U.S. patent application number 13/383368 was filed with the patent office on 2012-08-09 for apparatus and methods for treatment of arthrosis or osteoarthritis in a joint of a mammal or human patient.
This patent application is currently assigned to MILUX HOLDINGS SA. Invention is credited to Peter Forsell.
Application Number | 20120203353 13/383368 |
Document ID | / |
Family ID | 46453581 |
Filed Date | 2012-08-09 |
United States Patent
Application |
20120203353 |
Kind Code |
A1 |
Forsell; Peter |
August 9, 2012 |
APPARATUS AND METHODS FOR TREATMENT OF ARTHROSIS OR OSTEOARTHRITIS
IN A JOINT OF A MAMMAL OR HUMAN PATIENT
Abstract
A proposed treatment of arthrosis/osteoarthritis in a joint of a
mammal or human patient involves deposing a liquid material on at
least one damaged surface of the joint. To accomplish this, a
reservoir (110) is provided, which holds a volume of a
biocompatible material in liquid form outside of a body containing
the joint (J) to be treated. A proximal end (P) of a tube-shaped
instrument (120) is connected to the reservoir (110), and a distal
end (D) of the instrument (120) is inserted into the joint (J). The
liquid material is fed through the instrument (120) to the distal
end (D) for deposition on the at least one damaged joint surface.
The material is configured to assume a solid form under predefined
conditions (e.g. when cooling off or being exposed to a specific
type of radiation). When the material has the solid form, it has a
resistance to wear adapted to replace a worn out joint surface.
Inventors: |
Forsell; Peter; (Bouveret,
CH) |
Assignee: |
MILUX HOLDINGS SA
LUXEMBOURG
LU
|
Family ID: |
46453581 |
Appl. No.: |
13/383368 |
Filed: |
July 12, 2010 |
PCT Filed: |
July 12, 2010 |
PCT NO: |
PCT/SE10/50818 |
371 Date: |
January 10, 2012 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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61229752 |
Jul 30, 2009 |
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61229755 |
Jul 30, 2009 |
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61229761 |
Jul 30, 2009 |
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61229767 |
Jul 30, 2009 |
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61229778 |
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61229786 |
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Current U.S.
Class: |
623/23.42 |
Current CPC
Class: |
A61F 2/30 20130101; A61F
2002/307 20130101; A61F 2/30756 20130101; A61F 2/32 20130101; A61F
2/4618 20130101; A61F 2002/30757 20130101; A61F 2002/30583
20130101; A61F 2/30942 20130101; A61B 17/1666 20130101; A61B
17/1668 20130101; A61F 2002/465 20130101; A61F 2002/30672 20130101;
A61F 2002/30065 20130101; A61F 2002/4696 20130101; A61F 2002/30754
20130101; A61F 2002/4627 20130101 |
Class at
Publication: |
623/23.42 |
International
Class: |
A61F 2/30 20060101
A61F002/30 |
Foreign Application Data
Date |
Code |
Application Number |
Jul 10, 2009 |
SE |
0800975-4 |
Jul 10, 2009 |
SE |
0900957-2 |
Jul 10, 2009 |
SE |
0900958-0 |
Jul 10, 2009 |
SE |
0900959-8 |
Jul 10, 2009 |
SE |
0900960-6 |
Jul 10, 2009 |
SE |
0900961-4 |
Jul 10, 2009 |
SE |
0900962-2 |
Jul 10, 2009 |
SE |
0900963-0 |
Jul 10, 2009 |
SE |
0900964-8 |
Jul 10, 2009 |
SE |
0900965-5 |
Jul 10, 2009 |
SE |
0900966-3 |
Jul 10, 2009 |
SE |
0900968-9 |
Jul 10, 2009 |
SE |
0900969-7 |
Jul 10, 2009 |
SE |
0900970-5 |
Jul 10, 2009 |
SE |
0900971-3 |
Jul 10, 2009 |
SE |
0900972-1 |
Jul 10, 2009 |
SE |
0900973-9 |
Jul 10, 2009 |
SE |
0900974-7 |
Jul 10, 2009 |
SE |
0900975-4 |
Jul 10, 2009 |
SE |
0900976-2 |
Jul 10, 2009 |
SE |
0900977-0 |
Jul 10, 2009 |
SE |
0900978-8 |
Jul 10, 2009 |
SE |
0900979-6 |
Jul 10, 2009 |
SE |
0900980-4 |
Jul 10, 2009 |
SE |
0900981-2 |
Jul 30, 2009 |
SE |
PCT/SE2009/000502 |
Claims
1. An apparatus for treatment of arthrosis in a joint of a mammal
or human patient, the apparatus comprising: a reservoir configured
to hold a volume of a biocompatible material in liquid form having
a temperature higher than 100.degree. C. outside of a body
containing a joint (J) to be treated, and an instrument having a
general tube shape, a distal end (D) of the instrument being
configured to be inserted into the joint (J), a proximal end (P) of
the instrument (O) being connected to the reservoir (H O) and
configured to receive the liquid material there from, the
instrument being configured to feed the liquid material having a
temperature higher than 100.degree. C. from the proximal end (P) to
the distal end (D) for deposition on at least one damaged surface
(S) of the joint (J), such that adjacent nerves are damaged by the
heat of the material thus preventing pain from the damaged surface,
the material being configured to assume a solid form under
predefined conditions, and when in the solid form the material
having a resistance to wear adapted to replace a worn out joint
surface.
