DE10297396T5 - Apparatus and method for bone surgery - Google Patents

Abstract

A surgical tensioning device for application to a bone, the tensioning device comprising:
Jig location means adapted to mate with bone formations to place the jig in a predefined relation to the bone; and
A surgical tool guide means arranged relative to the jig location means such that the surgical tool guide means are adapted to guide a surgical tool to a predefined location on the bone formation when the jig is adapted to the bone formation.

Description

Territory of invention

The The present invention relates to an operation apparatus and on operations procedures, and in particular on those that associated with bone related surgery either in humans or in animals.

The Invention is primary has been developed for use in hip replacement surgery and is described below with reference to such applications. It However, it should be noted that the apparatus according to the present invention is not limited to this particular field of application, but also can be adapted for use with any Bone structure and in relation to different types of surgery.

State of technology

techniques the hip replacement surgery The prior art typically involves a surgeon, the first to expose the hip joint a relatively large one makes initial incision. The surgeon then typically manipulates that Leg of the patient to the hip bone to dislocate. This often requires the application of significant force to effect the dislocation. Excessive manipulation and the application of force can be for the patient cause collateral damage, possibly in postoperative Pain and / or prolonged Healing time results. The head of the femur becomes then cut off at the neck. In the hip, a cavity is evacuated to a prosthetic acetabulum shell (e.g., a LINK T.O.P. acetabular cup), and a prosthetic Shank (e.g., a LINK C.F.P. Hip Shaft) is inserted into the shaft of the femur. The surgeon typically aligns the cutting and broaching tools with the eye, possibly minor misalignments result. However, if the prostheses Once installed, you can visually imperceptible misalignments between the prosthetic The acetabular shell and the prosthetic femur head. This can cause problems such as a malposition of the leg, an incorrect leg length and / or an incorrect soft tissue tension. Additionally, in the long run, misaligned prosthetic components wear out faster, which This can give rise to the aseptic loss of components and potentially an early one Repetition of the operation is necessary.

Any Discussion of the prior art in the description should by no means be understood as a concession, that such prior art is well known or part common more general Knowledge in this area was.

Summary the invention

It is an object of the present invention, at least one of Disadvantages of the prior art to eliminate or improve or a suitable alternative specify.

According to a first aspect of the present invention, there is provided a surgical tensioning device for application to a bone, the tensioning device comprising:
Locating means of the tensioning device configured to mate with bone formations to locate the tensioning device in a predefined relationship with the bone; and
A surgical tool guide means arranged relative to the locating means of the tensioning device such that the surgical tool guiding means is adapted to guide a surgical tool to a predetermined location in the bone formation once the tensioning device is adjusted to the bone formation.

According to a second aspect of the invention, there is provided a surgical tensioning device for use on a femur during a hip replacement operation, the tensioning device comprising:
at least one approach adapted to mate with a bone formation on the femur to place the tension device in a predefined relation to the femur; and
one or more slits disposed relative to the at least one lug so that the one or more slits are adapted to guide a blade to a predetermined location on the bone formation once the chuck is fitted to the femur.

Preferably The at least one approach is a pole attached to a head of the Clamping device is arranged to define an end that adapts is to attack a thigh bone formation, and around thereby the one or more slots in a predefined one To position relation to the femur formation.

Further includes, preferably, the tensioning device at a base of the head arranged contours leading to a femoral formation fit and trained to attack it.

• a) Freilegen einer ersten Oberschenkelknochen-Formation und einer zweiten Oberschenkelknochen-Formation des Patienten;
• b) Einsetzen einer Spannvorrichtung, die ein Führungsmittel für ein chirurgisches Werkzeug hat an der Oberschenkelknochen-Formation, derart, dass das Führungsmittel für das chirurgische Werkzeug nahe bei der zweiten Oberschenkelknochen-Formation ist;
• c) Verwenden des Führungsmittels für das chirurgische Werkzeug zum Führen eines Schneidwerkzeuges, um an der zweiten Knochenformation eine Osteotomie vorzunehmen; und
• c) Entfernen eines abgetrennten Oberschenkelknochen-Kopfes von dem Hüftgelenk des Patienten.

According to a third aspect of the invention, a method is proposed for performing a hip replacement operation on a patient, the method comprising the following steps:

• a) exposing a first femoral formation and a second femoral formation of the patient;
• b) inserting a tensioning device having a surgical tool guide means on the femur formation such that the surgical tool guiding means is close to the second femoral formation;
• c) using the guide means for the surgical tool to guide a cutting tool to osteotomize the second bone formation; and
• c) Removal of a severed femoral head from the patient's hip joint.

Preferably the first femoral formation is a larger trochanter, and the second femoral formation is a femoral neck.

• e) Platzieren eines Führungsdrahtes in einen Oberschenkelknochenkanal eines Oberschenkelknochen-Schafts des Patienten;
• f) Verwenden des Führungsdrahtes zum Führen eines flexiblen Räumers, um in den Oberschenkelknochenkanal eine Öffnung zu bohren;
• g) Einsetzen eines prothetischen Schaftes in die Öffnung, derart, dass ein erstes Ende des Schaftes von einem Ende des Oberschenkelknochen-Schaftes vorsteht;
• h) Platzieren des ersten Endes in einer Hüftgelenkpfanne des Patienten;
• i) Einsetzen von Abstandselementen zwischen das Ende des Oberschenkelknochen-Schaftes und die Hüftgelenkpfanne;
• j) Verwenden eines Abstandselementes zum Bestimmen von Referenzpunkten an einer Hüftgelenkpfanne des Patienten;
• k) Verwenden der Referenzpunkte zum Schaffen einer Führung zum Räumen der Hüftgelenkpfanne;
• l) Platzieren eines prothetischen Probekopfes an dem ersten Ende;
• m) Platzieren einer Probe-Hüftgelenkspfannen-Schale in der geräumten Hüftgelenkspfanne;
• n) Platzieren des prothetischen Probekopfes in der Probe-Hüftgelenkspfannen-Schale;
• o) Einsetzen von Abstandselementen zwischen das Ende des Oberschenkelknochen-Schaftes und der Probe-Hüftgelenkspfannen-Schale, bis eine erforderliche Passung zwischen dem Probekopf und der Hüftgelenkpfanne erzielt ist; und
• p) Korrelieren der Anzahl oder der Größe der Abstandselemente mit einer erforderlichen Größe einer prothetischen Komponente für den Oberschenkelknochen-Kopf und den Oberschenkelknochen-Hals.

The method in the preferred embodiment also comprises combinations of the following steps:

• e) placing a guidewire in a femoral canal of a thighbone shaft of the patient;
• f) using the guidewire to guide a flexible scraper to drill an opening in the femoral canal;
• g) inserting a prosthetic shaft into the opening such that a first end of the shaft protrudes from one end of the femoral shaft;
• h) placing the first end in an acetabulum of the patient;
• i) inserting spacers between the end of the femoral stem and the acetabular cup;
• j) using a spacer to determine reference points on an acetabulum of the patient;
• k) using the reference points to provide a guide for broaching the acetabular cup;
• l) placing a prosthetic specimen cup at the first end;
• m) placing a trial acetabular shell in the cleared acetabular cup;
• n) placing the prosthetic specimen cup in the trial acetabular cup;
• o) inserting spacers between the end of the femoral stem and the trial acetabulum cup until a required fit is achieved between the sample cup and the acetabular cup; and
• p) correlating the number or size of spacers with a required size of a prosthetic component for the femur head and thighbone neck.

• i) Freilegen eines größeren Trochanters, und eines Oberschenkelknochen-Halses des Patienten;
• ii) Osteotomieren des Oberschenkelknochen-Kopfes;
• iii) Einsetzen eines prothetischen Schaftes oder eines Probe-Schaftes in einen Oberschenkelknochen-Schaft des Patienten derart, dass ein erstes Ende des Schaftes über ein Ende des Oberschenkelknochen-Schafts vorsteht;
• iv) Positionieren des ersten Endes in eine Hüftgelenkspfanne des Patienten;
• v) Aufbringen von einem oder mehreren Abstandselementen auf das erste Ende des Schafts;
• vi) Verwenden des einen oder der mehreren Abstandselemente zum Bestimmen von Referenzpositionen an der Hüftgelenkspfanne; und
• vii) Verwenden der Referenzpositionen zum Führen beim Räumen der Hüftgelenkspfanne.

According to a fourth aspect of the present invention, there is provided a method of performing a hip replacement operation on a patient, the method comprising the steps of:

• i) exposing a larger trochanter, and a thighbone neck of the patient;
• ii) osteotomy of the femur head;
• iii) inserting a prosthetic shaft or a trial shaft into a femoral shaft of the patient such that a first end of the shaft protrudes beyond an end of the femoral shaft;
• iv) positioning the first end in an acetabulum of the patient;
• v) applying one or more spacer elements to the first end of the shaft;
• vi) using the one or more spacers to determine reference positions on the acetabular cup; and
• vii) Use the reference positions to guide when clearing the acetabular cup.

Preferably the one or more spacers comprise markings, which are adapted to display the reference positions. Further is also preferred that step vii) the determination of a center includes the reference items and the use of this center as a center for clearing.

• A) Freilegen eines größeren Trochanters und eines Oberschenkelknochenhalses des Patienten;
• B) Osteotomisieren des Oberschenkelknochen-Kopfes;
• C) Einsetzen eines prothetischen Schaftes oder eines Probe-Schaftes in einen Oberschenkelknochen-Schaft des Patienten derart, dass ein erstes Ende des Schaftes über ein Ende des Oberschenkelknochen-Schaftes vorsteht;
• D) Einsetzen einer prothetischen Hüftgelenkspfannen-Schale oder einer Probe-Hüftgelenkspfannen-Schale in eine geräumte Hüftgelenkspfanne des Patienten;
• E) Einbringen eines oder mehrer Abstandselemente zu dem ersten Ende des Schafts, bis in dem Hüftgelenkbereich des Patienten eine gewünschte Gewebespannung erzielt worden ist; und
• F) Korrelieren der Anzahl oder der Größe von Abstandselementen mit einer erforderlichen prothetischen Komponentengröße.

