
surgery.
[0050] Preferably, the kit further comprises one or more acetabular
cup prostheses, selectable for implantation into the prepared
cavity.
[0051] In accordance with the present invention a surgical
instrument may also be provided which is a pusher suitable for
pressurizing a cemented acetabular cup into position in an
acetabulum. The pusher comprises a shaft having a length and being
connected at a first end to a pusher head, with at least part of
the length of the shaft being divergent from the axis formed
between the first end and the second end of the shaft. Preferably,
a substantially C-shaped portion is included along the length of
the shaft.
[0052] A pusher is used to push a cemented acetabular cup into a
prepared acetabulum and hold it in place under manual pressure
until the cement has cured.
[0053] The pusher head and shaft may be integral or alternatively
the head may be secured to the shaft by any of the connection means
set out above or by any other suitable means. The head is
preferably made from a suitable material, such as metal or plastics
material. The shaft is preferably rigid and is also preferably
provided with a handle at the end furthest from the head.
[0054] The kit may therefore also suitably comprise a pusher as
described above.
[0055] Specifically, the kit may further comprise a pusher
comprising a shaft having a length which runs from a first,
insertion end adapted for holding a selected prosthesis, to a
second end, the first and second ends defining an axis which runs
through these two end points, wherein at least part of the shaft is
divergent from said axis.
[0056] In accordance with the present invention a surgical
instrument may also be provided which is an impactor suitable for
use in impacting an uncemented acetabular cup into position in an
acetabulum. The impactor comprises a shaft having a length and
being connected at a first end to an impactor head, with at least
part of the length of the shaft being divergent from the axis
formed between the first end and the second end of the shaft.
Preferably, a substantially C-shaped portion is included along the
length of the shaft.
[0057] An impactor is used to impact an uncemented acetabular cup
into a prepared acetabulum using force applied to the free end of
the shaft.
[0058] The impactor head may be secured to the shaft by any of the
connection means set out above, for example by means of a universal
connector, or by any other suitable means. Alternatively, the
impactor head and shaft may be integral. The head is preferably
made from a suitable material, such as metal or plastics material
and is preferably provided with means to secure it to the
acetabular cup during impacting.
[0059] The shaft is preferably rigid. The shaft is also preferably
provided with a handle at the end furthest from the head.
[0060] The kit may therefore also suitably comprise an impactor as
described above. Specifically, the kit may further comprise an
impactor comprising a shaft having a length which runs from a
first, impaction end adapted for holding a selected prosthesis, to
a second end, the first and second ends defining an axis which runs
through these two end points, wherein at least part of the shaft is
divergent from said axis.
[0061] It is clearly preferred that for any pusher or impactor
instruments used the section of the shaft between the substantially
C-shaped portion and the first end of the shaft is straight. It is
also preferred that this section is relatively short, such that
this section does not encroach on the femur or femoral shaft when
in use. Preferably the section of the shaft between the
substantially C-shaped portion and the first end of the shaft and
the section of the shaft between the substantially C-shaped portion
and the second end of the shaft are both straight. It is further
preferred that these two sections are in line with each other as
this allows for accurate guidance.
[0062] It is also preferred that at least part of the length of the
shaft of any pusher or impactor instruments used is permanently
divergent from the axis which runs through the first end and the
second end of the shaft.
[0063] The provision of a substantially C-shaped portion or other
divergent portion along the length of the shaft of such pusher or
impactor instruments allows access of the head of the surgical
device to the acetabulum without full anterior displacement of the
femoral head and neck to assist in the fitting of an acetabular
cup.
[0064] In a fourth aspect a surgical instrument is provided which
is an osteophyte remover suitable for use in removing peripheral
acetabulum osteophytes.
[0065] The osteophyte remover comprises a shaft connected at a
first end to an osteophyte remover head, with at least part of the
length of the shaft being divergent from the axis formed between
the first end and the second end of the shaft. Preferably, a
substantially C-shaped portion is included along the length of the
shaft.
[0066] Accordingly, the invention provides an osteophyte remover
instrument for use in removing peripheral acetabulum osteophytes
comprising a shaft having a first and a second end, with the shaft
being connected at the first end to an oestoephyte remover head,
with the first and second ends defining an axis which runs through
these two end points, wherein at least part of the shaft is
divergent from said axis, allowing the head to access the
acetabulum in its true anatomical position while avoiding
encroachment of the shaft on surrounding body parts. Preferably,
the part of the shaft that is divergent from the axis is
substantially C-shaped or includes a substantially C-shaped
section. More preferably, the part of the shaft that is divergent
from the axis is a C-shape.