2. The apparatus according to claim 1, further comprising a
flexible and collapsible mould member having a pre-produced shape
adapted to a shape and size of at least one of the at least one
damaged surface (S) so as to contact and cover this surface (S),
the mould member being configured to be inserted into the joint (J)
and be form-fitted to said damaged surface (S), be connected to the
distal end (D) of the instrument and when placed in the joint (J)
receive the material in liquid form being fed through the
instrument, the mould member having an internal volume configured
to be filled with liquid material received via the instrument, and
the mould member being configured to enable the predefined
conditions for accomplishing a transition from the liquid form to
the solid form after that the mould member has been filled with the
liquid material.
3. The apparatus according to claim 2, wherein the mould member is
configured to be inserted into the joint (J) by passing via a bone
of the body.
4. The apparatus according to claim 2, wherein the mould member is
configured to be inserted into the joint (J) by passing via a bone
of the body from inside the abdomen.
5. The apparatus according to claim 2, wherein the mould member is
configured to be inserted into the joint (J) by passing via the
femoral bone of the body.
6. The apparatus according to claim 2, wherein the mould member is
configured to be inserted into the joint (J) by passing the capsula
of said joint (J).
7. The apparatus according to claim 2, wherein the mould member is
configured to be at least partly withdrawn from the joint (J) after
that the material has assumed its solid form.
8. The apparatus according to claim 2, wherein the reservoir is
configured to hold the material at an elevated pressure level
exceeding the normal atmospheric level, and the mould member is
configured to expand in response to receiving the material.
9. The apparatus according to claim 8, comprising an injection
member configured to inject the liquid material into the mould
member at the elevated pressure.
10. The apparatus according to claim 2, wherein the mould member
comprises an isolation material configured to reduce the risk of
body tissue being damaged by the liquid material having a
temperature above 37 degrees Celsius.
11. The apparatus according to claim 1, wherein the reservoir is
configured to hold the biocompatible material at a temperature of
at least 100 degrees Celsius.
12. The apparatus according to claim 1, wherein the reservoir
comprises at least one shield member configured to isolate the
reservoir from the body.
13. The apparatus according to claim 1, wherein the instrument
comprises at least one shield member configured to isolate the body
from liquid material passing through the instrument.
14. The apparatus according to claim 1, wherein the reservoir is
configured to hold the biocompatible material at a temperature of
at least 50 degrees Celsius.
15. The apparatus according to claim 1, wherein the reservoir is
configured to hold the biocompatible material at a temperature of
at least 70 degrees Celsius.
16. The apparatus according to claim 1, wherein the reservoir is
configured to hold the biocompatible material at a temperature of
at least 90 degrees Celsius.
17. The apparatus according to claim 1, wherein the reservoir is
configured to hold the biocompatible material at a temperature of
at least 150 degrees Celsius.
18. The apparatus according to claim 1, wherein the reservoir is
configured to hold the biocompatible material at a temperature of
at least 200 degrees Celsius.
19. The apparatus according to claim 1, wherein the reservoir is
configured to hold the biocompatible material at a temperature of
at least 300 degrees Celsius.
20. The apparatus according to claim 1, wherein the reservoir is
configured to hold the biocompatible material at a temperature of
at least 400 degrees Celsius.
21.-71. (canceled)
Description
BACKGROUND
[0001] The present invention relates generally to surgical
treatment of joints. More particularly the invention relates to an
apparatus and methods for treatment of arthrosis or osteoarthritis
in a joint of a mammal or human patient.
[0002] Traditionally, surgical treatment of damaged joint surfaces
(for example in the hip or knee joint) has implied a relatively
complicated procedure. For example, in case of arthrosis in the hip
joint, a substantial portion of the femoral bone is normally
replaced with a prosthesis. This type of operation affects
comparatively large muscles and/or many ligaments and tendons,
which in turn, leads to a long period of convalescence for the
patient. Moreover, if only the cartilaginous tissue of the joint is
damaged, it is actually unnecessary to remove the healthy femoral
bone tissue.
SUMMARY
[0003] The object is therefore to alleviate the above problems and
provide an uncomplicated solution for treating arthrosis in joints,
which minimizes the removal of healthy tissue and decreases the
period of convalescence and the pain to the area of the joint.
[0004] According to one aspect, an apparatus for treatment
comprises: a reservoir configured to hold a volume of a
biocompatible material in liquid form having a temperature higher
than 100.degree. C. outside of a body containing a joint to be
treated, and an instrument having a general tube shape, a distal
end of the instrument being configured to be inserted into the
joint, a proximal end of the instrument being connected to the
reservoir and configured to receive the liquid material there from,
the instrument being configured to feed the liquid material having
a temperature higher than 100.degree. C. from the proximal end to
the distal end for deposition on at least one damaged surface of
the joint, such that adjacent nerves are damaged by the heat of the
material, the material being configured to assume a solid form
under predefined conditions, and when in the solid form the
material having a resistance to wear adapted to replace a worn out
joint surface.