According to a fifth aspect of the present invention, there is provided a method of performing a hip replacement operation on a patient, the method comprising the steps of:

• A) exposing a larger trochanter and a femoral neck of the patient;
• B) osteotomy of the femur head;
• C) inserting a prosthetic shaft or a trial shaft into a femoral shaft of the patient such that a first end of the shaft protrudes beyond an end of the femoral shaft;
• D) inserting a prosthetic acetabular cup or trial hip cup into a cleared patient's acetabular cup;
• E) inserting one or more spacers to the first end of the shaft until a desired tissue tension has been achieved in the hip joint region of the patient; and
• F) Correlating the number or size of spacers with a required prosthetic component size.

Preferably the required prosthesis component size refers to a neck length a prosthetic component of the femur neck and Of the head. Furthermore, also preferably, at least some the spacers a thickness, corresponding to size increments between prosthetic components.

• A) Freilegen eines größeren Trochanters und eines Oberschenkelknochen-Halses des Patienten;
• B) Osteotomisieren des Oberschenkelknochen-Kopfes;
• C) Einsetzen eines prothetischen Schafts oder eines Probe-Schafts in einen Oberschenkelknochen-Schaft des Patienten derart, dass ein erstes Ende des Schaftes vorsteht über ein Ende des Oberschenkelknochen-Schafts;
• D) Einsetzen einer prothetischen Hüftgelenkspfannen-Schale oder einer Probe-Hüftgelenkspfannen-Schale in eine geräumte Hüftgelenkspfanne des Patienten; und
• E) Anbringen eines oder mehrerer Abstandselemente an dem ersten Ende des Schaftes, um eine erforderliche Orientierung der Hüftgelenkspfannen-Schale relativ zu dem Schaft zu determinieren.

According to a sixth aspect of the present invention, a method is proposed for performing a hip replacement operation on a patient, the method comprising the steps of:

• A) exposing a larger trochanter and a thighbone neck of the patient;
• B) osteotomy of the femur head;
• C) inserting a prosthetic stem or stem into a femoral stem of the patient such that a first end of the stem protrudes beyond an end of the femoral stem;
• D) inserting a prosthetic acetabular cup or trial hip cup into a cleared patient's acetabular cup; and
• E) attaching one or more spacer elements to the first end of the shaft to determine a required orientation of the acetabulum shell relative to the shaft.

According to a seventh aspect of the invention, a spacer is provided for use in a hip replacement operation, the spacer comprising:
a handle defining a first end; and
an alignment means disposed at or adjacent to the first end, the alignment means being adapted to mate with a prosthetic acetabular cup such that, in use, the cup is positioned in a predefined relation relative to an acetabulum of a patient.

According to an eighth aspect of the invention, an alignment handle is proposed for use in a hip replacement operation, the alignment handle comprising:
a body defining a distal end and a proximal end;
a gauge arranged at or near the proximal end; and
a connector located at or near the distal end for connection to
a prosthetic acetabular shell,
wherein the gage is adapted to indicate whether the prosthetic acetabular shell is in a predefined orientation with respect to at least a first plane in a frame of reference.

Preferably the reference system includes a local earth gravity field.

According to one ninth aspect of the invention, an alignment frame is provided, adapted for use with an alignment handgrip, such as described above, wherein the alignment frame comprises: a first end, adapted to abut against a flat surface around a second end of the Align alignment frame with respect to the flat surface; and at that second end arranged engaging means, which are adapted to Engagement with the alignment handle.

Preferably is the flat surface one side of a surgical table.

• a) Bohren eines Loches in den Oberschenkelknochen-Kopf, Einschrauben eines selbstschneidenden, mit Gewinde versehenen Gliedes in das Loch und Anwenden einer nach außen gerichteten Kraft auf das mit Gewinde versehene Glied, welche Kraft, in der Folge, aufgewandt wird auf den Oberschenkelknochen-Kopf; und/oder
• b) Zwängen eines Endes einer Kelle unter den Oberschenkelknochen-Kopf und Benutzen der Kelle als einen Hebel, um auf den Oberschenkelknochen-Kopf eine nach außen gerichtete Kraft aufzubringen.

According to a tenth aspect of the invention, a method is proposed for extracting a severed femoral head from the hip joint of a patient, the method comprising one or both of the following steps:

• a) Drilling a hole in the femur head, screwing a self-tapping threaded member into the hole and applying an outward force to the threaded member, which force, in turn, is applied to the femur head ; and or
• b) forcing one end of a trowel under the femur head and using the trowel as a lever to apply an outward force to the femoral head.

• a) Montieren der prothetischen Hüftgelenkspfannen-Schale an einem Schalen-Ausrichtwerkzeug;
• b) Positionieren des Schalen-Ausrichtwerkzeuges so, dass die prothetische Hüftgelenkspfannen-Schale benachbart zur geräumten Hüftgelenkspfanne ist;
• c) Orientieren des Schalen-Ausrichtwerkzeugs, um sicherzustellen, dass die prothetische Hüftgelenkspfannen-Schale in einer anatomisch korrekten Orientierung ist zum Einsetzen in die geräumte Hüftgelenkspfanne; und
• d) Einpressen der prothetischen Hüftgelenkspfannen-Schale in die geräumte Hüftgelenkspfanne.

According to an eleventh aspect of the invention, there is provided a method for inserting a prosthetic acetabular shell into the evacuated acetabulum of a patient during a hip replacement operation, the method comprising the steps of:

• a) mounting the prosthetic acetabular shell on a tray alignment tool;
• b) positioning the tray alignment tool so that the prosthetic acetabular cup is adjacent to the cleared acetabular cup;
• c) orienting the tray alignment tool to ensure that the prosthetic acetabular cup is in an anatomically correct orientation for insertion into the evacuated acetabular cup; and
• d) pressing the prosthetic acetabulum shell into the cleared acetabular cup.

• a) Installieren eines prothetischen Schaftes in den Oberschenkelknochen eines Patienten derart, dass ein Ende des Schaftes von einem Ende des Oberschenkelknochens vorsteht;
• b) Platzieren eines Probe-Kopfes auf dem Ende des prothetischen Schafts;
• c) Verwenden eines Ausrichtwerkzeuges für Abstandselemente zum Positionieren eines Abstandselementes zwischen dem Probe-Kopf und dem Ende des Oberschenkelknochens;
• d) Orientieren des Ausrichtwerkzeuges für das Abstandselement, um sicherzustellen, dass der Probe-Kopf sich in einer anatomisch korrekten Orientierung befindet;
• e) Überprüfen, ob die Beinlänge und/oder die Gewebe- und/oder Muskel-Spannung bei dem Patienten anatomisch korrekt ist;
• f) Wiederholen der Schritte c), d) und e) mit unterschiedlichen Abstandselement-Dicken oder Anzahlen von Abstandselementen, bis die Beinlänge und/oder die Gewebespannung und/oder die Muskelspannung des Patienten anatomisch akzeptabel sind, und Aufzeichnen der Abstandselement-Dicke oder der Anzahl der Abstandselemente, welche zu dem besten Resultat führt; und
• g) Korrelieren der Abstandselement-Dicke oder der Anzahl der Abstandselemente, die im Schritt f) bestimmt sind, mit der erforderlichen prothetischen Halslänge in Übereinstimmung mit einem vordefinierten Korrelierungsschema.

According to another aspect of the invention, a method is proposed for determining a size of a prosthetic neck length for a hip replacement operation, the method comprising the steps of:

• a) installing a prosthetic socket in the femur of a patient such that one end of the socket protrudes from one end of the femur;
• b) placing a trial head on the end of the prosthetic stem;
• c) using a spacer alignment tool to position a spacer between the probe head and the femur end;
• d) orienting the spacer alignment tool to ensure that the probe head is in an anatomically correct orientation;
• e) checking that the leg length and / or the tissue and / or muscle tension is anatomically correct in the patient;
• f) repeating steps c), d) and e) with different spacer thicknesses or numbers of spacers until the leg length and / or tissue tension and / or muscle tension of the patient is anatomically acceptable, and recording the spacer thickness or Number of spacers which leads to the best result; and
• g) correlating the spacer thickness or the number of spacers determined in step f) with the required prosthetic neck length in accordance with a predefined correlation scheme.

Short description the drawings

preferred embodiments The invention will now be described, for example only, with reference to the accompanying drawings, in which:

1 a perspective view of a clamping device according to the preferred embodiment of the present invention;

2 a top view of the in 1 shown clamping device is;

3 a side view of in 1 shown clamping device is;

4 a front end view of in 1 shown clamping device is;

5 a representation of a larger trochanter is shown in the femoral neck and femur head, with markings illustrating the locations at which the three available cutting lines intersect the femoral neck, and the manner in which the tensioning device engages the formations the thighbone attacks;

6 a perspective view of a spacer according to a preferred embodiment of the present invention;

7 a plan view of the in 6 shown spacer is;

8th Figure 3 is a perspective view of a trowel according to a preferred embodiment of the present invention;

9 to 16 including representations of steps involved in a method for performing a hip replacement operation according to the preferred embodiment of the present invention, wherein the 15 and 16 are schematic representations;

17 is a representation of a femur;

18 Fig. 10 is a plan view of another spacer according to the present invention;

19 a side view of the in 18 shown spacer is;

20 Figure 4 is a front elevational view of an alternative spacer according to the present invention;

21 a plan view of the spacer of 20 is;

22 a left-side view of the spacer of 20 is;

23 is a front view of yet another alternative spacer according to the invention;

24 Figure 5 is an enlarged partial view of a spacer illustrating the manner in which it engages an acetabular cup;

25 . 26 and 27 Side plan and end views are, respectively, to another preferred embodiment of a tensioner according to the present invention;

28 is a plan view of a drill;

29 is a plan view of a trowel;

30 is a plan view of an extractor;

31 and 32 Plan and side views respectively a thorn are;

33 and 34 Are plan views of respective left and right cup holders;

35 is a plan view of a handle device;

36 is a plan view of an alignment handle;

37 and 38 Are side and plan views respectively a first spacer;

39 and 40 Are side and plan views respectively a second spacer;

41 and 42 Are side and plan views respectively a third spacer;

43 and 44 Are side and plan views respectively an alignment frame;

45 a cross-sectional view of a mandrel or punching device is;

46 and 47 Plan and end views and a fastener of the driver are;

48 and 49 Plan and end views respectively of the drive head of the fastener of the driver are, in the 46 and 47 is shown;

50 and 51 Plan views of spacer members for operating on each of a left and a right hip;

52 and 53 Plan and end views respectively a medium with an additional spacer are;

