HK1251443B - Surgical trays, instruments and methods for implanting a hip replacement prosthesis - Google Patents

Description

Surgical tray, instrument and method for implanting hip replacement prosthesis

Technical Field

The present invention relates to surgical instruments and methods for use in connection with reverse hip prostheses. More particularly, the present invention relates to instrument trays, surgical tools, and trial implants for use in hip replacement surgery.

Background Art

A reverse hip prosthesis is described in U.S. Patent Nos. 8,313,531 B2 and 8,540,779 B2. The prosthesis and revision surgery method are also described in U.S. Patent No. 8,992,627 B2. The disclosures of these three patents are incorporated herein by reference in their entirety.

Summary of the Invention

As described in the patent cited above, a reverse hip prosthesis typically includes an acetabular ball and a femoral cup, wherein the acetabular ball is attached to a stem in the acetabular cup and the femoral cup is attached to the femoral stem, wherein the femoral cup forms an articulation on the acetabular ball. The surgical tray, tools, and methods of the present invention enable a surgeon to determine the best components of a reverse hip prosthesis for implantation into a patient based on size and angle using trial implants and specialized surgical tools. In this disclosure, applicants sometimes use the term "tool" to refer to surgical tools.

BRIEF DESCRIPTION OF THE DRAWINGS

1A and 1B illustrate a set of trays including tools for preparing a femur for implantation surgery.

2A, 2B, and 2C illustrate a set of trays including tools for preparing the acetabulum for implantation surgery.

3A, 3B and 3C illustrate a set of trays including trial implants and tools for sizing and implanting an acetabular cup and ball.

4A, 4B and 4C illustrate a set of trays including trial implants and tools for screening, sizing and implanting a femoral cup.

5A , 5B, 5C, 5D, and 5E include front, cross-sectional, and perspective views of a trial acetabular cup.

6A , 6B, 6C, and 6D include elevational, cross-sectional, and perspective views of a first trial acetabular ball for use with a trial acetabular cup.

7A , 7B, 7C, 7D, 7E, and 7F include front, cross-sectional, detail, and perspective views of a second trial acetabular ball for use with an implanted acetabular cup.

8A , 8B, 8C, 8D and 8E show various views of a second trial acetabular ball of the type shown in FIGs. 7A to 7F , with elevational and cross-sectional views of the ball positioned on the stem of an acetabular cup.

9A , 9B and 9C show a handle for installing and removing a trial acetabular cup in perspective and front views, and a cross-sectional view of the handle threaded into the trial acetabular cup positioned in a representative portion of the acetabulum.

10A, 10B, 10C, 10D, 10E, and 10F include front, cross-sectional, detail, and perspective views of a first trial femoral cup.

11A, 11B, 11C, 11D, 11E, and 11F include additional views of a first trial femoral cup of the type shown in FIGs. 10A-10F, as well as perspective and front views of the cup positioned in a first femoral implant.

12A , 12B, 12C, 12D, 12E, and 12F illustrate front, cross-sectional, detail, and perspective views of a second trial femoral cup.

Figures 13A, 13B, 13C, 13D, 13E, 13F and 13G show additional views of a second trial femoral cup of the type shown in Figures 12A to 12F, as well as perspective, front and cross-sectional views of the cup positioned in a second femoral implant.

14 is a cross-sectional view showing the first trial acetabular ball located in a trial acetabular cup and the tool used to attach and remove the ball from the cup.

15 is a cross-sectional view showing the first trial femoral cup in an articulated position on the first trial acetabular ball.

16A, 16B, 16C, 16D, 16E, 16F, 16G, and 16H illustrate various views of a compression assembly and components thereof for compressing a liner into a femoral cup.

17 is a front view of the compression assembly of FIGS. 16A-16H with a femoral cup therein.

FIG18 is a cross-sectional view of FIG17 .

19 is a perspective view of the insertion-removal tool.

FIG. 20 is a front view of the tool of FIG. 19 .

