U.S. patent number 3,702,611 [Application Number 05/155,718] was granted by the patent office on 1972-11-14 for surgical expansive reamer for hip socket.
Invention is credited to Meyer Fishbein.
United States Patent |
3,702,611 |
Fishbein |
November 14, 1972 |
SURGICAL EXPANSIVE REAMER FOR HIP SOCKET
Abstract
An expanding reamer is provided for surgical reaming of the
acetabulum in hip surgery. The reamer includes a head with a convex
end adapted to seat in a previously prepared concavity in the
central part of the acetabulum. This head pivotally mounts a set of
radially expansive blades. It is telescopically mounted on the end
of a rotary drive shaft, and the drive shaft mounts a cam actuator
which engages cam elements to expand the cutters progressively in
response to axial thrust exerted on the drive shaft by the surgeon
with the reamer head seated in the acetabulum. A spring is used to
contract the cutters when the reaming operation is interrupted.
Inventors: |
Fishbein; Meyer (Los Angeles,
CA) |
Family
ID: |
22556521 |
Appl.
No.: |
05/155,718 |
Filed: |
June 23, 1971 |
Current U.S.
Class: |
606/81; 82/1.2;
408/154; 408/159; 408/157 |
Current CPC
Class: |
A61B
17/1666 (20130101); Y10T 408/85884 (20150115); Y10T
82/12 (20150115); Y10T 408/8583 (20150115); Y10T
408/8585 (20150115) |
Current International
Class: |
A61B
17/16 (20060101); A61b 017/32 (); A61b 017/16 ();
B23b 051/00 () |
Field of
Search: |
;82/1.2 ;128/305,312
;408/154,157,158,159 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Pace; Channing L.
Claims
What is claimed is:
1. A rotary bone reamer for use in hip surgery, comprising:
a drive shaft having a rearward end and forward end adapted for
rotation from its rearward end by a driver;
a cutter head slidably mounted on the forward end portion of said
shaft for movement relative thereto between longitudinally extended
and longitudinally contracted positions, said cutter head having a
convex forward end wall adapted to seat in a previously prepared
concavity in the acetabulum;
a plurality of cutter blades pivotally mounted in said cutter head
to swing in spaced radial planes through the longitudinal axis of
said shaft between radially contracted and expanded positions;
a compression spring acting between said shaft and said cutter head
to yieldingly urge said shaft and cutter head toward a
longitudinally extended position of said shaft relative to said
head, and
actuator means on the forward extremity of said shaft for
operatively engaging said cutter blades to progressively expand
them radially in response to movement of said shaft from said
longitudinally extended position toward said longitudinally
contracted position.
2. The subject matter of claim 1, wherein said actuator means
includes camming means interacting said shaft and said cutters for
radially expanding said cutters in response to relative movement of
said shaft toward said cutter head.
3. The subject matter of claim 2, wherein said cutter blades have
cam slots convergent toward the forward end of the cutter head,
and
cam actuating pins mounted on said shaft and extending transversely
through said slots.
4. The subject matter of claim 1, wherein said cutter head
comprises a hollow cylinder, including also:
means detachably secured to the rearward end of said cutter head
including a rear closure wall for said hollow head,
a bearing sleeve for said shaft fixed to said closure wall and
affording said slidable mounting of said head on said forward end
portion of said shaft, and
said forward extremity of said shaft having thereon an enlarged
head normally yieldingly seated against the inner side of said
closure wall by said compression spring.
5. The subject matter of claim 1, including camming means
interacting between the forward end portion of said shaft and said
cutters for radially expanding said cutters in response to relative
displacement of said forward end portion of said shaft inwards into
said cutter head.