54 and 55 Plan and end views and an additional spacing element with a thicker width are;

56 is a side view of a pin extractor;

57 and 58 Are plan and end views respectively a pen;

59 to 62 Plan views of screws are;

63 . 64 and 65 Side plan and end views, respectively, of another embodiment of a tensioning device according to the invention are;

66 Fig. 10 is a perspective view of a patient just prior to beginning a hip replacement operation, showing a pelvic holder and the location of the initial incision relative to the prominency of the larger trochanter;

67 Figure 4 is a perspective view showing a tensioning device according to a preferred embodiment of the invention applied to a femur prior to separation of the femoral neck;

68 is a perspective view showing one end of the extractor of 30 shows that has been applied to a severed femoral head;

69 Figure 3 is a perspective view showing part of a tray alignment tool used in a patient's acetabular cup; and

70 Figure 12 is a perspective view showing part of a spacer alignment tool applied to a patient's acetabular cup.

detailed Descriptions of Preferred Embodiments

Referring to 1 is the surgical jig 1 adapted for use on a bone, eg on a femur 2 Although it is readily apparent that with detailed changes, the inventive concept can also be applied to clamping devices that are adapted for application to other bones. How best in 17 shown includes the femur 2 a femur head 3 , a thighbone neck 4 which is often, although not exclusive, the site for the incision, and the larger trochanter 5 , If the surgeon chooses to use LINK TOP acetabulum cups and CFP stems during hip replacement surgery, the femur head must 3 osteotomised (in other words, to be cut off), the incision taking place along a line transverse to the femur neck at a position about 1.5 cm away from the base of the larger trochanter 5 , Of course, other prostheses, such as MARGRON THR and SP2 equipment, may require that the incision be made elsewhere thighbone 2 takes place, for example, across the larger trochanter 5 , For such applications, the geometry of the clamping device 1 adapted as required.

The tensioning device 1 includes jig location or placement means 6 adapted to mate with bone formations 3 . 4 and 5 to the clamping device 1 in a predefined relation to the bone 2 to arrange. The tensioning device 1 further comprises guiding means 7 for a surgical tool so arranged relative to the chuck arrangement means 6 that as soon as the jig 1 to the bone formations 3 . 4 and 5 has been adapted, the surgical tool guide means are adapted to guide a surgical tool, eg a reciprocating blade, to a predefined location on the bone formation.

The tensioning device 1 includes a body 8th , One aspect of the jig arrangement means 6 takes the form of first and second opposing approaches 9 and 10 on, on the body 8th are arranged. The approaches 9 and 10 are adapted to mate with the femur neck 4 , Each of the approaches 9 and 10 has an elongated dimension that is oriented so that the elongated dimension of the lugs 9 and 10 is oriented in substantially the same direction as a longitudinal dimension of the femur neck 4 as soon as the tensioning device 1 to the thighbone neck 4 is adjusted. This is best in 5 shown where the lines 11 and 12 the places show where the approaches 9 and 10 each attack on the thighbone neck. The approaches 9 and 10 are with the thighbone neck 4 can be brought into a snap-fit procedure. Each of the approaches 9 and 10 is arcuate with a center of curvature extending along the longitudinal dimension.

Another aspect of the chuck assembly means 6 is an area 13 adapted to receive a bone formation, eg a femur head 3 , In the preferred embodiment, the surface defines 13 an inverted V-shape, as best in 4 shown. The inverted V-shaped surface 13 is formed by an inverted V-shaped member 14 that on the body 8th over a transversely extending member 16 is arranged. The inverted V-shaped member 14 is transversely offset to the lugs 9 and 10 , The section of the femur head 3 over which the inverted V-shaped member 14 is applied is in 5 through the lines 15 shown.

Yet another aspect of the root device locator 6 is a side wall 17 of the body 8th which is shaped to fit a bone formation. More specific is the sidewall 17 arcuate and formed with a curvature shaped to conform to a natural curvature of the larger trochanter 5 is applied. The line along which the side wall 17 on the natural curvature of the larger trochanter 5 is substantially applied, is best by the line 18 in 5 shown.

• • die Ansätze 9 und 10, die den Oberschenkelknochen-Hals umfassen;
• • das V-förmige Glied, das sich um zumindest einen Teil des Oberschenkelknochen-Kopfes windet, und
• • die bogenförmige Seitenwand 17, die an der natürlichen Krümmung des größeren Trochanters anliegt.

Therefore, the preferred embodiment fits into the 1 to 5 shown clamping device 1 with bone formations on the femur 2 together, via:

• • the approaches 9 and 10 that include the thighbone neck;
• The V-shaped member which winds around at least part of the femoral head, and
• • the arcuate side wall 17 , which is due to the natural curvature of the larger trochanter.

These locators assist each other in combination to ensure that the tensioner 1 exactly on the thighbone 2 placed and held in position, with the alignment prior to the separation of the femur neck 4 , Alternatively, the tensioning device could 1 also be oriented in reverse, so that the inverted V-shaped member 14 against the thighbone neck 4 is present, and the approaches 9 and 10 against the thighbone head. The positioning can be further ensured by driving one or more fasteners such as pins through the body 8th or the approaches 9 and 10 in the femur head 3 , Of course, damage to the femur head resulting from the fasteners is 3 of little importance, since the head 3 is to be separated. The pinning of the tensioning device 1 on the thighbone 3 can then be used to assist in removing the femur head after the incision, as discussed in more detail later.

The guide 7 for the surgical tool is between the inverted V-shaped member 14 and the approaches 9 and 10 arranged. This contributes to the tensioning device 1 in their leadership task against rotation or dislocation as a result of forces from the surgical tool to the tensioning device 1 can be transferred to support. The guide 7 for the surgical tool has the shape of one or more slits 20 in the body 8th are provided. The preferred embodiment has three slots 20 , Each slot is located at a different transverse position on the body 8th to allow the slots 20 lead a surgical tool to more than one predefined location on the bone formation. The predetermined locations are selected to correspond to differently sized prostheses. For example, one type of prosthesis requires the thighbone neck 4 is separated at a position which is 1.5 cm from the base of the larger trochanter, so therefore one of the slits 20 is arranged so that it leads the surgical tool to this position. Each of the slots 20 extends across the body 8th and is adapted for receiving and guiding a surgical tool, such as a reciprocating blade, such as a jigsaw. The positioning of the slots 20 as soon as the tensioning device 1 once on the femur 2 is set, is by lines 21 in 5 shown. Other preferred embodiments (not shown) are adapted for guiding different tools, for example, a tool guide means is a hollow cylindrical member adapted to guide a rotating drill bit.

Although this in the 1 to 4 not shown, the preferred embodiment includes one on the body 8th arranged handle. The handle has a length sufficient to extend outwardly from a patient once the jig is in place 1 adapted to the bone formation. This allows the surgeon to use the tensioning device 1 Manipulate past the patient's flesh until it reaches the thigh bone 2 matches.

• • zur Verwendung an Patienten, die eine starke anatomische Deformation des Oberschenkelknochenkopfes oder des Oberschenkelknochenhalses haben; oder
• • falls der Patient fettleibig ist, weil dies die Ertastung von anatomischen Charakteristika schwierig macht.

The preferred surgical procedure according to the present invention is particularly adapted to hip replacement surgery in cases of bone arthritis, rheumatoid arthritis and bone deterioration. However, the procedure is generally not recommended in the following circumstances:

• • for use on patients with severe anatomical deformity of the femoral head or thighbone neck; or
• • if the patient is obese, because this makes it difficult to sense anatomical characteristics.

During the execution of the preferred method of performing a hip replacement operation on a patient is a surgical approach from the side behind Although other surgical approaches are sufficient, too. In fact, others can surgical approach procedures be required if there is a contraindication to a surgical approach from the rear side, for example as a consequence of a preceding one Serious injury to the sciatic nerve.

The preferred method begins with a step a) - expose a larger trochanter 5 and the thighbone neck 4 of the patient. This implies that an initial incision is made in a thigh of the patient, which is between 3 cm and 7 cm, preferably 5 cm long. One end of the incision begins about 1 cm to 3 cm behind the larger trochanter 5 and bends backwards from there. The posterior aspect of the femoral neck 4 is uncovered by loosening a patient's tendon tendon, which can be attached for later re-attachment. A capsulectomy is also performed to the thighbone neck 4 fully expose. It is important to note that at this stage the femur head 3 not dislocated. The leg of the patient is held in a position of about 45 ° to the vertical, preferably by a leg holder. It can also help the surgeon to use a head lamp.

Step b) involves applying the tensioning device 1 that's the guide 7 for the surgical tool has, on the thigh bone 2 such that the guide means 7 for the surgical tool are proximal to the femur neck 4 , as in 9 shown. The tensioning device 1 is preferably formed as described above. A proper adjustment of the tensioning device 1 on the thigh bone 2 results in that the guiding means 7 for the surgical tool at about a predefined distance from the base of the larger trochanter 5 are arranged. In particular, the predefined distance is between 10 mm and 20 mm, and in the preferred embodiment, at least one of the slots 20 , 15 mm from the base of the larger trochanter 5 arranged away.

Optionally, the surgeon may have a depression or notch 22 in the thighbone neck 4 on the side of the femur head 3 at the point 26 of the separation cut. The depression or notch 22 is, preferably, shaped before the bone separation cut. The indentation can be formed by momentarily pressing a reciprocating jigsaw blade into the femur neck 4 or head 3 ,

Step c) involves the use of the surgical tool guiding means to guide a cutting tool to sever the femoral neck. Typically, the blade of a jigsaw passes through one of the slots 20 Guided to get in the place of bone separation against the femur neck 4 although other cutting means could be used as well. The jigsaw is then turned on, which causes the jig saw Cutting blade reciprocates, and that the jigsaw blade progressively transverse to the femur neck 4 is moved, as through the slot 20 Run until the thigh bone head 3 and part of the femur neck 4 are separated.

Step d) involves removing a severed femoral head from the patient's hip joint. To achieve this, a number of different techniques can be used. For example, a like in 8th shown trowel 23 used to separate the thighbone head 4 to pry out of the hip joint. The depression 22 may represent a convenient spot from which the thighbone head 3 with the trowel 23 , as in 10 ge shows, can be leveraged. An area 24 the trowel 23 is equipped with cutting means, such as a sharpened edge, to help sever the tendon 25 to assist the thigh bone head 3 inside the hips 26 holds. The sharpened edge 24 is between two protrusions 27 and 28 arranged, which help the surgeon, the trowel 23 to manipulate that sharpened edge 24 to the tendon 25 is directed. In other words, the surgeon places the trowel 23 so that the projections 27 and 28 on each side of the tendon 25 lie, and then the trowel along its longitudinal axis to the tendon 25 shifted so that the sharpened edge 24 the tendon 25 separates.