[0067] Preferably at least part of the length of the shaft is
permanently divergent from the axis which runs through the first
end and the second end of the shaft.
[0068] It is preferred that the section of the shaft between the
substantially C-shaped portion and the first end of the shaft,
which is connected to the osteophyte remover head, is straight. It
is also preferred that this section is relatively short, such that
this section does not encroach on the femur or femoral shaft when
in use.
[0069] The osteophyte remover head may be any head suitable for
removing peripheral osteophytes. Preferably the head comprises a
hemispherical portion and a disc portion, with the hemispherical
portion having a smaller radius than the disc portion. The
hemispherical portion is located centrally on one face of the disc
portion such that a section of the face is left exposed around the
hemispherical portion, said section having substantially uniform
width.
[0070] The hemispherical portion is preferably releasably secured
to the disc portion. The hemispherical portion may suitably be
secured to the disc portion by means of a screw, for example the
hemispherical portion may be provided with a screw in the center of
its base, and the disc portion provided with a correspondingly
shaped threaded hole in the center of one face to allow the
hemispherical portion to be screwed into the disc portion.
[0071] Preferably the hemispherical portion is smooth and has the
same radius as the cavity that has been reamed. The disc portion is
provided with a serrated section for removing peripheral
osteophytes. It is preferred that a serrated section is provided on
at least part of, and preferably most of, the area of the face to
which the hemispherical portion is secured which is not covered by
the hemispherical portion. However, a smooth section is preferably
provided around the periphery of the face, of substantially
constant width. Further, the disc portion preferably has smooth
edges.
[0072] In one embodiment, the disc portion is provided with a
centrally located circular serrated section on one face, with a
ring shaped smooth section being provided around the circular
section, extending to the edge of the face. The edges of the disc
portion are smooth. A hemispherical portion having a radius smaller
than that of the circular section is secured centrally to said face
of the disc, so as to leave a ring of serrated surface around its
periphery, with a ring of smooth surface being provided around the
periphery of the serrated ring, extending to the edge of the
face.
[0073] The peripheral osteophyte remover is preferably provided
with a rotational drive element for rotating the osteophyte remover
head. The rotational drive element may be a manual drive element
such as a handle to turn. Alternatively, the drive element may be
an electrical power source. Most preferably the rotational drive
element is an air powered or battery powered rotating drive
element. The drive element must provide high torque at a low speed
for maximum efficiency. The rotational drive element may be
provided with one or more gears.
[0074] A peripheral osteophyte remover is used to remove peripheral
osteophytes from the acetabulum after a cavity has been reamed. The
remover is provided with an osteophyte remover head comprising a
hemispherical portion having a radius approximately the same as the
radius of the cavity that has been reamed, and a disc portion
having a radius bigger than the radius of the cavity that has been
reamed. The osteophyte remover head is positioned in the cavity and
is rotated, thus causing peripheral osteophyte to be removed by the
serrated part of the disc portion, whilst the smooth periphery of
the disc portion prevents damage to the soft tissue. The shape of
the shaft allows positioning in the true anatomical position, and
therefore only the minimum required amount of peripheral osteophyte
is removed.
[0075] The osteophyte remover head may be secured to the shaft by
any of the connection means set out above, for example by means of
a universal connector, or by any other suitable means.
Alternatively, the osteophyte remover head and shaft may be
integral.
[0076] A protective sleeve preferably surrounds the rotatable drive
shaft. In one embodiment, the drive shaft is held to the protective
sleeve; for example with a series of bearings, which keep the drive
shaft from riding on the inside of the housing. Most preferably the
drive shaft rotates within the sleeve. The protective sleeve is
preferably made from metal, most preferably stainless steel. The
protective sleeve is preferably made from cannulated material. The
protective sleeve shields the drive shaft from body tissue during
use and also shields the body tissue from damage by the rotating
drive shaft.
[0077] The protective sleeve may comprise two or more sleeve
members that are separable from each other, e.g. to allow cleaning.
Such sleeve members may be connected by any suitable means. For
example, the drive shaft may include at one end a capture mechanism
adapted to receive an end of each of the housing members and align
them in the correct position, and at its other end a ring adapted
to interact with a catch in one of the housing members so as to
retain the housing members in a connected formation.