21 is an elevational view of another embodiment of a trial acetabular ball suitable for use with an insertion-removal tool.

22 is a perspective view illustrating the position of the tool of FIGS. 19 and 20 as the tool contacts the trial acetabular ball of FIG. 21 to facilitate removal of the ball from the acetabular cup.

FIG. 23 is a front view of a conventional electric drill used in surgery.

DETAILED DESCRIPTION

The tools for preparing the femur for hip implant surgery are included in the first set of steel trays 1 and 2 of Figures 1A and 1B, respectively. Tray 1 includes a reamer 3, a right-hand handle 4, and a left-hand handle 5. Tray 1 also includes a T-handle 6 and a box osteotome 7. After the femur has been prepared for surgery by removing the femoral head, the box osteotome 7 is used as a center punch to form an initial opening in the femur, which serves as a guide for correctly positioning the reamer 3. Then, the T-handle 6, which is suitable for being connected to the proximal end 3a of the reamer 3, is attached to the reamer, and the surgeon places the distal end 3b of the reamer 3 into the initial opening and rotates the handle while applying pressure to form a pocket in the femur. The right-hand handle 4 and the left-hand handle 5 are respectively suitable for being connected to the proximal end 3a of the reamer, for rotating the reamer to form a deep pocket in the femur, thereby preparing for using a broach 8, which is described below together with tray 2. A right-handed surgeon uses the right-hand handle 4 and a left-handed surgeon uses the left-hand handle 5 .

The tray 2 includes a set of two or more broaches 8 of different sizes. The broaches have sizes ranging from 9 mm (on the left hand side of Figure 1B) to 21 mm (on the right hand side of Figure 1B). In the figure, each broach 8 from left to right is 1 mm larger than the broach to its left. As can be seen from the figure, the broaches are tapered and the size of each broach refers to the maximum diameter at the top (proximal end 8a) of the broach. The broach 8 (also called a rasp) is inserted into the deep pocket and the broach 8 is struck into the femur at the proximal end 8a using a hammer 9. The handle 10 is screwed into the threaded recess 75a at or near the proximal end of the femoral implant 75 (see Figure 13) and is used to implant the femoral implant into the femur.

The instrument that is used to prepare acetabulum for hip joint transplantation surgery is included in the second set of steel trays 11, 12 and 13 of Fig. 2 A, Fig. 2 B and Fig. 2 C respectively. Tray 11 and tray 12 comprise two or more (25 are shown in Fig. 2 A and Fig. 2 B) acetabular osteotome 14 of different sizes jointly, and described acetabular osteotome 14 is used for acetabular bone being cut into suitable size to accommodate the acetabular cup of corresponding size. Drive shaft and drive shaft handle are used for drilling tool 140 (referring to Figure 23) being connected to acetabular osteotome 14. Tray 13 shows two drive shafts 15 of different sizes and two drive shaft handles 16. Drive shaft has the proximal end 15a that is suitable for being connected to the distal end 15b of osteotome and the proximal end 16b that is suitable for being connected to drive shaft handle 16. The proximal end 16a of drive shaft handle 16 is suitable for being connected to the chuck (chuck) 141 of drilling tool 140.

The trial implants and tools for implanting the acetabular cup and acetabular ball are included in the third set of steel trays 21, 22 and 23 of Figures 3A, 3B and 3C, respectively.

The tray 21 includes a drill guide handle 24, two or more drill bits 25, two or more drill guides 26, two or more second trial acetabular balls 27, and a trial acetabular ball insertion-removal tool 28. Each drill bit 25 has a drill guide of corresponding size.

The tray 22 includes two or more first trial acetabular balls 29 , two or more trial acetabular cups 30 , and a universal handle 31 .