[0005] According to one embodiment, the apparatus further includes
a flexible and collapsible mould member. This member has a
pre-produced shape adapted to a shape and size of at least one of
the at least one damaged surface. Thus, the mould member may
contact and cover this joint surface. Additionally, the mould
member is configured to be inserted into the joint, and be
form-fitted to said damaged surface. The mould member is also
configured to be connected to the distal end of the instrument, and
when placed in the joint (J) receive the material in liquid form
being fed through the instrument. The mould member has an internal
volume configured to be filled with liquid material received via
the instrument. Moreover, the mould member is configured to enable
the predefined conditions for accomplishing a transition from the
liquid form to the solid form after that the mould member has been
filled with the liquid material.
[0006] The mould member is advantageous, since it facilitates
targeting a predetermined volume of the liquid material to a
specific joint surface both in terms of thickness and lateral
coverage.
[0007] According to another aspect, the object is achieved by a
method for treatment of arthrosis in a joint of a mammal or human
patient. The method involves feeding a volume of a bio compatible
material in liquid form into a reservoir located outside of a body
containing a joint to be treated. The method further involves
inserting into the joint an instrument having a general tube shape.
A distal end of the instrument is configured to be inserted into
the joint, and a proximal end of the instrument is connected to the
reservoir. The method further involves receiving the liquid
material from the reservoir in the instrument, and feeding the
liquid material from the proximal end to the distal end of the
instrument. Thereafter, the material is deposed on at least one
damaged surface of the joint. Analogous to the above, the material
is configured to assume a solid form under predefined conditions,
and when in the solid form the material has a resistance to wear
adapted to replace a worn out joint surface. In further analogy to
the above, irregularities may be repaired on one or both of the
opposing surfaces in the joint.
[0008] According to yet another aspect, the object is achieved by a
surgical method for treatment of arthrosis in a joint of a mammal
or human patient. This method involves inserting in a first
position an arthroscopic instrument into a joint to be treated. The
instrument here includes a camera for viewing the joint. This
method further involves providing a reservoir with a volume of a
biocompatible material in liquid form outside of a body containing
the joint. Moreover, the method involves inserting into the joint
an instrument having a general tube shape. A distal end of the
instrument is configured to be inserted into the joint, and a
proximal end of the instrument is connected to the reservoir.
Additionally, the method involves receiving the liquid material
from the reservoir in the instrument, and feeding the liquid
material from the proximal end to the distal end of the instrument.
Then, the material is deposed on at least one damaged surface of
the joint. The material is configured to assume a solid form under
predefined conditions, and again, when in the solid form the
material has a resistance to wear adapted to replace a worn out
joint surface. Naturally, here, the camera facilitates execution of
the method.
[0009] According to a additional aspect, the object is achieved by
a surgical method for treatment of arthrosis in a joint of a mammal
or human patient. The method involves inserting in a first position
an arthroscopic instrument into a joint to be treated. Here, the
instrument includes a camera for viewing the joint. The method
further involves inserting in at least one second position at least
one surgical instrument into the joint. Moreover, the method
involves providing a reservoir with a volume of a biocompatible
material in liquid form outside of a body containing the joint. The
method further involves inserting into the joint an instrument
having a general tube shape. A distal end of the instrument is
configured to be inserted into the joint, and a proximal end of the
instrument is connected to the reservoir. Furthermore, the method
involves inserting a mould member into the joint. The mould member
has a pre-produced shape adapted to a shape and size of at least
one damaged surface of the joint, so as contact and cover this
surface when the mould member is placed in the joint. The mould
member is also flexible, collapsible and has an internal volume
configured to be filled with liquid material received via the
instrument. The mould member is connected to the distal end of the
instrument. The method further involves form-fitting the mould
member to said at least one damaged surface, injecting the material
into the mould member through the instrument, and receiving the
material in the mould member. Then, after that the mould member has
been filled with the liquid material, the material is caused to
transition from the liquid form to a solid form. When in the solid
form the material has a resistance to wear adapted to replace a
worn out joint surface.
[0010] Here, the mould member facilitates targeting a predetermined
volume of the liquid material to a specific joint surface both in
terms of thickness and lateral coverage. Hence, an even better end
result may be attained.
[0011] According to yet another aspect, the object is achieved by a
surgical method for treatment of arthrosis in a joint of a mammal
or human patient. The method involves inserting in a first position
an arthroscopic instrument into a joint to be treated. Again, the
instrument includes a camera for viewing the joint. The method
further involves inserting in at least one second position at least
one surgical instrument into the joint. A reservoir is provided
with a volume of a biocompatible material in liquid form outside of
a body containing the joint. The method also involves inserting
into the joint an instrument having a general tube shape. A distal
end of the instrument is configured to be inserted into the joint,
and a proximal end of the instrument is connected to the reservoir.