[0078] The provision of a substantially C-shaped portion or other
divergent portion along the length of the shaft of the osteophyte
remover allows access of the head of the surgical instrument to the
acetabulum without full anterior displacement of the femoral head
and neck to assist in the removal of peripheral osteophytes after
reaming.
[0079] The kit of the present invention, as described above, may
therefore also suitably comprise an osteophyte remover instrument
as described above.
[0080] Specifically, the kit of the present invention may further
comprise an osteophyte remover instrument for use in removing
peripheral acetabulum osteophytes comprising a shaft having a first
and a second end, with the shaft being connected at the first end
to an oestoephyte remover head, with the first and second ends
defining an axis which runs through these two end points, wherein
at least part of the shaft is divergent from said axis, allowing
the head to access the acetabulum in its true anatomical position
while avoiding encroachment of the shaft on surrounding body
parts.
[0081] The present invention provides, in a fifth aspect, a method
for performing hip surgery on a patient, comprising the steps of:
a) providing a surgical device for holding and rotating an
acetabular reaming head in accordance with the first aspect as
described above; b) providing an acetabular reaming head and
mounting the head on the first end of the device; and c) accessing
the acetabulum of the patient with the surgical device, in its
anatomical position of anteversion while avoiding encroachment on
surrounding body parts, and reaming the acetabulum with the reaming
head.
[0082] It is preferred that steps a)-c) are adapted to perform a
hip re-surfacing surgery.
[0083] The shaft of the device provided in step a) is preferably
surrounded by a sleeve that is C-shaped where the shaft is
divergent from the axis It is also preferred that the shaft of the
device provided in step a) has a drive element coupled to the
second end. In one embodiment, the shaft of the device provided in
step a) is coupled to a drive element between the first end and the
head.
[0084] It is preferable that the section of the shaft adjacent the
first end and the section of the shaft adjacent the second end are
aligned with one another.
[0085] In one embodiment of the method, the femoral head is
dislocated from the acetabulum being reamed in step c).
[0086] The method for performing hip surgery on a patient,
preferably comprises the steps of: a) providing a surgical device
for holding and rotating an acetabular reaming head according to
the first aspect of the invention as defined above; b) providing an
acetabular reaming head and attaching the head to the first end of
the device; c) accessing the acetabulum of the patient with the
surgical device, in its anatomical position of anteversion while
avoiding encroachment on surrounding body parts, and reaming the
acetabulum with the reaming head; d) providing an acetabular
prosthesis; e) providing a surgical device comprising a shaft
having a length which runs from a first, securement end to a second
end, the first and second ends defining an axis which runs through
these two end points, wherein at least part of the shaft is
divergent from said axis; and f) attaching the prosthesis to the
securement end and delivering the prosthesis into the acetabulum
along the insertion axis while avoiding encroachment on surrounding
body parts.
[0087] In the method it is preferred that step c) further comprises
making a posterior incision that splits the fibers of the gluteus
maximus of the patient, anteriorly to their insertion in the
ilio-tibial tract. In one embodiment, the device of step e) is a
pusher and the prosthesis of steps e) and f) is a trial or
definitive cemented component. In an alternative embodiment, the
device of step e) is an impactor and the prosthesis of steps e) and
f) is a trial or definitive cementless component.
[0088] The present invention also provides, in a sixth aspect, a
method for performing a total hip replacement comprising the steps
of: (a) making a posterior incision; (b) performing a femoral neck
osteotomy; (c) preparing the acetabulum to receive an acetabular
cup by reaming the acetabulum with a surgical instrument for
acetabular reaming according to the second aspect of the invention
as defined above; (d) securing an acetabular cup in the acetabulum;
(e) preparing the femur to receive a femoral stem; and (f) securing
a femoral stem to the femur.
[0089] Using the surgical instrument of the present invention in a
total hip replacement avoids the possibility of the instrument
encroaching on the shaft of the femur.
[0090] Preferably, in step (d) a device is used comprising a shaft
having a length which runs from a first end adapted for holding an
acetabular cup, to a second end, the first and second ends defining
an axis which runs through these two end points, wherein at least
part of the shaft is divergent from said axis. For example, an
instrument such as a pusher as described above or an impactor as
described above may be used.
[0091] The present invention further provides, in a seventh aspect,
a method for resurfacing a hip joint comprising the steps of: (a)
making a posterior incision; (b) preparing the acetabulum to
receive an acetabular cup by reaming the acetabulum with a surgical
instrument for acetabular reaming according to the second aspect of
the invention as defined above, without fully anteriorly displacing
the femoral head; and (c) securing an acetabular cup in the
acetabulum.