An alternative method of removing the femur head 4 can be applied if, as mentioned above, the tensioning device on the femur head 3 has been fixed by pins. In this case, the tensioning device can 1 Force be exercised, which over the pins on the femur head 3 is transferred. In some cases, this force alone may be enough to head the femur 3 to remove from the hip joint. In other cases, this force may assist other removal means, such as the trowel mentioned above 23 ,

It will be apparent to those skilled in the art that severing the thighbone neck 4 before removing the severed femoral head 3 advantageously avoids the need for prior dislocation of the hip joint in the prior art, whereby the damage caused thereby avoided or minimized and the surgical procedure is simplified. After removing the severed femur head 3 For example, the hip replacement operation may be completed in accordance with prior art techniques. However, a number of further improvements to a known surgical procedure are explained below.

• e) Platzieren eines Führungsdrahtes in den Oberschenkelknochenkanal 30 eines Oberschenkelknochen-Schaftes 31 des Patienten; (siehe 11);
• f) Verwenden des Führungsdrahtes 29 zum Führen eines flexiblen Räumers, um in den Oberschenkelknochenkanal 30 eine Öffnung zu bohren; und
• g) Einsetzen eines prothetischen Schaftes 33 in die Öffnung derart, dass ein erstes Ende 34 des Schaftes 33 von einem Ende des Oberschenkelknochen-Schaftes 31 vorsteht. Alternativ ist es möglich, anstelle des endgültigen Schaftes 33 einen herausnehmbaren Probe-Schaft zu verwenden. Sobald das Ersatz-Hüftgelenk dann einmal überprüft worden und ein zufriedenstellendes Resultat erhalten worden ist, werden die echten Komponenten anstelle der herausnehmbaren Proben-Komponenten implantiert.

One known method for implanting a prosthetic shaft into the femoral stem involves driving a bone compressor into the canal of the femur. An alternative given in the preferred embodiment of the present invention comprises the steps:

• e) placing a guidewire in the femoral canal 30 a thighbone shaft 31 the patient; (please refer 11 );
• f) using the guidewire 29 for guiding a flexible scraper to enter the femoral canal 30 to drill an opening; and
• g) insertion of a prosthetic shaft 33 in the opening such that a first end 34 of the shaft 33 from one end of the femoral shaft 31 protrudes. Alternatively, it is possible to replace the final shaft 33 to use a removable probe shaft. Once the replacement hip joint has then been checked and a satisfactory result obtained, the true components are implanted in place of the removable sample components.

• h) Platzieren des ersten Endes 34 in einer Hüftgelenkspfanne des Patienten;
• i) Einsetzen von Abstandselementen 35 (auch als Lollipops bezeichnet) zwischen das Ende des Oberschenkelknochen-Schafts 31 und die Hüftgelenkspfanne;
• j) Verwenden eines Abstandselementes 35 zum Bestimmen von Referenzpunkten 36 an einer Hüftgelenkspfanne des Patienten (siehe 12); und
• k) Verwenden dieser Referenzpunkte 36 als eine Leitlinie zum Räumen der Hüftgelenkspfanne.

The known method of evacuating a cavity into the acetabular cup involves aligning the broach with the eye. In contrast, the step of reaming the acetabular cup for fitting a prosthetic acetabular cup according to the preferred embodiment of the present invention comprises the following steps:

• h) Placing the first end 34 in an acetabulum of the patient;
• i) insertion of spacer elements 35 (also called lollipops) between the end of the femoral shaft 31 and the acetabular cup;
• j) Using a spacer 35 for determining reference points 36 on an acetabulum of the patient (see 12 ); and
• k) Using these reference points 36 as a guideline for clearing the acetabular cup.

More specific are the examples of spacers used in step i) 35 in the 6 and 7 shown. Its purpose is to place the thighbone in approximately the position it will take once the operation is completed. marks 40 at the spacers 35 provide a guideline for determining the reference points in step j). Preferably, the reference points 36 burned into the acetabulum using a heating element similar in function to the heated tip of a soldering iron. The distance island mente 35 include a handle 37 and a slot 38 to place on the first end 34 of the prosthetic stem 33 ,

The center of the reference points created in step j) 36 shows the starting point for clearing the acetabulum in step k). This provides a more accurate and consistent alternative to the prior art clearing technique, where alignment is performed with the eye.

Other examples of spacers 100 which can be used in steps i) and j) are in the 20 to 24 shown. These spacers 100 include an outer peripheral edge 123 having a radius of curvature substantially corresponding to a radius of curvature of a prosthetic acetabular shell 104 , In the preferred embodiment, the radius matches the curvature of the outer peripheral edge 123 to a radius of curvature of the smallest value of a range of prosthetic acetabular cups 104 , In step j), the surgeon uses the border 123 as a guide in branding the reference points 36 in the acetabular cup before clearing in step k).

The surgical procedure in a conventional hip replacement involves the surgeon making an informed assessment of the required size of the prosthetic components, such as a prosthetic neck / head length and the size of the acetabulum shell. Then, the hip joint is temporarily assembled using sample components that have the estimated size. If the resulting trial joint is unsatisfactory, for example as a result of incorrect tissue tension, the joint is dissected and different sized trial components are used. The preferred method of the present invention offers an alternative to this known procedure by again selecting the spacers 35 be used. How best in 18 shown has one or more of the spacers 35 or 45 a centrally located spherical surface 48 , which provides the shape of a femur head, and functions as a trial femur head. In some embodiments, the spherical surface is 48 a hemisphere corresponding to a part of a prosthetic head. The spherical surface 48 having spacer element 35 or 45 is at the first end 34 of the shaft 33 placed next to the acetabulum shell, leaving the spherical surface 48 the hip joint cup shell is opposite. The fat 39 each spacer 35 is selected with regard to available sizes of prosthesis components. For example, one prior art prosthetic component is available in three sizes, 40mm, 43.5mm, and 47mm. In this case, the thickness is 39 of at least two spacers 35 3.5 mm to correspond to the size increments between the available prosthesis components. These two spacers have flat parallel surfaces 46 and 47 , The effects of determining adjustment positions for different sized prosthesis components can be achieved in the same way by using different numbers or thicknesses of spacers 41 , For example, the edges of three spacers 35 shown to the first end 34 of the prosthetic stem 33 in 14 are applied. This provides a distance as would be achieved using the 47 mm prosthetic component. If two of the spacers 35 used, this gives a distance that can be assigned to a 43.5 mm prosthetic component, etc. As in 14 best shown is another spacer element 45 wedge-shaped. The wedge shape determines the anteversion (or "orientation") of the prosthetic acetabular shell and prosthetic femoral stem. An inverted wedge shape is required if a surgical approach is applied from the front or from the front and to the side. The wedge shape tapers from a maximum width of 14 mm to a minimum width of about 3.5 mm.

Other embodiments of spacers 100 adapted to regulate the anteversion of the prosthetic acetabular shell 103 are in the 20 to 24 shown. The spacer element 100 includes a handle 101 that's a first end 102 Are defined. At or adjacent to the first end 102 are alignment tools 103 intended. The alignment means 103 are adapted for mating with a prosthetic acetabular shell 104 , such that when used the shell 103 is positioned in a predefined relation with respect to an acetabular cup of a patient.

The alignment means 103 define a level 105 Adapted to concern at a corresponding level 106 the prosthetic acetabular shell 104 , The alignment means 103 include engaging means which take the form of one or more lugs 119 which are adapted to engage an internal concave surface 120 the prosthetic acetabular shell 104 , The level 105 is defined by a semicircular surface 107 and is at an acute angle 111 in relation to a plane 112 Arranged by the handle 101 is defined. As a result, the alignment means 103 the shape of a wedge-shaped limb 110 that at the first end 102 is arranged. Preferably, the angle is 111 within the range from 5 ° to 25 °. Even better, the angle is 111 within the range of 10 ° to 20 ° and is the angle 111 in the preferred embodiment about 15 °. This angle 111 is chosen to correspond to a natural angle of inclination of the hip joint.

In the preferred embodiment, the geometry of the alignment means with respect to the handle is selected to fit laterally for surgical approach to the hip operation. Of course, other surgical approaches may require having slightly varied geometries, such as the different handle geometry used in the art 23 shown and compared to 20 adapted to other surgical approaches. The general goal is to make sure the alignment device 103 the prosthetic acetabular cup 104 positioned with an anteversion substantially identical to the desired anteversion of the prosthetic cup 104 after completion of the operation, as soon as the spacer element 100 at an exposed end 34 a prosthetic thighbone shaft 33 is appropriate.

The alignment means 103 include a slot 108 adapted to receive a protruding end 34 a prosthetic thighbone shaft 33 , As soon as the end 34 of the shaft 33 once inside the slot 108 is placed, the spacer engages 100 on the shaft 33 in a similar way, as well as the spacer element 45 at the shaft end 34 in 14 attacks.

Angular skew of the prosthetic acetabular cup relative to the prosthetic stem 33 should reflect the natural geometry of the hip joint as accurately as possible. If the spacer element 100 around a rotation axis 118 is rotated, the direction of the 15 ° inclination changes. To give the surgeon a guide, whether the alignment means 103 positioned in the predefined relation with respect to an acetabular cup of a patient is on the spacer element 100 at or adjacent to the second end 113 an orientation guide 109 intended. The orientation guide 109 includes a lace or rotary pointer 114 standing on the spacer 100 is rotatably arranged so that it depends substantially vertically under the influence of gravity. The lace 114 is on a circular member 115 of the spacer element 100 by means of a pen 116 rotatably fixed. At the spacer element 100 is a reference point 117 arranged, such that the lace 114 in alignment with the reference point 117 depends if the alignment means 102 are positioned in the predetermined relation with respect to an acetabular cup of a patient. In other words, the lace hangs 114 in alignment with the reference point 117 as in the 20 and 23 shown as soon as the spacer element 100 the required rotational position with respect to the axis of rotation 118 has taken. So if the patient lies on his side, then the slot 108 in agreement with the end 34 of the prosthetic stem and becomes the spacer element 100 around the axis 114 Turned until the lace 114 with the reference point 117 aligned, and then becomes the prosthetic acetabular shell 103 the required anteversion in relation to the shaft 33 to have. This means that the spacer ensures, if used correctly, that the thicker end 121 of the wedge-shaped member 110 Aligned to the front of the patient while the thin end 122 is aligned to the back of the patient. Thus, the 15 ° slant points to the outer front of the patient, reflecting the natural geometry of the hip joint.