Furthermore, the method also involves inserting a mould member into
the joint. The mould member has a pre-produced shape adapted to a
shape and size of at least one of the damaged surface, so as
contact and cover the damaged surface when the mould member is
placed in the joint. Additionally, the mould member is flexible,
collapsible and has an internal volume configured to be filled with
liquid material received via the instrument. The mould member is
connected to the distal end of the instrument. The mould member is
also form-fitted to the damaged surface, the material is injected
into the mould member through the instrument, the material is
received in the mould member. Then, after that the mould member has
been filled with the liquid material, the method involves causing a
transition of the material from the liquid form to a solid form.
When in the solid form the material having a resistance to wear
adapted to replace a worn out joint surface.
[0012] Preferably, the mould member is designed to be at least
partially removed after that the biocompatible material has become
solid, and the method involves removing (at least partially) the
mould member from the joint at an appropriate stage of the
procedure. Alternatively, the mould member may be configured to
disintegrate automatically, e.g. in connection with the material
becoming solid.
[0013] According to still another aspect, the object is achieved by
a method for surgically placing the above-proposed apparatus in a
patient via a laparoscopic abdominal approach. The method involves
inserting a tube-shaped instrument into the abdomen of the
patient's body. The method also involves supplying gas into the
patient's abdomen via the tube-shaped instrument, so as to expand
the patient's abdominal cavity. At least two laparoscopic trocars
are placed in the patient's body, and a camera is inserted through
one of the laparoscopic trocars into the patient's abdomen.
Additionally, the method involves inserting at least one dissecting
tool through one of the at least two laparoscopic trocars. The
method further involves dissecting a bone area opposite to the hip
region. At least one hole is drilled in the bone of the patient
from the abdomen reaching the hip joint, and through this at least
one hole surgery and treatment are performed for treating arthrosis
or osteoarthritis of the hip by using the proposed apparatus. This
approach is advantageous, since it provides convenient access to
the hip joint, while leaving the musculature surrounding the hip
joint essentially intact.
[0014] According to a further aspect, the object is achieved by a
method for surgically placing the above-proposed apparatus in a
patient via a femoral bone approach. This method involves cutting
the patient's skin at the lateral upper femoral region, and
drilling at least one hole in the bone of the patient through the
upper femoral region reaching the hip joint. Surgery and treatment
for treating arthrosis or osteoarthritis of the hip is then
performed through this at least one hole by using the proposed
apparatus. Hence, a damaged hip joint can be treated in a very
straightforward manner, which causes a low degree of discomfort to
the patient. Also in this case, the musculature surrounding the hip
joint is at most insignificantly influenced.
[0015] In any of the embodiments the material could comprise at
least one material selected from the group consisting of:
polytetrafluoroethylene, perfluoroalkoxy, fluorinated ethylene
propylene, polyethylene, and acrylic polymer mixed with alumina
trihydrate.
[0016] One advantage is that very small incisions is required.
Thus, the healing process after the surgery can be made relatively
short. Moreover, no healthy bone tissue is removed unnecessarily.
Further advantages, beneficial features and applications will be
apparent from the following description and the dependent
claims.
BRIEF DESCRIPTION OF THE DRAWINGS
[0017] Embodiments are now to be explained more closely, which are
disclosed as examples, and with reference to the attached
drawings.
[0018] FIG. 1 schematically illustrates an apparatus according to
one embodiment;
[0019] FIG. 2 illustrates how the hip joint of a patient may be
reached according to two embodiments;
[0020] FIG. 3 schematically illustrates how a mould member adapted
to a first joint surface is connected to the proposed apparatus
according to a first embodiment;
[0021] FIG. 4 schematically illustrates how a mould member adapted
to a second joint surface is connected to the proposed apparatus
according to a second embodiment;
[0022] FIG. 5 illustrates how the knee joint of a patient may be
treated according to one embodiment;
[0023] FIG. 6 illustrates how laparoscopic/arthroscopic trocars are
approaching the hip joint from the abdominal side of the pelvic
bone;
[0024] FIG. 7 illustrates how a hole is being created in the pelvic
bone from the abdominal side thereof;
[0025] FIG. 8 illustrates how a small hole is being created in the
pelvic bone from the abdominal side thereof;
[0026] FIG. 9 illustrates how a hole is being created in the
femoral bone from the lateral side of the patient;
[0027] FIG. 10 illustrates how a hole has been created in the hip
joint capsule.
[0028] FIG. 11a shows a mould placing instrument.
[0029] FIG. 11b shows a mould placing instrument.