[0092] Using the surgical instrument of the present invention in
hip resurfacing avoids the possibility of the instrument
encroaching on the shaft of the femur and allows access to the
acetabulum without full anterior displacement of the femur.
[0093] Preferably, in step (c) a device is used comprising a shaft
having a length which runs from a first end, adapted for holding an
acetabular cup, to a second end, the first and second ends defining
an axis which runs through these two end points, wherein at least
part of the shaft is divergent from said axis. For example, an
instrument such as a pusher as described above or an impactor as
described above may be used.
[0094] Although the optimum method for carrying out hip replacement
or hip resurfacing surgery according to the present invention
includes the use of the surgical devices and/or instruments of the
present invention it is possible to reduce invasion connected with
hip surgery using conventional equipment using a surgical technique
according to the present invention.
[0095] For maximum reduction of invasion it is preferred to use the
devices and/or instruments of the present invention and the
surgical methods of the present invention.
[0096] The present invention also provides a method for performing
a total hip replacement comprising the steps of: making a posterior
incision positioned such that the fibres of the gluteus maximus are
split anteriorly to their insertion in the ilio-tibial tract;
performing a femoral neck osteotomy; preparing the acetabulum to
receive an acetabular cup by reaming the acetabulum; securing an
acetabular cup in the acetabulum; preparing the femur to receive a
femoral stem; securing a femoral stem to the femur.
[0097] The present invention further provides a method for
resurfacing a hip joint comprising the steps of: making a posterior
incision positioned such that the fibres of the gluteus maximus are
split anteriorly to their insertion in the ilio-tibial tract;
preparing the acetabulum to receive an acetabular cup by reaming
the acetabulum; and securing an acetabular cup in the
acetabulum.
[0098] The posterior incision preferably begins at a distance of X
cm down from the tip of the greater trochanter. X cm is the
distance from the tip of the greater trochanter to the point of
bisection of the lateral cortex by a line down the center of the
femoral neck. The incision extends at an angle of 40-50.degree.,
most preferably 45.degree. to the femoral shaft. The incision
preferably extends proximally and posteriorly to the femoral shaft.
The incision is preferably 5 to 12 cm, for example 7 to 12 cm, more
preferably 5 to 10 cm in length, for example 8 to 10 cm.
[0099] The position of the incision allows the fibres of the
gluteus maximus to be split along the incision resulting in the
fibres being split anteriorly to their insertion in the ilio-tibial
tract and the ilio-tibial tract is not incised.
[0100] In the replacement and resurfacing surgery the acetabular
cup is preferably fitted using the pusher and/or impactor devices
as defined above.
[0101] In the replacement and resurfacing surgery a step of
removing peripheral osteophytes from the acetabulum is preferably
included, after the reaming step and before the step of fitting the
acetabular cup. This step is preferably carried out using the
peripheral osteophyte remover according to the fourth aspect of the
invention.
[0102] The present invention also provides, in an eighth aspect, a
method for removing peripheral osteophytes from an acetabulum after
a cavity has been reamed in said acetabulum, comprising the steps
of: a) providing an osteophyte remover instrument for use in
removing peripheral acetabulum osteophytes according to the fourth
aspect of the invention as defined above; and b) positioning the
osteophyte remover head in the cavity, while avoiding encroachment
of the instrument on surrounding body parts, and removing
peripheral osteophyte from the cavity by rotating the osteophyte
remover head in the cavity.
[0103] Except where clearly indicated to the contrary by the
wording used, all of the preferred and optional features of each
aspect of the invention may be used in combination with one or more
of any of the other preferred or optional features.
BRIEF DESCRIPTION OF THE FIGURES
[0104] Embodiments of the invention will now be described in detail
with reference to the drawings in which:
[0105] FIG. 1 shows a cross section along the length of a pusher or
impactor as used in the present invention;
[0106] FIG. 2 shows a cross section along the length of a
peripheral osteophyte remover according to the present
invention;
[0107] FIG. 3 shows a cross section along the length of a surgical
device for holding and rotating a reaming head according to the
present invention;
[0108] FIG. 4 shows a cross section along the length of a surgical
reaming instrument according to the present invention;
[0109] FIG. 4a shows an enlarged view of an area of the instrument
shown in FIG. 4;
[0110] FIG. 5 shows a cross section through a human hip joint based
on an AP radiograph;
[0111] FIG. 6 shows a cross section through the lower part of a
human body showing the major muscle groups around the hip joint;
and
[0112] FIG. 7 shows a cross section through the lower part of a
human body showing the major muscle groups around the hip
joint.