• l) Platzieren eines Probe-Kopfes 41 auf dem ersten Ende 34;
• m) Platzieren einer Hüftgelenkspfannen-Probe-Schale 42 in der geräumten Hüftgelenkspfanne (siehe 13);
• n) Platzieren des Probe-Kopfes 41 in die Hüftgelenkspfannen-Probe-Schale 42; und
• o) Einsetzen eines oder mehrerer Abstandselemente 35 zwischen das Ende des Oberschenkelknochen-Schaftes 31 und des Hüftgelenkspfannen-Probe-Kopfes 41, bis eine erforderliche Passung zwischen dem Probe-Kopf 41 und der Hüftgelenkspfannen-Probe-Schale 42 erzielt ist (siehe 13, 14, 15 und 16); und
• p) Korrelieren der Anzahl oder der Größe an Abstandselementen 35 mit einer erforderlichen Größe einer prothetischen Komponente.

More specifically, the preferred method for determining the required size of prosthetic components comprises the following steps:

• l) Placing a probe head 41 on the first end 34 ;
• m) placing an acetabulum sample cup 42 in the cleared acetabulum (see 13 );
• n) Placing the probe head 41 in the acetabulum sample cup 42 ; and
• o) inserting one or more spacer elements 35 between the end of the femoral shaft 31 and the acetabulum probe head 41 until a required fit between the probe head 41 and the acetabulum sample cup 42 achieved (see 13 . 14 . 15 and 16 ); and
• p) correlating the number or size of spacers 35 with a required size of a prosthetic component.

The surgeon determines at step o) if there is a required fit between the trial head 41 and the acetabulum sample cup 42 by checking factors such as tissue tension, component alignment, leg length, etc. Once the required prosthetic component size has been determined in step n), the prosthetic trial components become 41 and 42 ( 15 ) replaced by the final prosthetic components 43 and 44 ( 16 ), although the acetabulum cup has not yet been inserted at this point. Another use of spacers 35 determines the final and exact orientation of the shell 44 opposite the shaft 33 , and only then will the shell 44 firmly attached to permanently attach in place. A lining is placed in the hip directing pans shell 44 brought, followed by the prosthetic head 43 , then the hip joint is reduced or moved. Then, once the required range of motion of the new joint has been confirmed, the layers are closed and the triceps tendon is fixed again.

The in the 25 to 65 illustrated instruments collectively form a preferred embodiment of a kit for performing the preferred surgical procedure. This preferred surgical procedure begins by positioning the patient in the transverse position with the operative side all the way up, as best shown in FIG 66 shown. Appropriate is a cymbal holder 230 used to set the patient in the required position. Preferably, the limb temperature of the patient is also lowered before and during the operation. The exposure of the trochanter begins with a 5 cm long incision along a line 231 , which is made about 2 cm behind the prominence (as a line 232 in 66 shown) of the larger trochanter 5 , Then the fascia of the sphincter is incised and the surgeon performs a blunt dissection until the neck 4 of the femur 2 is exposed. Under the skin line, intermittent automatic holders are used. The posterior aspect of the femoral neck 4 is uncovered by severing the tridentital tendon and short external rotators that are attached for later re-attachment. Capsuleectomy exposes the trochanteric fossa (ie, the base of the larger trochanter 5 ) and also puts the thighbone neck 4 then, then, accessible acetabular osteophytes are removed. Unlike prior surgical hip replacement procedures, the head becomes 3 not removed at this point. The surgeon may decide to use a head lamp for better vision. Preferably, any flushing fluid used during the operation is cooled to minimize bleeding.

The leg is placed in a leg holder and held at about 45 ° to the vertical. The surgeon grasps the tensioning device 140 at her handle 141 and manipulate the head 210 the tensioning device through the surgical wound of the patient to the thighbone neck 4 how best in 67 shown. The head 210 the tensioning device 140 includes tensioner locating means in the form of an elongated rod which serves as a spacer 142 acts. The spacer 142 has an end 211 , which rests against the trochanteric fossa, around the slit 143 the tensioning device 140 at the required position, which, in the preferred embodiment, is between 5mm and 25mm, and preferably 15mm, away from the trochanteric fossa.

The first version of the tensioning device 140 , as in 67 shown adapted for use on the left hip of the patient. Another version of the jig 140 is adapted for use on the right hip of the patient. The only substantial difference between the two versions is that the spacer 142 on the opposite sides of the head 210 is arranged.

Additional jig location means are provided by a surface 212 adapted to receive a bone formation. This area 212 is formed by contours 146 at the base of the head 210 which contours are adapted to mate with contours of the femur.

As soon as once the clamping device has been correctly positioned, as in

57 and 58 shown fixative like pins 143 through holes 144 in the head 210 the tensioning device 140 and in the femur head 3 driven.

The slot 143 is at an acute angle to the longitudinal dimension of the rod 142 The angle is dependent on the desired angle of the incision to match the particular prosthesis components used in the surgery. The slot 143 works as a guide means for a surgical tool, which by the clamping device 140 in the correct position for severing the neck 4 is positioned. Advantageously, the separation takes place while the femur head 3 is still located in the acetabular cup. The surgeon may also perform a secondary proximal part separation if deemed necessary.

Subsequently, to the separation of the neck 4 becomes the femur head 3 folded forward and then removed using one or more of a variety of possible options. The drill 147 , as in 28 can be used to drill a hole 233 in the femur head 3 , Then the self-tapping, threaded member 148 the extractor 149 in the hole 223 by turning the handle 150 screwed. Once the extractor once in the femur head 3 is arranged, the surgeon exerts an outward force on the handle 150 which, in turn, also on the femur head 3 is exercised around the thighbone 3 to remove. Another option, in conjunction with the extractor 149 can be used, or is not used, by the trowel 151 offered. The distal end 152 Tapered to a brim under the femur head 3 can be forced to assist when the head 3 is levered out of the acetabular cup. The rejuvenated end 152 can also be used to sever the head 3 in the acetabulum retaining tendon. Other removal options include dissecting or dissecting the head 3 ,

For the next surgical step, the patient's leg is supported perpendicular to the operating table. The proximal femur is prepared in accordance with standard prior art techniques using a trocar awl and a guide. Tipped Hohmanns (ie retractors) are placed on each side of the femoral neck. Alternatively, a broad, blunt hohmann can be found under the neck 4 be attached to the neck 4 to raise.

Behind the thorn 153 is at the driving surface 154 a bone compressor mountable by a pin 156 is held in place. The bone compressor is driven into the longitudinal axis of the femur using the spine 153 by hitting on the proximal end 157 with a hammer, a knocker or another suitable tool. This process forms a hollow area in the femoral canal for subsequent installation of a stem 34 (see below). The driving surface 154 of the thorn 153 becomes from the elongated longitudinal member 155 offset laterally to allow the surgeon to more easily propel the bone compressor in the correct direction while holding the spine 153 manipulated and maneuvered in the patient's wound. This helps to minimize the risk that the bone compressor will be driven into the femur at an angle that will cause an outer edge of the femur to break. A lime scraper is then used to attach to the end of the neck 4 to form a circular surface. The femur is now ready to insert a prosthetic shaft, which takes place after insertion of the acetabulum shell, as described below.

When next The surgeon positions the limb of the patient in a neutral Position on the operating table to prepare for clearing Acetabulum. Then a pointed Hohmann over the front edge area the acetabular cup placed. The acetabular cup is then cleared gradually using increasing diameters.

To insert the prosthetic acetabulum shell into the cleared acetabular cup, the following three components become a cup alignment tool 167 assembled. The in 36 shown alignment handle 159 who in 35 shown handle 213 , and either the left cup holder 158 or the right cup holder 158 as in the 33 and 34 each shown are assembled. The alignment handle 159 includes a body 182 , which is a distal end 161 and a proximal end 223 defined, with a handle 182 between the ends. A gauge in the form of a lace 172 is at the proximal end 223 intended. The gauge 172 is adapted to indicate whether the prosthetic acetabulum shell is in a predefined orientation with respect to at least a first plane in a reference system. At the distal end 161 a connector is provided, which is provided with an internally threaded sleeve 163 includes.

Either the left or the right cup holder 158 as required, is attached to the alignment handle 159 by means of fasteners 169 attached to a proximal end 164 of the cup holder 158 are provided. More specifically, the fasteners include 160 a lead 169 keyed into the connector at the distal end 161 of the alignment handle 159 fits to ensure proper relative alignment between the two components. Once these components are engaged, the internally threaded sleeve engages 163 on the external thread 224 of the cup holder 158 to bind the two components together.

The handle 213 allows the surgeon additional leverage in manipulating the cup alignment tool 167 , To the handle 213 with the cup holder 158 to connect, engages an external thread 163 on the handle 213 screwed to an internal thread 162 in the cup holder 158 is arranged. The resulting tray alignment tool 167 is in 69 illustrated (although here a part of the shell holder 158 is covered as a result of insertion into the wound 234 a patient).

The next step is to fit a prosthetic acetabular shell of appropriate size on the tray alignment tool 167 to install. Depending on the size of the prosthetic acetabulum shell, a spacer can be used 174 . 215 or 216 to be required. Spacer elements of different widths, as in the 37 to 42 illustrated, are engageable with a first end 168 a projection 170 at the distal end 165 of the cup holder 158 is provided. More specifically, one can be attached to the spacer element 174 planned projection 166 in a Press fit bring with a corresponding opening 214 that in the first end 168 the projection is provided.