6. The subject matter of claim 1, wherein said cutter head
comprises a hollow cylinder, including also:
means detachably secured to the rearward end of said cutter head
including a rear closure wall for said hollow head,
a bearing sleeve for said shaft fixed to said closure wall and
affording said slidable mounting of said head on said forward end
portion of said shaft,
said head comprising a piston slidable longitudinally inside said
hollow cylinder,
radial slots in said piston receiving said expansive and
contractive cutter blades,
cam slots in said cutter blades convergent toward the forward end
of the cutter head, and
cam actuating pins mounted on said piston and extending
transversely across said radial slots in said piston and through
said cam slots in said cutter blades.
7. The subject matter of claim 1, including pivot pins on said
cutter blades and half-rounded grooves sunk in the inner side of
said forward end wall are used to pivotally mount said cutter
blades, and
a removable plate seated against said end wall and engaged by said
spring serves to confine said pivot pins in said grooves under the
pressure of said spring.
Description
FIELD OF THE INVENTION
This invention relates to expanding reamers employed in the
preparation of an acetabulum to receive a cup or artificial socket
used in "total-hip" reconstructive surgery.
BACKGROUND OF THE INVENTION
To explain the expression "total-hip" surgery, consider the
condition wherein the hip socket or acetabulum and the femoral head
are badly deteriorated due to arthritis. In elderly patients
particularly, this diseased condition dictates the removal of the
head (ball) of the femur and its replacement by a polished metal
ball with shaft anchored in the intramedullary canal of the femur.
To provide a proper bearing surface for the ball, one that will not
limit the normal motion of the leg, it is necessary to reform the
normal socket, or acetabulum, reaming away the diseased bone and
cartilage to make a new structural base to receive a metallic or
plastic artificial socket matched to the artificial femoral head.
The artificial socket is affixed within the reformed acetabulum by
means of an acrylic cement, or other suitable means.
In shaping the acetabulum to receive the artificial socket, the
acetabulum is undercut so as to provide a peripheral shoulder
against which the cement and artificial socket are seated and thus
anchored to the bony structure of the acetabulum.
To accomplish an undercut of the acetabulum, there was developed a
reamer whose cutting blades could be manually expanded
incrementally. To perform this undercutting task, this reamer, with
blades in a retracted position, is inserted into the acetabulum,
its location in the acetabulum being predetermined by a hole bored
in the center of the acetabulum. After inserting the expanding
reamer into the acetabulum, a wheel crank which is connected to a
cam is rotated to extend the blades into contact with the surface
of the acetabulum. The expanding reamer is then rotated, making the
first cut into the walls of the acetabulum bony structure. The
cutting operation is stopped momentarily, and a second extension of
the blades is made by an angular rotation of the wheel crank to
force the blades into a second, deeper engagement with the
acetabulum wall. The reamer is rotated again and the cut thus
deepened. Such progressive incremental cuts are performed until the
surgeon deems the size of the undercut sufficient to form a shelf
in the acetabulum to which the cement matrix and artificial socket
may be satisfactorily anchored.
The object of this invention is to produce an expanding reamer
whose blade extension may be controlled while the reamer is
rotating, without need to stop the cutting operation to
progressively extend the blades as bony structure is removed.
Further objects are to simplify current reamer designs so that
unskilled persons can easily disassemble for cleaning and
reassembly without the use of any tools, and to improve upon
current expanding reamers, which are subject to blades becoming
disengaged from their cam actuators, in a way that eliminates this
danger completely.
BRIEF SUMMARY OF THE INVENTION
The invention provides a reamer head which is telescopically
mounted on the end of a powered drive shaft. This head has a
convex, semi-spherical end face of the same diameter and radius of
curvature as a previously prepared concavity formed in the central
region of the acetabulum; and the purpose, of course, is to extend
or widen this previously prepared concavity, on the same spherical
curve, using continuously progressively expanding reamer cutters,
or under reamer cutters, so as to complete the new socket, but
leaving an undercut shoulder around its periphery. The extremity of
the drive shaft within the reamer head has a cam actuator which
coacts with cam formations on the expansive cutters, which are
pivotally mounted in or on the reamer head so as to expand in
radial planes of the drive shaft axis. Thus, with the convex end of
the reamer head seated in the acetabulum, as earlier described,
axial thrust on the rotating drive shaft operates through the cam
actuator and cam formations to expand the cutters continuously and
progressively as the work proceeds. Maintenance of this axial
force, and the outward extension of the cutters, keeps the cutters
in direct contact with the wall of the acetabulum as it is cut
away. At the point where the surgeon feels that the acetabulum wall
has been fully prepared, the rotation is stopped and axial thrust
removed. On removal of the axial thrust, a compression spring
returns the cutters to their contracted static position, and also
returns the drive shaft to its original extended position relative
to the reamer head.