[0030] FIG. 11c shows a mould placing instrument;
[0031] FIG. 12 shows the insertion of a mould;
[0032] FIG. 13a shows the insertion of a mould;
[0033] FIG. 13b shows the insertion of a mould;
[0034] FIG. 13c shows the filling of a mould;
[0035] FIG. 13d shows the hip joint in section after the mould has
been filled;
[0036] FIG. 14 shows the placing of a mould in the knee joint;
[0037] FIG. 15 shows the placing of a mould in the knee joint;
[0038] FIG. 16 shows the filling of a mould in the hip joint;
[0039] FIG. 17 shows the filling of a mould in the hip joint;
[0040] FIG. 18 shows the filling of a mould in the hip joint;
[0041] FIG. 19 shows the hip joint in section after the mould has
been filled;
[0042] FIG. 20 shows a medical device for injecting a fluid.
DETAILED DESCRIPTION
[0043] We refer initially to FIG. 1, which schematically
illustrates an apparatus for treatment of arthrosis in a joint
according to one embodiment. Typically, the joint is included in a
human patient. However, technically, any other mammal may equally
well be treated by means of this apparatus, e.g. a horse.
[0044] The apparatus includes a reservoir 110 and an instrument
120. The reservoir 110 is configured to hold a volume of a
biocompatible material in liquid form outside of a body containing
a joint to be treated. The biocompatible material in the reservoir
110 is initially liquid. However, under predefined conditions the
material is configured to assume a solid form. For instance, the
material may be liquid when its temperature is above a certain
level, and solid otherwise; or it may be liquid until it is exposed
to a specific type of radiation, say ultraviolet light. These
aspects will be elaborated below. In any case, when in the solid
form the material has a resistance to wear adapted to replace a
worn out joint surface.
[0045] The instrument 120 has a general tube shape, which may be
substantially more elongated than what is apparent from the
examples shown in FIG. 1. The instrument 120 may also be
articulated (i.e. including one or more links), so as to enable a
more convenient access to joint surfaces inside the body.
Irrespective of the length and specific design of the instrument
120, a distal end D thereof 120 is configured to be inserted into
the joint to be treated. A proximal end P of the instrument 120 is
connected to the reservoir 110 and configured to receive the
material in liquid form from the reservoir 110. The instrument 120
is further configured to feed the liquid material from the proximal
end P to the distal end D, such that the material can be deposed on
at least one damaged joint surface. This instrument could also be
inserted into the joint via an arthroscopic trocar i.e. inside
another tube, wherein the end of the instrument could be more
flat.
[0046] According to one embodiment, it is presumed that the
biocompatible material in the reservoir 110 is liquid because it
has an elevated temperature (i.e. above 37 degrees Celsius), say
50, 70, 90, 100, 150, 200, 300 or 400 degrees Celsius, or any other
temperature within an interval from 37 to 500 degrees Celsius.
Therefore, the reservoir 110 is configured to hold the
biocompatible material at the temperature in question, i.e. 50, 70,
90, 100, 150, 200, 300, 400 degrees Celsius or more. To this aim,
the reservoir 110 preferably includes at least one shield member
115, which is configured to isolate the reservoir 110 from the
patient's body. Naturally, if the biocompatible material in the
reservoir 110 is hot, the material will be hot also when passing
through the instrument 120. Hence, the instrument 120 preferably
likewise includes at least one shield member 125 configured to
isolate the body from liquid material. The material being injected
at a high temperature will damage the adjacent nerves, thereby
reducing the pain to the area of the joint. Suitable biocompatible
materials being liquid at an elevated temperature, and that become
solid when cooling off, may comprise fluoropolymers, e.g. in the
form of polytetrafluoroethylene, perfluoroalkoxy and/or fluorinated
ethylene propylene.
[0047] According to another embodiment, it is presumed that the
biocompatible material in the reservoir 110 contains two different
components. Each of these components is liquid when isolated from
the other component. However, when the components are mixed in
predefined proportions they develop a solid material. Hence, the
two components may represent a hardenable component and a hardening
agent respectively. In this embodiment, the reservoir 110 is
configured to hold the two components separated from one another
during an initial phase of a treatment. During a surgery phase
subsequent to the initial phase, the reservoir 110 is configured to
mix the two components into a mix. Here, the components are mixed
in such proportions that the mix remains liquid during a period
required to feed the mix through the instrument 120 to the at least
one damaged joint surface in the joint to be treated. Moreover, the
instrument 120 is configured to enable such a conveying of the
mix.
[0048] According to another embodiment, it is presumed that the
biocompatible material in the reservoir 110 is liquid due to the
fact that the material has not yet been exposed to a specific type
of radiation. For example, the material is configured to be liquid
if it has been exposed to electromagnetic radiation whose intensity
in a predefined spectrum is below a first predefined energy level
per unit volume; and the material is configured to be solid if it
has been exposed to electromagnetic radiation whose intensity in
the predefined spectrum is above a second predefined energy level
per unit volume. Here, the apparatus includes an electromagnetic
radiation source, which is configured to convey electromagnetic
radiation in the predefined spectrum to the at least one damaged
joint surface via the instrument 120. Thus, by activating the
radiation source after deposition of biocompatible material on the
joint surface, the material may be caused to transition from the
liquid form to a solid form.