DEVICES OF THE PRESENT INVENTION
[0113] FIG. 1 shows a pusher/impactor instrument as used in the
present invention. The instrument 1 comprises a rigid,
substantially C-shaped, shaft 2 having a head 3 connected to a
first end 2a of the shaft 2. The head 3 is connected to the shaft 2
by a tapered portion 4 of the first end of the shaft 2a being
received in a corresponding aperture 5 in the base 3a of the head
3. The shaft is provided with a handle 6 at the end 2b of the shaft
furthest from the head 3.
[0114] The head 3 may be any suitable head for impacting or pushing
an acetabular cup (not shown) into the acetabulum of a hip joint
(not shown).
[0115] FIG. 2 shows a peripheral osteophyte remover instrument
according to the present invention. The instrument 101 comprises a
shaft 102 having a head 103 connected to a first end 102a of the
shaft 102. The drive shaft 102 is housed in a stainless steel
sleeve 108 within which the drive shaft 102 is free to rotate. The
sleeve 108 has a substantially C-shaped portion positioned near the
head 103 and a straight handle portion extending from the C-shaped
portion away from the head 103. A further straight portion is
provided extending from the substantially C-shaped portion towards
the head 103 in line with the handle portion.
[0116] The head 103 comprises a hemispherical portion 104 and a
disc portion 105. The hemispherical portion 104 has a radius
smaller than that of the disc portion 105, and is located centrally
on a first face of the disc portion 105, being secured by means of
a screw 107. A serrated section 105a is provided on the face of the
disc portion 105 to which the hemispherical portion is secured,
covering most of the area of said face that is not covered by the
hemispherical portion 104. However a smooth section 105b of
substantially constant width is provided around the periphery of
the face. The disc portion 105 has smooth edges.
[0117] The first end 102a of the drive shaft 102 is received by an
adapter 106 extending from the center of the disc portion 105. The
shaft 102 is provided with a rotatable drive element (not shown) at
the end 102b of the shaft furthest from the head 103. The first end
102a of the drive shaft 102 must be well secured in the adapter 106
to prevent eccentric rotation of the drive shaft at the end 102a.
The drive shaft 102 must cause true rotation of the head 103
through adapter 106.
[0118] FIG. 3 shows a surgical device 111 for holding and rotating
a reaming head according to the present invention. The device 111
comprises a rotatable drive shaft 112, which is a rotatable steel
power cable, providing rotation and flexibility. The first end 112a
of the drive shaft 112 is adapted so as to be connectable to a
reaming head. The second end 112b of the drive shaft 112 is
provided with a drive fitting 113, which is adapted to be linked to
a rotary power source.
[0119] The first end 112a connects to a reaming head by a bayonet
style mechanism. Accordingly, the first end 112a is provided with a
slide 115 carrying a pin component 116 of the bayonet mechanism.
The pin 116 co-operates with a catch 117 provided at the end of the
device 111, to form a bayonet that can capture a reaming head. This
mechanism allows a reaming head to be securely attached but also
easily removed, either for replacement with a different sized
reaming head or for cleaning.
[0120] The drive shaft 112 is housed in a stainless steel sleeve
114 within which the drive shaft 112 is free to rotate. The sleeve
114 has a substantially C-shaped portion X positioned near the
first end 112a and a straight handle portion Y extending from the
C-shaped portion away from the first end 112a A further straight
portion Z is provided extending from the substantially C-shaped
portion X towards the first end 112a in line with the handle
portion Y.
[0121] The substantially C-shaped portion X allows the reaming
device 111 to pass through a miniature incision in the skin without
impinging on the skin and to easily access the acetabulum without
the need to fully anteriorly displace the femoral head or without
encroaching on to the femoral shaft. The straight portion Y
provides a handle by which to maneuver the device and the straight
portion Z prevents eccentric rotation of the drive shaft where it
causes rotation of a head connected to the first end of the shaft.
The straight portions Y and Z are in line to allow accurate
guidance of an attached reaming head.
[0122] FIG. 4 shows a surgical reaming instrument 11 according to
the present invention. The instrument 11 comprises a rotatable
drive shaft 12, which is a rotatable steel power cable, providing
rotation and flexibility. The instrument 11 also comprises a head
13, which is connected to a first end 12a of the drive shaft 12.