The tray 23 includes the elements of the acetabular cup impactor assembly. The tray 23 includes another universal handle 31, an acetabular cup handle 32, an inner shaft 33 with a protruding handle 34 at its proximal end, two anteversion guide rods 35, at least one (and preferably, three) slotted clip kits 38, and at least one (and preferably, three) acetabular ball impactors 37. The tilt and anteversion guide 36 has a thumb screw (not shown) for maintaining the guide 36 in the appropriate position on the acetabular cup handle 32. This is described in detail in the applicant's co-pending international application No. PCT/US16/42441, filed on July 15, 2016.

The trial implant and tools for implanting the femoral cup are included in a fourth set of steel trays 41, 42 and 43 of Figures 4A, 4B and 4C, respectively.

Trays 41 and 42 include only two or more first trial femoral cups 44. These first trial femoral cups 44 may differ in size, neck length, and offset angle. Preferably, the first trial femoral cups 44 are adapted to be temporarily attached to the proximal end of the broach 8 from tray 2 before the broach is removed from the femur. Alternatively, the first trial femoral cups 44 may be temporarily attached to the proximal end of a femoral implant 49 as shown in Figures 11E and 11F.

The tray 43 includes two or more second trial femoral cups 45 adapted to be temporarily attached to a femoral implant 49 (see Figures 11E and 11F). The tray also includes a press 46 for pressing the polymer liner into the femoral cup, a femoral cup positioner 47, and plungers 48 and 48a (see also Figures 16C, 16D, 16E, and 16F).

More specifically, with respect to the various components included in the tray discussed above, Figures 5A to 5E illustrate various views of the trial acetabular cup 30. Figure 5E is a perspective view of the trial acetabular cup. Figure 5A is a side view, and Figure 5D is a cross-sectional view of Figure 5A. Figure 5B is a top view, and Figure 5C is a bottom view.

The trial acetabular cup 30 has an outer surface and an inner concave surface, wherein the outer surface is adapted to fit the treated surface of the acetabulum bone. Preferably, the outer surface is a convex surface. A handle 50 having an internally threaded opening 51 extends from the bottom of the concave surface, and the cup is characterized by a plurality of optional through openings 52. The threaded opening 51 accommodates the threads of a universal handle 31, which is used to install the cup 30 and remove the cup 30 from the acetabulum (see Figure 9C). The threads of the opening 51 also accommodate the first trial acetabular ball 29 shown in Figures 6A to 6D. The trial acetabular ball of the present invention is hemispherical and may include a flat portion and an inclined surface as described below. Figure 6D is a perspective view of the trial acetabular ball 29, Figure 6A is a side view, Figure 6B is a top view, and Figure 6C is a cross-sectional view. The threaded portion 60 is screwed into the opening 51. A hexagonal opening 61 is shown in the flat portion 62a and receives the tool 28 (see FIG. 3A ) used to screw the ball 29 into and out of the cup 30 . An optional beveled portion 62b is adjacent to the threaded portion 60 and creates a beveled edge around the base of the ball 29 .

7 and 8 relate to a second trial acetabular ball 27 .

Figures 7A to 7F show various views of the ball 27. The ball 27 may be temporarily attached to an implanted acetabular cup 70 (see Figures 8D and 8E) to determine the optimal size of ball for the prosthesis. Figures 8A to 8C show a second trial acetabular ball 27 in different views.

Figures 7F and 8C are perspective views of ball 27, Figures 7A and 8A are side views of ball 27, and Figures 7B and 8B are top views. Figure 7C is a bottom view of ball 27, and Figure 7D is a cross-sectional view taken along section line 7D in Figure 7A. A detailed view of the surrounding portion 7E of Figure 7D is shown in Figure 7E.

The second trial acetabular ball 27 includes a flat top portion 62 for imprinting identifying size information. The ball 27 has an opening 63 sized to fit over the stem 71 of the acetabular cup 70. A slot 64 is provided on one side of a protrusion 65 to make it easier to place the ball on and remove it from the stem 71.