[0049] According to another embodiment, it is presumed that the
biocompatible material in the reservoir 110 is liquid due to the
fact that the material has not yet been exposed to a specific type
of mechanical energy. For example, the biocompatible material may
be configured to be liquid when it has been exposed to ultrasonic
energy in a predefined spectrum whose intensity is below a first
predefined energy level per unit volume; and be solid when it has
been exposed to ultrasonic energy in the predefined spectrum above
a second predefined energy level per unit volume. Here, the
apparatus includes an ultrasound source configured to convey
ultrasonic energy in the predefined spectrum to the at least one
damaged joint surface via the instrument 120. Thus, by activating
the ultrasound source after deposition of bio compatible material
on the joint surface, the material may be caused to transition from
the liquid form to a solid form.
[0050] Preferably, since the bio compatible material will be
deposed in a patient's body, the reservoir 110 and the connection
between the reservoir 110 and the instrument 120 are configured to
maintain the material sterile throughout the entire procedure.
[0051] Furthermore, according to all aspects, it is advantageous if
the apparatus includes a light source 130 configured to illuminate
the joint being treated during deposition of the liquid material on
at least one damaged surface of this joint.
[0052] FIG. 2 illustrates how a damaged surface S of the hip joint
J of a patient is reached according to two embodiments. In both
cases the joint J is accessed through at least one bone of the
body, namely either by passing via the femoral bone 210 or the
pelvis bone 220
[0053] For example, the distal end D of the proposed instrument 120
may be inserted into the hip joint J by passing via the pelvis bone
220 from inside the abdomen, as illustrated to the right. Here, for
reasons of clarity, FIG. 2 only shows the distal-most end D of the
instrument 120 as a straight segment. However, of course, in order
to reach the joint J, the instrument 120 may be provided with one
or more links (not shown). According to one aspect, the apparatus
is surgically placed in the patient via a laparoscopic abdominal
approach, shown in FIG. 6. Specifically, this involves inserting
the tube-shaped instrument 120 into the abdomen of the patient's
body. Gas is then supplied into the patient's abdomen via the
instrument 120, so as to expand the abdominal cavity. At least two
laparoscopic trocars are placed in the patient's body, and a camera
is inserted through one of the laparoscopic trocars into the
patient's abdomen. Moreover, at least one dissecting tool is
inserted through one of the at least two laparoscopic trocars. The
method further involves dissecting a bone area opposite to the hip
region, and drilling at least one hole in the bone of the patient
from the abdomen reaching the hip joint, e.g. as illustrated in
FIG. 2. Surgery and treatment for treating arthrosis or
osteoarthritis of the hip joint J is then performed through this
hole by using the proposed apparatus.
[0054] Alternatively, the distal end D of the proposed instrument
120 may be inserted into the hip joint J by passing via the femoral
bone 210 of the body, as illustrated to the left in FIG. 2.
According to one aspect, the apparatus is surgically placed in the
patient via a femoral bone approach, which involves the following.
The patient's skin is cut at the lateral upper femoral region.
Then, at least one hole is drilled in the bone of the patient
through the upper femoral region reaching the hip joint J. Finally,
surgery and treatment is performed through this at least one hole
for treating arthrosis or osteoarthritis of the hip joint J by
using the proposed apparatus.
[0055] Preferably, the step of drilling the at least one hole in
the bone involves drilling the hole in such a way that a plug of
bone is detached into the abdomen. Prior to completing the
operation, the method further comprises replacing the plug.
[0056] The instrument 120 may also be configured to be inserted
into the joint J by passing via a capsula of the joint J.
[0057] Irrespective of how the joint J is accessed for treatment of
arthrosis therein, according to these embodiments, the method
involves the following. A volume of a bio compatible material in
liquid form is fed into the reservoir 110 of the apparatus. The
reservoir 110 is located outside of a body containing a joint J to
be treated. Then, the distal end D of the instrument 120 is
inserted into the joint J, and the proximal end P of the instrument
120 is connected to the reservoir 110. Subsequently, the liquid
material from the reservoir 110 is received in the instrument 120.
Thereafter, the liquid material is fed from the proximal end P to
the distal end D of the instrument 120, such that the material is
deposed on at least one damaged surface S of the joint J. Finally,
the material is caused to transition from the liquid form to a
solid form. When in the solid form, the biocompatible material has
a resistance to wear adapted to replace a worn out joint surface.
Namely, the material is configured to assume the solid form under
predefined conditions, for instance in response to a temperature
drop, or exposure to radiation.
[0058] FIG. 3 schematically illustrates how a mould member 140
adapted to a convex joint surface is connected to the proposed
apparatus according to one embodiment.
[0059] In addition to the embodiment shown in FIG. 1, the apparatus
of FIG. 3 includes a flexible and collapsible mould member 140.
This member 140 has a pre-produced shape adapted to a shape and
size of at least one damaged surface of a specific joint, for
instance the surface S of the femoral head represented in FIG. 2.
The shape and size of the at least one damaged surface may be
determined via a magnetic resonance imaging investigation, a
computer tomography x-ray investigation and/or via arthroscopy. The
pre-produced shape of the mould member 140 renders it adapted to
contact and cover the joint surface S.