The head 13 comprises a base portion 13a and a cutting portion 13b.
A rotatable drive element (not shown) is connected to the second
end 12b of the drive shaft 12.
[0123] The drive shaft 12 is housed in a stainless steel sleeve 14
within which the drive shaft 12 is free to rotate. The sleeve 14
has a substantially C-shaped portion A positioned near the head 13
and a straight handle portion B extending from the C-shaped portion
away from the head 13. A further straight portion C is provided
extending from the substantially C-shaped portion A towards the
head 13 in line with the handle portion B.
[0124] The substantially C-shaped portion A allows easy access of
the reaming instrument 11 to the acetabulum without the need to
fully anteriorly displace the femoral head or without encroaching
on to the femoral shaft.
[0125] The straight portion B provides a handle by which to
maneuver the instrument and the straight portion C prevents
eccentric rotation of the drive shaft where it causes rotation of
the head 13. The straight portions B and C are in line to allow
accurate guidance of the head 13.
[0126] The first end 12a of the drive shaft 12 is received by a
neck 15 extending from the center of the base 13a of the reaming
head 13. The first end 12a of the drive shaft 12 must be well
secured in the neck 15 to prevent eccentric rotation of the drive
shaft at the end 12a. The drive shaft 12 must cause true rotation
of the head 13 through neck 15.
[0127] The neck 15 is provided with a freely rotating collar 16
held in position around the neck 15 by two further collars 17a, 17b
fixedly attached to the neck 15 (see FIG. 4a). Bearing surfaces are
provided between the neck 15 and the collar 16. The head 13 is
secured to the sleeve 14 by means of a spring-biased lug 18 on the
collar 16 being received within a corresponding aperture 19
provided through the sleeve 14. The lug and aperture lock the
collar 16 in a fixed position within the sleeve 14, within which
the neck 15 is free to rotate. The lug 18 can be disengaged from
the aperture 19 by applying pressure through the aperture on to the
lug against the action of the spring.
[0128] The second end 12b of the drive shaft is connected to a
first end 20a of a connector 20. The drive shaft 12 is secured to
the connector 20 such that eccentric rotation is prevented. The
connector 20 is provided with an externally screw threaded portion
21 at the second end 20b. The connector 20 is secured by the
external screw threaded portion 21 to an internally screw threaded
connector 22 for connection to an air powered drive element (not
shown) suitable for providing high torque at a low speed. The
connector 22 is sized to fit partially into the sleeve 14 and has a
bearing surface to allow it to rotate within the sleeve 14. Grub
screws 23 can be used to further secure the connector 22 in
position with respect to drive shaft 12.
[0129] The cutting portion 13b can be any suitable cutting portion
for a reaming head depending on the patient and the required
result, for example suitable cutting portions are cheese grater
cutting portions for a reaming head. The cutting portion 13b is
secured to the base 13a of the head 13 by means of a fixed
projection 24 and a spring-biased projection 25 situated
diametrically opposite each other around the rim of base 13a
engaging corresponding apertures on the rim of the cutting portion.
The spring-biased projection 25 can be retracted into the base 13a
by means of lever 26. This is a standard fixing mechanism for a
cutting portion of a reaming head to be secured to the base.
[0130] The reaming instrument 11 is assembled by feeding the drive
shaft 12 into the sleeve 14 with the connector 20 being fed through
first. Apertures may be provided on the bends of the sleeve 14 to
allow the use of a poker to help the connector 20 pass round the
bends in the sleeve 14. The neck 15 of the head 13 is secured into
a first end of the sleeve 14 by means of the spring-biased lug 18.
The connector 22 is secured to the connector 20 by means of the
corresponding screw threads and the grub screws 23.
[0131] The connector 22 is then secured to a rotatable drive
element and an appropriate reaming head is secured to the base
13a.
[0132] In use the power source causes rotation of the connectors 22
and 20 and of the drive shaft 12 within the protective sleeve 14.
This action results in rotation of the neck 15 and the attached
reaming head about an axis X extending longitudinally through the
straight portions C and B. The neck 15, the connector 20 and the
straight portions C and B of the sleeve 21 ensure that true
rotation is transmitted along the length of the drive shaft 12 from
the power source to the head 13.