FIG9B shows the universal handle 31 in side view, and FIG9A shows the universal handle 31 in perspective view. FIG9C is a cross-sectional view of the universal handle 31 screwed into the trial acetabular cup 30 in a representative portion of the acetabulum bone 80. The handle 31 is used to place the trial cup 30 into the acetabulum bone 80.

Several views of a first trial femoral cup 44 are shown in Figure 10. Figure 11 shows further views of the cup 44 and a view of the cup 44 positioned within a femoral implant 49.

Three different perspective views of the first trial femoral cup 44 are shown in Figures 10F, 11A, and 11C. Figures 10A, 11B, and 11D show side views of the cup 44 taken from different angles. Figure 10B is a top view, Figure 10C is a bottom view, and Figure 10D is a cross-sectional view taken along section line 10D of Figure 10A. Figure 10E is a detail view of the surround portion 10E taken from Figure 10D. Figure 11F is a side view of the cup 44 attached to the implant 49, and Figure 11E is a perspective view of the cup 44 attached to the implant 49.

The first trial femoral cup 44 has a base portion 90 in the form of a stem that extends away from (i.e., opposite) the first concave portion 91. An opening 92 that receives the proximal end of the broach 8 or the stem of the implant 49 is included in the base portion 90. The provision of slots 93 and 93a makes it easier to place the cup on the broach or stem and facilitates subsequent removal of the cup.

A second trial femoral cup 45 is shown in multiple views in Figures 12A to 12F. Figures 13A to 13G show more views of the cup 45 and views of the cup 45 positioned in the femoral implant 75. A stereoscopic view of the cup 45 is shown in Figures 12F and 13D, a side view is shown in Figures 12A and 13A, a top view is shown in Figures 12B and 13C, and a bottom view is shown in Figures 12C and 13B. Figure 12D is a sectional view taken along section line 12D of Figure 12A, and Figure 12E is a detail view of the surrounding portion 12E taken from Figure 12D. Figure 13E is a stereoscopic view of the cup 45 positioned in the implant 75, Figure 13G is a side view of the cup 45 positioned in the implant 75, and Figure 13F is a sectional view of Figure 13G.

The second trial femoral cup 45 has a stem 95 extending away from the second concave portion 96 and adapted to be received within the femoral implant 75. An opening 97 in the stem 95 cooperates with a slot 98 to facilitate attachment and removal of the cup 45 to and from the femoral implant 75.

14 shows the trial acetabular ball insertion-removal tool 28 in cross section, inserted into the hexagonal opening of the trial acetabular ball 29. This is the location of the tool in relation to the ball for screwing the ball in or out of the trial acetabular cup 30, which is shown in a representative portion of the acetabular bone 80.

The trial femoral cup 44 is shown in position on the trial acetabular ball 29 in FIG15. The femoral cup 44 is attached to the implant 49, and the trial acetabular cup 30 is shown in the acetabulum bone 80.

Figure 16 shows the elements of a press 46 for pressing a polymer liner into a femoral cup. A stereoscopic view of the press 46 is shown in Figure 16A. Referring to Figures 16A to 16F and Figures 17 and 18, the press includes a base 101 to which a bracket 102 is attached. A pressing rod 103 is disposed on a shaft 104, and a cylindrical member 105 is disposed at the distal end of the shaft 104. The cylindrical member 105 contacts and presses on a plunger 48 of appropriate size. A femoral cup positioner 47 having a femoral cup 110 therein is positioned on the base 101. As shown in the cross-section in Figure 18, the concave portion of the polymer liner 111 is positioned on the plunger 106, and the convex portion of the liner 111 is positioned on the concave portion of the femoral cup 110. The plunger 48 is then pushed downward using the pressing rod 103 so that the cylindrical member 105 contacts and presses downward on the plunger while also holding the handle 108 steady until the liner 111 snaps into position in the concave portion of the femoral cup 110 .