[0060] Moreover, the mould member 140 is configured to be inserted
into the joint J in question and be form-fitted to the damaged
surface S. Depending on the location and type of joint, fitting the
mould member 140 to the surface S may require a number of
additional instruments (not shown). In any case, the mould member
140 is configured to be connected to the distal end D of the
instrument, 120 and when placed in the joint J, receive the
material in liquid form being fed through the instrument 120. The
mould member 140 has an internal volume that is configured to be
filled with liquid material received via the instrument 120.
Furthermore, after that the mould member 140 has been filled with
the liquid bio compatible material, the mould member 140 is
configured to enable the predefined conditions, which are required
to accomplish a transition of the biocompatible material from the
liquid form to the solid form.
[0061] Analogous to the embodiments described above with reference
to FIG. 1, the apparatus preferable includes a light source 130,
e.g. arranged in the instrument 120, configured to illuminate the
joint being treated during deposition of the liquid material in the
mould member 140.
[0062] It is further advantageous if an arthroscopic instrument
being inserted into the joint along with the instrument 120
includes a camera for viewing the joint.
[0063] Equivalent to the instrument 120 as such, the mould member
140 is configured to be inserted into the joint J by passing via a
bone 210 or 220 of the body. This may involve passing via a bone of
the body from inside the abdomen, or passing via the femoral bone
of the body.
[0064] According to some embodiments, the mould member 140 is
preferably adapted to be withdrawn (at least partly) from the joint
J after that the biocompatible material has assumed its solid
form.
[0065] FIG. 4 schematically illustrates how a mould member 140
having a pre-produced shape adapted to a concave joint surface is
connected to the proposed apparatus according to one embodiment.
Here, all reference signs which also occur in FIG. 1 or 3 designate
the same components/features as those described above with
reference to these figures.
[0066] According to one embodiment, the reservoir 110 is configured
to hold the material at an elevated pressure level exceeding the
normal atmospheric level. Thus, the mould member 140 may expand in
response to receiving the material. Naturally, this is applicable
to any configuration of the proposed mould member (i.e. not just
the specific design shown in FIG. 4).
[0067] Additionally, the apparatus may include an injection member
150 configured to inject the liquid material into the mould member
140 at the elevated pressure. Specifically, the material is
injected into the mould member 140 through the instrument 120. When
the mould member 140 has been filled with liquid material, this
material is caused to transition from the liquid form to the solid
form.
[0068] FIG. 5 illustrates how the knee joint J of a patient may be
treated according to one embodiment. Here, a mould member 140 is
form-fitted to one of the joint surfaces of the femur bone facing
the tibia bone 510, for instance by means of the apparatus shown in
FIG. 3.
[0069] Preferably, in this case, the distal end D of the instrument
120 is configured to be inserted into the joint J by passing via a
capsula of the joint J.
[0070] FIG. 6 shows a lateral view of the body of a human patient,
with the hip joint shown in section. The hip joint comprises a
caput femur 5 placed at the very top of collum femur 6 which is the
top part of the femur bone 7. The caput femur 5 is in connection
with the acetabulum 8 which is a bowl shaped part of the pelvic
bone 9. Laparoscopic/Arthroscopic trocars 33a,b,c is being used to
reach the hip joint 39 with one or more camera 34, a surgical
instrument 35 adapted to create a hole in the pelvic bone 9, or
instruments 36 for introducing, placing, connecting, attaching,
creating or filling a mould or an injected fluid.
[0071] FIG. 7 shows an embodiment, wherein the mould is to be used
for resurfacing the hip joint. For placing the mould in the hip
joint the hip joint needs to be reached, this could be through a
hole placed in the pelvic bone 9, the femoral bone 7 or the hip
joint capsule 12. FIG. 7 shows the hole 18 in the pelvic bone 9
according to a first embodiment, the hole 18 is large which allows
the mould to pass through said hole 18 in its full functional
size.
[0072] FIG. 8 shows the hole 20 according to a second embodiment
wherein the hole 20 created in a surgical or laparoscopic method is
much smaller allowing the surgical instrument creating the hole to
be smaller, and thus the incision and dissection performed in the
human body. To place the mould in the joint in this embodiment the
mould needs to be flexible or collapsible.
[0073] FIG. 9 shows the hip joint in section when creating a hole
in the femur bone 7. The hole in the femur bone passes through the
caput femur 5 into the hip joint and enables the surgeon to reach
the hip joint.
[0074] FIG. 10 shows the hip joint in section when creating a hole
in the hip joint capsule 12. The hole in the hip joint capsule
passes into the hip joint and enables the surgeon to reach the hip
joint.
[0075] FIG. 11a shows an instrument for placing a mould 81 in the
hip joint or the knee joint through a hole in the pelvic bone, the
femur bone, the hip joint capsule or an area of the knee. The
instrument comprises a piston 89 for transporting the mould 81 into
the joint.
[0076] FIG. 11b shows a section of the surgical instrument
comprising a tube like element 90 for housing of said mould 81.