[0133] Methods for Carrying Out Hip Surgery Using the Devices of
the Present Invention
[0134] 1) Pre-Operative Planning
[0135] From a plain AP radiograph of the patient's hip joint (shown
in FIG. 5) a line is drawn down the center of the femoral neck 19
to bisect the lateral cortex 20 of the femur 21 at a point 23
usually just below the greater trochanter 22. The distance (x cm)
from this point of bisection 23 to the tip of the greater
trochanter is measured (usually 5-8 cm with average of 6 or 7
cm).
[0136] 2) Technique
[0137] Anaesthetic General or spinal anaesthetic with 3 in 1
femoral nerve block using 30 ml of plain 0.25% Bupuvicane.
[0138] Position
[0139] True lateral position
[0140] Incision
[0141] FIG. 6 shows the main muscle groups around the hip joint
which are the gluteus maximus 25, the ilio-tibial tract 26, the
tensor fascia lata 27 and the gluteus medius 28. Using a sterile
marker pen, the position of the greater trochanter 22 is marked and
using a ruler point `x` is marked on the skin x cm (usually 6 or 7
cm) distal to the greater trochanter tip to locate the mid femoral
neck line bisection point 23 on the femur. Skin incision 24 is
started from the posterior border of the femur at the point `x`
going proximally and posteriorly at an angle of 45.degree. to the
femoral shaft 21 for 8-10 cm. The incision 24 will be in line with
the fibres of the gluteus maximus 25. The subcutaneous tissue is
incised along this line and the fibres of gluteus maximus 25 are
split along the whole length of the incision 24. The gluteus
maximus fibres 25 are split anteriorly to their insertion to
ilio-tibial tract 26 and the ilio-tibial tract 26 is not incised at
all.
[0142] FIG. 7 shows the main muscle groups around the hip joint
which are the gluteus maximus 25, the ilio-tibial tract 26, the
tensor fascia lata 27 and the gluteus medius 28. In a variation of
the method described in relation to FIG. 6, using a sterile marker
pen, the position of the greater trochanter 22 is marked and using
a ruler point `x` is marked on the skin x cm (usually 6 or 7 cm)
distal to the greater trochanter tip to locate the mid femoral neck
line bisection point 23 on the femur. Skin line 24' is marked from
point `x` going proximally and posteriorly at an angle of
45.degree. to the femoral shaft 21. A skin incision is made along
the line 24'. The skin incision is started 4 cms posterior to the
posterior border of femur 21 along line 24' and extended along this
line giving an initial incision of 5 cm. The incision along line
24' will be in line with the fibres of the gluteus maximus 25. The
incision can be extended on either end if needed depending on the
size of the patient. The subcutaneous tissue is incised along this
line 24' and the fibres of gluteus maximus 25 are split along the
whole length of the incision on line 24'. The gluteus maximus
fibres 25 are split anteriorly to their insertion to ilio-tibial
tract 26 and the ilio-tibial tract 26 is not incised at all.
[0143] Minimal bleeding occurs in these approaches as the incision
is at the watershed of the superior and inferior gluteal vessels.
The gluteus maximus muscle is retracted at right angles to its
fibres and adipose tissue overlying the short external rotators of
the hip will be exposed. The adipose tissue is cleared to expose
the short external rotators of the hip.
[0144] Thorough haemostasis is carried out of the vessels around
the insertion of the short external rotators. The piriformis,
inferior and superior gemalli are divided at their insertion and a
stay suture applied to the cut ends.
[0145] Retraction of the short external rotators posteriorly will
prevent injury to the sciatic nerve. The quadratus femoris is
released from its femoral insertion. This will expose the posterior
capsule of the hip joint. A thorough superior, posterior and
inferior capsulotomy of the hip is performed and the hip
dislocated. With forceful internal rotation of the hip, it is
possible to carry out anterior capsulotomy of the joint. Flexion of
the knee to 90.degree. will allow relaxation of the ilio-tibial
tract 26. Note that in internal rotation the split gluteus maximus
fibres 25 will tend to `snap shut`.