BRIEF DESCRIPTION OF THE DRAWINGS
In drawings, showing present illustrative embodiments of the
invention:
FIG. 1, is a side elevation of a reamer in accordance with the
invention, with parts broken away;
FIG. 2, is a front elevation of the reamer of FIG. 1;
FIG. 3, is a section taken on the broken line 3--3 of FIG. 2;
FIG. 3a, is a view showing a fragmentary portion of FIG. 3, but
with the reamer cutters in expanded position;
FIG. 4, is a rear elevational view of the reamer of FIG. 1;
FIG. 5, is a section taken on line 5--5 of FIG. 3;
FIG. 6, is a section taken on line 6--6 of FIG. 3;
FIG. 7, is a side elevational view of a tool used in the initial
preparation of the socket prior to use of the invention;
FIG. 8, is a front elevational view of the tool of FIG. 7;
FIG. 9, is a diagram illustrating the preparation of a hip socket
which has been prepared with use first of the reamers of FIGS. 7-8,
and next the reamers of the present invention;
FIG. 10, is a side elevational view of another embodiment of the
invention;
FIG. 11, is a longitudinal sectional view of the embodiment of FIG.
10 being taken on the section line 11--11 of FIG. 12;
FIG. 12, is a section taken on line 12--12 of FIG. 11.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
Reference is first had to the embodiment of the invention shown in
FIGS. 1-6. A shaft 20, adapted at one end, as at 21, for coupling
to an electric drill motor, not shown, has telescopically mounted
on its opposite end a hollow cylindrical reamer head 22 with a
convex, forward, semispherical end 23. Pinned onto a reduced end
portion of shaft 20 is an actuator comprising a stem 24 having a
radially enlarged cylindrical head or piston 25 on which the head
22 is slidably mounted. A coil compression spring 26 seats in a
socket 27 in the end of stem 24, and bears at its other end against
a radially slotted disc 28 seated at the inner end of the bore 30
in hollow head 22, against the inside surface 30 of end wall
23.
The disc 28 has three radial slots 32, and aligned therewith are
three longitudinal slots 34 in the cylindrical side wall of head
22, as well as three radial slots 35 in the piston 25. These sets
of slots are spaced apart by 120.degree. and afford accommodation
for three radially expansive reamer blades or cutters 36.
The rearward end of the cylindrical side wall of head 22 is reduced
and screw threaded to receive a lefthand threaded nut 40 which
confines a disc 42 that shoulders against the end of the head 22,
and forms a closure and abutment facing the piston 25 mounted on
the end of shaft 20. Disc 42 mounts a hollow shaft 42' containing
bearing bushings 43 for the drive shaft 20.
The three cutters 36 are pivotally mounted inside the nose of the
head 22, by arrangements best seen in FIGS. 3, 3a, and 5. These
include three radially disposed slots 45 in the inner face of end
wall 23, merging with the three slots 34 in the side wall of the
head, as seen best in FIG. 5. These slots 45 receive the cutter
tails 47 which are provided with cross-pivot pins 48 receivable in
half-round grooves 49 sunk into the inner side of end wall 23,
crosswise of but not as deep as the slots 45. The disc 28 held in
place by the spring 26, engages and confines the pins 48, and thus
holds them pivotally seated in the grooves 49 under spring
compression.
FIG. 3 shows the cutters 36 pivoted inward to their normal
contracted position, with their inner edges 54 parallel to and in
engagement against the stem 24.