[0077] FIG. 11c shows the surgical instrument according to another
embodiment in which the surgical instrument comprises a flexible or
bent part 91 improving the reach of the surgical instrument. The
surgical instrument according to any of the embodiments can be used
to place said mould 81 inside of a joint in any of the ways
described in the following embodiments.
[0078] FIG. 12 shows the step of placing a mould 81 inside of the
hip joint of a human patient through a hole 18 in the pelvic bone
9. The step of placing said mould 81 can be performed in a
surgical, or in a laparoscopic/arthroscopic method.
[0079] FIG. 13a,b,c,d shows an alternative approach to placing said
mould 81 in the hip joint of a human patient. Said alternative
approach comprises the steps of creating a hole 82 in the femur
bone 7 following a length axis of the collum femur 6, said hole
starting from the lateral side of the thigh, penetrating the cortex
of the femur bone 7 and eventually reaching the cortex of the caput
femur 5 from the inside thereof, penetrating said cortex and
entering into the hip joint. After the creation of the hole 82 in
the femur bone 7 the mould 81 is inserted into the hip joint
through the hole 82 using the surgical instrument 83 according to
any of the embodiments above, as shown in FIG. 13b.
[0080] FIG. 13c shows the mould 81 when being inserted into the hip
joint using the surgical instrument 83 adapted therefore.
[0081] FIG. 13d shows the mould 81 in place after insertion into
the hip joint, the surgical instrument used to place said mould 81
in the hip joint is retracted after the insertion is completed.
[0082] FIG. 14 shows the placing of a mould 81 in a knee 214 in a
surgical method. The mould 81 is placed using the surgical
instrument according to any of the embodiments above.
[0083] FIG. 15 shows the placing of a mould 81 in a knee 214 in a
laparoscopic/arthroscopic method. The mould 81 is placed using the
surgical instrument according to any of the embodiments above.
[0084] After the mould has been placed in the hip or knee joint it
is filled with a fluid adapted to harden to a medical device
adapted to serve as at least one artificial joint surface.
[0085] FIG. 16 shows the hip joint in section wherein an injecting
member 92 injects a fluid 93 into a mould 81 in the hip joint
through a hole 18 in the pelvic bone 9 from the opposite side from
acetabulum 8. The injecting member 92 comprises a piston 94 that
pushes said fluid 93 into the mould 81.
[0086] FIG. 17 shows the hip joint in section wherein an injecting
member 92 injects a fluid 93 into a mould 81 in the hip joint
through a hole 82 in the femur bone 7. The injecting member 92
comprises a piston 94 that pushes said fluid 93 into the mould
81.
[0087] FIG. 18 shows the hip joint in section, wherein an injecting
member injects a fluid 93 into a mould 81 in the hip joint through
a hole in the hip joint capsule 12. The injecting member 92
comprises a piston 94 that pushes said fluid 93 into the mould 81.
The fluid 93 is adapted to harden to create a medical device
adapted to serve as at least one artificial hip joint surface.
[0088] FIG. 19 shows the hip joint in section wherein the medical
device 93' is located between the acetabulum 8 and the caput femur
5 which has been created by the hardening of the fluid 93 adapted
to harden. Said medical device is adapted to serve as at least one
artificial hip joint surface. The hole in the pelvic bone is
preferably sealed with a bone plug 31 or a prosthetic part 98. The
mould 81 used to create the medical device 93' has been
removed.
[0089] FIG. 20 shows the injecting member 92 according to any of
the embodiments above, adapted to inject fluid 93 into a mould 81
in the hip joint or the knee joint. The injecting member 92 could
further be adapted to inject material 93 or a fluid 93 into a
connecting area between the pelvic bone 9 and a prosthetic part,
the pelvic bone 9 and a bone plug 31 or the caput femur 5 and a
prosthetic part. Said injecting member 92 comprises a container 107
adapted to hold a fluid 93 for injection. According to a first
embodiment said container 107 comprises two compartments 108a,b
adapted to hold two different fluids, said fluids being adapted to
harden when mixed. In the embodiment when the container 107 is
adapted to hold two fluids, it is conceivable that the injecting
member 105 further comprises a mixing member 109 wherein said two
fluids are being mixed before injection. According to a second
embodiment (not shown) said container 107 is adapted to keep said
fluid sterile. According to a third embodiment (not shown) said
container 107 is adapted to keep said fluid cold or hot and
according to a fourth embodiment (not shown) said container 107 is
adapted to keep said fluid in a dark environment. Furthermore a
combination of the above mentioned embodiments is conceivable.
[0090] The term "comprises/comprising" when used in this
specification is taken to specify the presence of stated features,
integers, steps or components. However, the term does not preclude
the presence or addition of one or more additional features,
integers, steps or components or groups thereof.
[0091] The reference to any prior art in this specification is not,
and should not be taken as, an acknowledgement or any suggestion
that the referenced prior art forms part of the common general
knowledge in Australia, or in any other country.
[0092] The invention is not restricted to the described embodiments
in the figures, but may be varied freely within the scope of the
claims.
* * * * *