[0146] 3a) For Total Hip Replacement Arthroplasty
[0147] Femoral neck osteotomy is performed. This will allow easy
access to the acetabulum. Further completion of circumferential
capsultomoy is carried out. Release of capsule is then performed. A
Homan retractor is inserted supero-anteriorly to the acetabulum and
the femur displaced anteriorly. A Styles nail is inserted into the
ischium, just posterior to the acetabular rim. Another Homan
retractor is inserted inferiorly peripheral to the transverse
ligament for tissue retraction inferiorly. This will give a good
access to the acetabulum. Acetabular reaming in its anatomical
position of anteversion is facilitated with the substantially
C-shaped reaming instrument of the present invention as there will
not be any encroachment of the reaming instrument drive shaft to
the femur. The acetabular preparation is completed and the cemented
or uncemented component is secured in the usual manner. A
substantially C-shaped pusher is used to pressurize the acetabular
component for the cemented component, alternatively a substantially
C-shaped impactor is used to impact an uncemented acetabular
component. Once the acetabular component is secured, peripheral
acetabular osteophytes are removed.
[0148] The femur is prepared next. To allow easy access to the
femoral shaft the hip is flexed to 45.degree., internally rotated
by 90.degree. and adducted by 30-40.degree. to allow delivery of
the osteotomised base of femoral neck. The femur is prepared and
the trial femoral component is inserted. The hip is reduced and
checked for stability. A definitive femoral component is
cemented/inserted.
[0149] Closure
[0150] The short external rotators and quadratus femoris muscles
are sutured back on to the femur. A drain is inserted in the wound
and brought proximally. The gluteus maximus fascia is closed over
the drain. If necessary a second drain can be inserted in the fatty
layer and the wound closed in layers.
[0151] 3b) For Hip Resurfacing
[0152] In view of the fact that the gluteus maximus tends to `snap
shut ` the anterior hip capsulotomy is carried out with alternate
retraction of proximal and distal aspect of the gluteus maximus
split. The hip can be put in extremes of internal rotation,
adduction and flexion to allow `delivery` of the femoral head into
the wound. Usually the femoral head can be delivered into the wound
at 90.degree. of internal rotation, 45.degree. of flexion and as
much adduction as possible. Partial release of gluteus maximus
insertion to the femur may be required in larger patients. The
femoral head and neck are measured for sizing of femoral head
component. The femoral head guide wire is inserted with the
centralizing femoral head jig.
[0153] The femoral head cuts are completed in the usual manner up
to the stage ready to implant the femoral component. Any femoral
head bone grafting or cementing holes are not done at this stage.
With the overall size of the femoral head reduced at this stage the
femoral head can easily be displaced to lie deep to the gluteus
medius with the hip in neutral position. This will also allow
further thorough anterior capsular release to be carried out. With
the femur in a more neutral position the gluteus maximus will be
relaxed. A supero-anterior Homan retractor, a Styles nail in the
ischium and a Homan retractor inferiorly will give adequate
exposure to the acetabulum. As gluteus maximus insertion to the
femur is not released in most patients, displacement anteriorly of
the femur is not fully possible. For this reason normal acetabular
reaming devices cannot be used as they will not allow reaming in
the anatomical anteversion position of the acetabulum. Therefore
the substantially C-shaped reaming instrument is used to ream the
acetabulum. The substantially C-shaped part of the reaming
instrument will allow reaming in the true anatomical position of
the acetabulum. The acetabular trial shaft will also have a
substantially C-shaped configuration and also the definitive
insertor of the acetabular component will have a substantially
C-shaped configuration to allow impaction of the acetabular
component. After completion of the trial acetabular component the
definitive acetabular component is impacted into position. All
peripheral acetabular osteophytes can be removed at this stage. The
Styles nail is removed and all the Homan retractors are removed.
The hip is internally rotated to 90.degree., flexed to 45.degree.
and adducted to allow delivery of the femoral head. A 3 mm vent
drill hole is made into the lesser trochanter to vent the femur. A
drainage cannula is inserted into the vent hole in the lesser
trochanter and connected to suction. The femoral neck is surrounded
with a split swab or special drapes and final preparation of the
femoral head is carried out including femoral head grafting or
drilling of the femoral head drill holes for cementation. The
femoral head is dried and the definitive femoral component is
cemented. All excess cement is cleared and the hip reduced. Routine
closure of the wound is carried out as described above.
[0154] 4) Post Operative Regime
[0155] In the immediate post-operative period a check x-ray is
carried out.
[0156] Adequate analgesia is maintained and after 6-8 hours the
patient can stand up with a Zimmer frame. The following day the
drains are removed and the patient mobilized with a Zimmer frame.
The patient should be able to transfer to a step
down/rehabilitation facility if the hemoglobin check is of
satisfactory level. When the patient can be discharged from the
step down facility to home environment depends on social
circumstances and agility of the patient.
* * * * *