The spring 26 is at this time expanded, and the cutter head 22
longitudinally extended to its maximum relative to the shaft 20 on
which it is telescopically mounted. The cutters 36 have convex,
bevelled cutter edges 54 which in the limiting contracted position
of FIG. 3, emerge only to a small degree, appropriate for the
beginning of a reaming cut, outside the slots 35 in the head
22.
FIG. 3a shows the cutter head with cutters fully expanded. The
contour of the convex end 23 of the cutter head is substantially
spheric, and the convex cutter edges 54, when the cutters are
expanded, are substantial continuations of this spheric or
semi-spheric contour.
To progressively expand the cutters from the position of FIG. 3 to
that of FIG. 3a, the following means have been provided: pins 60
are set into piston 25 transversely across slots 35, and these pins
engage in cam slots 62 formed in the cutters 36. These slots open
through the rearward ends of the cutters to enable assembly with
the pins 60, and have initial portions 63 parallel to the axis of
the shaft 20, and secondary camming portions 64 which converge
toward said shaft. Accordingly, if head 23 is supported, and shaft
20 subjected to an axial force, to the left in the drawings, the
shaft progressively compresses spring 26, and the pins 60, working
in the angular portions 64 of the slots 62, cam the cutters
outwardly about the pivots 48. Thus, assuming an electric drill
motor, not shown, to be coupled to the shaft 20, the head of the
reamer seated in a concave cavity already formed in the hip socket
and the drill motor operated to rotate the shaft, forward pressure
on the drill motor forces the shaft 20 forwardly, and the cutters
are expanded in proportion to the pressure exerted until their
limit of expansion is reached. By progressive application of
pressure, the reamer cutters are progressively expanded, and the
expansion can be continuous, and as rapid as is consistent with
clean, stable cutting.
Reference is next directed to FIG. 9, showing the acetabulum of a
hip, which has been initially prepared for use of the present
reamer by use of a known cutter 58 shown in FIGS. 7 and 8. This
tool has a shank 60 for rotation by a drill motor, and a head 61
having a convex face 62, with an arcuate cutter blade 63 mounted
therein, conforming to but rising a short distance above the face
62, bevelled in back of sharpened cutter edges 64. This cutter is
used first to form the central portion of the socket, along the arc
a FIG. 9. The bone will remain at this stage outside the
cylindrical outline indicated at c. The tool of the invention is
then inserted and seated against the central portion of the
spherical socket as thus partly prepared (along region a), and then
operated as described just above. The cutters 36 will then
progressively expand responsively to the axial force exerted by the
surgeon on the drill motor, to make a final cut as out to the line
r. The cuts are manipulated by the surgeon generally so that the
cut at r leaves a shelf or shoulder at s. The artificial plastic
socket is then cemented in place according to techniques now in
use, making use of the shoulder s to assure good anchorage.
The cutter 58 in some case is formed with a center point 70 so as
to form a conical center hole 71 in the socket, and in such case,
the head of the reamer may, if desired, be formed with a center
cone 72 for seating in this center hole, although this is not
essential.
FIGS. 10 to 12 show a modification, having a number of parts
corresponding generally and substantially exactly in function to
components of the first described embodiment. These will be
identified by like reference numerals but with the suffix a added
in the embodiment of FIGS. 10-12. Redescription of these similar
parts will not be required.
One difference to be pointed out in the embodiment of FIGS. 10-12
is the substitution for the center point of a cylindrical centering
hub 74 which is adapted for insertion and free rotation in a hole
previously drilled at the inner end of the acetabulum. The spring
26a seats in a socket 75 inside this hub and there is in this case
no disc such as the disc 28 of FIGS. 1-6. The cross pins 28a are
confined but loosely enough to permit pivoting by hold down screws
77.
The drawings and descriptions disclose two present preferred
embodiments of the invention but it will be understood that these
are for illustrative purposes only and that various changes in
design, structure and arrangement may be made without departing
from the spirit and scope of the appended claims.
* * * * *