The surgeon chooses a spacer 174 . 215 or 216 which has a suitable width, matching the size of the prosthetic cup to be inserted into the patient's hip. There is no spacer for the smallest prosthetic acetabulum shell 174 required. The spacers 174 . 215 and 216 are consumable articles made of a plastic material designed to withstand only one single operative use. The kit of instruments includes four screws 217 . 218 . 219 and 220 with different lengths, as in each case in the 59 to 62 illustrated. This arrangement of screws and spacers is useful for four sizes of prosthetic acetabular cups, and corresponds to:
Size 1 prosthetic acetabular shell: screw 217 and no spacer;
Size 2 of the prosthetic acetabular shell: screw 218 and spacer 174 ;
Size 3 prosthetic acetabular shell: screw 219 and spacer 215 ; and
Size 4 of the prosthetic acetabular shell: screw 220 and spacer 216 ,

Preferably, the screws 217 . 218 . 219 and 220 with the feature of a polygonal head 221 fitted. Each screw has a length just sufficient to extend axially through the opening 214 of the projection 170 to extend, with the head 222 the screw adjacent to the second end 271 of the projection 170 and with the threaded end 223 just over the first end 168 of the projection 170 and just about the respective spacer element 174 . 215 or 216 protruding, which may be engaged with the first end 168 , The protruding tip of the threaded end 223 is in screw engagement with the prosthetic acetabular shell 104 , In this way, the acetabular acetabular shell is attached to the cup alignment tool 167 assembled. More specifically, the acetabulum cup is engaged with the cup holder 158 such that a concave surface of the acetabulum shell is towards the second end 171 of the projection 170 has.

Then the surgeon manipulates the tray alignment tool 167 in the wound 234 , as in 69 shown so that the shell is adjacent to the vacated acetabular cup. It is now necessary to use the tray alignment tool 167 to orientate to ensure that the prosthetic acetabulum shell is in an anatomically correct orientation for insertion into the cleared acetabular cup. This is done using the gauge 172 on the alignment handle 159 in combination with an alignment frame 176 ,

The gauge 172 has a needle 173 which works as a lace. The needle 173 is at the alignment handle 159 rotatably arranged so that it depends substantially vertically under the influence of the local Erdanziehungsfeldes. The gage allows the surgeon to correctly align the acetabular cup in at least a first plane by positioning the cup alignment tool 167 so that the rotatable needle 173 of the laces 172 with a reference point in the form of a fixed needle 175 is aligned.

The in the 43 and 44 shown alignment frame 176 can be used to accurately align the acetabulum shell in a plane different from that through the laces 172 is affected. The alignment frame 176 includes a frame member 177 which is a first end 178 and a second end 179 Are defined. The frame member 177 is generally L-shaped when viewed from the side, and A-shaped when viewed from the front. At the first end 178 is a plant pillow 180 provided, which is adapted to rest on a flat surface, in particular on the vertical side of the operating table. For example, the surgeon can use the knees to hold the pillow 180 to press against the side of the operating table. The second end 179 of the alignment frame 176 is positioned adjacent to the hip of the patient.

Engagement means in the form of a slotted member 181 are at the second end 179 arranged and aligned so that they project to the hip of the patient. The open-ended slot 225 in the slotted limb 181 defines a semicircular surface 226 with an inner radius of curvature that coincides with an outer radius of curvature of the body 182 of the alignment handle 159 matches. In other words, the slot 225 formed with such a size that he is the body 182 of the alignment handle 159 absorbs and directs. The geometry is chosen so that the engagement of the alignment handle 159 into the intervention means 181 the alignment handle 159 in a predefined orientation with respect to a second level forces (which is different from the first level, the laces 172 assigned). The reason for this is that the slotted limb 181 a width 227 that is sufficient to ensure that the longitudinal axis of the body 182 with the axis of the slotted member 181 matches, as soon as the body 182 with the slotted member 181 is engaged. More specific is the body 182 Substantially perpendicular to the side of the operating table, when the body 182 inside the slotted member 181 located.

• • die Hüfte des Patienten ist auf dem Operationstisch in der vordefinierten Position;
• • das erste Ende 178 des Ausrichtrahmens 176 ist angelegt gegen die Seite des Operationstisches benachbart zur Hüfte des Patienten, so dass das geschlitzte Glied 181 zur Hüfte des Patienten weist;
• • der Körper 182 des Ausrichthandgriffs 159 ist in Eingriff mit dem geschlitzten Glied 181; und
• • die drehbare Nadel 173 des Senkels 172 ist mit der fixierten Nadel 175 ausgerichtet, um anzuzeigen, dass sich die prothetische Hüftgelenkspfannen-Schale in der vordefinierten Orientierung befindet,

dann kann sich der Chirurg darauf verlassen, dass die prothetische Hüftgelenkspfannen-Schalen beim Einsetzen in die Hüfte des Patienten korrekt positioniert ist.Preferably, the patient's hip is fixed on the operating table in a predefined position relative to the operating table, for example by using a pelvic support 230 and / or other means for fixing the position of the patient on the operating table. Once all of the following conditions are met:

• • the patient's hip is in the predefined position on the operating table;
• • the first end 178 of the alignment frame 176 is applied against the side of the operating table adjacent to the hip of the patient, so that the slotted member 181 facing the hip of the patient;
• • the body 182 of the alignment handle 159 is engaged with the slotted member 181 ; and
• • the rotatable needle 173 of the laces 172 is with the fixed needle 175 aligned to indicate that the prosthetic acetabular shell is in the predefined orientation,

then the surgeon can rest assured that the prosthetic acetabular cup is correctly positioned when inserted into the patient's hip.

At this point, the surgeon uses the spine device 183 , as in 45 illustrated to insert the acetabulum cup into the cleared acetabular cup. More specific is the driving head 184 the spine device 183 against the second end 171 of the projection 170 Placed and becomes a hammer or similar tool against the clubface 158 while the surgeon struck the spine device 183 by means of the handle 186 grasps. This process fixes the acetabulum shell in the cleared acetabular cup.

The fastener driver 187 is expedient an Allen key, as in the 46 and 47 illustrated that to the hexagon sockets 221 in the screws 217 . 218 . 219 or 220 suitable for fixing the acetabulum to the cup holder 158 , The Allen key 187 has a rounded driving end 188 that allows the screw 217 . 218 . 219 or 220 in addition to a direct straight alignment also from a range of deployment angle of the drive. This advantageously allows a degree of freedom for the surgeon to cope with the difficulty that may be associated with driving the screw through a wound 234 in the patient. The Allen key 187 also has a handle 189 adapted to facilitate the rotation of the driving head 188 , Once the screw 217 . 218 . 219 or 220 Once detached from the acetabulum shell, the cup holder becomes 158 pulled away from the patient.

If he wishes, can the acetabulum shell optionally further defined in the evacuated acetabulum by fixative like a screw, which passes through the acetabulum shell in the patient's pelvis is being driven. A lining then becomes in the acetabular shell used, and a dull Hohmann can under the lining be used to avoid a subsequent shift.

The leg of the patient is now held in a vertical position to the insertion of the shaft 33 For example, a CFP shaft to allow in the femoral canal. After inserting is an end 34 of the shaft 33 from the end of the femur.

It is now necessary to determine the prosthetic neck length required for proper postoperative leg length, tissue tension and muscle tension. A short probe head is placed on the shaft and the hip joint is reduced. How best in 70 now shown is a spacer alignment tool 189 assembled by attaching a left or right spacer 190 as required, on the alignment handle 159 in a similar manner as before the cup holder 158 at the handle device 159 was attached, ie the projection 191 is keyed into an opening in the distal end 161 the handle device 159 is provided and the sleeve 163 engages by screwing on the proximal end 192 of the spacer 190 at. Also similar to the previous assembly of the tray alignment tool 167 , the handle becomes 162 in an internal thread 193 screwed into the spacer adjacent to the proximal end 192 of the spacer 190 is provided. In other words, it is only necessary to assemble the spacer alignment tool 189 Simply start with the tray alignment tool and then the tray holder 158 through the spacer 190 to be replaced.

The spacer 190 includes a spacer 194 that has a slot 195 has adapted to attack at one end 34 of the shaft 33 , This positions the spacer 194 between the sample head and the end 34 of the femur, as in 70 (although the trial head is covered in the cleared acetabular cup). Once properly positioned, the test head is in the hemisphere area 203 , The surgeon then uses the lace again 172 and the alignment frame 176 to make sure the spacer element 194 and the test head are oriented in an anatomically correct manner when performing the subsequent tests.

With the spacer element 194 In situ, the surgeon tests whether leg length and / or tissue tension and / or muscle tension are sufficient. If not, the surgeon extracts the spacer alignment tool 189 and he claps an additional spacer element 196 with medium width (as in the 52 and 53 illustrated) on the spacer element 194 , The additional spacer element 196 with the middle width is over press-fitting formations 198 on the spacer element 194 clipped, which are provided on the two components. If leg length and / or tissue tension and / or muscle tension should still be insufficient, this process is repeated again with the additional spacer 197 a thick expanse, which then takes the place of additional spacer 196 occupies the middle width.

In other words, the test process with the spacers 194 . 196 or 197 with the different thicknesses repeated (or with a different number of spacers) until finally the anatomically correct leg length and / or tissue tension and / or muscle tension is achieved. The surgeon then notes the spacer thickness (or number of spacers) that gave the best results and correlates this with the required prosthetic neck length in accordance with a predefined correlation scheme. For example, the shortest prosthetic neck length is then used if the correct leg length and / or tissue tension and / or muscle tension is achieved without the need for an additional spacer element 196 or 197 , If the correct leg length, etc., is achieved, using the additional spacer 196 with the medium thickness then also a middle prosthetic neck length is used. If the correct leg length, etc., is achieved using the additional spacer 197 with the thickest width, then the longest prosthetic neck length is used. Of course, other correlation schemes may be provided for other embodiments of the invention.

This Process to ensure the prosthesis size required to the correct leg length etc., is preferable to the prior art method the technique that repeatedly involves the hip joint repeatedly remove until the correct size of the prosthesis components is identified.

The Hip becomes Now dislocated and the prosthetic test components are now replaced by the actual Prosthetic components, and the hip will now be reduced or installed. The surgeon now confirms that the leg of the patient has the proper range of motion, and leads one Double check through, if indeed an acceptable leg length, Tissue tension and muscle tension are given. The surgeon then leads Continue the operation in the standardized way by re-attaching the tricepital tendon and the short external rotators and through close of different layers. The application of a cooling sleeve at the hip area is recommended to help the postoperative rehabilitation.