FIG19 and FIG20 show an insertion-removal tool 120. The tool is similar in size and structure to a hemostat. The tool includes a handle 121 and a ratchet portion 122 at its proximal end. A hinge 123 is positioned to provide leverage, and a clamp 124 is provided at the distal end. The portion of the tool located between the hinge 123 and the clamp 124 can be selectively angled (e.g., at approximately 20° (not shown)).

In the present application, the preferred use of the tool 120 is to remove the trial acetabular ball 27a from the acetabular cup 70. To this end, Figure 22 shows the tool 120 positioned on the ball 27a. The ball 27a has all of the same features as the ball 27 described above, with the additional feature of an indentation 130 in the form of a circumferential groove that is configured to allow the ball to be gripped and pulled away from the stem 71 of the acetabular cup 70 (see Figure 8E).

Claims (6)

1. A surgical tray device configured for use in hip replacement surgery and components of the surgical tray device, comprising: The first tray includes tools configured for preparing the femur for implantation surgery, and the first tray includes multiple retractors of at least two different sizes. The second tray includes tools configured for preparing the acetabulum for implantation surgery. The second tray includes multiple bone cutters of at least two different sizes. The third set of pallets includes: Multiple experimental implants configured to determine, position, and implant a stemmed acetabular cup of a reverse hip joint, the stem forming part of the reverse hip joint acetabular cup, the third set of trays comprising: Multiple test acetabular cups of at least two different sizes, each test acetabular cup having a threaded opening, and Multiple test acetabular balls of at least two different sizes, each test acetabular ball having a threaded portion, wherein the test acetabular balls are removably attached to one or more test acetabular cups through engagement of the threaded opening with the threaded portion, and Multiple tools, configured to be removably attached to the test implant on the third tray, including tools removably attached to the test acetabular cup and tools removably attached to the test acetabular ball, and A fourth tray includes multiple other experimental implants and multiple tools for determining the size and implanting a femoral cup for use with a reverse hip prosthesis. The multiple tools of the fourth tray are configured to be removably attached to the other experimental implants, which include: Two or more first trial femoral cups, adapted for temporary attachment to the proximal end of the femoral implant or the retractor; Two or more second trial femoral cups, suitable for temporary attachment to a femoral implant; and Each of the first and second test femoral cups has a concave surface suitable for forming an articulation on an acetabular ball, the acetabular ball being configured to be mounted on the handle of the reverse hip joint acetabular cup. 2. The surgical tray device and its components according to claim 1, wherein the first set of trays comprises: A reamer having a distal end and a proximal end, the distal end of which is used for insertion into the femur; A right-hand handle for attaching to the proximal end of the reamer; A left-hand handle for attaching to the proximal end of the reamer; A T-shaped handle is used to connect to the proximal end of the reamer; Box-type bone scalpel; A hammer, used to strike the broach into the femur; and The handle has a threaded portion suitable for screwing into the proximal end of the femoral implant. 3. The surgical tray device and its components according to claim 1, wherein the second set of trays comprises: A drive shaft having a distal end, the distal end of which is adapted to be connected to a bone cutter; A drive shaft handle, adapted to be attached to the proximal end of the drive shaft. 4. The surgical tray device and its components according to claim 3, wherein the distal end of the drive shaft handle is adapted to be connected to the drive shaft, and the proximal end of the drive shaft handle is adapted to be connected to the drill bit. 5. The surgical tray device and its components according to claim 1, wherein the tools in the third set of trays include: Drill handle; Two or more drill bits; Two or more pilot drills; Two or more second-test acetabular balls; Two or more first-test acetabular balls; Two or more test acetabular cups; An acetabular cup impactor assembly includes a handle, an inner shaft, multiple tilting guides, a slotted clamp kit, and an acetabular ball impactor, wherein the inner shaft has a protruding handle at its proximal end. 6. The surgical tray device and its components according to claim 1, wherein the tools in the fourth set of trays include: A pressing element, a femoral cup locator, and a plunger are used to press the polymer liner into the femoral cup.