The pin tractor 199 can be used, if desired, the pins 143 to recover again earlier in the femoral head 3 and in the thighbone head 3 remained embedded after being removed from the patient. Furthermore, it may be necessary to have examinations on the femur head 3 in which case, removing the pins 143 may be required. For radially separated jaws 200 and 201 can a pen 143 in the opening 202 on the engaging member 203 be inserted over. The jaws are then crimped radially to each other, so that the engaging member 203 a lateral force on the depressions 228 can exercise, which is adjacent to the end 229 of the pen 143 are arranged, which causes the pin extractor 199 the pencil 143 firmly grasps. Then a longitudinal force is exerted on the pin tractor 199 pointing to the pen 143 is transferred to the extraction of the pen 143 assisted by the severed thighbone head. The longitudinal force can be applied by tapping with a hammer on the projection 204 ,

It is to be appreciated that the preferred method for this hip replacement operation offers a number of advantages over those of the prior art methods. In particular, the hip joint need not be dislocated before separation of the head; the accuracy and consistency of reaming of the femoral and acetabular cup channel is improved, and the process of establishing the required sizing and orientation of prosthetic components generally requires less trial and error. This typically results in a surgical procedure in which the patient's ligaments and muscular attachments experience minimal disruption, allowing faster rehabilitation of the patient with less postoperative pain. Other advantages typically associated with the preferred embodiment include reduced trimming, a reduced blood loss and fewer blood clots, a reduced risk of infection, a shorter hospital stay and reduced costs.

Even though the invention is described with reference to specific examples has been, it lies for Professionals in the field on hand that the invention also in many other forms are executed can.

Summary

The surgeon grasps the tensioning device by its handle and manipulates the head of the tensioning device through the patient's wound and onto the thighbone neck as best as possible 67 is illustrated. The head of the tensioner includes tensioner locating means in the form of an elongate rod which acts as a spacer. The spacer has an end which abuts the trochanteric fossa to position the slot of the tensioner at the required position, which, in the preferred embodiment, is between 5mm and 25mm, and more preferably 15mm from the trochanteric fossa , Additional chuck locators are formed by a surface adapted to receive a bone formation. This surface is provided by contours at the base of the head, which contours are adapted to mate with contours of the femur. The slot is oriented generally perpendicular to the longitudinal dimension of the rod. The slit functions as a guide means for a surgical tool which is positioned by the jig at the correct position for severing the neck. Preferably, the separation takes place while the femur head is still located in the acetabular cup.

Claims (100)

A surgical tensioning device for application in a bone, the tensioning device comprising: Fixture location means adapted to mate with bone formations around the chuck to arrange in a predefined relation to the bone; and guide means for a surgical tool that is relative to the jig location means are arranged that the guide means for the surgical Tools are adapted for guiding a surgical tool to a predefined location the bone formation, when the tensioning device is adapted to the bone formation. Surgical tensioning device according to claim 1, characterized characterized in that the tensioner locating means comprises a Spacers include adapted to abut a bone formation, around the guide for the surgical Tool at a predefined distance from the bone formation to position. Surgical tensioning device according to claim 2, characterized characterized in that the spacer is an elongate rod is. Surgical tensioning device according to any one of previous claims, characterized in that the tensioner locating means an area which is adapted to receive a bone formation. Surgical tensioning device according to claim 4, characterized characterized in that the surface contours included, which are adapted to match contours of the Bone. Surgical tensioning device according to any one of previous claims, characterized in that the tensioning device further comprises a Head included, which is arranged at a distal end of a handle is. Surgical tensioning device according to claims 3 and 6, characterized in that the rod is arranged on the head is. Surgical tensioning device according to claims 5 and 6, characterized in that the contours are based on the Head are provided. Surgical tensioning device according to claim 1, characterized characterized in that the guiding means for the surgical tool formed by one or more slits are. Surgical tensioning device according to claims 6 and 9, characterized in that the one or more slots are arranged on the head. Surgical tensioning device according to claims 7 and 10, characterized in that a longitudinal dimension of the rod itself at an acute angle relative to a longitudinal dimension of the slots. Surgical tensioning device according to any one of claims 9 to 11, characterized in that each of the one or the plurality of slots is formed for receiving and guiding a reciprocating blade. A surgical tensioner according to any one of claims 9 to 12, characterized characterizes that more than one slot is provided on the head, and that each slot is disposed at a different transverse position to allow the slots to guide a surgical tool to more than one predefined location on the bone formation. Surgical tensioning device according to claim 13, characterized in that each of the predefined locations the bone formation selected is to correspond with differently sized prostheses. Surgical tensioning device according to any one of previous claims, further characterized by fixing means for fixing the tensioning device on the bone in a required position. Surgical tensioning device according to claim 15, characterized in that the fixing means include pins, through holes in the head of the jig and in the bone are drivable. Surgical tensioning device according to any one of previous claims, characterized in that the tensioning device is adapted to match with a thigh bone. Surgical tensioning device according to claims 3 and 17, characterized in that the rod includes an end, that is adapted for concern with a trochanteric fossa, which is defined by the femur. Surgical tensioning device according to claim 18, characterized in that the rod is dimensioned to the guide devices for the surgical tool at a distance of between about 5 mm to 25 mm from the trochanteric fossa. Surgical tensioning device according to claim 19, characterized in that the distance is about 15 mm. Surgical tensioning device according to any one of previous claims, characterized in that the tensioner locating means include first and second opposing approaches, the on a body the tensioning device are arranged. A surgical tensioning device according to claim 21, characterized in that the lugs are adapted to mate with a neck of a thighbone. Surgical tensioning device according to claim 22, characterized in that each of the lugs has a longitudinal dimension which is oriented that the longitudinal dimension the approaches is oriented in substantially the same direction as a longitudinal dimension of the neck of the femur, once the jig adapted to the bone formation. Surgical tensioning device according to any one of previous claims 21 to 23, characterized in that the lugs with the bone formation can be brought into a Schnapppasseingrift. Surgical tensioning device according to claims 23 and 24, characterized in that the lugs are arcuate with a center of curvature, that is along the longitudinal dimension extends. Surgical tensioning device according to claim 25, characterized in that the surface is an inverted V-shape Are defined. Surgical tensioning device according to claim 26, characterized in that the inverted V-shaped surface is formed by a inverted V-shaped Limb that is attached to a body is arranged. Surgical tensioning device according to claims 21 and 27, characterized in that the inverted V-shaped member transversely offset from the lugs. Surgical tensioning device according to claim 28, characterized in that the guide means for the surgical Tool between the inverted V-shaped member and the lugs arranged are. Surgical tensioning device according to claim 6, characterized characterized in that the handle has a length sufficient to outward extending away from a patient as soon as the head of the jig adapted to the bone formation. A surgical tensioning device according to claim 21, characterized in that the tensioner locating means a sidewall of the body included, which is adapted to mate with a bone formation. Surgical tensioning device according to claim 31, characterized in that the side wall is arcuate. Surgical tensioning device after An Claim 32, characterized in that the arcuate side wall is shaped so that it rests against a natural curvature of the larger trochanter in the femur. Surgical clamping device for application on a thighbone while a hip replacement surgery, the tensioning device includes: at least one approach adapted to mate with a bone formation on the femur, around the tensioner in a predefined relation to the To arrange femurs; and one or more slots, which are arranged relative to the at least one approach such that the one or more slots are adapted to guide one Blade to a predetermined location on the bone formation as soon as the jig is brought together with the femur. A surgical tensioning device according to claim 34, characterized in that the at least one approach a rod which is arranged on a head of the tensioning device to a Defining an end adapted to engage a femoral formation, thereby defining the one or more slots in a predefined one Positioning relation to the femur formation. A surgical tensioning device according to claim 35, further comprising contours arranged at a base of the head are, with these contours matching and mating are formed with a thigh bone formation. Method for performing a hip replacement operation on a patient, the method including the steps of: a) Exposing a first femoral formation and a second Femoral bone formation of the patient; b) Apply a tensioning device, the guide means for a surgical tool has, at the first femur formation such that the guide means for the surgical tools are proximal to the second femoral bone formation; c) Using the guide means for the surgical tool for guiding a cutting tool to separate the second bone formation; and d) Removal of a severed femoral head from the hip joint of the patient. Method according to claim 37, characterized in that that the first femoral bone formation is a larger trochanter is, and that the second femoral bone formation is a femoral neck is. Method according to claim 37 or 38, characterized that step a) is to execute an initial incision in a thigh of the patient included with a length between 3 cm and 7 cm. Method according to claim 39, characterized that one end of the incision in about 1 cm to 3 cm behind the larger trochanter lies, and that the incision curves from the end to the rear. A method according to any one of claims 37 to 40, characterized in that step a) includes the step exposing a posterior aspect of the femoral neck by severing a tricepital tendon of the patient. Method according to claim 41, characterized that the triceps tendon is attached for later re-attachment. A method according to any one of claims 37 to 42, characterized in that step a) comprises the step to perform a capsularectomy to expose the femoral neck. A method according to any one of claims 37 to 43, in which one leg of the patient is fixed in one position will be below about 45 ° from the vertical while at least some of the surgical steps. Method according to claim 44, characterized in that that the position of the leg is determined by a leg holder. A method according to any one of claims 37 to 45, characterized in that the tensioning device in step b) in accordance is with any of the claims 1 to 36. A method according to any one of claims 37 to 46, characterized in that the guide means for the surgical Tool approximately at a predefined distance from the base of the larger trochanter are arranged when the jig on the femur is applied. Method according to claim 47, characterized that the predefined distance is between 10 mm and 20 mm. The method of any one of claims 37 to 48, further including the step of for a recess for the severing cut in the thigh bone neck on the side of the femur head. A method according to any one of claims 37 to 39, further including the steps: e) placing one guidewire into a femoral canal of a femoral shaft the patient; f) using the guide wire to guide a flexible one reamer around an opening to drill into the femoral canal; and g) insertion a prosthetic socket into the opening in such a way that a first end of the shaft from one end of the thighbone shaft protrudes. The method of claim 50, further including the steps: h) placing the first end in an acetabular cup the patient; i) inserting spacer elements between the end of the femoral stem and the acetabular cup; j) Using a spacer to determine reference points on an acetabular cup the patient; and k) using the reference points to provide a guide to clean up the acetabular cup. The method of claim 51, further including the steps l) Placing a prosthetic probe head at the first end; m) placing an acetabular cup in the cleared Acetabulum; n) Placing the prosthetic trial head in the acetabulum trial cup; and O) Insertion of spacers between the end of the thighbone shaft and the acetabular cup, until a desired one Fit between Prosthetic Prosthetic Head and acetabular cup achieved; and p) correlating the number or strength of the Spacer elements with a required size of a prosthetic component. Use of a clamping device according to any the claims 1 to 36 for placement on a femur for guiding when Cutting off the femur in a hip replacement procedure. Use of a clamping device for assembly a leadership system for use in a method of a hip replacement operation. Method for performing a hip replacement operation on a patient, the method comprising the steps of: i) Exposing a larger trochanter and a thighbone neck of the patient; ii) separating the femur head; iii) insertion of a prosthetic Stem or a trial stem into a femoral stem the patient such that a first end of the shaft over a Protruding end of thigh bone shaft; iv) Positioning of the first end in an acetabular cup the patient; v) applying one or more spacer elements at the first end of the shaft; vi) Using one or of the plurality of spacers for determining reference positions the acetabular cup; and vii) Using the reference positions to guide when clear the acetabular cup. Method according to claim 55, characterized that the spacers include markers that are arranged are for displaying the reference positions. A method according to claim 55 or 56, characterized that step vii) the determination of a center of the reference positions and using the center as a center for clearing. Method for performing a hip replacement operation on a patient, the method comprising the steps of: A) Exposing a larger trochanter and a thighbone neck of the patient; B) Disconnect the femur head; C) insertion of a prosthetic Shank or trial shaft into a thighbone shaft of the patient such that a first end of the shaft overlies one end of the femoral stem projecting; D) Inserting a prosthetic acetabular shell or an acetabular cup in a cleared acetabulum the patient; E) Applying one or more spacer elements on the first end of the shaft until a desired tissue tension in the Hip joint region of the Patient has been achieved; and F) Correlating the number or the size of the spacers with a required size of a prosthetic component. Method according to claim 58, characterized that the required size of the prosthetic component on a neck length a prosthetic component for refers to a thighbone neck and head. A method of performing a hip replacement surgery on a patient, the method the steps comprise: A) exposing a larger trochanter and a femoral neck of the patient; B) severing the femur head; C) inserting a prosthetic shaft or trial shaft into a femoral shaft of the patient such that a first end of the shaft protrudes beyond an end of the femoral shaft; D) inserting a prosthetic acetabular shell or acetabular cup into a cleared acetabulum of the patient; and E) applying one or more spacers to the first end of the shaft to determine a required orientation of the acetabulum shell relative to the shaft. Spacer element for use in a hip replacement operation, wherein the spacer comprises: one defining a first end Handle; and arranged on or adjacent to the first end Alignment means adapted to mate with a prosthetic acetabular shell, such that, in use, the shell is in a predefined one Relation to an acetabular cup a patient is positioned. Spacer according to Claim 61, characterized that the alignment means define a plane which is adapted to mate with a corresponding level of prosthetic Acetabular cup. Spacer according to claim 62, characterized that the plane in terms of one defined by the handle Plane forms an acute angle. Spacer element according to Claim 63, characterized that the angle is within the range of 5 ° to 25 °. Spacer element according to Claim 64, characterized that the angle is in the range of 10 ° to 20 °. Spacer element according to Claim 65, characterized that the angle is about 15 °. Spacer element according to any one of claims 62 to 66, characterized in that the plane is defined by a Semicircular surface. Spacer element according to Claim 67, characterized that the alignment means include a slot that adapts is for receiving a protruding end of a prosthetic thigh bone shaft. Spacer element according to any one of claims 61 to 68, further comprising orientation guidance means adapted to Providing a guide, until the alignment means in relation to the predefined relation an acetabular cup a patient are positioned. Spacer element according to Claim 69, characterized that the guidance means comprise a lace which is rotatably arranged on the spacer element, to hang down substantially vertically under the influence of gravity. The spacer element of claim 70, further comprising a reference point arranged on the spacer element such that the lace or swing pointer in alignment with the reference point hangs, when the alignment means in the predetermined relation with respect to an acetabular cup a patient are positioned. Spacer element according to any one of claims 61 to 71, characterized in that the alignment means engagement means which are adapted to engage a prosthetic Acetabular cup. Spacer element according to Claim 72, characterized the engagement means comprise one or more approaches that adapt are to mate with an internal surface of the shell. Spacer element according to any one of claims 61 to 73, characterized in that the alignment means an outer peripheral edge define a radius of curvature has substantially corresponding to a radius of curvature of a prosthetic Acetabular cup. Alignment handle for use in a hip replacement surgery, wherein the alignment handle comprises: a distal end and a proximal end defining body; one on or near the measuring gauge arranged at the proximal end; and one on or arranged near the distal end connector for connection with a prosthetic acetabular shell, in which The gauge is adapted to indicate whether the prosthetic acetabulum shell in a predefined orientation with respect to at least one first level in a reference system. Alignment handle according to claim 75, characterized the reference system comprises a local gravity field. Alignment handle according to claim 76, characterized that the gauge comprises a lance or rotary pointer which is rotatable arranged on the body is substantial under the influence of the local gravity field to hang down vertically. The alignment handle of claim 77, further comprising such on the body arranged reference point that the laces or rotary pointer in alignment depends on the reference point, if the prosthetic acetabular shell in the predefined orientation with respect to the first level is. An alignment handle according to any one of claims 75 to 78, further comprising a handle, to between the distal End and the proximal end is arranged. Alignment frame, adapted for use with a The alignment handle of any one of claims 75 to 79, wherein the alignment frame comprising: a first end adapted to abut against a plane Area, to align a second end of the alignment frame with respect to the planar surface; and engagement means disposed at the second end that adapts are for an engagement of the alignment handle. Alignment frame according to claim 80, characterized in that the engagement means comprise an open-ended slot. Alignment frame according to claim 81, characterized that the open-ended slot defines a semicircular surface having an inner circle Radius has that with an outer radius of the body of the alignment handle. An alignment frame according to claim 81 or 82, characterized characterized in that the engagement means have such a geometry, that an engagement of the alignment handle with the engagement means the alignment handle forces one with respect to the alignment frame to take predefined orientation. An alignment frame according to any one of claims 80 to 83, characterized in that the engagement of the Ausrichthandgriffes in the engaging means the alignment handle in the predefined Orientation forces differently with respect to at least one second level from the first level. An alignment frame according to any one of claims 80 to 85, further comprising a predefined position of the hip of the Patients relative to an operating table such that when every condition is given by: the hip of the patient is located in the predefined position; the first end of the alignment frame lies against a flat surface the operating table; the body of the alignment handle is engaged with the engaging means of the alignment frame; and the Measuring gauge of the alignment handle indicates that the prosthetic Acetabular cup located in the predefined orientation; the prosthetic Acetabular cup for insertion in the hip the patient is correctly positioned. Alignment frame according to claim 85, characterized that the flat surface of the operating table is one side of the operating table, and that the second end is positioned adjacent to the hip of the Patients. Method of extracting a severed femoral head from the hip joint a patient, the method being one or both of the following Steps includes: a) drilling a hole in the femur head, Screw in a self-tapping, threaded one Limb in the hole, and applying an outward Force on the threaded member, which force in consequence is also exerted on the femur head; and or b) constraints of one End of a trowel under the femur head and use the trowel as a lever to an outward force on the Exercise femoral head. Method of inserting a prosthetic acetabular cup in a cleared acetabulum a patient, the method comprising the steps of: a) Assemble the acetabular acetabular shell on a tray alignment tool; b) manipulating the tray alignment tool such that the prosthetic acetabular cup is adjacent to the cleared acetabulum is; c) orienting the tray alignment tool to ensure that the prosthetic acetabular shell in an anatomically correct orientation for insertion into the cleared acetabulum is; and d) Inserting the prosthetic acetabular shell in the vacated Acetabulum. Method according to claim 88, characterized in that in that the tray alignment tool comprises an alignment handle according to claim 75, and that the measuring gauge is used in step c) for Determine if the prosthetic acetabular shell is in anatomically correct orientation with respect to a plane. Method according to claim 89, characterized Step c) further involves the use of an alignment frame Claim 84 comprises for orienting the prosthetic acetabular shell in the anatomically correct orientation with respect to a second Level that is different from the first level. Method according to claim 90, characterized in that that step c) comprises the following substeps: c1) Position the hip the patient in a predefined position on the operating table; c2) Placing the first end of the alignment frame against a flat surface of the Operating table; c3) engaging the body of the body Handle with the engagement means of the alignment frame; and c4) Use the gauge of the alignment handle to indicate whether the prosthetic acetabular cup is in the anatomically correct orientation. Method for finding a size of a prosthetic neck length while a hip replacement surgery, the method comprising the steps of: a) Install one prosthetic stem in a femur of a patient such that one end of the shaft from one end of the femur projecting; b) placing a trial head at the end of the prosthetic shaft; c) Using a spacer alignment tool for positioning a spacer between the sample head and the end of the femur; d) Orienting the spacer alignment tool to make sure that the sample head is in an anatomically correct Orientation is; e) Testing for leg length and / or tissue tension and / or muscle tension of the patient is anatomically correct; f) Repeating steps c), d) and e) with different spacer thicknesses or numbers of spacers, until the leg length and / or Tissue tension and / or muscle tension of the patient anatomically is acceptable, and note the spacer thickness or number of Spacer elements which provides the best result; and G) Correlate the spacer thickness or number of spacers as determined in step f) with the required prosthetic Neck length in accordance with a predefined correlation scheme. Surgical jig, substantial here described with respect to any of the embodiments disclosed in the accompanying drawings Drawings are illustrated. Method for performing a hip replacement operation Substantially as described herein with respect to any of the Embodiments illustrated in the accompanying drawings. Spacer for use in a hip replacement operation Substantially as described herein with respect to any of the Embodiments illustrated in the accompanying drawings. Alignment handle, substantial as described here with reference to any of the appended drawings illustrated embodiments. Alignment frame substantially as described here with reference to any of the appended drawings illustrated embodiments. Method of extracting a severed femoral head from a hip joint a patient substantially as described herein with respect to Any of the embodiments illustrated in the accompanying drawings. Method of inserting a prosthetic acetabular cup in a cleared acetabulum a patient substantially as described herein with respect to Any of the embodiments illustrated in the accompanying drawings. Method for determining a size of a prosthetic neck length while a hip replacement surgery Substantially as described herein with respect to any of Embodiments illustrated in the accompanying drawings.